Eradication of Helicobacter pylori in patients without gastric symptoms suffering from recurrent aphthous stomatitis: A pilot study

Marina Latković; Lazar Ranin; Nevenka Teodorović; Marko Andjelković

doi:10.2298/VSP151014113L

Marina Latković University of Belgrade, Faculty of Dental Medicine, Department of Restorative Dentistry and Endodontics, Belgrade, Serbia.
Lazar Ranin University of Belgrade, Faculty of Medicine, Institute of Microbiology and Immunology, Belgrade, Serbia.
Nevenka Teodorović University of Belgrade, Faculty of Dental Medicine, Department of Restorative Dentistry and Endodontics, Belgrade, Serbia.
Marko Andjelković University of Belgrade, Faculty of Dental Medicine, Department of Prosthodontics, Belgrade, Serbia.

DOI: https://doi.org/10.2298/VSP151014113L

Keywords: stomatitis, aphthous, recurrence, helicobacter pylori, comorbidity, diagnosis, treatment outcome,

Abstract

Background/Aim. Helicobacter (H.) pylori is a widespread bacterium and its involvement in pathogenesis of gastric diseases is well-known. However, H. pylori role in etiology of other histologically similar conditions, especially recurrent aphthous stomatitis (RAS) is still controversial. Research regarding H. pylori and its association with RAS, as well as the treatment options were always conducted on patients with diagnosed gastric problems. The aim of this study was to determine whether H. pylori is present in the oral cavity of patients suffering from RAS but without any symptoms or medical history of gastric disease. Methods. A total of 15 patients with RAS participated in the study. None of the participants suffered from any gastrointestinal disorders. Two dental plaque samples from each participant were collected. The first was analyzed using rapid urease test and the second one was put in transport medium and sent for cultivation. The sensitivity of H. pylori to antibiotics was established using disk diffusion method of sensitivity testing for every patient individually and adequate therapy was prescribed. Results. Before the treatment the mean annual recurrence rate of RAS was 8.1 ± 2.1, with the average number of lesions being 3.9 ± 1.9. During the 12-month observation period after the eradication therapy, none of the patients reported recurrence of aphthous lesions. The treatment was successful in all cases. Conclusion. This study shows that RAS can be effectively treated by successful eradication of oral H. pylori, and that RAS could be possibly considered as an early warning sign of potential gastric infection by H. pilory.

References

Nguyen TN, Barkun AN, Fallone CA. Host determinants of He-licobacter pylori infection and its clinical outcome. Helicobacter 1999; 4(3): 185−97.

Fariborz MG, Asmar M, Bagherzadeh AH, Ekbataninezhad S. Helicobacter pylori infection in oral lesions of patients with recurrent aphthous stomatitis. Med Sci Monit 2005; 11(12): 576−9.

Victória JM, Kalapothakis E, Silva JD, Gomez RS. Helicobacter pylori DNA in recurrent aphthous stomatitis. J Oral Pathol Med 2003; 32(4): 219−23.

Mravak-Stipetić M, Gall-Trošelj K, Lukač J, Kusić Z, Pavelić K, Pavelić J. Detection of Helicobacter pylori in various oral le-sions by nested polymerase chain reaction (PCR). J Oral Pa-thol Med 1998; 27(1): 1−3.

Karaca S, Seyhan M, Senol M, Harputluoglu M, Ozcan A. The effect of gastric Helicobacter pylori eradication on recurrent aphthous stomatitis. Int J Dermatol 2008; 47(6): 615−7.

Shimoyama T, Horie N, Kato T, Kaneko T, Komiyama K. Helico-bacter pylori in oral ulcerations. J Oral Sci 2000; 42(4): 225−9.

Pavelić J, Gall-Trošelj K, Jurak I, Mravak-Stipetić M. Helicobacter pylori in oral aphthous ulcers. J Oral Pathol Med 2000; 29(10): 523.

Umeda M, Kobayashi H, Takeuchi Y, Hayashi J, Morotome-Hayashi Y, Yano K, et al. High prevalence of Helicobacter pylori de-tected by PCR in the oral cavities of periodontitis patients. J Periodontol 2003; 74(1): 129−34.

Malfertheiner P, Mégraud F, O'morain C, Hungin AP, Jones R, Axon A, et al. Current concepts in the management of Helicobacter pylori infection: The Maastricht 2-2000 Consensus Report. Aliment Pharmacol Ther 2002; 16(2): 167−80.

Malfertheiner P, Megraud F, O'morain C, Atherton J, Axon A, Bazzoli F, et al. Management of Helicobacter pylori infection: The Maastricht IV/Florence consensus report. Gut 2012; 61(5): 646−64.

Taş AD, Yakar T, Sakalli H, Serin E. Impact of Helicobacter pylori on the clinical course of recurrent aphthous stomatitis. J Oral Pathol Med 2013; 42(1): 89−94.

Mégraud F. H pylori antibiotic resistance: Prevalence, impor-tance, and advances in testing. Gut 2004; 53(9): 1374−84.

Whitley E, Ball J. Statistics review 4: Sample size calculations. Crit Care 2002; 6(4): 335−41.

Albanidou-Farmaki E, Giannoulis L, Markopoulos A, Fotiades S, Aggouridaki X, Farmakis K, et al. Outcome following treatment for Helicobacter pylori in patients with recurrent aphthous stomatitis. Oral Dis 2005; 11(1): 22−6.

Al-Ahmad A, Kürschner A, Weckesser S, Wittmer A, Rauberger H, Jakob T, et al. Is Helicobacter pylori resident or transient in the human oral cavity. J Med Microbiol 2012; 61(Pt 8): 1146−52.

Gebara EC, Faria CM, Pannuti C, Chehter L, Mayer MP, Lima LA. Persistence of Helicobacter pylori in the oral cavity after systemic eradication therapy. J Clin Periodontol 2006; 33(5): 329−33.

Morales-Espinosa R, Fernandez-Presas A, Gonzalez-Valencia G, Flores-Hernandez S, Delgado-Sapien G, Mendez-Sanchez JL, et al. Helicobacter pylori in the oral cavity is associated with ga-stroesophageal disease. Oral Microbiol Immunol 2009; 24(6): 464−8.

Burne RA, Chen YY. Bacterial ureases in infectious diseases. Microbes Infect 2000; 2(5): 533−42.

Liu Y, Yue H, Li A, Wang J, Jiang B, Zhang Y, et al. An epide-miologic study on the correlation between oral Helicobacter pylori and gastric H. pylori. Curr Microbiol 2009; 58(5): 449−53.

Gürbüz AK, Ozel MA, Yazgan Y, Celik M, Yildirim S. Oral colo-nization of Helicobacter pylori: Risk factors and response to eradication therapy. South Med J 2003; 96(3): 244−7.

Opavski N, Spuran M, Djukić S, Mijac V, Ranin L. Comparison of three diagnostic methods to confirm Helicobacter pylori in-fection. Srp Arh Celok Lek 2007; 135(1−2): 26−30. (Serbian)

Oshowo A, Tunio M, Gillam D, Botha AJ, Holton J, Boulos P, et al. Oral colonization is unlikely to play an important role in Heli-cobacter pylori infection. Br J Surg 1998; 85(6): 850−2.

Ship JA, Chavez EM, Doerr PA, Henson BS, Sarmadi M. Recurrent aphthous stomatitis. Quintessence Int 2000; 31(2): 95−112.

Brocklehurst P, Tickle M, Glenny AM, Lewis MA, Pemberton MN, Taylor J, et al. Systemic interventions for recurrent aphthous stomatitis (mouth ulcers). Cochrane Database Syst Rev 2012; 9: CD005411.