From the Guidelines
Helicobacter pylori prevalence in India is approximately 50-80% of the adult population, with regional variations and a higher prevalence in rural areas and among lower socioeconomic groups. The high prevalence of H. pylori infection in India is attributed to factors such as overcrowding, poor sanitation, and inadequate access to clean water 1. According to the available evidence, the prevalence of H. pylori infection tends to be higher in southern regions (70-80%) compared to northern India (50-60%) 1. The infection rate is also higher in rural areas than in urban centers, and most Indians acquire the infection during childhood, with prevalence increasing with age 1.
Key Factors Contributing to High Prevalence
- Overcrowding
- Poor sanitation
- Inadequate access to clean water
- Lower socioeconomic conditions
- Higher prevalence in rural areas
- Infection typically acquired during childhood
The high H. pylori burden in India contributes to the country's elevated rates of peptic ulcer disease, chronic gastritis, and gastric cancer 1. Despite improvements in living conditions, the bacterium's prevalence has remained relatively stable, suggesting deeply entrenched transmission patterns 1. For individuals in India with dyspepsia, ulcers, or other upper gastrointestinal symptoms, H. pylori testing should be considered, with treatment typically involving triple or quadruple therapy regimens that combine proton pump inhibitors with antibiotics 1. The most recent and highest quality study recommends standard triple therapy (amoxicillin, clarithromycin, and PPI) as first-line therapy if low clarithromycin resistance is present 1.
From the Research
Prevalence of Helicobacter pylori (H. pylori) Infection in India
- The prevalence of H. pylori infection in India is approximately 64% 2.
- A study conducted in Karnataka found that the prevalence of H. pylori was 43.2% among dyspeptic patients 2.
- In children, H. pylori infection is very common, especially in those from low socioeconomic backgrounds, with almost 80% of the population infected by the age of 10 3.
- Regional variations in H. pylori prevalence exist, with substantial differences in infection rates across different districts in India 2.
Regional Variations in H. pylori Prevalence
- A study found a significant correlation between district-specific H. pylori prevalence and the Multidimensional Poverty Index (MPI) in Karnataka 2.
- Metronidazole resistance is high in most regions of India, except Assam and Mumbai, while clarithromycin is found to be ineffective in South India, Gujarat, and Kashmir 4.
- Resistance to amoxicillin is generally low, except in certain regions such as Hyderabad, Chennai, and the Gangetic belt of North India 4.
Antibiotic Resistance Patterns
- The overall resistance to antibiotics was highest against metronidazole (77.65%), followed by amoxicillin (37.78%), levofloxacin (32.8%), clarithromycin (35.64%), furazolidone (12.03%), and tetracycline (11.63%) 4.
- Dual and multiple drug resistance were found in 26.5% and 8.8% of cases, respectively, in a study conducted in North India 5.
- Tetracycline and furazolidone have the least resistance rates and should be part of anti-H. pylori regimens 4.