Does Helicobacter pylori play a role in the development of chronic adenotonsillitis?

Prevalence of Helicobacter pylori in routine adult tonsillectomies

Helicobacter pylori, a curved bacterial rod and causative agent of peptic ulcer and gastric adenocarcinoma, is found as an infectious agent in the stomach of over half of the global population. H. pylori has been identified in oral biofilms and its presence in adenotonsillar tissues has been suggested, with variations in testing methodology both proving and disproving its presence. The current study employed 119 formalin-fixed paraffin-embedded tonsillar tissues from an adult population (n=86) in a major metropolitan city with immunohistochemistry procedures using a monoclonal antibody to determine the incidence of H. pylori in the tonsils. H. pylori was identified in 72.1% of the patients and was associated with Actinomyces spp. in 92.0% of those cases. The high incidence of H. pylori in patients undergoing tonsillectomy suggests that H. pylori may be a contributing factor for tonsillitis and tonsillar hypertrophy. Furthermore, the reservoir for H. pylori in the tonsils may explain why some persons remain refractory to antibiotic treatment for gastric H. pylori.

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.

The role of environmental tobacco exposure and Helicobacter pylori infection in the risk of chronic tonsillitis in children

CONTEXT AND OBJECTIVE:

Helicobacter pylori (H. pylori) is a chronic infectious pathogen with high prevalence. This study investigated the interaction between environmental tobacco exposure and H. pylori infection on the incidence of chronic tonsillitis in Chinese children.

DESIGN AND SETTING:

Cross-sectional study performed in an outpatient clinic in China.

METHODS:

Pediatric patients with chronic tonsillitis were enrolled. H. pylori infection was determined according to the presence of H. pylori CagA IgG antibodies. Serum cotinine levels and environmental tobacco smoke (ETS) exposure were determined for all participants.

RESULTS:

There was no significant difference in H. pylori infection between the children with chronic tonsillitis and children free of disease, but there was a significant difference in ETS between the two groups (P = 0.011). We next studied the association between ETS and chronic tonsillitis based on H. pylori infection status. In the patients with H. pylori infection, there was a significant difference in ETS distribution between the chronic tonsillitis and control groups (P = 0.022). Taking the participants without ETS as the reference, multivariate logistic regression analysis showed that those with high ETS had higher susceptibility to chronic tonsillitis (adjusted OR = 2.33; 95% CI: 1.67-3.25; adjusted P < 0.001). However, among those without H. pylori infection, ETS did not predispose towards chronic tonsillitis.

CONCLUSION:

Our findings suggest that tobacco exposure should be a putative mediator risk factor to chronic tonsillitis among children with H. pylori infection.

Correlation Between Tympanosclerosis and Helicobacter pylori

Background:

Tympanosclerosis is a condition caused by calcification of tissues in the middle ear mucosa that sometimes results hearing loss. Helicobacter pylori is one of the pathological and etiologic factors in the development of tympanosclerosis.

Objectives:

The purpose of this study was to show the role of H. pylori in the different aspects of chronic suppurative otitis media using the polymerase chain reaction (PCR) technique.

Patients and Methods:

This case-control and cross-sectional study was performed on all patients with chronic otitis media, candidates for surgical operations, in 2013. They were allocated into the case group with tympanosclerosis and the control group without tympanosclerosis. During the surgical operation, biopsy was done from middle ear and the samples were studied to see if they contained H. pylori using the PCR method.

Results:

From a total of 19 patients with tympanosclerosis , 16 cases (84.2%) were H. pylori positive, while in the control group 15 (45.4%) cases out of the 37 cases were H. pylori positive, which showed a significant difference (P = 0.002). Age and gender of the patients, ear dryness and perforation size were not correlated with the presence or absence of H. pylori.

Conclusions:

There is a significant correlation between tympanosclerosis and H. pylori (P = 0.002). This correlation can single out H. pylori as a pathological factor in the development of tympanosclerosis; however, further studies are needed to prove this correlation.

Prevalence of the Helicobacter pylori in the tonsils and adenoids

Introduction

There is an ongoing debate about the existence and effects of Helicobacter pylori (Hp) in adenotonsillar tissue.

Objective

A clinical study was conducted to assess the existence of Hp in the adenoid and/or adenotonsillar tissues, which were surgically excised due to chronic adenotonsillitis.

Methods

Phosphoglucosamine mutase gene for the detection of Hp and cytotoxin-associated gene as virulence gene were examined in 84 adenotonsillar tissues obtained from 64 patients and patients’ serum by using polymerase chain reaction.

Results

Hp IgG was detected in 57 (89%) patients’ serum. A total of seven tissue samples from 64 patients (10.9%) were found positive for Hp DNA, of which five were adenoids and two were tonsil tissues. All polymerase chain reaction positive samples were also positive for the cytotoxin-associated gene, which is a virulence determinant for the organism.

