# Impact of Helicobacter pylori Virulence Genotypes cagA, vacA, oipA, and babA2 on Severity of Gastropathies in Brazilian Patients

## TL;DR

This study examines how specific Helicobacter pylori gene combinations affect the severity of stomach diseases in Brazilian patients.

## Contribution

The study identifies a protective effect of combined virulence genes in H. pylori against certain gastropathies.

## Key findings

- The cagA/vacA/oipA/babA2 gene combination was protective against erosive esophagitis and duodenitis.
- No significant link was found between the gene combination and severe gastric diseases.
- A trend toward protection against gastric atrophy was observed.

## Abstract

Helicobacter pylori (H. pylori) is a Gram-negative, spiral-shaped bacterium that colonizes the human stomach and is linked to various gastroduodenal diseases. The severity of different clinical outcomes may be determined by the combination of virulence genes. The aim of this study was to assess the combinations of the cytotoxin-associated gene A (cagA), the vacuolating cytotoxin A gene (vacA), the outer inflammatory protein A gene (oipA), and the blood group antigen-binding adhesin gene (babA2) genotypes in H. pylori and their associations with the clinical outcomes of infection in patients from Central Brazil. This cross-sectional study included 106 patients who underwent endoscopy or gastrectomy. The presence and genotypes of H. pylori were confirmed using Polymerase Chain Reaction (PCR). Gastropathies were classified according to established severity criteria. Multivariate logistic regression and Venn diagrams were used to evaluate gene combinations. In this study, the infection prevalence was 65.1%. The cagA/vacA/oipA/babA2 combination showed a protective effect against erosive esophagitis (p = 0.002), erosive duodenitis (p = 0.003), and general duodenitis (p < 0.001). No significant association was observed between this gene combination and severe gastric diseases, although a trend toward protection against gastric atrophy was noted (p = 0.049). These findings suggest that the coexistence of cagA/vacA/oipA/babA2 may play a protective role against inflammatory lesions. Further studies should explore the functional role of these gene combinations, also considering the immunogenetic profile of the host.