{"id":1883,"date":"2010-10-01T01:00:00","date_gmt":"2010-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/ohdhaf-observatoire-hemorragies-digestives-hautes-en-afrique-francophone-methodes-et-resultats-preliminaires-dune-aventure-africaine-de-langh\/"},"modified":"2018-10-20T18:39:51","modified_gmt":"2018-10-20T16:39:51","slug":"ohdhaf-observatoire-hemorragies-digestives-hautes-en-afrique-francophone-methodes-et-resultats-preliminaires-dune-aventure-africaine-de-langh","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/ohdhaf-observatoire-hemorragies-digestives-hautes-en-afrique-francophone-methodes-et-resultats-preliminaires-dune-aventure-africaine-de-langh\/","title":{"rendered":"OHDHAF : Observatoire H\u00e9morragies Digestives Hautes en Afrique Francophone. M\u00e9thodes et r\u00e9sultats pr\u00e9liminaires d\u2019une aventure africaine de l\u2019ANGH."},"content":{"rendered":"

2010<\/strong><\/p>\n

Herv\u00e9 HAG\u00c8GE, Bruno LESGOURGUES et Olivier NOUEL.<\/em><\/p>\n

Vie Professionnelle <\/strong>– \u00a02010-06-07 –\u00a0 –<\/p>\n

________________________________<\/p>\n

Notre aventure africaine a commenc\u00e9 fin 2008, \u00e0 F\u00e8s, lors du XI\u00e8me congr\u00e8s de l\u2019AAFFCHGE (Association Africaine Francophone de Formation Continue en H\u00e9pato-Gastroent\u00e9rologie) o\u00f9 l\u2019ANGH avait \u00e9t\u00e9 invit\u00e9e \u00e0 pr\u00e9senter son exp\u00e9rience sur les \u00e9tudes multicentriques et les r\u00e9sultats de quelques observatoires nationaux. Cette exp\u00e9rience de la \u00ab vraie vie \u00bb a soulev\u00e9 beaucoup d\u2019int\u00e9r\u00eat et une adh\u00e9sion unanime a \u00e9t\u00e9 obtenue pour travailler ensemble \u00e0 l\u2019\u00e9laboration d\u2019un observatoire \u00e0 l\u2019\u00e9chelle du continent africain. Le choix du premier observatoire a port\u00e9 sur les h\u00e9morragies digestives hautes qui repr\u00e9sentent l\u2019une des principales urgences h\u00e9pato-gastroent\u00e9rologiques en Afrique.
\nM\u00e9thodes : Un conseil scientifique compos\u00e9 d\u2019h\u00e9pato-gastroent\u00e9rologues du Nord et du Sud a \u00e9t\u00e9 mis en place et un observatoire simple, mais r\u00e9aliste a \u00e9t\u00e9 \u00e9labor\u00e9. A l\u2019\u00e9chelle du continent africain, il n\u2019\u00e9tait pas envisageable d\u2019utiliser comme \u00e0 l\u2019ANGH des cahiers d\u2019observation qui transiteraient par des coordinateurs avant une centralisation des donn\u00e9es. Il a \u00e9t\u00e9 mis en place tout sp\u00e9cialement pour OHDHAF un outil de saisie via Internet, disponible partout en Afrique. Ces donn\u00e9es sont s\u00e9curis\u00e9es, avec un acc\u00e8s pour chaque centre \u00e0 la totalit\u00e9 de ses inclusions. Les donn\u00e9es sont ainsi imm\u00e9diatement exploitables pour des \u00e9tudes statistiques. Cet outil extr\u00eamement performant pourra d\u2019ailleurs \u00eatre utilis\u00e9 pour les futurs observatoires de l\u2019ANGH. OHDHAF a obtenu des soutiens financiers industriels et institutionnels pour pouvoir d\u00e9marrer. Il a \u00e9t\u00e9 pr\u00e9sent\u00e9 \u00e0 Yaound\u00e9, en octobre 2009 au XII\u00e8me congr\u00e8s de l\u2019AAFFCHGE et a d\u00e9but\u00e9 le 1er janvier 2010. Entre l\u2019id\u00e9e et le d\u00e9but du protocole, gr\u00e2ce \u00e0 l\u2019enthousiasme suscit\u00e9 et aux soutiens rapidement obtenus, \u00e0 peine 14 mois se sont \u00e9coul\u00e9s. L\u2019objectif principal de cette \u00e9tude est de d\u00e9crire les caract\u00e9ristiques \u00e9pid\u00e9miologiques actuelles des HDH communautaires et \u00e9galement les pratiques professionnelles, la morbidit\u00e9 et la mortalit\u00e9 hospitali\u00e8re en Afrique.
