cagA Type in H. pylori isolATed from dyspepTic pATienTs Vol 43 No. 1 January 2012 105 Correspondence: Chariya Chomvarin, Depart- ment of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand. Tel: 66 (0) 4336 3808; Fax: 66 (0) 4334 8385 E-mail: chariya@kku.ac.th INTRODUCTION Helicobacter pylori infection is associ- ated with the development of gastroduo- denal diseases, such as chronic gastritis, peptic ulcer and gastric cancer (Atherton, 2006). The cytotoxin-associated gene A (cagA) is one of the virulence genes re- lated to pathogenicity (Atherton, 2000). Epidemiological studies have suggested that the presence of cagA is associated with the development of peptic ulcer and gastric cancer (Blaser et al, 1995; Nomura et al, 2002; Salih et al, 2010), increased mu- cosal infammation (Peek et al, 1995) and cellular proliferation (Peek et al, 1997). H. pylori cagA-positive strains were found in 50-70% of H. pylori isolated from Western populations ( Rudi et al, 1998; Podzorski et al, 2003; Ribeiro et al, 2003; Erzin et al, 2006), whereas 80-100% of strains found in the Asian populations were cagA-positive strains (Maeda et al, 1998; Kim et al, 2001). CagA is located on the cag pathogenic- ity island (cagPAI) (Censini et al, 1996), which encodes a bacterial type IV secre- PREVALENCE OF cagA EPIYA MOTIFS IN HELICOBACTER PYLORI AMONG DYSPEPTIC PATIENTS IN NORTHEAST THAILAND Chariya Chomvarin 1 , Karnchanawadee Phusri 1 , Kookwan Sawadpanich 2 , Pisaln Mairiang 2 , Wises Namwat 1 , Chaisiri Wongkham 3 and Chariya Hahnvajanawong 1 1 Department of Microbiology, 2 Department of Medicine, 3 Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Abstract. The aims of this study were to determine the prevalence of cagA type in Helicobacter pylori isolated from dyspeptic patients in northeastern Thailand and to determine whether the pattern of cagA EPIYA motifs were associated with clinical outcomes. One hundred and forty-seven H. pylori-infected dyspeptic pa- tients were enrolled, of whom 68 had non-ulcer dyspepsia (NUD), 57 peptic ulcer disease (PUD), 18 gastric cancer (GCA), and 4 other gastroduodenal diseases. PCR and DNA sequence analysis were used to determine the cagA genotype and the pattern of EPIYA motifs. cagA-positive H. pylori were identifed in 138 (94%) of H. pylori-infected dyspeptic patients of whom 75 (54%) were of the Western-type, 44 (32%) the East Asian type and 19 (14%) of the other types. The Western type is signifcantly found in PUD patients (p = 0.0175). The majority of cagA EPIYA was EPIYA-ABC (43%) and EPIYA-ABD (28%). There is no signifcant correlation between the increase in number of EPIYA-C motifs and clinical outcomes. Thus, the most frequent cagA type found among northeastern Thai dyspeptic patients was the Western cagA type, which is signifcantly associated with PUD indicating a possible predictive parameter for clinical outcome. Keywords: Helicobacter pylori, cagA genotype, dyspeptic patients