Detection of Helicobacter pylori in dental plaque by reverse transcription-polymerase chain reaction

Transmission routes and patterns of helicobacter pylori

BACKGROUND AND OBJECTIVE

Helicobacter pylori (H. pylori), a gram-negative bacterium that colonizes the stomach, can cause chronic gastritis and peptic ulcers, as well as gastric cancer as a Class I carcinogen. However, the modes of H. pylori transmission are not clear. This review aims to clarify the transmission routes and patterns of H. pylori and identify efficacious prevention measures.

METHODS

Studies of H. pylori transmission were identified using PubMed, the Web of Science, and Cochrane Central; the retrieval deadline was October 2022.

RESULTS

The transmission routes of H. pylori are discussed, focusing on the five primary transmission routes, namely fecal-oral, oral-oral, gastric-oral, anal-oral, and genital-oral. We propose that H. pylori is contracted through multiple transmission routes. Additionally, we summarize the key transmission patterns of H. pylori, including person-to-person and animal-to-human transmission, as well as foodborne and occupational exposure.

CONCLUSION

Fecal-oral appears to be the most common H. pylori transmission routes. Although the oral-oral pathway is also important, the evidence does not support that this route of transmission is universal. The gastric-oral route occurs primarily in children and patients who are prone to vomiting. Meanwhile, the anal-oral and genital-oral routes remain hypothetical. Person-to-person and foodborne infections represent the predominant transmission patterns of H. pylori, whereas strong environmental and occupational limitations are associated with animal-to-human and occupational exposure.

40 Years of Helicobacter pylori: A Revolution in Biomedical Thought

Background: Various microorganisms such as bacteria, virus, and fungi can infect humans and cause not just a simple infection but septic conditions, organ dysfunction, and precancerous conditions or cancer involving various organ systems. After the discovery of the microscope, it was easier to discover and study such microorganisms, as in the case of Helicobacter pylori, a pathogen that was seen in the distant era of the nineteenth century but without being recognized as such. It took 100 years to later discover the pathogenesis and the cancer that this bacterium can cause. Since it was discovered, until today, there has been a continuous search for the understanding of its pathogenetic mechanisms, and the therapeutic approach is continuously updated. Methods: We investigated how diagnosis and therapy were dealt with in the past and how researchers sought to understand, exactly, the pathogenetic biomolecular mechanisms of H. pylori, from the genesis of the infection to the current knowledge, with an analysis of carcinogenic mechanisms in the stomach. We have examined the scientific evolution of the knowledge of the disease over these 40 years in the gastroenterological and pharmacological fields. This was possible through a search in the databases of Medline, the WHO website, the Centers for Disease Control and Prevention (CDC) website, PubMed, and Web of Science to analyze the earlier and the latest data regarding H. pylori. Results: With the scientific discoveries over time, thanks to an increasing number of progressions in scientific research in the analysis of the gastric mucosa, the role of Helicobacter pylori in peptic ulcer, carcinogenesis, and in some forms of gastric lymphoma was revealed. Furthermore, over the years, the biomolecular mechanism involvement in some diseases has also been noted (such as cardiovascular ones), which could affect patients positive for H. pylori. Conclusions: Thanks to scientific and technological advances, the role of the bacterium H. pylori in carcinogenesis has been discovered and demonstrated, and new prospective research is currently attempting to investigate the role of other factors in the stomach and other organs. Cancer from H. pylori infection had a high incidence rate compared to various types of cancer, but in recent years, it is improving thanks to the techniques developed in the detection of the bacterium and the evolution of therapies. Thus, although it has become an increasingly treatable disease, there is still continuous ongoing research in the field of treatment for resistance and pharma compliance. Furthermore, in this field, probiotic therapy is considered a valid adjuvant.

Type IV secretion of Helicobacter pylori CagA into oral epithelial cells is prevented by the absence of CEACAM receptor expression

Background

Helicobacter pylori typically colonizes the human stomach, but it can occasionally be detected in the oral cavity of infected persons. Clinical outcome as a result of gastric colonization depends on presence of the pathogenicity island cagPAI that encodes a type-IV secretion system (T4SS) for translocation of the effector protein CagA and ADP-heptose. Upon injection into target cells, CagA is phosphorylated, which can be demonstrated by in vitro infection of the gastric epithelial cell line AGS, resulting in cell elongation. Here we investigated whether H. pylori can exert these responses during interaction with cells from the oral epithelium. To this purpose, three oral epithelial cell lines, HN, CAL-27 and BHY, were infected with various virulent wild-type H. pylori strains, and CagA delivery and ADP-heptose-mediated pro-inflammatory responses were monitored.

Results

All three oral cell lines were resistant to elongation upon infection, despite similar bacterial binding capabilities. Moreover, T4SS-dependent CagA injection was absent. Resistance to CagA delivery was shown to be due to absence of CEACAM expression in these cell lines, while these surface molecules have recently been recognized as H. pylori T4SS receptors. Lack of CEACAM expression in HN, CAL-27 and BHY cells was overcome by genetic introduction of either CEACAM1, CEACAM5, or CEACAM6, which in each of the cell lines was proven sufficient to facilitate CagA delivery and phosphorylation upon H. pylori infection to levels similar to those observed with the gastric AGS cells. Pro-inflammatory responses, as measured by interleukin-8 ELISA, were induced to high levels in each cell line and CEACAM-independent.

Conclusions

These results show that lack of CEACAM receptors on the surface of the oral epithelial cells was responsible for resistance to H. pylori CagA-dependent pathogenic activities, and confirms the important role for the T4SS-dependent interaction of these receptors with H. pylori in the gastric epithelium.

A meta-analysis of the association between the presence of Helicobacter pylori and periodontal diseases

BACKGROUND

The objective of this meta-analysis is to evaluate the association between the presence of Helicobacter pylori (H pylori) and periodontal disease (PD).

METHODS

PubMed and EMBASE databases were searched to identify eligible articles published from inception up to April 2018. Further articles were retrieved through a manual search of recent reviews. Cross-sectional studies, case-control studies and cohort studies reporting the association between H pylori and PD were included. The pooled odds ratio (OR) and their 95% confidence interval (CI) were calculated.

RESULTS

Four case-control studies and nine cross-sectional studies were included. A total of 6800 patients were included in this review. The odds for oral H pylori positivity was 2.31 times (95% CI: 1.99-2.68) greater than those without H pylori. Subgroup analyses involving different study locations, designs, and types of study population showed the similar results. The pooled OR for the gastric disease patients was the largest (3.50, 95% CI: 2.22-5.53, five articles). Stomach H pylori was also significantly associated with PD, with OR 2.90 (95% CI: 1.37-6.14, two articles).

