Bad Breath?

H. pylori and Halitosis

A new study has linked the treatment of Helicobacter pylori (H. pylori) with curing the chronic bad breath (halitosis) associated with functional dyspepsia. H. pylori is a bacterium that infects the stomach, and is associated with stomach cancer and ulcer disease. Typically, exposure to the bacteria occurs in childhood; although it is often present without symptoms, and many may not even know that they have an infection.

Functional dyspepsia (FD) is a chronic disorder of sensation and movement (peristalsis) in the upper digestive tract. Peristalsis is the normal downward pumping and squeezing of the esophagus, stomach, and intestine, which begins after swallowing. We call this disorder functional because there are no observable or measurable structural abnormalities found to explain persistent symptoms. The cause of functional dyspepsia is unknown; however, several hypotheses could explain this condition even though none can be consistently associated with FD. Excessive acid secretion, inflammation of the stomach or duodenum, food allergies, lifestyle and diet influences, psychological factors, medication side effects (from drugs such as non-steroidal anti-inflammatory drugs and aspirin), and H. pylori infection have all had their proponents.

Halitosis comes with a significant social stigma and can have a serious impact on a person’s ability to function normally in society. It is classified into three distinct groups:

• genuine halitosis, which can be difficult for a person to even be aware of,
  
• pseudo-halitosis, in which a person believes they are emitting oral malodour but are not, and
  
• halitophobia, which occurs after successful treatment of genuine halitosis or pseudo-halitosis and involves a person continuing to believe that they have it.

In 80-90% of cases, the source of halitosis is the mouth (caused by decomposing food particles, cells, blood, or chemical components of saliva) and effective treatment is usually in the form of tooth brushing or special rinses.

Published in the journal, Medical Principles and Practice, a study analyzed 18 patients (10 men and 8 women) who all had functional dyspepsia, halitosis, and confirmed H. pylori infections. Very recent research has shown that H. pylori can sometimes be present in the mouth as well as the stomach, although the researchers of this study admit that they did not specifically test for H. pylori in the mouth. For this study, the participating patients’ relatives verified the genuine halitosis. Researchers specifically excluded anyone who was on antibiotics, proton pump inhibitors (PPIs), histamine-2 receptor antagonists (H2RAs), NSAIDs, or antihistaminic drugs.

After evaluating the subjects’ halitosis and other dyspepsia-related symptoms, researchers prescribed multiple drug therapies to eradicate the H. pylori infections. They then re-evaluated subjects’ symptoms 4-6 weeks after eradication and found that 16 patients no longer exhibited halitosis. Further, the multiple drug therapies resulted in a significant reduction in most other functional dyspepsia symptoms as well, such as epigastric pain, nausea, and the early feeling of fullness during meals (though not bloating).

This study supports previous research showing a link between Helicobacter pylori and halitosis; however, it will be up to future research to determine exactly how H. pylori contributes to bad breath, and whether the source is from H. pylori infection in the mouth and/or the stomach.

Staff Writers
First published in The Inside Tract® Newsletter Issue 176 - 2010

Reference:

Katsinelos P et al. Eradication Therapy in Helicobacter pylori-Positive Patients with Halitosis: Long-Term Outcome. Med Princ Pract. 2007;16:119-123. Doi:10.1159/000098364.

Bad Breath

Parasites

Parasites should be considered as a possible cause of bad breath in children. According to the report,¹ researchers decided to investigate the relationship between parasites and bad breath when a mother told them that the bad breath of her child infested with pinworm – a common parasite – disappeared after anti-parasitic treatment.

To investigate, the researchers gave 82 youngsters an anti-parasitic medication and another group of 80 children an inactive placebo. All of the parents of the children in the study had complained that their child had chronic bad breath.

Stool samples collected from the children were tested for the presence of parasites, such as pinworm, at the start and end of the study period.

Of the children found to have parasites in their stool samples, 18 of 28 who were treated recovered from halitosis, compared with 2 of 24 kids with parasites that received a placebo. Among those who did not have stool parasites, 14 of 52 improved with the treatment compared with 10 of 48 taking placebo

It seems that the anti-parasitic medication worked at reducing bad breath, whether or not the children had parasites.

Helicobacter pylori

Persistent bad breath may also be a warning sign that a patient is infected with Helicobacter pylori, a bacterium linked to ulcers, gastritis, and stomach cancer. Many cases of H. pylori infection emerge only when people develop symptoms, such as bloating, pain, or indigestion. The Turkish researchers wanted to assess the frequency of halitosis before and after eradication therapy for the bacterium. 

In this study,² 148 people who had a type of indigestion called dyspepsia, and bad breath, were given treatment to kill off H. pylori. Four weeks later their symptoms were assessed again. The results showed that, before treatment, bad breath was the third most common symptom, behind bloating and pain. More than 60% of the patients involved had halitosis. After eradication therapy however, many patients reported their bad breath had disappeared. In patients with confirmed H. pylori eradication, the most successfully resolved symptoms were halitosis and hunger-like pain.

A combination of antibiotics and drugs called proton pump inhibitors can clear the infection, and has a good likelihood of reducing halitosis.

Staff Writers
First published in The Inside Tract® Newsletter Issue 136 March/April 2003

References:

1. B Ermis, T Aslan, L Beder, M Unalacak. A Randomized Placebo-Controlled Trial of Mebendazole for Halitosis. Archives of Pediatrics and Adolescent Medicine. 2002; 156:995-998
2. E Serine, Y Gumurdulu, F Kayaselcuk et al. Halitosis in patients with Helicobacter pylori-positive non-ulcer dyspepsia: an indication for eradication therapy? European Journal of Internal Medicine. 2003;14(1):45-48