How helicobacter pylori effected Ulcers with Diabetic Patients: A Microbiological and Public Health Challenge in West Africa.

Helicobacter pylori-Associated Ulcers with Diabetic Patients: A Microbiological and Public Health Challenge in West Africa.

Author: Emmanuel Michael

Abstract

Helicobacter pylori infection is a common worldwide bacterial infection and is strictly associated with gastrointestinal disorders and peptic ulcers. In West Africa, where the prevalence of diabetes is rapidly rising, the coexistence of diabetes mellitus and H. pylori infection poses a substantial public health challenge. The aims of this review are to explore the microbiological aspects of H. pylori infection in patients that are diabetic in West Africa, its challenges to present public health systems and clinical implications in the West African region. We discuss the diabetes mellitus and H. pylori infection epidemiology in West Africa, the interactions between these two health conditions, and their joint impact on ulcer complications and formation. Furthermore, we highlight the necessity of effective strategies of diagnosis, treatment methods, and public health involvements to mitigate the H. pylori-associated ulcers burden among diabetic persons in the region.

Introduction

Helicobacter pylori is a harmful gram-negative bacterium that colonizes the gastric-intestinal mucosa of humans and majorly an etiological factor in the pathogenesis of several diseases of the gastroduodenal region, including gastritis, peptic ulcers, and gastric cancer (Marshall & Warren, 1984). Infection associated with H. pylori is highly prevalent globally, with differences in the rates of prevalence across diverse population groups and geographic regions (Hooi et al., 2017). In West Africa, the rates of H. pylori infection are reported to be significant, with studies signifying a prevalence range from 50% to 80% in some countries (Smith et al., 2016).

Diabetes mellitus is characterized by long-lasting hyperglycemia resulting from insulin secretion defects, action of insulin, or both, is a rising public health concern in the West African region (Saeedi et al., 2019). The West African region is rapidly experiencing an increase in the prevalence of diabetes, ascribed to sedentary lifestyles, urbanization, and changes in dietary habits (Ogurtsova et al., 2017). Diabetes mellitus predisposes persons to several complications, including neuropathy, cardiovascular disease, retinopathy, and nephropathy (American Diabetes Association, 2022). Furthermore, developing evidence proposes a bidirectional relationship between H. pylori infection and diabetes, with each condition influencing the outcomes and severity of others (Lutsey et al., 2009).

Epidemiology of H. pylori Infection and Diabetes Mellitus in West Africa

In the region of West Africa, H. pylori infection prevalence widely varies across age groups and countries, with higher rates reported in rural settlements and among lower socioeconomic status individuals (Smith et al., 2016). Some factors contribute to the H. pylori persistence and transmission in the region, including overcrowding, poor sanitation, and limited healthcare services accessibility (Aboderin et al., 2007). Moreover, cultural practices like sharing of utensils and communal eating may expedite the spread of the bacterium within communities and households.

In West Africa, the diabetes mellitus burden is escalating, driven by urbanization, demographic changes, and individual lifestyle (Ogurtsova et al., 2017). The prevalence of diabetes differs across countries but is usually higher in urbanized settlements than rural areas (Saeedi et al., 2019). Majority of the cases are type 2 diabetes in the region, with risk factors such as obesity, genetic predisposition, and physical inactivity. (Ogurtsova et al., 2017). Additionally, diabetes frequently remains undiagnosed or ill-managed due to lack of awareness, limited healthcare infrastructure, and financial constraints.

Interactions between H. pylori Infection and Diabetes Mellitus

The coexistence of diabetes mellitus and H. pylori infection can have numerous clinical implications, predominantly in the ulcer formation and complications context. H. pylori infection is a deep-rooted risk factor for peptic ulcers, together with duodenal and gastric ulcers (Malfertheiner et al., 2017). The colonization of the bacterium gastric mucosa induces chronic inflammation and causes disrupts of the mucosal barrier, predisposing the patients to ulceration in the presence of extra contributing factors like alcohol consumption and nonsteroidal anti-inflammatory drugs (NSAIDs).

In diabetic individuals, numerous mechanisms may contribute to an increased vulnerability to H. pylori-associated ulcers. Impaired gastric motility and chronic hyperglycemia can cause alteration in the gastric microenvironment, encouraging the growth and H. pylori persistence (Tseng et al., 2017). Furthermore, diabetic neuropathy might impair the sensation of discomfort or pain, causing delay in the ulcer symptoms recognition and resulting to delayed diagnosis and treatment (Vinik et al., 2013).

