Epidemiology, Diagnosis, Clinical Significance and Treatment of Helicobacter pylori Infection in Nigeria: A Critical Review

Abstract

Helicobacter pylori remains one of the most prevalent bacterial infections affecting the Nigerian population, with reported seroprevalence figures among the highest documented globally. Despite this burden, the relationship between infection, clinical outcome, and health system response in Nigeria remains incompletely characterised, and existing reviews on the subject are largely descriptive rather than critically integrative. This review synthesises and critically appraises the Nigerian and relevant regional African literature on the epidemiology, diagnostic practice, clinical and pathological significance, and treatment of H. pylori infection. Evidence indicates markedly heterogeneous prevalence estimates across age groups, geopolitical zones and diagnostic methods, generally exceeding two-thirds of adults and rising progressively through childhood in association with low socioeconomic status, household crowding, and inadequate water and sanitation infrastructure. Diagnosis in Nigeria continues to rely disproportionately on invasive endoscopic biopsy-based methods and serology, reflecting limited availability of urea breath testing, stool antigen assays and culture-based antimicrobial susceptibility testing. Clinically, infection is strongly associated with chronic gastritis and peptic ulcer disease, yet gastric cancer incidence in Nigeria remains comparatively low relative to infection prevalence, reproducing the so-called African enigma at a national level. Treatment outcomes are increasingly threatened by high but geographically variable antimicrobial resistance, particularly to metronidazole and, in some but not all locales, clarithromycin. Methodological heterogeneity, small sample sizes, hospital-based sampling frames, and the scarcity of population-representative and longitudinal data limit the strength of causal inference across all thematic areas. This review identifies priority research needs, including nationally representative prevalence surveys, expanded access to non-invasive and susceptibility-guided diagnostics, and prospective evaluation of resistance-adapted eradication regimens, and situates Nigerian data within an emerging Africa-specific consensus framework for management of the infection.