Global Prevalence of Helicobacter pylori Infection-Associated Gastric Preneoplastic Lesions in Pediatric Patients: A Systematic Review and Meta-Analysis.
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BACKGROUND: Helicobacter pylori (H. pylori) is the major cause of gastric mucosal precancerous lesions in adulthood, but its impact on pediatric patients remains unclear. We aimed to investigate H. pylori-induced gastric precancerous lesions in children and adolescents globally and analyze their influencing factors for related disease management and prevention. MATERIALS AND METHODS: We conducted a comprehensive literature search in major databases to identify studies including pediatric patients with gastric precancerous lesions and H. pylori infection status. Prevalence rates were computed using random-effects or fixed-effect models. A stratified analysis was conducted based on location, age, universal health coverage (UHC), and publication time. RESULTS: Among the 3359 relevant articles screened, 24 studies (7036 participants) met the inclusion criteria. The overall prevalence of precancerous lesions in H. pylori-infected patients was 17.2%, in which atrophic gastritis (AG) and intestinal metaplasia (IM) were 13.5% and 3.6%, respectively. Precancerous lesion rates in infected individuals across different regions were as follows: Africa at 33.8% (AG: 32.6%), Latin America at 22.1% (AG: 17.9%, IM: 4.0%), Asia at 18.1% (AG: 12.4%, IM: 4.4%, Dysplasia: 1.2%), and Europe at 6.3% (AG: 4.3%, IM: 1.7%). Infected adolescents (> 10 years) exhibited a higher prevalence of precancerous lesions than younger children (≤ 10 years) at 14.2% (AG: 9.7%, IM: 2.9%) versus 3.4% (AG: 2.3%, IM: 1.1%), respectively. The prevalence of precancerous lesions in infected patients was higher in areas with low-medium UHC compared with high UHC (24.0% vs. 12.5%). CONCLUSIONS: H. pylori infection causes significant gastric mucosal precancerous lesions in pediatric patients, representing a major concern for this population and a previously neglected area. Future in-depth investigations and proper management for related disease prevention are warranted. TRIAL REGISTRATION: PROSPERO number: CRD42023424683.