Halimeter ppb Levels as the Predictor of Erosive Gastroesophageal Reflux Disease

Background/Aims

In a previous issue published in Gut and Liver, we found that erosive changes in the esophagogastroduodenal mucosa were strongly correlated with increased levels of volatile sulfur-containing compounds (VSC), suggesting that halitosis could be a symptom reflecting the erosive status of the upper gut mucosa. Together with other studies showing a possible association between halitosis and gastroesophageal reflux disease (GERD), under the premise that halitosis could be one of extraesophageal manifestations of erosive GERD (ERD), we investigated the significance of Halimeter ppb levels on ERD compared to non-erosive gastroesophageal reflux disease (NERD).

Methods

Subjects were assigned to the NERD group if there was no evidence of esophageal erosive changes on endoscopy, despite reflux symptoms, and to the ERD group if they had GERD A, B, C, or D (according to the Los Angeles classification). The VSC levels were measured in all patients with either a Halimeter (before endoscopy) or by gas chromatography of the gastric juices aspirated during endoscopy.

Results

The VSC level differed significantly between the NERD and ERD groups (p<0.0001), suggesting that this can be used to discriminate between NERD and ERD. However, the VSC level did not differ significantly with the severity of GERD. Even though hiatal hernia and a body mass index of >24 kg/m² was significantly associated with ERD, there was no correlation with Halimeter ppb levels. Minimal-change lesions exhibited the highest VSC levels, signifying that minimal change lesions can be classified as ERD based on our finding that halimeter ppb levels were descrimitive of erosive change.

Conclusions

Erosive changes in the esophageal mucosa were strongly associated with VSC levels, supporting the hypothesis that halitosis can be a potential biomarker for the discrimination between ERD and NERD, reflecting the presence of erosive change in the lower esophagogastric junction.     

Oral malodor reduction by a palatal mucoadhesive tablet containing herbal formulation

OBJECTIVE: The aim of the present study was to test the effect of a palatal mucoadhesive tablet containing an herbal formulation on oral malodor production and volatile sulfide compound (VSC) levels, and to evaluate its antimicrobial activity. METHODS: A total of 56 healthy young volunteers participated in experiments 1 and 2. The palatal adhesive tablets were prepared with different active ingredients (herbal formulation, zinc and chlorhexidine), or without an active ingredient as control (placebo). Measurement included odor judge scores (two judges) and VSC readings by a sulfide monitor (Halimeter). In experiment 3, the antimicrobial activity of the herbal formulation ingredients (i.e. sage, Echinacea, Lavender and Mastic gum) were tested against three oral pathogens (Streptoccocus mutans, Porphyromonas gingivalis and Candida albicans) by the agar diffusion test. RESULTS: Application of the palatal adhesive tablets containing herbal formulation resulted in a significant reduction in both oral malodor scores (p<0.001) and VSC levels (p=0.013). Herbal formulation showed higher significance in VSC reduction (p=0.001), as compared to zinc and chlorhexidine (p=0.024 and 0.032, respectively). Sage, Lavender and Mastic gum showed antimicrobial activity against all three oral pathogens. CONCLUSIONS: Results of the present study suggest that the palatal adhesive tablets containing herbal formulation may serve as an effective means of treatment for patients complaining of oral malodor.     

挥发性硫化物检测仪和嗅觉测量口臭的相关性

[目的]比较采用挥发性硫化物(volatile sulfur compounds,VSCs)检测仪和嗅觉测量两种方法测量试验性口臭结果的相关性。[方法]36名健康自愿者含漱自制的"口臭造模液"(主要成分为VSCs)后,先后进行嗅觉测量和口腔VSCs检测。之后每隔1周重复上述试验1次,共测试4次。Spearman相关性检验2种方法测试口臭结果的相关性。[结果]4次测试的口腔VSCs体积分数(ppb)平均分别为688、662、684和602,VAS值平均分别为6.64、6.58、6.58和6.36。4次测试的口腔VSCs体积分数和嗅觉测量VAS值结果的相关系数r分别为0.845、0.769、0.602和0.696,统计学检验的P值均为0.000,提示2种测试方法测得的结果存在正相关关系。[结论]VSCs检测仪可以作为嗅觉测量的辅助手段,在后续的口臭防治相关产品开发时评估口臭改善状况的客观指标之用。     

