Extensive surveys will be necessary to elucidate the geographical distribution in East Asian countries. Interestingly, Staurosporine mw histological data from the antrum showed that the cag end junction type III was significantly associated with mild neutrophil infiltration and severe intestinal metaplasia. This is the first study to have demonstrated a relationship between cag end junction type and histological features; however the number of type III strains in this study was very small (n = 4) and further work will be necessary to clarify the importance of type III genotypes in countries where the prevalence of type III is high (e.g., South Asia). The multifactorial

JAK cancer model of gastric malignant transformation is currently accepted, and not only H. pylori virulence factors, but also other factors such as

host genetic susceptibility and environmental factors will undoubtedly play certain roles. In Vietnam, the incidence of gastric cancer in the northern City of Hanoi is reported to be 1.5 times higher than that in the Trichostatin A nmr southern City of Ho Chi Minh. Importantly, the two cities share a lot of similarity in terms of ethniCity, living standards, lifestyle and dietary habits. Therefore, these two cities can serve as a good model for understanding the role H. pylori virulence factors in the development of gastric cancer. In this study, the prevalence of Mirabegron the vacA m1 type, which is currently considered to be more toxic and more closely associated with the development of gastric cancer than the m2 type, was significantly higher in strains isolated in Hanoi than those originating from Ho Chi

Minh. Interestingly, compared with other East Asian countries such as Japan and Korea, where the incidence of gastric cancer is high, the prevalence of the vacA m1 type in Vietnam is much lower [13]. Taken together, our data support the hypothesis that the vacA m1 genotype is closely associated with gastric carcinogenesis and may provide a partial explanation for the Asian paradox. In addition, we have also found that the vacA m1 genotype was related to the development of peptic ulcers in the Vietnamese population. Although we failed to obtain evidence that m1 strains induced more severe gastric injury in terms of histology, our current data support the hypothesis that m1 strains are more toxic than m2 strains, and that the m1 genotype play a major role in countries where other factors are relatively homogeneous. Overall, we propose that examination of H. pylori genotypes in strains isolated from two cities in Vietnam, Ho Chi Minh and Hanoi, would be useful for investigating the roles of H. pylori-related factors in the pathogenesis of gastroduodenal disease.