Post on 04-Jun-2020
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PRISE EN CHARGE DE L’INFECTION A
HELICOBACTER PYLORI : LES
RECOMMANDATIONS INTERNATIONALES
SONT-ELLES APPLICABLES EN AFRIQUE ?
Dr Ruffin NTOUNDA,
CHU Saint-Pierre, Bruxelles
Belgian Hp and microbiota Study Group (BHpMSG)
Journées Scientifiques de la SCGE
Yaoundé, Octobre 2019
! sérendipité !
Barry J. Marshall et
J. Robin Warren, Prix
Nobel 2005 de médecine
La découverte de H. pylori par Marshall et Warren
en 1982 a bouleversé cette conception et a fait de
l'ulcère gastroduodénal une maladie
essentiellement infectieuse...
1/ Est- ce qu'il faut eradiquer Helicobacter pylori ?
2/ Les recommandations internationales sont-elles applicables
en Afrique ?
Pathogenesis of Helicobacter pylori Infection
- Host immune gene polymorphisms and gastric acid secretion largely determine the bacterium's ability to
colonize a specific gastric niche.
- Bacterial virulence factors such as the cytotoxin-associated gene pathogenicity island-encoded protein
CagA and the vacuolating cytotoxin VacA aid in this colonization of the gastric mucosa and subsequently
seem to modulate the host's immune system
Johannes G. Kusters, Arnoud H. M. van Vliet, and Ernst J. Kuipers Clin Microbiol Rev. 2006 Jul; 19(3): 449–490
PREVENTION OF GASTRIC CANCER AND OTHER COMPLICATIONS (WORKSHOP 3)
With 4 Guidelines on H pylori, What Should Clinicians Do Differently?
Since 2015, 4 major Helicobacter pylori consensus documents have been published
❑ American College of Gastroenterology Clinical Guideline
❑ Toronto Consensus
❑Houston consensus
❑ Maastricht V/Florence Consensus Report (which was updated
from an initial report published in 2012)
David A. Johnson, Medscape Gastroenterology, Aug 29, 2018
The Maastricht Florence Consensus
1996- Maastricht I- Gut 1997
2000- Maastricht II- APT 2002
2005- Maastricht III-Florence- Gut 2007
2010- Maastricht IV-Florence- Gut 2012
2015 – Maastricht V- Florence- Gut 2016
INDICATIONS
THERAPEUTIQUES
Helicobacter Pylori InfectionWhen to Eradicate, How to Diagnose and Treat
Wolfgang Fischbach and Peter Malfertheiner, Dtsch Arztebl Int 2018; 115(25): 429-36
Dépistage ciblé
Recommandation 7:
Tester et rechercher Hp chez les immigrants de première
génération (prévalence élevée d’infection )
(82% sont d'accord / tout à fait d’accord, Grade 1B).
Recommandation 8:
Les latino-américains et Les afro-américains peuvent être
testés en raison du taux élevé de l’infection à Hp dans ces
groupes
(91% d’accord / tout à fait d’accord, Grade 2C).
HOUSTON CONSENSUS CONFERENCE ON TESTING FOR
HELICOBACTER PYLORI INFECTION IN THE UNITED STATES
HASHEM B. EL-SERAG, JOHN Y. KAO, FASIHA , AL.
Clinical Gastroenterology and Hepatology 2018;16:992–1002
Recommandation 11:
Tester les membres de la famille vivant dans le même foyer
que des patients dont l’infection est activement prouvée
(experts versus sondage: 91% contre 78% sont d’accord / tout à fait d'accord, avis d’expert 1B)
Recommandation 12:
Tester Hp chez des patients avec ATCD familiaux d’ulcère
peptique
(experts versus sondage: 91% contre (73%) d'accord / tout à fait d'accord, avis d’expert 1B) .
HOUSTON CONSENSUS CONFERENCE ON TESTING FOR
HELICOBACTER PYLORI INFECTION IN THE UNITED STATES
HASHEM B. EL-SERAG, JOHN Y. KAO, FASIHA , AL.
