The prevalence of Helicobacter pylori infection in benign laryngeal disorders

Lack of Association of Helicobacter pylori in Laryngeal Pathologies

To study the association of Helicobacter pylori (H. pylori) in patients with laryngeal pathologies. Study design: prospective observational study. Tertiary care teaching hospital. One hundred consecutive patients with laryngeal lesions scheduled for microlaryngoscopy were enrolled in the study. Laryngopharyngeal reflux was assessed using the reflux symptom index and reflux finding score. Tissue samples from the laryngeal lesions were taken under general anaesthesia and were screened for the presence of H. pylori using real time polymerase chain reaction (PCR) for ureA genes and histopathological examination. Of the 100 patients, 14 had a significant reflux symptom index score and 35 had significant reflux finding score. The lesions in the study subjects included both benign and malignant laryngeal pathologies. Vocal cord polyps formed more than half of the laryngeal pathology (57%) studied. Our study could not detect H. pylori in any laryngeal lesions by PCR analysis and histopathological examination. H. pylori may not be associated with laryngeal pathologies.

The Role of Helicobacter pylori in Laryngopharyngeal Reflux

Objective The primary objective was to determine the prevalence of Helicobacter pylori among patients with laryngopharyngeal reflux. The secondary objective was determining if H pylori eradication leads to greater symptom improvement in patients with laryngopharyngeal reflux as compared with standard proton pump inhibitor therapy alone. Data Sources EMBASE, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, World Health Organization International Clinical Trials Registry Platform, European Union Clinical Trials Register, Cochrane Library databases of clinical trials, and ClinicalTrials.gov. Review Methods A systematic review was performed of studies assessing the diagnosis or treatment of H pylori among patients with laryngopharyngeal reflux. Randomized controlled trials, cohort studies, case-control studies, and case series were included. A meta-analysis of prevalence data and assessment of heterogeneity was performed on relevant studies. Results Fourteen studies were analyzed in the review, with 13 eligible for the meta-analysis. We determined that the prevalence of H pylori among patients with laryngopharyngeal reflux was 43.9% (95% confidence interval, 32.1-56.5). The heterogeneity of studies was high, with an overall I² value of 92.3%. We were unable to quantitatively assess findings for our secondary outcome, since H pylori identification and treatment were not the primary focus of the majority of studies. Conclusion There is a high rate of H pylori infection among patients with laryngopharyngeal reflux. The infection rate in North America and Western Europe has not been adequately studied. There is insufficient evidence to make a recommendation regarding the testing and treatment of H pylori infection among patients with laryngopharyngeal reflux.

Toward an Understanding of the Pathophysiology of Chronic Laryngitis

Chronic laryngitis, characterized by inflammation of the laryngeal tissues, is the most commonly diagnosed organic voice disorder, yet treatments targeting suspected etiologic factors have demonstrated limited efficacy. A major barrier to the development of improved medical therapies for chronic laryngitis is a fundamental gap in knowledge related to the pathophysiology of laryngeal inflammation. This article provides a review of the literature specific to laryngeal immunity in health and disease.

Lipopolysaccharide responsiveness in vocal fold fibroblasts

Background

Vocal fold fibroblast’s (VFF) strategic location in the lamina propria and their ability to respond to external stimuli by producing inflammatory molecules suggest their possible direct involvement in innate immunity. Toll-like receptors (TLRs) are an essential signaling component to this response, as they allow for recognition of various microorganisms, leading to subsequent induction of pro-inflammatory genes. The objective of this study was to elucidate the role of VFF in the host immune response and subsequent influence on inflammatory cytokine secretion.

Methods

VFF derived from polyp, scar, and normal tissue were treated with 5 μg/ml lipopolysaccharide (LPS). TLR1 through 9, CD14, and MD-2 were measured during stable conditions by polymerase chain reaction (PCR). Expression of TLR4 and IL-1R type-1 genes were quantified after 24 hrs LPS stimulation by reverse transcription-PCR. LPS responsiveness was determined by NF-κB nuclear translocation as measured by subunit p65 expression in nucleus with immunocytochemistry. Downstream effects were confirmed with immunoassay measuring IL-8 concentrations in supernatant after 8 hrs.

Results

All VFFs constitutively expressed TLR1 to 6, TLR9, CD14, and MD-2 mRNA. Polyp VFF exhibited significantly higher TLR4 transcript levels (p < 0.001) in comparison to scar and normal VFF. LPS stimulated scar and polyp VFF exhibited increased levels of p65 in the nucleus (p < 0.01) and secreted greater IL-8 protein (p < 0.0001) compared to normal VFF.

