Midede H. pylori Eradikasyon Oranları Oral H. pylorinin Dişeti (Periodontal) Tedavisi ile Eliminasyonu ile Artırılabilir mi? Literatür Taraması

Yıl 2023, Cilt: 33 Sayı: 3, 174 - 178, 31.07.2023

Ayla Öztürk

https://doi.org/10.5152/CRDS.2023.4909

Öz

Periodontal hastalıklar dişi destekleyen dokularda görülen dişler üzerinde yerleşen lokalize mikro- biyal dental plağın sebep olduğu yerkürede oldukça sık rastlanan kronik enfeksiyon hastalıklardır. Tedavi edilmediğinde zamanla alveolar kemik kaybı, ataçman kaybı ve dişlerde fonksiyon kaybına neden olabilir ve nihai olarak ise diş kaybı meydana gelebilir. H. pylori midede ve gastrointestinal sistemde kolanize olabilen Gr- spiral şekilli bir patojendir. Kronik gastrikten gastrik kansere kadar geniş yelpazede hastalıklara sebeb olabilir Bu nedenle bu potansiyel zararlı bakterinin eliminas- yonu önemlidir. Klasik sistemik H. pylori eradikasyon tedavisi başlangıçta başarılı olmasına rağ- men, artan antibiyotik direnci ve yan etkiler nedeniyle klinik ortamda başarı oranları düşürmüştür. Ayrıca artan rekürens oranları araştırmacıları, H. pylori için potansiyel ikincil kolonizasyon odağı aramaya itmiştir. Oral kavitede dental plaktan bu bakterinin kültüre edilmesinden sonra, araş- tırmalar oral kavitenin H. pylori için potansiyel barınak olup olamayacağı hipotezine yönelmiştir. Takip eden çalışmalar H. pyloriyi oral kavitede tespit edildiğini hatta oral H. pylori prevelansının mideden daha yüksek olduğunu bulmuştur. Özellikle dental plak içindeki H. pyloriye bir biyofilm yapısı içinde yer aldığından sistemik antibiyotikler etkili olamaz. Bu nedenle periodontal hasta- lıktaki gibi mekanik olarak uzaklaştırılması gerekir. Nitekim, klinik çalışmalar midedeki H. pylori enfeksiyon tedavisinin midedeki bakteriyi eradike ederken oral kavitedeki bakteriye etki etmedigi gösterilmiştir. Gittikçe artan çalışmalar periodontal tedavinin gastrik H. pylori eradikasyon tedavi- siyle eş zamanlı olarak uygulandığında tedavinin başarısını artırdığını göstermektedir. Bu nedenle gastroenterologlar ile diş hekimlerinin koordineli bir şekilde çalışması gastrik H. pylori eradikas- yon tedavisinin başarı oranlarını artırabilir. Bu derlemenin amacı oral H. pylori varlığı konusundaki delilleri ve ilave periodontal tedavinin mide eradikasyon tedavisine katkısı konusunda en güncel araştırmaları gözden geçirmektir.
Anahtar Kelimeler: Periodontal Tıp, Helicobacter pylori, Periodontal tedavi