Clinical Gastroenterology and Hepatology 2018;16:992–1002
Recommandation 14:
Tester H pylori chez les patients traités par des médicaments
dont l'absorption peut être affectée par l’infection (par exemple
L-DOPA, thyroxine)
(experts versus enquête 63% vs 68% d’accord / tout à fait d’accord, niveau d’experts 2C)
HOUSTON CONSENSUS CONFERENCE ON TESTING FOR
HELICOBACTER PYLORI INFECTION IN THE UNITED STATES
HASHEM B. EL-SERAG, JOHN Y. KAO, FASIHA , AL.
Clinical Gastroenterology and Hepatology 2018;16:992–1002
Colm O’Morain
Summary of the main studies performed from 1993à 2002 evaluating the impact of H. pylori eradication on the
regression of low grade gastric MALT lymphoma
Author Year N. Patients % remission
Wotherspoon,al 1993 6 83
Bayerdörffer, al 1995 33 69
Roggero, al. 1996 25 60
Fischbach, al. 1995 15 93
Montalban, al. 1996 9 88
Pinotti, al. 1997 45 68
Neubauer, al. 1997 50 80
Nobre-Leitao, al. 1997 17 100
Steinbach, al. 1998 28 50
Thiede, al. 1999 84 81
Fischbach, al. 2000 36 89
Accumulated data 1993-2002 604 72,8%
En 2010: 32 séries publiés, 1271 cas
Gastric Malt Lymphoma Stage IE-IIE
Hp positive Hp neg or
t (11;18 ) or undertermined Hp pos with t (11;18 )
Antibiotic resistant or
No lymphoma response
t repeat EGD 2-3 months
after eradication therap ry
Antibiotic resistant
Hp eradication therapy with
Standard antibiotics and PPI regimen
Hp test at 2-3 months and
2nd ligne antibiotic regimen if Hp detected Repeat
EGD and biopsies at 3-6 months
After Hp eradication
Gastric Malt Lymphoma Stage IE-IIE
Neg. for lymphoma Pos. for residual Pos. lymphoma , symptomatic
Lymphoma, asymptomatic or with other treat.
indications - overt
progression
- deep invasion
- nodal invasion
- t (11;18) translocation
After Hp eradication
EGD and biopsy
Every 6 months for 2 years
Then every 12-18 months
Radiotherapy
Chlorambucil or other alkylants
and or rituximab when
radiotherapy is not feasible or not
indicated
EGD and biopsy
Every3- 6 months
Gastric Malt Lymphoma, stade IV
Asymptomatic lymphoma Smptomatic lymphoma or
with other treatment indications:
- overt progression
- bulky disease
- Impending organ damage
- patient preference
Hp eradication therapy with standard antibiotics and PPI regimen
if the infection is present
Wait and see with EGD and
biopsies and EUS/ 6 months
Additional imaging if clinically
indicated bone marrow biopsy if
clinical indicated
Chemotherapy and/or Rituximab
Consider enrollment in clinical trial
Tests Diagnostiques
Diagnostic tests for the detection of H,pylori infection: Non invasive
Test Se(%) Sp(%) Advantages Disadvantages
Serology 76-84 79-90 Widely available, inexpensive Positive result may reflect previous rather than current infection, not useful after treatment
UBT >95 >95 High negative and positive predictive values, useful before and after treatment
False-negative results possible in the presence of PPI or with recent use of antibiotics of bismuth preparations, consederable resources and personnel required to perform test
Stool antigen
test
96 97 High negative and positive predictive valuesUseful before and after treatment
Process of stool collection may be distasteful to patient, false-negative results possible in the presence of PPI or with recent use of antibiotics or bismuth preparations
Diagnostic tests for the detection of H,pylori infection: Invasive
Test Se(%) Sp(%) Advantages Disadvantages
Histology 95 99 Excellent sens, and Sp, especially with special and immune stains, provides additionnal information about gastric mucosa
Expensive ( endoscopy and histopathology costs), interobserver variability, accuracy affected by PPIs and antibiotics use, requires trained personnel
RapidUrease
test
90 93 Rapid results, accurate in patients not using PPIs or antibiotics, no added histopathology cost
Requires endoscopy, less accurate after treatment or in patients using PPIs
Culture 58,1 100 Sp 100%, allows antibiotics sensitivity testing
Variable sensitivity: requires trained staff and properly equipped facilities, expensive
PCR ?
