Do you also have frequent stomach ulcers? Let's learn about H. pylori (Helicobacter pylori) tests in a simple way.

Do you also experience heartburn or stomach pain before meals or at night? Do you feel full or nauseous? Although many people think of these as 'gastritis', sometimes the cause of this can be a small bacteria in our stomach. This bacteria is called H. pylori. So, today we will talk about who this bacteria is and what tests are done to detect it.

Who is this H. pylori?

Simply put, H. pylori (Helicobacter pylori) is a type of bacteria that can live in our stomach and small intestine. When this bacteria infects us, it starts to damage the lining of our stomach over time. This can cause the stomach lining to become inflamed, a condition we call gastritis . Also, if this damage continues, it can lead to ulcers in the stomach or small intestine, called peptic ulcers .

Many people in Sri Lanka have this infection. But not everyone develops symptoms. But if symptoms do appear, it is very important to get proper treatment.

When is an H. pylori test needed?

If you have the following symptoms, your doctor may suspect an H. pylori infection and order a test to confirm it.

• A burning, gnawing pain in the middle or upper abdomen, especially during meals or at night.
• If you feel like the pain is easing a bit after eating or taking an antacid for gastritis.
• Bloating .
• Nausea and vomiting .

If you have symptoms like these, it is best to see a doctor and seek advice.

What types of tests are used to detect H. pylori?

There are four main ways to find out if you have this bacteria in your body. Depending on your symptoms and condition, your doctor will recommend the most appropriate test for you.

Let's talk about these tests in a little more detail .

Now let's see how exactly each of these tests is performed.

Urea Breath Test

This is the easiest and most widely used test available to detect H. pylori.

First, you are asked to breathe into a balloon-like bag. Then, you are given a special liquid containing urea to drink. After about 15 minutes, you are asked to breathe into a new bag again.

Imagine, if you have H. pylori bacteria in your stomach, that bacteria breaks down the urea in the liquid you drank and produces a gas called carbon dioxide. Then, the amount of carbon dioxide in the second breath you exhale is higher. That increase is the evidence that there is an infection.

Stool Antigen Test

For this test, you will be given a small container to collect a stool sample at home. You will be given clear instructions on how to do this. This is how you will collect the sample and submit it to the lab.

This test looks for antigens in your stool that are specific to the H. pylori bacteria. Antigens are like the bacteria's "identification card." Their presence in your stool means that the bacteria is in your digestive system.

Blood Test

This is just like a regular blood test. A small sample of blood is taken from your arm and sent to a lab.

This tests your blood for proteins called antibodies that your body's immune system has created against H. pylori infection.

Endoscopy and Biopsy

This is the most accurate test for detecting H. pylori, but it is a little more complicated than the others.

During this procedure, you will be given medication to help you sleep. Then, your doctor will insert a thin, flexible tube (endoscope) down your throat and into your stomach and small intestine. The camera at the end of this tube can be used to examine the inside of your stomach.

If an infection or ulcer is suspected, the doctor can use a small instrument that goes through the tube to take a very small piece of tissue (a biopsy) from the stomach wall. It is then sent to a lab to confirm whether H. pylori is present.

How should you prepare before the test?

This is very important. Before some tests, your doctor may ask you to stop taking certain medications for a few days or weeks. These medications can cause the test results to be inaccurate (they can show that you have an infection when you don't).

The medications that are usually advised to be stopped are:

• Antibiotics
• Bismuth subsalicylate (some medicines for stomach upset, such as Pepto-Bismol®)
• Proton Pump Inhibitors (PPIs) (these are medications commonly prescribed for gastritis, such as Omeprazole and Esomeprazole)

Also, some tests (such as breath tests and endoscopy) require you to refrain from eating or drinking for a few hours.

But remember, only stop taking your medication as your doctor tells you to. Never stop taking your medication on your own. Follow the instructions you receive exactly.

What do the test results say?

The result you get can be "Positive" (+ve) or "Negative" (-ve).

What is a positive (+ve) result?

This means that you have (or have had) an H. pylori infection.

• If your breath, stool, or endoscopy test is positive , it means you currently have an active infection . Your doctor will then prescribe medications, including antibiotics, to kill the bacteria.
• If a blood test is positive , it could indicate a current or past infection. Your doctor will explain exactly what to do about it.

What is a negative (-ve) result?

This means that you do not have an H. pylori infection. However, if you still have symptoms, your doctor may recommend other tests to find the cause.

So, what is the best and most accurate test?

This depends on your situation.

• Endoscopy with biopsy is the most accurate test, but it is a bit more complicated. If you don't need to see the inside of your stomach, your doctor may refer you to a simpler test first.
• The breath test is the most accurate of the non-invasive tests.
• Although blood tests are easy to perform, they have limitations because they cannot accurately tell you if you have an active infection.

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