Conclusion

This study suggests that children are exposed to Hp at an early age of their life in this province. Hp may have a role in the pathogenesis of chronic adenotonsillitis, especially in endemic areas.

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

There has been conflicting results regarding the presence of H. pylori in tonsillar tissue. Our objective was to analyze for the presence of H. pylori in tonsillar tissue in patients undergoing tonsillectomy for chronic recurrent tonsillitis using rapid urease test in a Tertiary care academic medical center in a sub Saharan hospital. A prospective cross-sectional analysis of 39 consecutive cases of patients undergoing tonsillectomy secondary to chronic recurrent tonsilitis was done. Rapid urease test was conducted on each tonsillectomy tissue and results were determined using color change at specific time intervals within 24 h. Average age of the patients was 4.3 years. Among the 39 tonsillar tissues analysed using rapid urease test, H. pylori was present in 30.5 % of the samples. Colonisation by H. pylori of the palatine tonsils is a new frontier with conflicting results depending on the accuracy of the test method used and population studied. More studies need to be performed to ascertain the different rates of colonisation based on geographical regions.

Pilot study: Association between Helicobacter pylori in adenoid hyperplasia and reflux episodes detected by multiple intraluminal impedance in children

OBJECTIVES

The aim of this pilot study was to investigate an association between laryngopharyngeal reflux detected by combined multiple intraluminal impedance and pH monitoring and Helicobacter pylori in adenoid hyperplasia detected with real time polymerase chain reaction (PCR).

METHODS

The study group consisted of 30 children (median age 5.34 years) with extraesophageal symptoms of gastroesophageal reflux disease with adenoid hyperplasia. All children underwent adenoidectomy with subsequent PCR detection of H. pylori DNA in the tissue and multiple intraluminal impedance and pH monitoring. The most proximal impedance sensor was located 1cm caudal to the entrance of the oesophagus.

RESULTS

We found significant differences in the number of reflux episodes among patients with PCR positivity (median 35) and negativity (median 0) of H. pylori (p-value of Mann-Whitney U-test 0.0056). Patients with PCR positivity of H. pylori had significantly more reflux episodes reaching the upper oesophageal sphincter (p-value of Mann-Whitney U-test 0.023). The absence of reflux episode was the only independent factor for PCR negativity of H. pylori in the multiple logistic regression model.

CONCLUSIONS

These results support the hypothesis that reflux episodes reaching the upper oesophageal sphincter may play an important role in the transmission of H. pylori into lymphoid tissue of the nasopharynx and thus may contribute to adenoid hyperplasia in children.

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.

Relationship between Helicobacter pylori Adenotonsillar Colonization and Frequency of Adenotonsillitis in Children

BACKGROUND

There are insufficient data in the literature on the presence of Helicobacter pylori in tonsil and adenoid tissue of patients with only airway obstruction. This study examined the presence of H. pylori in surgical cases with airway obstruction or recurrent infection.

AIMS

To investigate the relationship between H. pylori adenotonsillar colonisation and the frequency of adenotonsillitis and to compare paediatric and adult patients according to H. pylori tonsillar colonisation.

STUDY DESIGN

Prospective clinical trial.

METHODS

PATIENTS SCHEDULED FOR ADENOIDECTOMY OR TONSILLECTOMY WERE CLASSIFIED INTO THREE GROUPS BASED ON INDICATIONS: paediatric infection (n=29), paediatric obstruction (n=29) and adult infection (n=12). Tissue samples obtained from patients were examined for the presence of H. pylori by culture, rapid urease test and polymerase chain reaction.

RESULTS

Forty-nine tonsil tissues were examined. Positive results were found in two specimens with the rapid urease test (4.1%) and three with polymerase chain reaction examination (6.1%). Only three positive polymerase chain reaction results (5.8%) were identified in 52 adenoid tissue samples. There were no statistically significant differences in the presence of H. pylori between paediatric infection and obstruction groups or between paediatric infection and adult infection groups.

CONCLUSION

In our study, there was a low incidence of H. pylori colonisation in tonsil and adenoid tissues. Regarding H. pylori colonisation, there was no significant difference between paediatric infection and obstruction groups. Also, no significant difference was found between adult and paediatric cases.

