Information regarding Helicobacter pylori antibiotic resistance in Indonesia was previously inadequate. We assessed antibiotic susceptibility for H. pylori in Indonesia, and determined the association between virulence genes or genetic mutations and antibiotic resistance. We recruited 849 dyspeptic patients who underwent endoscopy in 11 cities in Indonesia. E-test was used to determine the minimum inhibitory concentration of five antibiotics. PCR-based sequencing assessed mutations in 23S rRNA, rdxA, gyrA, gyrB, and virulence genes. Next generation sequencing was used to obtain full-length sequences of 23S rRNA, infB, and rpl22. We cultured 77 strains and identified 9.1% with clarithromycin resistance. Low prevalence was also found for amoxicillin and tetracycline resistance (5.2% and 2.6%, respectively). In contrast, high resistance rates to metronidazole (46.7%) and levofloxacin (31.2%) were demonstrated. Strains isolated from Sumatera Island had significantly higher metronidazole resistance than those from other locations. Metronidazole resistant strains had highly distributed rdxA amino acid substitutions and the 23S rRNA A2143G mutation was associated with clarithromycin resistance (42.9%). However, one strain with the highest MIC value had a novel mutation in rpl22 without an A2143G mutation. Mutation at Asn-87 and/or Asp-91 of gyrA was associated with levofloxacin-resistance and was related to gyrB mutations. In conclusions, although this is a pilot study for a larger survey, our current data show that Indonesian strains had the high prevalence of metronidazole and levofloxacin resistance with low prevalence of clarithromycin, amoxicillin, and tetracycline resistance. Nevertheless, clarithromycin- or metronidazole-based triple therapy should be administered with caution in some regions of Indonesia.

Indonesia is a big country with multiethnic populations whose gastric cancer risks have not been elucidated. We performed a nationwide survey and obtained histological specimens from 1053 individuals in 19 cities across the country. We examined the gastric mucosa, the topography, the atrophic gastritis risk factors, and the gastric cancer risk scores. Almost half (46.1%) of the patients with dyspeptic symptoms had histological abnormalities; chronic (36.3%) and atrophic gastritis (28.9%) being the most frequent. Individuals of the Timor ethnicity had the highest prevalence of acute (52.6%) and chronic gastritis (68.4%), even those negative for H . pylori . Our topographic analysis showed the majority of patients had predominantly antral acute and chronic gastritis. A multivariate logistic regression model showed age (Odds ratio [OR], 1.107), Timor ethnicity (OR, 8.531), and H . pylori infection (OR, 22.643) as independent risk factors for presence of atrophic gastritis. In addition, the gastric cancer risk score was highest in those from Timor, Papuan, and Bugis ethnic populations. Overall, Indonesia is a low-risk gastric cancer country. However, several ethnic groups displayed severe gastric mucosa symptoms suggesting policy makers should focus on those ethnic groups to perform gastric cancer screenings and to eradicate H . pylori .

We measured the accuracy of the urine test (RAPIRUN) for detection of Helicobacter pylori infection in Indonesia (Jakarta, Pontianak, and Jayapura) using histology confirmed by immunohistochemistry and/or culture as gold standards. We also used immunohistochemistry to identify CagA phenotype and analyzed H. pylori CagA diversity in Indonesia. The overall prevalence of H. pylori infection in 88 consecutive dyspeptic patients based on the urine test was 15.9% (14/88), 38.1% for patients in Jayapura that had higher prevalence of H. pylori infection than that in Jakarta (9.7%, P = 0.02) and Pontianak (8.3%, P = 0.006). Overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of RAPIRUN were 83.3%, 94.7%, 71.4%, 97.3%, and 93.2%, respectively. All of the H. pylori-positive patients were immunoreactive for anti-CagA antibody but not immunoreactive for East Asian specific anti-CagA antibody in all H. pylori-positive subjects. We confirmed the high accuracy of RAPIRUN in Indonesian population. In general, we found less virulent type of H. pylori in Indonesia, which partly explained the low incidence gastric cancer in Indonesia.

