Prevalence of Helicobacter pylori colonisation in tonsillar tissue in cases of chronic tonsillitis: a prospective study


  • Vellamparambil Sreejaraj Department of ENT, Amala Institute of Medical Sciences, Thrissur, Kerala, India
  • Paul Vazhapilly Sumam Department of ENT, Amala Institute of Medical Sciences, Thrissur, Kerala, India
  • Verghese Nevil Department of ENT, Amala Institute of Medical Sciences, Thrissur, Kerala, India
  • Karuthedath Sridevi Department of ENT, Amala Institute of Medical Sciences, Thrissur, Kerala, India
  • Ariyamparampil Rajagopalan Vinayakumar Department of ENT, Amala Institute of Medical Sciences, Thrissur, Kerala, India



Helicobacter pylori, Dental plaques, Chronic tonsillitis


Background: Human stomach is not the only reservoir of Helicobacter pylori but it has been detected in dental plaques, oral lesions and saliva. It could play role in the pathogenesis of various otorhinolaryngologic problems and remains debatable. This study was aimed to find out the prevalence of H. pylori in tonsillar tissue of patients with chronic tonsillitis by rapid urease test in a tertiary hospital in Kerala.

Methods: Prospective cross sectional study was done in patients who attended the outpatient department of ENT with a history suggestive of chronic tonsillitis. The patient satisfied the criteria for chronic recurrent tonsillitis were subsequently posted for tonsillectomy. Each specimen was subjected to rapid urease test.  

Results: Total 228 patients were included in this study with age ranging between 3 and 31 years (10.0±7.1), with most common age being <10 years in 159 patients (69.7%). Male to female ratio was 1.4:1. Among these, the presence of H. pylori was seen in only 6/228 patients.

Conclusions: The possibility of tonsillar tissue acting as a reservoir for H. pylori infection is very low.

Author Biography

Paul Vazhapilly Sumam, Department of ENT, Amala Institute of Medical Sciences, Thrissur, Kerala, India

Asst. Professor


Warren JR, and Marshall BJ. Unidentified curved bacilli on gastric epithelium in active chronic gastritis. Lancet. 1983;1(8336):1273-5.

Kusters J, Arnoud H, Kuipers E. Pathogenesis of Helicobacter pylori infection. Clin Microbiol Rev. 2006;19:449–90.

Cirak MY, Ozdek A, Yilmaz D, Bayiz U, Samim E, Turet S. Detection of Helicobacter pylori and its CagA gene in tonsil and adenoid tissues by PCR. Arch Otolaryngol Head Neck Surg. 2003;129:1225-9.

Bujanover Y, Reif S, Yahav J, Helicobacter Pylori and Peptic Disease in the Pediatric Patient. Pediatr Clin North Am. 1996;43:213–34.

Oshowo A, Tunio M, Gillam D, Botha AJ, Holton J, Boulos P, et al. Oral colonization is unlikely to play an important role in Helicobacter pylori infection. Br J Surg. 1998;85:850-2.

Unver S, Kubilay U, Sezen OS, Coskuner T. Investigation of Helicobacter pylori colonization in adenotonsillectomy specimens by means of the CLO test. Laryngoscope. 2001;111:2183–6.

Unal M, Oztu L, Oztu C, Kabal A. The seroprevalence of Helicobacter pylori infection in patients with obstructive sleep apnoea: a preliminary study. Clin Otolaryngol Allied Sci. 2003;28:100-2.

Ozdek A, Cirak YM, Samim E, Bayiz U, Safak MA, Turet S. A possible role of Helicobacter pylori in chronic rhinosinusitis: a preliminary report. Laryngoscope. 2003;113:679-82.

Dagli M, Eryilmaz A, Uzun A, Kayhan B, Karabulut H. Investigation of Helicobacter pylori in the middle ear of the patients with chronic otitis media by CLO test and 14C urea breath test. Otol Neurotol. 2006;27:871-3.

Kurtaran H, Uyar ME, Kasapoglu B, Turkay C, Yilmaz T, Akcay A, et al. Role of Helicobacter pylori in pathogenesis of upper respiratory system diseases. J Natl Med Assoc. 2008;100:1224-30.

Lukes Pˇ, Astl J, Pavlik E, Potuzˇnikova B, Terzl IS, Betka J, Helicobacter pylori in tonsillar and adenoid tissue and its possible role in oropharyngeal carcinogenesis. Folia Biol (Praha). 2008;54:33–9.

Brook PY, Foote PA, Jr. Changes in the core tonsillar bacteriology of recu¨rrent tonsillitis: 1977—1993. Clin Infect Dis. 1995;21:171-6.

Skinner LJ, Winter DC, Curran AJ, Barnes C, Kennedy S, Maguire AJ, et al. Helicobacter pylori and tonsillectomy. Clin Otolaryngol Allied Sci. 2001;26:505-9.

Peterson WL, Graham DY, Feldman M, Friedman LS, Slesenger MH (Eds.), Helicobacter pylori. Gastrointestinal and liver disease, seventh ed., Saunders, Philedelphia; 2002: 732-746.

Di Bonaventura G, Neff M, Neri G, Neri G, Catamo G, Piccolomini R. Do tonsils represent an extragastric reservoir for Helicobacter pylori infection? J Infect. 2001;42(3):221–2.

Dye KD, Marshall BJ, Frierson HF, de Boer WA, Jansen JB. Is CLO test alone adequate to diagnose Campylobacter pylori? Am J Gastroenterol. 1988;83:1032.

Schnell GA, Schubert TT, Barnes WG, et al. Comparison of urease, H&E and culture tests for Campylobacter pylori. Gastroenterol. 1988;94:410.

Zhang JP, Peng ZH, Zhang J, Zhang XH, Zheng QY. Helicobacter pylori infection in the pharynx of patients with chronic pharyngitis detected with TDI-FP and modified Giemsa stain. World J. Gastroenterol. 2000;21:468-72.

Minocha A, Raczkowski CA, Richards GJ. Is a history of tonsillectomy associated with a decreased risk of Helicobacter pylori infection? J Clin. Gastroenterol. 1997;25:580-2.

Di Bonaventura G, Catamo G, Neri M, Neri G, Piccolomini R. Absence of Helicobacter pylori in tonsillar swabs from dyspeptic patients. New Microbiol. 2000;23:445-8.

Jelavic B, Bevanda M, Ostojic M, Leventic M, Vasilj M, Knezevic E. Tonsillar colonization is unlikely to play important role in Helicobacter pylori infection in children. Int J Pediatr Otorhinolaryngol. 2007;71:585-90.






Original Research Articles