Chapter 9 - Helicobacter pylori in Sub-Saharan Africa

Abstract

Based on recent studies, the association between humans and Helicobacter pylori originated in Africa 88,000–116,000years ago, and spread from Africa with its human host approximately 60,000years ago. The prevalence of H. pylori infection in sub-Saharan Africa is high, although significant differences exist in prevalence rates within countries in this region. Evidence would suggest that the major mode of transmission of H. pylori is person to person via the fecal oral, gastro-oral, or oral-oral route. While many studies support the view that transmission of H. pylori occurs within the family setting, and in particular from mother to child, a number of studies provide evidence that in some countries within sub-Saharan Africa acquisition appears to occur outside the family setting. Debate continues regarding the authenticity of the African enigma in relation to gastric cancer; however, current evidence would suggest that the rates of duodenal ulcer disease (DU) and Gastric ulcer disease (GU) are similar to those in other countries. Studies investigating the prevalence of the H. pylori virulence factors cagA, vacA, and iceA in this region are increasing; however, the reported association between these factors and disease outcome is not consistent across countries within sub-Saharan Africa. As in many countries worldwide, resistance rates of H. pylori to the currently recommended antibiotic therapies are increasing in sub-Saharan Africa, some countries within this region reporting significantly higher resistance rates than those reported in Western populations.