What Is H. pylori?
Helicobacter pylori (H. pylori) is a spiral-shaped bacterium that infects the stomach lining and the upper part of the small intestine (duodenum). It’s one of the most common bacterial infections in the world, affecting more than half the global population. In Singapore, H. pylori prevalence is estimated to be around 30–40% among adults, with higher rates observed in older populations and those born before 1970.
This bacterium can survive in the acidic environment of the stomach by producing urease, an enzyme that neutralises gastric acid. Once it penetrates the protective mucous lining, it can trigger inflammation (gastritis), peptic ulcers, and even increase the risk of gastric cancer.
H. pylori in Singapore: A Local Context
In Singapore, the infection is more commonly acquired during childhood. Risk factors include high-density living conditions, family history, poor sanitation, and communal eating practices. While the standard of hygiene is high in modern Singapore, older generations and foreign-born residents may have acquired the infection earlier in life, especially if they spent time in countries with lower sanitation standards.
Public health studies in Southeast Asia, including Singapore, have noted that the infection rate is declining among younger cohorts due to improved sanitation and increased awareness of gastrointestinal health.
Common Symptoms of H. pylori
Most people with H. pylori are asymptomatic, which means the infection may go unnoticed for years. However, when symptoms appear, they typically indicate damage to the stomach lining or development of ulcers. H. pylori symptoms may include:
- Abdominal pain or discomfort, especially when the stomach is empty
- Bloating or excessive gas
- Nausea or vomiting
- Frequent burping
- Loss of appetite
- Feeling full after eating small amounts (early satiety)
- Unexplained weight loss
- Dark or tarry stools, which may indicate gastrointestinal bleeding
In children, the signs may be more subtle, such as poor appetite, nausea, or intermittent abdominal pain. Parents are advised to consult a paediatrician if these symptoms persist.
How Is H. pylori Spread?
H. pylori is primarily transmitted through oral-oral or faecal-oral routes. It spreads via:
- Sharing utensils with an infected person
- Poor hand hygiene, especially after using the toilet
- Consumption of contaminated water or undercooked food
Although Singapore has robust food safety and water treatment systems, cross-border travel and food prepared in unsanitary conditions may still pose risks. Moreover, in multi-generational households where family members share meals and cutlery, the risk of transmission increases if one person is infected.
How Is H. pylori Diagnosed in Singapore?
If a healthcare provider suspects H. pylori infection, they may order one or more of the following diagnostic tests:
1. Urea Breath Test
Patients ingest a urea solution labelled with a carbon isotope. If H. pylori is present, it breaks down the urea, releasing carbon dioxide that is detected in the patient’s breath. This non-invasive test is highly accurate and available at most major hospitals and diagnostic centres in Singapore.
2. Stool Antigen Test
This test detects H. pylori proteins in a stool sample. It’s commonly used in public polyclinics and private clinics due to its affordability.
3. Blood Antibody Test
Although less commonly used due to its inability to distinguish between current and past infections, it can still be helpful for initial screening.
4. Gastroscopy (Upper Endoscopy) with Biopsy
This is a more invasive procedure, typically recommended when there are alarm symptoms (e.g. weight loss, anaemia, persistent vomiting). It allows visual inspection of the stomach and collection of tissue samples for biopsy and urease testing.
Estimated Cost in Singapore:
- Urea Breath Test: SGD $180–$250
- Stool Test: SGD $60–$100
- Gastroscopy with Biopsy: SGD $600–$1,200 (including consultation and sedation)
Treatment Options for H. pylori
If diagnosed, H. pylori infection should be treated promptly to reduce the risk of complications such as ulcers or gastric cancer. The standard first-line treatment is known as triple therapy:
1. Two Antibiotics:
- Amoxicillin
- Clarithromycin or Metronidazole (depending on resistance)
2. Proton Pump Inhibitor (PPI):
- Omeprazole, Esomeprazole, or Lansoprazole
This regimen is typically prescribed for 14 days. In cases of antibiotic resistance or treatment failure, quadruple therapy is used, which includes a bismuth compound (e.g. Pepto-Bismol).
Medication Availability in Singapore: All standard medications are widely available at polyclinics, general practitioners (GPs), and hospitals. Talicia®, a newer formulation that combines omeprazole, amoxicillin, and rifabutin in a single capsule, is also available in some specialist clinics.
Estimated Cost of Full Treatment Course:
- Public polyclinic: SGD $60–$120
- Private GP or specialist: SGD $150–$400
Follow-Up Testing: A repeat stool or breath test is usually done 4–6 weeks after treatment to confirm eradication.
Diet Tips for Managing H. pylori
While diet alone won’t cure H. pylori, certain foods can help soothe the stomach and support recovery:
Foods to Eat:
- Probiotics (yoghurt, kefir, kimchi)
- Fibre-rich fruits and vegetables (broccoli, cabbage, bananas)
- Green tea and honey (both have mild antibacterial properties)
- Lean proteins like fish and tofu
Foods to Avoid:
- Spicy dishes (chilli crab, laksa)
- Acidic fruits (oranges, pineapples)
- Fried and fatty foods
- Alcohol and caffeinated drinks (kopi, teh)
Eating smaller, more frequent meals can also help reduce gastric irritation.
Long-Term Risks: Gastric Cancer
Persistent H. pylori infection is a known risk factor for gastric (stomach) cancer. According to the Singapore Cancer Registry, gastric cancer remains among the top ten cancers in Singaporean men.
Those with a family history of stomach cancer or chronic gastritis may benefit from routine screening and early eradication treatment. MOH guidelines recommend testing and treating even asymptomatic patients with high-risk backgrounds.
Prevention Tips
To reduce your risk of H. pylori infection:
- Wash hands thoroughly before meals and after using the toilet
- Avoid sharing utensils, cups, or food, especially in large gatherings
- Ensure water is from a clean, safe source
- Be cautious with food from uncertain hygiene sources (e.g. overseas street food)
FAQs about H. pylori (Singapore Edition)
Q: Is H. pylori infection curable?
Yes. With a full course of prescribed antibiotics and acid suppressants, the cure rate exceeds 85%.
Q: Can children get H. pylori?
Yes, especially if they live in high-density homes or have infected family members.
Q: Can I get reinfected after treatment?
While rare in Singapore, reinfection can happen through close contact with an infected person or contaminated food.
Q: How long does it take to recover?
Ulcer healing may take weeks to months even after the infection is cleared. Follow-up testing and dietary care are essential.
Q: Where can I get tested in Singapore?
Testing is available at polyclinics, restructured hospitals like SGH and NUH, and private clinics. Prices vary by test type and facility.
Final Thoughts
H. pylori infection is highly treatable, and early diagnosis can prevent serious complications like ulcers or gastric cancer. In Singapore, the infection rate is lower than in many other Asian countries, but public awareness, good hygiene, and regular medical check-ups remain vital. If you’re experiencing persistent gastric symptoms or have a family history of stomach cancer, speak to a healthcare professional today.
If you’re looking for more resources on gastrointestinal health or need help booking a screening, consult your GP or gastroenterologist for tailored care.
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