Analysis of Helicobacter pylori Genotypes and Risk Factors of the Peptic Ulcer Bleeding

초록

Background/objectives: Rates of emergency operation for peptic ulcer bleeding have not decreased although the rates of operation for peptic ulcer have decreased. The mortality & morbidity have not reduced than previous data in spite of development of medicine and method for peptic ulcer bleeding. Many factors had been reported as risk factors of peptic ulcer bleeding. The reason of higher incidence of ulcer complications in the elderly may be due to interaction between NSAIDs use & H. Pylori infection. But whether H. Pylori infection potentiates this gastrointestinal toxicity of NSAIDs is still unresolved. Also H. Pylori genotypes vacA (s1a and mid-region), cagA, iceA virulence genes & its combinations are related with peptic ulcer disease. We studied subtypes cagA, vacA, and iceA of H. Pylori and known risk factors such as age, smoking, alcohol, NSAIDs use for recent one month. Methods: 69 peptic ulcer patients underwent EGD and biopsies were done for histologic examination, culture & CLO test for H. Pylori. Patients taking antibiotics, PPI, and bismuth, and undergoing previous gastric operation were excluded. We studied DNA analysis of s1, s2, m1, m2, icea1, icea2, and cagA by PCR and s1 subtype by DNA sequencing. We interviewed past history of NSAIDs, smoking, and alcohol. The mean age were 45.3 years old in BPU(bleeding peptic ulcer) group and 47.3 in NBPU(nonbleeding peptic ulcer). Male to female ratio was 1.4:1 in BPU and 3.1:1 in NBPU. Results: there were no statistically significant differences in age, sex, smoking and alcohol history between two groups. NSAIDs use was significantly higher in BPU irrespective of H. Pylori positivity(p=0.034). There was no statistical significance of positive rate of cagA(66.7% in BPU, 73.7% in NBPU), subtype of iceA(iceA1 66.7%, iceA2 0% in BPU, iceA1 70.2%, iceA2 1.8% in NBPU), and vacA(m1 66.7%, m2 0% in BPU, m1 71.9%, m2 10.5% in NBPU/s1a 8.3%, s1c 58.3%, s1a+c 0% in BPU, s1a 21.2%, s1c 52.6%, s1a+c 8.8% in NBPU). Conclu