Prevalence of H. pylori in India
India is classified as a high-prevalence region for H. pylori infection, with immigrants from India serving as a reservoir for the infection when they migrate to low-prevalence countries. 1
Global Context and India's Classification
While the provided evidence does not contain specific numerical prevalence data for India itself, the guidelines consistently categorize India among high-prevalence populations:
India is explicitly grouped with other high-prevalence regions including Central and South America, the Caribbean, Eastern Europe, and Asia, where H. pylori prevalence can exceed 80% in some developing nations. 1
Globally, approximately 50% of the world's population is infected with H. pylori, with significant geographic variation ranging from less than 20% in developed countries to over 80% in parts of Africa and developing nations. 2, 3, 4, 5
Africa has the highest pooled prevalence at 70.1%, while developed regions like Switzerland have prevalence as low as 18.9%. 4
Clinical Implications for Indian Populations
First-generation immigrants from India maintain their elevated risk of H. pylori-related diseases similar to their country of origin, even after relocating to low-prevalence countries, thereby increasing the healthcare burden in host nations. 1
Key Risk Factors in High-Prevalence Regions:
Socioeconomic factors drive prevalence, with infection strongly linked to inadequate sanitation, crowded living conditions, lack of indoor plumbing, and limited access to clean water. 1, 3
Childhood acquisition is typical, with most infections occurring during childhood through intrafamilial transmission. 2, 6, 3
Nutritional factors matter, as inadequate consumption of fruits, vegetables, and vitamin C increases infection risk, while food prepared under suboptimal conditions or exposed to contaminated water elevates transmission. 3
Testing Recommendations for Indian Populations
The Houston Consensus Conference recommends testing first-generation immigrants from high-prevalence areas like India with 82% agreement and high-level evidence. 1
Specific High-Risk Groups Warranting Testing:
- Individuals with uninvestigated dyspepsia (100% agreement, high evidence) 1
- Those with family history of gastric cancer (100% agreement, moderate evidence) 1
- Family members residing in the same household as infected patients (91% agreement, moderate evidence) 1, 6
Cancer Risk Considerations
H. pylori causes 71-95% of all gastric cancers, and the lifetime risk of developing gastric cancer varies geographically from 0.6% in the United States to 20% in high-risk countries like Japan and China. 2, 7
In high-prevalence populations like India, the test-and-treat strategy is most cost-effective where H. pylori prevalence exceeds 20%, as this approach provides better symptom resolution and cancer prevention. 1, 2
Common Pitfalls to Avoid:
Do not rely solely on serology in high-prevalence populations, as false positives are common; instead, use urea breath test or monoclonal stool antigen tests for diagnosis. 1
Do not delay eradication once diagnosed, as all major gastroenterological societies recommend immediate treatment when H. pylori is detected. 2, 7
Screen family members of infected individuals, as intrafamilial clustering is well-documented and household members face significantly elevated risk. 6