Helicobacter pylori and tonsillectomy

Otitis media with effusion: The role of Helicobacter Pylori in its pathogenesis

BACKGROUND

Otitis Media with Effusion (OME) is the most common disease of the middle ear. Different factors play a role in its pathogenesis, such as viral and bacterial infections, allergy, morphological and functional changes of nasal passage, Eustachian Tube (ET), and cleft palate. This study aims to investigate the Helicobacter Pylori presence in middle ear effusions from patients with OME through RT-PCR and compare our results with results from other published articles.

METHODS

The study was carried out from October 2007 to February 2009, in the Department of Otorhinolaryngology of SS. Annunziata Hospital, Chieti, Italy. 132 consecutive patients with OME were included in the study. Fluid in the middle ear was assessed for the presence of Helicobacter Pylori through RT-PCR.

RESULTS

132 consecutive patients with OME were included in the study. The patients were between ages 8 and 78 (median 50); 62 were males (47%), 70 were females (53%), and 53 patients had bilateral OME (40%). 185 samples were collected from 132 patients. Of the 185 samples taken from the ear, 21 (11.35%) were not adequate for the correct execution of the DNA extraction procedure. The remaining 167 samples, subjected to RT-PCR, did not show in any case an increase in fluorescence linked to the FAM fluorophore, thus demonstrating the complete absence of Helicobacter Pylori.

CONCLUSION

Based on the results obtained, we can affirm that although a third of the cases of OME is correlated to the presence of reflux, Helicobacter Pylori does not seem to play any role in the pathophysiology of OME as it cannot be found in endo-tympanic exudate.

The role of Helicobacter Pylori and laryngopharyngeal reflux in recurrent tonsillitis

OBJECTIVES

To detect Helicobacter Pylori [HP] in tonsillar tissue of recurrent tonsillitis cases and assess the possible role of Laryngopharyngeal reflux [LPR] in tonsillar HP infection.

METHODS

A prospective study was done on the cited subject in a sample size of 50 paediatric patients [Age group: 6-18 years] suffering from recurrent tonsillitis. LPR was diagnosed by Reflux Symptom index [RSI] and Reflux Finding score [RFS]. A score of more than 7 and 13 was regarded as significant for RFS and RSI respectively. Patients with both scores significant were regarded to be suffering from LPR. Tonsillar specimen after tonsillectomy were subjected to urease test, histopathology [ Modified Giemsa Staining] and culture to detect HP. A minimum of two positive tests of the mentioned three were taken as gold standard to diagnose colonization of HP. Tabulated data was statistically analysed.

RESULTS

We recorded an incidence of 9% [18 cases] for LPR in recurrent tonsillitis. No case of HP colonization of tonsils was detected in this case series, even in patients of LPR.

CONCLUSION

We conclude that tonsils are not an extra gastric reservoir of HP. In addition, there is no aetiological relationship between recurrent tonsillitis and HP. And lastly, LPR is not a significant factor for colonization of tonsils by HP.

Helicobacter pylori in Otorhinolaryngology: Cause or Bystander

The bacteria Helicobacter pylori (H. pylori) have been identified in the extragastric tissues in the head and neck. The origin and pathogenicity of these bacteria in the head and neck are not known. Gastric reflux and nasal or oral routes are the possible modes of spread. In many sinonasal, pharyngeal, laryngeal, and middle ear disorders, laryngopharyngeal reflux has been identified as a contributing or causative factor. One possible mode by which laryngopharyngeal reflux may contribute is by seeding of the extragastric mucosa with H. pylori. The clinical significance of the discovery of H. pylori in extragastric tissues in the head and neck is unclear. There is no evidence of a pathologic or active role of H. pylori in otorhinolaryngological disorders. The suggestion that the sinonasal cavities and pharynx may serve as a reservoir for H. pylori and that reinfection of the stomach occurs after eradication therapy awaits further studies for confirmation. No connection was observed between H. pylori found in the stomach and H. pylori found in the head and neck. Also, these bacteria, found in the head and neck tissues, may be accidental or innocent bystanders that do not affect the pathways of otolaryngological and gastroduodenal diseases. This review examines the evidence for a possible relationship of H. pylori with otorhinolaryngological diseases.

Activation of Helicobacter Pylori Causes Either Autoimmune Thyroid Diseases or Carcinogenesis in the Digestive Tract

Helicobacter pylori has been implicated in stimulation of immune system, development of autoimmune endocrinopathies as autoimmune thyroiditis (AT) and on other hand induction of immunosupresion activates gastric and extra-gastric diseases such as gastric ulcer or cancer. It causes persistent lifelong infection despite local and systemic immune response. Our results indicate that Helicobacter pylori might cause inhibition of the specific cellular immune response in Helicobacter pylori-infected patients with or without autoimmune diseases such as AT. We cannot also declare the carcinogenic effect in oropharynx. However the association of any infection agents and cancerogenesis exists. The adherence of Helicobacter pylori expression and enlargement of benign lymphatic tissue and the high incidence of the DNA of Helicobacter pylori in laryngopharyngeal and oropharyngeal cancer is reality. LTT appears to be a good tool for detection of immune memory cellular response in patients with Helicobacter pylori infection and AT. All these complications of Helicobacter pylori infection can be abrogated by successful eradication of Helicobacter pylori.