Colm O’Morain
Colm O’Morain
Artificial intelligence diagnosis of Helicobacter pylori infection
using blue laser imaging-bright and linked color imaging: a single-center prospective study
Hirotaka Nakashimaa , al,Annals of Gastroenterology (2018) 31, 1-7
Feature maps of the AI corresponding to the endoscopic images. Endoscopic images of a H. pylori-positive subject (test group). An image in WLI of EGD (A) showsyellowish mucosa in the lesser curvature (lower part of the picture). An image in BLI-bright (B) shows small whitish spots scattered over the mucosal surface (regionbetween the central part and the lower right part of the picture). An image in LCI (C) shows a pale-white color change in the same area. Feature maps of convolutionallayers during the AI test are also shown for WLI (D), BLI-bright (E) and LCI (F). In each IEE image, the AI responded to the lesser curvature of the stomach, which was theregion of mucosal atrophy with intestinal metaplasia, indicated by a light green or a light blue colorAI, artificial intelligence; WLI, white light imaging; BLI, blue laser imaging; LCI, linked color imaging; H. pylori, Helicobacter pylori
Image enhanced endoscopy. (A) Narrow band imaging (NBI) of the gastric mucosa. Round homogeneous sized pits with regularly arranged
collecting venules are shown (left). This pattern (regular arrangement of collecting venules) named ‘RAC’ pattern in the corpus mucosa
highly indicates a Helicobacter pylori negative state. In the H. pylori-infected mucosa with inflammation, pit patterns are elongated, varied in
sizes and shapes with spaces between them. Collecting venules are obscured owing to inflammation (centre). When intestinal metaplasia
develops, the pit pattern is further elongated with light blue lines (light blue crest sign) decorating the pits margins (right). The images were
provided by Dr Kazuyoshi Yagi. (B) Blue laser imaging (BLI) of the gastric mucosa. BLI is a new modality of image enhancement. The BLI-
bright mode can easily obtain lower magnification images, similar to the NBI images in (A) (left). With BLI-magnification mode, further
mucosal details including periglandular capillary networks (red coloured circles surrounding the pits) are seen (centre). BLI endoscopy is
useful for identifying the area of intestinal metaplasia where greenish coloured elongated pit patterns predominate (right).
The images were provided by Dr Hiroyuki Osawa, Jichi Medical University.
Magnifying NBI (left) and BLI (right) features of Hp infection negative (Hp−, upper) and positive (Hp+, lower) gastric mucosa. Hp− gastric
mucosa is characterized as small, round pits, accompanied with regular honeycomb-like SECNs, being regularly interspersed with collecting
venules (light blue arrow). On the other hand, Hp+ gastric mucosa is characterized as enlarged or elongated pits with unclear SECNs or dense
fine irregular vessels. NBI, narrow-band imaging; BLI, blue laser imaging; Hp, Helicobacter pylori; SECNs, subepithelial capillary networks.
Typical images for gastric pathology using MLI. a, b Same patient, (c, d) different patients. a Overview image of CG with larger areas of
mucosal atrophy with a yellow appearance in white light. b Mucosal atrophy at the lesser curvature using LCI atrophy appears white and
deeper vascular structures can be visualized. c Patchy distribution of IM in the antrum appearing as white areas in BLI mode. d
Magnification of angulus revealing light blue crest sign (arrows) as a sign of IM.
