Population-Based Screening and Eradication of Helicobacter pylori in a Resource-Limited Population of Sub-Saharan Africa

Abstract

Background: Helicobacter pylori (H. pylori) infection is a common cause of chronic dyspepsia worldwide. Its prevalence in the developing world remains understudied, however. Given that H. pylori is the most significant risk factor for developing gastric cancer, an accurate assessment of the effectiveness of population-based screening and eradication of H. pylori is warranted. The objectives of this study were to determine the prevalence of H. pylori, to identify risk factors associated with H. pylori colonization, and to assess the efficacy of triple therapy on H. pylori eradication within a region of sub-Saharan Africa.Methods: We administered a dyspepsia questionnaire to 376 randomly selected adult residents of the Namutumba District in Uganda. Participants submitted a stool sample for H. pylori fecal antigen testing. H. pylori-positive participants were given standard triple therapy. The efficacy of triple therapy on H. pylori eradication was established by fecal H. pylori antigen testing and improvement in dyspepsia scores after treatment. Dyspeptic, H. pylori-negative participants were administered daily omeprazole for one month. Logistic regression analyses were used to identify factors associated with H. pylori positivity, chronic dyspepsia, and H. pylori eradication failure.Results: The prevalence of H. pylori within the study population was 48%. A higher level of education was significantly associated with H. pylori positivity. 87% of study participants reported at least one symptom of dyspepsia, with 43% reporting moderate or severe dyspepsia. Dyspepsia severity was independent of H. pylori status. Standard triple therapy resulted in ~90% eradication. Missing four or more doses of the triple therapy regimen was significantly associated with H. pylori eradication failure.Conclusions: Chronic dyspepsia is a common complaint in this sub-Saharan population but is not by itself a defining feature of H. pylori positivity. Clinical suspicion for H. pylori within this population should nonetheless remain high, given the high prevalence of positivity among all those with dyspepsia, including many with relatively mild dyspeptic symptoms. Population-based screening and adherence to standard triple therapy are effective at eradicating H. pylori within this region. Trial Registration: This study was registered in ClinicalTrials.gov (TRN: NCT04525664, registered 24 August 2020 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04525664). This study adheres to CONSORT guidelines.