Prevalence of the Helicobacter pylori in the tonsils and adenoids

Introduction

There is an ongoing debate about the existence and effects of Helicobacter pylori (Hp) in adenotonsillar tissue.

Objective

A clinical study was conducted to assess the existence of Hp in the adenoid and/or adenotonsillar tissues, which were surgically excised due to chronic adenotonsillitis.

Methods

Phosphoglucosamine mutase gene for the detection of Hp and cytotoxin-associated gene as virulence gene were examined in 84 adenotonsillar tissues obtained from 64 patients and patients’ serum by using polymerase chain reaction.

Results

Hp IgG was detected in 57 (89%) patients’ serum. A total of seven tissue samples from 64 patients (10.9%) were found positive for Hp DNA, of which five were adenoids and two were tonsil tissues. All polymerase chain reaction positive samples were also positive for the cytotoxin-associated gene, which is a virulence determinant for the organism.

Conclusion

This study suggests that children are exposed to Hp at an early age of their life in this province. Hp may have a role in the pathogenesis of chronic adenotonsillitis, especially in endemic areas.

Prevalence of H. Pylori in Tonsillar Tissue of Patients with Chronic Recurrent Tonsillitis Using Rapid Urease Test in a Tertiary Referral Hospital in Sub Saharan Africa

There has been conflicting results regarding the presence of H. pylori in tonsillar tissue. Our objective was to analyze for the presence of H. pylori in tonsillar tissue in patients undergoing tonsillectomy for chronic recurrent tonsillitis using rapid urease test in a Tertiary care academic medical center in a sub Saharan hospital. A prospective cross-sectional analysis of 39 consecutive cases of patients undergoing tonsillectomy secondary to chronic recurrent tonsilitis was done. Rapid urease test was conducted on each tonsillectomy tissue and results were determined using color change at specific time intervals within 24 h. Average age of the patients was 4.3 years. Among the 39 tonsillar tissues analysed using rapid urease test, H. pylori was present in 30.5 % of the samples. Colonisation by H. pylori of the palatine tonsils is a new frontier with conflicting results depending on the accuracy of the test method used and population studied. More studies need to be performed to ascertain the different rates of colonisation based on geographical regions.

Laryngopharyngeal reflux and Helicobacter pylori

Laryngopharyngeal reflux (LPR) occurs when gastric contents pass the upper esophageal sphincter, causing symptoms such as hoarseness, sore throat, coughing, excess throat mucus, and globus. The pattern of reflux is different in LPR and gastroesophageal reflux. LPR usually occurs during the daytime in the upright position whereas gastroesophageal reflux disease more often occurs in the supine position at night-time or during sleep. Ambulatory 24-h double pH-probe monitoring is the gold standard diagnostic tool for LPR. Acid suppression with proton pump inhibitor on a long-term basis is the mainstay of treatment. Helicobacter pylori (H. pylori) is found in many sites including laryngeal mucosa and interarytenoid region. In this paper, we aim to present the relationship between LPR and H. pylori and review the current literature.

Does tonsillectomy affect the outcome of drug treatment for the eradication of gastric H pylori infection? A pilot study

Eradication of Helicobacter pylori, which is associated with diverse gastroduodenal pathologies of varying severity, is sometimes challenging. We conducted a prospective study to determine the effect of tonsillectomy on the eradication of H pylori from the gastrointestinal tract. Our study population was made up of 46 patients-32 females and 14 males, aged 14 to 58 years (mean: 28.84 ± 9.65)-who had chronic tonsillitis and concomitant dyspepsia. An initial gastrointestinal endoscopy was performed to obtain specimens for histology and a rapid urease test. These gastroscopies revealed that 32 patients were H pylori-positive (69.6%) and 14 were H pylori-negative (30.4%); these groups were designated A and B, respectively. The 32 H pylori-positive patients were divided into three subgroups based on the sequence in which they underwent drug therapy and tonsillectomy. All 3 subgroups received the same 14-day combination-drug regimen for eradication of gastric H pylori. The patients in group A1 (n = 12) underwent tonsillectomy prior to receiving drug treatment; 2 months after the cessation of drug therapy, they underwent a second gastroscopy. The patients in group A2 (n = 10) received drug treatment first followed by tonsillectomy; 2 months later, they underwent their second gastroscopy. The patients in group A3 (n = 10) received drug treatment first, then they underwent a second gastroscopy, and then they were taken for tonsillectomy. The success or failure of H pylori eradication was determined by the second gastroscopy. Also, analyses were performed after tonsillectomy to look for H pylori infection in tonsillar specimens. Eradication of gastric H pylori was achieved in 9 of the 12 group A1 patients (75.0%), 8 of the 10 group A2 patients (80.0%), and 7 of the 10 group A3 patients (70.0%); there were no statistically significant differences among the three groups. Likewise, there were no significant differences between any subgroups or combination of subgroups in terms of tonsillar positivity. As far as we know, this is the first study to investigate the effect of tonsillectomy on the outcome of H pylori eradication treatment. In light of our findings, we may speculate that tonsillar tissue does not seem to be a reservoir for H pylori infection. Although tonsillectomy had no significant effect on gastric H pylori eradication in our study, our results might have been skewed by the relatively small size of our sample.

