Prospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 27, 2023; 15(12): 1325-1332
Published online Dec 27, 2023. doi: 10.4254/wjh.v15.i12.1325
High incidence of periodontitis in patients with ascitic decompensated cirrhosis
Sven Pischke, Mohamad Motee Ashouri, Ulrike Peters, Anita Shiprov, Julian Schulze Zur Wiesch, Martina Sterneck, Frank Fischer, Peter Huebener, Maria Mader, Lutz Fischer, Thorben Fründt, G Aarabi, Thomas Beikler
Sven Pischke, First Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg 20246, Germany
Mohamad Motee Ashouri, Anita Shiprov, Julian Schulze Zur Wiesch, Martina Sterneck, Peter Huebener, Maria Mader, Thorben Fründt, First Department of Medicine, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
Mohamad Motee Ashouri, Anita Shiprov, Periodontics, Preventive and Restorative Dentistry, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
Ulrike Peters, Frank Fischer, G Aarabi, Thomas Beikler, Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
Lutz Fischer, Department of Visceral Transplantation, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
Author contributions: Pischke S and Ashouri MM contributed equally to this work; Pischke S, Ahouri MM, Peters U, Shiprov A, Schulze Zur Wiesch J, Sterneck M, Fischer F, Hüberner P, Mader M, Fischer L, Fründt T, Aarabi G and Beikler T designed this study and wrote the manuscript.
Institutional review board statement: This prospective study was reviewed and approved by the Ethics Committee of the Medical Council of Hamburg (PV-4081 and MC-368/18). The study was performed according to the recommendations of the Declaration of Helsinki. The retrospective analysis of the control cohort was completely anonymized and therefore did not require any clarification or formal ethics committee approval according to local laws and regulations.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sven Pischke, MD, PhD, Associate Professor, Department of Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany. spischke@uke.de
Received: August 29, 2023
Peer-review started: August 29, 2023
First decision: September 14, 2023
Revised: September 27, 2023
Accepted: December 6, 2023
Article in press: December 6, 2023
Published online: December 27, 2023
Processing time: 117 Days and 17.5 Hours
Abstract
BACKGROUND

Periodontitis has been associated with various liver diseases. However, the relevance of periodontitis in the progression of decompensated cirrhosis remains inconclusive. In particular, it is unclear whether the common periodontitis pathogens, Porphyromonas gingivalis (P. gingivalis) and Actinobacillus actinomycetemcomitans (A. actinomycetemcomitans), can be detected not only in the oral mucosa but also in ascites and stool.

AIM

To investigate the significance of periodontitis, P. gingivalis, and A. actinomycetemcomitans in cirrhosis patients with ascitic decompensation.

METHODS

This prospective study was conducted at the University Hospital Hamburg-Eppendorf, a tertiary center in Northern Germany. A cohort of 27 patients with ascitic decompensated liver cirrhosis underwent dental examinations to assess the association between periodontitis and various clinical parameters of cirrhosis, as well as patient outcomes. PCR was used to test gingival samples, ascites, and stool for the presence of P. gingivalis and A. actinomycetemcomitans. Gingival samples were collected by probing the deepest gum pocket of a sextant and wiping them on a cotton swab.

RESULTS

Periodontitis was diagnosed in 22 out of 27 (82%) ascite patients, which is significantly more common than in a control cohort of 100 unselected patients (59%, P = 0.04). P. gingivalis was detected in the gingiva of six patients, and one of them also had P. gingivalis in their stool. However, P. gingivalis was not found in the ascites of any patient. Five out of six patients with P. gingivalis had periodontitis (83%). A. actinomycetemcomitans was not detected in any sample. Patients without periodontitis had a significantly higher mortality rate compared to those with periodontitis, and survival (Kaplan-Meier analysis) was longer in patients with periodontitis (P = 0.02). Transplant-free survival was also more common in patients with periodontitis compared to those without (63% vs 0%, P = 0.02).

CONCLUSION

Decompensated cirrhotic patients frequently suffer from periodontitis. However, there was no evidence of the translocation of P. gingivalis or A. actinomycetemcomitans into ascites. The survival of cirrhotic patients with periodontitis was not reduced.

Keywords: Cirrhosis; Ascites; Decompensation; Periodontitis; Survival; Gingiva

Core Tip: In this prospective cohort study, we aimed to assess the prevalence of periodontitis and the potential dissemination of classical periodontitis pathogens into ascites among 27 cirrhotic patients experiencing ascitic decompensation. We also compared this group with 100 unselected patients from a dental practice. Our findings revealed that decompensated cirrhotic patients often experience periodontitis. However, we did not observe any evidence of the translocation of Porphyromonas gingivalis or Actinobacillus actinomycetemcomitans into ascites. Furthermore, the presence of periodontitis did not appear to have a detrimental effect on the survival of cirrhotic patients.