The Singapore Family Physician
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Vol 43 No. 2 - Updates in Rheumatology
Testing And Treating Helicobacter Pylori Infection
The Singapore Family Physician
Vol 43
No 2
- Updates in Rheumatology
52
- 54
1 April 2017
0377-5305
Helicobacter pylori (H. pylori) is an important pathogen in the stomach which can cause chronic inflammation, predisposing patients to peptic ulcer disease. It is also a
class 1 human carcinogen, increasing the risk of gastric carcinoma. Eradication of H. pylori has been shown to be effective in the prevention of peptic ulcer disease as
well as gastric carcinoma. Singapore is an intermediate-risk area for gastric cancer, and the seroprevalence of H. pylori infection is 31 percent. Testing for H. pylori consists of non-invasive tests such as H. pylori serology, stool antigen assay, and the urea
breath test, as well as invasive tests requiring oesophago-gastro-duodenoscopy (OGD) and biopsies for the rapid urease test, histology, and cultures. Stool
antigen assay represents a more accurate non-invasive outpatient test for H. pylori at slightly increased cost in the primary care setting, as positive H. pylori serology
does not necessarily imply active infection. Triple therapy remains an effective first-line eradication treatment in Singapore from studies of H. pylori resistance locally. Treatment failures should be retreated with quadruple therapy or other strategies such as concomitant therapy, hybrid therapy and
sequential therapy.