Aktaş Bora, Başyiğit Sebahat, Yüksel Osman, Akkan Tolga, Atbaşı Suna Tülin, Uzman Metin, Yılmaz Barış, Şimşek Gülçin, Nazlıgül Yaşar
Departments of aGastroenterology bInternal Medicine cDentistry dPathology, Keçiören Training and Research Hospital eDepartment of Gastroenterology, Hacettepe University School of Medicine, Ankara fDepartment of Gastroenterology, Osmaniye State Hospital, Osmaniye, Turkey.
Eur J Gastroenterol Hepatol. 2015 Jul;27(7):769-75. doi: 10.1097/MEG.0000000000000372.
Mercury exposure is encountered most commonly in individuals with amalgam fillings. The toxic, bactericidal, and immunosuppressive effects of mercury are well known. Furthermore, multiple antibiotic resistance can be transferred, together with mercury resistance. The aim of this study was to investigate the frequency of Helicobacter pylori infection in dyspeptic patients with amalgam fillings and the effect of the amalgam fillings on H. pylori eradication rates in these patients.
Four hundred and seventy-five patients who presented with dyspeptic complaints and underwent upper gastrointestinal endoscopy and gastric biopsy were included in this study. One hundred and sixty-nine (35.6%) patients were negative and 306 (64.4%) patients were positive for H. pylori. All of the participants underwent dental examinations in a blinded manner. The participants were divided into two groups on the basis of the presence of amalgam fillings. The H. pylori-positive patients were divided randomly into three subgroups: patients who received concomitant therapy (CT) (rabeprazole-amoxicillin-clarithromycin-metronidazole for 14 days; n=122); patients who received quadruple therapy (QT) (rabeprazole-tetracycline-metronidazole-colloidal bismuth subcitrate for 10 days; n=97); and patients who received levofloxacin-based therapy (LT) (rabeprazole-amoxicillin-levofloxacin for 10 days; n=87). Eradication success was detected by a urea breath test 6 weeks after the end of treatment.
The frequency of H. pylori infection was significantly lower in the filling group compared with the nonfilling group (53.7 and 78.8%, respectively; P<0.001). The eradication rates in the CT, QT, and LT groups were 65.5, 67.0, and 58.6%, respectively, in the intention-to-treat (ITT) analysis and 69.6, 70.7, and 62.2%, respectively, in the per-protocol (PP) analysis. In all of the H. pylori-positive patients and separately in the CT and LT groups, the eradication rates were significantly lower in the filling group compared with the nonfilling group. However, in the QT group, there was no significant difference between the patients with and without fillings (P=0.001, 0.003, 0.012, 0.14, respectively). Logistic regression analysis showed that the absence of amalgam filling exerts independent effects on the increased frequency of H. pylori infection and increased rate of H. pylori eradication.
This is the first study to show a lower frequency of H. pylori colonization in patients with amalgam fillings than without and that H. pylori eradication rates are lower in patients with amalgam fillings compared to those without.
汞暴露在有汞合金补牙材料的个体中最为常见。汞的毒性、杀菌作用和免疫抑制作用已为人熟知。此外，多重耐药性可与汞抗性一起转移。本研究的目的是调查有汞合金补牙材料的消化不良患者中幽门螺杆菌感染的频率，以及汞合金补牙材料对这些患者幽门螺杆菌根除率的影响。
本研究纳入了475例有消化不良症状并接受上消化道内镜检查和胃活检的患者。169例（35.6%）患者幽门螺杆菌检测为阴性，306例（64.4%）患者幽门螺杆菌检测为阳性。所有参与者均以盲法接受牙科检查。根据是否存在汞合金补牙材料将参与者分为两组。幽门螺杆菌阳性患者被随机分为三个亚组：接受联合治疗（CT）的患者（雷贝拉唑 - 阿莫西林 - 克拉霉素 - 甲硝唑，疗程14天；n = 122）；接受四联疗法（QT）的患者（雷贝拉唑 - 四环素 - 甲硝唑 - 枸橼酸铋钾，疗程10天；n = 97）；以及接受左氧氟沙星治疗（LT）的患者（雷贝拉唑 - 阿莫西林 - 左氧氟沙星，疗程10天；n = 87）。治疗结束6周后通过尿素呼气试验检测根除成功率。
补牙组幽门螺杆菌感染频率显著低于未补牙组（分别为53.7%和78.8%；P < 0.001）。意向性分析（ITT）中，CT、QT和LT组的根除率分别为65.5%、67.0%和58.6%，符合方案分析（PP）中分别为69.6%、70.7%和62.2%。在所有幽门螺杆菌阳性患者中，以及分别在CT组和LT组中，补牙组的根除率显著低于未补牙组。然而，在QT组中，有补牙材料和无补牙材料的患者之间没有显著差异（P分别为0.001、0.003、0.012、0.14）。逻辑回归分析表明，无汞合金补牙材料对幽门螺杆菌感染频率增加和幽门螺杆菌根除率提高具有独立影响。
这是第一项表明有汞合金补牙材料的患者幽门螺杆菌定植频率低于无汞合金补牙材料患者，且有汞合金补牙材料的患者幽门螺杆菌根除率低于无汞合金补牙材料患者的研究。
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