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Helicobacter Pylori Infection

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What is a Helicobacter Pylori infection?

Helicobacter Pylori, more commonly known as H.Pylori in Singapore, is a type of bacteria that has infected half of the world’s population1. When a person is infected, the H.Pylori bacteria enters the body and lives in their stomach for many years without any symptoms. For most people, this infection does not cause any problems, however, in some individuals, the H.Pylori bacteria can cause gastritis, duodenitis, peptic ulcer disease, and stomach cancer (also known as gastric cancer)2.

The H.Pylori bacteria is able to adapt the environment and make it a suitable place for it to live and proliferate3. For example, the stomach is an extremely acidic place due to the stomach acids produced to aid digestion. The H.Pylori bacteria is able to reduce the acidity of the stomach and improve its survivability there3. It can live in the stomach for many years and most people will probably not even realise they are infected with the H.Pylori bacteria3.

What are the common causes of H.Pylori infection in Singapore?

The H.Pylori bacteria can be passed from person to person via direct contact with stools, vomit, and saliva4. It can also be passed via infected water and food and via the oral-faecal route4. Most of the time, people are infected as children.  Adults are not immune and can also be infected quite easily as the H.Pylori bacteria is able to live undetected for many years in the infected person’s stomach.

What are the symptoms of a H.Pylori infection?

Most people who are infected with H.Pylori will be asymptomatic and if symptoms do appear, they only appear years after an infection. Approximately 5-10% of infected individuals go on to develop the following symptoms2

  • Abdominal pain
  • Lack of appetite
  • Feeling full after a small meal
  • Nausea or vomiting
  • Dark/bloody stools
  • Bloating
  • Peptic ulcer disease (gastric or duodenal ulcers)
  • Gastritis/duodenitis

In some rare cases, H.Pylori infection may cause a number of changes in the stomach lining which can then ultimately result in stomach cancer (also known as gastric cancer).

Is a H.Pylori infection painful?

Yes, it can be especially if it causes Gastritis (Gastric Inflammation or Ulceration).

Who is at risk of a H.Pylori infection in  Singapore?

Most people get infected by the H.Pylori bacteria in childhood.

Living with someone who has a H.Pylori infection: if someone in your household has a H.Pylori infection, it can be easily transmitted to you since it can be passed via contaminated food and drinks.

Living in over-crowded conditions: having more people living in the same home as you can increase your risk of getting infected.

Living with no access to clean water: H.Pylori bacteria often live in contaminated food and water, having access to clean water will reduce your risk of an infection.

Living in a developing country: studies have shown that living in a developing country will put you at a higher risk of getting a H.Pylori infection.

How is a H.Pylori infection diagnosed?

Testing for a H.Pylori infection can be conducted before and after treatment (to check if the bacteria has been completely irradicated). H.Pylori infection can be diagnosed using the following tests2:

  • Stool test: using a stool antigen test and a stool polymerase chain reaction (PCR) test. These tests check for the presence of any proteins associated with H.Pylori. The stool PCR test can also be used to check if it is resistant to any treatment.
  • Breath test: also called a urea breath test, it involves swallowing pills or fluids that contain tagged carbon molecules which gets released as carbon if you do have a H.Pylori infection. This test involves you blowing into a bag and a device is used to detect if any carbon molecules are present.
  • Scope test: a gastroscopy can be conducted to check for the cause of your symptoms. A thin and flexible tube with a light and camera attached at one end will be inserted into your mouth and guided down your oesophagus and into your stomach and duodenum (upper part of the small intestine).

What are the treatment options for a H.Pylori infection in Singapore?

The treatment options for a H.Pylori infection depend on the severity of your symptoms and if it has progressed to anything more serious like gastritis, duodenitis, peptic ulcer disease, and stomach/gastric cancer

Treatment options are2,6:

  • Antibiotics: a combination of two antibiotics will be used to prevent the bacteria from developing resistance. It usually involves a 2-week course and must be completed even if you feel better.
  • Proton pump inhibitor (PPIs): these help to reduce the amount of acid present in the stomach, making it easier for your stomach lining to heal.
  • Bismuth subsalicylate: these are usually prescribed together with antibiotics and a PPI to help protect the stomach lining.
  • Histamine receptor blockers (H2 blockers): these prevent the stomach from producing too much acid which helps you heal. These are only prescribed if PPIs cannot be used.

Antibiotics, PPIs, and bismuth subsalicylate are usually prescribed together, and treatment will last approximately 14 days. After the treatment ends, you will have to go through another round of testing to check if the H.Pylori bacteria has been cleared from your body. If treatment worked, you may continue with your life while maintaining good hygiene habits. If treatment did not work, you will have to undergo another round of treatment.

Frequently asked questions

What will happen if H.Pylori goes untreated?
If a H.Pylori infection does not cause any symptoms, it can go untreated. If your H.Pylori infection is causing symptoms, it must be treated so that it does not progress to gastritis, duodenitis, and in rare cases stomach cancer.

References:

  1. Kaisa Thorell, P. L. (2017). Genomics of Helicobacter pylori. Helicobacter.
  2. Lamont, J. T. (2022, August 3). Patient education: Helicobacter pylori infection and treatment (Beyond the Basics). Retrieved from UpToDate: https://www.uptodate.com/contents/helicobacter-pylori-infection-and-treatment-beyond-the-basics
  3. Berger, A. (2000). Scientists discover how helicobacter survives gastric acid. British Medical Journal, 268.
  4. Mayo Clinic Staff. (2022, May 5). Helicobacter pylori (H. pylori) infection. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/h-pylori/symptoms-causes/syc-20356171
  5. Kallirroi Kotilea, P. B. (2019). Epidemiology, Diagnosis and Risk Factors of Helicobacter pylori Infection. In S. B. Shigeru Kamiya, Helicobacter pylori in Human Diseases (pp. 17-33). Springer.
  6. Bernstein, S. (2020, December 7). What Is H. pylori? Retrieved from WebMD: https://www.webmd.com/digestive-disorders/h-pylori-helicobacter-pylori

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