感官分析法和便携式硫化物检测仪检测口臭的相关性研究

目的比较感官分析法(鼻测法)和便携式硫化物检测仪(商品名Halimeter)检测口臭之间的准确性和一致性。方法首先对2名嗅辨员进行嗅觉检测试验,以确定其进行感官分析评分的资质。选择86例符合试验条件的受试者,分别用感官分析法评价口臭程度,硫化物检测仪检测口腔挥发性硫化物(VSC)含量,使用SPSS11.0软件分析鼻测法得分均值和VSC水平的关系。结果2名嗅辨员一致性良好,Kappa值达到0.568,P<0.01。鼻测法得分均值与Halimeter检测所得硫化物峰值之间相关系数r=0.538,P<0.01;与硫化物稳定值之间相关系数r=0.546,P<0.01。结论鼻测法得分和Halimeter检测的口腔VSC含量之间存在显著相关关系,提示Halimeter可在一定程度上作为鼻测法的辅助手段,用以检测口臭。     

口臭与牙周炎及舌苔的相关性研究

目的　探讨口臭及口气中挥发性硫化物 (volatilesulphurcompounds ,VSCs)与牙周炎及舌苔的相关性 ,舌在口臭及VSCs产生中的作用。方法　选择 6 0例全身健康、有口臭的牙周炎患者 ,鼻闻法检查口臭程度 ,使用便携式口臭测量仪分别测量清除舌苔前后的VSCs量。记录牙周袋探诊深度(probingdepth ,PD)及PD≥ 4mm位点比例 ,出血指数 (bleedingindex ,BI) ,菌斑指数 (plaqueindex ,PLI)及舌苔厚度与面积。结果　Spearman相关分析法显示 ,口臭值、VSCs量与BI、PLI、舌苔厚度存在明显的正相关性 (P <0 0 1) ,与舌苔面积也有关系 (P <0 0 5 )。口臭值与PD及PD≥ 4mm位点比例无关 ,VSCs量与PD及PD≥ 4mm位点比例存在一定的相关性 (r=0 2 6 ,P <0 0 5 )。清除舌苔可以明显降低VSCs量 (t=10 15 ,P <0 0 1) ,其减少量与舌苔厚度及面积均有明显相关性 (P <0 0 1)。结论　口臭值、VSCs量与BI、PLI及舌苔均有关系 ,而牙周袋PD只与VSCs量有关系 ;虽然清除舌苔可以明显降低VSCs量 (降低 36 7% ) ,但由于存在如何完全彻底清除舌苔的问题 ,所以舌与牙周炎在口臭及VSCs形成中的作用尚需进一步研究。     

个性化口腔卫生指导对口腔中挥发性硫化物含量的影响

目的 探讨单纯个性化口腔卫生指导对于清除菌斑、改善口臭及降低口腔中挥发性硫化物(VSCs)水平的作用.方法 选择31例鼻闻法评价口臭程度(OS)≥2的牙用炎患者,对其实施口腔卫生指导.指导前后,用口臭测量仪测量口腔中VSCs水平,并检查菌斑指数(PU).结果 口腔卫生指导前PLI为3.09±0.44,指导后降至2.63±0.46,差异有统计学意义(P<0.05);VSCs由指导前的(186.87±130.95)ppb降至指导后的(154.00±131.49)ppb,但差异无统计学意义(P>0.05);口腔卫生指导前OS值是2.68±0.70,之后是2.35±0.75,差异有统计学意义(P<0.05).结论 口腔卫生指导有助于口臭患者清除菌斑、改善口腔卫生状况,但降低口腔中VSCs含量的作用有限.     