Pendahuluan. Risiko infeksi Helicobacter pylori (H. pylori) dikaitkan dengan banyak faktor yang terkait dengan pejamuagen-lingkungan. Etnis adalah salah satu faktor dari pejamu yang banyak diteliti di luar negeri. Prevalensi infeksi H. pylori didapatkan lebih tinggi pada etnis tertentu seperti misalnya di Cina. Berdasarkan teori migrasi dan teori transmisi, diduga infeksi H. pylori akan dibawa oleh penduduk yang bermigrasi dari daerah dengan prevalensi tinggi ke tempat tujuan migrasi. Etnis Tionghoa di Kalimantan Barat berasal dari daerah Cina Selatan dengan prevalensi infeksi H.pylori tinggi. Diperkirakan ada perbedaan angka prevalensi infeksi H. pylori pada etnis Tionghoa dibandingkan pada etnis asli Kalimantan Barat, yaitu etnis Dayak. Penelitian ini dilakukan untuk mengetahui perbedaan angka prevalensi, karakteristik epidemiologis dan gambaran hasil pemeriksaan endoskopi pada subjek etnis Tionghoa dan Dayak dengan sindrom dispepsia.Metode. Penelitian ini menggunakan studi potong lintang untuk mengetahui perbedaan angka prevalensi infeksi H.pylori. Penelitian dilakukan di RSU Santo Antonius Pontianak dari bulan Desember 2014 sampai Juni 2015 dengan metode pengambilan sampel secara consecutive sampling. Angka prevalensi infeksi H. pylori disajikan dalam angka persentase, sedangkan perbedaan karakteristik epidemiologis dan perbedaan gambaran hasil pemeriksaan endoskopi pada etnis Tionghoa dan Dayak dianalisis dengan analisis bivariat menggunakan chi-square dengan tingkat kemaknaan (p)=0,05.Hasil. Dari 203 subjek yang diteliti, terdiri dari 102 subjek etnis Tionghoa dan 101 subjek etnis Dayak, didapatkan angkaprevalensi H. pylori sebesar 40,8%. Prevalensi pada etnis Tionghoa didapatkan lebih tinggi dibanding etnis Dayak,berturut-turut sebesar 48,0% dan 33,7%. Tidak ditemukan adanya perbedaan karakteristik epidemiologis dan temuan hasil pemeriksaan endoskopi yang bermakna pada kedua kelompok etnis.Simpulan. Terdapat perbedaan angka prevalensi infeksi H. pylori pada etnis Tionghoa (48,0%) dibanding etnis Dayak (33,7%). Namun, tidak ada perbedaan karakteristik epidemiologis dan gambaran hasil pemeriksaan endoskopi pada kedua kelompok etnis tersebut.Kata kunci: Dayak, etnis, Helicobacter pylori, sindrom dispepsia, Tionghoa The Difference in Prevalence of Helicobacter pylori Infection between Chinese and Dayak Ethnics with Dyspepsia SyndromeIntroduction. Helicobacter pylori (H. pylori) infection risk is associated with many factors related to host-agent-environment. Ethnicity is one of the host factors which was the most studied factor overseas. The prevalence of H. pylori infection was found higher in certain ethnic such among Chinese. Based on migration and transmission theory, it was suspected that H. pylori infection was transmitted by people migrating from areas with a high prevalence of infection to the destination area. Chinese in West Borneo are originated from South China region where the prevalence of H. pylori infection is high. It is estimated that there are differences in the prevalence of H. pylori infection among Chinese compared to the native people of West Borneo, the Dayaknese. Methods. This was a cross-sectional study to determine the differences in the prevalence of H. pylori infection. The study was conducted at St. Antonius General Hospital Pontianak from December 2014 to June 2015 with consecutive samplingmethod. H. pylori infection prevalence is presented in percentage numbers, while the epidemiological characteristics and endoscopic finding differences among Chinese and Dayaknese were analyzed by bivariate analysis using the chi-square with significance value (p) = 0.05.Results. From a total of 203 subjects in this study, consisted of 102 Chinese subjects and 101 Dayaknese subjects, the prevalence of H. pylori infection was 40.8%. The prevalence among Chinese is higher than Dayaknese, which is 48.0% and 33.7%, respectively. There is no difference in the epidemiological characteristics and endoscopic findings in both ethnic groups.Conclusions. The prevalence of H. pylori infection among the Chinese (48.0%) is higher than among Dayaknese (33.7%). There is no difference in the epidemiological characteristics and endoscopic findings among both ethnic groups.Keywords: Chinese, Dayak, Dyspeptic syndrome, Ethnic, Helicobacter pylori

Latar belakang: Diabetes melitus merupakan suatu penyakit metabolik dengan karakteristik berupa hiperglikemia yang terjadi karena kelainan sekresi insulin, kerja insulin ataupun keduanya. Salah satu cara mengetahui kontrol glukosa darah adalah HbA1c, semakin tinggi kadarnya maka risiko komplikasi juga meningkat pada pasien diabetes melitus tipe 2. Nefropati diabetik adalah salah satu komplikasi diabetes melitus yang ditandai dengan penurunan laju filtrasi glomerulus (LFG) dan proteinuria. Penelitian ini bertujuan untuk mencari hubungan antara kadar HbA1c dan fungsi ginjal berdaasarkan LFG dan proteinuria pada penderita diabetes melitus tipe 2. Metode: Penelitian ini menggunakan metode potong lintang. Subjek adalah 51 penderita diabetes melitus di Rumah Sakit Umum St. Antonius Pontianak yang dipilih dengan cara consecutive sampling. Data diperoleh melalui anamnesis, data laboratorium dan data rekam medik pasien. Hasil: Uji statistik korelatif koefisien kontingensi menunjukkan hubungan antara HbA1c dan LFG dengan nilai p= 0.431 dan r= 0,226 dan hubungan antara HbA1c dan proteinuria dengan nilai p= 0.450 dan r= 0.222. Kesimpulan: Tidak terdapat hubungan yang bermakna antara kadar HbA1c dan fungsi ginjal berdasarkan LFG dan proteinuria pada penderita diabetes melitus tipe 2.