Effect of antibacterial therapy and salivary secretion on the efficacy of Helicobacter pylori eradication in duodenal ulcer patients.
OBJECTIVE
Oral health status may play a role in Helicobacter pylori eradication. Because adequate secretion of saliva promotes oral health, the aim of the study was to assess the effect of salivary secretion on the efficacy of H pylori eradication from the stomach.


METHODS
The study involved 90 H pylori-positive subjects with duodenal ulcer (68 men, 22 women, aged 20-70 years) in whom saliva was collected under basal conditions for 45 min before antibacterial treatment began. They received no drugs for at least 3 days prior to saliva collection. A 7-day course of either of 2 eradication regimens--omeprazole, amoxicillin, and tinidazole (OAT); or omeprazole, amoxicillin, and clarithromycin (OAC)--was used. The efficacy of eradication therapy was evaluated 30 days after its completion.


RESULTS
The efficacy of H pylori eradication from the stomach (per protocol analysis) was 77.5% in the group of subjects treated with OAT and 81.6% with OAC. Combined analysis of both groups (OAT+OAC) showed reduced salivary secretion in subjects with eradication failure (0.395 +/- 0.266 vs 0.25 +/- 0.176 mL/min, P=.042). A similar outcome was obtained when the OAT group was analyzed separately (0.436 +/- 0.316 vs 0.211 +/- 0.216 mL/min, P=.022), but in the OAC group the difference was not significant. In the combined analysis, the efficacy of eradication therapy was lower in women than in men (52.9% vs 86.9%, P=.005). In women, it corresponded to salivary secretion (successful eradication 0.337 +/- 0.133 mL/min, unsuccessful eradication 0.180 +/- 0.144 mL/min, P=.043); whereas in men, the difference was not significant (successful eradication 0.405 +/- 0.282 mL/min, unsuccessful eradication 0.321 +/- 0.186 mL/min).


CONCLUSIONS
Low salivary secretion may contribute to the decrease in efficacy of H pylori eradication from the stomach, at least in subjects treated with certain drug regimens.
Namiot
Zbigniew
Z
Department of Physiology, Medical University of Bialystok, Poland. namiotz@poczta.onet.pl
Namiot
Dorota B
DB
Kemona
Andrzej
A
Stasiewicz
Jan
J
D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D017291:Clarithromycin / Q000627:therapeutic use; D004381:Duodenal Ulcer / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000382:microbiology; D009853:Omeprazole / Q000627:therapeutic use; D012463:Saliva / Q000187:drug effects / Q000378:metabolism*; D012737:Sex Factors; D013270:Stomach / Q000382:microbiology; D014011:Tinidazole / Q000627:therapeutic use; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D014011:Tinidazole; D000658:Amoxicillin; D017291:Clarithromycin; D009853:Omeprazole