Presence of different genotypes of Helicobacter pylori in patients with chronic tonsillitis and sleep apnoea syndrome

Helicobacter pylori, a well-known gastric pathogen, has been detected in the oral cavity and oropharynx in tonsillar tissue. In our study, the presence of H. pylori in the tonsillar tissue of patients with chronic tonsillitis and sleep apnoea syndrome (SAS) was investigated. The aim was to detect and genotype H. pylori for a collection of data supporting the possible role of H. pylori in the aetiology of chronic tonsillitis and SAS. Helicobacter pylori was detected by real-time polymerase chain reaction (rt-PCR). 89 patients, 60 with a diagnosis of chronic tonsillitis and 29 with SAS, were tested. In the chronic tonsillitis group, Helicobacter was detected in 48 (80 %) specimens, cagA gene was detected in 12 samples (25 %) and 12 samples were negative. In SAS group, Helicobacter was found in 24 samples (82.76 %), cagA gene was detected in 5 (20.83 %) and 5 samples (17.24 %) were negative. Helicobacter pylori-specific immunoglobulins were tested by ELISA in the serum of 57 patients only with 41 (71.93 %) showing positive. Our results on H. pylori DNA detection and H. pylori seropositivity show 26.32 % discrepancy, slightly in favour of rt-PCR (15.79 % compared to 10.53 %). The H. pylori presence in tonsillar tissue does not depend on the type of oropharyngeal disease (p = 0.756). This study shows that oropharynx constitutes an extragastric reservoir of H. pylori infection which could serve as an aetiopathogenetic factor for chronic tonsillitis and tonsillar hyperplasia by SAS. No conclusion has yet been drawn about the mechanism of the process.

Detection of Helicobacter pylori in oropharyngeal lymphatic tissue with real-time PCR and assessment of its carcinogenic potential

Helicobacter pylori (HP) is considered a major gastric pathogen with oncogenic potential. The aim of this study was to determine whether HP is present in oropharyngeal lymphoid tissue and whether oropharyngeal HP strains carry virulence factor genes known to be involved in gastric carcinogenesis. The study included 104 subjects (41 patients with tonsillar carcinoma, 38 with chronic tonsillitis and 25 with obstructive sleep apnoea syndrome--OSAS). Detection of specific serum anti-HP antibodies was performed with an ELISA. The presence of HP in tissue was determined by culture and real-time PCR. Detection of virulence factors genes was also performed. Specific antibodies were found in 78.05% of tumour cases, 34.21% of chronic tonsillitis cases, and 72.0% of OSAS cases. The presence of HP in the tissue was detected in 73.91% of tonsillar tumours, 70.0% of tonsillitis cases, and 69.23% of OSAS specimens. The results of the virulence factor gene analysis showed the majority of the s1b (52.4%) and m2 (59.5%) alleles of vacA gene and limited abundance of cagA gene (12.5%). Results confirm that HP may colonise oropharyngeal lymphoid tissue. Oropharyngeal HP colonisation was frequently found in the oropharyngeal cancer group and in patients with benign oropharyngeal diseases. A virulence factor gene analysis showed differences from the predominant strains most commonly found in the stomach. The strains obtained from the oropharynx differed primarily by the lower abundance of the cagA gene and carried the less virulent vacA gene allele combination.

Assessment of helicobacter pylori prevalence by scorpion real-time PCR in chronic tonsillitis patients

Background:

Occasionally, bacteria or viruses enter the tonsils and these organs become overwhelmed by bacterial or viral infection leading to inflammation. Some studies confirmed the presence of Helicobacter pylori in tonsillar specimens of patients suffering from chronic tonsillitis and some others did not. The difference in results in various studies might be due to different laboratory methods. The aim of this study was to investigate the presence of H. pylori Deoxynucleic acid (DNA) in archival tonsillar tissues of patients with chronic tonsillitis by a rapid, sensitive, and specific technique of Scorpion real-time polymerase chain reaction (PCR).

Materials and Methods:

Scorpion real-time PCR and modified McMullen's staining was performed on 103 archival paraffin-embedded tonsillar samples collected from patients with chronic tonsillitis following tonsillectomy operation.

Results:

Our findings showed that H Cell and Molecular Research Center. pylori DNA was present in 21.35% of total specimens by using Scorpion real-time PCR. Modified McMullen's staining of paraffin-embedded sections was positive in 19 patients. Out of our 103 samples, 50 samples showed positive a rapid urease test whereas 53 samples demonstrated negative results, 20 produced positive PCR results, and 83 were negative for H. pylori. There was no significant relationship between the presence of H. pylori, sex, age, and place of residence.

Conclusion:

Although the existence of H. pylori in tonsillar tissue samples of patients with chronic tonsillitis is controversial, however, our results showed that in our studied specimens, a significant number of patients with chronic tonsillitis had H. pylori colonization.

Agreement rate of rapid urease test, conventional PCR, and scorpion real-time PCR in detecting helicobacter pylori from tonsillar samples of patients with chronic tonsillitis

Background:

Helicobacter pylori is capable of inducing systemic inflammatory reactions through immunological processes. There are several methods to identify the presence of H. pylori in clinical samples including rapid urease test (RUT), conventional polymerase chain reaction (PCR), and the Scorpion real-time PCR.

Aim:

The aim of the present study is to compare the agreement rate of these tests in identifying H. pylori in tonsillar biopsy specimens collected from patients with chronic tonsillitis.

Materials and Methods:

A total of 103 tonsil biopsy samples from patients with clinical signs of chronic tonsillitis were examined with RUT, PCR, and Scorpion real-time PCR. The degree of agreement between the three tests was later calculated.

