Helicobacter pylori: the African enigma

Editor,—A major advance in gastroenterology was the discovery that Helicobacter pylori causes chronic active gastritis, and is associated with duodenal ulcers and with gastric cancer. In an international study on 17 populations from 13 countries, it was concluded that there is a roughly six-fold risk of gastric cancer in populations with 100% H pylori infection.1 2 In Africa, a puzzling feature is that although there is a very high prevalence of the infection, associated …