Conclusion

VFF constitutively express genes for the receptors essential to the host immune response. Scar and polyp VFF produced greater LPS responsiveness resulting in over-activated inflammatory patterns. These findings support VFF role in the pathogenesis of inflammatory vocal fold disorders and suggests their presence in the wound bed could lead to chronic inflammation.

Association between infection of virulence cagA gene Helicobacter pylori and laryngeal squamous cell carcinoma

BACKGROUND

The aim of the study was to evaluate the presence of cagA gene Helicobacter pylori in etiopathogenesis of initiation and development of larynx squamous cell carcinoma (LSCC) and its predictable role as a prognostic factor.

MATERIAL AND METHODS

The prospective, controlled study involved a series of 75 patients (65 male, 10 female, mean age 59.1 years, range 43 to 79 years) with larynx cancer. Samples of larynx cancerous tissue, each of 10-15 mg, were obtained from fresh tissues and were used for nucleic acid purification. DNA was extracted from 225 samples (larynx tumor - I (75), margin of tumor and normal tissue - II (75) and normal larynx tissue from opposite side to the tumor - III). All samples were subjected to H. pylori ureA detection by the PCR H. pylori diagnostic test. Samples that were positive for ureA H. pylori gene were evaluated for cagA H. pylori gene.

RESULTS

Presence of H. pylori cagA gene was identified in 46,7% to 49,3% of 75 H. pylori ureA gene-positive larynx cancer depending of tissue location. There was a correlation of high incidence of positive cagA gene in larynx cancer tissue in supraglottic versus subglottic and glottic location. We observed a predominance of cagA gene in LSCC in patients with positive cervical lymph nodes and clinical stage T3 and T4.

CONCLUSIONS

H. pylori is present in larynx tissue and may be a possible carcinogen or co-carcinogen in LSCC development, but that must be addressed by future investigations. The presence of cagA gene in larynx cancer tissues significantly decreases survival rate and increases the disease recurrence possibilities.

Helicobacter pylori and its role in vocal folds' minimal lesions

BACKGROUND

  Chronic laryngitis and/or vocal fold minimal lesions (VFMLs) are common associations with gastro esophageal reflux disease. Helicobacter pylori (HP) is a Gram-negative spiral organism accused of being a common cause of gastritis, gastroesophageal reflux disease and peptic ulcer. HP has been recently isolated from tonsils, adenoids, sinus and middle ear mucosa in patients with chronic sinusitis or chronic middle ear effusion.

OBJECTIVE

  The objective of this study is to assess the presence of HP in VFMLs.

METHODS

  The study included 14 patients with VFMLs [six cases with vocal fold polyps and four cases with vocal fold nodules, and four cases with posterior granulomas; one of them associated with right vocal fold (VF) nodule]; all underwent carbon-13 urea breath test, esophago-gastro-duodenoscopy with gastric biopsy and direct laryngoscopy with microlaryngosurgery to extract the VF lesions. Biopsies were subjected for two tests: detection of the 23S ribosomal RNA gene of HP by real-time polymerase chain reaction (RT-PCR) and immunohistochemical reactions (IHC).

RESULTS

  HP was detected by RT-PCR in 10 of 14 patients with VFML; HP was also detected by IHC in the same number of VFML and gastric mucosa specimens.

CONCLUSION

  HP is a common finding in cases of VFML; its eradication should be considered when dealing with a patient with VFML.

Helicobacter pyloriinfection and its correlation to extraesophageal and esophageal reflux in contact granuloma patients

To evaluate the presence of Helicobacter pylori (H. pylori) infection and its correlation to extraesophageal and esophageal reflux, 18 consecutive contact granuloma patients were examined by laryngoscopy, 24-hour double probe pH monitoring and [13C]-urea breath test. Sixteen of the 18 patients (89%) were H. pylori-negative, while 2 patients (11%) showed positive test results. Extraesophageal reflux was detected in 14 patients; one of them was H. pylori-positive. In the ten patients with abnormal distal esophageal reflux, one was H. pylori-positive. The present results do not confirm increased prevalence for H. pylori infection in contact granuloma patients and the occurrence of H. pylori infection was not correlated to the amount of pharyngeal or esophageal acid exposure.