A) White light imaging with a small-caliber endoscope shows a small red area measuring 3 mm in diameter on the posterior wall
near the gastric angle, which is not suspicious for gastric cancer. (B) Linked color imaging enhances the red lesion and the
surrounding red portion. (C) Bright blue laser imaging reveals a discolored lesion measuring 10 mm around a central red area. (D)
Blue laser imaging produces a high color contrast between the malignant lesion and the surrounding mucosa. Several irregular
vessels are seen in the discolored lesion even with small-caliber endoscopy, suggesting early gastric cancer.
Esophagogastroduodenoscopy (EGD) is of growing importance
in the diagnosis of Helicobacter pylori (H. pylori) gastritis,
Image-enhanced endoscopy (IEE) with magnifying function is
useful for improving the diagnosis of H. pylori infection. H•
The AI demonstrated an excellent ability to diagnose H. pylori
infection using the novel IEEs
AI technology with IEE is likely to become a useful image
diagnostic tool for H. pylori infection
Hirotaka Nakashimaa , al,Annals of Gastroenterology (2018) 31, 1-7
Gisbert JP, EHMSG , Magdeburg 2016
Gisbert JP, EHMSG , Magdeburg 2016
Quadritherapie Bismuthée 10j Concomitant au moins 10j
Concomitant 14j Q. Bismuthée 10j
Trithérapie optimisée en fonction
De la sensibilité à la Clari et Aux
quinolones
JD de Korwin. JFHOD 2016
1e Ligne
2e Ligne
3e Ligne
Echec Echec
Echec Echec
Culture ou PCR
- Clari-S : IPP-Amoxi-Clari 14 jours (Amoxi 1gx3)
- Clari-R et Quinolones-S : IPP-Amoxi-Levo 14j
- Clari-R et Quinolones-R : IPP-Amoxi-Metro 14j
Traitement empirique de l'infection à Hp en France après Maastricht V
ou
Updated German Guidelines 2016
Low risk of Clari-R High risk of Clari-R
1st Line STT (14 days better than 7 days) or
Bismuth quadruple therapy
Bismuth quadruple therapy or
Concomitant quadruple
Risk factors for clarithromycin
resistance
- Geographical background
- Prior macrolide exposure
- Femal gender
Fischbach W et al. Z Gastroenterol 2016;54:327-63
Carlo A Fallone, al. Gastroenterology 2016;151:51–69The Toronto Consensus
Evidence-based Treatment Regimens for H. pylori Infection in North America, Listed in Recommended Order
Sheila E. Crowe, N Engl J Med 2019;380:1158-65
SCHEMAS
THERAPEUTIQUES et
RESULTATS
Triple therapy when Hp infection is known to be susceptible to clarithromycin
•PPI x2
•Amoxi (1g) x2
•Clari (500mg) x2
(or Tini or Metro (500mg) x2)
For 10 days, preferably 14 days
Traitement Hp en 2019: Triple therapie standardLow Clari-R
Pays Type trait Tx d'éradication Auteurs, Année
Japon Controlé: Metro vs Clari Metro: 98%
Clari: 60%
Mabe K, 2018
Rwanda Controlé:
Metro vs Clari vs Cipro
Metro:64%
Clari: 87%
Cipro: 81%
Kabakambira JD, 2018
Turquie Meta Analyse: Durée 7j vs 14j 57% vs 60% Sezgin O, 2019
Chine Controlé: Triple vs Bismuth
triple
Triple 7j: 79%
14j;89=%
Bismuth 7j: 82%
Leow AH, 2018
Inde Controlé: standard vs “ Daily
Single-dose triple
86% vs 90%
(meilleure
compliance)
Shahbazi S, 2018
O'Connor et al. Helicobacter 2019
Sequential therapy
• PPI + Amoxi (1g) x2 for 5 days
followed by
• PPI +Clari (500mg) + Tini (500mg) or
