Skip to main content

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



The effectiveness of Helicobacter pylori (H. pylori) eradication depends on the treatment protocol. This study investigates the H. pylori eradication rate in Africa using the best available evidence from databases.


Databases were searched and results were pooled together. Heterogeneity between studies was assessed using I2 test statistics. Stata version 13 software was employed to compute the pooled eradication rate. In the subgroup analysis comparison, the finding is considered significant when the confidence intervals did not overlap.


Twenty-two studies from 9 African countries with a total population of 2,163 were included in this study. The pooled eradication rate of H. pylori was 79% (95% CI: 75%-82%), 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 with histology alone (22.3%; 95% CI:15%-29%). Significant heterogeneity was observed with pooled prevalence (I2 = 93.02%, P < 0.000).


In Africa, the first-line therapy showed a variable eradication rate for H. pylori. This study demonstrates the necessity to optimize current H. pylori treatment regimens in each country, taking into account the antibiotic susceptibility. Future RCT studies with standardized regimens are warranted.

Peer Review reports


Helicobacter pylori (H. pylori) is a microaerophilic, Gram-negative, spiral-shaped motile bacterial pathogen that colonizes the gastric mucosa of approximately half of the world’s population. H. pylori infection is associated with gastritis, peptic ulcer, atrophic gastritis, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma (MALT). The presentation of a range of clinical conditions is primarily determined by bacterial virulence, host genetics, and the individual’s lifestyle [1,2,3,4]. The prevalence of H. pylori infection varies globally, with Africa being the highest infection rate [5]. The bacterium is primarily acquired during early childhood under low socioeconomic conditions and close family contact [6].

According to the Maastricht VI/Florence consensus report 2022, individuals with or without clinical evidence of H. pylori infection are recommended to receive first-line eradication therapy to prevent the development of infection-associated complications, such as gastritis and cancer [7]. Moreover, large-scale eradication of H. pylori in a population reduced the incidence and mortality of gastric cancer [8]. In light of this, guidelines have been developed as a national or regional first-line eradication protocol that consists of different antibiotic combinations, including triple therapies, bismuth-free therapies (sequential, concomitant, or hybrid regimens), and bismuth-based quadruple therapy [9]. The effectiveness of eradication therapy has been assessed based on the pre-protocol analysis and categorized as excellent (≥ 95% success), good (≥ 90% success), borderline acceptable (85–89% success), or unacceptable (< 85% success) [10]. The presence of H. pylori resistance to one or more antimicrobial agents or poor medication adherence increases the likelihood of treatment failure, even with excellent regimens.

H. pylori eradication rate differs in different settings based on the type of regimen employed, duration of therapy, and local antibacterial susceptibility pattern. According to a recent systematic review and meta-analysis, first-line treatment had a 98% global H. pylori eradication rate, with a subcontinental success rate of 98% in Asia, 94% in Africa, 94% in Europe, 93% in South America, and 84% in North America. In this report, five African countries with a total of 7 studies comprising 1021 patients were included, Morocco (n = 3), Egypt (n = 1), Kenya (n = 1), Nigeria (n = 1), and Tunisia (n = 1) [11].

However, there is no pooled eradication rate consisting of observational and randomized controlled trials for H. pylori infection in Africa. However, small-scale studies were reported in different countries in Africa. Therefore, African studies differ in study settings, methodology, and other characteristics. In addition, no systematic review or meta-analysis has been conducted on the eradication rate of H. pylori infection in Africa. Therefore, we have undertaken a systematic review to determine the eradication rate of H. pylori in Africa using previously published articles.


Databases and search strategy

PubMed, Google Scholar, Hinari, Scopus, and the Directory of Open Access Journals (DOAJ) were searched to identify potential articles on H. pylori eradication in Africa. The search was conducted following PRISMA guidelines and checklists [12], Fig. 1.

Fig. 1
figure 1

PRISMA flow chart of studies selection

Quality assessment

The quality of included studies was assessed by using a revised Cochrane risk-of-bias tool for randomized trials (RoB2) and Risk Of Bias in Non-Randomized Studies-of Interventions (ROBINS-I) (Supplementary files 1 and 2). The authors independently assessed the quality of each study, and a consensus was reached on twenty-two studies conducted in nine African countries.

