Helicobacter pylori and tonsillectomy

Abstract

Tonsillar tissue is a component of mucosa-associated lymphoid tissue (MALT), which has evolved to protect vulnerable mucosal surfaces. Helicobacter pylori, implicated as an aetiological factor in duodenal ulcers and gastritis, induces the appearance of lymphoid aggregates (MALT) in the stomach. This organism is cytotoxic via a nitric oxide synthase cascade. The possibility that tonsillar tissue processes Helicobacter pylori or that Helicobacter pylori can colonize the palatine tonsils is explored. The study design was that of a prospective study. We determined if Helicobacter pylori (i) forms part of the normal microenvironment of the tonsil, (ii) plays a role in the pathogenesis of tonsillitis and (iii) is associated with increased expression of inducible nitric oxide synthase (iNOS) in macrophages of the tonsil. Serology for Helicobacter pylori was performed on 50 patients undergoing tonsillectomy. Tonsillar specimens were monitored for urease activity by CLO test (a sealed plastic slide holding an agar gel, which contains urea and detects the urease enzyme of Helicobacter pylori), and immunocytochemically probed for Helicobacter pylori and iNOS expression. The mean age of this patient group was 17.2 years (3-36 years). Fourteen (28%) were sero-positive for Helicobacter pylori but no evidence of this pathogen was found in any tonsillar specimen. The number of macrophages staining for iNOS, per field, under a magnification of x40, was increased in sero-positive patients (13.3 +/- 1.3 versus 9.9 +/- 0.7; P = 0.01). Helicobacter pylori does not appear to colonize the tonsil. We believe that Helicobacter pylori primes the tonsils by inducing macrophage iNOS expression. The higher expression in sero-positive patients is a reflection of a pro-inflammatory reaction to Helicobacter pylori that is both local and systemic.

Association of cagA+ Helicobacter pylori with Adenotonsillar Hypertrophy

“…Detection of H. pylori from tonsil or adenoid tissues has been studied by a number of other investigators using CLO or PCR. Some researchers did not detect any H. pylori (di Bonaventura et al 2001;Skinner et al 2001;Yilmaz 2004), whereas the other reported various percentages for the presence of the pathogen, even higher than reported in the present study (Unver et al 2001;Cirak et al 2003). The difference observed between those studies may be due to particular characteristics of population or diversity of the methods used.…”

Prevalence of H. Pylori in Tonsillar Tissue of Patients with Chronic Recurrent Tonsillitis Using Rapid Urease Test in a Tertiary Referral Hospital in Sub Saharan Africa

“…pylori is known to be involved in the pathogenesis of various disease conditions, including duodenal ulcers, gastric conditions, IgA nephropathy and gastric adenomas with various host reservoirs acting as a nidus for continued persistence of the organism [3]. The human palatine tonsil has been proposed as one of the extra gastric reservoirs of H. pylori and various studies have been undertaken to study its role [7][8][9][10][11]. Other studies dispute the fact that the human palatine tonsil may be an extragastric reservoir of H. pylori [12,13].…”

Prevalence of Helicobacter pylori colonisation in tonsillar tissue in cases of chronic tonsillitis: a prospective study

“…Some researchers stated that H. pylori plays a role in the pathogenesis of chronic adenotonsillitis. 3,13 But others demonstrated that there are no such association. Hence this study was aimed to find out the prevalence of H. pylori in tonsillar tissue of patients with chronic tonsillitis by rapid urease test in a tertiary hospital in Kerala.…”