Most South Africans have H. pylori. Most will never know
About 77% of South Africans are thought to carry it. You probably picked it up before you were five, from someone in your house, and it has probably sat there ever since without causing you a moment of trouble. The question is whether yours is one of the ones that does.
The short version: H. pylori is a bacterium that lives in your stomach lining. Around 77% of South Africans are thought to have it. Most people who have it never get a single symptom. A few get gastritis or ulcers, and a small number go on to develop stomach cancer, which is why the World Health Organization puts it in the same carcinogen class as tobacco smoke. If you want to know whether you have it, that's a standalone stool test at R269. Whether yours needs treating is a question for a doctor.
In short
- About 3 in 4 South Africans are estimated to carry it. You probably got it before you were 5, from someone at home.
- Most people never notice it. Some get gastritis or ulcers, and a small number develop stomach cancer.
- It turns down your stomach acid, which is why it's linked to low iron and low vitamin B12, not just to sore stomachs.
- There are 4 ways to test for it and they don't answer the same question. A blood test can't tell current infection from an old one.
- Our standalone H. pylori stool antigen test is R269. It finds active infection, which is what you actually want to know.
No doctor's referral, no appointment. A stool sample you collect at home, or a kit you pick up at a branch in Observatory, Parktown North or Hillcrest. Results in 5 to 7 working days.
What is H. pylori?
Your stomach is about as acidic as battery acid. That's on purpose. It's a chemical airlock between whatever you've just eaten and the rest of you, and for most of the last century doctors were sure nothing could survive in there. Ulcers, everyone agreed, came from stress and spicy food.
Then in 1983 two Australian researchers found a spiral-shaped bacterium sitting in the stomach lining and said it was causing the ulcers. Nobody believed them. So one of them, Barry Marshall, got fed up and drank a culture of it. He was vomiting within days and had gastritis on biopsy. They both got a Nobel Prize for it 22 years later.
H. pylori gets away with living there by burrowing into the mucus that coats your stomach wall and making an enzyme that neutralises the acid right around itself. Most people pick it up before school age, from close contact at home. Once it's settled in, it usually stays for life unless someone sets out to get rid of it.
~50%
of the world's population has it
77.6%
estimated prevalence in South Africa
87.7%
estimated prevalence in Nigeria
Africa has more of it than anywhere else in the world. Prevalence follows crowding, sanitation and income, not anything you did or didn't do.
What does it actually do?
For most people, nothing they'd ever notice. It sits there quietly irritating the stomach lining and that's the end of it.
For a smaller group it does a lot more. H. pylori causes chronic gastritis and it causes peptic ulcers. Over decades it also raises the risk of two cancers: stomach adenocarcinoma, and a lymphoma of the stomach lining called MALT lymphoma. That's why the WHO puts it in carcinogen class 1, the same group as tobacco smoke.
Both of those things are true at the same time. It's a class 1 carcinogen, and almost nobody who has it gets cancer from it. Think about the numbers: 3 in 4 South Africans are estimated to carry this, and stomach cancer is nowhere near that common. A positive result means book an appointment. It doesn't mean lie awake.
What symptoms should I look out for?
Indigestion that won't settle. Burning stomach pain, especially between meals or at night. Bloating, nausea, losing weight without trying, or trouble swallowing.
Any of those can have half a dozen other causes, so none of them proves anything on its own. They're just the ones you shouldn't sit on for six months.
Is the African enigma real?
Researchers have been arguing about this one for 40 years, and it's worth knowing about because you'll run into it if you go looking.
Sub-Saharan Africa has the highest H. pylori prevalence in the world and, going by the numbers we have, comparatively little stomach cancer. Someone called that gap the African enigma, and a small industry grew up explaining it: protective genes, diet, parasite co-infection, different bacterial strains.
But there's a solid argument that the gap was never really there.
One review went looking for it properly. It pooled 40 prospective endoscopy studies from 17 African countries, covering 20 531 patients. Duodenal ulcers turned up in 21.1%, gastric ulcers in 3.4%, stomach cancers in 2.4%. Those aren't unusual numbers. They look a lot like the ones you get in wealthy countries.
The authors concluded the enigma doesn't exist and never did. They argued it was built on anecdote, and on data from people who couldn't easily get to a hospital and weren't living long enough to develop the cancer in the first place.
Why this isn't just an academic squabble. Stomach cancer takes decades to build. If people can't easily get an endoscopy, and are dying of something else at 60, the cancers that would have shown up at 75 never make it into anyone's statistics. What gets counted and what's actually happening are two different numbers.
Serious researchers are still on both sides of this and we're not going to settle it here. But what it means for you is simple. If you've got symptoms, "we don't really get that here" isn't a reason to leave them alone.
Why is H. pylori a gut health issue?
Most people file it under ulcers and stop there. The knock-on effects are the more interesting part, and they're why it sits on a gut panel instead of in a box of its own.
Start with the acid. Turning it down is how the bacterium survives, but that acid was doing a job. You need it to break iron and vitamin B12 out of your food so your body can absorb them further down. Less acid, less absorption. The link is well established enough that if someone's got iron deficiency nobody can explain, testing for H. pylori is one of the standard next steps.