Metro (500mg) x2 for a further 5 days
( Total 10 days)
Concomitant therapy
• PPI +
• Amoxicillin (1g) +
• Clarithromycin (500mg) +
• Tinidazole or Metro (500mg)
Twice daily for 10-14 days
Sequential - Concomitant therapyor Hybrid
PPI +Amoxicillin (1g) x2 for 7 days
Followed by
PPI, Amoxi (1g), Clari(500mg) and Tini
or Metro (500mg) for a further 7 days
( Total 14 days)
Traitement Hp en 2019Quadruple: concomitant, Sequentiel, Hybrid
Pays Type trait Tx d'éradication Auteurs, Année
Meta-analyse, Conc. vs
triple
23 études controlées
N=6632
Conc 5-10 j > Triple 7-1à j
Mais Conc = Triple 14j
Chen MJ, 2018
Hybrid bénéfice du sequentiel +
conco; mais compliance
mauvaise
Taiman Etude controlée
N=352
Reverse -Hybrid 96%
Q. Bismuth= idem
HSU PL, 2018
Espagne Cross selected selectional Conco 98%
Bismuth 94%
Macias Garcia,2019
Rescue 3è ligne
Conco 14j
Résistant
- Clari-R:79%
- Levo-R: 95%
- Metro-R: 67%
Non resistant: 81%
Huang HT, 2018
Bismuth quadruple therapy
•PPI x2
•Bismuth x4 (subsalicylate or subcitrate)
•Tetracycline hydrochloride (500mg) x4
with meals and at bedtime (bismuth and TTC)
•Tinidazole or Metro (500mg) x3 with meal
(for 10 days, or preferaly 14 days)
Alternatives:• Pylera + PPI x2 for 10-14 days
Nonghua Lu ,EHMSG , Magdeburg 2016
The fourth chinese consensus report on the management of H.pylori infection
Liu Wen Zhong, al. J Digestive Disease 2013;14:211-221
Essais thérapeutiques avec Pylera(Bismuth, metro, TTC)
Traitement Hp en 2019: Bismuth
Pays Type trait Tx d'éradication Auteurs, Année
Europ
Hp-Eurog
N=1141
1è ligne
88% McNicholl AG, 2019
Italie N=500 Seq= 91%
Pylera= 92%
Fiorini, 2018
Chine controlé Avec Bismuth=85%
Sans Bismuth= 64%
Long X, 2018
O'Connor et al. Helicobacter 2019
Real-Word studies of Bismuth-based quadruple regimens
Study Zagari Agudo-Fernandez
Country Italy Spain
Number 376 185
1st line (%) 91,4 78,2
2nd line(%) 87,5 85,3
3rd line (%) 91,7 61,3
Adverse Events(%) 32,4 3,8
Abondoned(%) 6,1 4,9
O'Connor et al. Helicobacter 2019
Fluoroquinolone therapy when Hp infection is known to be susceptible to fluoroquinolones
•PPI x2
•Amoxi (1g) x2
•Fluoroquinolone (Levo 500mg) x1
(or x2)
For 10-14 days
Traitement Hp en 2019: Levofloxacine
Pays Type trait Tx d'éradication Auteurs, Année
Iran Controlé Seq 10j: 78%
Conco 14j: 83%
Hajiani E, 2018
Mexico Controlé Levo triple:63%
Stand triple:58%
Ladron-e-Guevara,2018
Pakistan Controlé
N=300
Levo 14j: 92%
Stand: 87%
Latif S, 2018
Italie Levo
+/- lactoferine
avec lactoferine:96%
Sans lactoferine: 75%
Ciccaglione, 2019
O'Connor et al. Helicobacter 2019
Rifabutin triple therapy
• PPI x2 +
• Rifabutin (150mg) x2 +
• Amoxicillin (1g) x2
( Total 14 days)
J. P. Gisbert,X. CalvetAliment Pharmacol Ther 2012; 35: 209–221
Review article: rifabutin in the treatment of
refractory Helicobacter pylori infection
One randomized trial showed that regimens with
rifabutin were effective rescue therapies in
patients with treatment failure who had H. pylori
infection that was resistant to both
metronidazole and clarithromycin
Perri F, Festa V, Clemente R, et al. Am J Gastroenterol 2001; 96: 58-62.
