Virulence Factor, virD

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.

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.

Genetic Characteristics:

- Part of the CagA “pathogenicity island”

- Both VirB & VirD 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.


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

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

Clinical Implications:

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

- Peptic ulcers

- May induce mucosal atrophy and metaplastic changes

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.

Associations with Disease:

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


- 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. (What is the 5R Protocol?)

- 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

- See the GI-MAP Antibiotic Resistance Genes results for Helicobacter when designing an antibiotic protocol

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