CONCLUSIONS

This meta-analysis supports an association between H pylori and PD. More well-designed studies, especially prospective cohort studies are necessary to confirm these results.

Presence of Helicobacter Pylori in the Stomach and Laryngeal Mucosal Linings in Patients with Laryngeal Cancer

SUMMARY – Helicobacter (H.) pylori is the cause of one of the most common chronic bacterial infections in humans. Risk factors for the development of laryngeal cancer are cigarette smoke, alcohol, and human papillomavirus. Several papers report on H. pylori isolated in tooth plaque, saliva, middle ear and sinuses. Many articles describe the presence of H. pylori in laryngeal cancer cases, however, without noting the possible source of infection, i.e. stomach or oral cavity. The aim of this study was to determine which patients and to what extent simultaneously developed H. pylori colonization in the stomach and the larynx. Prospective examinations were performed in 51 patients with laryngeal squamous cell carcinoma. The study group included patients with laryngeal squamous cell carcinoma histopathologically confirmed by two independent pathologists. The patients underwent fiber esophagogastroduodenoscopy with tumor tissue biopsy. Laryngeal and gastric biopsies were examined by histologic staining technique for histopathologic detection of H. pylori and with DNA analyses using the standardized fluorescent ABI Helicobacter plus-minus PCR assay. Laryngeal carcinoma patients showed positive H. pylori test results simultaneously in the laryngeal and stomach areas, implying H. pylori transmission from the stomach to the laryngeal area. In addition, H. pylori positive test results along with negative H. pylori results in the stomach region were also recorded, suggesting a possible bacteria migration from the oral cavity. In conclusion, H. pylori was found in the area of laryngeal carcinoma, and its migration appeared likely to occur both upwards (from the stomach to the mouth) and downwards (from the oral cavity to the stomach).

Association between Helicobacter pylori gastritis and dental diseases: A cross-sectional, hospital-based study in Eastern Saudi Arabia

BACKGROUND

There is inconsistent evidence about the association between Helicobacter pylori (H. pylori) and dental diseases with possible effect of environmental factors. The aims of the study were to assess (1) the association between gastric and oral H. pylori colonization and (2) the association between oral colonization of H. pylori and dental diseases.

METHODS

A cross-sectional study was conducted in King Fahad University hospital in Khobar, Eastern Saudi Arabia in 2017. Patients admitted to the Endoscopy Unit were recruited and clinically examined for plaque, decayed teeth (D), filled teeth (F), missing teeth (M), periodontal pocket depth (PPD), attachment loss (AL), and gingival bleeding in addition to assessing their age, gender, education, tooth brushing, flossing, and tobacco use with a questionnaire. Pooled dental plaque samples were collected and analyzed using nested polymerase chain reaction PCR to detect oral H. pylori. Gastroscopy was used to extract biopsies to assess gastritis and the presence of gastric H. pylori using Giemsa stain. Regression analysis was used to assess differences between patients with and without gastritis, oral H. pylori and gastric H. pylori in the percentage of sites with gingival bleeding, PPD, CAL, D, M, and F with adjustment for confounders.

RESULTS

One hundred twenty patients were included. Most of them brushed daily (82.6%) and had university education (45.7%). Of these, 34.2% had gastric H. pylori and 5% had oral H. pylori. No significant association was observed between the percentage of sites with gingival bleeding, mean PPD, AL, F, and either gastritis, the presence of oral or gastric H. pylori. Patients with gastritis had significantly higher number of D and M than patients without gastritis (P = 0.03).

CONCLUSIONS

In this study, the presence of gastric and oral H. pylori in patients with good oral hygiene and moderate socioeconomic status is not significantly associated with periodontal diseases. Patients with gastritis tend to have a higher number of decayed and missing teeth.

The investigation of Helicobacter pylori in the dental biofilm and saliva samples of children with dyspeptic complaints

Background

The oral cavity can be an extra-gastric reservoir for Helicobacter pylori (H.pylori). This can play a role in the pathogenesis of halitosis, glossitis, recurrent aphthous stomatitis, and dental caries. The present study was conducted to detect the presence of H.pylori within the dental biofilm and in saliva samples collected from children suffering from dyspepsia and children without any gastrointestinal complaints. Associations with gastric infection, halitosis, and some oral parameters were also evaluated.

Methods

Seventy children (aged between 5–16) with dyspepsia were selected for the study group and control group composed of 30 healthy children without dyspepsia were also included in the study. After detailed oral and clinical examinations for oral parameters, saliva, and supragingival dental biofilm samples were collected for 16S rRNA and 23S rRNA genes detection by real-time polymerase chain reaction (RT-PCR). The presence of gastric H.pylori was evaluated in endoscopic biopsy specimens histopathologically. Halitosis was evaluated by benzoyl-DL-arginine-naphthylamid (BANA) test. Salivary S.mutans and Lactobacilli sp. counts were also carried out by commercial kits.

Results

H.pylori was histopathologically detected amongst 83% of the children with the dyspeptic condition. The detection rate of this bacteria in dental biofilm and saliva samples and halitosis were found relatively higher in the dyspeptic children rather than the control group (p < 0.01). Halitosis was not significantly different between dyspeptic children and those detected with H.pylori (p > 0.05). In the gastric H.pylori positive group with dyspepsia, DMFT/S and dmft/s numbers and plaque indices were found higher than the control group (p < 0.01). Only plaque indices of gastric H.pylori negative group with dyspepsia were found higher than the control group (p < 0.01). S.mutans and Lactobacilli sp. counts were not significantly different between gastric H.pylori positive and negative groups (p > 0.05). Comparing to those with negative for both genes, in children whose dental biofilm and saliva samples were positive for both 16S rRNA and 23S rRNA genes, significantly higher results for halitosis, and DMFS numbers and significantly lower results for dmfs numbers and pH values were found (p < 0.01).

Conclusions

Helicobacter pylori can occur in the oral cavity aside and independently from the stomach. However, the high number of bacteria in the oral cavities of children with gastric H.pylori, an association between the presence of H.pylori and halitosis, DMFS, and pH were found.

Electronic supplementary material

The online version of this article (doi:10.1186/s12903-017-0361-x) contains supplementary material, which is available to authorized users.

Clinical Comparative Study of the Effects of Helicobacter Pylori Colonization on Oral Health in Children

OBJECTIVE

To isolate Helicobacter pylori (HP) from the dental plaque of a selected group of children and to compare the oral and salivary findings of patients with those of a healthy control group.

METHODS

A total of 70 children aged 5-15 years were included in this study. An intraoral examination was performed for each patient, and dental plaque and saliva specimens were collected for analysis. Oral health conditions, nutritional habits, tooth brushing frequency, saliva pH levels, flow velocity, and buffering capacities were noted. The Kruskal-Wallis test was used for comparison of the DMFT and dft index. The significance level was set at p=0.05.