\nR\u00e9sultats : Quinze pays africains et plus de 60 centres participent \u00e0 ce protocole. Apr\u00e8s des d\u00e9buts laborieux, plus de 800 patients ont \u00e9t\u00e9 inclus en 5 mois avec un recrutement qui devient exponentiel et permet d\u2019esp\u00e9rer plus de 3000 inclusions d\u2019ici le 31 d\u00e9cembre 2010, date de fin des inclusions. Voici les r\u00e9sultats pr\u00e9liminaires au 21 mai 2010. 690 inclusions ont \u00e9t\u00e9 r\u00e9alis\u00e9es dans 8 pays : Alg\u00e9rie, Burkina Fasso, Burundi, Cameroun, C\u00f4te d\u2019Ivoire, Maroc, S\u00e9n\u00e9gal et Tchad. Il s\u2019agissait de 421 hommes et 269 femmes \u00e2g\u00e9s en moyenne de 50,4 \u00b1 19,0 ans. L\u2019h\u00e9morragie \u00e9tait r\u00e9v\u00e9l\u00e9e par une h\u00e9mat\u00e9m\u00e8se dans 75% des cas, un m\u00e9l\u00e9na dans 23% des cas et une an\u00e9mie aigu\u00eb dans 2% des cas. 54% des patients avaient des probl\u00e8mes h\u00e9modynamiques \u00e0 l\u2019arriv\u00e9e : pression art\u00e9rielle systolique 100\/min. L\u2019h\u00e9moglobin\u00e9mie \u00e9tait en moyenne \u00e0 9,3 \u00b1 3,1 g\/dl. La prise de m\u00e9dicaments pouvant favoriser ou aggraver l\u2019h\u00e9morragie \u00e9tait peu fr\u00e9quente : aspirine 12,5%, AINS 11,7%, anticoagulant 3,3%, antiagr\u00e9gant plaquettaire 1,9%. Une endoscopie a \u00e9t\u00e9 r\u00e9alis\u00e9e chez 88,1% des patients. Il existait un saignement actif dans 16,1% des cas et un geste d\u2019h\u00e9mostase a pu \u00eatre r\u00e9alis\u00e9 dans 14,6% des cas. La principale cause de l\u2019h\u00e9morragie \u00e9tait l\u2019ulc\u00e8re duod\u00e9nal : 26,6%, puis la rupture de varices \u0153sophagiennes ou cardio-tub\u00e9rositaires: 21,8%. Seulement 60% des patients ont \u00e9t\u00e9 hospitalis\u00e9s. 37% ont \u00e9t\u00e9 transfus\u00e9s de 3,1 \u00b1 1,7 unit\u00e9s. Des IPP ont \u00e9t\u00e9 utilis\u00e9s chez 60% des patients et des produits r\u00e9duisant l\u2019hypertension portale chez 6,6% des patients. Une r\u00e9cidive h\u00e9morragique a \u00e9t\u00e9 observ\u00e9e dans 5,4% des cas et la mortalit\u00e9 n\u2019a \u00e9t\u00e9 que de 5,1%. L\u2019h\u00e9morragie elle-m\u00eame \u00e9tait la principale cause du d\u00e9c\u00e8s.
\nConclusion : L\u2019ANGH s\u2019investit dans la r\u00e9alisation d\u2019observatoires multicentriques \u00e0 l\u2019\u00e9chelle du continent africain. OHDHAF est le premier observatoire de ce type. Les r\u00e9sultats int\u00e9ressants et le fonctionnement satisfaisant permettent d\u2019envisager pour l\u2019ANGH d\u2019autres aventures africaines\u2026<\/p>\n","protected":false},"excerpt":{"rendered":"

2010 Herv\u00e9 HAG\u00c8GE, Bruno LESGOURGUES et Olivier NOUEL. Vie Professionnelle – \u00a02010-06-07 –\u00a0 – ________________________________ Notre aventure africaine a commenc\u00e9 fin 2008, \u00e0 F\u00e8s, lors du XI\u00e8me congr\u00e8s de l\u2019AAFFCHGE (Association Africaine Francophone de Formation Continue en H\u00e9pato-Gastroent\u00e9rologie) o\u00f9 l\u2019ANGH avait \u00e9t\u00e9 invit\u00e9e \u00e0 pr\u00e9senter son exp\u00e9rience sur les \u00e9tudes multicentriques et les r\u00e9sultats de […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[5],"tags":[21],"class_list":["post-1883","post","type-post","status-publish","format-standard","hentry","category-professionnel","tag-21"],"yoast_head":"\nOHDHAF : Observatoire H\u00e9morragies Digestives Hautes en Afrique Francophone. 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