Overview of Helicobacter pylori Infection in Indonesia: What Distinguishes It from Countries with High Gastric Cancer Incidence?

Helicobacter pylori infects more than half the human popula-
tion. However, the prevalence in Indonesia is low, as is the
prevalence of gastric cancer. Hence, it could be instructive
to compare these prevalence rates and their determining
factors with those of countries that have high gastric can-
cer incidence. Ethnicity and genetic characteristics of H.
pylori are important determinants of the H. pylori infection
rate in Indonesia. The infection rate is higher in Bataknese,
Papuans and Buginese than in Javanese, the predominant
ethnic group. Ethnicity is also an important determinant of
the genetic characteristics of H. pylori . Analysis of CagA in
the EPIYA segment showed that the predominant genotypes
in Papuans, Bataknese and Buginese are ABB-, ABD- and
ABC-type CagA, respectively. Meanwhile, in the countries
with high gastric cancer incidence, almost all strains had
East Asian type CagA. An antibiotic susceptibility evaluation
showed that the standard triple therapy can still be used
with caution in several cities. There is a very high rate of
resistance to second-line regimens such as levofloxacin and
metronidazole. Recent studies have shown that furazolidone,
rifabutin and sitafloxacin are potential alternative treatments
for antibiotic-resistant H. pylori infection in Indonesia. Rather
than focusing on early detection and eradication as in coun-
tries with high gastric cancer prevalence, countries with low
gastric cancer prevalence should focus on screening the sev-
eral groups that have a high risk of gastric cancer.