RESULTS

The prevalence of HP in dental plaque was higher in study group than controls (p<0.05). There were no significant differences between groups with respect to DMFT and dft scores, nutritional habits, tooth brushing frequency, saliva pH level or flow velocity (p>0.05). Meanwhile, the buffering capacity of saliva was lower in HP gastritis patients (p<0.05).

CONCLUSION

There was a high prevalence of HP in dental plaque; thus, the oral cavity may be an important reservoir for HP. Good oral hygiene could be a positive contributor to the treatment of gastritis.

A Newly Developed Nested PCR Assay for the Detection of Helicobacter pylori in the Oral Cavity

GOALS

To develop a new nested polymerase chain reaction (PCR) assay for identifying Helicobacter pylori DNA from dental plaque.

BACKGROUND

H. pylori is one of the most common chronic bacterial pathogens in humans. The accurate detection of this organism is essential for proper patient management and for the eradication of the bacteria following treatment.

STUDY

Forty-nine patients (24 males and 25 females; mean age: 51; range, 19 to 94 y) were investigated for the presence of H. pylori in dental plaque by single-step PCR and nested PCR and in the stomach by single-step PCR, nested PCR, and histologic examination.

RESULTS

The newly developed nested PCR assay identified H. pylori DNA in gastric biopsies of 18 patients who were histologically classified as H. pylori-positive and 2 additional biopsies of patients who were H. pylori-negative by histologic examination (20/49; 40.8%). Dental plaque samples collected before and after endoscopy from the 49 patients revealed that single-step PCR did not detect H. pylori but nested PCR was able to detect H. pylori DNA in 40.8% (20/49) patients. Nested PCR gave a higher detection rate (40.8%, 20/49) than that of histology (36.7%, 18/49) and single-step PCR. When nested PCR results were compared with histology results there was no significant difference between the 2 methods.

CONCLUSIONS

Our newly developed nested PCR assay is at least as sensitive as histology and may be useful for H. pylori detection in patients unfit for endoscopic examination.

Comparison of Helicobacter Pylori Genotypes Obtained from the Oropharynx and Stomach of the Same Individuals – A Pilot Study

Helicobacter pylorihas been recently detected in the oral cavity and oropharynx. However, the role it plays in oral and oropharyngeal pathogenesis remains unclear. The virulence ofH. pyloristrains can be distinguished according to the virulence factors genes carried. Our research has been focused on realtime PCR analysis ofcagAandvacAgenes ofH. pyloristrains in tonsils and tonsillar squamous cell cancer and their comparison withH. pyloristrains obtained from the gastric mucosa of the same patients. Urea breath test (UBT) test was used to detect a gastricH. pyloriinfection in 20 patients with previously provenH. pyloriin the oropharynx. Genotyping ofH. pyloriin gastric biopsies was performed in patients with positive gastric infection. Out of 20 patients positive for oropharyngealH. pylori, 8 were positive for concurrent gastricH. pyloriinfection. In 6 of them gastric biopsies were obtained. Comparison of oropharyngeal and stomachH. pylorigenotypes showed important differences. Four of 6 patients had differentH. pyloristrains in the oropharynx and stomach. The differences were found incagAgene as well as invacAgene. The finding of oral presence ofH. pyloriwithout concurrent stomach infection was confirmed using UBT. The results show that more than oneH. pyloristrain can be present in oropharynx and stomach in the same patient. The oropharyngeal infection seems to be independent to the gastric infection.

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.

The frequency of Helicobacter pylori in dental plaque is possibly underestimated

OBJECTIVE

The commonest bacteria, causing infection across the world is Helicobacter pylori, which colonizes the human stomach. This bacteria has also been detected in some extra-gastric ecological niches such as the oral cavity and water. However, the results of H. pylori detection in extra-gastric ecological niche are controversial. The improvement of the sensitivity and the specificity of the detection methods appear to be some of the main bottleneck issues in providing compelling evidence. The aim of this study was to detect the presence of this organism in dental plaque samples using an analytically sensitive and specific Polymerase Chain Reaction (PCR) as well as a new nucleic acid detection method termed the Loop-mediated Isothermal Amplification (LAMP).

DESIGN

In a descriptive cross-sectional study 45 participants enrolled and dental plaque samples were collected from at least two teeth surfaces (one anterior and one posterior tooth) using a sterile periodontal curette. The DNA content was extracted from the samples and the presence of H. pylori was determined by PCR and LAMP reactions.

RESULTS

The frequency of detection of H. pylori in the dental plaque samples were 44% (20/45), 66.67% (30/45) and 77.78% (35/45) using PCR, LAMP and positivity for both tests, respectively.

CONCLUSION

The high frequency of H. pylori was detected in the dental plaque samples of the participants, which concurs with the high prevalence of this bacteria in the population. This is one of the highest reported rates around the world. The results reveal that dental plaque can be one of the main causes of re-infection and also be the cause of oral-oral transmission.

Environmentally Transmitted Pathogens

This chapter describes a variety of pathogens found in the environment that are capable of infecting humans and causing disease. Different classes of pathogens are discussed including bacteria, parasites and viruses. For each pathogen, data are provided on the incidence of the organism in a particular environmental matrix such as water, food or municipal waste. In addition, we discuss: the disease caused by the particular microbe; the mode of transmission; the incubation time needed within the host prior to the onset of disease; and the duration of illness. Fate and transport of pathogens in the environment are also described. A variety of bacterial pathogens are discussed including waterborne and waterbased bacteria. Parasites discussed include protozoa, nematodes, cestodes and trematodes. For viruses, both enteric and respiratory viruses are included.

Oral Cavity as an Extragastric Reservoir of Helicobacter pylori

Background. Several studies were reported on the prevalence, and relationship between the existence of Helicobacter pylori (H. pylori) in oral cavity and in stomach of patients. The purpose of this study was to systematically review the existing literature on the presence of H. pylori in the oral cavity and its link to gastric infection, the existence of coinfection, and the impact of anti-H. pylori therapy on the dental plaque and vice versa. Method. Two authors independently searched the Medline, EMBASE, Cochrane Library, Web of Science, Google Scholar, and Scopus databases for relevant studies. The articles were analyzed critically and all qualified studies were included. The search was carried out by using a combined text and the MeSH search strategies: using the key words Helicobacter, Helicobacter pylori, and H. pylori in combination with dental plaque, periodontitis, and oral hygiene. Results. The data was presented in 8 tables and each topic separately discussed. Conclusion. Based on the systematic review of the available literature on H. pylori infection and its presence in the oral cavity, it can be concluded that dental plaque can act as a reservoir, and proper oral hygiene maintenance is essential to prevent reinfection. Due to the diversified methods and population groups involved in the available literature, no concrete evidence can be laid down. Further studies are necessary to establish the role of H. pylori in the oral cavity and its eradication on preventing the gastroduodenal infection.

