ORIGINAL ARTICLE

CagA in Barrett’s oesophagus in Colombia, a country with a high prevalence of gastric cancer

M Kudo^1,2, O Gutierrez³, H M T El-Zimaity¹, H Cardona³, Z Z Nurgalieva¹, J Wu¹ and D Y Graham¹

¹ Michael E DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX 77030, USA
² Hokkaido University, Graduate School of Medicine, Department of Internal Medicine, Gastroenterology and Haematology Section, Kita 15 jo, Nishi 7 Chome, Kita-Ku, Sapporo Hokkaido, 060-8638, Japan
³ National University, Department of Internal Medicine, Gastroenterology Unit, Bogotá, Colombia

Correspondence to:
Correspondence to:
Dr H M T El-Zimaity
Rm 3A-320 (111D), Veterans Affairs Medical Center, 2002 Holcombe Blvd, Houston, Texas 77030, USA; hzimaity{at}bcm.tmc.edu

Background: In the USA, atrophic gastritis and gastric cancer are rare, whereas gastro-oesophageal reflux disease (GERD) is common. Infection with Helicobacter pylori, especially a CagA positive strain, is unusual in patients with GERD/Barrett’s oesophagus in the USA.

Aim: To examine the relation between Barrett’s oesophagus and CagA positive H pylori in Colombia, a country with a high prevalence of CagA positive H pylori associated atrophic gastritis and gastric cancer.

Methods: Helicobacter pylori and CagA status was determined among Colombian patients with long segment Barrett’s oesophagus and a control group with simple H pylori gastritis. Helicobacter pylori status was determined using a triple stain and CagA status was determined by immunohistochemistry using a specific rabbit anti-CagA serum.

Results: Gastric and oesophageal mucosal biopsies were obtained from 51 patients—39 men (mean age, 57.8 years; SD, 13.1) and 12 women (mean age, 51.8 years; SD, 14.4)—with documented long segment Barrett’s oesophagus. The results were compared with 24 Colombian patients with H pylori gastritis without oesophageal disease. Thirty two patients with Barrett’s oesophagus had active H pylori infection. CagA status was evaluated in a subset of 23 H pylori infected patients with Barrett’s oesophagus, and was positive in eight of these patients compared with 19 of 24 controls (p = 0.01).

Conclusions: Although most Colombian patients with Barrett’s oesophagus had H pylori infection, CagA positive infections were unusual. These data illustrate how consistent corpus inflammation reduces acid secretion, which prevents Barrett’s oesophagus among those with abnormal gastro-oesophageal reflux barriers.

Abbreviations: GERD, gastro-oesophageal reflux disease

Keywords: CagA; Barrett’s oesophagus; Helicobacter pylori; Colombia; gastro-oesophageal reflux disease; oesophageal adenocarcinoma

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