Data extraction

Data were extracted into a customized Microsoft excel spreadsheet. The characteristics of extracted data in each study include: first author name, year of publication, country of study, study design, number of study participants, characteristics of study participants (naïve or nan-naïve), laboratory methods for H. pylori positivity test, number of H. pylori-positive participants, H. pylori eradication regimen, duration of follow up, laboratory methods for H. pylori eradication confirmation, and number of H. pylori eradicated individuals. In addition, graphs of the summary of the risk of bias were developed using RevMan 5.3 (Cochrane Informatics and Knowledge Management Department, London, UK).

Data analysis

Statistical analyses were conducted using Stata version 13.0 (StataCorp, LP, college station, TX). The eradication rate values were pooled using the metaprop command in Stata. The heterogeneity of the studies was assessed using the I2 statistic, and significance was declared at I2 > 50% and Q-test (p < 0.10). Because of high heterogeneity among the studies, the random-effects model (REM) was used to estimate the pooled proportion and 95% CIs using the DerSimonian and Laird methods. The Freeman-Turkey double arcsine transformation was used to avoid missing proportions near or at 0 and 1 from the meta-analysis. Subgroup analysis was done by study design, country, laboratory tests for H. pylori infection, eradication regimen, type of regimen analysis, characteristics of the study population, follow-up duration, and tests employed to confirm eradication. The presence of publication bias was tested using Egger’s test. Forest plots and tables were constructed to display the individual studies and pooled results.

Publication bias and sensitivity analysis

A funnel plot was drawn to evaluate the potential for publication bias. The funnel plots’ gap suggests potential publication bias. In addition, Egger’s regression asymmetry tests were used to assess publication bias, with p < 0.05 considered to indicate potential publication bias. Finally, sensitivity and leave-one-out analysis were done to evaluate the prime determinant of the pooled eradication rate and to detect the possible causes of heterogeneity between studies.


Characteristics of included studies

Twenty-two studies from nine African countries with a total population of 2,163 met the inclusion criteria of the meta-analysis. These studies were published articles from 1992 to 2020, and the number of articles by country is indicated in Table 1. The detailed characteristics of included studies are presented in Table 2. Among the included studies, 8 were observational, and 14 were randomized control trials (RCT). Except for Abd-Elsalam et al., 2016, all study participants were newly diagnosed cases with gastrointestinal disorder. Twelve studies used multiple tests to detect H. pylori, while 10 employed a single test to declare H. pylori infection. Eighteen studies employed a single test, and 4 studies used multiple tests to prove H. pylori eradication. The H. pylori eradication rates in the qualified studies ranged from 22.3% to 90%.

Table 1 Number of articles included in the study by country
Table 2 Lists and characteristics of included 22 studies

The eradication rate and the retrieved studies varies with time. Trend analysis is done to explore the time effect of the study using a scatter plot as indicated in Fig. 2. The trend analysis shows that from 2000 to 2010 there is no eradication study and no variability observed with time.

Fig. 2
figure 2

Trends in H. pylori eradication rate in Africa

Pooled eradication rate of H. pylori

A total of 2,163 people tested positive for H. pylori in Africa. Of which 1,659 confirmed eradication following first-line eradication therapy in the period under review. Our meta-analysis revealed pooled eradication rate of 79% (95% CI: 75%-82%), I2 = 93.02% (Fig. 3). Moreover, the funnel plot for publication bias supported Egger’s regression (p = 0.672) test, which showed no significant publication bias (Fig. 4).

Fig. 3
figure 3

Forest plots of the pooled eradication rates of Helicobacter pylori infection by first-line standard therapy in Africa from 22 studies

Fig. 4
figure 4

Funnel plot showing absence of publication bias with no small study effects, p = 0.672. Publication bias assessment funnel plot; Egger’s regression test (p = 0.672)

Subgroup eradication rate of H. pylori

Subgroup analyses were conducted by country, study design, type of analysis, study population, duration of therapy, outcome measures and regimen. The pooled data were from nine countries. In addition, more studies were conducted in Egypt, which showed an eradication rate of 82%, and almost all countries showed a similar eradication rate except Ivory Coast (22.3%) (Table 3).