Prevalence of Helicobacter pylori in adenotonsillar hypertrophy in children

CONCLUSION

Our results encourage the notion that the pharynx could be an extragastric reservoir of Helicobacter pylori (HP). The study confirmed the presence of HP in adenotonsillar tissue in children. It could have importance in the pathophysiology of upper respiratory diseases. However, its precise role in these processes remains unclear and requires further studies.

OBJECTIVE

A prospective study was carried out to evaluate the presence of HP in tonsillar and adenoid tissue in children. The study focused on real-time PCR analyzing CagA and VacA genotypes of HP strains.

METHODS

A total of 37 consecutive pediatric patients with adenotonsillar hypertrophy indicated for surgery were observed in a prospective study. Adenoidectomy and/or tonsillectomy was performed in each patient; 49 specimens were taken, 32 from adenoids and 17 from tonsils. The presence of HP and its genotype were tested in all samples by real-time PCR analysis.

RESULTS

Of 49 samples analyzed, 48 were positive for the presence of HP (98%), so only 1 sample was negative. While the genotype VacAs1bm2 was definitely dominant in adenoid tissue, wider distribution was observed in tonsillar tissue. Cag(+) strains represented one-fifth of all samples (21%).

A Cross-Sectional Survey of Dental Caries, Oral Hygiene, and Helicobacter pylori Infection in Adults

We explored the epidemiological risk factors for dental caries to help explain differences in the prevalence of adult dental caries. We examined 841 people for the presence of Helicobacter pylori in their dental plaque and for dental caries. Of the 841 subjects, 574 (68.25%) were infected with H pylori, and 516 (61.36%) were diagnosed with dental caries. Among the 574 subjects with H pylori, the prevalence of dental caries was 73.52% (422/574), while the prevalence among the 267 cases without H pylori was 35.21% (94/267). A correlation existed between the presence of H pylori and the occurrence of dental caries (χ2 = 112.8, P < .01, odds ratio = 5.110, 95% confidence interval = 3.740-6.982). The 574 persons with H pylori had a higher mean dental plaque index than those without. In conclusion, H pylori infection in the oral cavity is associated with dental caries and poor dental hygiene.

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.

Presence of Helicobacter pylori in subgingival plaque of periodontitis patients with and without dyspepsia, detected by polymerase chain reaction and culture

BACKGROUND

Helicobacter pylori is an important gastrointestinal pathogen that is strongly associated with gastritis as well as peptic ulcer disease. Antimicrobial therapy frequently fails to cure H. pylori infection, which suggests there may be sanctuary sites where the organism resides. This study was aimed to assess the role of oral cavity as a reservoir of H. pylori by evaluating the occurrence of the organism in subgingival plaque of dyspeptic patients by polymerase chain reaction as well as culture.

MATERIALS AND METHODS

Thirty chronic periodontitis patients whose biopsy specimens were found to be H. pylori positive with rapid urease test and histopathologic examination were considered as cases and 20 chronic periodontitis patients who never had any symptoms of gastritis or peptic ulcer were taken as controls. Subgingival plaque samples were collected and sent to microbiological laboratory for detection of H. pylori by 16S rRNA based polymerase chain reaction as well as culture.

RESULTS

60% of the samples were found to be positive with polymerase chain reaction in the case group when compared to 15% in the controls. Also, 30% of the cases were found to be positive with culture compared to none in controls.

CONCLUSION

A higher frequency of detection of H. pylori in those patients with positive antral biopsy report was seen. Also, polymerase chain reaction was found to be more sensitive than culture for detection. Thus, we conclude that detection of H. pylori in dental plaque of dyspeptic patients cannot be neglected and might represent a risk factor for recolonization of stomach after systemic eradication therapy.

Urease and Helicobacter spp. antigens in pulmonary granuloma

Pulmonary sarcoidosis, a human disease of unknown cause, has no animal model. Sarcoidosis patients have serum antibodies specific for Helicobacter pylori and its surface enzyme urease. H. pylori do not survive in the high-oxygen pulmonary atmosphere, but urease may access the lung by oesophageal reflux. A model was established in rats to study gastro-oesophageal reflux of urease into the airways. Pathology in tissues from human sarcoidosis patients was compared with that in the rat model. Changes observed in the rat model included prominent peribronchial lymphocytic infiltration, which is seen occasionally in human sarcoidosis. Granulomas, pathognomonic for human sarcoidosis, occurred occasionally in the lungs of rats given urease protein intratracheally, but were widespread when urease was coupled to microbeads and administered intravenously. Biomarkers associated with human sarcoidosis (interleukin1-β and platelet-activating factor) were up-regulated acutely in the rat model. Further investigations with this model may provide significant insights into the origin and pathogenesis of pulmonary diseases in man and other species that carry gastric Helicobacter spp. and its associated enzyme.

Live Helicobacter pylori in the root canal of endodontic-infected deciduous teeth

BACKGROUND

Many polymerase chain reaction (PCR)-based studies have shown that Helicobacter pylori DNA is prevalent in the oral cavity, but reports on the isolation of live bacteria are extremely rare. Thus, it is still unclear whether H. pylori can indeed survive in the oral environment.

METHODS

Here we used electron microscopy, selective growth techniques, urease assays, 16S rRNA PCR, and western blotting to investigate the possible presence of live H. pylori in 10 root canal and corresponding plaque samples of endodontic-infected deciduous teeth in three children.

RESULTS

Although H. pylori DNA was verifiable by PCR in several plaque and root canal samples, bacterial colonies could only be grown from two root canals, but not from plaque. These colonies were unequivocally identified as H. pylori by microscopic, genetic, and biochemical approaches.

CONCLUSIONS

Our findings show that root canals of endodontic-infected teeth may be a reservoir for live H. pylori that could serve as a potential source for transmission.

Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association?: a scientific statement from the American Heart Association

A link between oral health and cardiovascular disease has been proposed for more than a century. Recently, concern about possible links between periodontal disease (PD) and atherosclerotic vascular disease (ASVD) has intensified and is driving an active field of investigation into possible association and causality. The 2 disorders share several common risk factors, including cigarette smoking, age, and diabetes mellitus. Patients and providers are increasingly presented with claims that PD treatment strategies offer ASVD protection; these claims are often endorsed by professional and industrial stakeholders. The focus of this review is to assess whether available data support an independent association between ASVD and PD and whether PD treatment might modify ASVD risks or outcomes. It also presents mechanistic details of both PD and ASVD relevant to this topic. The correlation of PD with ASVD outcomes and surrogate markers is discussed, as well as the correlation of response to PD therapy with ASVD event rates. Methodological issues that complicate studies of this association are outlined, with an emphasis on the terms and metrics that would be applicable in future studies. Observational studies to date support an association between PD and ASVD independent of known confounders. They do not, however, support a causative relationship. Although periodontal interventions result in a reduction in systemic inflammation and endothelial dysfunction in short-term studies, there is no evidence that they prevent ASVD or modify its outcomes.

