Helicobacter pylori infection--current status in Singapore

Helicobacter pylori infection is a common infection in Singapore affecting about 31% of the population. The seroprevalence of H. pylori infection increases with age from 3% in children below 5 years to 71% in adults above 65 years. Amongst the races, Chinese and Indians had similar rates of seropositivity (34.3% and 33.6%) while in Malays it was significantly lower (13.7%; P < 0.05). H. pylori infection is associated with peptic ulcer disease (both duodenal and gastric ulcer) as well as gastric cancer [adenocarcinoma, early gastric cancer and mucosa-associated lymphoma of T cell type (MALT) lymphoma]. Its role in non-ulcer dyspepsia is controversial. H. pylori was found in 31% of non-ulcer dyspepsia patients in Singapore compared with 28% in normal healthy controls. Gastric emptying test using indigestible solids shows that gastroparesis per se, H. pylori in the presence of gastroparesis (but not H. pylori alone) are related to dyspeptic symptom. H. pylori plays a synergistic role with non-steroidal anti-inflammatory drugs (NSAIDs) in causing bleeding in gastric ulcer but not in duodenal ulcer. Invasive and non-invasive methods are available for diagnosis of H. pylori and should be used to establish the aetiology of gastro-duodenal disease. Currently two groups of therapeutic regimes with eradication rates of 90% are available: bismuth containing regimes and proton-pump inhibitors based regimes. Triple therapy for one week (using three drugs effective against H. pylori) is currently the treatment of choice.