Results:

There was a poor degree of agreement between RUT and PCR and also RUT and Scorpion real-time PCR (Kappa=0.269 and 0.249, respectively). In contrast with RUT, there was a strong degree of agreement between PCR and Scorpion real-time PCR (Kappa=0.970).

Conclusion:

The presence of a strong agreement between the Scorpion real-time PCR and PCR as well as its technical advantage over the conventional PCR assay, made the Scorpion real-time PCR an appropriate laboratory test to investigate the presence of H. pylori in tonsillar biopsy specimens in patients suffering from chronic tonsillitis.

The Role of Helicobacter pylori in Upper Respiratory System Infections: Is it More Than Colonization?

Helicobacter pylori (HP) is recognized as a common chronic human bacterial infection and is the most common cause of gastritis. Recent studies suggest an increased HP prevalence in patients with various extra-digestive inflammatory diseases. Since many respiratory diseases are characterized by chronic inflammation as well as increased immune response, and HP may enter the nasopharyngeal cavity by gastroesophageal reflux, an association between respiratory disorders and HP infection has been suggested. Several studies discover HP in clinical samples from the patients with upper respiratory system infections. Even some of them revealed a relief after the treatment directed to HP eradication. However some studies do not support this theory and whether this association means a definite proof of a causal relationship between HP and respiratory diseases needs to be clarified. In this study, we aimed to review the reports about the role of HP in upper respiratory system infections.

Incidence of Helicobacter pylori infection and their clarithromycin-resistant strains in otitis media with effusion regarding phenotypic and genotypic studies

Helicobacter pylori (H. pylori) are pathogenic bacteria that infect a half of the human population, colonize gastric mucosa and can be found in gastric juice. Reflux of gastric juice has been suggested to be associated with glue ear in children. It has been suggested that tonsil and adenoid tissues are potential reservoirs of H. pylori infection. These observations raise the question as to whether H. pylori infection might have a role in otitis media with effusion (OME) in children. The objectives of this research were to evaluate the incidence and possible role of H. pylori in the pathogenesis of OME in children and to evaluate the clarithromycin-resistant strains. Molecular assessment was done to evaluate the culture results vs. molecular study. A total of 60 children, who were prone to ventilation tube insertion, adenoidectomy and/or tonsillectomy were included in the study. The control group consisted of 40 children who underwent adenoidectomy and/or tonsillectomy without the history of OME. Samples of the middle ear fluid and mucosa, adenoid tissue, tonsillar tissue and gastric lavage were cultured and underwent polymerase chain reaction (PCR) analysis then were assembled by using QIAxcel System as capillary electrophoresis for H. pylori detection. There was significant difference between the results of cultures and PCR (P < 0.05). Middle ear fluid culture was positive for H. pylori in 40% of the patients vs. 56.7% PCR results while middle ear mucosa culture was positive in 20% vs. 26.7% PCR results. Gastric lavage culture was positive in 46.6% of the patients and PCR was positive in 63.3% of the patients. Adenoid culture and PCR were positive in 56.3% for each, while tonsil culture was positive in 70% and PCR was positive in 90%. H. pylori presence in the gastric lavage, the tonsillar and adenoid tissues by culture and PCR was significantly more frequent in the study group compared to the control group. The minimum inhibitory concentration (MIC) values of clarithromycin-resistant isolates ranged from 1.5 to 8 μg/ml. This study showed the presence of H. pylori in around 50% of the patients with OME. PCR revealed its sensitivity than culture techniques. The incidence of clarithromycin resistance was found to be high among the isolates (39.6%).

A study to detect Helicobacter pylori in adenotonsillar tissue

We conducted a prospective study to investigate the possibility of Helicobacter pylori colonization on tonsillar and adenoid tissues. Our study group was made up of 84 consecutively presenting children aged 4 to 12 years who had undergone adenotonsillectomy or adenoidectomy with or without ventilation tube insertion. The excised specimens were analyzed by rapid urease testing and histopathologic examination to detect H pylori. Histologic sections were subjected to hematoxylin and eosin staining and Giemsa staining as performed in routine gastric biopsies. We found no H pylori colonization in any specimen. Therefore, we consider the possibility of H pylori colonization of adenotonsillar tissue unlikely, even though the authors of some recent studies have reported such a finding. Other means of detecting possible H pylori colonization in the upper aerodigestive tract rely on invasive biopsy procedures, which are difficult to use in clinical practice. Therefore, on the basis of our findings and our review of the literature, we conclude that looking for H pylori in the upper aerodigestive tract is not only clinically useless, but damaging, as well.

Detection of Helicobacter pylori in adenotonsillar tissue of children with chronic adenotonsillitis using rapid urease test, PCR and blood serology: a prospective study

OBJECTIVE

Contradictory results have been reported regarding Helicobacter pylori (H. pylori) detection in adenotonsillar tissue. The aims of this study were to investigate whether adenotonsillar tissue of symptomatic children with chronic adenotonsillitis harbors the H. pylori organism, using two biopsy-based invasive methods namely; rapid urease test (RUT) and polymerase chain reaction (PCR) as well as blood serology and to compare the results obtained from each of these methods to the "gold standard".