At the crossroads: mucosal immunology of the larynx

The larynx sits at the crossroads between gastrointestinal and respiratory tracts. Besides its intrinsic importance in breathing, swallowing and voice production, the larynx is also exposed to unique immunological challenges. Given the propensity of chronic inflammatory conditions such as chronic laryngitis, which affects up to 20% of Western populations, it is surprising that our understanding of the immunology of this organ remains relatively limited. Recent work on the immunological architecture of the laryngeal mucosa, and its changes that result from external challenges and inflammatory conditions, provided valuable insight into the fascinating immunology of this organ. The lessons learnt from these investigations may go beyond devising improved therapy for chronic laryngeal inflammation. Establishing whether and how the laryngeal mucosa may be involved in the modulation of wider mucosal responses may provide novel routes to the treatment of inflammatory diseases of the respiratory and alimentary tracts such as asthma and inflammatory bowel disease.

The role of gastric Helicobacter pylori infection in laryngopharyngeal reflux disease

OBJECTIVES

To investigate the role of Helicobacter pylori (H pylori) infection in laryngopharyngeal reflux (LPR).

STUDY DESIGN

A prospective multidisciplinary clinical study.

METHODS

Forty-four adult patients who applied to our ENT clinic with LPR symptoms were evaluated. Then these patients underwent upper gastrointestinal system endoscopy and double probe pH monitoring. In addition, during the endoscopy multiple biopsies from the stomach were obtained to detect H pylori.

RESULTS

Results from 32 LPR positive patients were assessed (10 male and 22 female). There were no statistically significant differences between the presence of H pylori and sex, age, degree of gastritis and esophagitis, and also the number of reflux, fractional acid exposure time regarding proximal probe readings. Similarly for both proximal and distal probe readings, the average score of esophageal acid clearance was not statistically significant (P > 0.05). In addition, no statistically significant difference was found between the presence of H pylori and GERD (P > 0.05).

CONCLUSIONS

The results of this study demonstrated that there is no relationship between gastric H pylori infection and LPR.

EBM RATING

B-3b.

A pilot study of Helicobacter pylori infection and risk of laryngopharyngeal cancer

BACKGROUND

Squamous cell carcinoma of the laryngopharynx has been linked to laryngopharyngeal reflux disease. Helicobacter pylori corpus gastritis decreases gastric acid secretion and provides some protection against complications of gastroesophageal reflux, including adenocarcinoma of the distal esophagus. The aim of this study was to investigate whether H. pylori infection also protects against laryngopharyngeal carcinoma.

METHODS

This was a case-control study comparing patients with histologically confirmed, previously untreated laryngeal or pharyngeal squamous cell carcinomas with cancer-free controls selected from a pool of hospital-based cancer-free controls identified during a similar time period. Each subject completed a self-administered questionnaire that elicited information on age, sex, ethnicity, and tobacco and alcohol consumption. The 120 case subjects were frequency matched to 120 control subjects on age (+/- 5 years), sex, tobacco use, and alcohol use; all subjects were non-Hispanic whites. H. pylori and human papillomavirus type 16 (HPV-16) seropositivity was determined by use of an enzyme-linked immunosorbent assay.

RESULTS

The serologic assay was unsuccessful in one case subject and nine control subjects; therefore, 119 case subjects and 111 control subjects were included in the analysis. The proportion of subjects with anti-H. pylori immunoglobulin G was similar between the two groups (32.8% among cases vs 27.0% among controls; p = .342). Although seropositivity was more common in the patients with laryngeal cancer (39.1%) than in the patients with pharyngeal cancer (28.8%), this difference was neither significant (p = .241) nor associated with a significant risk of laryngeal cancer (adjusted odds ratio, 1.53; 95% confidence interval, 0.69-3.41). H. pylori seropositivity was more common among patients who were HPV-16 seronegative (38.2% vs 22.9%, p = .081), and this was particularly true among patients with laryngeal cancer (47.1% vs 18.2%; p = .089).

CONCLUSIONS

These results do not show that H. pylori infection either protects against or promotes laryngopharyngeal carcinoma. However, segregation analyses suggested that H. pylori may play a role in laryngeal cancers not associated with HPV-16 infection, and further study in this group is warranted.

Allergy and the contemporary laryngologist

The author believes that allergy plays an important role in the field of laryngology. Not every patient has significant allergic problems, but the allergic factor in laryngeal problems should not be underestimated. The insights and technology for research have never been better. Many cause-and-effect relationships have been suggested and often provide the working basis for current therapeutics. Many current models of operation need to be verified, explored further, and modified through research. It is hoped that new technologies will achieve a higher degree of sensitivity without sacrificing specificity. Better specificity is particularly needed in allergy testing and in testing thyroid and pulmonary function. The author hopes that the contemporary laryngologist/otolaryngologist will use this overview to formulate a complete and orderly approach to laryngeal problems. Because of the complexity of laryngeal problems, referral to other specialists may be necessary. The laryngologist, however, should be able to orchestrate the appropriate use of technologies and health care specialists to address these problems.