ABSTRACT
Periodontal diseases are chronic infectious diseases caused by microbial dental plaque local- ized on teeth. Periodontitis is very common worldwide. When not treated, it can cause alveolar bone loss and attachment loss and lead to loss of function in teeth over time, and the final pic- ture may be tooth loss. Helicobacter pylori is a spiral-shaped pathogen that can cause a wide range of diseases ranging from chronic gastric to gastric cancer, primarily colonized in the stom- ach and gastrointestinal system. Therefore, elimination of this potentially harmful bacterium is important. Although initially conventional systemic eradication therapy was successful, increas- ing antibiotic resistance and side effects decreased their success rates in the clinical setting. Additionally, increasing recurrence rates have prompted researchers to seek for alternative res- ervoirs for Helicobacter pylori. After isolation of Helicobacter pylori from dental plaque by culture method, researchers conducted trials to see whether the oral cavity could be a potential shelter for Helicobacter pylori. The following studies have detected Helicobacter pylori in the oral cavity. Interestingly, the Helicobacter pylori prevalence was higher in the oral cavity than in the stomach.
Systemic antibiotics do not affect particularly Helicobacter pylori in dental plaque due to its biofilm structure. Therefore, it must be removed mechanically as in periodontal disease. As a matter of fact, clinical studies have shown that Helicobacter pylori infec- tion treatment eradicates the bacteria in the stomach but does not affect the bacteria in the oral cavity. Moreover, clinical studies showed that periodontal treatment increases the success rate of gastric eradication therapy when used as an adjunct to the con- ventional triple eradication therapy. Based on these data, coordination of gastroenterologists with dentists may increase the suc- cess rate of gastric Helicobacter pylori eradication treatment. Therefore, the aim of this review is to discuss the existing evidence for the presence of Helicobacter pylori in the oral cavity and the contribution of periodontal treatment as an adjunct to gastric Helicobacter pylori eradication therapy.
Keywords: Helicobacter pylori, periodontal medicine, periodontal treatment

