The Effect of Helicobacter pylori Gene Combinations of cagA, cagE, virB11, vacA, and babA on the Outcome of Gastric Disease in a Southern Moroccan Population

<i>Helicobacter pylori</i> (<i>H. pylori</i>) possess an arsenal of virulence genes that makes them the main etiological factor in gastric diseases. In this study, 120 southern Moroccan patients who were dyspeptic were profiled to investigate the potential association between disease severity and the combination of multiple virulence genes. Gastric biopsies were taken from patients, followed by histopathological evaluation and genotyping of <i>H. pylori</i> using PCR. <i>H. pylori</i> was detected in 58.3% of cases, and genotypes were distributed as follows: <i>oipA</i> (94.3%), <i>cagA</i> (62.9%), <i>virB11</i> (60%), <i>babA</i> (55.7%), <i>dupA</i> (54.3%), <i>cagE</i> (51.4%), <i>iceA1</i> (31.4%), <i>iceA2</i> (45.7%), <i>vacA s2m2</i> (47.1%), <i>vacA s1m1</i> (30%), and <i>vacA s1m2</i> (7.1%). Statistically significant associations with males were observed for the <i>cagA</i>, <i>cagE</i>, and <i>virB11</i> genes and multiple strain infections. Multivariate analysis revealed an association between <i>cagE</i> and heightened neutrophil activity, with an odds ratio (OR) of 4.99 (<i>p</i> = 0.03). The gene combination [<i>cagA</i> (+), <i>cagE</i> (+), <i>virB11</i> (+), <i>vacA s1m1</i>, and <i>babA</i> (+)] emerged as a predictive factor for gastric cancer (OR = 11.10, <i>p</i> = 0.046), while the combination [<i>cagA</i> (-), <i>cagE</i> (-), <i>virB11</i> (-), <i>vacA s2m2</i>, <i>babA</i> (+)] was associated with gastric atrophy (OR = 10.25, <i>p</i> = 0.016). Age (≤40 years) (OR = 5.87, <i>p</i> = 0.013) and moderate to severe bacterial density (OR = 15.38, <i>p</i> = 0.017) were identified as predictive factors for follicular gastritis. These findings underscore the significance of multigene profiling as a prognostic marker and emphasize the importance of age and sex in preventing adverse outcomes in severe gastric diseases.