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PubMed2006

Influence of mouth washing procedures on the removal of drug residues following inhalation of corticosteroids.

Mouth washing after inhalation of corticosteroids is effective for prevention of local adverse effects such as hoarseness and oropharyngeal candidiasis. To establish an optimal procedure for such mouth washing, we investigated the removal rates of drug residues remaining on the oropharyngeal mucosa using various mouth washing methods following inhalation. A beclomethasone dipropionate metered dose inhaler (BDP-MDI) (100 microg) and a fluticasone propionate dry powder inhaler (FP-DPI) (100 microg) were used. The effects of different mouth washing methods were evaluated by quantification of drugs in the expectorated rinse solution using an HPLC method. The amounts of BDP recovered in the rinse after gargling and rinsing for 5 s each were 47.1+/-13.6 microg, while they were 42.9+/-9.4 microg after rinsing alone for 10 s and 38.7+/-9.2 microg after gargling alone for 10 s. Under the same conditions, FP amounts were 32.9+/-7.3 microg, 28.9+/-2.4 microg, and 27.1+/-7.9 microg, respectively. In a comparison of washing time, the amounts of BDP recovered were 49.8+/-9.7 microg after gargling and rinsing for 2 s each, 53.5+/-10.2 microg after those for 3 s each, and 47.1+/-13.6 microg after those for 5 s each, while the amounts of FP under the same conditions were 36.4+/-2.4 microg, 33.3+/-6.4 microg, and 32.9+/-7.4 microg, respectively. As for the effect of time lag before mouth washing, the amount of BDP recovered decreased by 65.7% with a lag time of 1 min and by 5.6% after 10 min, while that of FP decreased by 51.1% with a lag time of 1 min and by 7.7% after 10 min. Our results suggest that the amount of drugs removed by mouth washing is significantly associated with the time lag between inhalation and mouth washing. We concluded that immediate gargling and rinsing after inhalation is most useful for the removal of drugs following inhalation of corticosteroids.

Administration, Inhalation↗
PubMed2001

[Effects of mouthwashes on the structural characteristics of human mixed saliva].

Effects of TANA hygienic liquids on the structural characteristics of mixed saliva were studied in 9 subjects aged 15-20 years after tooth cleaning with Colgate and Pepsodent toothpastes. Tooth cleaning with Colgate paste led to structural changes in the saliva, but gargling with hygienic liquids "Soft Fluoride Gargling" and "Tartar Control" helped preserve its structure. Structural characteristics of the oral fluid were retained after tooth cleaning with Pepsodent toothpaste. Gargling with the above hygienic liquids after tooth cleaning with Pepsodent led to structural changes in the saliva or created conditions for such changes. "Fluoride Gargling for Children" used after tooth cleaning with both toothpastes promoted alkalization of the oral fluid, which can lead to lithogenesis in the oral cavity.

Adolescent↗
PubMed2000

Effects of three techniques on maximum posterior movement of the tongue base.

Effects of three techniques designed to improve maximum range of posterior movement of the base of tongue were investigated under videofluoroscopy in 20 subjects. Retraction of the tongue base during 3-ml pudding swallows, tongue pull-back, yawn, and gargle tasks was measured in millimeters, with the second cervical vertebra as a reference point and was judged subjectively as well. The gargle task was the most successful in eliciting most tongue base retraction for the group of subjects, although not in every subject. Gargle also resulted in greater tongue base movement than swallow more often than the other two voluntary tasks. Clinicians' subjective judgment of "most" retracted tongue base position was generally reliable in comparison with actual measurements. The number of repeat swallows on each bolus correlated significantly with the approximate percentage of residue in the valleculae as judged clinically.

Adult↗
PubMed1984

Subjective response to cigarette smoking following airway anesthetization.

Subjective response to cigarette smoking was assessed after partial blockade of upper and lower airway sensations by the topical application of lidocaine. Pack-a-day smokers were given one cigarette after each of four conditions: (1) mouth anesthesia, obtained by rinsing the mouth with 2% lidocaine; (2) mouth and pharyngeal anesthesia, in which subjects rinsed their mouths and gargled with 2% lidocaine; (3) upper and lower airway anesthesia, in which subjects rinsed their mouths and gargled with a 2% lidocaine solution, and inhaled a mist containing 4% lidocaine (60 breaths); and (4) saline control, in which all solutions (rinse, gargle and inhalation) were saline. A significant linear decline in cigarette craving occurred with increasing anesthesia, and desirability ratings over the first several puffs were also reduced by anesthesia. These results suggest that sensory cues are important factors in smoking satisfaction, and their influence can be analyzed with the use of local anesthetics.