Traitement Hp en 2019: Probiotics
Pays Type trait Tx d'éradication Auteurs, Année
Espagne Standard vs Concomitant
+ Lacobacillus vs Placebo
N=209
Placebo= 95%
Probiotics=97%
McNicholl AG.2018
By
Chinese
Group
MetaAnalyse
40 etudes
8924 patients
- ↑ Eradication
- ↓ Effet II
Dore MP.2019
O'Connor et al. Helicobacter 2019
Kawashima K, al. Dig Liver Dis. 2016
Vonoprazan
The First-in-Class Potassium-
Competitive Acid Blocker,
(Vonoprazan Fumarate)
Eradication rate of Vonoprazan VPZ triple therapy (1wk)
Murakami K et al. Gut 2016; 65: 1439-46
VAC or LAC triple
Traitement Hp en 2019: Vonoprazan
- N= 1355, 1stline
Standard 86%
Voroprazan Triple 97% erad
- MetaAnalyse, 5 studies, 1599 patients
Clari-S: Vonoprazan triple = Standard triple: 95% vs 93%
Clari-R: Vonoprazan triple ≠ Standard triple: 82% vs 40%
Mori N, al.Biomed Rep. 2018
Li M, al. Helicobacter. 2018
Helicobacter Pylori: New Therapies
❑ Bromopyruvate ( anticancereux)
❑ Goshuyuto ( Herbicide): Japon
❑ Lactoferrine bovine 10 mg/ml
❑ Dual therapy > concomitant ( Taiwan)
- IPP+ Amoxi high dose
Yang X, al.Medicine (Baltimore) 2019
Sue S, al. J Gastroenterol Hepatol 2019
DISCUSSION
Evolution of primary resistance of H.pylori to Clarithromycin,
Metronidazole and Fluoroquinolones in Brussels, Belgium
Macrolides (10.5% to 18%),
Nitro-imidazoles (28% to 40%)
Fluoroquinolones (12.4% to 22.8%)
VERONIQUE Y MIENDJE DEYI; M'Kinansoi S Lare, Alain
Burette; Ruffin NTOUNDA; Samy Cadranel; Okyay ELKILIC,
PATRICK BONTEMS; Marie HALLIN,
Diagn Microbiol Infect Dis. 2019 Jul 30:114875
Hp resisance to antibiotics in the studies published during the last year worldwide
Author N Region AMO% CLA% Met% Quin% TTc% Rif% Fur%
Liu 1117 China 3,4 22,1 78,2 19,2 1,9 1,5 -
Forini 1424 Italy 0,06 35,9 40,2 29,3 - - 0,06
Bashir 270 Algeria 5,2 29,7 46,7 17,2-17,9 2,6 - -
Lopo 2194 Portugal 0,1 42 25 9-18 0,2 - -
Gonzalez-
Hormazabal
191 Chile - 31,2 - 14,1 - - -
Mosites 800 USA - 28,8 42,8 45-58,7 - - -
Saniee 218 Iran 27,1 34,4 79,4 27,9 38,5 - 23,9
Khien 2318 Vietnam 15 34,1 69,4 - 17,9 - -
Kageyama 208 Japan 13 48 49 - - - -
Zhang 144 China - 70 - 6 - - -
Pinkowska 170 Poland - 46 56 39,2 - - -
Lee 74 S-Korea 6,7 31 41,8 - - -
O'Connor et al. Helicobacter 2019
Pan- European Registry on H. pylori management (Hp- EuReg):
interim analysis of 16 600 first- line treatments
A. G. McNicholl et al. Helicobacter 2018
Pan- European Registry on H. pylori management
(Hp- EuReg): interim analysis of 16 600 first- line treatments
❑ La gestion de l'infection à Hp par les gastro-
entérologues européens est hétérogène, sous-
optimale et souvent en contradiction avec les
recommandations actuelles.
