Dental hygiene in addition to drug treatment for Helicobacter pylori eradication

Background

Helicobacter pylori is a bacteria that is considered to be the main cause of long-term inflammation and ulcers of the stomach, and research has also linked it to diseases such as cancer of the stomach and lymph nodes. Globally, the bacteria affects about half the world's population. To eliminate H. pylori infection and prevent its recurrence, physicians can use various combinations of medications, including antibiotics and proton pump inhibitors (which reduce stomach acid production). This is known as eradication therapy. However, H. pylori may also reside inside the mouth, and researchers do not know whether or not its presence there changes the effectiveness of eradication therapy aimed at the stomach. Given this open debate, it is necessary to clarify whether periodontal therapy is an effective added treatment for H. pylori infection of the stomach and whether its use combined with eradication therapy can prevent recurrence better than eradication therapy alone. Periodontal therapy consists of procedures carried out to support the health of the structures in the mouth that support teeth, such as the jaw bone and gums. It includes oral hygiene instruction, toothbrushing, the use of mouthwash, and the professional removal of dental plaque and tartar from the teeth and gum line. This summary of a Cochrane review represents what we know about the benefits and harms of periodontal therapy as an accompanying treatment for H. pylori infection of the stomach in adults.

Study characteristics

After searching for all relevant studies to August 2015, we found seven small randomized controlled trials (considered the highest quality study design) involving 691 participants aged 17 to 78 years.

Key results

The results indicated that periodontal therapy as an added treatment had some benefits on eradication of gastric H. pylori for short-term and long-term follow-up. The eradication (the reduction of the prevalence of H. pylori in stomach to normal range) and non-recurrence (the proportion of participants that remained free of gastric H. pylori after successful eradication therapy) rates increased in people who received periodontal therapy plus eradication treatment, when compared with those who received eradication treatment alone.

Quality of the evidence

Because there were not very many participants or trials included in our analyses, we cannot draw a firm conclusion about the use of periodontal therapy for all patients with gastric H. pylori infection in clinical practice.

Based on the results in this review, large-scale randomized controlled trials comparing periodontal therapy plus eradication treatment with eradication treatment alone would be useful to generate stronger evidence on the use of periodontal therapy as an additional treatment for patients with gastric diseases caused by H. pylori.

Authors' conclusions: 

Overall, periodontal therapy could increase the efficiency of H. pylori eradication and the non-recurrence rate of gastric H. pylori. In view of the limited number and quality of included studies, it will be necessary to conduct more well-designed, multicenter, and large-scale RCTs to determine the effects of periodontal therapy in eradicating gastric H. pylori and suppressing the recurrence of this bacterium in the stomach.

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Background: 

Helicobacter pylori is estimated to affect about half the world's population and is considered as the main cause of chronic gastritis and peptic ulcer disease. Eradication of H. pylori infection accelerates ulcer healing and prevents relapse, reducing incidence of H. pylori-related gastric diseases. Numerous studies have provided evidence that the oral cavity could be a potential reservoir for H. pylori. The presence of oral H. pylori might affect the efficiency of eradication therapy and act as a causal force for its recurrence. Conversely, other investigators have indicated that the colonization and growth of H. pylori differs between the oral cavity and the stomach. Considering the open debate on the topic, it's necessary to clarify whether periodontal therapy is an effective adjunctive treatment for gastric H. pylori infection.

Objectives: 

To assess the effects of periodontal therapy plus eradication therapy versus eradication therapy alone for gastric H. pylori infection. The secondary objective is to compare the non-recurrence rate at long-term follow up in different treatment groups.

Search strategy: 

We identified randomized controlled trials (RCTs) by searching the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 8), MEDLINE (1946 to August 2015), EMBASE (1980 to August 2015), and the Chinese Biomedical Database (1978 to August 2015). We also searched both ClinicalTrials.gov and the WHO ICTRP portal in October 2015. We handsearched the reference lists of included studies to identify relevant trials.

Selection criteria: 

RCTs comparing periodontal therapy plus eradication treatment with eradication treatment alone, regardless of language of publication.

Data collection and analysis: 

Two reviewers selected the trials that met the inclusion criteria and extracted the details of each study independently. The data were pooled using both fixed-effect and random-effects models and results calculated as odds ratios (OR) with their 95% confidence intervals (CIs) based on an intention-to-treat analysis. However, because there was little difference in the results from these two models, we only reported the results from the fixed-effect model.

Main results: 

We included seven small RCTs involving 691 participants aged 17 to 78 years in our meta analyses. The primary result showed that periodontal therapy combined with H. pylori eradication treatment increased the eradication rate of gastric H. pylori compared with eradication treatment alone (OR 2.15; 95% CI 1.47 to 3.14; P < 0.0001) in people with H. pylori infection. In addition, periodontal therapy also had benefits on long-term gastric H. pylori eradication. After eradication of H. pylori, the non-recurrence rate of gastric H. pylori infection increased in participants treated with periodontal therapy compared with those who received eradication therapy alone (OR 3.60; 95% CI 2.11 to 6.15; P < 0.00001). According to the GRADE approach, the overall quality of the evidence was 'moderate' for eradication rate of gastric H.pylori and 'low' for non-recurrence rate of gastric H. pylori.

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