African EnigmaA term referring to the alleged dissociation between the prevalence of Helicobacter pylori infection in the African population and H. pylori-related diseases, including duodenal ulcer, gastric ulcer, and gastric cancer. A meta-analysis of 40 prospective endoscopic studies from 17 African countries encompassing 20,531 patients between 1972 and 2001 concluded that H. pylori-related clinical outcomes were indeed common; duodenal ulcers occurred in 21%, gastric ulcers in 3%, and gastric cancers in 2%, thus militating against the validity of the African enigma. The myth resulted from reliance on anecdotal data and selection bias in populations with extremely limited access to health care and a relatively short life expectancy.
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