Table 3 The subgroup analysis of included studies by country, study design, type of analysis, study population, duration of therapy, outcome measures and regimen from 22 studies in Africa


The 22 studies included in our analysis showed the pooled eradication rate in Africa was estimated to be 79% (95% CI: 75–82). This overall eradication rate is lower than reports from Ethiopia (90%), Nigeria (87%), South Africa (86%), Egypt (82%), Morocco (82%), and higher than reports from Tanzania (69%), Kenya (68%) and Ivory Coast (22.3%). These differences might be attributed to methods employed to diagnose H. pylori, type of eradication regimen and duration of therapy, local H. pylori pretreatment resistance,and drug adherence, as stated by previous reports [35,36,37,38,39].

Trend analysis in H. pylori eradication from the 22 studies showed that presence of few studies in the year between 1990s and 2000. There is no relevant study between the year 2000 and 2010. The trend also showed that more publications coming out since 2011. This trend analysis showed that decrease in H. pylori eradication rate. Similar studies indicated that decreasing trends of eradication rate for H. pylori over the years [40]. On the other hand, H. pylori eradication rate consistent in study conducted for a decade [41]. The decrement in eradication rate could be attributed to increasing resistance due to increased antibiotic exposure.

The eradication rate for H. pylori varies in different regions of the world. The overall success of eradication depends on the choice of eradication regimen, duration of the treatment, and local and regional antibiotic resistance pattern of H. pylori. The World Gastroenterology Organization (WGO), in its 2023 guideline, recommended the minimum acceptable eradication rate greater than 80% on an intention-to-treat basis using PPI-clarithromycin plus amoxicillin in areas where clarithromycin resistance is low or moderate [42]. Determining the national and regional eradication rate is fundamental to establish an appropriate eradication protocol for H. pylori infection. Estimating the effectiveness of H. pylori eradication is difficult since factors like pretreatment antibiotic resistance have a profound effect [43,44,45,46]. Some studies consider distinct H. pylori diagnosis or eradication confirmation tests and employ different eradication regimens and/or duration based on the local guideline on the H. pylori treatment [47,48,49]. In the regional context, H. pylori treatment in Africa largely depends on an empirical approach despite the highest infection rate in the world [50, 51].

In the subgroup analysis by country, the highest eradication rate of 90% was from Ethiopia, and the lowest was 22.3% from Ivory Coast, as shown in Table 3. The eradication rate depends on the sensitivity and specificity of tests that detect H. pylori. The sensitivity and specificity of diagnostic or screening techniques depend on the laboratory techniques employed, personal skill to perform the test, and even the brand of reagents and facility standard. In the study from Ivory Coast, the H. pylori pre-and post-eradication detection was based on histological examination of gastric biopsy, which is less sensitive than conventional techniques such as urease test, anti-H. pylori antibody test, and PCR detection of bacterial genome. This finding is consistent with studies showing that treatment efficacy varies with H. pylori detection techniques [52,53,54,55].

This analysis presented the cumulative eradication rate for Africa and identified factors associated with eradication. In addition, the study included a sub-group analysis of differences in study design, country, treatment regimen, type of analysis, duration of eradication therapy, weeks of outcome measure and tests employed for H. pylori diagnosis and eradication confirmation. Africa contains 54 countries; however, this study has picked up reports only from 9 countries. Moreover, one-third of data are reported from Egypt. The fact might influence the generalization of our findings. Thus, eradication studies in Africa are so rare that more research must be promoted. There are so many regimen subgroups and result could be difficult to comprehend. But the general finding is that there is not significant variability among the regimen subgroups.

The current study included from observational to randomized control trails whereas the previous systematic review and network meta-analysis included only randomized controlled trials [11]. In Africa there is only very few RCT and only 7 articles are included. As a result, paucity of literature landscape in Africa, the current study has included observational study in addition to RCT. This has given a better understanding of eradication rate in Africa than the previous global meta-analysis. The study suffers from heterogeneity and there is no generalizable finding.


