role of helicobacter pylori in recurrent aphthous stomatitis in children

ABSTRACT

Helicobacter pylori [HP] organisms are spiral, microaerophilic, gram-negative bacteria affecting 70-90% of the population in developing countries. Infection is acquired before the age of 10 years. HP causes the majority of gastric and duodenal ulcers. Transmission may be by; ingestion, fecal-oral and oral-oral routes. In recurrent aphthous stomatitis [RAS], various microorganisms have been suspected but, the histological similarities between RAS and peptic ulcers, and the response of RAS to the broad-spectrum antibiotics suggested that HP may has a probable role in RAS development. To determine the presence of Helicobacter pylori and, if detected, its potential prevalence in causing recurrent aphthous ulcers confined to mucosa-associated lymphoid tissues [MALT] of the pharynx. 17-months prospective, controlled study. Pediatric Department, Tanta University Hospitals, Tanta, Egypt. A total of 80 patients with recurrent multiple aphthous ulcers of the oral cavity and pharynx were assigned to group 1 [n=32] [6-12 years; mean age, 8 +/- 2 years; 14 male and 18 female], in whom the ulcers were strictly limited to the mucosa-associated lymphoid tissues, or group 2 [n=48] [7-13 years; mean age, 9 +/- 3 years; 22 male and 26 female], in whom the ulcers were randomly distributed in the oral cavity and pharynx. 20 sex- and age-matched children served as normal control. Helicobacter pylori DNA was extracted from 3mm diameter tissue samples and polymerase chain reaction [PCR] amplifications were performed for the16S ribosomal RNA gene. HP DNA was detected in 24 patients [75%] in group [I]; in group [II], 6 patients [12.5%] were shown to be PCR positive. HP DNA was not detected in any of the control samples. There is a possible causative role for HP in recurrent aphthous ulcerations with a characteristic distribution and affinity to MALT of the pharynx. Hence; RAS and the risk of HP-associated gastrointestinal complications can be decreased with therapies for eradicating HP. It is recommended that tonsillectomy and adenoidectomy for MALT affected by RAS, improving oral hygiene may protect the host against HP infection and re-infection