What is H. Pylori (Helicobacter Pylori) Infection?
H. pylori infection is a common bacterial infection affecting the stomach, possibly occurring in more than half of the world’s population. Many individuals remain unaware of the infection, which often causes no symptoms or serious health issues.
However, when it progresses, H. pylori can lead to severe conditions such as peptic ulcers (sores in the stomach), gastritis (inflammation of the stomach lining), and stomach cancer. Understanding its causes, symptoms, diagnosis, and treatment options is essential in preventing serious complications.
Infection Causes, Symptoms and Prevention
H. pylori bacteria can neutralise stomach acid, enabling it to survive and thrive in the stomach for extended periods.
Helicobacter pylori (H. pylori) infection is a common bacterial infection that affects the stomach and duodenum (the first part of the small intestine). It produces an enzyme called urease, which can neutralise the stomach’s acidic environment to help it survive. This allows the bacteria to stay in the body for years without causing symptoms in most people. As a result, many remain unaware of the infection unless symptoms appear.
H. pylori infection can cause stomach discomfort, often burning or dull pain.
Amongst the small percentage of infected individuals that do experience symptoms, they may include:
Burning or dull pain in the stomach that can last for minutes to hours and worsens when empty
Pain that subsides after eating or taking antacids (medication to reduce stomach acid)
Painful or disturbed digestion (dyspepsia)
Frequent burping
Bloating
Nausea, vomiting, weight loss and loss of appetite are possible but not everyday.
As H. pylori multiplies, it can erode the stomach lining, potentially leading to complications like gastric ulcers
An important point is that H. pylori continues multiplying over time, potentially damaging the stomach lining. Specifically, H. pylori can lead to issues such as stomach ulcers, gastritis, or, in severe cases, stomach cancer in the following ways:
Weakening the protective stomach lining increases the risk of damage from digestive fluids like gastric acid and pepsin, which can result in painful peptic ulcers.
Adhering to stomach cells triggers an inflammatory response (gastritis).
Increasing the risk of developing certain stomach cancers with chronic infection.
If you notice any of the following symptoms, seek immediate medical attention:
Severe stomach pain that wakes you at night
Bloody or black, tarry stools
Bloody or black vomit, or vomit that resembles coffee grounds
These signs could indicate serious stomach conditions such as peptic ulcers or other severe medical issues.
Prevention of H. Pylori
According to the 2016 study ‘The Changing Profile of Helicobacter pylori Antibiotic Resistance in Singapore: A 15-Year Study,’ roughly one in three Singaporeans has had an H. pylori infection. While preventing infection may not be entirely possible, you can take active steps to lower your risk and reduce its spread.
Since H. pylori is transmitted through direct contact with saliva, vomit, faecal matter, or contaminated food and water, make sure to:
Drink clean water and avoid contaminated water sources. When unsure, opt for bottled water.
Maintain proper hygiene by washing your hands thoroughly (for at least 20 seconds) before and after using the bathroom, eating, etc
Use clean water for food preparation, and make sure to thoroughly cook your food as bacteria can be present in raw meat, vegetables and fruits
Avoid sharing utensils with others.
H. Pylori Diagnosis in Singapore: Test, Test Kit, Lab Test & Endoscopy
H. pylori infection can be diagnosed through various methods, including a blood test.
Symptoms of an H. pylori infection often overlap with those of other stomach conditions. As such, a comprehensive assessment of the patient’s current condition and medical history is important for doctors to diagnose accurately. This may include understanding:
The onset of symptoms
The frequency and intensity of symptoms
Any self-medication the patient has been taking
In Singapore, there are also several diagnostic tests for H.pylori, including:
Stool Test: A sample from your stool is collected to trace for the presence of H.pylori in the faeces.
Lab Test: A blood test can also be used to identify the the presence of H. pylori-specific antibodies that could indicate the presence of the bacteria.
Urea Breath Test: A non-invasive test that detects H. pylori by measuring substances in a patient’s breath after they consume a specialised solution that the bacteria can break down. The test involves:
Rinse your mouth with water.
Drink a small container of tasteless liquid containing a radioactive tracer.
Wait for 20 minutes.
Blow into a straw to collect your breath in a container with a blue liquid.
Once the liquid turns clear, enough breath has been collected, and the sample is sent for analysis.
