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5THE CORRELATION BETWEEN THE SATURATION OF THE GASTROINTESTINAL TRACT
BY HELICOBACTER PYLORI AND CARIES
Abstract
The article is devoted to the relationship between the colonization of the gastrointestinal tract Helicobacter pylori and the incidence of caries. It consists of a survey and research part. The aim of the study was to investigate the relationship between the colonization of the gastrointestinal tract Helicobacter pylori and the development of dental caries. A review of the literature on the concept of Helicobacteriosis and its pathogen, the properties of urease, which distinguishes this bacterium, caries and the relationship of diseases of the oral cavity with Helicobacter pylori. The study was conducted on vacationers of the sanatorium and includes the method of questioning, biochemical and statistical methods. In modern medicine, attention is drawn to the relationship of the oral cavity with diseases of the stomach and intestines. The oral cavity is a reservoir of the Helicobacter pylori bacterium - the causes of various gastrointestinal pathologies (Goll-Troelj, 2009; Fontham, 1995). Today, the issue of the connection of the dissemination of the digestive system Helicobacter pylori with the development of dental caries is not sufficiently studied. This determined the purpose and objectives of our study.
Keywords
Helicobacter pylori, caries, Complaints, Gastrointestinal tract
AUTHORS
Elena E. Simonyan
Student, Faculty of General Medicine, Northern State Medical University.
51, Troitskiy Ave., Arkhangelsk, 163000, Russia E-mail: elena.simonyan1994@mail.ru
Dmitry P. Tatarenko
Doctor, Sanatorium "Solnechny".
66, Kuibyshev St., Kislovodsk, 357700, Russia E-mail: elena.simonyan1994@mail.ru
Research objectives:
- Biochemical method to establish Helicobacter pylori-status of the gastrointestinal tract of patients with gastroenterological complaints.
- Interrogate patients who are biochemically examined for tooth decay, the frequency and nature of relapse using the questionnaire method.
- Perform statistical processing of the obtained data using a biochemical method of examination and examination of the dentist.
- Establish a statistical relationship between the Helicobacter pylori-status of the gastrointestinal tract of patients and the incidence of tooth decay.
1. Introduction
1.1. The urgency of the problem
Dental caries is the process of demineralization and destruction of hard tooth tissues with the formation of a cavitary defect. Characterized by the appearance on the enamel pigmentation spots of a yellowish-brown color, bad breath, the reaction of the tooth to acid, sweet, cold or hot food, aching pain.With the development of deep caries it is possible the formation of cysts, the attachment of pulpitis, and then the periodontitis. Running tooth decay can lead to tooth loss. The presence of unsanitary carious cavities increases the risk of developing acute and chronic diseases of the body (Miller, 2008).
1.2. Morphology of Helicobacter pylory
Helicobacter pylori, previously Campylobacter pylori, is a gram-negative, microaerophilic bacterium found usually in the stomach. It was identified in 1982 by Australian scientists Barry Marshall and Robin Warren, who found that it was present in a person with chronic gastritis and gastric ulcers, conditions not previously believed to have a microbial cause. It is also linked to the development of duodenal ulcers and stomach cancer. However, over 80% of individuals infected with the bacterium are asymptomatic, and it may play an important role in the natural stomach ecology (Epidemiology of Hecobacter pylory, 1994).
More than 50% of the world's population harbor H. pylori in their upper gastrointestinal tract. Infection is more common in developing countries than Western countries. H. pylori's helical shape (from which the genus name derives) is thought to have evolved to penetrate the mucoid lining of the stomach. Up to 85% of people infected with H. pylori never experience symptoms or complications. H. pylori is microaerophilic - that is, it requires oxygen, but at lower concentration than in the atmosphere. It contains a hydrogenase that can produce energy by oxidizing molecular hydrogen (H2) made by intestinal bacteria. It produces oxidase, catalase, and urease.
