What are Helicobacter pylori (H. pylori) tests?
The Helicobacter pylori test is used to detect infections caused by the bacteria H. pylori, which infects the lining of the stomach and the first part of the small intestine (duodenum).
This bacteria can cause several digestive conditions, including peptic ulcers (open sores on the lining of the digestive tract) and gastritis (inflammation of the stomach lining).
There are several methods for testing for H. pylori infection, ranging from taking breath or stool samples to collecting tissue samples from inside the stomach. In Singapore, these tests are widely available at hospitals, polyclinics, or private GP clinics, making it easy to treat any symptoms early.
When do I need an H. pylori test?
Your healthcare provider may recommend this test if you show symptoms of peptic ulcer disease or gastritis to see if the H. pylori bacterium is the cause. Here are the symptoms where your doctor may recommend this test, including
Loss of appetite.
Frequent burping.
Bloated stomach.
Nausea or vomiting.
Unexplained weight loss.
Having or having had ulcers in the stomach or duodenum.
A gnawing or burning sensation in the middle of the upper stomach.
Abdominal pain that worsens on an empty stomach.
Feeling of fullness shortly after eating (indigestion).
Because H. pylori infection doesn't always cause symptoms, you may be unaware of an existing infection. Consider getting tested if you have risk factors for H. pylori, such as
A personal or family history of gastric cancer.
Has been using anti-inflammatory medications or aspirin for a long time.
Living in areas with high risks of H. pylori infection, such as in crowded conditions or places lacking clean water.
Having close contact with someone infected with H. pylori.
When to see a doctor immediately
See your doctor immediately if you have any of these symptoms, as they might suggest a bleeding peptic ulcer in your stomach or duodenum, which includes:
Severe abdominal pain that disrupts sleep.
Having difficulty breathing.
Black, tarry stools.
Bloody vomit that looks like coffee grounds.
H. pylori infections can last a lifetime and are associated with an increased risk of stomach cancer. Early treatment can help prevent these infections from progressing to a more serious stage.
If you’re experiencing any of the mentioned symptoms or have risk factors, request an appointment with Thomson Medical. Our specialists can assist with further diagnosis, including an H. pylori test, to determine the underlying cause of your symptoms and provide a tailored treatment plan.
What to prepare before the test
About 2 to 4 weeks before the test begins, your healthcare provider may ask you to stop taking some medications that can affect the accuracy of the test results, which include:
Antibiotics
Bismuth subsalicylate, which is used to treat diarrhoea in adults and adolescents.
Over-the-counter medications like proton pump inhibitors (PPIs), which reduce the production of stomach acid, such as omeprazole and lansoprazole.
Some other medications can cause false negative results, so that your test shows a negative result even though you have an infection.
In addition, you may also be asked to fast for at least 6 hours before the test, especially if you are having an endoscopy (a procedure where a long, thin tube is inserted into your body).
Follow your healthcare provider's instructions on stopping medications and fasting to ensure accurate test results. If you have any concerns or questions, do not hesitate to talk to your healthcare provider.
During the test
There are four common tests that can be done to test for H. pylori infection. These tests can help detect an active infection or find out if you've been infected in the past.
The type of test you have at your appointment will be decided by your healthcare provider. They may recommend one test or a combination of tests, depending on your symptoms and medical history. The doctor may perform the following four tests:
Urea breath test
The urea breath test is the most common method for detecting H. pylori because it uses the bacteria's natural ability to break down urea into carbon dioxide. An increase in this carbon molecule may indicate the presence of this bacteria.
How it works
First, you'll exhale into a balloon-like bag to get a baseline sample of your carbon dioxide.
Next, you'll drink a pill or solution containing urea
If you have H. pylori, the bacteria will start breaking down the urea into carbon dioxide.
After about 15 minutes, you'll give a second breath sample.
The second sample is compared to the first sample to search for changes in carbon dioxide levels. If the second sample contains more carbon molecules than the first, you have an H. pylori infection.
This non-invasive test usually takes 15-30 minutes and can be done on adults and children over 6 years old.
Stool test
Using a stool sample is another non-invasive procedure of detecting H. pylori. There are two ways to test a stool sample for H. pylori, which are:
Stool antigen test (SAT)
It searches for a specific antigen, a type of protein, associated with the H. pylori bacterium in the stool.
Stool PCR test
A more advanced test that uses a polymerase chain reaction (PCR) to identify the genetic material of H. pylori. However, this test is pricier than a stool antigen test and may not be available at all medical centres.
Collection process
Your healthcare provider will probably give you a container or kit with instructions on how to collect a stool sample at home. There are different ways to collect the sample, so follow the instructions carefully. In general, you'll need to:
Label the container with your name, date and time of collection
Collect the stool sample without contaminating it with urine, toilet paper or water
Close the container and wash your hands thoroughly
Return the sample according to the instructions provided
If you're collecting a sample from diapers, you'll get special instructions for using plastic wrap inside of a clean diaper. In certain cases, a provider may use a swab to take a stool sample from the rectum.
Blood test
A blood test is used to detect antibodies, proteins that your immune system makes when it detects a harmful intruder, associated with H. pylori infection. This H. pylori test is the same as other routine blood tests, where a blood sample is taken from a vein in your arm using a needle.
Once the sample is collected, the needle is removed, and a piece of gauze and a bandage are placed over the puncture site. Your blood sample will then be sent to a laboratory to be tested for H. pylori antibodies.
