Identification of Helicobacter pylori infection in symptomatic patients in Surabaya, Indonesia, using five diagnostic tests

The prevalence of Helicobacter pylori infection in Indonesia is controversial. We examined
the H. pylori infection rate in 78 patients in a hospital in Surabaya using five different tests,
including culture, histology, immunohistochemistry, rapid urease test, and urine antibody test.
Furthermore, we analysed virulence factors in H. pylori strains from Indonesia. The H. pylori
infection rate was only 11·5% in all patients studied, and 2·3% of Javanese patients and 18·0% of
Chinese patients were infected (P=0·01). Although severe gastritis was not observed, activity and
inflammation were significantly higher in patients positive for H. pylori than in patients negative
for H. pylori. Among genotypes identified from five isolated strains, cagA was found in four; two
were vacA s1m1. All cagA-positive strains were oipA ‘on’ and iceA1 positive. We confirmed both
a low H. pylori infection rate and a low prevalence of precancerous lesions in dyspeptic patients
in a Surabaya hospital, which may contribute to the low incidence of gastric cancer in Indonesia.