| Helicobacter pylori (Hp) is a gram-negative and removable bacterium, spiral on morphology. In the etiology, Hp is the main pathogenic factor for chronic gastric diseases; also it is the important etiological factor for gastric cancer, and was first confirmed as the microbial carcinogen for human cancer by WHO. In the fourth national consensus report with treatment of Hp infection, all Chinese scholars agree that eradication of Hp could be regarded as the best thoroughly treatment for gastritis and peptic ulcer, also could be confirmed as the first line for gastric mucosa lymphoma. As well, eradication of Hp could be the prevention for peptic ulcer and gastric cancer, further to eliminate the possibility of gastric cancer. However, there are more than half of the world’s populations suffering from Hp, and significantly higher in developing countries than in developed countries. The result of national investigation from 2001 to 2004 by Chinese medical association showed the infection rate of Hp was 59% in China, and increasing year by year with annual rate of 0.5%-1%. It is clear natural populations are susceptible for gastric Hp, once suffering from Hp infection, patients would probably have gastric Hp lifelong without any eradication treatment, and the positive rate would increase with age. Therefore, the eradication of gastric Hp plays an important role in human health.Nevertheless, the infection of gastric Hp cannot be eradicated by systemic drug therapy yet, it is difficult to be completely eliminated and showed existence of recurrent infection in most cases. There is not a best clinical traetment for complete eradication of Hp. The main reason may be that, the mechanism of sufferring from Hp in hunman body is not clear yet, as well as the pathogenic mechanism. Most scholars concern Hp can be found in other repositories except gastry in human body.Periodontal disease is the most common and oldest human oral diseases, also is the primary reason for loss of adult teeth in China, and the periodontal disease is closely related to the overall health. Periodontal disease includes two categories, gingivitis and periodontitis; the former only has the damage of gingival tissue whithout periodontal tissue, but the latter damages the four kinds of periodontal supporting tissue and forms real periodontal pocket. Chronic periodontitis is one of the most common types in periodontitis, accounts for 95%, caused by nonspecific infection and etiology with local irritation, such as calculus and subgingival plaque, most patients are adults, and the prevalence rate increases after 35 years old. Recently, with the development of periodontal medicine, there is a bidirectional effects between chronic periodontitis and systemic disease, such as diabetes, coronary heart disease, kidney disease and pregnancy.In 1989, Krajden isolated Hp from the dental plaque of patients with gastritis. In 1993, Ferguson acquired Hp with survival ability from the saliva of gastric patients. Therefore, some scholars proposed Hp cloud colonize and strange in oral cavity and the oral cavity may be the main additional repository for Hp, and becomes the source of infection.In recent years, most studies focus on the relationship between periodontal disease and Hp, the periodontal pocket may provide favorable environment for Hp to survive and reproducate, biofilm plaque may help Hp to escape the attack from drugs; But some researches showed the genotype of oral Hp was different from gastric Hp, so there may be no intrinsic relevance. Consequently, the transmission and the physiological mechanism were not yet clear for Hp between periodontal disease and gastritis. Meantime, systemic drug therapy can reduce gastric Hp infection, but the effect for oral Hp is poor, after eradication of gastric Hp, oral Hp could lead to the reinfection of gastric Hp or the recurrence of gastrointestinal diseases by the way of gastro to oral or oral to oral. Therefore, in order to improve the eradication rate of gastric Hp, in addition to taking correct systemic drug therapy, we should also pay attention to the colonization and storage of Hp in human body, and then Hp can be thoroughly eradicated.Most past studies only discussed the effect of periodontal status on gastric Hp infection, or analysed the relationship between oral Hp and gastric Hp, rarely discussed the coexistence relationship among chronic periodontitis, oral Hp and gastric Hp. Thereby, the coexistence relationship would be first analysis in this study among chronic periodontitis, oral Hp and gastric Hp at the same time, also to investigate that whether chronic periodontitis can improve the rate of Hp infection or not, and to study the probable mechanism of dental plaque, then to provide experimental record for confiming that the oral cavity is an important repository of Hp. And further research would be take to evaluate the effect of periodontal initial therapy on the Hp infection, and to hope that through the intervention research, the result can provides the theory basis for the clinical prevention of chronic periodontitis and Hp, so the reaserch has important clinical significance for the eradication of Hp infection.This study consists of two chapters below:Chapter oneStudy on the coexistence