Infections with Helicobacter pylori and challenges encountered in Africa

Abstract

Helicobacter pylori ( H. pylori ) is the causative agent of gastritis, peptic ulcer disease, mucosa associated lymphoid tissue lymphoma and gastric cancer (GC). While this bacterium infects 50% of the world’s population, in Africa its prevalence reach as high as 80% as the infection is acquired during childhood. Risk factors for H. pylori acquisition have been reported to be mainly due to overcrowding, to have infected siblings or parent and to unsafe water sources. Despite this high H. pylori prevalence there still does not exist an African guideline, equivalent to the Maastricht V/Florence Consensus Report of the European Helicobacter and Microbiota Study Group for the management of this infection. In this continent, although there is a paucity of epidemiologic data, a contrast between the high prevalence of H. pylori infection and the low incidence of GC has been reported. This phenomenon is the so-called “African Enigma” and it has been hypothesized that it could be explained by environmental, dietary and genetic factors. A heterogeneity of data both on diagnosis and on therapy have been published. In this context, it is evident that in several African countries the increasing rate of bacterial resistance, mainly to metronidazole and clarithromycin, requires continental guidelines to recommend the appropriate management of H. pylori . The aim of this manuscript is to review current literature on H. pylori infection in Africa, in terms of prevalence, risk factors, impact on human health, treatment and challenges encountered so as to proffer possible solutions to reduce H. pylori transmission in this continent.

Gastroesophageal reflux disease in a typical African population: a symptom-based multicenter study

“…Nigeria is a large West African country located on the gulf of Guinea with a population of about 200 million and diverse culture, making it ideal for a survey intended to reflect the situation in Africa. The country also has a high prevalence of Helicobacter pylori infection, similar to what obtains in other African countries where the isolates are both CagA and VacA positive in over 90% of cases [16].…”

Characteristics of Helicobacter pylori strains isolated from Mauritanian patients

“…Recently, Smith et al published a review of the current literature on H pylori infection in Africa. No data were reported for Mauritania, especially regarding clarithromycin resistance, for guiding first‐line antibiotic therapy 14 . Indeed, epidemiological data in Mauritania remain scarce because of diagnostic testing barely performed in routine clinical laboratories.…”

Identifying the best regimen for primary eradication of Helicobacter pylori: analysis of 240 cases

“…As a class I carcinogen of gastric cancer, H. pylori is the devil pathogen infecting approximately 50% of the world's population BACPPI-10 = bismuth quadruple therapy for 10 days. (Peleteiro et al, 2014;Smith et al, 2019). Accordingly, the infection rate of H. pylori in Chinese adults is reported as high as 40%-60% (Nagy et al, 2016).…”