Is there an association between Helicobacter pylori cytotoxin Cag A seropositivity and risk for gastric cancer?
Baiocchi, G.L.; Vettoretto, N.; Colombrita, D.; Giovanetti, M.; Coniglio, A.; Bonardelli, S.; Pelizzari, A.; Ronconi, M.; Tiberio, G.A.; Giulini, S.M.
Annali Italiani di Chirurgia 73(6): 571-6; discussion 577-8
2002
ISSN/ISBN: 0003-469X PMID: 12820580 Document Number: 542440
Since discovered in 1990, Cag A, a protein expressed by specific strains of Helicobacter pylori, was thought able to explain why only a few Helicobacter infected patients develop peptic diseases and gastric cancer. However, clinical trials provide discordant results. In this study we evaluate Helicobacter pylori and Cag A seropositivity in 35 cancer affected patients, in 36 gastritis affected patients and in 40 healthy blood donors by means of two commercially available fluorescence enzyme-immunoessay (ELISA). Odds ratios determination strongly suggests that Cag A bearer Helicobacter strains play a pathogenetic role in gastric diseases (OR 4.23, 95% CI 3.22-5.24 for cancer versus healthy volunteers, OR 3.2, 95% CI 2.19-4.21 for gastritis versus asymptomatic patients), but is unable to demonstrate a direct carcinogenic activity (cancer-gastritis difference is not significant: OR 1.32, 95% CI 0.39-1.25). Cag A seropositivity can be considered a risk factor for peptic disease, and only indirectly for gastric carcinoma. The paper also discuss some sampling, laboratory and statistical bias that can explain a wide eterogenity of the results reported in the literature.