TUGAS BACA

Meta-analysis on the global prevalence of H. pylori infection has shown an overall prevalence of 44.3%,
and estimated prevalences are as high as 89.7% in Nigeria and as low as 10.0% in Indonesia and 8.9% in
Yemen.
Systematic review with meta-analysis: the worldwide prevalence of Helicobacter pylori infection
Pharmacol Ther. 2018;47:868–876
Seroprevalence of H. pylori infection was significantly higher in subjects aged
50-59 years, males, low income group, and subjects from provinces. Notably,
there is a gender-related difference in the prevalence of H. pylori infection
manifesting as a lower rate of infection in young women and an earlier
plateau of infection rate in men.

Factors known to be associated with H plori prevalences in adults:

- Geographic areas
- Infected siblings
- Household income
- Mother’s education
- Poor living sanitation
- Source of drinking water
- Crowding
- Types of housing
Referensi: Miklos, BG. Helicobacter pylori: A Worldwide Perspective 2014. Bentham Science Publishers
What are the risk factors for the H. pylori infection in Indonesia?
• The latest study reported by Darnindro et al found that the incidence of H. pylori infection in
patients with poor sanitation was higher compared with patients who had a good sanitation
status. The lower the sanitation status, the higher the risk of H. pylori infection (OR=2.5; 95%
CI=1.01–6.19; p=0.044).
• Furthermore, the use of public toilets can increase the spread of infection because of
individual’s lack of hygienic behaviour. Also, the use of wells, especially shallow wells, as a
water source increases the risk of transmission of H. pylori.
• Darnindro et al reported that the incidence of H. pylori infection in areas with a low clean
water index was higher than in areas with a high clean water index. The lower the index, the
greater the risk of H. pylori infection (OR=1.524; 95% CI=0.57–4.04; p=0.396).
• Darnindro et al also showed that 13.5% of their sample had a high crowding index, although
the association between H. pylori infection and crowding did not achieve statistical
significance (OR=1.2; 95% CI=0.37–4.49). 5
• Our study, conducted from January 2014 to February 2015, involved a total of 267 patients
with dyspeptic symptoms on Java, Papua, Sulawesi, Borneo, and Sumatra islands. The
patients aged 50–59 had a significantly higher H. pylori infection rate than did the 30–39-
year-old group (OR=2.98; p=0.05). The Protestants had a significantly higher H. pylori
infection rate than did the Catholics (OR=4.42; p=0.008). The infection rate was also
significantly lower among people who used tap water as their source of drinking water
compared with those who drank from wells or rivers (OR=9.67; p=0.03).

Referensi: Syam, AF. Current situation of Helicobacter pylori infection in Indonesia. The Medical Journal of Indonesia. Desember 2016. 25: 4
• The main determinants of successful H.
pylori eradication are the choice of regimen, the
patient’s adherence to a multi-drug regimen with
frequent side-effects, and the sensitivity of the H.
pylori strain to the combination of antibiotics
administered (Factual statement; moderate quality of
evidence).
• In patients with persistent H. pylori infection, every
effort should be made to avoid antibiotics that have
been previously taken by the patient (unchanged from
previous ACG guideline (1)) (Strong recommendation;
moderate quality of evidence).
• Although H. pylori antimicrobial resistance can be
determined by culture and/or molecular testing, (strong
recommendation; moderate quality of evidence), these
tests are currently not widely available in the United
States.
• Whenever H. pylori infection is identified and treated,
testing to prove eradication should be performed using a
urea breath test, fecal antigen test or biopsy-based
testing at least 4 weeks after the completion of antibiotic
therapy and after PPI therapy has been withheld for 1–2
weeks. (Strong recommendation; Low quality of
evidence (for the choice of methods to test for
eradication: Moderate quality of evidence)).
TERIMA KASIH