Then there's everything else living down there. Your stomach isn't sterile, and changing how acidic it is changes what can survive in it and in the stretch below it. That's the argument for looking at H. pylori next to the rest of your gut flora instead of on its own.
So if you're exhausted, your iron is low and nobody knows why, and your digestion has been off for months, you might not have 3 problems. You might have 1.
Which H. pylori test should I get?
Most people end up with whichever test was easiest to arrange rather than the one that answers what they actually wanted to know. These 4 are not interchangeable.
| Test | What it finds | What to know |
|---|---|---|
| Blood antibody test | Antibodies your immune system made | Can't tell a current infection from one you cleared years ago, because antibodies hang around. Guidelines say don't use it to diagnose an active infection or to check treatment worked. |
| Urea breath test | Active infection, by catching the enzyme at work | The most accurate non-invasive option in pooled analyses, and the usual choice for checking an infection has cleared. |
| Stool antigen test | Active infection, by finding bacterial protein | Widely used, backed by guidelines, and comparable to invasive testing. |
| Stool PCR | The bacterium's DNA | Finds the organism, and can also pick up mutations linked to treatment resistance. No other non-invasive test does that. |
That first row catches people out constantly. When 3 in 4 people have been exposed to something, a positive antibody test barely narrows anything down, and it can't tell you whether a course of treatment worked. If someone's handed you a blood result and told you you've got H. pylori, that result might be describing an infection your body dealt with 10 years ago.
One caveat that applies to all 4. A Cochrane review of the non-invasive tests found significant uncertainty about how accurate any of them really are, and rated all but one of the studies it looked at as poor quality. Breath tests came out on top. The confidence behind that ranking is thinner than most articles on this let on.
How does Epicentre test for H. pylori?
With a stool antigen test. It's R269, it's a standalone test, and it looks for the bacterium itself rather than for antibodies. That's the second row of the table above, the guideline-backed one that tells you whether there's an active infection right now.
You don't need a doctor's referral and you don't need an appointment. Collect the sample at home or pick a kit up at a branch, and results come back in 5 to 7 working days.
H. Pylori Antigen test
R269If your question is "do I have H. pylori", this is the test. One stool sample, one answer, R269. It finds active infection rather than the leftover antibodies from an infection you might have cleared years ago.
Answers: do I have H. pylori right now?
Doesn't answer: what else is going on in your gut.
Sample: stool, collected at home or at a branch.
When would I want a gut panel instead?
Only if your question is bigger than H. pylori. The gut panels are 45-target PCR screens that cover probiotics, pathogens, parasites, E. coli strains and H. pylori all at once. They cost a lot more, and if all you want to know is whether you've got H. pylori, they're the wrong purchase.
They make sense when your digestion has been off for months, you don't know why, and you want to see the whole picture rather than rule out one organism.
Complete Gut Profile
R4,50045 targets from one sample: 17 beneficial probiotics, 8 core bacteria, 9 harmful pathogens, 5 E. coli strains, 4 parasites and H. pylori. This is the one that puts a positive H. pylori result in context instead of leaving it sitting there on its own looking alarming.
It's also the one that speaks to the acid argument above. If H. pylori is changing the environment in your gut, the rest of your flora is where you'd see it.
Answers: what's in my gut, good and bad, and how do they sit together?
Sample: stool, collected at home.
There's also a Gut Essentials Test at R2,500, which is a 17-target probiotic screen and does not include H. pylori, and a Gut Deep Dive at R5,950 which adds a disease-association report to the 45 targets. Both are on the gut health page. Our gut panels were developed and are overseen by Prof Veron Ramsuran, our head of laboratory. Prices are 2026 cash rates including VAT and may change; in-store pricing applies.
What do I need to do before I collect the sample?
Wait 2 weeks after you finish any course of antibiotics. Test sooner and you can get a false negative, because the antibiotics have knocked the numbers down without necessarily clearing anything.
If you're doing a gut panel rather than the standalone test, stop taking probiotics 2 weeks beforehand too. If you don't, you'll be measuring the supplement instead of yourself.
You don't need to change your diet either way. Collect the sample at home or pick a kit up at a branch, get it back to us within 24 hours, and keep it in the fridge until you do. Results take 5 to 7 working days.
What if it comes back positive?
Go back to the number at the top of this page. 3 in 4 South Africans are estimated to have this. A positive result puts you with the majority, not in trouble.
Whether it gets treated is a clinical call, not a laboratory one. It depends on your symptoms, your own history, what runs in your family, and what else came back on the report. Treatment works, and it's a course your doctor prescribes and then follows up to check it did the job.
We're a laboratory. We test and we report, and we don't diagnose, prescribe or treat. What we can do is put you in touch with independent partner doctors, with no obligation to use them.
Basically
You probably have H. pylori. So does most of the country, and most of us will go our whole lives without it causing a problem.
What matters is whether yours is doing something, and that's a question a stool antigen test answers for R269. A blood antibody result can't, because it can't tell now from 10 years ago. So if your stomach has been off, or your iron is low and nobody can say why, that's the test to ask for.
