Around half the world’s population is considered to be affected by Helicobacter pylori (H. pylori). H. pylori infection is considered to be the main cause of chronic gastritis and peptic ulcer disease although only a small proportion of those infected with H. pylori develops related diseases. A number of studies have suggested that the oral cavity is a reservoir for H. pylori. Although colonisation and growth of H. pylori may be different in the mouth and stomach it has been suggested that periodontal therapy may be a potentially effective adjunctive treatment for gastric H. pylori infection.

The main aim of this Cochrane review was to assess the effects of periodontal therapy plus eradication therapy versus eradication therapy alone for gastric H. pylori infection.

Methods

Searches were conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, the Chinese Biomedical Database, ClinicalTrials.gov and the WHO ICTRP portal. Randomised controlled trials (RCTs) comparing periodontal therapy plus eradication therapy versus eradication therapy alone were considered.

Two reviewers independently selected studies, abstracted data and assessed study quality using the Cochrane risk of bias tool. The data were pooled using both fixed-effect and random-effects models and results calculated as odds ratios (OR) with their 95% confidence intervals (CIs) based on an intention-to-treat analysis.

Results

• 7 small RCTs involving a total of 691 patients (382 in intervention groups, 309 in controls) were included.
• 6 of the included studies were conducted in China, 1 in Serbia.
• Periodontal therapy combined with H. pylori eradication treatment increased the eradication rate of gastric H. pylori compared with eradication treatment alone
• Odds ratio (OR) = 2.15 (95%CI; 1.47 to 3.14) P < 0.0001 in people with H. pylori infection.
• Patients receiving periodontal therapy and H. pylori eradication also had a greater chance of non-recurrence, OR = 3.60 (95%CI; 2.11 to 6.15) P < 0.00001.
• According to the GRADE approach, the overall quality of the evidence was ’moderate’ for eradication rate of gastric H.pylori and ’low’ for non-recurrence rate of gastric H. pylori.

Conclusions

The authors concluded

Overall, periodontal therapy could increase the efficiency of H. pylori eradication and the non-recurrence rate of gastric H. pylori. In view of the limited number and quality of included studies, it will be necessary to conduct more well-designed, multicenter, and large-scale RCTs to determine the effects of periodontal therapy in eradicating gastric H. pylori and suppressing the recurrence of this bacterium in the stomach.

Comments

This Cochrane review identified just 7 small trials that suggest that periodontal treatment may provide a useful adjunct to H. pylori eradication treatment. The authors highlight that the majority of the included studies were of low quality and the majority of them have been conducted in just one country. As a result further large high quality RCTs are needed to assess the adjunctive effect of periodontal therapy on H. pylori eradication treatment.

Links

Primary paper

Ren Q, Yan X, Zhou Y, Li WX. Periodontal therapy as adjunctive treatment for gastric Helicobacter pylori infection. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No.: CD009477. DOI: 10.1002/14651858.CD009477.pub2.

http://onlinelibrary.wiley.com/enhanced/doi/10.1002/14651858.CD009477.pub2