A South African perspective on Helicobacter pylori: Prevalence, epidemiology and antimicrobial chemotherapy

Abstract

The spiral shaped Gram-negative bacterium, Helicobacter pylori colonizes the stomach of more than 50% of the world's population and can persist for a lifetime if not completely eradicated. High prevalence of the bacterium is common in most population although a majority of the infected patients remain asymptomatic; with only a small subset of infected people experiencing H. pylori-associated illnesses such as chronic gastritis, gastric and duodenal ulcers, mucosa associated lymphoid tissue lymphoma as well as adenocarcinoma. H. pylori is common in South Africa with prevalence ranging from 50-84% as depicted in the various studies conducted across the country. Infection is usually acquired in childhood and is associated with low socio-economic status, overcrowding, poor sanitation and unclean water supplies which appear to influence the rate of transmission. Eradication of this pathogen is a global challenge due to its alarming rate of drug resistance. Triple therapy consisting of a proton pump inhibitor and clarithromycin and either metronidazole or amoxicillin, is recommended for treatment. In this article, we review the major studies conducted based on H. pylori prevalence, epidemiology and antimicrobial chemotherapy in South Africa. Overall, the results of the findings indicate a high prevalence of H. pylori, resistance to recommended therapy and identified the need to consider natural products, including medicinal plants and honey as leads, which may offer useful alternatives in the treatment of H. pylori-related infections in South Africa and the world at large.