In Africa, the first-line therapy showed variable eradication rate for H. pylori. This study demonstrates the need to reassess antibiotic susceptibility in each country and optimize current H. pylori treatment regimens. Antibiotic susceptibility of H. pylori should be investigated in each nation of Africa. Although gastrointestinal disorders and associated H. pylori infections are common problems in Africa, less attention is given to translate the efficiency of eradication and improve the eradication regimen. Future RCT studies with standardized regimens are required.

Availability of data and materials

All data generated or analyzed are included in the result of the manuscript and its supplementary files.



Confidence interval

H. pylori :

Helicobacter pylori


Omeprazole + Amoxicillin + Clarithromycin


Omeprazole + Clarithromycin + Metronidazole


Omeprazole + Amoxicillin + Metronidazole


Lansoprazole + Amoxicillin + Clarithromycin


Pantoprazole + Amoxicillin + Clarithromycin


Rabeprazole + Amoxicillin + Clarithromycin


Omeprazole + Clarithromycin + Nitazoxacine


Omeprazole + Amoxicillin + Clarithromycin + Simvastatin


Omeprazole + Levofloxacin + Doxycycline + Nitazoxanide


Dexlansoprazole + Levofloxacin + Amoxicillin


Omeprazole + Clarithromycin + Tinidazole


Prospective study;


Randomized control trial


Per protocol


Intention to treat


Fecal antigen test


Urea breath test




Rapid urease test




  1. Schmidt HM, Ha DM, Taylor EF, Kovach Z, Goh KL, Fock KM, Barrett JH, Forman D, Mitchell H. Variation in human genetic polymorphisms, their association with Helicobacter pylori acquisition and gastric cancer in a multi-ethnic country. J Gastroenterol Hepatol. 2011;26(12):1725–32.

    Article  CAS  PubMed  Google Scholar 

  2. Chiarini A, Calà C, Bonura C, Gullo A, Giuliana G, Peralta S, D’Arpa F, Giammanco A. Prevalence of virulence-associated genotypes of Helicobacter pylori and correlation with severity of gastric pathology in patients from western Sicily, Italy. Eur J Clin Microbiol Infect Dis. 2009;28(5):437–46.

    Article  CAS  PubMed  Google Scholar 

  3. Rosenstock S, Jørgensen T, Bonnevie O, Andersen L. Risk factors for peptic ulcer disease: a population based prospective cohort study comprising 2416 Danish adults. Gut. 2003;52(2):186–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Jin G, Lv J, Yang M, Wang M, Zhu M, Wang T, Yan C, Yu C, Ding Y, Li G, et al. Genetic risk, incident gastric cancer, and healthy lifestyle: a meta-analysis of genome-wide association studies and prospective cohort study. Lancet Oncol. 2020;21(10):1378–86.

    Article  CAS  PubMed  Google Scholar 

  5. Hooi JKY, Lai WY, Ng WK, Suen MMY, Underwood FE, Tanyingoh D, Malfertheiner P, Graham DY, Wong VWS, Wu JCY, et al. Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-Analysis. Gastroenterology. 2017;153(2):420–9.

    Article  PubMed  Google Scholar 

  6. Yuan C, Adeloye D, Luk TT, Huang L, He Y, Xu Y, Ye X, Yi Q, Song P, Rudan I. The global prevalence of and factors associated with Helicobacter pylori infection in children: a systematic review and meta-analysis. Lancet Child Adolesc Health. 2022;6(3):185–94.

    Article  PubMed  Google Scholar 

  7. Malfertheiner P, Megraud F, Rokkas T, Gisbert JP, Liou JM, Schulz C, Gasbarrini A, Hunt RH, Leja M, O'Morain C et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022;71(9):1724–62.

  8. Chiang TH, Chang WJ, Chen SL, Yen AM, Fann JC, Chiu SY, Chen YR, Chuang SL, Shieh CF, Liu CY, et al. Mass eradication of Helicobacter pylori to reduce gastric cancer incidence and mortality: a long-term cohort study on Matsu Islands. Gut. 2021;70(2):243–50.

