Abstract
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.
Highlights
Severe atrophic gastritis (AG) with intestinal metaplasia (IM) is an initial marker for gastric cancer [1, 2], the world’s fifth most common cancer and the third leading cause of cancer death based on report from Global Cancer Incidence, Mortality and Prevalence (GLOBOCAN) 2018
We found a significantly higher AG prevalence among the individuals with acute chronic gastritis than that in patients with non-chronic acute gastritis (126/164 [76.8%] vs. 54/186 [40.9%], odd ratio (OR) = 8.28, 95%CI = 5.00–13.11, P < 0.001), but we found no difference in the IM prevalence between patients with acute chronic gastritis and those with non-acute chronic gastritis (12/186 [6.5%] vs. 12/164 [7.3%], P = 0.914) (S3 Table)
After classifying the atrophic risk based on the operative linked gastritis atrophy (OLGA) scores as belonging to the high risk if the OLGA score >2 or to the low risk if the OLGA score 2 [25], the peoples in Timor and Papuan groups had the highest risk for gastric cancer based on the OLGA score (23.7% and 9.3%, respectively), and we found a significant association between ethnic group and the high-risk prevalence (P < 0.001) (S5 Table)
Summary
Severe atrophic gastritis (AG) with intestinal metaplasia (IM) is an initial marker for gastric cancer [1, 2], the world’s fifth most common cancer and the third leading cause of cancer death based on report from Global Cancer Incidence, Mortality and Prevalence (GLOBOCAN) 2018. (http://gco.iarc.fr/). Severe atrophic gastritis (AG) with intestinal metaplasia (IM) is an initial marker for gastric cancer [1, 2], the world’s fifth most common cancer and the third leading cause of cancer death based on report from Global Cancer Incidence, Mortality and Prevalence (GLOBOCAN) 2018. A modified gastric cancer risk index (GCRI) [13] was developed based on the criteria initially proposed by Meining et al [7, 13], which showed a benefit as a detection tool. The addition of AG in the assessment of modified GCRI was due to the common prevalence of AG in the high risk gastric cancer countries [13]. The operative linked gastritis atrophy (OLGA) score has been shown to be a good marker for gastric cancer risk even in very heterogenic populations [14]
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