On the contrary, H. pylori infection may influence the progression and pathogenesis of diabetes mellitus through several mechanisms, such as alterations in gut microbiota, chronic low-grade inflammation, and host immune responses modulation (Lutsey et al., 2009). Research have suggested that the H. pylori eradication may improve glycemic control in diabetic individuals, even though the evidence is inconclusive, and more research is required to elucidate the clinical implications and underlying mechanisms (Zhu et al., 2015).

Clinical Management of H. pylori-Associated Ulcers in Diabetic Patients

The clinical management of H. pylori-associated ulcers in diabetic individuals necessitates a multidisciplinary approach, involving endocrinologists, gastroenterologists, dietitians, infectious disease specialists. H. pylori infection diagnosis can be challenging in diabetic individuals due to overlapping comorbidities and symptoms. Nevertheless, there are numerous available diagnostic modalities, including urea breath tests, serological tests, endoscopic biopsy and stool antigen tests with histological investigation (Leal et al., 2020).

The H. pylori infection treatment typically involves proton pump inhibitors (PPIs) and antibiotics combination (such as amoxicillin, clarithromycin and metronidazole) to promote ulcer healing and achieve bacterial eradication (Malfertheiner et al., 2017). However, the antibiotics choice may be limited in diabetic individuals with comorbidities such as drug allergies or renal impairment. Moreover, the effectiveness of standard triple therapy may be antibiotic resistance compromised, predominantly in regions with high H. pylori resistance and prevalence rates (Graham et al., 2019).

With H. pylori-associated ulcers diabetic patients, optimal glycemic control is important for complications prevention and ulcer healing promotion. Modified lifestyle, including weight management, dietary changes, and regular physical activity, play a vital role in management of diabetes and prevention of ulcer. Furthermore, blood glucose levels close monitoring, timely adjustments of oral hypoglycemic agents or insulin and medication adherence are essential to maintain and achieve glycemic targets (American Diabetes Association, 2022).

Public Health Implications and Challenges

The diabetes mellitus and H. pylori infection coexistence poses significant public health systems challenges in West African region, where resources are often inadequate, and fragile healthcare infrastructure. The H. pylori-associated ulcers burden places other strain on already overstrained healthcare services, resulting to inadequate treatment, delays in diagnosis, and poor clinical results. Furthermore, the high prevalence of diabetes and H. pylori in the region underscores the crucial need for effective control measures and prevention.

The interventions of public health aimed at reducing the H. pylori-associated ulcers burden in diabetic patients should emphasize on numerous key strategies:

• Health Education and Awareness: In other to promote awareness of diabetes mellitus, and H. pylori infection, and their complications among patients, healthcare providers, and the general public is important to facilitate prompt management and early detection.
• Screening and Diagnosis: Systematic screening programs implementation for diabetes mellitus and H. pylori infection in high-risk populations, including individuals with diabetic conditions associated with gastrointestinal complications or symptoms, can expedite early diagnosis and intervention.
• Access to Healthcare Services: Improved access to inexpensive healthcare services, including specialist consultations, diagnostic tests, and medications is critical to ensure appropriate and timely management of H. pylori-associated ulcers in diabetic individuals.
• Antibiotic Stewardship: Antibiotic stewardship programs Implementing towards optimizing the use of antibiotics and mitigate antibiotic resistance emergence is essential for preserving the effectiveness of H. pylori eradication regimens in diabetic individuals.
• Research and Surveillance: Conducting epidemiological research to monitor H. pylori infection and and diabetes mellitus trends, as well as patterns of antimicrobial resistance, it is essential to inform evidence-based policy decisions and interventions.

Conclusion

In conclusion, diabetes mellitus and H. pylori infection coexistence signifies a substantial public health and microbiological challenge in the West African region. The interface between these two health conditions contributes to the peptic ulcers pathogenesis, resulting to complicated clinical management. The effective control and prevention of H. pylori-associated ulcers in diabetic patients necessitate a comprehensive method, integration of clinical care, research efforts and public health interventions. Through addressing the fundamental determinants and implementing evidence-based strategies, it is likely to reduce the H. pylori-associated ulcers burden and improve the health outcomes of diabetic patients in the West African region.

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