    CAS  PubMed  Google Scholar 

  9. De Francesco V, Bellesia A, Ridola L, Manta R, Zullo A. First-line therapies for Helicobacter pylori eradication: a critical reappraisal of updated guidelines. Ann Gastroenterol. 2017;30(4):373–9.

    PubMed  PubMed Central  Google Scholar 

  10. Graham DY, Lee YC, Wu MS. Rational Helicobacter pylori therapy: evidence-based medicine rather than medicine-based evidence. Clin Gastroenterol Hepatol. 2014;12(2):177-186.e173; Discussion e112-173.

    Article  PubMed  Google Scholar 

  11. Zamani M, Alizadeh-Tabari S, Zamani V, Shokri-Shirvani J, Derakhshan MH. Worldwide and Regional Efficacy Estimates of First-line Helicobacter pylori Treatments: A Systematic Review and Network Meta-Analysis. J Clin Gastroenterol. 2022;56(2):114–24.

    Article  PubMed  Google Scholar 

  12. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Abd-Elsalam S, Kobtan A, El-Kalla F, Elkhalawany W, Nawasany SE, Saif SA, Yousef M, Ali LA, Soliman S, Mansour L, et al. A 2-week Nitazoxanide-based quadruple treatment as a rescue therapy for Helicobacter pylori eradication: A single center experience. Medicine (Baltimore). 2016;95(24):e3879.

    Article  CAS  PubMed  Google Scholar 

  14. Elkhodary NM, Farrag KA, Elokaby AM, El-Hay Omran GA. Efficacy and safety of 7 days versus 10 days triple therapy based on levofloxacin-dexlansoprazole for eradication of Helicobacter pylori: A pilot randomized trial. Indian J Pharmacol. 2020;52(5):356–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Farhoud NS, Ibrahim OM, Ezzat SE. Efficacy and Cost-effectiveness Comparison of 10-Day, 14-Day Sequential Versus 14-Day Triple Therapies for Treating Helicobacter pylori Infection in Egyptian Patients. J Clin Gastroenterol. 2020;54(9):806–12.

    Article  PubMed  Google Scholar 

  16. Hanafy AS, El Hawary AT, Hamed EF, Hassaneen AM. Impact of Helicobacter pylori eradication on refractory thrombocytopenia in patients with chronic HCV awaiting antiviral therapy. Eur J Clin Microbiol Infect Dis. 2016;35(7):1171–6.

    Article  CAS  PubMed  Google Scholar 

  17. Hassan AM, Shawky MAE, Mohammed AQ, Haridy MA, Eid KA. Simvastatin improves the eradication rate of Helicobacter pylori: upper Egypt experience. Infect Drug Resist. 2019;12:1529–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Shehata MA, Talaat R, Soliman S, Elmesseri H, Soliman S, Abd-Elsalam S. Randomized controlled study of a novel triple nitazoxanide (NTZ)-containing therapeutic regimen versus the traditional regimen for eradication of Helicobacter pylori infection. Helicobacter 2017;22(5):e12395.

  19. Abou-Saif MA, Ahmed AS, Mohammed N. Sequential therapy versus standard triple therapy for Helicobacter pylori eradication. Am J Res Commun. 2015;3:132–46.

    Google Scholar 

  20. Benajah DA, Lahbabi M, Alaoui S, El Rhazi K, El Abkari M, Nejjari C, Amarti A, Bennani B, Mahmoud M, Ibrahimi SA. Prevalence of Helicobacter pylori and its recurrence after successful eradication in a developing nation (Morocco). Clin Res Hepatol Gastroenterol. 2013;37(5):519–26.

    Article  PubMed  Google Scholar 

  21. Lahbabi M, Alaoui S, El Rhazi K, El Abkari M, Nejjari C, Amarti A, Bennani B, Mahmoud M, Ibrahimi A, Benajah DA. Sequential therapy versus standard triple-drug therapy for Helicobacter pylori eradication: result of the HPFEZ randomised study. Clin Res Hepatol Gastroenterol. 2013;37(4):416–21.

