What is Helicobacter pylori?

Helicobacter pylori is a spiral shaped bacterium that lives in the stomach and duodenum (section of intestine just below stomach).

It is now known to be associated with gastric and duodenal ulcers, and stomach cancers.

How common is this infection?

In Singapore, the prevalence rate in the community without any symptom was estimated to increase with age from three percent in children below five years old to 71% in adults above 65.

What are the symptoms of H pylori infection?

Most individuals with chronic gastritis or duodenitis have no symptoms. However, some people develop more serious problems, including stomach or duodenal ulcers. 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-colored 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 an important risk factor for stomach cancer.

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

There are several ways to diagnose H. pylori.
1.Non-invasive Methods:

  • Serology – Blood tests – for H pylori-specific antibody
  • Stool test for Helicobacter pylori antigen
  • Urea breath test – patient drink a specialized solution containing a substance labelled with 13C [carbon] – or 14C-labeled urea that is broken down by the Helicobacter pylori bacterium. The breakdown products can be detected in a person’s breath.

2.Invasive test – Endoscopy of the upper gastrointestinal tract can confirm the infection of Helicobacter pylori and evaluate the condition associated with this infection – gastritis, gastric or duodenal ulcer, etc.

Who should be tested?

1.Patients with symptoms as above.
2.Patients with higher risk of gastric cancer, e.g. family history of gastric cancer.


Treatment involves taking combination of medications for 14 days.

It generally consists of a gastric medication known as proton pump inhibitors, and two antibiotics and probiotics.

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

Post-treatment test

In some patients, the H pylori may not be eradicated with the standard course three-drug regimen. The doctor will arrange for repeat H pylori test, usually a urea breath test to document successful therapy.

If the bacteria are not eradicated in the first round, the patient may need to go on a two-week regimen consisting of four drugs.

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