1.3. Physiology of H.pylory
Outer membrane. H. pylori possesses five major outer membrane protein families. The largest family includes known and putative adhesins. The other four families are porins, iron transporters, flagellum-associated proteins, and proteins of unknown function. Like other typical Gram-negative bacteria, the outer membrane of H. pylori consists of phospholipids and lipopolysaccharide (LPS). The O antigen of LPS may be fucosylated and mimic Lewis blood group antigens found on the gastric epithelium. The outer membrane also contains cholesterol glucosides, which are present in few other bacteria (Rees & Botham, 2011).
1.4. Pathophysiology. Adaptation to the stomach's acidic envoironment
To avoid the acidic environment of the interior of the stomach (lumen), H. pylori uses its flagella to burrow into the mucus lining of the stomach to reach the epithelial cells underneath, where it is less acidic. H. pylori is able to sense the pH gradient in the mucus and move towards the less acidic region (chemotaxis). This also keeps the bacteria from being swept away into the lumen with the bacteria's mucus environment,
86 Modern European Researches No 3 / 2017 which is constantly moving from its site of creation at the epithelium to its dissolution at the lumen interface.
H. pylori is found in the mucus, on the inner surface of the epithelium, and occasionally inside the epithelial cells themselves. It adheres to the epithelial cells by producing adhesins, which bind to lipids and carbohydrates in the epithelial cell membrane. One such adhesin, BabA, binds to the Lewis b antigendisplayed on the surface of stomach epithelial cells. Another such adhesin, SabA, binds to increased levels of sialyl-Lewis x antigen expressed on gastric mucosa (Aydemir, Tekin & Aktuno, 2012). In addition to using chemotaxis to avoid areas of low pH, H. pylori also neutralizes the acid in its environment by producing large amounts of urease, which breaks down the urea present in the stomach to carbon dioxideand ammonia. These react with the strong acids in the environment to produce a neutralized area around H. pylori. Urease knockout mutants are incapable of colonization. In fact, urease expression is not only required for establishing initial colonization but also for maintaining chronic infection.
H. pylori is a major cause of certain diseases of the upper gastrointestinal tract. Rising antibiotic resistance increases the need to search for new therapeutic strategies; this might include prevention in the form of vaccination. Much work has been done on developing viable vaccines aimed at providing an alternative strategy to control H. pylori infection and related diseases, including stomach cancer. Researchers are studying different adjuvants, antigens, and routes of immunization to ascertain the most appropriate system of immune protection; however, most of the research only recently moved from animal to human trials. An economic evaluation of the use of a potential H. pylori vaccine in babies found its introduction could, at least in the Netherlands, prove cost-effective for the prevention of peptic ulcer and stomach cancer. A similar approach has also been studied for the United States (Goll-Troelj, 2009).
I.5. Inflammation, gastritis, and ulcer
H. pylori harms the stomach and duodenal linings by several mechanisms. The ammonia produced to regulate pH is toxic to epithelial cells, as are biochemicals produced by H. pylori such as proteases, vacuolating cytotoxin A (VacA) [this damages epithelial cells, disrupts tight junctions and causes apoptosis, and certain phospholipases. Cytotoxin associated gene CagA can also cause inflammation and is potentially a carcinogen.
Colonization of the stomach by H. pylori can result in chronic gastritis, an inflammation of the stomach lining, at the site of infection. Helicobactercysteine-rich proteins (Hcp), particularly HcpA (hp0211), are known to trigger an immune response, causing inflammation. Chronic gastritis is likely to underlie H. pylori-related diseases.
Ulcers in the stomach and duodenum result when the consequences of inflammation allow stomach acid and the digestive enzyme pepsin to overwhelm the mechanisms that protect the stomach and duodenal mucous membranes. The location of colonization of H. pylori, which affects the location of the ulcer, depends on the acidity of the stomach. In people producing large amounts of acid, H. pylori colonizes near the pyloric antrum(exit to the duodenum) to avoid the acid-secreting parietal cells at the fundus (near the entrance to the stomach). In people producing normal or reduced amounts of acid, H. pylori can also colonize the rest of the stomach.