Adult↗
PubMed1999

Performance of virus isolation and Directigen Flu A to detect influenza A virus in experimental human infection.

BACKGROUND: Few data exist to assess the sensitivity of different specimen types for viral detection during the course of influenza virus infection. OBJECTIVES: This study assessed the relationships between quantitative influenza A virus replication and antigen detectability by the enzyme immunosorbent assay (EIA) Directigen Flu A in different type of samples during experimental human infection. STUDY DESIGN: Fourteen volunteers were inoculated with influenza A virus A/Texas/36/91 (H1N1). Four specimens types were collected in sequence for quantitative isolation in cell culture and antigen testing from days 1 to 8 after inoculation. RESULTS: Seventy-one (63%) of nasopharyngeal wash specimens were culture positive, compared to 51 (46%) of throat gargles, 51 (46%) of nasal swabs, and 27 (24%) of throat swabs. All subjects shed virus in their nasopharyngeal wash at least one day and 86% of subjects had a positive nasopharyngeal wash culture on day 2 after inoculation. The mean viral titers were highest on day 2 post inoculation for all specimen types and averaged 3.6 log10 TCID50/ml for nasal washes, 1.2 log10 TCID50/ml for throat gargles, 1.8 log10 TCID50/ml for the nasopharyngeal swabs, and 0.6 log10 TCID50/ml for the throat swabs. Mean viral titers in the nasal washes were significantly different (P<0.05) compared to other specimen types. The peak of sensitivity of EIA (compared to culture) was the second day after inoculation. Nasopharyngeal and throat swab results were combined for this analysis and considered positive by culture if positive in either or both samples. Thus, on day 2 the number of EIA positive samples relative to the number culture positive was 9/12 (75%) for nasopharyngeal wash specimens, 2/9 (22%) for throat gargles, and 7/11 (64%) for the combined throat and nasal swabs specimens. CONCLUSIONS: Nasopharyngeal washes are the most sensitive sample type detecting influenza A virus in adults. For rapid diagnosis the Directigen Flu A is an alternative with a sensitivity compared to culture ranging between 64 and 78% if performed on nasopharyngeal specimens on day two or three after experimental infection in adults. However, if performed on other specimens or later in the course of infection the sensitivity is lower.

Adult↗
PubMed1991

Relationship between cytomegalovirus and colonization of the oropharynx by gram-negative bacilli following renal transplantation.

Numerous investigators have reported an increased incidence of pneumonia caused by Gram-negative bacilli and other secondary pathogens in transplant recipients infected by cytomegalovirus (CMV). To determine if CMV infections are related to colonization of the upper respiratory tract by Gram-negative bacilli, we examined prospectively 22 renal transplant recipients with sequential bacteriological, virological and biochemical examinations performed just prior to and at various times after transplantation. Only 11% of subjects had Gram-negative bacilli isolated from gargle specimens prior to transplantation, as compared to 54% after transplantation. More importantly, after transplantation, subjects with active CMV infections were more likely to have prolonged oropharyngeal carriage of Gram-negative bacilli than subjects without CMV infections (36% v. 25%). During active CMV infections, the rate at which Gram-negative bacilli were isolated from gargle specimens rose from 28 to 47%. During culture-positive CMV infections, the isolation rate reached 57% and was significantly different from that of CMV-negative samples (P less than 0.01). The increased rate of Gram-negative bacillary isolation from gargle specimens during CMV infections was not a function of type of immunosuppressive agents used, rejection episodes, antibiotic administration, concomitant hepatitis B, Epstein-Barr (EBV) virus, or herpes simplex virus infections, or alterations in salivary fibronectin concentrations.

Adult↗
PubMedDate not supplied

The effect of the use of mouthwash on ethylglucuronide concentrations in urine.