Presence of different genotypes of Helicobacter pylori in patients with chronic tonsillitis and sleep apnoea syndrome

Helicobacter pylori, a well-known gastric pathogen, has been detected in the oral cavity and oropharynx in tonsillar tissue. In our study, the presence of H. pylori in the tonsillar tissue of patients with chronic tonsillitis and sleep apnoea syndrome (SAS) was investigated. The aim was to detect and genotype H. pylori for a collection of data supporting the possible role of H. pylori in the aetiology of chronic tonsillitis and SAS. Helicobacter pylori was detected by real-time polymerase chain reaction (rt-PCR). 89 patients, 60 with a diagnosis of chronic tonsillitis and 29 with SAS, were tested. In the chronic tonsillitis group, Helicobacter was detected in 48 (80 %) specimens, cagA gene was detected in 12 samples (25 %) and 12 samples were negative. In SAS group, Helicobacter was found in 24 samples (82.76 %), cagA gene was detected in 5 (20.83 %) and 5 samples (17.24 %) were negative. Helicobacter pylori-specific immunoglobulins were tested by ELISA in the serum of 57 patients only with 41 (71.93 %) showing positive. Our results on H. pylori DNA detection and H. pylori seropositivity show 26.32 % discrepancy, slightly in favour of rt-PCR (15.79 % compared to 10.53 %). The H. pylori presence in tonsillar tissue does not depend on the type of oropharyngeal disease (p = 0.756). This study shows that oropharynx constitutes an extragastric reservoir of H. pylori infection which could serve as an aetiopathogenetic factor for chronic tonsillitis and tonsillar hyperplasia by SAS. No conclusion has yet been drawn about the mechanism of the process.

The Role of Helicobacter pylori in Upper Respiratory System Infections: Is it More Than Colonization?

Helicobacter pylori (HP) is recognized as a common chronic human bacterial infection and is the most common cause of gastritis. Recent studies suggest an increased HP prevalence in patients with various extra-digestive inflammatory diseases. Since many respiratory diseases are characterized by chronic inflammation as well as increased immune response, and HP may enter the nasopharyngeal cavity by gastroesophageal reflux, an association between respiratory disorders and HP infection has been suggested. Several studies discover HP in clinical samples from the patients with upper respiratory system infections. Even some of them revealed a relief after the treatment directed to HP eradication. However some studies do not support this theory and whether this association means a definite proof of a causal relationship between HP and respiratory diseases needs to be clarified. In this study, we aimed to review the reports about the role of HP in upper respiratory system infections.

Ribosomal therapy in the treatment of recurrent acute adenoiditis

The aim of this study was to evaluate the efficacy of an oral ribosomal immunotherapy in the management of children with recurrent acute adenoiditis (RAA). 60 children with RAA were included and randomly assigned into two groups (group A and B). Group A children underwent ribosomal prophylaxis, while group B received a placebo. Before, at the end and 6 months after start of the therapy, children underwent medical history, ENT examination, plasma levels of immunoglobulins class E, A, G, M (IgE, IgA, IgG, IgM), tympanometry, active anterior rhinomanometry and VAS scores by children' parents. After the treatment and at the end of the study, in the group A, the serum concentration of IgE was significantly (P < 0.05) lower than in group B (77.34 +/- 6.23 vs. 95.49 +/- 7.07 mg/dl; 74.82 +/- 6.26 vs. 94.44 +/- 7.44 mg/dl), IgA titers were significantly (P < 0.05) higher than in group B (312.04 +/- 18.41 vs. 213.20 +/- 11.82; 309.07 +/- 18.33 vs. 211.73 +/- 11.54 mg/dl) as well as serum concentration of IgG (1401.12 +/- 118.81 vs. 1101.81 +/- 109.64 mg/dl; 1412.19 +/- 116.43 vs. 1144.06 +/- 103.58 mg/dl). At the end of the study, comparison between the two groups showed, in group A: 77% of children (n = 23), versus 23% (n = 7) of group B, with a type A tympanogram; significant (P < 0.05) nasal flow decrease at the rhinomanometric measures; VAS scores were significantly (P < 0.05) improved (1.8 +/- 0.22 vs. 5.1 +/- 0.59) and frequency, severity and social impact of RAA episodes were significantly (P < 0.05) lower than group B. Our results show the therapeutic effectiveness of this approach in the prophylaxis of recurrent acute adenoiditis.

Helicobacters and extragastric diseases

For two decades, Helicobacter pylori has been considered as the culprit in many extragastric manifestations. However, for several of these supposed associations the hypothesis of an etiological role has not yet been fully investigated. This may be due to a series of factors linked to the epidemiological features of the studies and to the diseases investigated. This review attempts to highlight the main reported associations of H. pylori with extragastric manifestations during the last year. The most convincing data arise in the field of idiopathic thrombocytopenic purpura (ITP) and sideropenic anemia. Long-term follow-up studies have shown that 50% of subjects with ITP maintain a hematological response after H. pylori eradication. There is also growing evidence of the role of H. pylori in other diseases, including ischemic heart disease even though results are not conclusive.