While Helicobacter pylori (H pylori) infection rates have decreased steadily during the past 30 years, they remain high worldwide in children and adolescents aged 18 years and younger, especially those in low- and middle-income countries and older children, researchers reported in the Lancet: Child & Adolescent Health.

The systematic review and meta-analysis sought to estimate the global prevalence of H pylori infection in children and adolescents aged ≤18 years, as well as identify factors associated with H pylori infection in this age group. The investigators searched PubMed, Embase, MEDLINE, and Scopus for observational population-based studies published between database inception and October 25, 2021.

A total of 198 cross-sectional studies with 152,650 children were included. The estimated overall prevalence of H pylori infection in children worldwide during the past 30 years is 32.3% (95% CI, 27.3-37.8), according to multilevel mixed-effects meta-regression analysis.

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The prevalence of H pylori infection in children steadily decreased by more than half during the past 30 years, from 42.2% before 2000, to 31.9% from 2000 to 2009, and to 19.3% in 2010 and later. The prevalence of H pylori infection in children was not different between boys and girls and was significantly higher in rural areas vs urban areas.

The global prevalence of H pylori infection in older children was significantly higher compared with younger children, ranging from 26.0% in children aged ≤6 years to 41.6% in those aged 13 to 18 years. The highest prevalence of H pylori infection in children was found in the African region (44.1%), and the lowest incidence was in the Western Pacific region (20.0%). H pylori infection rates in children in low-income and middle-income countries (43.2%) were almost twice those among children in high-income countries (21.7%).

Based on serology indicating past or present infection, the global prevalence of pediatric H pylori infection was 28.6% (95% CI, 23.0-35.0). According to direct detection indicating present infection, the prevalence was 35.9% (95% CI, 29.2-43.2).

Lower economic status (odds ratio [OR], 1.63; 95% CI, 1.46-1.82), having more siblings or children (OR, 1.84; 95% CI, 1.44-2.36), having an infected mother (OR, 3.31; 95% CI, 2.21-4.98), having an infected sibling or siblings (OR, 3.33; 95% CI, 1.53-7.26), and room sharing (OR, 1.89; 95% CI, 1.49-2.40) were factors that were consistently associated with a higher prevalence of H pylori infection in children as detected by serology, urea breath tests, or stool antigen tests.

Study limitations include the absence of data from all countries, geographical areas, and study years, especially in the African and South-East Asian regions. Additionally, the meta-analysis included studies with various designs and diagnostic methods in different population settings, which contributes to overall study heterogeneity.

“[O]ur systematic review and meta-analysis shows that H pylori infection is still highly prevalent in children and adolescents globally, but is decreasing with global development and approaching the [United Nations’] Sustainable Development Goals (ensuring healthy lives and promoting well-being for all at all ages),” stated the study authors. “The prevalence of H pylori infection is still high enough to warrant large prevention and treatment programs.”


Yuan C, Adeloye D, Luk TT, et al. 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):185-194. doi: 10.1016/S2352-4642(21)00400-4

This article originally appeared on Gastroenterology Advisor