GI-MAP by Diagnostic Solutions

Virulence Factor, virB

Optimal Result: 0 - 0.0001 Units.

The virulence factor genes on GI-MAP are found exclusively on the genome of H. pylori.

These genes code for proteins that will predispose one to more serious H. pylori infections

Helicobacter pylori (H. pylori):

Recent studies have shown that nearly 50% of the world’s population may harbor H. pylori. And, although many carriers are asymptomatic, H. pylori is known to have a causative role in ulcers, chronic gastritis, and stomach cancer.

Additionally, in early phases of colonization, patients may experience hypochlorhydria followed by a change to hyper aciduria. Over time, additional H. pylori strains may colonize, including those with Virulence Factors and increased disease potential.


- Fecal contamination, oral to oral, and family inter-infection are common modes of transmission

Clinical Implications

- Dyspepsia, abdominal pain, nausea, vomiting and chronic gastrointestinal symptoms

- Peptic ulcers

- May induce mucosal atrophy and metaplastic changes

Virulence Factors:

Of the 50% of the population believed to be infected with H. pylori, only 2% develop gastric cancer. Positive H. pylori virulence factors on the GI-MAP represent the genetic potential for an H. pylori strain to cause pathology. For example, some clinicians may choose an aggressive treatment protocol for a patient with dyspepsia and a family history of gastrointestinal cancer, who shows elevated H. pylori and positive virulence factors. 

Potential treatment options to discuss with health care professional:

- Asymptomatic patients may not require treatment

- Consider herbal formulas to eradicate or suppress H. pylori. Ingredients may include: deglycyrrhizinated licorice, mastic gum, methylmethionine sulfonium chloride, vitamin C, zinc carnosine, bismuth citrate, berberine, goldenseal, oil of oregano, grape extract, Chinese goldthread extract, yerba mansa extract

- See pancreatic elastase-1 to determine if maldigestion and/or hypochlorhydria might be present

- Consider high-dose probiotics and 5R Protocol (see this blog article)

- Rebuild healthy gastric mucosa by reducing stress and giving soothing and healing agents such as glutamine, aloe, DGL, and vitamin A

- Address dental hygiene; the mouth is a reservoir for H. pylori

- Consider sources of exposure, especially romantic partners or family members

- Address other imbalances on the GI-MAP

» For peptic ulcer disease, the firstline triple therapy (prescription) treatment includes a proton pump inhibitor, clarithromycin, and amoxicillin or metronidazole

» Fluoroquinolones and tetracycline are used in second-line regimens against H. pylori

What does it mean if your Virulence Factor, virB result is too high?

Genetic characteristics:

- Part of the CagA “pathogenicity island”

- Both genes can potentiate CagA virulence factor by aiding in its transmission to host epithelial cels

- In the absence of CagA, these virulence factors are unlikely to change clinical outcome of H. pylori infections.

Associations with Disease:

Evaluate next to CagA virulence factors. VirB & VirD, if positive, can potentiate CagA virulence and clinical associations

How to target treatments in the presence of Virulence factors:

- Generally, when virulence factors are present, the treatment goal will be to fully eradicate the H. pylori population. This can be confirmed by retesting the full GI-MAP, the pathogen panel, or the H. Pylori panel 4-6 weeks after completing treatment. The goal is to achieve a result of <dl on the retest. The exception to this may be VirB and VirD if they are found in isolation (without CagA).

- Below is a chart of treatment considerations for each of the virulence factors. These would be used in addition to the standard treatments for H. pylori alone.

H. pylori virulence factors and treatment considerations:

Virulence Factor

Special Treatment Considerations


More aggressive treatment may be warranted; consider the use of adhesion inhibitions, particularly cranberry


Target inflammatory support, promote T-cell activity, consider curcumin, resveratrol/red wine, ginger, Nigella sativa, low salt diet


Consider the use of demulcents for mucosal protection


Inflammatory support, consider the use of adhesion inhibitors


Inflammatory support


Mitochondrial support, consider Nigella sativa, green tea, red wine/resveratrol, Scutellaria baicalensis

VirB & VirD

No additional treatments necessary

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