❑ Seuls les quadruple-therapies d'une durée d'au
moins 10 jours peuvent atteindre un taux
d'éradication supérieur à 90 %.
A. G. McNicholl et al. Helicobacter 2018
A recent observational study showed that only 35% of patients
who had been treated for H. pylori infection underwent follow-up
testing to confirm eradication and that many patients who had
treatment failure were retreated with the same regimen
Rubin J, Lai A, Al.Gastroenterology 2018; 154: S503-S504.
Epidémiologie de l’infection à Helicobacter Pylori à Yaoundé :
de la particularité à l’énigme Africaine
Firmin Ankouane Andoulo, Dominique Noah Noah,&, Michèle Tagni-Sartre3,
Elie Claude Ndjitoyap Ndam, Katleen Ngu Blackett
Pan African Medical Journal. 2013 16:115
171 sujets symptomatiques.
Test rapide à l'uréase kit commercial Pronto Dry®
La prévalence Hp 72,5% (124/171)
H.pylori était de 63,0% pour l'ulcère duodénal,
50% pour l'ulcère gastrique et
100% pour le cancer gastrique.
Conclusion: la prévalence de l'infection à H.pylori au Cameroun est très élevée et
significativement liée à l'âge de moins de 40 ans.
Molecular detection of Hp and its antimicrobial resistance in Brazzaville, Congo
Antibiotics Resistance (%)
Clarithromycin 1,7
Tetracycline 2,5
Quinolone 50
•Hp prevalence : 89 %
•Ontsira Ngoyi EN, al. Helicobacter. 2015 Aug;20(4):316-20
Antibiotique Tx Resistance (%)
Amoxicilline 0
Tetracycline 0
Clarithromycine 8,9
Levofloxacine 75
Metronidazole 100
• 58 patients (Dl Abd), Age moyen=39 ans homme=60 %
• Biopsies stockées à -18° (Kivu), puis congelées à -70 °(BXL)
• 23 souches ( 1 souche morte, 5 souches contaminées)
Natmako S, Nteranya O, Mwengte J, Van Gossum M, Miendje Y, 2016.
Profil de resistance aux antibiotiques de l’Hp dans la région du Sud-Kivu : Resultats préliminaires d’une étude
monocentrique
Resistance Primaire en Algerie
Clarithromycine Metronidazole
Boucekkine Mouffok Djennane-Hadibi 2003 2013 2015
12,5% 12% 33%
LARH 2008
37%
Boucekkine T,al. 2003Mouffok F, al.Saidal santé Fev 2013
Djennane-Hadibi F,al. Microbiol drug Resistance 2015
•Reza Ghotaslou, al, World J Methodol,2015 Sep 26;5(3):164-174
Prevalence of Antibiotic Resistance in Helicobacter pylori:A Systematic Review and Meta-analysis in World Health
Organization Regions
Alessia Savoldi, Elena Carrara, David Y. Graham, Michela Conti, and Evelina Tacconelli. Gastroenterology 2018;155:1372–1382
Prevalence of Antibiotic Resistance in Helicobacter pylori:A Systematic Review and Meta-analysis in World Health
Organization Regions
Alessia Savoldi, Elena Carrara, David Y. Graham, Michela Conti, and Evelina Tacconelli. Gastroenterology 2018;155:1372–1382
Prevalence of Antibiotic Resistance in Helicobacter pylori:A Systematic Review and Meta-analysis in World Health
Organization Regions
Alessia Savoldi, Elena Carrara, David Y. Graham, Michela Conti, and Evelina Tacconelli. Gastroenterology 2018;155:1372–1382
Prevalence of Antibiotic Resistance in Helicobacter pylori:A Systematic Review and Meta-analysis in World Health
Organization Regions
Alessia Savoldi, Elena Carrara, David Y. Graham, Michela Conti, and Evelina Tacconelli. Gastroenterology 2018;155:1372–1382
Efficacy of Helicobacter pylori eradication regimens in Rwanda: a randomized controlled trial
JD Kabakambira, al.BMC Gastroenterol. 2018; 18: 134.
