Analysis of risks of gastric cancer by gastric mucosa among Indonesian ethnic groups

by Muhammad Miftahussurur, Langgeng Agung Waskito, Ari Fahrial Syam, Iswan Abbas Nusi, I Dewa Nyoman Wibawa, Yudith Annisa Ayu Rezkitha, Gontar Siregar, OK Yulizal, Fardah Akil, Willy Brodus Uwan, David Simanjuntak, Jimmy Bradley Waleleng, Alexander Michael Joseph Saudale, Fauzi Yusuf, Hasan Maulahela, Marselino Richardo, Abdul Rahman, Yoma Sari Namara, Eko Sudarmo, Pangestu Adi, Ummi Maimunah, Poernomo Boedi Setiawan, Kartika Afrida Fauzia, Dalla Doohan, Tomohisa Uchida, Maria Inge Lusida, Yoshio Yamaoka

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.