Helicobacter pylori Across Continents: Contrasts in Epidemiology, Genetics, Clinical Impact, and Management Between East and West

Abstract

Helicobacter pylori (H. pylori) remains one of the most widespread and clinically significant bacterial infections globally, affecting over half the world’s population. This review explores the geographic contrasts in H. pylori epidemiology, genetic diversity, disease burden, and management strategies, with a particular focus on differences between Eastern and Western regions. East Asia bears a disproportionately high burden of H. pylori-associated diseases, especially gastric cancer, due to more virulent strains and distinct patterns of gastritis. Genetic variations in key virulence factors such as cagA and vacA contribute to regional differences in clinical outcomes. Diagnostic and therapeutic approaches also vary widely, shaped by healthcare infrastructure, screening practices, and antibiotic-resistance profiles. Advances in endoscopic techniques and personalized medicine have improved early detection and treatment in high-incidence regions, while Western countries face challenges in implementing widespread screening due to lower disease prevalence. This review highlights the importance of region-specific strategies, genomic surveillance, and international collaboration to address disparities in disease outcomes and improve access to care. Understanding the complex interplay between bacterial genetics, host factors, and environmental influences is essential for developing effective prevention, diagnostic, and eradication programs tailored to diverse populations.