Two studies were performed to evaluate the effect of alcohol containing mouthwash on the appearance of ethyl glucuronide (EtG) in urine. In the first study, 9 volunteers were given a 4-oz bottle of mouthwash, which contained 12% ethanol. They gargled with all 4 oz. of the mouthwash at intervals over a 15-min period. All urine samples were collected over the next 24 h. Of 39 provided urine samples, there were 20 > 50 ng/mL, 12 > 100 ng/mL, 5 > 200 ng/mL, 3 > 250 ng/mL, and 1 > 300 ng/mL. The peak concentrations were all within 12 h after the exposure. In the second study, 11 participants gargled 3 times daily for 5 days. The first morning void was collected. Sixteen of the 55 submitted samples contained EtG concentrations of greater than 50 ng/mL. All of them were less than 120 ng/mL. These studies show that incidental exposure to mouthwash containing 12% ethanol, when gargling according to the manufacturer's instructions, can result in urinary EtG values greater than 50 ng/mL. All specimens were negative for ethanol. The limits of detection and quantitation for the EtG testing were 50 ng/mL.

Ethanol↗
PubMed2004

The effect of a chlorhexidine regimen on de novo plaque formation.

OBJECTIVE: To evaluate the effect of a pretreatment regimen that combined meticulous mechanical tooth cleaning with the daily use of chlorhexidine (rinse, gargle and tongue application) on de novo plaque formation and on the recolonization of various microbiological species in plaque and saliva during a 4-day period of no oral hygiene. MATERIAL AND METHODS: Ten subjects aged 24-36 years with gingivitis were recruited. The study was designed as a double blind cross-over clinical trial including two phases. Each experimental phase comprised one preparatory period of 7 days and one plaque accumulation period of 4 days. During the preparatory period, the volunteers (i) performed meticulous mechanical tooth cleaning using toothbrush and dentifrice and (ii) were, in addition, given two sessions of professional tooth cleaning (PTC) The final PTC was delivered after bacterial sampling had been made on Day 0. In the Control group, no additional plaque control measures were included. In the Test group, the participants in addition to the mechanical measures (i) rinsed twice daily, for 60 s each time with a 0.2% chlorhexidine solution, (ii) gargled twice daily for 10 s with the chlorhexidine preparation, and finally (iii) brushed the dorsum of the tongue for 60 s, twice daily, with a 1.0% chlorhexidine gel. During the 4-day plaque accumulation period, the participants abstained from all mechanical and chemical plaque control measures. On Days 0, 1, 2 and 4 the quantity and quality of plaque formed was assessed by clinical means and by DNA probe techniques. The microbiota of the saliva was studied in samples obtained on Days 0 and 4. RESULTS: It was demonstrated that chlorhexidine used as a mouthrinse combined with gargling and tongue application during the preparatory period significantly retarded the amount of plaque that formed on tooth surfaces during the following 4 days of no oral hygiene. Further, the number of microorganisms present in the biofilm representing Days 0, 1 and 2 of the "plaque accumulation period" was apparently affected by the use of the antiseptic. Among the microorganisms influenced by the chlorhexidine regimen, a substantial number belonged to the genus Actinomyces. It was also observed that the adjunctive use of chlorhexidine reduced the number of bacteria present in saliva at the end of the preparatory period (i.e. on Day 0). After 4 days of no oral hygiene, the microbiota of the newly formed plaque in the Test and Control groups had many features in common. CONCLUSION: Habitat is critical in controlling the bacterial composition of the dental biofilm. The microbiota will tend to go back to the one that is characteristic of a given subject, once chemical antimicrobial means are withdrawn.

Adult↗
PubMed1995

[The prevention and treatment of oral cavity ulcer and infection of patients with oral cavity malignant cancer after chemotherapy]

44 oral cavity malignant cancer patients who underwent operation and chemotherapy are taken as the Experiment Group,using a mixture liquid of Calcii Folinas and Gentamycin to rinse out the mouth.48 patients using single drug gargle as the Comparison Group,The comparison between the two gargles' effects on oral ulcer and infection shows that the incidence of oral ulcer in the Comparison Group(P<0.05),and there is a significant difference.The oral infection incidence is lower too (P>0.05).There is no statistical difference.The expeiment suggests that gargling with mixture liquid is superior to using single drug liquid.

Journal Article↗
PubMed2004

[Influence of urease activity of the oral cavity and oropharynx on 13C-urea breath test].

