Low-grade intestinal metaplasia in Indonesia: Insights into the expression of proinflammatory cytokines during Helicobacter pylori infection and unique East-Asian CagA characteristics

Management of dyspepsia and Helicobacter pylori infection: the 2022 Indonesian Consensus Report

“…The risk of gastric cancer in Indonesia is low supported by the low intestinal metaplasia grade in Indonesian general population [ 53 ]. Even within H. pylori infected patients, recent study revealed that the proinflammatory cell infiltration and cytokine expression response in Indonesian population during H. pylori infection is generally not robust, thus, reducing the risk factors of gastric cancer development [ 53 ]. Another possible reasons could be that sodium consumption among the Indonesian population was generally lower than that in other countries, especially other than South-East Asian countries [ 54 – 56 ].…”

“…While Indonesian population generally have low gastric cancer incidence, however, patients from Timor, Papua, and Bugis ethnic groups remain showed higher gastric cancer risk factors compared to other ethnicities [ 47 ]. Even without H. pylori infection, these ethnicities tend to have higher pro-inflammatory cytokines expression compared to others [ 53 ]. Thus, special consideration must be given if the patients come from these ethnicities.…”

“…In Indonesia, general prevalence of H. pylori is low which is similar to the intestinal metaplasia and gastric cancer prevalence [ 53 ]. However, ethnicities such as Timor, Papuan, Batak, and Bugis were proven to have higher risk of H. pylori infection and gastric cancer, regardless of where they live.…”

“…Should not be used solely to diagnose H. pylori infection [ 40 , 54 ] Urine test 83 95 Easy sampling method without the need for special skills and tools Sampling is cheaper than serum sampling False negative results with low concentrations of IgG Lower accuracy Requires more time for interpretation; Lack of availability. Should not be used to diagnose H. pylori infection [ 50 ] Invasive test RUT 90 95 Rapid result warranting the fast management for H. pylori eradication False negative in patients with recent GI bleeding or with the use of PPIs, antibiotics, or bismuth containing compounds Validated for some kits [ 53 ] Histology 42–99 100 Histochemical staging is the standard for H. pylori gastritis assessment Widely available In cases with low levels of H. pylori , histological stains can provide a negative result Widely available in Indonesia [ 51 ] IHC 65–98 100 IHC staining for H. pylori has a lower inter-observer variation compared to histo- chemical stains IHC staining procedure is more expensive than histochemical stains and it is not available in all laboratories In cases of chronic (active) gastritis in which H. pylori is not detected by histochemistry, IHC of H. pylori can be used as an ancillary test [ 51 ] Culture 55–73 100 Allows an evaluation of antibiotic resistance irrespective of the intrinsic mechanism involved …”