Effectiveness of eradication therapy for Helicobacter pylori infection in Africa: A systematic review and meta-analysis

Abstract

Abstract Background The effectiveness of Helicobacter pylori (H. pylori) eradication depends on the treatment protocol. This study aimed to investigate the H. pylori eradication effectiveness in Africa using the best available evidence from databases. Methods PubMed, Google Scholar, Hinari, Scopus, and the directory of Open Access Journals (DOAJ) were searched. The quality of each included study was assessed using Cochrane risk-of-bias tool for randomized trials (RoB2) and Risk of Bias in Non-Randomized Studies of Intervention (ROBINS-I) for observational studies. Heterogeneity between studies was assessed using I2 test statistics based on the random effect model. Stata version 13 (College Station, Texas 77845 USA) software was employed to compute the pooled eradication rate. Forest plots and tables were used to present the data. Results Twenty-two studies from 9 African countries with a total population of 2,163 met the inclusion criteria and were included in the analysis. The pooled eradication rate of H. pylori by standard therapy was 79% (95% CI: 75%, 82%), with heterogeneity (I2 = 93.02%). In the subgroup analysis by study design, a higher eradication rate was reported from observational studies (85%, 95% CI: 79%-90%), compared to randomized control trials (77%, 95% CI: 73%-82%); by the duration of therapy, higher eradication rate was reported in 10-days regimen (88%, 95% CI: 84–92), compared to 7-days regimen (66%, 95% CI: 55–77); by country, the highest eradication rate was found in Ethiopia (90%; 95% CI: 87%-93%) and the lowest eradication rate was reported in Ivory Coast (22.3%; 95% CI:15%-29%); by type of H. pylori test, the highest eradication rate was reported when rapid urease test coupled with histology (88%, 95% CI: 77–96), and the lowest eradication rate was reported using histology alone (22.3%; 95% CI:15%-29%). Conclusions Eradication therapy for H. pylori in Africa had eradication rates that could be considered effective even in the lowest reported cases. This study demonstrates the necessity to optimize current H. pylori treatment regimens in each country, taking into account the antibiotic susceptibility of the bacteria.