Find out what's actually in there
The H. pylori test is R269 and you don't need a referral for it. If your question is bigger than one bacterium, tell us what you're dealing with and we'll point you at the right panel instead.
Frequently Asked Questions
How common is H. pylori in South Africa?
Estimated prevalence here is around 77.6%, and Africa has more of it than any other region. Roughly half the world's population has it. Most people pick it up in early childhood from close contact at home, and it usually stays for life unless someone deliberately treats it. Prevalence follows crowding, sanitation and income rather than anything about how you live.
Does having H. pylori mean I'll get stomach cancer?
No. The WHO classes it as a class 1 carcinogen and it does raise the risk of stomach cancer and MALT lymphoma, but almost nobody who carries it develops either, and most people never get symptoms at all. A positive result is a reason to talk to a doctor about whether it should be treated. It isn't a diagnosis of anything.
What symptoms does H. pylori cause?
For most people, none. For a smaller group it causes chronic gastritis or peptic ulcers, which can show up as indigestion that won't settle, burning stomach pain between meals or at night, bloating or nausea. Because it turns down your stomach acid it's also linked to low iron and low vitamin B12, so unexplained tiredness can be part of the picture. None of these symptoms proves anything on its own.
Which H. pylori test is best?
It depends what you're asking. A urea breath test is the most accurate non-invasive option in pooled analyses and it's the usual choice for checking that treatment worked. A stool antigen test also finds active infection and is backed by guidelines. Stool PCR finds the bacterium's DNA and can also pick up mutations linked to treatment resistance. A blood antibody test is the one to watch: antibodies stick around after an infection clears, so it can't tell current from past.
Why doesn't a blood test settle it?
Because it measures antibodies, not the bacterium, and antibodies stay in your blood long after an infection has gone. In a country where most people have been exposed, a positive antibody result tells you very little, and it can't confirm whether treatment worked. Tests that find the organism itself, in stool or on your breath, answer the question a blood test can't.
How much does an H. pylori test cost in South Africa?
With a standalone H. Pylori Antigen stool test at R269. It looks for the bacterium itself, so it tells you whether there's an active infection now rather than whether you've ever had one. No doctor's referral is needed. You collect the sample at home or pick a kit up at a branch, get it back within 24 hours and keep it refrigerated, and results take 5 to 7 working days. H. pylori is also one of the 45 targets on our Complete Gut Profile at R4,500, but that panel is for people who want the whole gut picture, not for someone who just wants to know about H. pylori.
Is the African enigma real?
It's disputed. The African enigma describes the gap between very high H. pylori prevalence in sub-Saharan Africa and comparatively low recorded stomach cancer. One review pooled 40 prospective endoscopy studies from 17 African countries and 20 531 patients, found ulcer and cancer rates much like those in wealthy countries, and argued the enigma doesn't exist. The authors put it down to anecdote and to data from people who couldn't easily reach a hospital and weren't living long enough for the cancer to show. Serious researchers are still on both sides, and either way symptoms should be looked at rather than assumed harmless.
What these words mean
- H. pylori
- Short for Helicobacter pylori. A spiral-shaped bacterium that lives in the lining of the stomach, usually picked up in early childhood and usually kept for life.
- Gastritis
- Inflammation of the stomach lining. H. pylori is the most common cause of the long-running kind.
- Peptic ulcer
- A sore in the lining of the stomach or the first part of the small intestine. Most of them are caused by H. pylori.
- Antigen test
- A test that looks for a piece of the organism itself. Because it finds the bacterium rather than your response to it, it tells you about an infection you have now.
- Antibody test
- A blood test that looks for your immune system's response. Antibodies stay in your blood after an infection clears, so it can't tell a current infection from an old one.
- Eradication
- Clearing the infection with treatment. Checking it worked needs a test that finds the organism, not an antibody test.
References
- Helicobacter pylori patient isolates from South Africa and Nigeria differ in virulence factor pathogenicity profile and associated gastric disease outcome. Scientific Reports 2020. Read it
- Evidence-based examination of the African enigma in relation to Helicobacter pylori infection. PMID 16036504
- Helicobacter pylori infection in Africa: update of the current situation and challenges. Digestive Diseases 2022. Read it
- Forty years of Helicobacter pylori: the African perspective. Digestive Diseases 2024. Read it
- Accuracy of different non-invasive methods for identifying Helicobacter pylori. Cochrane Database of Systematic Reviews. Read it
- Evolution of diagnostic methods for Helicobacter pylori infections: from traditional tests to high technology, advanced sensitivity and discrimination tools. Diagnostics 2022;12(2):508. Read it
This article is general health information and not medical advice. Epicentre is a diagnostic laboratory: we provide testing and reporting, and we do not diagnose, prescribe or treat. Whether an H. pylori infection should be treated is a clinical decision for a doctor. If you have persistent stomach pain, difficulty swallowing, unexplained weight loss, vomiting blood or black stools, see a doctor promptly rather than waiting for a test result.