The inflammatory response caused by bacteria colonizing near the pyloric antrum induces G cells in the antrum to secrete the hormone gastrin, which travels through the bloodstream to parietal cells in the fundus. Gastrin stimulates the parietal cells to
87 Modern European Researches No 3 / 2017 secrete more acid into the stomach lumen, and over time increases the number of parietal cells, as well. The increased acid load damages the duodenum, which may eventually result in ulcers forming in the duodenum (Miller, 2008).
1.6. Prevention
The presence of bacteria in the stomach may be beneficial, reducing the prevalence of asthma, rhinitis, dermatitis, inflammatory bowel disease, gastroesophageal reflux disease, and esophageal cancer by influencing systemic immune responses.
Recent evidence suggests that nonpathogenic strains of H. pylori may be beneficial, e.g., by normalizing stomach acid secretion, and may play a role in regulating appetite, since its presence in the stomach results in a persistent but reversible reduction in the level of ghrelin.
Acute infection may appear as an acute gastritis with abdominal pain (stomach ache) or nausea. Where this develops into chronic gastritis, the symptoms, if present, are often those of non-ulcer dyspepsia: stomach pains, nausea, bloating, belching, and sometimes vomiting or black stool (Lohr,1990).
Individuals infected with H. pylori have a 10 to 20% lifetime risk of developing peptic ulcers and a 1 to 2% risk of acquiring stomach cancer. Inflammation of the pyloric antrum is more likely to lead to duodenal ulcers, while inflammation of the corpus (body of the stomach) is more likely to lead to gastric ulcers and gastric carcinoma. However, H. pylori possibly plays a role only in the first stage that leads to common chronic inflammation, but not in further stages leading to carcinogenesis. A meta-analysis conducted in 2009 concluded the eradication of H. pylori reduces gastric cancer risk in previously infected individuals, suggesting the continued presence of H. pylori constitutes a relative risk factor of 65% for gastric cancers; in terms of absolute risk, the increase was from 1.1% to 1.7%. H. pylori has been associated with colorectal polyps and colorectal cancer. It may also be associated with eye disease (Goll-Troelj, 2009).
Alkaline reaction of saliva and increase in the rate of its secretion are a necessary compensatory mechanism, which is included by the body during the period of exacerbation of the underlying disease. The bicarbonates contained in the saliva can neutralize up to 3% of hydrochloric acid, and the concentration of bicarbonates in the saliva increases in parallel with the increase in the acid-forming function of the stomach. It is known that the pH of saliva is the main natural regulator of biochemical processes in the oral cavity, on the one hand, and at the same time, a factor that plays a decisive role in the occurrence of dental caries. It was found that the visible demineralizing effect of tooth enamel is observed at a pH value in the oral cavity equal to 6.0 or lower. In the stage of exacerbation of the disease in Hp-negative patients, the level of free sialic acids and protein-bound sialic acids in saliva is significantly lower than that of healthy people (Berroteran, 2002).
The results obtained can be explained by the ability of Hp to synthesize proteases and ammonia, which, in the conditions of the oral cavity, dismantles polypeptide molecules, causing the catabolism of protein-bound sialic acids to free sialic acids. Change in free and protein-bound sialic acids in mixed saliva leads to a violation of its rheological properties, in particular, to increase the viscosity and, as a consequence, the rapid accumulation of plaque, whose enzymatic activity due to microflora leads to depolymerization and demineralization of tooth enamel (Ning Leel, 1994).
2. Materials and Methods
The material of the study was 144 results of a dentist's examination of the resting sanatorium (53 men (36.81%) and 91 women (63.19%)) to which 110 test tubes of the urease test were used and copies of 5 urease biochemical test results, 20 analyzes Blood, 55 result of esophagofibrogastroduodenoscopy, conducted prior to arrival on vacation in a sanatorium, which confirmed the presence of Helicobacter pylori in the gastrointestinal tract.