We examined whether 13C-urea breath test with powdered 13C-Urea is affected with urease activity in the oral cavity and oropharynx in H. pylori negative cases. We also examined whether the degree of gargling affects the results of 13C-UBT. The results demonstrated that the urease activity not only in the oral cavity, but in the oropharynx may influence the UBT value. Therefore, it is possible that the UBT value may be affected with relic urease activity in the oropharynx if only the oral cavity is gargled. In conclusion, Gargling of the oropharynx in addition to the oral cavity is important to obtain true negative diagnosis with 13C-UBT in patients without Helicobacter pylori infection.

Adult↗
PubMed2006

Efficacy of sucralfate in the postoperative management of uvulopalatopharyngoplasty: a double-blind, randomized, controlled study.

OBJECTIVE: To evaluate the effectiveness of sucralfate in influencing throat pain, otalgia, analgesic requirement, bleeding, mucosal recovery, and incidence of postoperative bleeding in patients undergoing uvulopalatopharyngoplasty. DESIGN: A prospective double-blind randomized study. SETTING: University-affiliated tertiary referral hospital. PARTICIPANTS: Eighty adult patients with obstructive sleep apnea syndrome requiring uvulopalatopharyngoplasty were recruited and randomly allocated into either a sucralfate treatment group or a control group. INTERVENTIONS: All patients underwent uvulopalatopharyngoplasty. Patients enrolled in the sucralfate group (n=40) were instructed to gargle the sucralfate suspension and then to swallow. Patients enrolled in the control group (n=40) were instructed to gargle placebo suspension at the same doses and schedule. MAIN OUTCOME MEASURES: Postoperative throat pain, otalgia, amount of analgesic required, degree of strength (defined as patients' general well-being and return to regular daily activities), percentage of mucosal covering, and postoperative bleeding. RESULTS: Throat pain and otalgia occurred significantly less often in sucralfate group, with less analgesic requirement and with rapid mucosal healing and early return to regular daily activities. There was no significant difference in episodes of postoperative bleeding between the 2 groups (P=.37). CONCLUSIONS: Although sucralfate therapy may not provide complete analgesia after uvulopalatopharyngoplasty, it may reduce the amount of analgesic required, thus preventing dose-related adverse effects from the analgesic agent. It can also significantly reduce the total number of days needed to return to normal daily activities (P=.41).

Analgesics↗
PubMed2003

Oral administration of specific yolk antibodies (IgY) may prevent Pseudomonas aeruginosa infections in patients with cystic fibrosis: a phase I feasibility study.

Respiratory infection is the major cause of morbidity and mortality in cystic fibrosis (CF) patients. Chronic Pseudomonas aeruginosa (PA) infections ultimately occur in virtually all patients. It is impossible to eradicate PA when a patient has been chronically colonized. Immunotherapy with specific egg-yolk antibodies (IgY) may be an alternative to antibiotics for the prevention of PA infections. We wanted to determine if treatment with specific IgY can prolong the period between the first and the second PA colonization? And long-term, can the treatment diminish the number of positive PA cultures and postpone the onset of chronic colonization? CF patients gargled daily with an IgY-antibody preparation, purified from eggs of hens immunized with PA bacteria. They were compared to a group of patients who did not gargle with the preparation. Both groups had their first colonization with PA eradicated by antibiotics. The basic treatment was essentially the same in both groups. In the initial study, the period between the first and second colonization with PA was significantly prolonged for the treated vs. the control group (Kaplan-Meier P = 0.015, Breslow test). In the prolonged study, the treated group had only 2.5 sputum cultures positive for PA per 100 months of observation, and none of these patients became chronically colonized with PA. No adverse events were reported. In the control group, 13.7 cultures per 100 months of observation were positive for PA, and 5 (24%) patients became chronically colonized with PA. This feasibility study shows that antipseudomonal IgY has the potential to effectively prevent PA colonization without any severe adverse effects. A phase III study should be initiated.

Adolescent↗
PubMed1998

Combined use of blood and oropharyngeal samples for noninvasive diagnosis of Pneumocystis carinii pneumonia using the polymerase chain reaction.