METHODS

This prospective clinical study was carried out on 20 children aged between 2 and 10 years scheduled for tonsillectomy +/- adenoidectomy in a tertiary referral center. Exclusion criteria included: use of antacids, H(2) blockers or antibiotics during the previous month before surgery and adenotonsillectomy for obstructive sleep apnea. Core biopsy samples from resected adenotonsillar tissue was tested for H. pylori detection using both RUT and PCR assay for the ureC gene. Preoperative patient venous blood samples were also tested for H. pylori IgG antibodies. As a "gold standard", examined tissue was considered to be H. pylori infected if the two biopsy specimen-based methods (RUT and PCR) yielded positive results.

RESULTS

Thirty adenotonsillectomy specimens were tested (20 tonsils and 10 adenoids). RUT was positive in 16 (53.3%) specimens (12 tonsils and 4 adenoids). According to the "gold standard", 11/16 were considered false-positive, yielding this test sensitivity 100% and specificity 56%. The ureC gene sequence was detected by PCR in 5 (16.6%) specimens (3 tonsils and 2 adenoids), all of which were also positive by RUT, thus were considered H. pylori infected. Accordingly, PCR had a 100% sensitivity and specificity. Serology testing was positive for H. pylori IgG antibodies in 4/20 patients (20%), only two of them were found to have H. pylori infected adenotonsillar tissue.

CONCLUSIONS

Based on our findings it seems that adenotonsillar tissue may constitute an extra-gastric reservoir for H. pylori in symptomatic children with chronic adenotonsillitis. RUT was found to be of less accuracy than PCR in H. pylori detection in an extra-gastric location, thus results of previous studies using this test alone for detection of oral H. pylori should be treated with caution.

Comparative assessment of Helicobacter pylori colonization in children tonsillar tissues

OBJECTIVE

The objective was to survey the results of RUT (rapid urease test) in children tonsillar tissues.

METHODS

In a prospective clinical study 285 children (4-14 years) tonsillar tissue tested with RUT (rapid urease test) and histopathologic biopsy and simultaneously serum IgG Helicobacter pylori level was measured for all patients.

RESULTS

One hundred and thirteen patients (39.6%) were positive to H. pylori in histopathologic examination. Forty patients (14%) had positive RUT and 15 patients had positive serum IgG anti-H. pylori level. In 40 patients the results in both histopathology and RUT were positive (P=0.000) although in 172 patients the results in both histopatologhic and RUT were negative (P=0.000).

CONCLUSIONS

This study showed that H. pylori was present in tonsillar tissue and RUT is not sensitive enough for diagnosis of H. pylori in tonsillar tissue. Indicating that H. pylori has a possible role in reservoir of H. pylori in children.

Detection of Helicobacter pylori in adenotonsiller tissue specimens by rapid urease test and polymerase chain reaction

In recent studies, there have been many arguments concerning Helicobacter pylori being reservoir in adenotonsillar tissue. In this study, our objective was to detect whether adenoid and/or tonsillar tissue of patients diagnosed with chronic adenotonsillitis was a reservoir for H. pylori. This study was performed with 47 patients with the diagnosis of chronic tonsillitits and adenoid hypertrophy. Helicobacter pylori was searched by rapid urease test (RUT) and polymerase chain reaction (PCR). Presence of H. pylori glmM gene (formerly named as ureC gene) was tested using ureC and ureC2 primers. Fifty-five specimens used in the study were made up of 35 adenoid and 20 tonsil tissues. Rapid urease test was positive in three (5.5%) specimens. Helicobacter pylori was not detected in any of the patients by PCR. Further studies are needed to clarify the possible role of H. pylori in upper aerodigestive tract diseases such adenotonsillitis.

Does Helicobacter pylori play a role in etiology of nasal polyposis?

OBJECTIVE

Investigation of the possible relation between nasal polyposis (NP) and Helicobacter pylori (HP).

PATIENTS AND METHODS

Biopsy specimens of 25 patients with NP were evaluated. There were 16 men and 9 women enrolled in the study (NP) group. There were 10 men and 4 women in the control group. Campylobacter-like organism (CLO) test, immunohistochemical examination on nasal polyp tissue biopsy specimens and serological analysis were used for detecting HP.

RESULTS

There was only one (4%) positive NP case for CLO test. There were six cases in the study group with positive anti HP IgG test. Two control nasal mucosa were CLO positive. There were three cases in control group with positive anti HP IgG. There were no positive cases with positive anti IgM HP regarding both the study and the control groups. The immunohistochemical examination of the specimens taken from the patients with NP and control patients revealed that all patients were negative for HP. Positive CLO test and serologic test ratios were not statistically significant between NP and control groups.

CONCLUSION

The results of this study did not confirm other investigators. The suggested role of HP in the previous reports regarding NP may demonstrate transient occurrence of HP. It may not be treated as a possible etiological factor in NP.

Does Helicobacter pylori play a role in the development of chronic adenotonsillitis?

OBJECTIVE

Evaluation of the possible relationship between chronic adenotonsillitis and Helicobacter pylori (HP).

PATIENTS AND METHODS

The study was performed prospectively on 91 pediatric patients who underwent tonsillectomy, adenoidectomy or adenotonsillectomy due to chronic tonsillitis and/or adenoiditis. The adenotonsillectomy specimens were examined for HP colonization by rapid urease test (RUT) and immunohistochemical evaluation. Before surgery, anti-HP IgG and IgA antibody titers were detected by enzyme linked immunosorbent assay (ELISA) test in venous blood samples of the patients.