Anahtar Kelimeler

Helicobacter pylori, periodontal medicine, periodontal treatment

Kaynakça

• 1. Tonetti MS, Greenwell H, Kornman KS. Staging and grading of peri- odontitis: framework and proposal of a new classification and case definition. J Periodontol. 2018;89(suppl 1):S159-S172. [CrossRef]
• 2. Marsh PD, Moter A, Devine DA. Dental plaque biofilms: communities, conflict and control. Periodontol 2000. 2011;55(1):16-35. [CrossRef]
• 3. Larsen T, Fiehn NE. Resistance of Streptococcus sanguis biofilms to antimicrobial agents. APMIS. 1996;104(4):280-284. [CrossRef]
• 4. Teughels W, Godts C, Quirynen M, Jakubovics N. Biofilm and perio- dontal microbiology. Carranza’s Clinical Periodontology. 12th ed. St Louis: Elsevier Inc 2015:132-169.
• 5. Palmer Jr RJ. Composition and development of oral bacterial com- munities. Periodontol 2000. 2014;64(1):20-39. [CrossRef]
• 6. Paster BJ, Olsen I, Aas JA, Dewhirst FE. The breadth of bacterial diversity in the human periodontal pocket and other oral sites. Peri- odontol 2000. 2006;42:80-87. [CrossRef]
• 7. Krajden S, Fuksa M, Anderson J, et al. Examination of human stom- ach biopsies, saliva, and dental plaque for Campylobacter pylori. J Clin Microbiol. 1989;27(6):1397-1398. [CrossRef] 8. Malfertheiner P, Megraud F, O'Morain CA, et al. Management of Heli- cobacter pylori infection—the Maastricht V/Florence consensus report. Gut. 2017;66(1):6-30. [CrossRef]
• 9. Wroblewski LE, Peek RM, Wilson KT. Helicobacter pylori and gastric cancer: factors that modulate disease risk. Clin Microbiol Rev. 2010;23(4):713-739. [CrossRef]
• 10. Bouvard V, Baan R, Straif K, et al. A review of human carcinogens-Part B: biological agents. Lancet Oncol. 2009;10(4):321-322.[CrossRef]
• 11. Van Cutsem E, Sagaert X, Topal B, Haustermans K, Prenen H. Gastric cancer. Lancet. 2016;388(10060):2654-2664. [CrossRef]
• 12. Kaptan K, Beyan C, Ural AU, et al. Helicobacter pylori—is it a novel causative agent in vitamin B12 deficiency? Arch Intern Med. 2000;160(9):1349-1353. [CrossRef]
• 13. Emilia G, Longo G, Luppi M, et al. Helicobacter pylori eradication can induce platelet recovery in idiopathic thrombocytopenic purpura. Blood. 2001;97(3):812-814. [CrossRef]
• 14. Wang ZW, Li Y, Huang LY, et al. Helicobacter pylori infection contrib- utes to high risk of ischemic stroke: evidence from a meta-analysis. J Neurol. 2012;259(12):2527-2537. [CrossRef]
• 15. Danesh J. Coronary heart disease, Helicobacter pylori, dental dis- ease, Chlamydia pneumoniae, and Cytomegalovirus: meta-analyses of prospective studies. Am Heart J. 1999;138(5 Pt 2):S434-S437. [CrossRef]
• 16. Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017;112(2):212-239. [CrossRef]
• 17. Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet. 1984;1(8390):1311-1315. [CrossRef]
• 18. Vakil N. H. pylori treatment: new wine in old bottles? Am J Gastroen- terol. 2009;104(1):26-30. [CrossRef]
• 19. Gasparetto M, Pescarin M, Guariso G. Helicobacter pylori eradication therapy: current availabilities. ISRN Gastroenterol. 2012;2012:186734. [CrossRef]
• 20. Akdeniz V, Akalın AS, Elif Ö. Helicobacter pylori enfeksiyonunda pro- biyotiklerin rolü. Gıda. 2018;43:943-956.
• 21. Czesnikiewicz-Guzik M, Bielanski W, Guzik TJ, Loster B, Konturek SJ. Helicobacter pylori in the oral cavity and its implications for gastric infection, periodontal health, immunology and dyspepsia. J Physiol Pharmacol. 2005;56(suppl 6):77-89.
• 22. Al Sayed A, Anand PS, Kamath KP, Patil S, Preethanath RS, Anil S. Oral cavity as an extragastric reservoir of Helicobacter pylori. ISRN Gastroenterol. 2014;2014:261369. [CrossRef]
• 23. Anand PS, Kamath KP, Anil S. Role of dental plaque, saliva and peri- odontal disease in Helicobacter pylori infection. World J Gastroen- terol. 2014;20(19):5639-5653. [CrossRef]
• 24. Gebara EC, Faria CM, Pannuti C, Chehter L, Mayer MP, Lima LA. Per- sistence of Helicobacter pylori in the oral cavity after systemic eradi- cation therapy. J Clin Periodontol. 2006;33(5):329-333. [CrossRef]
• 25. Miyabayashi H, Furihata K, Shimizu T, Ueno I, Akamatsu T. Influence of oral Helicobacter pylori on the success of eradication therapy against gastric Helicobacter pylori. Helicobacter. 2000;5(1):30-37. [CrossRef]
