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Responses of Endoscopy Patients in Ladakh, India, to Helicobacter pylori Whole-Cell and CagA Antigens

Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee,¹ Departments of Medicine and Microbiology, New York University, New York School of Medicine, and Veteran Affairs Medical Center, New York, New York,² Sonam Norbu Memorial Hospital, Leh, Ladakh, India,⁴ Mayo Clinic, Rochester Minnesota³

Received 10 April 2002/ Returned for modification 21 May 2002/ Accepted 2 July 2002

Although Helicobacter pylori is a cosmopolitan colonizer of the human stomach, the responses among persons in remote populations from whom H. pylori was cultured have not been studied. We report on studies of 189 persons in the Ladakh region of India in whom serum immunoglobulin G responses to H. pylori whole-cell and CagA antigens were measured. H. pylori was isolated from 68 of these patients. An H. pylori whole-cell antigen derived from Ladakhi strains outperformed a similar antigen from U.S. strains, as determined by antigen-specific enzyme-linked immunosorbent assays. In total, 95% of the population was seropositive, including individuals responding only to the CagA antigen. Correlation with culture results showed that these were true positives and, therefore, that the H. pylori whole-cell serology was falsely negative in some cases. In addition to establishing a collection of H. pylori isolates from a remote area in the world, we show that use of H. pylori whole-cell and CagA serology together increases the sensitivity for the detection of colonization.

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