The questioning of vacationers during the primary reception of a gastroenterologist in a sanatorium was conducted (Annex 1 to Order, 2014). Evaluation of the carious process was carried out by the method of T. Vinogradova, which involves determining the prevalence and intensity of the process. T.F. Vinogradova points out that dental caries is currently considered as a multifactorial pathological process characterized by focal demineralization of hard tooth tissues with the formation of a carious cavity. The prevalence of dental caries was expressed as a percentage. To do this, the number of people who found some or other manifestations of dental caries (except for focal demineralization) was divided by the total number of subjects examined in this group and multiplied by 100. The intensity of dental caries was determined by the number of teeth affected by caries: treated, untreated and removed. For this purpose, the WHO Expert Committee on Dentistry (1962) proposed the use of the KPI index (K - carious tooth, P - sealed, Y - remote) (Rees & Botham, 2011).
A statistical relationship was established between the incidence of tooth decay and previously exhibited gastroenterological diagnoses, as well as complained of resting complaints.
3. Results
A dentist examined 144 patients. Of these, 110 patients underwent a biochemical test for Helicobacter pylori. According to the results of this study, all 104 patients were Helicobacter pylori-positive, i.e. The difference in the results of the initial and post-loading changes in the color of the indicator composition exceeded 2 mm.
The questionnaire took into account previously exposed diagnoses of diseases of the gastrointestinal tract. A single diagnosis was established in 51 patients (35.42%), combined with 43 patients (29.86%). There were those vacationers who had not previously been diagnosed with gastroenterology - 50 patients (34.72%).
The frequency of occurrence of previously exposed diagnoses that were indicated at the reception of a gastroenterologist was analyzed: chronic gastritis was exposed to 47 patients (32.64%), chronic gastroduodenitis to 33 patients (22.92%), chronic pancreatitis - to 20 patients (13.89%), Gastroesophageal reflux disease - 17 patients (11,81%), chronic cholecystitis - 15 patients (10,42%), biliary dyskinesia - 10 patients (6.94%), duodenal ulcer - 9 patients (6, 25%), gastric ulcer - 8 patients (5.55%), postcholecystectomic syndrome - 7 patients (4.86%) and cholelithiasis - 6 patients (4.17%).
4. Discussions
Analyzing the diagnoses exhibited by the rest earlier, it can be concluded that the urease test was mainly carried out by patients with diseases of the stomach and duodenum.
Among vacationers who had been exposed before a gastroenterology diagnosis (94 patients), 70 teeth suffer from caries of teeth, which is 74.47%. Among those patients who had not previously been diagnosed with gastrointestinal disorders (50 patients), only 5 patients have stomatitis, which is only 10%. Thus, tooth caries is 64.47% more common among those who suffer from diseases of the gastrointestinal tract than in people without such pathologies.
For more accurate statistics, previously exposed patient diagnoses were divided into groups for those organisms whose pathologies are the above diagnoses.
Diagnoses exhibited earlier by the holiday-makers are pathologies of the following organs: the stomach - in 105 cases (72.92% of all diagnoses), duodenum - in 42 cases (29.17%), combined pathology of the stomach and duodenum - in 33 cases - ( 22.92%), pancreas in 20 cases (13.89%), gall bladder and bile ducts - in 38 cases (26.39%).
Thus, it can be concluded that the gastroenterologist was approached for admission, and accordingly, a biochemical urease study of the presence of Helicobacter pylori, mainly patients with gastric and duodenal pathologies, was conducted.
The frequency of occurrence of gastroenterological complaints presented by patients who were questioned was analyzed. Pain or any uncomfortable sensations in the epigastric region was noted by 75 patients (52.08%), heartburn - 49 patients (34.03%), flatulence - 35 patients (24.31%), bitter taste in the mouth, which occurs mainly In the morning - 11 patients (7.64%), intestinal colic and discomfort in the small intestine - 9 patients (6.25%), periodic constipation - 7 patients (4.86%), weight in the epigastric region - 5 patients (3.47%), "hungry" pain at night - 4 patients (2.78%), periodic nausea -1 patient (0.7%). Complaints were absent in 25 patients (17.36%).