relationship among chronic periodontitis, oral Helicobacter pylori and gastric Helicobacter pylori infectionObjectiveTo investigate the coexistence relationship among chronic periodontitis, oral Hp, and gastric Hp.Method1. Study subjiectFrom 2012 September to 2013 March,228 cases were randomly selected from the Department of Stomatology in the second hospital affiliated to Guangzhou Medical University as the research object. Respondents aged from 26 to 66 years old.Inclusion criteria:age >20 years old, there are not less than 20 natural tooth in the mouth. According to the standard which is formulated in the world periodontal disease classification conference held in 1999 by the USA periodontal disease association, periodontal disease is divided into two categories, Gingivitis and periodontal disease, chronic periodontitis is the most common periodontitis, patients diagnosed with chronic periodontitis are regaded as periodontitis group in this study.Exclusion criteria:smokers; patients had received periodontal treatment within 12 months; patients had taken antibiotics and bismuth or proton pump inhibitors and other stomach medicine within 3 months; patients have suffered from other systemic disease affected periodontal health; patients with pregnancy and lactation.2. Periodontal examinationAt first,10 index tooth of every subject were selected according to the WHO community periodontal index (CPI), all subjects were received periodontal examination by the same clinician, and write down the score of CPI. Next, all subjects divided into two groups, chronic periodontitis group and periodontal healthy group.3. Detection of Helicobacter pyloriDental plaque was collected by a sterile curette with the neck of four first molar teeth (with the second molar tooth if the first molar tooth was missing), and then put the collected dental plaque into the yellow central reaction zone of test paper or into the solution of reagent tube, using rapid urea enzymatic to detect the oral Hp infection status. At last, the gastric Hp infection of every subject was detected by C-14urea breathing test (UBT) detection in the Department of nuclear medicine from the Second Affiliated Hospital of Guangzhou Medical University, all esubjects were required to be fasting in the early morning or with 3 hours after eating, firstly they toke one capsule of C-14Urea Capsules, sit quietly in 25 minutes, then blow into the sample bottle with absorbent of CO2 containing by blow pipe within 1-3min, following the sample bottle of C-14radioactivity apparatus (DPM) was detected in a liquid scintillation determination, when the detection value greater than 100dpm, the infection of Hp could be determined to be positive.4. Data statistical analysisAll the data were analyzed by using SPSS 13.0 statistical software. Chi square test was used to analyze the difference of sex, and Mann-Whitney U test was used to analyse the difference of age; the correlation between oral Hp infection and gastric Hp infection was also statistical analysised by Chi square test, so did the difference of oral Hp infection between chronic periodontitis group and periodontal health group, similarly to the difference of gastricl Hp infection. P<0.05 was statistical selected.Result.1. There was no obvious difference with sex (x2= 0.084, P>0.05) and age (U= 4628, P>0.05) between chronic periodontitis group and periodontal health group.2. There was close correlation between oral Hp infection and gastric Hp infection in the total population (x2= 51.846, P<0.05).3. The correlation between oral Hp infection and gastric Hp infection was found in chronic periodontitis group(x2=27.089, P<0.001).4. In periodontal health group, there was inverse correlation between oral Hp infection and gastric Hp infection(x2=23.793, P<0.001)5. The positive rate of oral Hp was significantly higher in the chronic periodontitis group than that in the periodontal health group (χ2=4.554, P<0.05).6. The positive rate of gastric Hp in chronic periodontitis group was higher than that in the periodontal health groups, but without statistical difference (χ2=121,p>0.05).Conclusion:1. There is a close relationship between Hp infection and gastric infection of oral Hp; oral cavity is one of the largest repositories in human body besides the stomach.2. Whether the subject suffers from chronic periodontitis or with periodontal healthy, there is a close relationship between oral Hp infection and gastric Hp infection,it is further proof that oral cavity is one of the largest repositories in human body besides the stomach.3. Chronic periodontitis is a risk factor for oral Hp infection, the micro-environment of periodontal inflammation and periodontal pocket may be conducive to growth and reproduction of Hp in the oral cavity.4. Based on the limitations of analysis for this cross-sectional design and the statistical sample size of the study, gastric Hp infection rate of patients with chronic periodontitis is not higher than that of periodontal healthy subjects.Chapter twoResearch about the effect of periodontal initial therapy on gastric Helicobacter pylori eradicationObjectiveStudy the effect of periodontal initial therapy on gastric Hp eradication of patients who have received systemic eradication therapy.Method1. Study