Abstract
BACKGROUND: The epidemiology of Helicobacter pylori in Lebanon is underreported. We aimed to estimate the infection proportion, clarithromycin resistance, and virulence determinants of H. pylori among symptomatic patients with suspected peptic ulcers in Tripoli, North Lebanon. METHODS: Eighty-seven patients undergoing routine endoscopy screening for peptic ulcers were selected. Culture and Allplex™ H. pylori and ClariR Assay were performed. Antimicrobial susceptibility testing for clarithromycin, tetracycline, levofloxacin, and rifampicin was performed using the E-test method. The virulence factors (cagA, vacA, dupA, iceA1, iceA2, and oipA) were screened and/or typed by PCR. RESULTS: Overall, 32.2 % (28/87) of the patients were found to be infected with H. pylori. Five isolates were resistant to clarithromycin, associated with specific point mutations of A2143G (4/5) or A2142C (1/5). The vacA was found in all tested isolates, with s2m2 being the predominant vacA genotype. The 3' end variable region of cagA was identified in 44.4% of isolates, where cagA typing indicated their belonging to Western types. The other virulence determinants were dupA (77.8%), iceA1 (61.1%), oipA (55.6%), and iceA2 (50%). CONCLUSIONS: Our findings demonstrate the circulation of H. pylori among symptomatic patients with suspected peptic ulcers in Lebanon, characterized by a rich and diverse pool of virulence genes and the emergence of resistance to clarithromycin and levofloxacin. Large-scale surveillance is crucial for quantifying the burden of H. pylori infection, monitoring antimicrobial resistance trends, and ensuring timely updates to eradication treatment policies.