Published online Jul 7, 2019. doi: 10.3748/wjg.v25.i25.3183
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
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.
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.