title: Periodontal therapy as adjunctive treatment for gastric Helicobacter pylori infection.
abstract: BACKGROUND
  Helicobacter pylori is estimated to affect about half the world's population and is considered as the main cause of chronic gastritis and peptic ulcer disease. Eradication of H. pylori infection accelerates ulcer healing and prevents relapse, reducing incidence of H. pylori-related gastric diseases. Numerous studies have provided evidence that the oral cavity could be a potential reservoir for H. pylori. The presence of oralH. pylori might affect the efficiency of eradication therapy and act as a causal force for its recurrence. Conversely, other investigators have indicated that the colonization and growth of H. pylori differs between the oral cavity and the stomach. Considering the open debate on the topic, it's necessary to clarify whether periodontal therapy is an effective adjunctive treatment for gastric H. pylori infection.
  
  
  OBJECTIVE
  To assess the effects of periodontal therapy plus eradication therapy versus eradication therapy alone for gastric H. pylori infection. The secondary objective is to compare the non-recurrence rate at long-term follow up in different treatment groups.
  
  
  METHODS
  We identified randomized controlled trials (RCTs) by searching the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 8), MEDLINE (1946 to August 2015), EMBASE (1980 to August 2015), and the Chinese Biomedical Database (1978 to August 2015). We also searched both ClinicalTrials.gov and the WHO ICTRP portal in October 2015. We handsearched the reference lists of included studies to identify relevant trials.
  
  
  METHODS
  RCTs comparing periodontal therapy plus eradication treatment with eradication treatment alone, regardless of language of publication.
  
  
  METHODS
  Two reviewers selected the trials that met the inclusion criteria and extracted the details of each study independently. 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. However, because there was little difference in the results from these two models, we only reported the results from the fixed-effect model.
  
  
  RESULTS
  We included seven small RCTs involving 691 participants aged 17 to 78 years in our meta analyses. The primary result showed that periodontal therapy combined with H. pylori eradication treatment increased the eradication rate of gastric H. pylori compared with eradication treatment alone (OR 2.15; 95% CI 1.47 to 3.14; P < 0.0001) in people with H. pylori infection. In addition, periodontal therapy also had benefits on long-term gastric H. pylori eradication. After eradication of H. pylori, the non-recurrence rate of gastric H. pylori infection increased in participants treated with periodontal therapy compared with those who received eradication therapy alone (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
  Overall, periodontal therapy could increase the efficiency of H. pylori eradication and the non-recurrence rate of gastricH. 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.
authors: Department of Gastroenterology, First Hospital of Lanzhou University, No. 1, Donggang West Road, Lanzhou City, Gansu, China, 730000.
authors: Qian
authors: Q
authors: Ren
authors: Xiang
authors: X
authors: Yan
authors: YongNing
authors: Y
authors: Zhou
authors: Wei Xin
authors: WX
authors: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016481:Helicobacter Infections / Q000517:prevention & control / Q000628:therapy*; D016480:Helicobacter pylori; D006801:Humans; D008875:Middle Aged; D010517:Periodontics; D010518:Periodontitis / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D055502:Secondary Prevention / Q000379:methods