The Role of Helicobacter pylori in Upper Respiratory System Infections: Is it More Than Colonization? Curr Infect Dis Rep. 2012;14:128-136. [PMID: 22311663 DOI: 10.1007/s11908-012-0237-9]

Possible Role of Helicobacter pylori in Ear Nose and Throat Diseases

Background

Helicobacter pylori is assumed to cause many gastric and extragastric diseases. We aimed to assess the possible association role of H. pylori in Otitis media with effusion (OME), nasal polyps and adenotonsillitis.

Patients and Methods

A total of 186 patients with various ear, nose and throat diseases were included. The study comprised 78 children with chronic adenotonsillitis, 43 children with nasal polyps and 65 children with OME. OME patients were assigned to two subgroups: those who have and those who did not have adenoid hyperplasia. Among the patients with bilateral nasal polyps, 20 individuals had recurrent nasal polyps and 23 had de novo nasal polyps. Patients who have chronic adenotonsillitis were divided into three groups: those with chronic tonsillitis and those who underwent tonsillitis, those with chronic adenoiditis and adenoidectomy was performed, and those with chronic adenotonsillitis and underwent adenotonsillectomy. In addition to examination of H. pylori antigen in stool samples of all included patients, real-time polymerase chain reaction (RT-PCR) for detection of H. pylori in the effusion fluid was performed, additionally, Giemsa stain was used for detection of H. pylori organism within the tissue samples when available.

Results

Frequency of H. pylori in effusion fluid was 28.6% in patients with OME and adenoid hyperplasia, while in those with OME it was only 17.4% with a p value of 0.2. Nasal polyp biopsies were positive in 13% patients of denovo, and 30% patients with recurrent nasal polyps, p=0.2. De novo nasal polyps were more prevalent in the positive stools than recurrent ones, p=0.7. All adenoid samples were negative for H. pylori, only two samples of tonsillar tissue (8.3%) were positive for H. pylori, and stool analysis was positive in 23 patients with chronic adenotonsillitis.

Conclusion

Lack of association between Helicobacter pylori and occurrence of OME, nasal polyposis or recurrent adenotonsillitis.

The role of Helicobacter Pylori and laryngopharyngeal reflux in recurrent tonsillitis

OBJECTIVES

To detect Helicobacter Pylori [HP] in tonsillar tissue of recurrent tonsillitis cases and assess the possible role of Laryngopharyngeal reflux [LPR] in tonsillar HP infection.

METHODS

A prospective study was done on the cited subject in a sample size of 50 paediatric patients [Age group: 6-18 years] suffering from recurrent tonsillitis. LPR was diagnosed by Reflux Symptom index [RSI] and Reflux Finding score [RFS]. A score of more than 7 and 13 was regarded as significant for RFS and RSI respectively. Patients with both scores significant were regarded to be suffering from LPR. Tonsillar specimen after tonsillectomy were subjected to urease test, histopathology [ Modified Giemsa Staining] and culture to detect HP. A minimum of two positive tests of the mentioned three were taken as gold standard to diagnose colonization of HP. Tabulated data was statistically analysed.

RESULTS

We recorded an incidence of 9% [18 cases] for LPR in recurrent tonsillitis. No case of HP colonization of tonsils was detected in this case series, even in patients of LPR.

CONCLUSION

We conclude that tonsils are not an extra gastric reservoir of HP. In addition, there is no aetiological relationship between recurrent tonsillitis and HP. And lastly, LPR is not a significant factor for colonization of tonsils by HP.

Impact of gastric Helicobacter pylori infection on nasal mucociliary clearance

OBJECTIVES

This study aimed to investigate the relationship between the presence of gastric Helicobacter pylori (HP) infection and nasal mucociliary clearance (NMC) time and to analyze the effect of HP eradication on NMC time.

MATERIALS AND METHODS

Patients who underwent gastric biopsy and had a positive result for HP constituted the study group, while the control group consisted of the patients who had a negative biopsy result. Two groups were compared in terms of NMC times. Quadruple medication therapy was given to HP-positive patients for 14 days for eradication and NMC time was measured again in these patients 8 weeks after eradication. Statistical analyses were performed with SPSS software (version 22.0; SPSS, Chicago, Illinois, USA).

RESULTS

There were 60 patients in the study group (HP +), while the control group (HP -) included 50 patients. Mean NMC times were 12.86 ± 2.62 and 8.32 ± 2.24 for the study and control groups, respectively (p < 0.001). Pre- and post-eradication mean NMC times of the HP + patients were 12.71 ± 2.58 and 8.62 ± 1.39, respectively (p < 0.001).

CONCLUSION

We determined that NMC time was significantly higher in HP-positive patients when compared with HP-negative patients, and the NMC times went back to normal after eradicating the HP infection. Because NMC dysfunction plays an essential role in the pathogenesis of chronic rhinosinusitis (CRS), we propose that eradication of HP can have positive effects on the prognosis of CRS. Further studies are needed to establish this relationship.