Upper endoscopy
If other tests don't provide enough information, or if your healthcare provider needs to do additional tests for further assessment, an upper endoscopy may be done.
This test is the most accurate for detecting H. pylori, but it is also the most invasive. Your healthcare provider may do this test if they're looking for other problems (such as signs of cancer) in addition to H. pylori infection.
During the procedure
You will lie down on an examination table.
You'll be given an anaesthetic to help you relax and numb your throat so you won't feel any pain.
A thin, flexible tube (endoscope) with a camera is passed through your mouth and into your upper digestive tract (stomach and duodenum).
The endoscope allows your doctor to look at your upper digestive tract and take small samples of tissue (biopsies).
These samples will be sent to a laboratory to test for H. pylori infection and other digestive problems.
After the procedure, you'll recover for an hour or two while the anaesthetic wears off.
If your test results are positive for H. pylori, your doctor will typically prescribe antibiotics to combat the infection. You will also take other medicines to relieve your symptoms and help heal your stomach lining.
After you finish your treatment, your healthcare provider may order repeat tests to make sure all the H. pylori bacteria are gone. You'll usually have to wait at least four weeks after finishing your antibiotic treatment to have a repeat test.
To determine which H. pylori test is suitable for your medical needs, request an appointment with Thomson Medical. Our specialists can provide a personalised recommendation and guide you through the treatment process.
Are there any risks to testing?
Most H. pylori tests are safe and low-risk, including the urea breath test, the stool antigen test, and the blood antibody test. An upper endoscopy is generally safe but has a slightly higher risk because of the sedation and insertion of the scope. Potential risks of endoscopy include:
Sore throat.
Mild bloating due to air in the stomach.
Reaction to anaesthesia (drowsiness, nausea or dizziness).
Very rare complications, such as bleeding, infection, or perforation (small tear) of the stomach lining, can occur.
FAQ
What happens if an H. pylori test is positive?
If your test results are positive for H. pylori, your doctor will usually prescribe antibiotics to combat the infection. You will also receive other medicines to relieve your symptoms and help heal your stomach lining.
After completing your treatment, your healthcare provider may order follow-up tests (usually performed at least four weeks after finishing antibiotics) to confirm that all H. pylori bacteria have been eliminated.
What are three symptoms of an H. pylori infection?
Common symptoms of an H. pylori infection include:
A gnawing or burning sensation in the middle of the upper stomach
Abdominal pain that worsens on an empty stomach
Feeling of fullness shortly after eating (indigestion)
Other symptoms may include stomach pain, loss of appetite, frequent burping, bloated stomach, nausea or vomiting, and unexplained weight loss.
Does the H. pylori test need fasting?
Yes, some H. pylori tests do require fasting, especially the urea breath test and the endoscopy test, which need to be fasted at least 6–8 hours prior to the procedure. For accurate results, follow your healthcare provider's specific instructions regarding fasting requirements.
What not to eat with H. pylori?
When you have an H. pylori infection, certain foods can irritate your stomach lining and worsen symptoms. Avoid the following foods if you have an H. pylori infection:
Spicy foods
Hot peppers, chillies, and spicy seasonings can irritate the stomach lining and exacerbate symptoms like pain or discomfort.
Acidic foods
Citrus fruits (oranges, lemons, limes) and juices (like tomato juice) can increase stomach acidity, which may worsen irritation.
Fatty or fried foods
Foods high in fat (fried food, fatty meats) can delay stomach emptying, increase acid production, and make your symptoms worse.
Caffeinated beverages
Coffee, tea, energy drinks, and sodas with caffeine can increase stomach acid production and lead to discomfort.
Alcohol
Alcohol can irritate the stomach lining, slow down healing, and interact with medications like antibiotics or PPIs (proton pump inhibitors).
Carbonated drinks
Soda, sparkling water, or carbonated beverages may cause bloating and excessive gas.
Dairy (in some people)
Dairy products, like milk and cheese, can cause irritation in some people, especially those with lactose intolerance, and may worsen symptoms like bloating.
Can H. pylori be cured?
Yes, H. pylori infections can be cured with proper treatment. The infection is typically treated using a combination of medications designed to eliminate the bacteria and promote healing of the stomach lining.
Treatment usually lasts for 10-14 days, and it is important to complete the full course of antibiotics, even if symptoms improve early. If treatment is followed correctly, the cure rate for H. pylori is around 80-90%. In some cases, a second round of treatment may be required to ensure that all H. pylori bacteria have been cleared.
How is H. pylori transmitted?
H. pylori is typically spread by person-to-person contact, often in environments with poor sanitation or hygiene.
Oral-to-oral transmission
H. pylori can be spread by direct contact with the saliva of an infected person, such as through kissing or sharing eating utensils.
Fecal-to-oral transmission
The bacteria can be transmitted when someone ingests contaminated food or water and comes in contact with faeces. This type of infection can occur in places with poor sanitation, where there is a lack of clean drinking water and hygienic food handling.
Contaminated water or food
H. pylori can survive in water or food that has been contaminated by infected people's faeces. The risk of transmission increases in areas with unsafe drinking water or where food handling hygiene is compromised.
The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations based on your medical conditions, request an appointment with Thomson Medical.
For more information, contact us:
Thomson Specialists Paragon (Health Screening)
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Call: 6735 0300
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