Oral H. pylori Prevalence in Intellectually/Developmentally Disabled Adults

描述(申请人提供)：幽门螺杆菌(H.Pylori)细菌在胃和十二指肠溃疡、胃食道反流病和胃腺癌的病因中发挥重要作用。据报道，智力残疾/发育残疾(ID/DD)成年人的幽门螺杆菌感染率约为普通人群的两倍，复发率高出七倍，导致胃癌死亡率增加。口腔可能是幽门螺杆菌的蓄水池，从而导致胃部感染的复发。许多研究已经在牙菌斑中发现了幽门螺杆菌，这是一种对系统性抗生素相对耐药的环境。系统性抗生素被用来治疗幽门螺杆菌感染，但似乎并不能根除口腔中的幽门螺杆菌。据报道，由于口腔卫生不足，ID/DD成人的口腔状况较差，导致牙菌斑、龋齿和牙周病增加。此外，口腔状况差(牙周病)与幽门螺杆菌血清阳性有关。虽然ID/DD成年人的幽门螺杆菌胃感染率较高，但对他们口腔中幽门螺杆菌的流行率却一无所知。拟议的探索性研究将在这一弱势群体中解决以下问题：1)ID/DD成年人牙菌斑中幽门螺杆菌的流行率是多少？2)口腔状况差是否与幽门螺杆菌胃感染有关？3)在全身抗生素治疗后，幽门螺杆菌是否在ID/DD成人的牙菌斑中持续存在，如果是，它是否与胃部感染的复发有关？这项针对112名住院ID/DD患者和112名对照受试者的流行病学研究将包括口腔检查、指数、牙菌斑采样和基线的C13尿素呼气试验，以确定患病率。套式聚合酶链式反应(PCR)将被用来检测牙菌斑中的幽门螺杆菌。对于基线胃幽门螺杆菌检测呈阳性的ID/DD受试者，将在一年内重复进行口腔采样和胃测以确定持久性。如果口腔健康状况差和口腔幽门螺杆菌感染率与胃幽门螺杆菌感染相关，未来将进行一项试点临床试验，以调查口腔和胃中幽门螺杆菌基因株之间的一致性，各种干预措施对口腔健康、口腔幽门螺杆菌感染率和幽门螺杆菌胃感染的影响。这项拟议的研究响应了卫生局局长的国家行动呼吁，进行研究以阐明潜在的机制，并确定口腔感染和全身疾病之间的任何因果关系。这项拟议的研究还涉及减少健康差距、提高生活质量以及降低弱势人群发病率和死亡率的必要性。项目简介：幽门螺杆菌感染是美国住院智力和发育障碍(ID/DD)患者发病的一个重要原因。有理由调查口腔健康是否与幽门螺杆菌感染和幽门螺杆菌感染在ID/DD患者中的复发有关。这项拟议的研究将为临床试验提供试点数据，并增加有关口腔状况和幽门螺杆菌感染的知识。我们的结果可能表明，专业的口腔护理在医学上是必要的，以减少幽门螺杆菌感染引起的ID/DD患者的发病率和死亡率。这项研究与2010年健康人群消除健康差距的总体目标是一致的。这也符合卫生局局长的国家行动呼吁，以确定口腔保健需求，完善特殊需要患者的护理方案，并进行研究以确定口腔感染与全身疾病之间的关系。

DESCRIPTION (provided by applicant): Helicobacter pylori (H. pylori) bacteria play a significant role in the etiology of gastric and duodenal ulcers, gastro-esophageal reflux disease and gastric adenocarcinoma. Intellectually disabled/developmentally disabled (ID/DD) adults are reported to have H. pylori infection at approximately twice the rate of the general population and experience recurrence at a seven-fold higher rate, contributing to increased mortality due to gastric cancer. The oral cavity may serve as a reservoir for H. pylori and subsequently contribute to the recurrence of gastric infection. Numerous studies have identified H. pylori in dental plaque, an environment that is relatively resistant to systemic antibiotics. Systemic antibiotics are used to treat H. pylori infections but do not appear to eradicate H. pylori in the mouth. The oral status of ID/DD adults is reported to be poor due to inadequate oral hygiene, leading to increased plaque, caries and periodontal disease. Furthermore, poor oral status (periodontal disease) has been associated with H. pylori seropositivity. While ID/DD adults have elevated rates of H. pylori gastric infections, nothing is known about the prevalence of H. pylori in their oral cavities. The proposed exploratory research will address the following questions in this disadvantaged population: 1) What is the prevalence of H. pylori in the dental plaque in ID/DD adults? 2) Is poor oral status associated with H. pylori gastric infection? and 3) Does H. pylori persist in the dental plaque of ID/DD adults after systemic antibiotic treatment, and if so, is it associated with recurrence of gastric infection? This epidemiological study of 112 institutionalized ID/DD and 112 control subjects will involve oral examinations, indices, dental plaque sampling, and C13 Urea Breath Tests at baseline to determine prevalence. Nested Polymerase Chain Reaction (PCR) analyses will be used to detect H. pylori in the dental plaque. For those ID/DD subjects who have a positive gastric H. pylori test at baseline, repeated oral sampling and gastric tests will be performed over 1 year to determine persistence. If poor oral health status and oral H. pylori prevalence are correlated with gastric H. pylori infections, a future pilot clinical trial will be conducted to investigate the concordance between genetic strains of H. pylori in the mouth and stomach, the effect of various interventions on oral health, oral H. pylori prevalence, and H. pylori gastric infections in ID/DD adults. The proposed research responds to the Surgeon General's National Call to Action to conduct studies to elucidate underlying mechanisms and determine any causal associations between oral infections and systemic conditions. The proposed research also addresses the need to reduce health disparities, improve quality of life, and reduce morbidity and mortality in vulnerable populations. Project Narrative: Helicobacter pylori infections are a significant cause of morbidity in institutionalized intellectually and developmentally disabled (ID/DD) persons in the United States. There is reason to investigate whether there is an association between oral health and H. pylori infection and recurrence of H. pylori infection in ID/DD individuals. The proposed study would provide pilot data for a clinical trial and add to the knowledge concerning oral status and H. pylori infection. Our results may demonstrate that professional oral care is medically necessary for the reduction of morbidity and mortality caused by H. pylori infection in ID/DD persons. This research is consistent with the Healthy People 2010 overarching goal of eliminating health disparities. It is also consistent with the Surgeon General's National Call to Action to determine oral health care needs, refine protocols of care for special needs patients, and to conduct studies to determine associations between oral infections and systemic conditions.