subjectFrom 2012 August to 2013 January,105 patients were randomly selected as the object of clinic study in the Department of internal medicine and Department of Stomatology from the Second Affiliated Hospital of Guangzhou Medical University. Respondents aged 23 to 65 years old.Inclusion criteria:age >20 years old; patients once had diagnosis of gastric Hp infection without serious complications, and just accepted the systemic drug therapy (triple therapy), C-14urea breath test was negative for Hp infection; patients had been diagnosed with chronic periodontitis; patients have not received any periodontal treatment within 12 months, such as oral health education, ultrasonic scaling, supragingival scaling, and so on. There are at least 16 teeth in the oral cavity; there are at least 4 molars (excluding the third molar).Exclusion criteria:smokers; patients suffer from other systemic disease which could affect periodontal health; women with pregnancy and lactation.Chronic periodontitis grading standards:according to the recommendations of USA periodontology centers for disease control and prevention, to be divide into mild periodontitis, moderate periodontitis, and severe periodontitis.2. Periodontal examinationEvery subject received periodontal examination of all teeth to assess whole periodontal status by the same inspection physician using special periodontal probe, and periodontal conditions of each tooth was record, involved the probing depth (PD), attachment loss (AL) and sulcus bleeding index (SBI). All subjects were randomly divided into two groups according to periodontal examination, experimental group and control group.3. Periodontal initial therapyThe experimental group received periodontal initial therapy completely by one experienced periodontist. Periodontal initial therapy involved oral health instruction, ultrasonic supragingival scaling, subgingival scaling, root planing and extraction of the useless teeth. The control group received no treatment.4. Detection of gastric Helicobacter pyloriAll patients reviewed after 1 month,6 months and 12 months later following up periodontal examination, required fasting in the morning or eating three hours later, using the urea breath C-14detection method to check the gastric Hp infection.5. Data statistical analysisAll the data were analyzed by using SPSS 13.0 statistical software. Chi square test was used to analyze the difference of sex, as well as PD and SBI; Mann-Whitney U test was used to compare the difference of age, using t-test to analyzs the difference of AL; chi square test was also used to compare the difference of gastric Hp eradication rate after 1 month,6 months, and 12 months. P<0.05 was statistical significant selected.Result1. There was no significant difference between the gender (x2=0.035, P>0.05), similarly, there was no difference for the age (U= 1056, P>0.05).2. No significant differences had been found between the overall periodontal condition of treatment group and that of control group, it means that PD (W=1102, P>0.05), AL (t=-0.135, P>0.05) and SBI (W= 1142, P>0.05) were all without statistically difference.3. There was no difference of Hp eradication rate between the two groups after 1 month (χ2=0.028, P>0.05).4.6 month later, the Hp eradication rate of experimental group was higher than that of the control group, the difference was statistically significant (χ2= 5.643, P<0.05).5.12 month later, the Hp eradication rate of experimental group was still higher than that of the control group (χ2=4.238, P<0.05).Conclusion1. In this study, the difference of age and gender between the two groups had not been found significantly.2. Probing depth (PD), attachment loss (AL) and gingival bleeding index (SBI) are the common indexes for describing clinical periodontal status, the equilibrium had been ensured between the two groups.3. Patients with Hp infection who suffer from chronic periodontitis should be combined with periodontal initial treatment after systemic drug therapy, then the eradication rate of gatric Hp can be raised; improvement of the periodontal status has strong effect effect on the eliminiation or survival of gastric Hp.In summary, the analysis of this study showed that weather the subjects had suffered from chronic periodontitis, or with periodontal healthy patients, oral Hp infection and gastric Hp infection are intrinsically linked, there may have exist bidirectional between oral Hp infection and gastric Hp infection; the infection rate of oral Hp could be improved by chronic periodontitis, oral cavity may be an important repository for Hp in human body. Periodontal therapy had a positive effect on Hperadication rates, there was a strong influence on the elimination or survival of Hp by improving the periodontal status, through the detailed and repeated periodontal maintenance therapy, the periodontal inflammatory state could be effectively improve in long-term, and the pylorus spiral bacillusrecurrence rate also would be reduced. But the pathophysiological mechanismsof the relationship between chronic periodontitis and Hp needs to be further studied, and the same for the principle specific of periodontal therapy for Helicob acter pylori eradication rate... |
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