Re-Evaluating Therapeutic Strategies for Helicobacterpylori: Limitations of Current Approaches and Emerging Alternatives in High-Burden Kenyan Settings
Helicobacterpylori remains a major public health challenge in Kenya, where persistently high infection rates, socioeconomic vulnerabilities, and limited diagnostic capacity contribute to substantial gastrointestinal morbidity and an elevated risk of gastric cancer. This narrative review synthesizes fragmented evidence published over the past 16 years to provide an integrated overview of H.pylori epidemiology, diagnostic practices, treatment barriers, and emerging therapeutic innovations within the Kenyan context. A targeted search of major scientific databases and grey literature identified 12 relevant studies conducted across diverse Kenyan regions. Diagnostic approaches varied considerably, although stool antigen testing was most frequently employed. Across 11 studies reporting prevalence data (1526/3229 samples), a simple sample-size-weighted prevalence of 47.3% (95% CI: 45.6% - 49.0%) was observed, highlighting a substantial national burden. Reported risk factors included low socioeconomic status, limited hygiene awareness, reliance on untreated water sources, and household crowding. Management remains complicated by rising antimicrobial resistance, empirical treatment practices, and restricted access to culture and susceptibility testing. A range of emerging biologic and non-antibiotic modalities, such as bacteriophage therapy, engineered endolysins, and other innovative therapeutic platforms, is gaining attention. These modalities show promising invitro activity, and subsequent sections focus on the specific scientific, translational, and regulatory considerations that shape their feasibility within Kenya’s health-system constraints. By consolidating dispersed findings and situating them within Kenya’s health-system realities, this review highlights critical gaps in surveillance, diagnostics, and therapeutic innovation, underscoring the need for strengthened research capacity and targeted evaluation of emerging therapies.
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