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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
High incidence of periodontitis in patients with ascitic decompensated cirrhosis
Sven Pischke, Mohamad Motee Ashouri, Ulrike Peters, Anita Shiprov, Julian Schulze Zur Wiesch, Martina Sterneck, Frank Fischer, Peter Huebener, Maria Mader, Lutz Fischer, Thorben Fründt, G Aarabi, Thomas Beikler
Sven Pischke, First Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg 20246, Germany
Mohamad Motee Ashouri, Anita Shiprov, Julian Schulze Zur Wiesch, Martina Sterneck, Peter Huebener, Maria Mader, Thorben Fründt, First Department of Medicine, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
Mohamad Motee Ashouri, Anita Shiprov, Periodontics, Preventive and Restorative Dentistry, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
Ulrike Peters, Frank Fischer, G Aarabi, Thomas Beikler, Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
Lutz Fischer, Department of Visceral Transplantation, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
Author contributions: Pischke S and Ashouri MM contributed equally to this work; Pischke S, Ahouri MM, Peters U, Shiprov A, Schulze Zur Wiesch J, Sterneck M, Fischer F, Hüberner P, Mader M, Fischer L, Fründt T, Aarabi G and Beikler T designed this study and wrote the manuscript.
Institutional review board statement: This prospective study was reviewed and approved by the Ethics Committee of the Medical Council of Hamburg (PV-4081 and MC-368/18). The study was performed according to the recommendations of the Declaration of Helsinki. The retrospective analysis of the control cohort was completely anonymized and therefore did not require any clarification or formal ethics committee approval according to local laws and regulations.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Sven Pischke, MD, PhD, Associate Professor, Department of Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany. spischke@uke.de
Received: August 29, 2023
Peer-review started: August 29, 2023
First decision: September 14, 2023
Revised: September 27, 2023
Accepted: December 6, 2023
Article in press: December 6, 2023
Published online: December 27, 2023
ARTICLE HIGHLIGHTS
Research background
This pilot study examines the prevalence of periodontitis in cirrhotic patients experiencing ascite decompensation.
Research motivation
Previous studies have not investigated whether bacteria from the oral mucosa associated with periodontitis can be translocated into the ascites of cirrhotic patients.
Research objectives
To investigate the significance of periodontitis in cirrhotic patients with ascites.
Research methods
This is a prospective cohort study. The oral hygiene and dental status of 27 patients with cirrhosis and ascites decompensation were documented. The prevalence of periodontitis in these patients was compared to that of 100 unselected patients from a standard dental practice. Samples from ascites and gingiva were tested for Porphyromonas gingivalis (P. gingivalis) and Actinobacillus actinomycetemcomitans (A. actinomycetemcomitans) using PCR.
Research results
Periodontitis was diagnosed in 22 out of 27 patients (82%) with ascites. This rate is significantly higher than in the control group of 100 unselected patients, where the rate was 59% (P = 0.04). P. gingivalis was identified in the gingiva of six patients and concurrently in the stool of one patient. However, P. gingivalis was not found in the ascites of any patient. Of the patients who tested positive for P. gingivalis, 83% (five out of six) suffered from periodontitis. A. actinomycetemcomitans was not detected in any of the samples. Significantly, a greater number of patients without periodontitis passed away compared to those with periodontitis, and the survival rate (as determined by the Kaplan-Meier analysis) was longer for patients with periodontitis (P = 0.02). Transplant-free survival was observed more often in patients with periodontitis than those without (63% vs 0%, P = 0.02).
Research conclusions
Periodontitis is common in cirrhotic patients with ascites.
Research perspectives
Hepatologists should recommend regular dental visits for cirrhotic patients. Future studies should assess whether this recommendation improves dental health and reduces the incidence of periodontitis.
