Demographic and Clinical Predictors of Helicobacter pylori Infection in Symptomatic Patients From Middle Eastern Countries: A Systematic Review and Meta-Analysis
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Background: Helicobacter pylori infection remains common in symptomatic populations, but prevalence and associated clinical, endoscopic, and socioeconomic factors vary across Middle Eastern settings. This review estimated pooled prevalence and summarized factor-specific associations with H. pylori positivity. Methods: PubMed, Web of Science, Google Scholar, and Semantic Scholar were searched through 1 June 2026 for observational studies involving symptomatic adult or pediatric patients tested for H. pylori. Prevalence was synthesized using a random-effects model. Clinical, endoscopic, demographic, socioeconomic, and environmental factors were evaluated as separate associations rather than combined into category-wide summary effects. Methodological quality was assessed using the Joanna Briggs Institute checklist. Results: Eleven studies comprising 10,814 participants with assessable H. pylori status were included. Pooled prevalence was 37.62% (95% CI 27.02–48.21%), with substantial heterogeneity (I²=99%). Positive clinical associations included abdominal pain, anorexia, pallor/low hemoglobin, weight loss, and hematemesis; vomiting showed a large but highly imprecise estimate. Endoscopic associations included antral nodularity, gastric and duodenal erosions, duodenal ulcer, gastritis, mosaic gastritis, and esophagitis/GERD. Environmental and socioeconomic associations included daycare/community contact, large household size, illiteracy, bed sharing, low income, street-food consumption, unsafe water supply, and overcrowding. Conclusion: H. pylori infection is common but heterogeneous among symptomatic regional populations. Several clinical, endoscopic, and socioeconomic factors are associated with positivity, but these observational associations should not replace guideline-recommended diagnostic testing. Keywords: Helicobacter pylori; Prevalence; Dyspepsia; Associated Factors; Endoscopic Findings; Socioeconomic Factors; Middle East
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