Searching for Helicobacter pylori and Chlamydia pneumoniae in primary endodontic infections

OBJECTIVES

The purpose of this study was to search samples from primary endodontic infections for the presence of two common human bacterial pathogens - Helicobacter pylori and Chlamydia pneumoniae.

METHODS

Genomic DNA isolated from samples taken from 25 root canals of teeth with asymptomatic (chronic) apical periodontitis and 25 aspirates from acute apical abscess was initially amplified by the multiple displacement amplification approach and then used as template in species-specific polymerase chain reaction (PCR) for detection of H. pylori and C. pneumoniae.

RESULTS

All clinical samples were positive for the presence of bacterial DNA. However, no clinical sample was positive for either H. pylori or C. pneumoniae.

CONCLUSIONS

Neither H. pylori nor C. pneumoniae were found in samples from primary endodontic infections. These findings suggest that these species are not candidate endodontic pathogens and that the necrotic root canal does not serve as a reservoir for these human pathogens in healthy patients.

Absence ofHelicobacter pyloriin healthy laryngeal mucosa

Objectives:

To evaluate the presence ofHelicobacter pyloriin healthy laryngeal mucosa.

Design:

Prospective analysis ofHelicobacter pyloricolonisation in healthy laryngeal mucosa, using the13C urea breath test and polymerase chain reaction analysis.

Subjects:

Twenty randomly chosen men (28–78 years) without laryngeal pathology or gastrointestinal disease were investigated. All subjects were scheduled for elective operative procedures, under general, endotracheal anaesthesia. Cytobrush samples were taken forHelicobacter pyloriDNA detection. Nested polymerase chain reaction testing was performed on DNA solutions using two primer pairs from the urease A gene of theHelicobacter pylorigenome. The13C urea breath test was performed on two exhalation samples.

Results:

Eight (40 per cent) of the subjects were positive for urease on urea breath testing; none were positive forHelicobacter pyloriDNA on polymerase chain reaction testing.

Conclusion:

Based on these results, we do not considerHelicobacter pylorito be a normal constituent of healthy laryngeal microflora.

The occurrence of Helicobacter pylori antigens in dental plaque; an association with oral health status and oral hygiene practices

PURPOSE

Helicobacter pylori present in the oral cavity can be a source of gastric infection. Since in the oral cavity H. pylori is mostly found in dental plaque, the aim of the study was to determine whether the oral health status and oral hygiene practices affect the incidence of H. pylori antigens in dental plaque.

MATERIALS AND METHODS

The study was performed in 155 patients aged 19-78 years. Patients who had taken antibiotics within 4 weeks preceding the study and those with a past history of H. pylori eradication were excluded. Each patient filled out a questionnaire on the procedures of dental plaque removal from natural teeth and dentures, and underwent oral examination. H. pylori antigens in supragingival plaque were determined by the immunological method with the use of a kit for detection of H. pylori antigens in stool samples.

RESULTS

The presence of H. pylori antigens in dental plaque was found in 65.6% of the study subjects. The oral health status, frequency of dentist visits as well as the number and technique of dental plaque removal from natural teeth and dentures did not differ significantly between patients with infected and non-infected dental plaque.

CONCLUSIONS

The occurrence of H. pylori antigens in dental plaque of natural teeth is not associated with oral health status or dental plaque removal practices from both natural teeth and removable dentures.

Presence of Helicobacter pylori in supragingival dental plaque of individuals with periodontal disease and upper gastric diseases

BACKGROUND

Helicobacter pylori is a Gram-negative microorganism which is able to colonize the gastric mucosa and is associated with peptic ulcer, gastric carcinoma, and gastric mucosa-associated lymphoid tissue lymphoma. Several studies have detected this bacterium in the oral cavity, suggesting it as a potential reservoir. The aim of this study was to investigate the presence of H. pylori in the oral cavity of individuals with periodontal disease and gastric diseases.

METHODS

115 individuals, with mean age 49.6 (±5.8) years, were divided in 4 groups: (A) with gastric diseases and periodontal disease; (B) with gastric diseases and no periodontal disease; (C) without gastric diseases and without periodontal disease, (D) without gastric diseases and with periodontal disease. Supra and subgingival plaque samples were collected from posterior teeth of the individuals with sterile paper points, and prepared for Polymerase Chain Reaction analysis. Fisher's exact test was used for detecting statistical differences between groups (p<0.05).

RESULTS

H. pylori was detected in supragingival plaque of 9/36 (25%) of group A, 1/31 (0.3%) of group B, 0 (0%) of group C and 3/36 (8.3%) of group D. No subgingival samples were positive for H. pylori. There was a statistically higher prevalence of H. pylori in groups A and D when compared to B and C (p<0.05).

CONCLUSION

H. pylori was detected in the supragingival plaque, but not in the subgingival plaque, of individuals with periodontal disease and upper gastric diseases. There was an association between the supragingival colonization of H. pylori and oral hygiene parameters such as the presence of plaque and gingival bleeding.

Oxidative stress induced mechanisms in the progression of periodontal diseases and cancer: a common approach to redox homeostasis?

There is documented evidence of significant associations between cancer of the lung, kidney, pancreas, hematological and oral cancers and periodontal diseases of the supporting structures of the teeth. Enhanced lipid peroxidation, raised levels of TBARS and the oxidative stress marker malondealdehyde have been detected in breast cancer with reduced antioxidant capacity, also characteristic of periodontal diseases. Antioxidants could overcome this deficit and attenuate disease progression by down regulating glutathione detoxification/redox buffering system and inhibiting key transcription factors. Periodontal disease may be a critical marker of a susceptible immune system, or initiate cancer risk with a pro-oxidant inflammatory profile.

Effect of dental plaque control on infection of Helicobacter pylori in gastric mucosa

BACKGROUND

Data on the role of dental plaque in the transmission of Helicobacter pylori have varied. Furthermore, there has been few reports on the relationship between dental plaque control and H. pylori infection of gastric mucosa. The purpose of this study was to elucidate this potential relationship.

METHODS

The (13)C urea breath test was conducted on 56 subjects who received dental plaque control and 51 subjects who did not.

