Aims: To assess the associations between cagA and vacA genotypes of H. pylori with precancerous gastric lesions in patients with gastritis; and with the differentiation of cancer lesions in patients with gastric cancer (GC). Patients and methods: A prospective cross-sectional study was conducted at the University Medical Center at Hochiminh city from December 2008 to August 2010. Of 78 patients with GC and 91 patients with gastritis who were all H. pylori-positive and successully identified H. pylori genotypes using multiplex PCR were recruited. H. pylori infection status was identified using PCR, CLO test and pathology. Chi-squared and va Fishers exact tests were used to analyzed the data. Results: All patients with GC had cagA-positive and vacA s1 subtype. There was a significant association between vacA ml and the moderate-to-poor differentiation of cancer lesion (p = 0.044). Compared to vacA m2 subtype, patients with vacA ml subtype had a higher risk to have atrophy and intestinal metaplasia in the gastric specimen taken from location about 5cm above the border of the {;ancer lesion, with the odds ratios of 4.95 (CI 95 percent,1.46 - 17.76) and 8.06 (CI 95 percent,1.57 - 55.27), respectively. In the group of patients with gastritis, the rates of cagA-positive, vacA sl and vacA ml subtypes were 92.3 percent (84/91), 96.7 percent (88/91) and 40.7 percent (37/91), respectively. The authors have not identified any association between H. pylori genotypes with the precancerous gastric findings in this subgroup of patients. Conclusion: In gastric cancer patients, vacA ml genotype showed a significant relation with the moderate-to-poor differentiation of cancer lesion as well as the presence of atrophy and intestinal metaplasia in the basal gastric mucosa. However, the authors have not found the similar association in patients with gastritis. This was a novel detection in the study for pathophisiology of gastric cancer.
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