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H. Pylori Screening

H. pylori is a spiral-shaped bacteria that is notorious for causing stomach-related issues.
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H. pylori is a spiral-shaped bacteria that is notorious for causing stomach-related issues. The bacteria can alter the surrounding environment and minimise acidity to enhance their survival. In view of its shape, H. pylori can almost effortlessly penetrate the stomach lining. While the bacteria are generally not life threatening, they can potentially cause a myriad of digestive problems, especially in people with compromised immune systems or a history of digestive issues.

Helicobacter pylori is a highly prevalent chronic bacterial infection that is present in nearly 31% of Singaporeans. Majority of people infected with H. pylori never exhibit any symptoms or complications. However, clinical evidence has shown that H. pylori remains a major treatable risk factor for peptic ulcer and gastric malignancy. Fortunately, a H. pylori infection can be treated.

What's the link between H. pylori and gastric cancer?

Once a person is infected with H. pylori, the digestive lining, especially the stomach and duodenum (small intestines) can become inflamed. Overtime, the intestinal lining gets eroded by the inflammation and infection, leading to presentation of painful ulcers, or in severe cases, perforation of the intestinal lining. In mild cases, patients can present with vague nausea, indigestion, or bloatedness. In more severe cases, persistent abdominal pain and vomiting may occur.

Clinical research has proven that those suffering from H. pylori infection are up to 8 times more likely to get some kind of stomach cancer or gastric cancer. However, this particular bacterium is one potential cause of stomach cancer. Other risk factors of gastric cancer include smoking, a diet low in fruits and vegetables, as well as a history of stomach surgeries.

What do H. pylori do?

Most people with a H. pylori infection never experience any significant health concerns. However, in some people, the bacteria can potentially trigger long-lasting irritation, swelling, as well as pain in the stomach leading to stomach ulcers. If left untreated, this can potentially lead to cancer.

Research shows that nearly 44% of people worldwide have a H. pylori infection and the bacteria is believed to account for the majority of stomach ulcers, one of the leading causes of stomach cancer.

Although the bacteria are not generally harmful, H. pylori infections can lead to a plethora of problems, especially in people with a weakened immune system or a history of stomach issues. To help curb any potential health complications such as gastritis and stomach cancer, schedule an appointment with a doctor if you suspect that you may be suffering from an H. pylori infection.

How do I know if I have H. pylori infection?

Most individuals suffering from H. pylori infections have no obvious symptoms. But some people develop more serious symptoms, such as abdominal cramps and pain due to duodenal and stomach ulcers. Not to forget, patients without any symptoms may also have indolent ulcers– as mild cases have no symptoms whatsoever.

Generally, patients who present with Helicobacter pylori infection tend to have mild non-specific symptoms such as discomfort or pain in your upper abdomen, feeling full after consuming a small amount of food, nausea, reduced appetite, vomiting, and tar-coloured or dark stools. In more severe cases, with long standing intestinal ulcers, one can present with fatigue, dizziness, and palpitations secondary to losing blood/iron from the intestinal ulcers.

What can be done to diagnose an H. pylori infection?

There are various tests and procedures that can be used to establish whether you have an H. pylori infection. Screening tests are crucial for the detection of bacteria. Repeat clearance testing after initial treatment is useful to ensure the bacteria is completely eradicated. H. pylori diagnostic tests may include a blood test, urea-breath test, an upper endoscopy exam, and a simple stool exam.

Stool test

There are two distinct types of stool tests:

  • Stool antigen test: most popular stool test for H. pylori. It detects the proteins or antigens that are associated with infection from Helicobacter pylori in your stool.
  • Stool PCR test: a laboratory exam known as a stool polymerase chain reaction test can also effectively detect the presence of bacteria in stools. This test can also identify mutations that may be resistant to medications used in the treatment of bacterial infection. The stool PCR test is fairly costly and may also not be available at all medical centres.

Urea-Breath test

During this particular test, also referred to as a urea-breath test, the patient swallows a pill, pudding, or liquid that features tagged molecules of a carbon. If you are infected with H. pylori, the carbon will be released when the solution comes into contact with the bacteria in your stomach. Bearing in mind that your system absorbs the carbon, your body releases it when you exhale. To measure the release of carbon, you blow into a bag and your doctor uses special equipment to detect the carbon molecules. The level of the carbon hence will correlate with the amount of bacteria in the stomach.