RESULTS

The prevalence of H. pylori in the gastric mucosa was 19.64% in patients who received dental plaque control, which was significantly lower than in those without dental plaque control (84.31%).

CONCLUSION

Long-term professional dental plaque control was associated with less gastric reinfection by H. pylori, suggesting that dental plaque control may help to prevent H. pylori-induced gastric disease or reinfection.

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.

Unreliability of results of PCR detection of Helicobacter pylori in clinical or environmental samples

The aim of this study was to compare published Helicobacter pylori primer pairs for their ability to reliably detect H. pylori in gastric biopsy specimens and salivary samples. Detection limits of the 26 PCR primer pairs previously described for detection of H. pylori DNA in clinical samples were determined. Sensitivity and specificity were determined using primers with detection limits of <100 CFU/ml using 50 H. pylori-positive and -negative (by concordance by culture and histology) coded gastric biopsy specimens. These results were then confirmed with gastric biopsy specimens and saliva from patients with confirmed H. pylori status. Five of the twenty-six previously reported primer pairs (HP64-f/HP64-r, HP1/HP2, EHC-U/EHC-L, VAG-F/VAG-R, and ICT37/ICT38) had detection limits of <100 CFU/ml in the presence of gastric tissue. None had 100% specificity or sensitivity; all produced false-positive results. The HP64-f/HP64-r for ureA and HP1/HP2 for 16S rRNA individually had sensitivities and specificities of >90% with gastric biopsy specimens. No combinations of primer pairs improved the results. Using these five primer pairs, 54% of the positive saliva samples were determined to be false positive; both the HP64-f/HP64-r and the HP1/HP2 sets produced false positives with saliva. We conclude that clinicians should not rely on results using current PCR primers alone to decide the H. pylori status of an individual patient or as a basis for treatment decisions. The results of studies based on PCR identification of H. pylori in environmental samples should be viewed with caution. Possibly, specific primers sets can be identified based on the presence of multiple putative virulence factor genes.

Environmentally Transmitted Pathogens

Pathogenic microorganisms usually originate from an infected host or directly from the environment; however, only a small proportion of these microbes cause infection. This chapter discusses the pathogens that are transmitted through the environment such as bacteria, viruses, and protozoa. Many human pathogens can be transmitted only by direct or close contact with an infected person or animal such as herpesvirus. Virus transmission by the airborne route may be both direct and indirect inhalation of infectious droplets or through contact with contaminated fomites. Water-borne diseases—such as yellow fever, dengue, filariasis, malaria, onchocerciasis, and sleeping sicknessare transmitted by insects that breed in water or live near water. The common bacterial pathogens transmitted through water include Salmonella, Escherichia coli, Shigella, Campylobacter, Yersinia, Vibrio, Helicobacter, and Legionella. Opportunistic pathogens are also numerous in the environment, and the most important opportunistic pathogen is Pseudomonas aeruginosa. Viruses are a leading cause of gastroenteritis and water-borne outbreaks may be caused by norovirus, hepatitis A virus, Coxsackie virus, echovirus, and adenoviruses. Respiratory diseases are also associated with a large number of viruses such as rhinoviruses, coronaviruses, parainfluenza viruses, respiratory syncytial virus (RSV), influenza virus, and adenovirus. Generally, viral and protozoan pathogens survive longer in the environment than enteric bacterial pathogens.

Study on the relationship between Helicobacter pylori in the dental plaque and the occurrence of dental caries or oral hygiene index

BACKGROUND

The aims of our study were to determine the presence of Helicobacter pylori DNA in the dental plaque of Chinese children aged 3-6 years by nested polymerase chain reaction (PCR) and to investigate the relationship between this infection and the occurrence of dental caries or oral hygiene index.

METHODS

Two hundred and fourteen children from a kindergarten in Guangzhou City of China were evaluated. The children's plaques were assessed by plaque indices of Quigley-Hein. Dental plaque was analyzed using nested PCR for two sets of primers directed to the 860-bp fragment of H. pylori genomic DNA, which have been reported to be highly sensitive and specific by other researchers.

RESULTS

H. pylori was detected in dental plaque samples from 126 children, and 70 children with dental caries carried H. pylori in dental plaque. Of these children without infection, only 36 of 88 suffered dental caries. Besides, the average dental plaque index of 126 H. pylori-positive children was higher than that of 88 children without infection. In the present study, there was a significant correlation between H. pylori infection and dental caries or dental hygiene.

CONCLUSION

The oral cavity may be a reservoir for H. pylori infection in children. H. pylori in dental plaque may play a role in the occurrence of dental caries, and poor oral hygiene may represent a risk factor for H. pylori in the oral cavity.

Detection of Helicobacter pylori by polymerase chain reaction in the subgingival biofilm and saliva of non-dyspeptic periodontal patients

BACKGROUND

Helicobacter pylori has been associated with the development of peptic ulcers and gastric cancer. Although the oral cavity may be a source of transmission, it is unknown whether it acts as a permanent reservoir for this bacterium, particularly in the presence of periodontal disease. The purpose of this study was to evaluate the prevalence of H. pylori by polymerase chain reaction (PCR) in the subgingival biofilm and saliva of subjects with periodontitis.

METHODS

Samples were obtained from 56 periodontally healthy subjects and 169 subjects with chronic periodontitis. DNA was extracted from the samples, and the detection of H. pylori was carried out by PCR using the JW22/23 primers.

RESULTS

In general, H. pylori was detected in 24% of all samples evaluated. A significantly higher prevalence of H. pylori was observed in subgingival biofilm samples (33.3%) compared to saliva samples (20%) (P <0.05). H. pylori was detected significantly more often in the saliva and subgingival samples from subjects with periodontitis (23.5% and 50%, respectively) compared to samples from periodontally healthy subjects (7.3% and 11.4%, respectively; P <0.05).

CONCLUSION

H. pylori was detected frequently in the oral microbiota of subjects with periodontitis, suggesting that periodontal pocketing and inflammation may favor the colonization by this species.

A critical evaluation of the evidence on a causal relationship betweenHelicobacter pyloriand otitis media with effusion

Objective:

There is growing interest in the presence ofHelicobacter pyloriin the upper aerodigestive tract, and in the middle ear in patients with otitis media with effusion. Some studies have reported detectingH pyloriin the middle ear, although reports to the contrary exist. In this study, we critically evaluate the evidence for the theory thatH pyloriin the middle ear plays a role in otitis media with effusion.

Material:

We undertook a systematic review of all available studies investigating the presence ofH pyloriin the middle ear of patients with otitis media with effusion. The current literature was critically analysed using the key words and phrases ‘Helicobacter pylori’ ‘otitis media with effusion’, ‘serous otitis media’, ‘glue ear’ and ‘middle ear’. Six original research papers were identified, studying a total of 203 patients and 27 controls; two of these papers were randomised, controlled studies and four were prospective, cohort studies.

