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.

First published in the Inside Tract® newsletter issue 176 – 2010
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.