PREVALENCE OF INFECTION WITH
					<i>CAG</i>A-POSITIVE <i>HELICOBACTER PYLORI</i> STRAINS
					AMONG CHILDREN AND ADOLESCENTS IN SOUTHERN BRAZIL

OLIVEIRA, Juliana Ghisleni de; FERREIRA, Cristina Helena Targa; CAMERIN, Anna Carolina Saraiva; ROTA, Cláudia Augustin; MEURER, Luíse; SILVEIRA, Themis Reverbel da

doi:10.1590/S0004-28032014000300003

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Original Articles • Arq. Gastroenterol. 51 (3) • Jul-Sep 2014 • https://doi.org/10.1590/S0004-28032014000300003 linkcopy

PREVALENCE OF INFECTION WITH CAGA-POSITIVE HELICOBACTER PYLORI STRAINS AMONG CHILDREN AND ADOLESCENTS IN SOUTHERN BRAZIL

Prevalência da infecção por cepas de Helicobacter pylori cagA-positivo em crianças e adolescentes do Sul do Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Context Helicobacter pylori (H. pylori) has a worldwide distribution, but the prevalence of infection, virulence factors, and clinical presentation vary widely according to the studied population. In Brazil, a continental country composed of several ethnicities and cultural habits, the behavior of infection also appears to vary, as many other studies have shown.

Objectives Describe the prevalence of infection with cagA-positive H. pylori strains in a group of children and adolescents who underwent esophagogastroduodenoscopy in Porto Alegre, Rio Grande do Sul.

Methods Fifty-four gastric biopsy specimens of children and adolescents with H. pylori infection demonstrated by histology, urease test and molecular analysis were tested for the presence of cagA positive H. pylori strains by the polymerase chain reaction method.

Results he prevalence of cagA-positive H. pylori was 29.6% (95% confidence interval, 18 to 43.6%). There were no statistically significant differences in clinical or demographic characteristics or in the endoscopic and histological features of patients infected with cagA-positive strains as compared with those infected by cagA-negative strains.

Conclusions he study showed a low prevalence of infection with cagA-positive H. pylori strains among children and adolescents who underwent EGD in southern Brazil, in comparison to studies conducted with children from other regions of Brazil. There was no association between the presence of cagA-positive strains and more severe clinical presentations in the studied sample.

Helicobacter pylori; Helicobacter infections, genetics; Prevalence; Child

Parameter	Finding
Age*	9.8±4.4 (1.8-18.5)
Gender†
Male	27 (50)
Female	27 (50)
EGD indication†
Abdominal pain	18 (34.6)
Vomiting/GERD	13 (24.9)
Investigation of malabsorption	11 (21.2)
Gastrointestinal bleeding	7 (13.4)
Others	5 (5.9)
Water supply†
Mains	47 (94)
Other	3 (6)
Sewage system†
Yes	47 (94)
No	3 (6)
Maternal education†
≤ 8 years	29 (60)
9-11 years	14 (29)
> 11 years	5 (11)
Paternal education†
≤ 8 years	33 (72)
9-11 years	7 (15)
> 11 years	6 (13)
People per room of household†‡
≤ 0.5	4 (8)
0.5-0.99	17 (35)
1-1.99	24 (49)
≥ 2	4 (8)
Family history of peptic ulcer disease†
Yes	15 (29)
No	37 (71)
Family history of stomach cancer†
Yes	10 (19)
No	42 (81)

	cagA status		P-value
	Negative (n = 38)	Positive (n = 6)
	n (% valid)	n (% valid)
Endoscopic finding			*
Normal	5 (13)	5 (31)	0.14
Gastritis nodular	19 (50)	10 (63)	0.59
Other gastritis	12 (32)	2 (13)	0.19
Duodenal ulcer	1	0	NR*
Histologic finding
Gastritis classification			0.89
Mild	17 (45)	6 (38)
Moderate	19 (50)	9 (56)
Marked	2 (5)	1 (6)
Activity			0.78
Mild	23 (61)	9 (56)
Moderate	13 (34)	7 (44)
Marked	2 (5)	0
H. pylori density			0.89
Mild	5 (14)	3 (19)
Moderate	27 (75)	11 (69)
Marked	4 (11)	2 (12)
Lymphoid hyperplasia			0.21
Yes	15 (39)	10 (63)
Intestinal metaplasia			*
Yes	0	0
Atrophy			*
Yes	2	0

Author, year	Genotyping method	Prevalence (%) n/total	Clinical presentation (n) and cagA gene
Place of study	Genotyping method	95%CI	Clinical presentation (n) and cagA gene
Queiroz et al.⁽²³⁾, 2000	PCR from isolates obtained by culture	60/80 (75)	Duodenal ulcer (27)
Belo Horizonte, Minas Gerais	PCR from isolates obtained by culture	64-81	100% cagA-positive
Ashour et al.⁽¹⁾, 2002	PCR from isolates obtained by culture	38/55 (69)	Duodenal ulcer (24)
Belo Horizonte, Minas Gerais	PCR from isolates obtained by culture	55-81	94.7% cagA-positive
Gatti et al.⁽¹²⁾, 2006	Direct PCR of gastric biopsy specimen	38/57 (67)	Chronic gastritis (29)
Marília, São Paulo	Direct PCR of gastric biopsy specimen	53-79	69% cagA-positive
Cartágenes et al.⁽⁶⁾, 2009	Antibody anti-cagA by ELISA method	39/50 (78)	Not described
Belém, Pará	Antibody anti-cagA by ELISA method	64-89	Not described
Our study	Direct PCR of gastric biopsy specimen	16/54 (29.6)	No statistically significant association
Our study	Direct PCR of gastric biopsy specimen	18-43.6	No statistically significant association

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[TFN01t01] EGD: esophagogastroduodenoscopy; GERD: gastroesophageal reflux disease; PCR: polymerase chain reaction.

[TFN02t01] * Mean ± standard deviation (range); † Frequency observed (%, percentage of valid findings); ‡ Not counting bathrooms. After Staat et al.⁽30⁾.