Results:

At present, there is poor evidence for the existence ofH pylori-associated otitis media with effusion.

Conclusions:

Further research in the field is needed in order to delineate the presence ofH pyloriand its role in the pathogenesis of otitis media with effusion.

Helicobacter pylori in the oral mucosa of patients submitted to allogeneic haematopoietic stem cell transplantation

This study was designed to investigate the impact of haematopoietic stem cell transplantation (HSCT) on Helicobacter pylori colonization of the oral mucosa by nested polymerase chain reaction (nested-PCR). Forty six consecutive patients submitted to HSCT and 46 healthy volunteers were included in the study. Oral swabs were taken from the oral mucosa of the patients and control group. The medical records of the patients were reviewed and the following information was retrieved: gender and age of the patient, donor gender, primary disease, stem cell source (bone marrow or blood stem cells), leukocyte, neutrophil and platelet counts, and chronic graft versus host disease (cGVHD) of salivary glands. The results demonstrated an increased frequency of H. pylori in the oral mucosa of HSCT patients compared to controls (rho = 0.002). The presence of H. pylori in the oral mucosa was not related to the severity of cGVHD. The median counts of platelet/mm3, leukocytes/mm3 and neutrophils/mm3 in the group of HSCT patients positive for H. pylori were not statistically different from those of the patients negative for it. In conclusion, the present study shows increased frequency of H. pylori in the oral mucosa of HSCT patients compared to non-transplanted healthy volunteers.

Implications of oral Helicobacter pylori for the outcome of its gastric eradication therapy

BACKGROUND AND AIMS

Helicobacter pylori (H. pylori) is an important pathogen in gastritis, peptic ulcer and possibly gastric cancer, but several questions remain unanswered. Particularly how the organism is transmitted and what is the relationship between oral presence of H. pylori and the gastric infection. Accordingly, we aimed to characterize the H. pylori in oral cavity and to evaluate its relationship to gastric H. pylori infection.

MATERIALS AND METHODS

Out of total 100 screened for H. pylori infection female subjects (40 to 85 y), 49 patients (pts), who had positive C-urea breath test (UBT) and dyspeptic symptoms, agreed for 1 week regimen of triple anti-H. pylori therapy. The presence of H. pylori in oral cavity was assessed using bacterial culture from saliva and gingival pockets. Gastric H. pylori infection was estimated using capsulated C-urea breath test and plasma anti-H. pylori IgG and saliva IgA antibodies. In addition, plasma gastrin, ghrelin, and pepsinogen I were measured by radioimmunoassay. In selected patients, gastroscopy was additionally performed and gastric biopsy samples were taken for H. pylori random amplification of polymorphic DNA genetic profiling.

RESULTS

The triple therapy resulted in gastric H. pylori eradication in 79% pts, along with significant decrease of plasma gastrin combined with an increase in plasma ghrelin and pepsinogen I (PgI) levels and a marked alleviation of dyspeptic symptoms. In contrast to gastric effects, the eradication therapy failed to cause any changes in the presence of H. pylori in oral cavity. Moreover no relationship was observed between the presence of H. pylori in oral cavity and the gastric H. pylori eradication. In line with these findings, no relationship between gastric and oral H. pylori was found using genetic profiling by random amplification of polymorphic DNA.

CONCLUSIONS

H. pylori was detected both in the oral cavity and the stomach but oral H. pylori had no relation to gastric H. pylori and remained unaffected by eradication of gastric H. pylori.

Prevalence of Campylobacter species, Helicobacter pylori and Arcobacter species in stool samples from the Venda region, Limpopo, South Africa: studies using molecular diagnostic methods

OBJECTIVES

This study determined the prevalence of Campylobacter spp., Helicobacter pylori and Arcobacter spp. in stool samples from Venda in relation to diarrhea, intestinal inflammation and HIV status using specific molecular methods.

METHODS

Stool samples were collected from hospital patients (255) and primary school children (67). Genomic DNA was extracted from the stools and molecular methods including PCR, PCR followed by restriction analysis and multiplex PCR were used to test for the different organisms. The lactoferrin content of the stools was determined using commercial kits from TechLab (Blacksburg, VA, USA).

RESULTS

The prevalence of the different organisms was 50.6% for H. pylori, 10.2% for C. jejuni, 6.2% for A. butzleri, 6.5% for C. coli, 3.1% for C. concisus, 2.8% for A. cryaerophilus and 1.9% for A. skirrowii. Of all the organisms, only C. jejuni was significantly associated with diarrhea (84.8%) (chi2=21.025, P<0.001) and elevated levels of lactoferrin (78.8%) (chi2=16.919, P<0.005) and was an important pathogen associated with diarrhea among HIV positive individuals (22.8%).

CONCLUSIONS

Campylobacter infections are common causes of gastroenteritis in Venda. Non-C. jejuni/coli Campylobacters such as C. concisus as well as A. butzleri and H. pylori may be involved in gastrointestinal diseases in the region but further studies are needed to confirm this hypothesis.

Association between hepatitis A virus and Helicobacter pylori in a developing country: the saga continues

BACKGROUND

The epidemiologic association between Helicobacter pylori and hepatitis A virus (HAV) has been evaluated by various different groups with conflicting conclusions. The aim of the present study was to determine the prevalence of HAV and H. pylori infection among adolescents attending high schools in Lebanon, and to identify the sociodemographic factors associated with their prevalence, individually and concurrently.

METHODS

Nine hundred and two school students 14-18 years of age were selected randomly from 30 schools scattered all over Lebanon and tested for IgG antibodies against hepatitis A and H. pylori. Each student received a copy of a self-administered questionnaire to be completed by his/her parents inquiring about demographics, history of immunization, and prior viral hepatitis illness in the student. Bivariate analysis examined the association between different sociodemographic variables and prior HAV or H. pylori infection, and multivariate regression analysis was done to determine the factors independently associated with prior infection.

RESULTS

Using ELISA the seroprevalence of antibodies against HAV was 71.3% as compared to 61.6% for anti-H. pylori. A total of 9.1% of those tested were negative for both agents. A multinomial regression analysis revealed that place of residence in relation to district or urban versus rural areas, in addition to mothers' education, were important determinants for the incidence of both agents.

CONCLUSION

The low number of subjects negative for both H. pylori and HAV antibodies in Lebanon is indicative of their high prevalence in the country. It is possible that this high prevalence reflects an age-specific prevalence rather than a true association.

Persistence of Helicobacter pylori in the oral cavity after systemic eradication therapy

AIM

The present study aimed to evaluate if the oral cavity of chronic periodontitis patients can harbor Helicobacter pylori after systemic eradication therapy.