Efficacy of Helicobacter pylori eradication regimens in Rwanda: a randomized controlled trial
JD Kabakambira, al,BMC Gastroenterol. 2018; 18: 134.
- Coûts, efficacité et profil d'innocuité documentés dans cette
étude; => utiliser clarithromycine et des thérapies combinées à
base de ciprofloxacine pour l'éradication de H. pylori au Rwanda.
- Métronidazole à base de la trithérapie est inférieure et mauvais
choix parmi les quatre schémas thérapeutiques étudiés.
Classification de OLGA et OLGIM: impacts de facteurs ethniques, démographiques et
environnementaux
Afr. sub-saharienne: Hp elevé, moins d'ulcus et cancer
< type de souche, facteurs immunitaires, génétiques, diététiques
G1: Patient europeens (680) G2= centre africain (250)
- Pas de différence significative sur la sévérité des gastrites
- Role de l'Hp et l'âge dans la sévérité, mais pas de facteurs
geographiques
- Lésions endoscopiques significatives: 27% G1 et G2
Van Gossum M, al. JFHOD 2020
Images obtained with a normal-caliber endoscope: (A) white light imaging and (B) linked color imaging cannot clearly reveal the site of the
early gastric cancer (white arrows) because of the tangential view. (C) Blue laser imaging with middle magnification shows a brown
malignant lesion surrounded by green mucosa (white arrows). (D) Blue laser imaging using high magnification shows irregular
microvascular and irregular microstructural patterns on the mucosal surface
Pimentel-Nunes Pedro et al. MAPS II … Endoscopy 2019; 51: 365–388
•Facteurs à retenir lors du choixd’un traitement éradicateur Hp
•WGO Global Guideline Hp in developing countries, 2010
Niveau de ressources à disposition et options diagnostiques
•WGO Global Guideline Hp in developing countries, 2010
•Prevalence of antibiotic resistance in Hp: A recent literature review
Reza Ghotaslou, al, World J Methodol,2015 Sep 26;5(3):164-174
Contrôle d’éradication
❑Au plus tôt 4 semaines après la fin du traitement.
❑ Lorsque l'endoscopie n'est pas nécessaire, seul le BTU ou le test à
l'antigène fécal est acceptable.
❑ Le bismuth et les ATB doivent être arrêtés pendant 28 j et les IPP
pendant 14 j avant le BTU
❑ Le HpSAg fécal ne devrait pas être effectué moins de 4 sem ( de
préférence 8 à 12 sem) après le traitement.
Conclusion I
- Helicobacter pylori est carcinogene de classe 4, son éradication ne
laisse aucun doute dans les inications bien précises
- Les recommandations internationales offrent actuellement plusieurs
possibilités de prise en charge qui peuvent s'appliquer partout dans
le monde
- La zone Afrique, particulièrement la zone sub-saharienne soufre
beaucoup du manque de moyens diagnostiques et therapeutiques,
mais les resultats des études publiées, certes peu nombreux,
montrent que ces recommandations sont bien adaptables
Conclusion II
- Afr. sub-saharienne: Hp elevé, moins d'ulcus et cancer < type
de souche, facteurs immunitaires, génétiques, diététiques
- L'endoscopie diagnostique fait de grands progrès. est ce que
l'intelligence artificielle est l'avenir ? Celà reste à demontrer et
difficile à généraliser
- Le consensus Brésilien par exemple recommande encore les
schemas à base de Clarithromycine malgré Clari-R> 15% car
Bismuth non disponible
- Levofloxacin, Sitafloxacin, Furazolidone, Rifabutine restent
interessants en “Rescue”
« Tant que les lions n'auront pas leurs propres
historiens, les histoires de chasse ne peuvent que
chanter la gloire du chasseur ».