RESULTS

The RUT was positive in only two of the adenoidectomy specimens (2.2%) and in none of the tonsillectomy specimens. A positive result was not detected in any tonsillectomy specimens using immunohistochemical examination. Serum IgG antibody was positive in 21 (23%) patients, IgA antibody was detected in 7 (7.69%) patients and both tests were positive only in 3 (3.29%) patients.

CONCLUSION

The results of this study suggested that HP would not colonize in tonsil tissue of patients with chronic tonsillitis.

Helicobacter pylori in the palatine tonsils of patients with IgA nephropathy compared with those of patients with recurrent pharyngotonsillitis

Helicobacter pylori infection is acquired by oral ingestion. However, the morphology and microscopic localization of H pylori in the human oral cavity and pharynx are unknown. In the present study, we performed immunohistochemistry, immunoelectron microscopy, in situ hybridization, and polymerase chain reaction to identify H pylori in the palatine tonsils of 32 patients with immunoglobulin A nephropathy (IgAN) and 141 patients with recurrent pharyngotonsillitis (RPT). H pylori in coccoid form was present in bacterial colonies and horny layers of the stratified squamous epithelium in tonsillar crypts. We described for the first time the morphology of H pylori in palatine tonsils. Most bacterial colonies were sulfur granules with Actinomyces israelii (A israelii), and A israelii showed significant coexistence with H pylori (P=.011). The prevalence of H pylori in palatine tonsils of the RPT group increased steeply with age, but one fourth of the patients were found not to have tonsillar H pylori in adulthood. All patients with IgAN had H pylori in palatine tonsils. The prevalence of H pylori was greater in the IgAN group than in the RPT group, and the difference was statistically significant (P<.001). In contrast, A israelii was unrelated to age and clinical diagnosis (P=.722). In conclusion, our results demonstrate that H pylori in coccoid form is present in palatine tonsils and may indicate that H pylori in palatine tonsils is among the antigens causative of IgAN.

Comparison of Helicobacter Pylori Colonization on the Tonsillar Surface versus Tonsillar Core Tissue as determined by the CLO test

We conducted a prospective study to determine the correlation between the presence or absence of Helicobacter pylori on the tonsillar surface and in the tonsillar core as determined by the Campylobacter- like organism (CLO) rapid urease enzyme test. Our study population was made up of 55 patients who underwent adenoidectomy, tonsillectomy, or both from December 2002 through April 2003 at Khalili Hospital in Shiraz, Iran. Of these 55 patients, 45 (82%) were positive and 10 (18%) were negative for H pylori colonization as determined by CLO testing. Analysis of samples obtained from individual patients revealed differences in H pylori colonization between tonsillar surface samples and the core tissue samples. Of 106 tonsils obtained from 53 patients who underwent adenotonsillectomy or tonsillectomy, H pylori was found on 56 tonsillar surface samples (53%) and 24 tonsillar core samples (23%); only 13 tonsils (12%) contained H pylori both on the surface and in the core. We conclude that a surface swab is neither specific nor sensitive as an indicator of the presence or absence of H pylori colonization in tonsillar core tissue.

Tonsillar colonization is unlikely to play important role in Helicobacter pylori infection in children

OBJECTIVE

To determine (i) seroprevalence of Helicobacter pylori (HP) infection in children undergoing tonsillectomy, (ii) possible HP colonization on tonsils of children and its importance in HP transmission, and (iii) if four examined socio-economic factors are the risk factors for HP transmission and HP colonization on tonsils in children.

METHODS

Rapid urease test (RUT) of tonsils, and serologic blood tests for HP were performed in 77 children (aged 4-14 years) in Bosnia and Herzegovina (B-H), undergoing tonsillectomy. RUT positive tonsils were cultured for HP. RUT positive children were tested using (13)Carbon-urea breath test ((13)C-UBT). Information about socio-economic potential risk factors was obtained from the parents.

RESULTS

Out of 139 pharyngeal and palatine tonsils, 17 palatine tonsils in 14 children were RUT positive and had negative HP culture. Eight children had positive both RUT and (13)C-UBT. There was no significant difference between children with hypertrophy and those with recurrent tonsillitis comparing their serologic tests results. There was no significant difference between seronegative (n=61) and seropositive (n=16) children comparing their age, sex, parental education level, owning a family courtyard, attending a children's collective, and owning a pet cat.

CONCLUSIONS

The results in this prospective study do not support the notion that tonsils are an important reservoir for HP transmission in children in B-H. The examined socio-economic factors did not enhance HP seropositivity rate in children.

Investigation of Helicobacter pylori in tonsillary tissue with Pronto Dry test and pathologic examination

OBJECTIVE

The objectives of this clinical study were to identify, by means of the Pronto Dry test and pathologic examination, Helicobacter pylori (HP) in tonsillary tissue and to establish the role of HP in tonsillary microbiology by identifying that bacterium in the tonsillary mucosa or within the tonsil core.

METHODS

The subjects consisted of 52 patients (25 men and 27 women; age range, 3-65 years; mean age, 15.1+/-14.5 years) who were scheduled to undergo tonsillectomy for the treatment of chronic tonsillitis and who had not been treated with an antibiotic or a bismuth-containing compound for 6 months before the initiation of the study. In each patient, two specimens (one 4 mm x 4 mm tissue sample from the nonmucosal tonsil core and one 4 mm x 4 mm sample of mucosal tissue) were excised from both tonsils immediately after tonsillectomy. The specimens were placed in the Pronto Dry test kit, and the test results were obtained 1 h later. The remaining tonsillary tissues were submitted for pathologic analysis via hematoxylin-eosin stain, Giemsa stain, Warthin-Starry silver stain, and staining for inducible nitric oxide synthase (iNOS).