    Article  CAS  PubMed  Google Scholar 

  22. Seddik H, Ahid S, El Adioui T, El Hamdi FZ, Hassar M, Abouqal R, Cherrah Y, Benkirane A. Sequential therapy versus standard triple-drug therapy for Helicobacter pylori eradication: a prospective randomized study. Eur J Clin Pharmacol. 2013;69(9):1709–15.

    Article  CAS  PubMed  Google Scholar 

  23. Zeriouh M, Elmekkaoui A, Bouqfar M, Zazour A, Khannoussi W, Kharrasse G, Abda N, Ismaili Z. Non-Bismuth Quadruple Therapy, Sequential Therapy or High-Dose Esomeprazole and Amoxicillin Dual Therapy for First-Line Helicobacter pylori Eradication: A Prospective Randomized Study. Cureus. 2020;12(12):e11837.

    PubMed  PubMed Central  Google Scholar 

  24. Louw JA, Zak J, Lucke W, Le Roux E, Jaskiewicz K, Winter T, Lastovica A, Marks IN. Triple therapy with sucralfate is as effective as triple therapy containing bismuth in eradicating Helicobacter pylori and reducing duodenal ulcer relapse rates. Scand J Gastroenterol Suppl. 1992;191:28–31.

    Article  CAS  PubMed  Google Scholar 

  25. Louw JA, van Rensburg CJ, Hanslo D, Grundlings HD, Girdwood AH, Marks IN. Two-week course of pantoprazole combined with 1 week of amoxycillin and clarithromycin is effective in Helicobacter pylori eradication and duodenal ulcer healing. Aliment Pharmacol Ther. 1998;12(6):545–50.

    Article  CAS  PubMed  Google Scholar 

  26. Louw JA, Van Rensburg CJ, Moola S, Kotze D, Marks IN. Helicobacter pylori eradication and ulcer healing with daily lansoprazole, plus 1 or 2 weeks co-therapy with amoxycillin and clarithromycin. Aliment Pharmacol Ther. 1998;12(9):881–5.

    Article  CAS  PubMed  Google Scholar 

  27. Wong BC, Chang FY, Abid S, Abbas Z, Lin BR, Van Rensburg C, Chen PC, Schneider H, Simjee AE, Hamid SS, et al. Triple therapy with clarithromycin, omeprazole, and amoxicillin for eradication of Helicobacter pylori in duodenal ulcer patients in Asia and Africa. Aliment Pharmacol Ther. 2000;14(11):1529–35.

    Article  CAS  PubMed  Google Scholar 

  28. Moubri M, Burucoa C, Kalach N, Larras RR, Nouar N, Mouffok F, Arrada Z. Performances of the IDEIA HpStAR Stool Antigen Test in Detection of Helicobacter pylori Infection Before and After Eradication Treatment in Algerian Children. J Trop Pediatr. 2019;65(3):210–6.

    Article  PubMed  Google Scholar 

  29. Moubri M, Kalach N, Larras R, Berrah H, Mouffok F, Guechi Z, Cadranel S. Adapted first-line treatment of Helicobacter pylori infection in Algerian children. Ann Gastroenterol. 2019;32(1):60–6.

    PubMed  Google Scholar 

  30. Gebeyehu E, Nigatu D, Engidawork E. Helicobacter pylori eradication rate of standard triple therapy and factors affecting eradication rate at Bahir Dar city administration, Northwest Ethiopia: A prospective follow up study. PLoS ONE. 2019;14(6):e0217645.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Onyekwere CA, Odiagah JN, Igetei R, Emanuel AO, Ekere F, Smith S. Rabeprazole, clarithromycin, and amoxicillin Helicobacter pylori eradication therapy: report of an efficacy study. World J Gastroenterol. 2014;20(13):3615–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Jaka H, Mueller A, Kasang C, Mshana SE. Predictors of triple therapy treatment failure among H. pylori infected patients attending at a tertiary hospital in Northwest Tanzania: a prospective study. BMC Infect Dis. 2019;19(1):447.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Laving A, Kamenwa R, Sayed S, Kimang’a AN, Revathi G. Effectiveness of sequential v. standard triple therapy for treatment of Helicobacter pylori infection in children in Nairobi. Kenya S Afr Med J. 2013;103(12):921–4.

