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World J Gastroenterol. Jul 7, 2019; 25(25): 3183-3195
Published online Jul 7, 2019. doi: 10.3748/wjg.v25.i25.3183
Infections with Helicobacter pylori and challenges encountered in Africa
Stella Smith, Muinah Fowora, Rinaldo Pellicano
Stella Smith, Muinah Fowora, Department of Molecular Biology and Biotechnology, Nigerian Institute of Medical Research, Lagos PMB 2013, Nigeria
Rinaldo Pellicano, Unit of Gastroenterology, Molinette Hospital, Turin 10126, Italy
Author contributions: Smith S and Pellicano R contributed equally to the concept and design of the study; while all authors were involved in the literature review and analysis, drafting and critical revision and editing and final approval of the final version.
Conflict-of-interest statement: No potential conflict of interest and no financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Stella Smith, PhD, Director (Research), Department of Molecular Biology and Biotechnology, Nigerian Institute of Medical Research, 6 Edmond Crescent, Yaba, Lagos PMB 2013, Nigeria. stellasmith@nimr.gov.ng
Telephone: +234-803-7058989
Received: March 17, 2019
Peer-review started: March 18, 2019
First decision: April 4, 2019
Revised: May 2, 2019
Accepted: May 31, 2019
Article in press: June 1, 2019
Published online: July 7, 2019
Processing time: 114 Days and 18.2 Hours
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.

Keywords: Helicobacter pylori; Africa; Risk factors; African enigma; Prevalence; Treatment; Diagnosis

Core tip: Africa has the highest rates of global prevalence of Helicobacter pylori (H. pylori) infection worldwide. Nevertheless, scarce data are available, describing in some cases both inappropriate diagnostic approaches and therapeutic regimens. This probably depends on the lack of continental consensus guideline for the management of H. pylori infection. As a consequence, there is an increasing number of papers reporting, in several countries, a high rate of bacterial resistance to the most commonly used antibiotics for H. pylori treatment. This manuscript gives an update on the African literature about H. pylori infection and on the present and future challenges in this context.