Thus, the structure of complaints of holidaymakers indicates that patients with complaints to the upper sections of the gastrointestinal tract (stomach, duodenum, cardiac sphincter) were mainly sent to the urease study.
The relationship of the presence of complaints to the absence of a gastroenterological diagnosis, exposed earlier, was determined. Of those who had not previously been diagnosed with gastrointestinal pathology, 36 patients (72% of those without a diagnosis) presented gastroenterological complaints. There were no complaints in 14 patients (28%).
Thus, gastroenterological complaints were presented by most patients who were examined. Even those vacationers who had not previously been exposed to a gastroenterological diagnosis had complaints about the digestive system.
Earlier, 80 patients (55.56%) were examined for Helicobacter pylori, of which Helicobacter pylori was positive in 77 patients (96.25% of previously examined).
Results of esophagofibrogastroduodenoscopy were provided by 55 patients (68.75% previously examined), Helicobacter pylori blood test - 20 patients (25%), biochemical urease test for Helicobacter pylori - 5 patients (6.25%). Of these results, 2 conclusions of esophagofibrogastroduodenoscopy - Helicobacter pylori-negative and in the 1st blood test there was no evidence of Helicobacter pylori.
Thus, using the results of previous studies for the presence of Helicobacter pylori, the result of our biochemical test was confirmed in 77 patients (74.04% of our studies). Of these, the findings of esophagogibrogastroduodenoscopy confirmed the result of our study in 55 cases (52.88%), the conclusion of a blood test for Helicobacter pylori - in 20 cases (19.23%), and the results of a respiratory urease study in 5 cases (4.81%).
With the help of the questionnaire, the incidence of tooth decay was determined among a contingent of vacationers who underwent a biochemical urease study for Helicobacter pylori. As already mentioned, the result of the presence of Helicobacter pylori was positive in all patients. Among the patients examined, 75 patients with tooth decay (72.12%) suffer from tooth decay.
Thus, patients with positive colonization of Helicobacter pylori are at high risk of tooth decay.
The dependence of the incidence of tooth decay and gastroenterological diagnoses, which were exhibited earlier by vacationers participating in the questionnaire, was also analyzed. Among those who had been diagnosed earlier, 50 patients with tooth decay (53.19%) suffer from tooth decay, and 25 patients (50%) suffer from caries of teeth among those who did not have a gastroenterological diagnosis.
Among those tourists who had no gastroenterological diagnosis and no gastroenterological complaints (25 patients), 5 patients (20%) suffer tooth decay.
Thus, the results of statistical processing of the results of the study show that among patients with gastrointestinal diseases the incidence of dental caries is 3.19 + -0.05% higher than among those with gastroenterological diseases, but there are complaints of the gastrointestinal tract. As for the contingent that has neither gastroenterological diseases nor similar complaints, in this case the incidence of tooth decay is even lower than those who do not have diseases, but there are at least complaints about digestive organs (by 30%), And in comparison with those who have at least one gastroenterological diagnosis, the incidence of tooth decay is even more different (by 33.19 + -0.05%).
A statistical study was made of the indicators of the color change in the indicator composition of all the results of a biochemical urease study (104 patients). The average value of the change in color of the indicator composition before the use of the aqueous carbamide solution (initial value) was 6.82 mm, and after the use of the carbamide solution (postload value) - 11.59 + -0.05 mm. The average value of the difference between these two indices is 4.77 + -0.05 mm.
Thus, the average value of the difference in the initial and post-loading parameters of the color change in the indicator composition of the biochemical study in the examined vacationers is 2.39 + -0.05 times higher than the norm (2 mm).
A comparative statistical characteristic of indicators of the color change of the indicator composition in patients with incidence and in those without incidence of caries of the teeth was made.
