About Helicobacter Pylori

Helicobacter pylori (H. pylori) is 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:

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

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

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 mediterranean56.5% (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 mediterranean56.5% (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 mediterranean56.5% (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 es 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

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