Department of Periodontology, School of Dentistry, Ondokuz Mayıs University, Samsun, Turkey.
Int Dent J. 2021 Jun;71(3):188-196. doi: 10.1111/idj.12616. Epub 2021 Jan 26.
The efficacy of conventional systemic antibiotic therapy for eradication of Helicobacter pylori has been seriously challenged by antibiotic resistance. Identification of alternative therapeutic strategies might help to overcome this limitation. The aim of this study was to update previous meta-analyses that investigated the effect of periodontal treatment on gastric H. pylori eradication.
A systematic electronic search of the literature was conducted to identify all published clinical trials that compared the effect of adjunct periodontal treatment on conventional systemic H. pylori eradication therapy.
The updated analysis (consisting of 541 participants representing six studies) demonstrated that, compared with conventional systemic eradication therapy alone, the addition of periodontal treatment resulted in improvements in gastric H. pylori eradication rates with OR 4.11 (P = 0.01). Moreover, not to lose any data, the previously presented Chinese results that could not be assessed by any available mechanism deduced from previously published meta-analysis and with other records were re-analysed. Similarly, the second meta-analysis adding up to a final cluster of 10 studies (909 participants) gives further credence to periodontal treatment as a useful concomitant therapy in the H. pylori eradication therapy (odds ratio [OR] = 2.65; P = 0.0002). Finally, the meta-analysis of four trials consisting of 177 cases and 161 controls showed that periodontal treatment also improved non-recurrence rates of gastric H. pylori infection, with an OR of 5.36 (P-value = 0.0002).
Although the inclusion of five additional clinical trials in this updated meta-analysis has not changed the result of the previous review, the current meta-analysis is superior for having removed one study involving the use of chlorhexidine, which did not meet appropriate criteria for inclusion. Our results strengthen the value of periodontal treatment as an adjunctive remedy. Consistency of these results suggests that the incorporation of professional periodontal treatment with systemic eradication therapy may be a wise strategy, enhancing the efficacy of H. pylori eradication therapy. Systematic review registration: in PROSPERO ID number: CRD42019119347.
抗生素耐药性严重挑战了传统系统抗生素疗法根除幽门螺杆菌的疗效。寻找替代治疗策略可能有助于克服这一限制。本研究旨在更新以前的荟萃分析，这些分析研究了牙周治疗对胃幽门螺杆菌根除的影响。
系统地电子搜索文献，以确定所有比较辅助牙周治疗对常规系统幽门螺杆菌根除治疗效果的已发表临床试验。
更新的分析（包括来自六项研究的 541 名参与者）表明，与单独接受常规系统根除治疗相比，牙周治疗的加入可提高胃幽门螺杆菌根除率，优势比为 4.11（P=0.01）。此外，为了不丢失任何数据，重新分析了之前无法通过任何可用机制评估的、先前发表的荟萃分析中推断出的、以及其他记录中的以前呈现的中国结果。同样，第二个荟萃分析增加了总共 10 项研究（909 名参与者）的结果，进一步证实了牙周治疗作为幽门螺杆菌根除治疗的一种有用的辅助治疗方法（优势比[OR]=2.65；P=0.0002）。最后，对四项包含 177 例病例和 161 例对照的试验进行的荟萃分析表明，牙周治疗也提高了胃幽门螺杆菌感染的非复发率，优势比为 5.36（P 值=0.0002）。
尽管本更新荟萃分析纳入了五项额外的临床试验，但并未改变之前综述的结果，当前荟萃分析更具优势，因为它剔除了一项涉及使用洗必泰的研究，该研究不符合纳入标准。我们的结果增强了牙周治疗作为辅助治疗的价值。这些结果的一致性表明，将专业牙周治疗与系统根除治疗相结合可能是一种明智的策略，可以提高幽门螺杆菌根除治疗的疗效。系统评价注册：在 PROSPERO 编号：CRD42019119347。