Upper Endoscopy: This is typically done for patients with apparent symptoms and involves the following steps:
Patients are given an anaesthesia
A thin, flexible tube with a camera attached is inserted via the mouth to visually inspect the upper gastrointestinal tract for signs of H.pylori infection.
A tissue sample (biopsy) can also be taken from the stomach lining for further testing.
You can visit Singapore's ACE Specialist Surgery and Endoscopy (ACE) clinic for this procedure.
To ensure accurate results, patients must follow these preparations before testing:
Stop taking antibiotics for at least four weeks
Pause stomach medications, such as acid suppressants, for two weeks prior
Fast for six hours before a urea breath test
Although H. pylori testing is not usually recommended for patients without symptoms or a history of peptic ulcer disease, those at higher risk may consider screening. If in doubt, consult an Endocrine Specialist to determine whether H. pylori testing suits you.
In Singapore, there are several H.pylori risk factors to note:
Age: Children can be susceptible to H. pylori infection, especially if they do not practice good hygiene. Additionally, individuals aged 50 and above are also at higher risk.
Predisposition to Stomach Cancer: If you have a known risk of developing stomach cancer or a family history of the disease, you may want to consider H. pylori testing.
Living Conditions: People who live in crowded households or lack access to clean water are at higher risk of infection. If you live with someone who has tested positive for H. pylori infection, you are highly advised to get tested as well.
Treatments for H. Pylori: Medications, Lifestyle Changes & More
Common treatment for H. pylori infection involves a prescription for antibiotics and a proton pump inhibitor (PPI).
To treat H.pylori infection in Singapore, the standard medication options include:
Antibiotics: At least two types of antibiotics are prescribed to eradicate H.pylori bacteria.
Proton pump inhibitor (PPI): This medication reduces acid production in the stomach and help heal ulcers (if present).
Bismuth subsalicylate: This medication can be added to promote healing of the stomach lining and kill H.pylori bacteria when necessary.
Histamine receptor blockers (H2 blockers): An alternative for patients who cannot tolerate PPIs.
A common approach to treating H. pylori infection is triple therapy, which includes two antibiotics and a PPI. The antibiotics target the bacteria, while the PPI reduces acid production and helps heal ulcers (if present). Most patients can clear the infection with this approach.
However, as with any antibiotic treatment, completing the entire course as prescribed is essential. This helps minimise re-infection risk and ensures sufficient medication for potential ulcers to heal. The total treatment duration is typically 10 to 14 days. If triple therapy is ineffective, bismuth subsalicylate is added as a next step.
As we now know, leaving H. pylori untreated may lead to severe complications in some individuals, including peptic ulcers, gastritis, and stomach cancer. Hence, it is advisable to seek medical treatment if you experience symptoms of an H. pylori infection. In some cases, untreated H. pylori infection can cause persistent stomach pain that may interfere with daily activities.
Recovery: Time / Rate Follow-up, Recurrence
Patients can expect to return for a follow-up four weeks after completing their prescribed treatment. This interval is necessary because most patients require retesting to confirm the bacteria have been eliminated, and any remaining medication in the system may affect test accuracy.
During this waiting period, you should be mindful of their diet while adhering to your medication. For those with an H. pylori infection, it is advisable to avoid foods and drinks that may further irritate the stomach, including:
Coffee, alcohol, and carbonated drinks may increase stomach acid production.
Spicy and oily foods can further irritate the stomach lining.
The chance of the same infection recurring is generally low. However, maintaining proper hygiene and adopting a healthy lifestyle is still important to strengthen immunity and reduce the risk of reinfection.
At ACE, our care team, led by Dr Reyaz, is dedicated to providing high-quality, evidence-based medical care tailored to each patient's unique health needs to optimise their physical well-being. In addition to precision care, the team is committed to streamlining procedures by conducting multiple tests within the same day, aiding you in a faster recovery journey.
Ang TL, Fock KM, Ang D, Kwek AB, Teo EK, Dhamodaran S. The Changing Profile of Helicobacter pylori Antibiotic Resistance in Singapore: A 15-Year Study. Helicobacter. 2016;21(4):261-265. doi:10.1111/hel.12291
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Dr Reyaz Singaporewalla Senior Consultant , Gastrointestinal Endoscopy and Surgery