• 26. Ökte E, Ünsal B, Bal B, Akbay A, Yücesoy V, Baloş K. % 0.3 Triklosan İçeren Diş Macunlarının Mikrobiyal Dental Plak Ve Dişeti Sağlığı Yönünden Klinik Olarak Karşılaştırılması. Atatürk Univ Diş Hekimliği Fak Derg (J Dent Fac Atatürk Uni). 1997;7:47-53.
• 27. Gao J, Li Y, Wang Q, Qi C, Zhu S. Correlation between distribution of Helicobacter pylori in oral cavity and chronic stomach conditions. J Huazhong Univ Sci Technolog Med Sci. 2011;31(3):409-412. [CrossRef]
• 28. Jia CL, Jiang GS, Li CH, Li CR. Effect of dental plaque control on infec- tion of Helicobacter pylori in gastric mucosa. J Periodontol. 2009;80(10):1606-1609. [CrossRef]
• 29. Yuksel Sert SY, Ozturk A, Bektas A, Cengiz MI. Periodontal treatment is more effective in gastric Helicobacter pylori eradication in those patients who maintain good oral hygiene. Int Dent J. 2019;69(5):392-399. [CrossRef]
• 30. Song HY, Li Y. Can eradication rate of gastric Helicobacter pylori be improved by killing oral Helicobacter pylori? World J Gastroenterol. 2013;19(39):6645-6650. [CrossRef]
• 31. Tongtawee T, Wattanawongdon W, Simawaranon T. Effects of perio- dontal therapy on eradication and recurrence of Helicobacter pylori infection after successful treatment. J Int Med Res. 2019;47(2):875- 883. [CrossRef]
• 32. Bouziane A, Ahid S, Abouqal R, Ennibi O. Effect of periodontal therapy on prevention of gastric H elicobacter pylori recurrence: a system- atic review and meta‐analysis. J Clin Periodontol. 2012;39(12):1166- 1173. [CrossRef]
• 33. Ren Q, Yan X, Zhou Y, Li WX. Periodontal therapy as adjunctive treat- ment for gastric Helicobacter pylori infection. Cochrane Database Syst Rev. 2016;2(2):CD009477. [CrossRef]
• 34. Ozturk A. Periodontal treatment is associated with improvement in gastric Helicobacter pylori eradication: an updated meta-analysis of clinical trials. Int Dent J. 2021;71(3):188-196. [CrossRef]
• 35. Yee JK. Helicobacter pylori colonization of the oral cavity: A mile- stone discovery. World J Gastroenterol. 2016;22(2):641-648. [CrossRef]
• 36. Okuda K, Ishihara K, Miura T, Katakura A, Noma H, Ebihara Y. Helico- bacter pylori may have only a transient presence in the oral cavity and on the surface of oral cancer. Microbiol Immunol. 2000;44(5):385-388. [CrossRef]
• 37. Birek C, Grandhi R, McNeill K, Singer D, Ficarra G, Bowden G. Detec- tion of Helicobacter pylori in oral aphthous ulcers. J Oral Pathol Med. 1999;28(5):197-203. [CrossRef]
• 38. Leimola‐Virtanen R, Happonen RP, Syrjänen S. Cytomegalovirus (CMV) and Helicobacter pylori (HP) found in oral mucosal ulcers. J Oral Pathol Med. 1995;24(1):14-17. [CrossRef] 39. Song Q, Lange T, Spahr A, Adler G, Bode G. Characteristic distribu- tion pattern of Helicobacter pylori in dental plaque and saliva detected with nested PCR. J Med Microbiol. 2000;49(4):349-353. [CrossRef]
• 40. Socransky SS, Haffajee AD. Dental biofilms: difficult therapeutic tar- gets. Periodontol 2000. 2002;28:12-55. [CrossRef]
• 41. Souto R, Colombo AP. Detection of Helicobacter pylori by polymer- ase chain reaction in the subgingival biofilm and saliva of non-dys- peptic periodontal patients. J Periodontol. 2008;79(1):97-103. [CrossRef]
• 42. Ferguson DA, Li C, Patel NR, Mayberry WR, Chi DS, Thomas E. Isola- tion of Helicobacter pylori from saliva. J Clin Microbiol. 1993;31(10):2802-2804. [CrossRef]
• 43. Young KA, Allaker RP, Hardie JM. Morphological analysis of Helico- bacter pylori from gastric biopsies and dental plaque by scanning electron microscopy. Oral Microbiol Immunol. 2001;16(3):178-181. [CrossRef]
• 44. Siddiq M, Haseeb-ur-Rehman, Mahmood A. Evidence of Helicobacter pylori infection in dental plaque and gastric mucosa. J Coll Physi- cians Surg Pak. 2004;14(4):205-207.
• 45. Zou QH, Li RQ. Helicobacter pylori in the oral cavity and gastric mucosa: a meta‐analysis. J Oral Pathol Med. 2011;40(4):317-324. [CrossRef]
• 46. Berberoğlu A, Çaygür A, Muhammed B, Tümer H, YILMAZ G. Diştaşlari temizliği, kök yüzeyi düzleştirmesi ve polisajda güncel kavramlar: derleme. Atatürk Univ Diş Hekimliği Fak Derg. 2014;24:418-426.
• 47. Zaric S, Bojic B, Jankovic Lj, et al. Periodontal therapy improves gas- tric Helicobacter pylori eradication. J Dent Res. 2009;88(10):946- 950. [CrossRef]