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Helicobactor Pylori

What is Helicobactor Pylori?

Infection with the bacteria Helicobacter pylori is present in up to 31% of Singaporeans 1. The majority of people infected with H. pylori never experience any symptoms or complications. However, colonisation with helicobacter pylori is a major risk factor for peptic ulcer disease as well as gastric malignancy2

Patients with dyspepsia (painful, difficult, or disturbed digestion) should consider being tested for helicobacter pylori infection3H. pylori can be detected either through gastroscopy or through a carbon urea breath test. 

Upon detection, H. pylori infection is treated with a course of antibiotics. Confirmation of eradication is necessary for all patients after treatment.

Helicobacter pylori


Most individuals with chronic gastritis or duodenitis have no symptoms. On the other hand, some people develop more serious problems, including ulcers of the stomach or duodenum. Ulcers can cause a variety of symptoms or no symptoms at all. Common complaints include pain or discomfort (usually in the upper abdomen), bloating, feeling full after eating a small amount of food, lack of appetite, nausea, vomiting and dark or tar-coloured stools. Ulcers that bleed can cause a low blood count and fatigue.

Less commonly, chronic gastritis causes abnormal changes in the stomach lining, which can lead to certain forms of cancer. It is uncommon to develop cancer as a result of H. pylori infection. Nevertheless, because so many people in the world are infected with H. pylori, it is considered to be a common cause of stomach cancer.

Is this infection common?

In Singapore, the prevalence rate in the community (without any symptom) was estimated to increase with age from 3% in children below 5-year-old to 71% in adults above 65.

How does the doctor make a diagnosis of H pylori infection?

There are several ways to diagnose H. pylori.

Urea breath test - patient drinks a specialised solution containing a substance (13C [carbon] - or 14C-labeled urea) that is broken down by the H. pylori bacterium. The breakdown products can be detected in a person's breath.


Urea breath test

Endoscopy of the upper gastrointestinal tract can confirm certain gastrointestinal conditions, such as peptic ulcer, as well as infection with H. pylori. It is generally reserved for patients with symptoms.

Blood tests – for H. pylori-specific antibody.
Who should be tested?
  1. Patients with symptoms indicated above.
  2. Patients with higher risk of gastric cancer, e.g. family history of gastric cancer.

Treatment involves taking several medications for seven to 14 days – typically a gastric medication known as proton pump inhibitors, and two antibiotics.

It is important to take your medication regularly as instructed to ensure complete eradication of H. pylori. Failing this, the bacterial may recur, and may even develop antibiotic resistance.

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