Studies by Rautelin HI et al and Li SL et al found that MMP-9 level increased significantly in the gastric mucosa of gastritis patients with positive H. pylori compared to the negative [22, 23]. In a study conducted by Oliviera, it was found that H. pylori through a T4SS (Type IV Secretion System) pathway increases the activity of MMP-9 as a response to the invasion of H. pylori on the gastric epithelium .