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There is marked global geographic variation in both the incidence of gastric cancer and genetic features of\n                    <jats:italic toggle=\"yes\">H. pylori<\/jats:italic>\n                    strains. Geographic diversity among\n                    <jats:italic toggle=\"yes\">H. pylori<\/jats:italic>\n                    strains can be linked to ancestral human migrations and subsequent\n                    <jats:italic toggle=\"yes\">H. pylori<\/jats:italic>\n                    evolution within human population groups. In this review, we discuss how geographic diversity among\n                    <jats:italic toggle=\"yes\">H. pylori<\/jats:italic>\n                    strains is an important factor contributing to geographic variations in gastric cancer incidence. We focus on geographic variations in genes encoding secreted\n                    <jats:italic toggle=\"yes\">H. pylori<\/jats:italic>\n                    proteins (CagA and VacA), outer membrane proteins (BabA, HopQ, HopH\/OipA, HomB, AlpA, and AlpB), and enzymes required for lipopolysaccharide synthesis, and we discuss how these variations can impact gastric cancer pathogenesis. We discuss the concept of\n                    <jats:italic toggle=\"yes\">H. pylori<\/jats:italic>\n                    -human co-evolution, including selective forces that may influence\n                    <jats:italic toggle=\"yes\">H. pylori<\/jats:italic>\n                    evolution within human populations. Finally, we discuss recent changes in\n                    <jats:italic toggle=\"yes\">H. pylori<\/jats:italic>\n                    \u2013human relationships, including a declining prevalence of\n                    <jats:italic toggle=\"yes\">H. pylori<\/jats:italic>\n                    , changes in\n                    <jats:italic toggle=\"yes\">H. pylori<\/jats:italic>\n                    populations, and potential adverse consequences of mismatch between the ancestry of\n                    <jats:italic toggle=\"yes\">H. pylori<\/jats:italic>\n                    strains and the ancestry of human hosts.\n                  <\/jats:p>","DOI":"10.1128\/mmbr.00204-24","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T13:01:15Z","timestamp":1785157275000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":1,"title":["<i>Helicobacter pylori<\/i>\n                    geographic variation: a window into global differences in gastric cancer incidence"],"prefix":"10.1128","volume":"90","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6366-0570","authenticated-orcid":false,"given":"Chiamaka D.","family":"Okoye","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05dq2gs74","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center","place":["Nashville, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4498-3619","authenticated-orcid":false,"given":"Georgia C.","family":"Caso","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05dq2gs74","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center","place":["Nashville, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8503-002X","authenticated-orcid":true,"given":"Timothy L.","family":"Cover","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05dq2gs74","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center","place":["Nashville, USA"]},{"id":[{"id":"https:\/\/ror.org\/02vm5rt34","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Medicine, Vanderbilt University School of Medicine","place":["Nashville, USA"]},{"id":[{"id":"https:\/\/ror.org\/05dq2gs74","id-type":"ROR","asserted-by":"publisher"}],"name":"Vanderbilt Institute for Infection, Immunology, and Inflammation, Vanderbilt University Medical Center","place":["Nashville, USA"]},{"name":"Veterans Affairs Tennessee Valley Healthcare System","place":["Nashville, 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