Midede H. pylori Eradikasyon Oranları Oral H. pylorinin Dişeti (Periodontal) Tedavisi ile Eliminasyonu ile Artırılabilir mi? Literatür Taraması

Periodontal hastalıklar dişi destekleyen dokularda görülen dişler üzerinde yerleşen lokalize mikro- biyal dental plağın sebep olduğu yerkürede oldukça sık rastlanan kronik enfeksiyon hastalıklardır. Tedavi edilmediğinde zamanla alveolar kemik kaybı, ataçman kaybı ve dişlerde fonksiyon kaybına neden olabilir ve nihai olarak ise diş kaybı meydana gelebilir. H. pylori midede ve gastrointestinal sistemde kolanize olabilen Gr- spiral şekilli bir patojendir. Kronik gastrikten gastrik kansere kadar geniş yelpazede hastalıklara sebeb olabilir Bu nedenle bu potansiyel zararlı bakterinin eliminas- yonu önemlidir. Klasik sistemik H. pylori eradikasyon tedavisi başlangıçta başarılı olmasına rağ- men, artan antibiyotik direnci ve yan etkiler nedeniyle klinik ortamda başarı oranları düşürmüştür. Ayrıca artan rekürens oranları araştırmacıları, H. pylori için potansiyel ikincil kolonizasyon odağı aramaya itmiştir. Oral kavitede dental plaktan bu bakterinin kültüre edilmesinden sonra, araş- tırmalar oral kavitenin H. pylori için potansiyel barınak olup olamayacağı hipotezine yönelmiştir. Takip eden çalışmalar H. pyloriyi oral kavitede tespit edildiğini hatta oral H. pylori prevelansının mideden daha yüksek olduğunu bulmuştur. Özellikle dental plak içindeki H. pyloriye bir biyofilm yapısı içinde yer aldığından sistemik antibiyotikler etkili olamaz. Bu nedenle periodontal hasta- lıktaki gibi mekanik olarak uzaklaştırılması gerekir. Nitekim, klinik çalışmalar midedeki H. pylori enfeksiyon tedavisinin midedeki bakteriyi eradike ederken oral kavitedeki bakteriye etki etmedigi gösterilmiştir. Gittikçe artan çalışmalar periodontal tedavinin gastrik H. pylori eradikasyon tedavi- siyle eş zamanlı olarak uygulandığında tedavinin başarısını artırdığını göstermektedir. Bu nedenle gastroenterologlar ile diş hekimlerinin koordineli bir şekilde çalışması gastrik H. pylori eradikas- yon tedavisinin başarı oranlarını artırabilir. Bu derlemenin amacı oral H. pylori varlığı konusundaki delilleri ve ilave periodontal tedavinin mide eradikasyon tedavisine katkısı konusunda en güncel araştırmaları gözden geçirmektir. Anahtar Kelimeler: Periodontal Tıp, Helicobacter pylori, Periodontal tedavi ABSTRACT Periodontal diseases are chronic infectious diseases caused by microbial dental plaque local- ized on teeth. Periodontitis is very common worldwide. When not treated, it can cause alveolar bone loss and attachment loss and lead to loss of function in teeth over time, and the final pic- ture may be tooth loss. Helicobacter pylori is a spiral-shaped pathogen that can cause a wide range of diseases ranging from chronic gastric to gastric cancer, primarily colonized in the stom- ach and gastrointestinal system. Therefore, elimination of this potentially harmful bacterium is important. Although initially conventional systemic eradication therapy was successful, increas- ing antibiotic resistance and side effects decreased their success rates in the clinical setting. Additionally, increasing recurrence rates have prompted researchers to seek for alternative res- ervoirs for Helicobacter pylori. After isolation of Helicobacter pylori from dental plaque by culture method, researchers conducted trials to see whether the oral cavity could be a potential shelter for Helicobacter pylori. The following studies have detected Helicobacter pylori in the oral cavity. Interestingly, the Helicobacter pylori prevalence was higher in the oral cavity than in the stomach. Systemic antibiotics do not affect particularly Helicobacter pylori in dental plaque due to its biofilm structure. Therefore, it must be removed mechanically as in periodontal disease. As a matter of fact, clinical studies have shown that Helicobacter pylori infec- tion treatment eradicates the bacteria in the stomach but does not affect the bacteria in the oral cavity. Moreover, clinical studies showed that periodontal treatment increases the success rate of gastric eradication therapy when used as an adjunct to the con- ventional triple eradication therapy. Based on these data, coordination of gastroenterologists with dentists may increase the suc- cess rate of gastric Helicobacter pylori eradication treatment. Therefore, the aim of this review is to discuss the existing evidence for the presence of Helicobacter pylori in the oral cavity and the contribution of periodontal treatment as an adjunct to gastric Helicobacter pylori eradication therapy. Keywords: Helicobacter pylori, periodontal medicine, periodontal treatment

Keywords:

Helicobacter pylori, periodontal medicine periodontal treatment,

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