Scope test

A doctor may also carry out a scope test to establish whether you have an infection with H. pylori. This test is also called the upper endoscopy examination. During this test, your doctor will offer you sedative medication that helps you relax. After that, your doctor will insert a long, highly flexible device equipped with a camera into your throat through your stomach and duodenum. This device allows your doctor to view any issues in your upper digestive tract. To screen for H. pylori, your doctor will usually extract a tissue sample during the endoscopic procedure to examine for the presence of the bacteria.

Although this particular test is slightly more invasive, it is conclusive and effective in screening for H pylori infection. It can also be conducted to help diagnose other digestive issues besides H. pylori infection.

How is H. pylori infection treated?

Thankfully, H. pylori infection is a very treatable condition. It is often treated using at least two different courses of antibiotic medications, which are taken at the same time. This is to prevent H. pylori from developing a resistance to one particular antibiotic. 

The available treatment options for an H. pylori infection include:

  • Histamine (H-2) inhibitors: work by blocking a substance referred to as histamine, which triggers the production of acid.
  • Proton pump inhibitors: also known as PPIs, these medications work by preventing acid from being produced in your stomach. Common examples of proton pump inhibitors include omeprazole, pantoprazole, and Iansoproazole.
  • Bismuth subsalicylate: also known as Pepto-Bismol, this medication works by coating the sores caused by the bacteria and protecting them against stomach acid.
  • Antibiotics: often the first line of defence against H. pylori infection. Two antibiotics are often recommended because it helps minimise the risk of antibiotic resistance as well as treatment failure.

With proper treatment and management, H. pylori infection can easily be treated. Furthermore, if successfully treated, your risk of getting peptic ulcers will significantly reduce. However, a H. pylori infection can potentially recur after initial treatment if you fail to take your medication as prescribed by your doctor. Make sure you finish your medication, even if your symptoms improve before the course of the treatment is completed.

FAQ

When should I visit a doctor for H. pylori infection?

Most people suffering from H. pylori infection will never exhibit any symptoms. But it is highly recommended that you schedule an appointment with a doctor if you experience the following symptoms:

  • Difficulty swallowing
  • A sudden, unexplained weight loss
  • Blood in your stool
  • Weakness and lethargy during the better part of the day
  • Constant bloating
Why is it important to seek treatment for H. pylori infection?
Individuals with a history of H. pylori infection or those who are currently experiencing peptic ulcers should seek immediate treatment for their symptoms. Research has proven that getting treated for H. pylori infection will not only help eliminate the symptoms associated with the condition, but may also address risk factors associated with complications and other stomach-related health concerns.
What will happen if I don't treat my H. pylori infection?
Patients with long standing H. Pylori infection can develop gastritis– inflammation of the stomach lining. People suffering from gastritis can experience a number of symptoms, ranging from abdominal discomfort, indigestion, bloatedness, pain, loss of appetite, as well as nausea.

If left untreated, more serious complications such as peptic ulcers, gastritis, lymphoma, and stomach cancer may occur in people with H. pylori infection. With the chronicity of the bacterial infection, intestinal lining can be eroded, leading to ulcers and perforation of the stomach or duodenum lining. Patients can manifest symptoms such as poor eating, weight loss, bloatedness, nausea, and abdominal pain. Long standing unhealed intestinal ulcers are a known risk factor for intestinal cancer. Hence, it is important to consider treating H. pylori infection.
What is the best treatment option for H. pylori?
H. pylori infections are often treated using a combination of antibiotic drugs and a proton-pump inhibitor. Proton-pump inhibitors are medications that minimise the acidity in your stomach. This type of treatment is commonly referred to as triple therapy, which involves taking two types of antibiotics and a proton-pump inhibitor for two weeks. Speak to your doctor to understand more about triple therapy.
Is there any vaccine for H. pylori?

Currently, there is no vaccine for H. pylori. 

However, there are a couple of things you can do to prevent its transmission and spread, including:

  • Drinking water from a clean, safe source
  • Thoroughly wash your hands after using the bathroom as well as before eating
  • Consuming properly cooked food
  • Avoid sharing meals without common utensils

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