Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2016; 8(1): 40-54
Published online Jan 15, 2016. doi: 10.4251/wjgo.v8.i1.40
Helicobacter pylori infection and gastric carcinoma: Not all the strains and patients are alike
Natale Figura, Luigi Marano, Elena Moretti, Antonio Ponzetto
Natale Figura, Department of Medical, Surgical and Neurological Sciences, University of Siena and Policlinico S. Maria alle Scotte, 53100 Siena, Italy
Luigi Marano, General, Minimally Invasive and Robotic Surgery, Department of Surgery, Hospital San Matteo degli Infermi, 06049 Spoleto, Perugia, Italy
Elena Moretti, Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
Antonio Ponzetto, Department of Medical Sciences, University of Torino, 10126 Torino, Italy
Author contributions: All the authors contributed equally in the design of the review, acquisition and interpretation of data and drafting the manuscript, which was approved by them all.
Conflict-of-interest statement: The authors have no conflict of interest or financial ties to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Natale Figura, Professor, Department of Medical, Surgical and Neurological Sciences, University of Siena and Policlinico S. Maria alle Scotte, Viale Bracci, 53100 Siena, Italy.
Telephone: +39-5-77585463 Fax: +39-5-77233446
Received: June 14, 2015
Peer-review started: June 17, 2015
First decision: August 4, 2015
Revised: October 6, 2015
Accepted: November 3, 2015
Article in press: November 4, 2015
Published online: January 15, 2016
Core Tip

Core tip: CagA and the cagA types may play different roles in the intestinal and diffuse histotypes of gastric carcinoma (GC); The current criteria of Helicobacter pylori (H. pylori) strain classification based on their carcinogenic potential gave rise to confusion and should be unified. The possible role of inflammatory cytokine haplotypes in GC development should be reassessed taking into account some host’s factors, the most important being different ethnic origin. Infection by the cagA positive H. pylori genotype may determine an increased inflammatory response and a consequent enhancement of mutagenesis rate, oxidative-stress, reactive oxygen species generation, dysfunction of DNA repair mechanisms, genetic instability and resultant high risk of GC development.