From the Guidelines
The current global prevalence of Helicobacter pyli infection is approximately 50% of the global population, with the highest prevalence in developing countries. This estimate is based on recent studies, including a 2020 guideline on perforated and bleeding peptic ulcer 1 and a 2021 expert review on the management of refractory H. pyli infection 1.
Key Points
- The worldwide prevalence of H. pyli infections is approximately 50%, as stated in the 2020 guideline 1.
- The infection is more prevalent in developing countries due to factors such as overcrowding, poor sanitation, and limited access to clean water.
- Recent trends indicate a gradual decline in H. pyli prevalence in many developed countries over the past decades due to improved hygiene, antibiotic use, and better living conditions.
- Antibiotic resistance is increasing globally, particularly to clarithromycin, metronidazole, and levofloxacin, complicating treatment efforts.
- The infection remains a significant public health concern as it is the primary cause of peptic ulcer disease and gastric cancer, with the World Health Organization classifying H. pyli as a Class I carcinogen, as noted in the 2021 expert review 1.
Regional Prevalence
- Africa: 70-80%
- Latin America: 60-70%
- Asia: 55-65%
- North America, Western Europe, and Australia: 20-40%
Treatment and Prevention
- Eradication strategies continue to evolve, with quadruple therapy regimens becoming standard in many regions due to rising antibiotic resistance.
- The choice of treatment regimen should be based on the knowledge of the underlying prevalence of resistant strains in the community, as recommended in the 2020 guideline 1.
From the Research
Global Prevalence of H. pylori Infection
- The global prevalence of Helicobacter pyli (H. pylori) infection has been studied extensively, with varying results across different regions and time periods 2, 3.
- A systematic review and meta-analysis published in 2017 found that the pooled prevalence of H. pylori infection varied significantly across different regions, with Africa having the highest prevalence (70.1%) and Oceania having the lowest prevalence (24.4%) 2.
- The same study estimated that approximately 4.4 billion individuals worldwide were infected with H. pylori in 2015 2.
- A more recent systematic review and meta-analysis published in 2023 found that the global prevalence of H. pylori infection decreased from 58.2% in the 1980-90 period to 43.1% in the 2011-22 period, with the largest decline occurring in the WHO African region 3.
- The prevalence of H. pylori infection was found to be lower in younger people, high-income countries, and countries with high levels of universal health coverage 3.
Regional Variations in H. pylori Prevalence
- The prevalence of H. pylori infection varies significantly across different regions, with some countries having a much higher prevalence than others 2, 3.
- For example, the prevalence of H. pylori infection was found to be as high as 87.7% in Nigeria and as low as 18.9% in Switzerland 2.
- The regional variations in H. pylori prevalence are likely due to differences in socioeconomic factors, sanitation, and access to healthcare 2, 3.
Temporal Trends in H. pylori Prevalence
- The global prevalence of H. pylori infection has been declining over time, particularly in the 2011-22 period 3.
- The decline in H. pylori prevalence is likely due to improvements in sanitation, increased access to healthcare, and the use of antibiotics to treat H. pylori infections 3.
- However, the decline in H. pylori prevalence has been uneven, with some regions and countries experiencing a more significant decline than others 3.