Cytotoxin associated gene A-positive Helicobacter pylori strains in dyspeptic pregnant women

Abstract

Objective: The aim of the present study was to compare the Helicobacter pylori (HP) seropositivity and cytotoxin associated gene A (cagA) status in pregnant women with dyspeptic complaints and pregnant women with no gastrointestinal symptoms. Study design: Seventy-one consecutive pregnant women with gastrointestinal complaints and 72 age-matched pregnant women without any gastrointestinal symptoms or a history of gastrointestinal disease were included in the study. Demographic characteristics and H. pylori and cytotoxin associated gene A status of the groups were analysed. Results: The prevalence of H. pylori seropositivity was slightly but not significantly higher in patients with dyspeptic complaints compared to the controls (74.6% versus 63.8%, respectively, P>0.05). The incidence of dyspeptic complaints were 53.5% in HP-seropositive and 40.9% in HP-seronegative women (P>0.05). The prevalence of cytotoxin associated gene A positivity among H. pylori-seropositive women was significantly higher in dyspeptic pregnants compared to the controls (75.5% versus 45.7%, respectively, P=0.002). Among HP-seropositive women, the incidence of dyspeptic complaints was significantly higher in cagA-positive patients compared to the cagA-negative ones (65.6% versus 34.2%, respectively, P=0.002). When analysed according to the trimesters, the prevalence of cytotoxin associated gene A positivity among H. pylori-seropositive women was significantly higher in dyspeptic pregnants compared to the controls in the first trimester (68.0% versus 34.8%, respectively, P=0.021). Conclusion: Cytotoxin associated gene A-positive, virulant H. pylori strains were found to be more frequently associated with dyspeptic complaints in pregnant women.

Introduction

Dyspeptic complaints are common in pregnancy and further evaluation usually is not considered in pregnant women with such gastrointestinal symptoms. Pregnant women have a predisposition to dyspepsia because gastric contents are close to gastroesophageal junction, gastric pressure is elevated and lower esophageal sphincter tone is decreased, especially in advanced gestation. On the other hand, high hormonal levels during pregnancy can slow down gastrointestinal motility and alleviate symptoms [1]. Mild to moderate dyspepsia is commonly associated with nausea and vomiting and complicates nearly half of all pregnancies [1].

Helicobacter pylori (HP) is a gram negative rod associated with ulcer disease. It has also been reported that HP was associated with nonulcerative dyspepsia [2], [3]. HP colonizes gastric mucosa with a high prevalence rate (range 20–80%) and significant percentages of patients with dyspepsia are seropositive for HP [4]. Higher serum IgG titers for HP was shown in patients with hyperemesis gravidarum compared to control pregnant women [5], [6] but HP-seropositivity was examined in only a few studies in patients with dyspeptic complaints [7], [8].

Cytotoxin associated gene A (cagA) has been demonstrated in some strains of HP. CagA encodes a protein that has a molecular weight of 120–140 kDa and it is considered as a marker for virulance. Patients infected with cagA-positive HP have been reported to have a greater risk of developing duodenal ulcer disease and gastric adenocarcinoma [9]. HP strains positive for cagA could also be responsible for upper abdominal symptoms in nonulcerative dyspepsia. It has been reported that patients with cagA-positive HP strains have more dyspeptic symptoms than patients with cagA-negative HP strains, as well as HP-negative nonulcerative dyspeptics [10].

The aim of the present study was to compare the HP-seropositivity and cagA status in pregnant women with dyspeptic complaints and pregnant women with no gastrointestinal symptoms.