To evaluate the clinical use of a polymerase chain reaction (PCR) assay for diagnosis of Pneumocystis carinii pneumonia (PCP) using samples collected noninvasively, the Internal Transcribed Spacers (ITSs) nested PCR was performed on 148 samples from 40 subjects. Bronchoalveolar lavage (BAL) fluid sera, gargled oropharyngeal washes, and peripheral blood mononuclear cells (PBMC) from 14 AIDS patients (mean age, 35.6 years; mean CD4+ cell count, 49.2 cells/mm3) with proven PCP and from 13 HIV-seropositive controls (mean age, 34.6 years; mean CD4+ cell count, 107.3 cells/mm3) with other AIDS-related opportunistic infections were evaluated. Sera and oropharyngeal samples were also collected from 13 HIV-seronegative health care personnel working in an infectious disease ward for use as negative controls. The ITSs nested PCR confirmed the morphological diagnosis of PCP in all patients when BAL fluid was tested (100% sensitivity). This technique also detected Pneumocystis carinii DNA in oropharyngeal samples from 78.6% of patients, in sera from 71.4% of patients, in PBMC from 35.7% of patients. When all results obtained after ITSs nested PCR were considered together for the same patient, the sensitivity for PCP diagnosis was 100% for blood and oropharyngeal samples (gargled saline), as confirmed by subsequent BAL. All samples collected noninvasively from 26 of 26 controls were negative using ITSs nested PCR (100% specificity).

AIDS-Related Opportunistic Infections↗
PubMed1999

Anesthesia of the airway by aspiration of lidocaine.

PURPOSE: Lidocaine instilled onto to the back of the tongue of a supine subject and aspirated has been reported to provide effective topical anesthesia of the airway. The purpose of this study was to observe endoscopically the fate of lidocaine so instilled and document the efficacy of anesthesia for awake fibreoptic intubation. METHODS: In Part I of the study, a fibreoptic bronchoscope was positioned in the pharynx of three volunteers lying supine and the route followed by tinted lidocaine solution instilled onto the back of the protruded tongue during mouth breathing was observed. In Part 2, the airway of 39 patients requiring awake fibreoptic intubation was anesthetized by having them gargle twice with 5 ml lidocaine 2%, followed by instillation of 0.2 ml-kg(-1) or 20 ml lidocaine 1.5% (whichever was less) onto the dorsum of their tongues as described above. The efficacy of anesthesia was scored by the patient reaction (coughing or gagging) to instrumentation in the pharynx, at the glottis, and in the trachea; to passage of the tracheal tube into the trachea; and to the presence of the tube in the trachea. RESULTS: Lidocaine instilled on to the back of the tongue was swallowed initially but ultimately pooled in the pharynx and was aspirated. In all patients the trachea was intubated without requiring supplemental lidocaine, and all but one patient tolerated the tracheal tube in situ. CONCLUSION: A combination of lidocaine gargles and lidocaine instilled on to the back of the tongue and aspirated provides effective anesthesia of the pharynx, larynx, and trachea for awake fibreoptic intubation.

Adult↗
PubMed2005

Salivary bisphenol-A levels detected by ELISA after restoration with composite resin.

Bisphenol-A diglycidylether methacrylate (Bis-GMA), which is synthesized from bisphenol-A (BPA), a compound with exogenous endocrine disrupter action, is widely used as a dental material. During clinical filling with sealants and composite resins, the compounds are solidified by polymerization and then used. However, it has been noted that unpolymerized monomers may become dissolved in saliva. In this study using a competitive ELISA system, we investigated the changes in the BPA concentration in saliva after restoration with composite resins. Commercial composite resins from nine companies were tested. Mixed saliva was collected from 21 subjects. Based on the dynamics of salivary BPA detected by this ELISA system, we concluded that several tens to 100 ng/ml of BPA were contained in saliva after filling teeth with composite resin but that sufficient gargling can remove it from the oral cavity. Our data suggest that sufficient gargling after treatment is important for risk management.

Benzhydryl Compounds↗
PubMed2001

Potential use of tea extract as a complementary mouthwash: comparative evaluation of two commercial samples.

