About Helicobacter pylori

Helicobacter pylori (H. pylori) is a gram-negative curved rod or s-shaped bacterium that infects the gastric mucosa3

First discovered in 1982 by Warren and Marshall, it was later classified as a ‘carcinogen’ by the World Health Organization in 19945,6

H. pylori infection appears to be acquired throughout life, but commonly starts in infancy7

Routes of H. pylori transmission include:7

  • Faecal-oral­
  • Oral-oral (dental)
  • Gastro-oral
  • Sexual behaviour

Once a person acquires H. pylori infection, the bacteria usually persists throughout their lifetime3

After entering the host stomach, four critical steps occur to establish successful H. pylori colonisation, persistent infection, and disease pathogenesis:8,9

Worldwide impact

Almost 50% of adults are infected by H. pylori worldwide1

Europe45.7% (95% CI: 44.3-47.1) Adapted from: Chen YC, et al. 202412
Eastern mediterranean 56.5% (95% CI: 53.4-59.4) Adapted from: Chen YC, et al. 202412
Americas49.0% (95% CI: 45.5-52.4) Adapted from: Chen YC, et al. 202412
Africa56.5% (95% CI: 52.3-60.6) Adapted from: Chen YC, et al. 202412
Southeast Asia44.2% (95% CI: 39.7-48.8) Adapted from: Chen YC, et al. 202412
Western Pacific49,4% (95% CI: 48.1-50.6) Adapted from: Chen YC, et al. 202412
Europe45.7% (95% CI: 44.3-47.1) Adapted from: Chen YC, et al. 202412
Eastern mediterranean 56.5% (95% CI: 53.4-59.4) Adapted from: Chen YC, et al. 202412
Americas49.0% (95% CI: 45.5-52.4) Adapted from: Chen YC, et al. 202412
Africa56.5% (95% CI: 52.3-60.6) Adapted from: Chen YC, et al. 202412
Southeast Asia44.2% (95% CI: 39.7-48.8) Adapted from: Chen YC, et al. 202412
Western Pacific49,4% (95% CI: 48.1-50.6) Adapted from: Chen YC, et al. 202412
Europe45.7% (95% CI: 44.3-47.1) Adapted from: Chen YC, et al. 202412
Eastern mediterranean 56.5% (95% CI: 53.4-59.4) Adapted from: Chen YC, et al. 202412
Americas49.0% (95% CI: 45.5-52.4) Adapted from: Chen YC, et al. 202412
Africa56.5% (95% CI: 52.3-60.6) Adapted from: Chen YC, et al. 202412
Southeast Asia44.2% (95% CI: 39.7-48.8) Adapted from: Chen YC, et al. 202412
Western Pacific49,4% (95% CI: 48.1-50.6) Adapted from: Chen YC, et al. 202412

Global prevalence (%) of H. pylori infection in adults by WHO regions12

H. pylori prevalence can also vary depending on age, associated diseases, geographic regions, race/ethnicity, socioeconomic status, and hygienic conditions3

H. pylori remains a major global health problem13

H. pylori antibiotic resistance is alarming and is considered a major cause of eradication failure14,15

Clarithromycin resistance16 32% (95% CI: 25-31)
Metronidazol resistance16 38% (95% CI: 33-42)
Levofloxacin resistance16 14% (95% CI: 12-16)

Pooled prevalence (2006-2016) of primary and secondary H. pylori antibiotic resistance to clarithromycin, metronidazole, and levofloxacin in Europe16

H. pylori antibiotic resistance is part of a larger, global antibiotic resistance crisis17,18

Antibiotic resistance caused

~1.3 million

deaths worldwide (in 2019)18

Antimicrobial misuse and overuse drives the development of drug-resistant pathogens18

Consequences of infection

H. pylori-associated gastritis is the underlying cause of almost all gastric diseases19

Extra-gastric diseases also associated with H. pylori infection:3

  • Unexplained iron deficiency anaemia
  • Vitamin B12 deficiency
  • Idiopathic thrombocytopenic purpura (in some instances)

H. pylori symptoms

The symptoms of H. pylori can include alarm and non-alarm symptoms3,22

Which patients should be tested?

According to international guidelines, the following patient profiles should be investigated for H. pylori3,4

Dyspeptic patients with or without alarm symptoms

  • Patients with a family history of gastric cancer
  • Patients with a history of endoscopic resection of early gastric cancer
  • Patients with low-grade gastric MALT

Patients with long-term PPI use

  • High risk patients already on long-term aspirin
  • Naïve patients starting long-term NSAID therapy

Immigrants from areas with a high prevalence of H. pylori infection

  • Patients with iron-deficiency anaemia when other causes have been excluded
  • Adult patients with immune thrombocytopenia

Patients with active or history of peptic ulcer disease

Testing methods

Patients aged <50 years with dyspepsia3,4

Patients aged ≥50 years with dyspepsia or at any age with ALARM SYMPTOMS3,4

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