RESULTS

The results of the Pronto Dry test were positive for HP in 42% (n=22) of the excised mucosal tissue and in 47% (n=24) of the excised core tissue. In 27% (n=14) of the patients, both the core and the mucosal tissues tested positive for HP. There was no significant difference between the positive Pronto Dry test ratios of the biopsies obtained from the mucosa and those obtained from the core (P=0.693). iNOS staining showed that macrophage iNOS activity was significantly higher (P=0.025) in biopsied mucosal tissues with a positive Pronto Dry test result than in those with a negative result. Light microscopy revealed no HP in samples stained with hematoxylin-eosin stain, Giemsa stain, or Warthin-Starry silver stain.

CONCLUSION

Positive Pronto Dry test results and the results of iNOS staining showed that HP contributes to chronic tonsillitis, especially at the mucosal layer. Although HP does not colonize, it contributes to the chronic tonsillary inflammatory process as a triggering agent by affecting macrophages in the tonsil and thus increasing iNOS expression.

Is Helicobacter pylori really present in the adenoids of children?

Adenoid hyperplasia is a common cause of nasal obstruction in the pediatric age group. Recently, the adenoids were shown to harbor Helicobacter pylori (HP) based only on the rapid urease test (RUT). We conducted this pilot study to identify the presence of HP in the adenoids histologically and assess the reliability of both the RUT and histology in detecting HP in an extragastric location, using nested (two-steps) polymerase chain reaction (nPCR). Consecutive patients undergoing adenoidectomy for obstructive adenoid hyperplasia were enrolled. Adenoid specimens were subjected to the RUT. Histological sections stained with hematoxylin and eosin, Giemsa and Warthin-Starry were examined. We then used nPCR to detect the presence of HP in the studied specimens. Twenty-five patients (3-10 years; mean of 5.5 years) were enrolled. Twenty-one (84%) adenoids were positive by the RUT. Seventeen (68%) had bacteria on histological sections; four (16%) contained HP-like organisms. However, all specimens were negative by nPCR. No patient had a history of symptoms suggestive of laryngopharyngeal reflux within 6 months of the study. In conclusion, the children enrolled in this study did not have HP in their adenoids. High false positive results can occur with the RUT when used on adenoid tissues. It is not possible to rely solely on morphology to detect HP in an extragastric location. The nPCR remains the best way to identify HP accurately, but does not imply its presence in an active role.

Association of cagA+ Helicobacter pylori with adenotonsillar hypertrophy

Cytotoxin-associated gene A (cagA) of Helicobacter pylori (H. pylori) encodes a highly immunogenic and virulence-associated protein. The presence of cagA(+) H. pylori strains in tonsil and adenoid tissues may affect clinical outcome. The aim of the present study was to determine the presence of H. pylori cagA gene in tonsil and adenoid tissues and to establish the potential association of cagA(+) H. pylori in recurrent adenotonsillitis (RAT) and adenotonsillar hypertrophy (ATH). For this aim, a total of 118 tissue samples (71 tonsil and 47 adenoid tissues) were collected from a total of 71 children: 28 cases with RAT and 43 cases with ATH. The samples were analyzed for glmM gene to detect the infection with H. pylori by polymerase chain reaction (PCR). H. pylori-positive samples were further analyzed for the presence of the cagA gene. The PCR analysis showed that 29 samples (24.6%) were positive for H. pylori. Seventeen out of these 29 samples (58.6%) were found positive for cagA; the cagA gene was detected in 12 samples of ATH and 5 samples of RAT. The presence rate of cagA gene was significantly higher (p < 0.05) in ATH patients than that found in RAT patients. These results suggest that presence of cagA(+) H. pylori may be associated with development of ATH.

Possible role of Helicobacter pylori in the etiopathogenesis of chronic otitis media

OBJECTIVE

To investigate a possible contribution from Helicobacter pylori to the etiopathogenesis of chronic otitis media.

STUDY DESIGN

Prospective clinical trial.

METHODS

Tympanomastoidectomy, radical mastoidectomy, and modified radical mastoidectomy procedures were performed according to the pathology of ear disease. Biopsy specimens were taken from middle ear, mastoid antrum, and tympanic orifice of eustachian tube. Helicobacter pylori DNA was extracted from these biopsy specimens by using nested polymerase chain reaction.

RESULTS

Helicobacter pylori DNA was detected in 3 (7.9%) of 38 chronic otitis media patients.

CONCLUSION

Even though it is possible to detect Helicobacter pylori in middle ear cleft in chronic otitis media, its role in the etiopathogenesis of the issue is controversial.

Does Helicobacter pylori colonize the nasopharynx of children and contribute to their middle ear disease?

OBJECTIVE

There is growing interest in studying the presence of HP in the upper aerodigestive tract. It was shown in several pilot studies that it colonizes the area, while other authors found no evidence of its presence there and a third group of authors believed that it had only a transient presence there. In this study we investigated a possible role for HP in middle ear disease in children.