Relationships between Solobacterium moorei and Prevotella intermedia in subgingival microbiota of periodontitis patients with halitosis: A preliminary study using qPCR

ObjectiveSolobacterium moorei is suggested to be associated with the production of volatile sulphur compounds (VSCs) and can be found in subgingival plaques of deep periodontal pockets. We examined whether this bacterium’s count was reduced in periodontitis patients with halitosis following non-surgical periodontal treatment, while the bacterial count of Prevotella intermedia was measured simultaneously as a control.Material & methodsThis clinical study included 20 adults with chronic periodontitis who complained of halitosis. The bacterial relationship in the subgingival plaque sample was measured after 8 weeks post-treatment, including the probing pocket depth (PPD). Quantitative real-time PCR (qPCR) was used to measure the proportion of S. moorei, while the concentrations of H₂S and CH₃SH were determined using oral ChromaTM.ResultsThe presence of S. moorei was consistently observed in participants with periodontitis before and after non-surgical periodontal treatment and consistent showed a significantly lower proportion compared with P. intermedia. Solobacterium moorei showed a strong positive correlation with H₂S and CH₃SH concentrations, but a negative correlation with deep periodontal pocket measurements. Conversely, reduced P. intermedia may be more associated with a deep pocket, independent of the concentration of CH₃SH.ConclusionThe study data showed that the proportion of S. moorei in the subgingival biofilm can be related to halitosis in periodontitis patients.     

西帕依固龈液治疗口臭随机对照试验的Meta分析

目的:系统评价西帕依固龈液治疗口臭的临床疗效.方法:计算机检索美国图书馆PubMed/MEDLINE、CNKI中国知网(总库)、维普期刊资源整合服务平台相关文献.根据Jadad量表对纳入文献进行质量评价.采用Cochrane协作网提供的RevMan 5.3分析软件进行Meta分析.结果:共纳入8项临床随机对照研究(RCT)、608例有口臭症状患者.依据Meta分析结果,西帕依固龈液与安慰剂比较治疗口臭的评分(organoleptic score,OS)[WMD=-0.43,95％ CI(-0.57,-0.29)]、菌斑指数(plaque index,PLI) [WMD=-1.59,95％ CI(-1.67,-1.51)]均显示有显著差异;西帕依固龈液与西药比较治疗口臭OS[WMD =0.16,95％ CI(0.05,0.28)]效果略差且降低PLI[WMD=0.10,95％ CI(0.03,0.18)]的抑菌效果也略差.西帕依固龈液与生理盐水治疗口臭临床总有效率差异有统计学意义[RR:1.64,95％CI(1.11,2.42)].结论:西帕依固龈液治疗口臭疗效优于安慰剂,可有效降低口臭值和菌斑指数,与西药相比降低口臭值、抑菌方面稍显欠缺.     

Systemic effects of H2S inhalation at human equivalent dose of pathologic halitosis on rats

Objectives: Halitosis is composed by hundreds of toxic gases. It is still not clear whether halitosis gases self-inhaled by halitosis patients cause side effects. The aim of the study was to investigate the effect of H₂S inhalation at a low concentration (human equivalent dose of pathologic halitosis) on rats.

Materials and methods: The threshold level of pathologic halitosis perceived by humans at 250?ppb of H₂S was converted to rat equivalent concentration (4.15?ppm). In the experimental group, 8 rats were exposed to H₂S via continuous inhalation but not the control rats. After 50 days, blood parameters were measured and tissue samples were obtained from the brain, kidney and liver and examined histopathologically to determine any systemic effect.

Results: While aspartate transaminase, creatine kinase-MB and lactate dehydrogenase levels were found to be significantly elevated, carbondioxide and alkaline phosphatase were decreased in experimental rats. Other blood parameters were not changed significantly. Experimental rats lost weight and became anxious.

Histopathological examination showed mononuclear inflammatory cell invasion in the portal areas, nuclear glycogen vacuoles in the parenchymal area, single-cell necrosis in a few foci, clear expansion in the central hepatic vein and sinusoids, hyperplasia in Kupffer cells and potential fibrous tissue expansion in the portal areas in the experimental rats. However, no considerable histologic damage was observed in the brain and kidney specimens.

Conclusions: It can be concluded that H₂S inhalation equivalent to pathologic halitosis producing level in humans may lead to systemic effects, particularly heart or liver damage in rats.