Presence of Helicobacter Pylori in the Stomach and Laryngeal Mucosal Linings in Patients with Laryngeal Cancer.

Helicobacter (H.) pylori is the cause of one of the most common chronic bacterial infections in humans. Risk factors for the development of laryngeal cancer are cigarette smoke, alcohol, and human papillomavirus. Several papers report on H. pylori isolated in tooth plaque, saliva, middle ear and sinuses. Many articles describe the presence of H. pylori in laryngeal cancer cases, however, without noting the possible source of infection, i.e. stomach or oral cavity. The aim of this study was to determine which patients and to what extent simultaneously developed H. pylori colonization in the stomach and the larynx. Prospective examinations were performed in 51 patients with laryngeal squamous cell carcinoma. The study group included patients with laryngeal squamous cell carcinoma histopathologically confirmed by two independent pathologists. The patients underwent fiber esophagogastroduodenoscopy with tumor tissue biopsy. Laryngeal and gastric biopsies were ex-amined by histologic staining technique for histopathologic detection of H. pylori and with DNA analyses using the standardized fluorescent ABI Helicobacter plus-minus PCR assay. Laryngeal car-cinoma patients showed positive H. pylori test results simultaneously in the laryngeal and stomach areas, implying H. pylori transmission from the stomach to the laryngeal area. In addition, H. pylori positive test results along with negative H. pylori results in the stomach region were also recorded, suggesting a possible bacteria migration from the oral cavity. In conclusion, H. pylori was found in the area of laryngeal carcinoma, and its migration appeared likely to occur both upwards (from the stomach to the mouth) and downwards (from the oral cavity to the stomach).

[Extra-gastrointestinal tract diseases and Helicobacter pylori infection]. / Bolesti izvan zeluca i probavnog sustava i infekcija Helicobacterom pylori.

Helicobacter pylori infection is linked to conditions of the upper gastrointestinal tract, including peptic ulcer and gastric adenocarcinoma na MALT lymphoma. It has also been associated with wide variety of extragastric and non-gastrointestinal conditions. However, the evidence in support of Helicobacter pylori infection as a cause of the non-gastrointestinal tract diseases is not widely understood. We reviewed the medical literature in regard to putative association of Helicobacter pylori infection and non-gastrointestinal tract condition, notably cardiovascular, autoimmune and dermatological diseases. The majority of published papers examining the potential causal relationship were case-control studies, cross-sectional and cohort studies while only a few recent articles that did not confirm the evidence of causal relationship represent well designed population-based prospective studies. The lack of clear evidence for etiopathogenetic associations of Helicobacter pylori infection and non-gastrointestinal tract conditions should focus our attention on appropriate testing and treatment of Helicobacter pylori infection in patients with conditions that are of proven association such as peptic ulcer disease.

[Gastric ulcer and Helicobacter pylori infection]. / Zelucani ulkus i infekcija Helicobacterom pylori.

Helicobacter pylori infection and the use of non-steroidal anti-inflammatory drugs (NSAID) are considered to be the two major risk factors implicated in the development of gastric ulcer. Helicobacter pylori infection related chronic gastritis is known to be the underlying condition which may lead to gastric ulcer. Development of gastric ulcer as the consequence of underlying chronic gastritis is caused by many factors. Treating Helicobacter pylori infection entails the healing of gastric ulcer, it concomitantly prevents recurrences and complications of gastric ulcer, primarily bleeding, and changes the natural course of gastric ulcer disease. Continuation of antisecretory maintenance treatment beyond ulcus healing and eradication of Helicobacter pylori infection is only indicated in risk groups. Patients with gastric ulcer caused by NSAID use are managed with antisecretory therapy.

[Helicobacter pylori--overview of therapy]. / Helicobacter pylori--pregled terapijskih mogucnosti.

The clinical significance of Helicobacter pylori infection in the etiopathogenesis of many gastroduodenal disorders, especially peptic ulcer disease and current awareness of the benefits of its eradication has entirely changed the current treatment of these diseases. Eradication was already defined as the disappearance of Helicobacter pylori from the gastric mucosa (finding negativization) confirmed at least 4 weeks (or later) after completed antibiotic eradication therapy. The regimen has to be simple, cheap and tolerable so that the patient could carry it out completely and as easy as possible (good compliance is required). The success of Helicobacter pylori eradication, evaluated by the strict "intention-to-treat" criteria, has to be higher than 80%. Current modern therapy should be triple and not longer than 7 days. One of three proton pump inhibitors is recommended as the antisecretory component (omeprazole, pantoprazole or lansoprazole). Two of three following antibiotis is added to this therapy: metronidazole/tinidazole, clarithromycin or amoxicillin. Treatment failure and growing number of antimicrobial resistant Helicobacter pylori strains require new ways of therapy and more effective drugs. Our results of 7-, 10- and 14-day therapy consisting of omeprazole, amoxicillin and metronidazole are poorer than those of drug combination including clarithromycin instead of amoxicillin. The results of Clinical Hospital "Merkur" showed that combination of amoxicillin, metronidazole and pantoprazole was more effective than the same combination with omeprazole, and the opposite was true for metronidazole and azithromycin combined with omeprazole and pantoprazole, respectively. The results of other medical centers prescribing the same eradication protocols were completely different. The differences are probably caused by poor patient compliance.