Rare Helicobacter pylori Infection May Explain Low Stomach Cancer Incidence: Ecological Observations in Bali, Indonesia.

Akihiro Hosono,Didik Setyo Heriyanto,Teguh Triyono,Moestikaningsih Moestikaningsih,Tjok Gede Oka,Fx Ediati Triningsih,Tsutomu Tanaka,Shinkan Tokudome,Sadao Suzuki,I Ketut Mulyadi,Soeripto Soeripto

doi:10.7314/apjcp.2016.17.3.979

Akihiro Hosono, Didik Setyo Heriyanto + Show 9 more

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https://doi.org/10.7314/apjcp.2016.17.3.979

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Abstract

The incidence rate of stomach cancer in Bali, Indonesia, is estimated to be strikingly lower than that in Japan. We conducted an on-site ecological study to investigate the association between the stomach cancer incidence and Helicobacter pylori (H. pylori) infection. Recruiting 291 healthy persons (136 men and 155 women) from the general population in Bali, Indonesia, we conducted a urea breath test (UBT) to examine H. pylori infection, along with a pepsinogen test to detect chronic atrophic gastritis and urine analysis to estimate sodium and potassium excretion. UBT positivities were 9% (2-15, 95% confidence interval) for men and 7% (1-12) for women, and positive cases for H. pylori IgG antibodies were 1% (0-3) for men and 3% (0-5) for women, significantly lower than the respective values in Japan. Positive pepsinogen tests in Bali were 0% (0-0) for men and 1% (0-4) for women, also significantly lower than the Japanese figures. Computed values for daily salt excretion were 13.3±4.1 g (mean ± SD) for men and 11.1±3.1 g for women, as high as corresponding Japanese consumption values. Moreover, the estimated potassium excretion was 3.2±0.7 g for men and 2.8±0.6 g for women in Bali, significantly higher than the figures in Japan. There were no associations across genetic polymorphisms of IL-beta, TNF-alpha, and PTPN11 with UBT positivity. The low incidence of stomach cancer in Bali may thus mainly be due to the rare H. pylori infection. Namely, the bacterium infection seems to be a critical factor for gastric cancer rather than host or other environmental factors.

Highlights

Helicobacter pylori (H. pylori) is regarded as a carcinogen for stomach cancer along with other contributory factors, such as smoking and intake of salt and salty foods (IARC, 1994; 2003; Graham and Graham, 2002; WCRF/AICR, 2007)
We found no significant difference in the intake of salt and salty foods between H. pylori-positive and -negative Balinese subjects
The low incidence of stomach cancer in Bali appeared attributable to a rare H. pylori infection and chronic atrophic gastritis along with low smoking rates and high consumption of fruit and vegetables

Summary

Introduction

Helicobacter pylori (H. pylori) is regarded as a carcinogen for stomach cancer along with other contributory factors, such as smoking and intake of salt and salty foods (IARC, 1994; 2003; Graham and Graham, 2002; WCRF/AICR, 2007). It destroys gastric mucous membranes and induces chronic atrophic gastritis which is the precursor lesion for stomach cancer (Parsonnet et al, 1991; Graham and Graham, 2002; Oishi et al, 2006). Since it has been suggested that the incidence of stomach cancer is low in Bali, Indonesia from a hospital-based cancer registry (Soeripto, 2003), we conducted an on-site ecological study of stomach cancer to elucidate the risk/preventive factors of stomach cancer by sampling breath, blood and urine, and by conducting a surveillance of smoking and alcohol drinking habits and consumption of vegetables and fruit, salt and salty foods

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