Aim

Periodontitis has been proposed to lead to Helicobacter pylori (H. pylori) infection which could cause many gastrointestinal tract cancers. This study aimed to determine the association between periodontitis and survival outcomes in individuals with respect to H. pylori infection or not.

Materials and Methods

4955 subjects aged 20 to 90, who had both received periodontal examinations and H. pylori serum test in the Third National Health and Nutrition Examination Survey (NHANES III) database, were included. Logistic regression models were used to analyze the association between periodontitis and H. pylori seropositive (H. pylori infection). Survival analysis was performed using the NHANES III linked to mortality data. The Cox proportional hazards regression was carried out to investigate the association between periodontitis and gastrointestinal tract cancer mortality in individuals with/without H. pylori infection.

Results

Compared to periodontal health, periodontitis was significantly associated with increased odds of H. pylori infection (OR = 1.271, 95% CI = 1.177 to 1.372). Periodontitis significantly increased the mortality risk of all causes (HR = 1.574, 95% CI = 1.327 to 1.866), all cancers (HR = 1.948, 95% CI = 1.701 to 2.232), gastrointestinal tract cancers (HR = 4.140, 95% CI = 3.656 to 4.687), gastric cancer (HR = 4.288, 95% CI = 3.969 to 4.632), and colorectal cancer (HR = 4.814, 95% CI = 3.849 to 6.020) in subjects with H. pylori infection after adjusting for health-related factors. Periodontitis was significantly related to the decreased survival time in subjects with gastrointestinal tract (p = 0.001) or colorectal cancer (p = 0.002) and H. pylori infection.

Conclusion

Our study demonstrated that periodontitis was significantly associated with higher mortality risk of gastrointestinal tract, gastric, and colorectal cancer in subjects with H. pylori infection. Due to an interactive effect between periodontitis and H. pylori infection on cancer mortality, H. pylori infection present a significant moderation effect to regulate the association between periodontitis and all-cancer, gastrointestinal tract cancer, and colorectal cancer mortality.