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Helicobacter pylori infection and its treatment in Singapore.

K G Yeoh Associate Professor & Consultant Helicobacter pylori infection is now recognised to be the most important aetiology for peptic ulcer disease and a significant risk factor for gastric cancer. Half the world’s population is infected and it is a global health problem. The infection is common in Singapore and its epidemiology has been well described. The prevalence of infection increases with age in all races, from 3% in children below 5 years to 71% in adults above 65 years(1). The pattern is similar to that in developed countries. However there are marked differences among the three major ethnic groups(2). The prevalence of H pylori infection is highest in Indians, followed by Chinese and lowest in Malays. For instance in the age group 51-60 years, the prevalence of (H pylori) antibodies is 70% in Indians, 43% in Chinese and 35.7% in Malays (p<0.01). The corresponding odds ratio for infection in Indians and Chinese are 3.0 (1.5 to 5.9) and 1.5 (0.7-2.9) respectively, compared to Malays. The majority of people with H pylori infection do not develop clinical disease or symptoms, and the lifetime risk of developing ulcer disease is estimated at 10-15% while that of gastric cancer is 1-2%. Who should be treated? Consensus guidelines(3,4) have been developed to provide guidance on indications for therapy (Table I) and treatment regimes. The strongest evidence for the treatment of H pylori is in association with peptic ulcer disease. Eradication has been shown to heal ulcers, dramatically reduce recurrence and produce long term remission(5). It is also cost-effective because it prevents recurrence of ulcer disease and its complications. Whether the infection should be treated in patients with non-ulcer dyspepsia is still a matter of controversy. What is the best treatment? Evidence from randomised controlled trials show that the best results are obtained with a