OBJECTIVE: To evaluate the potential of using tea extracts as complementary mouthwash and to test the comparative efficacy of two commercial samples. DESIGN: A randomized controlled trial with 30 healthy human volunteers was carried out. The subjects were randomly assigned to 5 groups of 6 subjects per group. The ability of Ndu tea (from Cameroon) and Lipton tea (from Nigeria) to reduce colony forming units (CFU) in the liquid expectorated after 60 seconds of gargling from the mouth of the volunteers at 5 and 60 minutes were evaluated. These were compared to the values obtained from bank water and Minty Brett (thymol 0.047%), a standard antiseptic. SETTING: University of Nigeria, Nsukka, Enugu State, Nigeria. SUBJECTS: Thirty healthy human volunteers (18 males and 12 females, between 22-30 years of age) who met the eligibility requirement of being nonsmokers and not taking any other antimicrobial agent were selected for the study. RESULT: Relative to the bank water, the results indicated that the hot water extract of both teas significantly (p < 0.05) reduced CFU per milliliter in the liquid expectorated after gargling at both 5 and 60 minutes. Minty Brett showed higher activity than both tea extracts; however, unlike Minty Brett both extracts still reduced the CFU per milliliter at time 60 minutes (an indication of longer duration of activity). The combination of the tea extracts with sodium lauryl sulfate (1.2% w/v), a surfactant and emulsifier, significantly increased the antimicrobial activity relative to each tea alone. Comparatively, the activity of Ndu tea was found to be slightly higher than that of Lipton tea but this was not significant (p < 0.05). CONCLUSION: Lipton and Ndu tea extracts potently reduced the CFU per milliliter. This activity was potentiated by sodium lauryl sulfate. Although Minty Brett had more potent antimicrobial activity, both tea extracts have longer duration of activity. The results indicate the potential usefulness of tea extracts as a complementary mouthwash.

Adult↗
PubMed2006

Preliminary study on the effect of oral care on recovery from surgery in elderly patients.

This study aimed to clarify the effectiveness of post-operative oral care, including tooth brushing, denture cleaning and tongue cleaning, after digestive tract surgery. Subjects included 30 elderly patients aged 60-98 years (74.9 +/- 7.8 years) who underwent digestive tract surgery. Subjects were randomly divided into an intervention group and a control group. In the intervention group, the following oral care was provided daily over a 5-min period in the morning starting at baseline (day of surgery) and continued for 5 days: gargling with povidone iodine, tooth brushing, denture cleaning using a special brush and tongue cleaning using a tongue brush. In the control group, the subjects only gargled with povidone iodine. We compared the following variables between the two groups at baseline and 5 days later: the sensation of dry mouth, intra-oral gas concentration, pulmonary sounds, body temperature and bacterial flora. The number of patients with abnormal pulmonary sounds (dry or moist rales) increased from 1 to 2 in the intervention group and from 0 to 4 in the control group (P < 0.05). The average number of bacterial species per subject for the control group was 3.64 +/- 1.34 pre-operatively and 3.50 +/- 1.74 post-operatively, whereas that for the intervention group was 3.08 +/- 0.95 pre-operatively and 2.62 +/- 0.65 post-operatively. In the intervention group, there was a significant decrease in the number of bacterial species (P < 0.05). These findings indicate that post-operative oral care in elderly patients undergoing digestive tract surgery lowers the number of bacterial species found in the oral cavity. This effect, in turn, might improve respiratory function.

Aged↗
PubMed2005

Methodology and transport medium for collection of Helicobacter pylori on a string test in remote locations.

BACKGROUND: Helicobacter pylori can be isolated from patients using the string test but contaminating oral and nasopharyngeal microflora need to be suppressed by rapid plating out onto selective culture media. Recently, use of this diagnostic method was enhanced by using a novel transport medium to collect specimens from subjects in a remote Australian clinic over 1300 km from the laboratory. METHODS: Retrieved string tests were transported to the laboratory in chilled polystyrene boxes in 5 ml screw-cap bottles with 3 ml of a brain heart infusion broth plus antibiotics. These were 20 g/ml vancomycin, 10 g/ml trimethoprim, 10 g/ml cefsulodin, and 10 g/ml amphotericin B. A comparison was made between subjects who gargled with a chlorhexidine mouthwash before swallowing the string test and those who did not. RESULTS: Forty-five urea breath test-positive subjects were tested and H. pylori was isolated from 34 of them. Successful culture was achieved from string tests that were in transit for up to 29 hours and where the maximum temperature in the transport box was 14 degrees C. The additional use of a mouthwash had a marked effect on the isolation rate. H. pylori was cultured from 75% of subjects who gargled but only from 39% who did not. CONCLUSIONS: This methodology and transport medium can broaden the use of the string test to more remote geographic areas where endoscopy is not feasible so that H. pylori isolates may still be obtained for diagnostic and epidemiologic studies. The value of this promising methodology of collection and transport should be assessed in a controlled study.

Adolescent↗