    Article  PubMed  Google Scholar 

  34. Doffou AS, Attia KA, Bathaix MFY, Bangoura AD, Kissy-Anzouan YH, Kouamé HD, Mahassadi KA, N’Da KJ, Kouyaté M, Assi C. The Helicobacter pylori eradication rate in a high prevalence area (West Africa): three triple therapy comparative study. Open Journal of Gastroenterology. 2015;5(12):200.

    Article  CAS  Google Scholar 

  35. Hu Y, Zhu Y, Lu NH. Novel and Effective Therapeutic Regimens for Helicobacter pylori in an Era of Increasing Antibiotic Resistance. Front Cell Infect Microbiol. 2017;7:168.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Bago P, Vcev A, Tomic M, Rozankovic M, Marusić M, Bago J. High eradication rate of H. pylori with moxifloxacin-based treatment: a randomized controlled trial. Wiener klinische Wochenschrift. 2007;119(11–12):372–8.

    Article  CAS  PubMed  Google Scholar 

  37. Gumurdulu Y, Serin E, Ozer B, Kayaselcuk F, Ozsahin K, Cosar AM, Gursoy M, Gur G, Yilmaz U, Boyacioglu S. Low eradication rate of Helicobacter pylori with triple 7–14 days and quadriple therapy in Turkey. World J Gastroenterol. 2004;10(5):668–71.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Paoluzi OA, Del Vecchio BG, Visconti E, Coppola M, Fontana C, Favaro M, Pallone F. Low efficacy of levofloxacin-doxycycline-based third-line triple therapy for Helicobacter pylori eradication in Italy. World J Gastroenterol. 2015;21(21):6698–705.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Di Ciaula A, Scaccianoce G, Venerito M, Zullo A, Bonfrate L, Rokkas T, Portincasa P. Eradication rates in Italian subjects heterogeneously managed for Helicobacter pylori infection. Time to abandon empiric treatments in Southern Europe. JGLD. 2017;26(2):129–37.

    Article  PubMed  Google Scholar 

  40. Kim SE, Park MI, Park SJ, Moon W, Choi YJ, Cheon JH, Kwon HJ, Ku KH, Yoo CH, Kim JH, et al. Trends in Helicobacter pylori eradication rates by first-line triple therapy and related factors in eradication therapy. Korean J Intern Med. 2015;30(6):801–7.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Yoon JH, Baik GH, Sohn KM, Kim DY, Kim YS, Suk KT, Kim JB, Kim DJ, Kim JB, Shin WG, et al. Trends in the eradication rates of Helicobacter pylori infection for eleven years. World J Gastroenterol. 2012;18(45):6628–34.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Katelaris P, Hunt R, Bazzoli F, Cohen H, Fock KM, Gemilyan M, Malfertheiner P, Mégraud F, Piscoya A, Quach D, et al. Helicobacter pylori World Gastroenterology Organization Global Guideline. J Clin Gastroenterol. 2023;57(2):111–26.

    Article  PubMed  Google Scholar 

  43. Selgrad M, Tammer I, Langner C, Bornschein J, Meißle J, Kandulski A, Varbanova M, Wex T, Schlüter D, Malfertheiner P. Different antibiotic susceptibility between antrum and corpus of the stomach, a possible reason for treatment failure of Helicobacter pylori infection. World J Gastroenterol. 2014;20(43):16245–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Park CS, Lee SM, Park CH, Koh HR, Jun CH, Park SY, Lee WS, Joo YE, Kim HS, Choi SK, et al. Pretreatment antimicrobial susceptibility-guided vs. clarithromycin-based triple therapy for Helicobacter pylori eradication in a region with high rates of multiple drug resistance. Am J Gastroenterol. 2014;109(10):1595–602.

    Article  CAS  PubMed  Google Scholar 

  45. Mahachai V, Thong-Ngam D, Noophun P, Tumwasorn S, Kullavanijaya P. Efficacy of clarithromycin-based triple therapy for treating Helicobacter pylori in Thai non-ulcer dyspeptic patients with clarithromycin-resistant strains. J Med Assoc Thai. 2006;89 Suppl 3:S74-78.

