Published online Oct 21, 2013. doi: 10.3748/wjg.v19.i39.6645
Revised: June 1, 2013
Accepted: July 4, 2013
Published online: October 21, 2013
Processing time: 263 Days and 15.1 Hours
AIM: To evaluate the influence of oral Helicobacter pylori (H. pylori) on the success of eradication therapy against gastric H. pylori.
METHODS: A total of 391 patients with dyspepsia were examined for H. pylori using the saliva H. pylori antigen test (HPS), 13C-urea breath test (UBT), gastroscopy, and gastric mucosal histopathological detection. Another 40 volunteers without discomfort were subjected to HPS and 13C-UBT, and served as the control group. The 233 patients who were 13C-UBT+ were enrolled in this study and divided into 4 groups. Patients who were HPS- and 13C-UBT+ (n = 53) received triple therapy alone. Those who were both HPS+ and 13C-UBT+ (n = 180) were randomly divided into 3 groups: (1) the O+G+t group which received triple therapy alone (n = 53); (2) the O+G+tm group which received both triple therapy and mouthrinse treatment (n = 65); and (3) the O+G+tmp group which received triple therapy, mouthrinse, and periodontal treatment (n = 62). The HPS and 13C-UBT were continued for 4 wk after completion of treatment, and the eradication rate of gastric H. pylori and the prevalence of oral H. pylori in the 4 groups were then compared.
RESULTS: The eradication rates of gastric H. pylori in the O-G+t group, the O+G+tm group, and the O+G+tmp group were 93.3%, 90.0%, and 94.7% respectively; all of these rates were higher than that of the O+G+t group (78.4%) [O-G+t group vs O+G+t group (P = 0.039); O+G+tm group vs O+G+t group (P = 0.092); O+G+tmp group vs O+G+t group (P = 0.012); O+G+tm group vs O-G+t group (P = 0.546); O+G+tmp group vs O-G+t group (P = 0.765); O+G+tm group vs O+G+tmp group (P = 0.924)]. The eradication of gastric H. pylori was significantly improved using the combination of triple therapy, mouthrinse, and periodontal treatment. The eradication rates of gastric H. pylori in the peptic ulcer group, chronic atrophic gastritis group and control group were higher than in the duodenitis group and the superficial gastritis group. The prevalence rates of oral H. pylori in the O-G+t group, O+G+t group, O+G+tm group and O+G+tmp group following treatment were 0%, 76.5%, 53.3%, and 50.9%, respectively [O-G+t group vs O+G+t group (P < 0.0001); O+G+tm group vs O+G+t group (P = 0.011); O+G+tmp group vs O+G+t group (P = 0.006); O+G+tm group vs O-G+t group (P < 0.0001); O+G+tmp group vs O-G+t group (P < 0.0001); O+G+tm group vs the O+G+tmp group (P = 0.790)]. Both mouthrinse and periodontal treatment significantly reduced the prevalence of oral H. pylori.
CONCLUSION: Mouthrinse treatment alone or combined with periodontal treatment can, to some extent, reduce the prevalence of oral H. pylori and improve the eradication rate of gastric H. pylori.
Core tip: The average eradication rate of gastric Helicobacter pylori (H. pylori) has decreased in recent years. However, some foreign studies have shown that the eradication rate of gastric H. pylori may be improved by eliminating the presence of oral H. pylori rather than increasing the dose of antibiotics. In most studies, H. pylori DNA was detected and used to confirm oral H. pylori infection, and later determine whether professional periodontal treatments were effective in killing oral H. pylori. To avoid the expensive and complicated techniques involved with this approach, the current study used a cost-effective and simple method to test for and eliminate oral H. pylori. This method can be used to prove the elimination of gastric H. pylori, and is practical for use in the clinic.