Intranasal Helicobacter pylori infection in patients with chronic rhinosinusitis with polyposis

Objective

To determine the prevalence of Helicobacter pylori infection in nasal biopsy specimens from patients with chronic rhinosinusitis with polyposis versus control patients, and to assess the correlations between H pylori infection identified in the nasal tissue and patients’ sociodemographic data and reflux-related symptoms and signs.

Methods

Nasal biopsy samples were taken from 75 adult patients who underwent nasal surgery for chronic rhinosinusitis with polyposis (clinical group, n = 45) and a deviated septum (control group, n = 30). H pylori infection was identified using histochemical and rapid urease tests.

Results

The prevalence of intranasal H pylori infection was significantly higher in the clinical group (28.9 per cent) compared to the control group (3.3 per cent) (p = 0.005). A significant yet weak association was found between positive H pylori status and laryngopharyngeal reflux related hypertrophy of the posterior commissure of the larynx. No other correlations reached statistical significance.

Conclusion

H pylori infection is potentially related to chronic rhinosinusitis with polyposis. Further research is needed to clarify the role of H pylori as a risk factor for the development of sinonasal diseases and to examine its link with laryngopharyngeal reflux.

Helicobacter pylori in the tonsillar tissue: a possible association with chronic tonsillitis and laryngopharyngeal reflux

Objective:

To identify Helicobacter pylori infection in tonsillar tissue samples from patients undergoing tonsillectomy for chronic tonsillitis versus tonsillar hypertrophy, and to assess the possible relationships between H pylori and patients’ sociodemographic data and laryngopharyngeal reflux.

Methods:

In this prospective study, 97 patients who underwent tonsillectomy were divided into the following 2 groups: patients with chronic tonsillitis (n = 62) and patients with tonsillar hypertrophy (control group; n = 35). H pylori infection in the tonsillar biopsy samples was identified using histochemical and rapid urease tests.

Results:

The incidence of H pylori infection was significantly higher in the chronic tonsillitis group (56.5 per cent) compared to the control group (31.4 per cent). Similar findings were obtained for both subgroups of adults (68.6 vs 42.3 per cent) and children (40.7 vs 0.0 per cent). Significant relationships between a positive H pylori finding and laryngopharyngeal reflux related signs of vocal fold oedema, diffuse laryngeal oedema and hypertrophy of the posterior commissure were revealed.

Conclusion:

H pylori infection may be related to chronic tonsillitis and laryngopharyngeal reflux.

Increased Exhaled 8-Isoprostane and Interleukin-6 in Patients with Helicobacter pylori Infection

BACKGROUND

Helicobacter pylori (H. pylori) infection triggers both local inflammation, usually in gastric mucosa, and chronic systemic inflammation. It is assumed that this local and systemic inflammation is caused by extracellular products excreted by H. pylori. The aim of this study was to investigate the possible association between H. pylori infection and a local inflammatory response in the airway by using exhaled breath condensate technique.

MATERIALS AND METHODS

This study includes 41 H. pylori seropositive patients who have gastric symptoms and 27 healthy control subjects. Pulmonary function tests (PFT), chest X ray, and physical examination were performed in all patients and interleukin-6 (IL-6), 8-isoprostane and nitrotyrosine levels were measured in exhaled breath condensate.

RESULTS

Levels of IL-6 and 8-isoprostane in exhaled breath condensate (EBC) were significantly higher in H. pylori positive patients than control subjects (p < 0.05). Nitrotyrosine levels were also higher in H. pylori positive patients but the difference was not statistically significant. Both groups had similar leukocyte counts, C-reactive protein (CRP) levels and PFT parameters.

CONCLUSION

H. pylori infection causes an asymptomatic airway inflammation which can be detected by exhaled breath condensate. The clinical importance of this inflammation remains unclear.

An association between Helicobacter pylori and upper respiratory tract disease: Fact or fiction?

Helicobacter pylori (H. pylori) is a major cause of chronic gastritis and gastric ulcers and considerable evidence supports the notion that infection with this bacterium is also associated with gastric malignancy in addition to various other conditions including pulmonary, vascular and autoimmune disorders. Gastric juice infected with H. pylori might play an important role in upper respiratory tract infection. Although direct and/or indirect mechanisms might be involved in the association between H. pylori and upper respiratory tract diseases, the etiological role of H. pylori in upper respiratory tract disorders has not yet been fully elucidated. Although various studies over the past two decades have suggested a relationship between H. pylori and upper respiratory tract diseases, the findings are inconsistent. The present overview describes the outcomes of recent investigations into the impact of H. pylori on upper respiratory tract and adjacent lesions.