“…Environment-, host-, and strain-dependent factors could play a role in the evolution of the infection. Similarly to other bacterial pathogens which present pathogenic and nonpathogenic variants of the same species, such as uropathogenic (16,28) and enteropathogenic (22) Escherichia coli, Salmonella enterica serovar Typhimurium (11,23), and highly pathogenic Yersinia species (4,25), H. pylori strains isolated from patients suffering from the most severe gastric diseases possess a pathogenicity island in their genome named the cag pathogenicity island (1,6,7,15,19). The term "pathogenicity island" is used to indicate the presence of a large chromosomal segment (30 kb or more in size) containing a cluster of virulence genes and presenting several characteristics suggesting a possible origin by horizontal transfer from another bacterial species, such as a GϩC content different from that of the rest of the genome, the presence of repeated sequences, and a possible insertion within tRNA genes (10,11).…”