Is a female of Indonesian and Chinese descent at a greater risk for Helicobacter pylori (H. pylori) infection?

H. pylori Risk in Indonesian and Chinese Descent Females

Yes, a female of Indonesian and Chinese descent is at greater risk for H. pylori infection compared to Western populations, with prevalence rates in developing Asian countries reaching 70-90% of the population. 1, 2

Geographic and Ethnic Risk Factors

The risk for H. pylori infection is substantially elevated in individuals of Asian descent, particularly those from Indonesia and China:

• Developing Asian countries demonstrate H. pylori prevalence of 70-90%, compared to lower rates in developed Western nations 1
• Chinese populations specifically have been identified as having different gastric cancer risk profiles, with studies noting that indigenous Chinese populations may have elevated gastric cancer risk associated with H. pylori 3
• Asian ethnicity is recognized as a risk factor for gastric cancer independent of documented gastric intestinal metaplasia (GIM), and this should be considered in clinical decision-making 3

Clinical Implications for Gastric Cancer Risk

The elevated H. pylori prevalence translates to meaningful downstream cancer risk:

• The NCCN guidelines specifically recommend stronger consideration for EGD surveillance in Lynch syndrome patients of Asian descent, reflecting the recognized elevated gastric cancer risk in Asian populations 4
• Within Asia-Pacific regions, geographic variation in gastric cancer risk ranges from 2-4% in Western populations to 30% in Korean populations 4
• H. pylori eradication reduces incident gastric cancer risk by 32% (RR 0.68; 95% CI 0.48-0.96) and gastric cancer mortality by 33% (RR 0.67; 95% CI 0.38-1.17) 3

Transmission and Environmental Factors

The higher prevalence in Indonesian and Chinese populations relates to specific transmission patterns:

• Person-to-person transmission occurs through oral-oral routes (vomitus, saliva) or fecal-oral routes, with higher incidence in crowded living conditions and poor sanitation 1
• Waterborne transmission from fecal contamination is particularly important in regions with untreated water, common in developing countries 1
• Low socioeconomic status, inadequate sanitation, and crowded living conditions facilitate transmission among family members 1, 2
• Food prepared under suboptimal conditions or exposed to contaminated water increases infection risk 1

Practical Recommendations

For this patient population, active screening for H. pylori should be strongly considered, particularly if she has:

• Family history of gastric cancer (4.5-fold increased risk) 3
• Immigration status from high-prevalence regions (infection status remains high in immigrants from countries with high H. pylori prevalence) 2
• Plans for or existing gastric intestinal metaplasia, where H. pylori eradication is specifically recommended 3

Testing should utilize validated serological tests or non-invasive methods such as urea breath test or stool antigen detection 3, 2, 5

If H. pylori is detected, eradication therapy should be pursued given the established reduction in gastric cancer risk, with confirmation of eradication recommended due to high treatment failure rates 3

Important Caveats

• Asian Americans have the highest prevalence of CYP2C19 poor metabolizer genotypes, which may affect PPI-based eradication therapy efficacy 3
• Smoking nearly doubles the risk of persistent H. pylori infection following therapy (OR 1.95; 95% CI 1.55-2.45), so smoking cessation should be addressed 3
• The combination of H. pylori infection and atrophic gastritis determined by serological examination identifies subjects at particularly high risk for gastric cancer 3