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CNAA / Theses / 2007 / May /

Genomic heterogeneity of Helicobacter pylori in gastroduodenal ulcer and the efficacy of treatment

Author: Elena Creangă
Degree:doctor of medicine
Speciality: 14.00.05 - Internal Diseases (with specification: Pulmonology, Gastroenterology, Hepatology, Nephrology, Functional Diagnostics and Endoscopy)
Scientific adviser: Ion Ţîbîrnă
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Scientific consultant: Nicolae Barbacar
doctor habilitat, professor, Institute of Genetics, Physiology and Plant Protection of the ASM
Scientific council:


The thesis was presented on the 30 May, 2007
Approved by NCAA on the 20 September, 2007


Adobe PDF document0.27 Mb / in romanian


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Adobe PDF document 0.68 Mb / in romanian
124 pages


pathogenesis, genotype, virulence, H. pylori; CagA+, VacA+, IceA1+, BabA+ genes, endoscopic aspect, histopatologic modifications, eradication, pathogenicity iland, cytokines, duodenal ulcer, polyresistance, antibodies to H. pylori, degree of colonisation, PCR, primer.


A total of 118 patients diagnosed with duodenal ulcer H pylori positive (n=54), duodenal ulcer H. pylori negative (n=50) gastric ulcer H. pylori positive (n=14), was studied, having been analyzed from endoscopic and histologic points of view. For endoscopic and histological classification the Sydnei system has been used. The polymerase chain reaction (PCR) was used to detect CagA and VacA genes of H. pylori using specific primers. It was revealed a positive association between CagA, VacA genes and DU. The patients infected with CagA, VacA-positive strains had a more several abdominal pain, dyspepsia, pyrozis in comparison with CagA/VacA -negative H. pylori strains (p<0,05). The endoscopic modifications was shown that the patients infected with CagA, VacA -positive strains were more accentuated and also more frequent: erythema (92,6%), hypertrophy (18,5%), and 26% mucous atrophy (p<0,05). The endoscopic modifications have had histopatologic correspondents: the presence of atrophy and lymphoid aggregates, H. pylori activity and chronic inflammation also were significantly higher in the CagA-positive group in comparison with CagA/VacA -negative H. pylori strains. Treatment efficacy was higher in patients with duodenal ulcer infected with H.pylori CagA- strains. CagA/VacA -negative H. pylori strains seems to increase the eradication rates of H. pylori when one-week triple therapy is used. On multivariate analysis, patients with H. pylori negative duodenal ulcer were more likely to be older, had evolution with rarely ingravescence. The histologic and endoscopic modifications of the lot that have associated the infection H. pylori were more accentuated and more frequent (p<0,001). It is important to ascertain the H pylori status before starting eradication therapy.