Aims-To investigate the prevalence of Helicobacterpylori in the saliva ofpatients infected with this bacterium. Methods-A novel polymerase chain reaction (PCR) assay was developed to detect Hpylori in saliva and gastric biopsy specimens from patients undergoing endoscopy. Results-Our PCR assay amplified a 417 base pair fragment of DNA from all 21DNAs derived from H pylon clinical isolates but did not amplify DNA from 23 non-H pylon strains. Sixty three frozen gastric biopsy and 56 saliva specimens were tested. H pylon specific DNA was detected by PCR in all 39 culture positive biopsy specimens and was also identified from another seven biopsy specimens which were negative by culture but positive by histology. H pylon specific DNA was identified by PCR in saliva specimens from 30 (75%) of 40 patients with H pylori infection demonstrated by culture or histological examination, or both, and in three patients without H pylon infection in the stomach. Conclusion-The results indicate that the oral cavity harbours H pylon and may be the source of infection and transmission. (J Clin Pathol 1995;48:662-666)

Helicobacter pylori was grown in low numbers from the saliva of one of nine patients who were positive for gastric H. pylori. The saliva-derived isolate from this patient was identical to the antral biopsy-derived isolate from the same patient and differed from isolates cultured from the antral biopsies of all other patients by soluble-protein electrophoresis, restriction endonuclease DNA analysis, and Southern blot hybridization. This is the first observation, to our knowledge, of the recovery of viable H. pylori from saliva.

Pharmacobezoars, bezoars comprised of medications, are unusual entities. Medications reported to cause bezoars include aluminum hydroxide gel, enteric-coated aspirin, sucralfate, guar gum, cholestyramine, enteral feeding formulas, psyllium preparations, nifedipine XL, and meprobamate. They most often occur, as do bezoars of any type, in a background of altered motility or anatomy of the gastrointestinal tract. Bowel hypoactivity, dehydration, and concomitant use of anticholinergics and narcotis appear to contribute to the propensity for bezoar formation by aluminum hydroxide gel and Isocal. The hygroscopic properties of psyllium and guar gum appear to contribute to their propensity to form bezoars. Insolubility of the carrying vehicle of enteric-coated aspirin and nifedipine is the setting in which these medications form bezoars. In contrast to nonmedication bezoars, pharmacobezoars may produce additional symptoms, those related to the release of their active ingredients. In patients with suspected gastrointestinal tract emptying problems, whether esophageal, gastric, small bowel, or colonic, the astute clinician should consider pharmacobezoar in the differential diagnosis.

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