    PubMed  Google Scholar 

  46. Wong WM, Gu Q, Wang WH, Fung FM, Berg DE, Lai KC, Xia HH, Hu WH, Chan CK, Chan AO, et al. Effects of primary metronidazole and clarithromycin resistance to Helicobacter pylori on omeprazole, metronidazole, and clarithromycin triple-therapy regimen in a region with high rates of metronidazole resistance. Clin Infect Dis. 2003;37(7):882–9.

    Article  CAS  PubMed  Google Scholar 

  47. Lee SY. Current progress toward eradicating Helicobacter pylori in East Asian countries: differences in the 2013 revised guidelines between China, Japan, and South Korea. World J Gastroenterol. 2014;20(6):1493–502.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol. 2017;112(2):212–39.

    Article  PubMed  Google Scholar 

  49. Coelho LG, Coelho MC. Clinical management of Helicobacter pylori: the Latin American perspective. Dig Dis (Basel, Switzerland). 2014;32(3):302–9.

    Article  Google Scholar 

  50. Smith SI, Ajayi A, Jolaiya T, Onyekwere C, Setshedi M, Schulz C, Otegbayo JA, Ndip R, Dieye Y, Alboraie M, et al. Helicobacter pylori Infection in Africa: Update of the Current Situation and Challenges. Dig Dis (Basel, Switzerland). 2022;40(4):535–44.

    Article  Google Scholar 

  51. Jaka H, Rhee JA, Östlundh L, Smart L, Peck R, Mueller A, Kasang C, Mshana SE. The magnitude of antibiotic resistance to Helicobacter pylori in Africa and identified mutations which confer resistance to antibiotics: systematic review and meta-analysis. BMC Infect Dis. 2018;18(1):193.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Wang YK, Kuo FC, Liu CJ, Wu MC, Shih HY, Wang SS, Wu JY, Kuo CH, Huang YK, Wu DC. Diagnosis of Helicobacter pylori infection: Current options and developments. World J Gastroenterol. 2015;21(40):11221–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Lee JY, Kim N. Diagnosis of Helicobacter pylori by invasive test: histology. Ann Transl Med. 2015;3(1):10.

    PubMed  PubMed Central  Google Scholar 

  54. Lunet N, Peleteiro B, Carrilho C, Figueiredo C, Azevedo A. Sensitivity is not an intrinsic property of a diagnostic test: empirical evidence from histological diagnosis of Helicobacter pylori infection. BMC Gastroenterol. 2009;9:98.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Kocsmár É, Szirtes I, Kramer Z, Szijártó A, Bene L, Buzás GM, Kenessey I, Bronsert P, Csanadi A, Lutz L, et al. Sensitivity of Helicobacter pylori detection by Giemsa staining is poor in comparison with immunohistochemistry and fluorescent in situ hybridization and strongly depends on inflammatory activity. Helicobacter. 2017;22(4):e12387.

    Article  Google Scholar 

Download references


Not applicable.


The authors declare that they did not receive funding for this research from any source.

Author information

Authors and Affiliations



SF: Conceived and designed the study, analyzed data, and drafted the manuscript. SD: interpret the results and review the manuscript. AG: assess methodological quality and review the manuscript. HI and HY: review the manuscript. SF, SD, AG, HE and SS select and evaluate the quality of studies and extract data. All authors revised, edited, and approved the manuscript.

Corresponding author

Correspondence to Sintayehu Fekadu.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Additional file 1:

Supplementary file 1. ‘Checklist risk-of-bias assessment for randomized trials (RoB2)’.

Additional file 2:

Supplementary file 2. 'Checklist risk-of-bias in non-randomized studies of intervention (ROBINS-I).'

Additional file 3:

Supplementary file 3. Databases and search strategy.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fekadu, S., Engiso, H., Seyfe, S. et al. Effectiveness of eradication therapy for Helicobacter pylori infection in Africa: a systematic review and meta-analysis. BMC Gastroenterol 23, 55 (2023).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: