Eradikacija Helicobacter pylori kod bolesnika bez gastričkih simptoma koji imaju rekurentni aftozni stomatitis: pilot studija
Sažetak
Uvod/Cilj. Helicobacter (H.) pylori je široko rasprostanjena bakterija i njen uticaj na nastanak gastričkih oboljenja vrlo dobro je dokumentovan. Međutim, uloga H. pylori u patogenezi histološki sličnih oboljenja, posebno rekurentnog aftoznog stomatitisa (RAS), nije dovoljno istražena. Dosadašnje studije, u kojima je ispitivana veza između H. pylori i RAS, kao i moguće terapijske opcije, bile su usmerene ka bolesnicima sa prethodno dijagnostikovanim gastričkim smetnjama. Cilj ovog istraživanja bio je da se utvrdi da li je H. pylori prisutan u usnoj duplji i kod bolesnika bez simptoma i istorije gastričkih oboljenja koji pate od RAS. Metode. U studiji je učestvovalo 15 bolesnika koji pate od RAS. Bolesnici nisu imali smetnje vezane za gornji deo digestivnog trakta. Po dva uzorka dentalnog plaka prikupljena su od svakog bolesnika. Jedan plak je ispitivan uz pomoć brzog ureaza testa, dok je drugi stavljen u transportni medijum i poslat na kultivaciju. Osetljivost H. pylori na antibiotike određivana je uz pomoć antibiograma za svakog bolesnika posebno i, u skladu sa rezultatima, prepisivana je odgovarajuća terapija. Rezultati. Pre lečenja prosečan broj epizoda RAS tokom godine iznosio je 8,1 ± 2,1, sa prosečno 3,9 ± 1,9 aftoznih lezija. Tokom 12-mesečnog perioda nakon eradikacione terapije, ni kod jednog bolesnika nije došlo do ponovne pojave afti. Terapija je bila uspešna kod svih bolesnika. Zaključak. Rezultati ovog istraživanja pokazuju da se RAS može uspešno lečiti eradikacijom H. pylori i da se sama pojava RAS može posmatrati kao rano upozorenje na moguću gastričku infekciju.
Reference
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.