Anti-CagA antibodies are associated with atrophic gastritis in a population at high gastric cancer risk: a morphometric study by computerized image analysis

Background, CagA-positive Helicobacter pylori strains appear to increase the risk for atrophic gastritis. Aim, To verify the association between CagA status and atrophic gastritis in the general population by means of computerized image analysis. Subjects, Forty-jive subjects were chosen out of a representative sample of a population at high gastric cancer risk. Methods, Helicobacter pylori status was assessed by IgG ELISA, rapid urease test and histology. Serum anti-CagA antibodies were detected by western blotting. Subjects were subdivided into 3 groups. 15 subjects Helicobacter pylori positive CagA-positive, 15 Helicobacter pylori positive CagA-negative and 15 controls Helicobacter pylori negative. Biopsies were studied using the Sydney System score. A computerized image analysis was used to count inflammatory cells in the lamina propria and to measure the area of the gastric glands. Results. Anti-CagA antibodies were associated with reduction of gland area (126671 +/- 81032 mu(2)/mm(2) vs 231384 +/- 54159; p = 0.0001), with increasing both of polymorphonuclear cells (426 +/- 238 cell/mm(2) vs 136 +/- 69; p = 0.0001) and mononuclear cells (8675 +/- 1304 cell/mm(2) vs 7241 +/- 1230; p = 0.003). Conclusions. The association of anti-CagA antibodies with a high grade of gastric atrophy further supports the hypothesis that Helicobacter pylori CagA-positive strains can promote the multifactorial process of gastric carcinogenesis.