Gastric cancer burden and regional disparities among Helicobacter pylori-positive patients in the Americas: a systematic review and meta-analysis.

[BACKGROUND] Helicobacter pylori infection is a significant risk factor for gastric cancer (GC), particularly in populations across the Americas. Previous studies have suggested a link between HP and GC, but variability in prevalence across regions has yet to be fully explored. The aim of this study is to quantify the prevalence of GC in HP-positive patients across the Americas, identifying disparities by country, region, and demographic factors.

[METHODS] The study followed the PRISMA guidelines and was registered with PROSPERO (CRD42024585790). A systematic search of PubMed, Scopus, LILACS/BVS, and Web of Science databases was conducted until August 20, 2024. Eligibility criteria included studies with patients aged 18 years or older, with confirmed diagnosis of gastric cancer, and H. pylori infection status. Risk of success was assessed using the Newcastle-Ottawa Scale, and publication success was assessed using the Egger test. Pooled prevalence was calculated using a meta-analysis of proportions with a random-effects model, and heterogeneity was assessed using the I statistic. There was no funding for this study.

[RESULTS] Fifty-nine studies, with 5,734,656 patients (134,755 HP-positive), met the inclusion criteria. The overall prevalence of GC in HP-positive patients in the Americas was 25.56% (95% CI: 20.72-30.40), with high heterogeneity (I2 = 100%, p < 0.05). South America showed a higher prevalence (27.66%, 95% CI: 22.36-32.96) than North America (23.47%, 95% CI: 20.72-30.40). Peru had the highest prevalence at 52.11%, followed by Chile (50.94%) and Honduras (45.62%); Colombia and the United States showed lower rates, at 15.65% and 23.02%, respectively.

[CONCLUSION] This meta-analysis highlights a significant GC prevalence among HP-positive patients in the Americas, with marked variability between countries.