Helicobacter pylori in the oral mucosa of patients submitted to allogeneic haematopoietic stem cell transplantation

Abstract

ABSTRACT:This study was designed to investigate the impact of haematopoietic stem cell transplantation (HSCT) on Helicobacter pylori colonization of the oral mucosa by nested polymerase chain reaction (nested-PCR). Forty six consecutive patients submitted to HSCT and 46 healthy volunteers were included in the study. Oral swabs were taken from the oral mucosa of the patients and control group. The medical records of the patients were reviewed and the following information was retrieved: gender and age of the patient, donor gender, primary disease, stem cell source (bone marrow or blood stem cells), leukocyte, neutrophil and platelet counts, and chronic graft versus host disease (cGVHD) of salivary glands. The results demonstrated an increased frequency of H. pylori in the oral mucosa of HSCT patients compared to controls (ρ = 0.002). The presence of H. pylori in the oral mucosa was not related to the severity of cGVHD. The median counts of platelet/mm 3 , leukocytes/mm 3 and neutrophils/mm 3 in the group of HSCT patients positive for H. pylori were not statistically different from those of the patients negative for it. In conclusion, the present study shows increased frequency of H. pylori in the oral mucosa of HSCT patients compared to non-transplanted healthy volunteers. DESCRIPTORS:Helicobacter pylori; Bone marrow transplantation; Mouth mucosa. RESUMO:O objetivo do estudo é investigar o impacto do transplante de células-tronco hematopoiéticas (TCTH) na colonização da mucosa bucal pela Helicobacter pylori através do "nested-PCR". Quarenta e seis pacientes submetidos ao TCTH e 46 indivíduos saudáveis foram incluídos no estudo. Raspados de mucosa bucal foram realizados nos pacientes do grupo de estudo e grupo controle. Os dados médicos dos pacientes foram revisados e as seguintes informações foram coletadas: gênero e idade do paciente, gênero do doador, doença primária, fonte de células-tronco (medula óssea ou células-tronco sanguíneas), número de leucócitos, neutrófi los e plaquetas, doença do enxerto contra o hospedeiro crônica (DECHc) de glândulas salivares. Os resultados demonstram aumento na freqüência de H. pylori na mucosa bucal de pacientes submetidos ao TCTH comparado com grupo controle (ρ = 0.002). A presença da H. pylori na mucosa bucal não teve relação com a severidade da DECHc. As medianas de número de plaquetas/mm 3 , leucócitos/mm 3 e neutrófi los/mm 3 no grupo de pacientes TCTH positivos para H. pylori não foram estatisticamente diferentes das medianas dos pacientes negativos. Concluindo, o presente estudo mostra um aumento da freqüência da H. pylori na mucosa bucal de pacientes submetidos ao TCTH quando comparada com a de um grupo de voluntários não transplantados saudáveis.

Potential protective effect of Helicobacter pylori on the development of gastrointestinal GvHD

“…Although in the paper by Correia-Silva et al, 38 no relationship between HP infection and the development of GvHD was observed in 46 patients who received an allogeneic transplant, our group reported in a retrospective study 15 with 198 patients that HP infection had a negative modulating effect on the development of acute GvHD (RR = 0.60 (95% CI: 0.46-0.79) P = 0.001) and chronic GvHD (RR = 0.75; (95% CI: 0.61-0.92) P = 0.016). Furthermore, the presence of HP was inversely correlated with the histological severity of GvHD (P = 0.003).…”

Helicobacter pyloriand its reservoirs: A correlation with the gastric infection

“…These findings suggest that these species are not possible endodontic pathogens and that the necrotic root canal does not serve as a reservoir for these human pathogens in healthy patients [37] . In another study by Correia-Silva Jde et al [38] , many H. pylori-positive results were found in the oral mucosa of 46 haematopoietic stem cell transplantation (HSCT) patients. The authors report that their findings may be due to the patients' poor oral hygiene during the transplantation and/or immunosuppression procedures involved in HSCT therapy [38] .…”

“…In another study by Correia-Silva Jde et al [38] , many H. pylori-positive results were found in the oral mucosa of 46 haematopoietic stem cell transplantation (HSCT) patients. The authors report that their findings may be due to the patients' poor oral hygiene during the transplantation and/or immunosuppression procedures involved in HSCT therapy [38] . Other authors note that, because "the oral cavity is a frequent site of local infections and an important port of entry for systemic infections in HSCT recipients..., the presence of H. pylori in the oral cavity may be a risk factor for infection or reinfection of the stomach of these patients" [9,38] .…”

“…The authors report that their findings may be due to the patients' poor oral hygiene during the transplantation and/or immunosuppression procedures involved in HSCT therapy [38] . Other authors note that, because "the oral cavity is a frequent site of local infections and an important port of entry for systemic infections in HSCT recipients..., the presence of H. pylori in the oral cavity may be a risk factor for infection or reinfection of the stomach of these patients" [9,38] . Though this literature review shows that the exact role played by H. pylori in oral cavity infections has not been confirmed, these findings may be relevant to the gastrointestinal pathology of HSCT patients.…”