MATERIAL AND METHODS

Consecutive patients undergoing myringotomy and adenoidectomy for chronic otitis media with effusion or recurrent otitis media were enrolled. Middle ear fluids were cultured on three types of agar plate (Brucella + laked horse blood; Brucella + sheep blood; and chocolate). A double polymerase chain reaction (PCR) was run to detect urease-C and adhesion subunit genes. Rapid urease enzyme testing and PCR were used on the adenoid specimens. Parents were interviewed regarding symptoms suggestive of gastroesophageal reflux in their children.

RESULTS

Eighteen patients were enrolled in the study (mean age 4.4 years; age range 3-8 years) with an equal gender distribution. All 28 middle ear fluid cultures were negative in all 3 media. Twenty-one of the 28 samples contained DNA, yet PCR revealed that none of them belonged to HP. Ten of the 13 adenoid specimens obtained were positive on rapid urease testing, but none on PCR. Seven of the 18 patients had at least 1 symptom suggestive of gastroesophageal reflux during the 6 months preceding the study but this did not have an impact on any of the results.

CONCLUSION

There was no evidence from this study that Helicobacter pylori (HP) colonizes the nasopharynx of children with middle ear disease, whether dyspeptic or not. There is also no apparent role for this bacterium in middle ear pathology.

Does Helicobacter pylori have role in development of otitis media with effusion?

OBJECTIVE

Recently, it was suggested that tonsil and adenoid tissues may act as a reservoir for Helicobacter pylori (HP). A connection between chronic tubotympanal disorders and gastroesophageal reflux is well recognized, but the mechanism underlying this relationship is unclear. In this study, we investigated possible presence of HP in adenoid tissue and middle ear effusions in patients with chronic otitis media with effusion (OME) and we compared the data with the results of the children who had adenoid hypertrophy without OME.

METHODS

The study was comprised of 38 consecutive children with adenoid hypertrophy and/or chronic OME. The patients were divided into two groups. The first group included 18 subjects having OME+adenoid hypertrophy and the second group included 20 subjects having solely adenoid hypertrophy. Each patient underwent the appropriate surgical procedure; myringotomy, placement of tympanostomy tubes and/or adenoidectomy. After myringotomy, the middle ear effusions were collected in a suction and collection device and a core biopsy specimen was taken from each adenoid tissue following adenoidectomy. DNA extracted from these samples was used for the amplification of 23S ribosomal RNA gene of HP by real-time polymerase chain reaction (RT-PCR).

RESULTS

In the first group 34 effusion samples were obtained from ears of 18 patients (two had unilateral OME). HP was found to be positive in 12 children (67%) and 16 of 34 ears (47%) with RT-PCR. In eight children HP was positive in only one ear and in four children in both ears. No positive reaction was seen in tissue samples obtained from adenoids of these patients. In the second group a positive reaction was seen in adenoid tissue of only one patient.

CONCLUSIONS

This study showed that there is HP presence in middle ears of the children with chronic OME, indicating HP having a possible role in OME pathogenesis. In addition, we demonstrated HP presence in only 1 of 38 adenoid specimens supporting the idea that adenoid tissue does not act as a reservoir for HP.

Are tonsils a reservoir for Helicobacter pylori infection in children?

OBJECTIVE

Helicobacter pylori (H. Pylori) has been associated with the development of gastritis, peptic ulcer and gastric cancer. Although H. pylori infects up to more than half of the world's population, to date the precise modes of transmission has not been fully understood yet. Therefore a study was planned to investigate whether the tonsils and the adenoid tissue were the reservoir or the gate for the entrance of H. pylori.

METHODS

The adenotonsillectomy specimens obtained from 50 children, between two and 10 years of age were examined for H. Pylori colonization by the CLO-test method. Before tonsillectomy, anti-H. pylori IgG antibody titers were detected by commercial enzyme immunoassay method in venous blood and H. pylori antigen enzyme immunoassay for detection of H. pylori in stool was used to define current infection status.

RESULTS

The stool antigen was positive in 25 (50%) of 50 children. Serum IgG antibody was positive in 28 (56%) patients and both tests were positive in 21 (42%) patients. H. pylori positivity was not detected in any one of the adenotonsillectomy specimens with the CLO-test method.

CONCLUSION

In this study although H. pylori was detected in stools of children, it was not detected in adenotonsillectomy specimens with CLO-test method. The results may indicate that H. pylori does not colonize in either adenoid or tonsils and that these tissues do not constitute a reservoir for H. pylori infection.

The seroprevalence of Helicobacter pylori infection in patients with obstructive sleep apnoea: a preliminary study

We investigated the seroprevalence of Helicobacter pylori in patients with obstructive sleep apnoea. A prospective clinical study consisting of 19 patients, aged 23-72 years with confirmed obstructive sleep apnoea by overnight polysomnography, and 36 control subjects, aged 25-61 years with no history of obstructive sleep apnoea and gastroesophageal reflux complaints, was conducted. Titres of serum H. pylori IgG antibody were assayed by a serum enzyme-linked immunoabsorbant assay. The difference between the study and control groups was analysed by chi-squared test. Seventeen of the 19 patients (89.5%) were found to be H. pylori positive. However, 21 of the 36 control subjects (58.3%) were H. pylori positive. The seropositivity of H. pylori in obstructive sleep apnoea patients was found to be significantly higher than the control group (P = 0.017). The result of our study shows that there is a high association between H. pylori infection and obstructive sleep apnoea. This data may be important for future treatment strategies of the disease.