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. 2017 May;58(5):234-240.
doi: 10.11622/smedj.2017037.

The diagnosis and management of H. pylori infection in Singapore

Claire Alexandra Zhen Chew  1 , Tong Fong Lye  2 , Daphne Ang  1 , Tiing Leong Ang  1
Affiliations

The diagnosis and management of H. pylori infection in Singapore

Claire Alexandra Zhen Chew et al. Singapore Med J. 2017 May.

Abstract

Helicobacter pylori (H. pylori) is an infection that has a role in causing dyspepsia and complications such as peptic ulcer disease and gastric malignancies. In the primary care setting, one can adopt a stepwise approach with the 'test-and-treat' strategy to manage H. pylori-associated dyspepsia in young patients without alarm symptoms. Empiric first-line therapies should be for a two-week duration; options include clarithromycin-containing triple therapy alone or with the addition of bismuth, concomitant therapy and bismuth quadruple therapy. Post-treatment carbon urea breath test must be performed at least four weeks after the end of treatment to confirm the cure. Options for empiric second-line treatment include bismuth quadruple therapy and levofloxacin-containing triple therapy. Patients with persistent or alarm symptoms should be referred for further evaluation. Patients with persistent infection should be referred for gastroscopy so that gastric biopsies can be obtained for H. pylori culture and antibiotic susceptibility testing.

Keywords: H. pylori; acid suppression; antibiotic resistance; dyspepsia.

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Figures

Fig. 1
Fig. 1
Flow chart shows the stepwise approach to management of H. pylori-associated dyspepsia in the primary care setting. C-UBT: carbon urea breath test
Box 1
Box 1
Options for empiric first-line treatment of H. pylori.
Box 2
Box 2
Options for empiric second-line treatment of H. pylori.
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