Impact of Helicobacter pylori Virulence Genotypes cagA, vacA, oipA, and babA2 on Severity of Gastropathies in Brazilian Patients

<i>Helicobacter pylori</i> (<i>H. pylori</i>) is a Gram-negative, spiral-shaped bacterium that colonizes the human stomach and is linked to various gastroduodenal diseases. The severity of different clinical outcomes may be determined by the combination of virulence genes. The aim of this study was to assess the combinations of the cytotoxin-associated gene A (<i>cagA</i>), the vacuolating cytotoxin A gene (<i>vacA</i>), the outer inflammatory protein A gene (<i>oipA</i>), and the blood group antigen-binding adhesin gene (<i>babA2</i>) genotypes in <i>H. pylori</i> and their associations with the clinical outcomes of infection in patients from Central Brazil. This cross-sectional study included 106 patients who underwent endoscopy or gastrectomy. The presence and genotypes of <i>H. pylori</i> were confirmed using Polymerase Chain Reaction (PCR). Gastropathies were classified according to established severity criteria. Multivariate logistic regression and Venn diagrams were used to evaluate gene combinations. In this study, the infection prevalence was 65.1%. The <i>cagA</i>/<i>vacA</i>/<i>oipA</i>/<i>babA2</i> combination showed a protective effect against erosive esophagitis (<i>p</i> = 0.002), erosive duodenitis (<i>p</i> = 0.003), and general duodenitis (<i>p</i> < 0.001). No significant association was observed between this gene combination and severe gastric diseases, although a trend toward protection against gastric atrophy was noted (<i>p</i> = 0.049). These findings suggest that the coexistence of <i>cagA</i>/<i>vacA</i>/<i>oipA</i>/<i>babA2</i> may play a protective role against inflammatory lesions. Further studies should explore the functional role of these gene combinations, also considering the immunogenetic profile of the host.