title: Rare Helicobacter pylori Infection May Explain Low Stomach Cancer Incidence: Ecological Observations in Bali, Indonesia.
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.
authors.affiliation: Department of Health and Nutrition Policy, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan E-mail : tokudome2013@gmail.com.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Tanaka
authors.forename: I Ketut
authors.initials: IK
authors.lastname: Mulyadi
authors.lastname: Moestikaningsih
authors.forename: Tjok Gede
authors.initials: TG
authors.lastname: Oka
authors.lastname: Soeripto
authors.forename: Fx Ediati
authors.initials: FE
authors.lastname: Triningsih
authors.forename: Teguh
authors.initials: T
authors.lastname: Triyono
authors.forename: Didik Setyo
authors.initials: DS
authors.lastname: Heriyanto
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hosono
authors.forename: Sadao
authors.initials: S
authors.lastname: Suzuki
authors.forename: Shinkan
authors.initials: S
authors.lastname: Tokudome
mesh_terms: D000328:Adult; D001944:Breath Tests / Q000379:methods; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000453:epidemiology* / Q000378:metabolism; D016480:Helicobacter pylori / Q000472:pathogenicity*; D006801:Humans; D015994:Incidence; D007214:Indonesia / Q000453:epidemiology; D007564:Japan / Q000453:epidemiology; D008297:Male; D020116:Pepsinogen A; D054592:Protein Tyrosine Phosphatase, Non-Receptor Type 11 / Q000378:metabolism; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000378:metabolism / Q000382:microbiology*; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D014508:Urea / Q000378:metabolism
chemical_list: D014409:Tumor Necrosis Factor-alpha; D014508:Urea; D020116:Pepsinogen A; C516724:PTPN11 protein, human; D054592:Protein Tyrosine Phosphatase, Non-Receptor Type 11