MATERIALS AND METHODS

Samples of 30 patients (15 with gingivitis and 15 with chronic periodontitis) positive for H. pylori in the stomach were evaluated. Samples were collected 3 months after triple systemic antibiotic therapy from saliva, microbiota from the dorsum of the tongue, supra- and sub-gingival plaque as well as gastric biopsies. DNA of each sample was extracted by the boiling method and used as a template in polymerase chain reaction with the primers JW22/23.

RESULTS

Eighteen patients (60%) harboured H. pylori in their mouths. Five patients (16.6%) were positive in saliva, two (6.6%) on the dorsum of the tongue, nine (30%) in supra-gingival plaque, 14 (46.6%) in sub-gingival plaque and three (10%) in the stomach. There was no statistically significant difference between study groups.

CONCLUSION

Eradication of H. pylori after therapy was more effective for the stomach than for the mouth (p<0.001). Mouths of patients with gingivitis or with chronic periodontitis, who are positive for H. pylori in their stomachs, may be considered as reservoirs of these bacteria.

Comparison of a monoclonal antigen stool test (Hp StAR) with the 13C-urea breath test (UBT) in monitoring Helicobacter pylori eradication therapy

AIM: To evaluate the agreement between a mAb-based stool test (HP StAR) and the urea breath test (UBT) in monitoring (H pylori) infection after eradication therapy.

METHODS: Patients with discordant results on UBT and Hp StAR underwent endoscopy with biopsies for rapid urease test, culture, and histology to confirm H pylori status.

RESULTS: Among 250 patients (50±14 years), 240 (96.0%) had concordant UBT and Hp StAR tests with a significant correlation between DOB and A values (R = 0.87; P<0.0001). The remaining 10 (4.0%) patients had discordant tests (positive Hp StAR and negative UBT) with the Hp StAR inaccurate in five cases (false positive) and UBT inaccurate in the other five cases (false negative). The “maximal expected” sensitivity, specificity, +PV, -PV, +LR, and -LR were 91%, 100%, 100%, 97.4%, , and 8.2 respectively, for the UBT, and 100%, 97.4%, 91%, 100%, 38.8, and 0, respectively, for the Hp StAR. Overall accuracy for both tests was 98%.

CONCLUSION: Both the UBT and the Hp StAR are equally accurate in monitoring H pylori infection. Nowadays, the choice of the “best” non-invasive H pylori test in the post-treatment setting should be done not only in terms of diagnostic accuracy but also in view of cost and local facilities.

Occurrence of Helicobacter pylori in dental plaque and saliva of dyspeptic patients

BACKGROUND

Helicobacter pylori infection in the stomach is associated with gastric and duodenal ulcers, gastric cancers and gastric lymphoma. The organism is transmitted by ingestion, but the oral-oral route and the fecal-oral route are also suggested. The prevalence of infection with H. pylori in developing countries, including Brazil, is higher than in developed countries.

PURPOSE

This study aimed to evaluate the role of the oral cavity as a reservoir of this species, by evaluating the occurrence of H. pylori in supragingival dental plaque and in saliva of Brazilian dyspeptic patients, whether harboring the organism or not in the stomach.

MATERIAL AND METHODS

Forty-nine patients reporting dyspeptic symptoms were subjected to oral clinical examination and collection of saliva and supragingival dental plaque samples prior to the endoscopic examination. The detection of H. pylori in oral samples was performed by PCR using 16S rRNA primers. The bacteria were detected in stomach by means of the rapid urease test.

RESULTS

Helicobacter pylori was detected in the stomach of 20 of 49 subjects reporting dyspeptic symptoms. The organism was detected in only one supragingival plaque sample, obtained from a patient positive for the urease test in the stomach and in none of the salivary samples.

CONCLUSION

Supragingival dental plaque and saliva may not be relevant reservoirs of H. pylori.

Well water--one source of Helicobacter pylori colonization

Helicobacter pylori (H. pylori) is one of the world's most widespread microorganisms. Its acquisition in humans remains poorly understood, however, epidemiological studies have identified drinking water as reservoir for the bacterium. The aim of this study was to investigate the prevalence of H. pylori infection among individuals using or drinking previously H. pylori tested well water. Applying household cluster sampling, a total of 91 subjects, all using or drinking well water (13 of either H. pylori positive or negative wells), were screened for their H. pylori status. The group was comprised of 73 adults and 19 children under the age of 18. H. pylori infection was determined using the [13C]urea breath test. A self-administered or parent-completed questionnaire provided information on living conditions and lifestyle habits including the use or drinking of well water. Logistic regression analyses associated the drinking of H. pylori positive well water with a positive colonization status [Odds Ratio (OR) 8.3; 95% confidence interval (95% CI) 2.4-29]. In summary, the use or drinking of H. pylori contaminated well water appears associated with the acquisition of a H. pylori infection. This study is based on a relatively small and inhomogeneous population sample and should be repeated to confirm the results.

Prevalence of Helicobacter pylori detected by polymerase chain reaction in the oral cavity of periodontitis patients

Helicobacter pylori is an important gastrointestinal pathogen associated with gastritis, peptic ulcers, and an increased risk of gastric carcinoma. The oral cavity has been indicated as a possible H. pylori reservoir, and may therefore be involved in the reinfection of the stomach which sometimes follows treatment of H. pylori infection. The objective of the present study was to evaluate the prevalence of H. pylori as detected by polymerase chain reaction (PCR) in the oral cavity of periodontitis patients testing positive for this bacterium in the stomach. Thirty adult patients with alterations of the superior digestive tract, testing urease positive after endoscopy and biopsy, were selected. A full-mouth periodontal examination was performed in every patient and the subjects were allocated to two groups: gingivitis (15 patients) and chronic periodontitis (15 patients). Plaque and saliva samples collected from each patient were stored in 0.5 ml of TE buffer. DNA was extracted from the samples by the boiling method and was evaluated for the presence of H. pylori using the PCR method. JW 22/23 primers were used. The DNA of ATCC H. pylori 43629 (positive control) and water (negative control) were used for controlling the reactions. Of the 30 evaluated patients, 13 (43.3%) harbored H. pylori in the mouth. The bacterium was not found on the dorsum of the tongue of any patient, but was found in saliva in three patients (10%), in the supragingival plaque in six patients (20%), and in the subgingival plaque in eight patients (26.6%). The presence of H. pylori was similar in the gingivitis and chronic periodontitis groups. In conclusion, a high percentage of patients harbored H. pylori in their mouth. The bacterium was detected in saliva, supragingival and subgingival plaque, suggesting that these sites may be considered reservoirs for H. pylori in urease-positive patients.

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.