Among those patients who suffer from caries, the mean value of the initial color change of the indicator composition is 7.39 + -0.05 mm, and the post-loading carbamide solution is 12.92 + -0.05 mm. Thus, the average post-nasal color change in the indicator composition is 1.11 times greater than that of all travelers having a biochemical urease study of the presence of Helicobacter pylori. The average value of the difference between these two indices in this patient population is 5.53 + -0.05 mm, which is 1.16 times higher than the average value for all patients subjected to a biochemical test and 2.77 + -0.05 times Exceeds the norm (2 mm.).
Among the examined patients who do not suffer from caries, the average value of the initial color change of the indicator composition is 5.34 + -0.05 mm, post-loading -8.14 + -0.05 mm, which is 1.59 times less than this value Contingent, who has tooth decay. The average value of the difference between the initial and post-load ingindicators in this category of investigated is 2.8 + -0.05 mm, which is 1.98 times less
91 Modern European Researches No 3 / 2017 than the average in the examined, caries-affected teeth and 1.4 + -0.05 times higher Normal value (2 mm).
Thus, it can be concluded that in patients with dental caries the concentration of Helicobacter pylori is 1.98 times higher than in patients without dental caries.
5. Conclusions
1. Patients with positive colonization of Helicobacter pylori are at high risk of tooth decay (72.12%).
2. Among patients with gastrointestinal diseases, the incidence of tooth decay is 64.47% higher than among those with gastroenterological diseases, but there are complaints about the gastrointestinal tract.
3. The average value of the difference in the initial and post-loading parameters of the color change in the indicator composition of the biochemical study in the patients studied is 2.39 times greater than the normal value.
4. In patients with caries, the concentration of Helicobacter pylori is 1.98 times higher than in patients not suffering from this disease.
Practical recommendations and prospects for further research.
In the course of our scientific work, a direct correlation of the colonization of the gastrointestinal tract Helicobacter pylori with the incidence of tooth decay (72.12%) is shown. In this regard, practical recommendations consist in confirming the need to take into account the Helicobacter pylori status of a patient with oral diseases and it is recommended that anti-Helicobacter therapy be included in the complex treatment of dental caries.
The data of our studies show the need to study the connection of caries with the bacterium Helicobacter pylori more deeply. So, for example, the prospect of our further research is the study of Helicobacter pylori-status of the oral cavity of caries of different age categories.
REFERENCES
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TRANSLATION AS A PHENOMENON OF BICULTURAL AESTHETICS (BASED ON KAZAKH AND ENGLISH POETRY)
Abstract
The article is devoted to the poetic analysis of the phenomenon of bicultural aesthetics based on poems of the prominent Kazakh poets, whose works have been translated into many world languages. Poetic heritage and translations of the poet serve as a factor of bicultural and simultaneously conjugative aesthetics. Translation analysis clearly shows that the creative writings of Kazakh poet is a bright example of not only lingual-cultural but also artistic and aesthetic interferentiality. This is a condition for simultaneous "destruction" of aesthetic integrity of the original and formation of a new one in the translation. We have outlined this phenomenon as conjugative one.
Keywords
bicultural aesthetics, conjugation, interferential, aesthetic tension
AUTHOR
Svetlana V. Ananyeva
Head of department of Analytics and Foreign Literary relations Institute of Literature and Art named after M.O. Auezov. 29, Kurmangazi St., Almaty, 050010, Kazakhstan. E-mail: svananyeva@gmail.com
Alimjan T. Khamrayev
Chief Researcher of Analytics and Foreign Literary relations Institute of Literature and Art named after M.O. Auezov. 29, Kurmangazi St., Almaty, 050010, Kazakhstan. E-mail: atilivaldi61@gmail.com
1. Introduction 1.1. Actual problem
Modern Kazakh literature attracts the attention of the foreign reader mainly because it reflects, on the one hand, the socio-economic and cultural-political changes of the modern post-Soviet area, and on the other hand - the historical past of
