{"id":1964,"date":"2012-10-01T01:00:00","date_gmt":"2012-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/helicobacter-pylori-quoi-de-neuf\/"},"modified":"2018-10-20T18:40:04","modified_gmt":"2018-10-20T16:40:04","slug":"helicobacter-pylori-quoi-de-neuf","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/helicobacter-pylori-quoi-de-neuf\/","title":{"rendered":"\u00ab Helicobacter pylori : quoi de neuf ? \u00bb"},"content":{"rendered":"

2012<\/strong><\/p>\n

A Courillon-Mallet (Villeneuve-Saint-Georges)<\/em><\/p>\n

Gastroent\u00e9rologie <\/strong>– \u00a02012-08-11 –\u00a0CF –<\/p>\n

________________________________<\/p>\n

H pylori n\u2019est plus un probl\u00e8me d\u2019avenir dans les pays europ\u00e9ens. La pr\u00e9valence de l\u2019infection diminue et n\u2019est plus que de 9.3% chez des jeunes hommes et femmes incorpor\u00e9s dans la marine nationale en 2010 .Toutefois, si on consid\u00e8re que 25 % de la population adulte fran\u00e7aise est encore infect\u00e9e, l\u2019infection reste un probl\u00e8me d\u2019actualit\u00e9 . D\u2019autre part, la pr\u00e9valence de l\u2019infection reste tr\u00e8s \u00e9lev\u00e9e dans de nombreux pays voisins de la France et concerne donc de nombreux patients migrants soign\u00e9s en France. Nous n\u2019avons donc pas fini de parler de H pylori\u2026<\/p>\n

De nouvelles recommandations europ\u00e9ennes sur la prise en charge de l\u2019infection \u00e0 H.pylori ont \u00e9t\u00e9 publi\u00e9es r\u00e9cemment et les recommandations fran\u00e7aises datant de 1995 et 1999 ont \u00e9t\u00e9 revues.(Gut. 2012 May;61(5):646-64) Une fiche de conseil de pratique les r\u00e9sumant a \u00e9t\u00e9 publi\u00e9e sur le site de la SNFGE. (http:\/\/www.snfge.org\/01-Bibliotheque\/0K-Conseils-pratique\/pdf\/Conseil-de-Pratique-SNFGE–H-pylori.pdf)
\nLes indications d\u2019\u00e9radication ont \u00e9t\u00e9 \u00e9largies et concernent d\u00e9sormais :
\n\u2022\tles apparent\u00e9s au premier degr\u00e9 de patients ayant un cancer de l\u2019estomac et les patients \u00e0 risque de cancer gastrique du fait de l\u00e9sions pr\u00e9n\u00e9oplasiques telles que m\u00e9taplasie intestinale \u00e9tendue ou atrophie s\u00e9v\u00e8re fundique ou du fait d\u2019une pr\u00e9disposition g\u00e9n\u00e9tique personnelle au cancer gastrique (PAF,HNPCC, Peutz Jeghers).
\n\u2022\tles patients ayant un traitement prolong\u00e9 par IPP (sup\u00e9rieur \u00e0 6 mois), bien qu\u2019il n\u2019y ait aucune \u00e9tude \u00e9pid\u00e9miologique montrant un sur risque de cancer chez les patients sous IPP au long cours.
\n\u2022\tles patients avant chirurgie bariatrique par bypass, le bypass isolant une grande part de l\u2019estomac et ne permettant plus la surveillance endoscopique de l\u2019estomac.
\n\u2022\tles cas d\u2019an\u00e9mie par carence en fer ou en vitamine B12 sans cause retrouv\u00e9e ou de purpura thrombop\u00e9nique immunologique. Dans ces cas, une relation avec l\u2019infection a \u00e9t\u00e9 \u00e9voqu\u00e9e et l\u2019\u00e9radication bact\u00e9rienne doit \u00eatre propos\u00e9e.
\n\u2022\tbien sur, les indications classiques telles que ulc\u00e8re duod\u00e9nal ou gastrique, traitement prolong\u00e9 par AINS, lymphome gastrique du MALT .
\n Enfin , du fait de la diminution de la pr\u00e9valence de l\u2019infection et de l\u2019incidence du cancer en Europe, contrairement \u00e0 certains pays asiatiques \u00e0 tr\u00e8s forte incidence de cancer gastrique , aucun pays europ\u00e9en ne propose de d\u00e9pistage et de traitement syst\u00e9matique \u00e0 l\u2019adolescence pour pr\u00e9venir le cancer. Seul un d\u00e9pistage cibl\u00e9 est recommand\u00e9. Pour \u00e9largir le d\u00e9pistage, des biopsies syst\u00e9matiques sont recommand\u00e9es m\u00eame en l\u2019absence de l\u00e9sion visible au cours des endoscopies. <\/p>\n

Le traitement
\nCes derni\u00e8res ann\u00e9es ont \u00e9t\u00e9 marqu\u00e9es par une augmentation rapide du taux de r\u00e9sistance bact\u00e9rienne aux antibiotiques. Une \u00e9tude portant sur 2204 patients dans 18 pays europ\u00e9ens, r\u00e9v\u00e8le un taux de r\u00e9sistance \u00e0 la clarithromycine de 17.5% chez les adultes et 31.8 % chez le enfants et de 21.3% en France.(Gut. 2012 May 12. [Epub ahead of print]) Pour la levofloxacine les taux de r\u00e9sistance europ\u00e9ens sont de 14.1% et en France de 17.8%. Les taux de r\u00e9sistance dans les diff\u00e9rents pays europ\u00e9ens sont variables et directement corr\u00e9l\u00e9s \u00e0 la consommation d\u2019antibiotiques par pays. La France est au 5 \u00e8me rang en terme de consommation de macrolides et quinolones et en terme de taux de r\u00e9sistance bact\u00e9rienne ! Sachant que la r\u00e9sistance \u00e0 ces 2 classes d\u2019antibiotiques a un impact tr\u00e8s n\u00e9gatif sur le taux d\u2019\u00e9radication , la trith\u00e9rapie classique associant IPP , amoxicilline et clarithromycine recommand\u00e9e jusqu\u2019\u00e0 pr\u00e9sent en France doit \u00eatre abandonn\u00e9e. L\u2019utilisation de l\u00e9vofloxacine pr\u00f4n\u00e9e en deuxi\u00e8me ligne doit \u00eatre r\u00e9serv\u00e9e aux souches sensibles donc apr\u00e8s antibiogramme. Les recommandations de traitement de premi\u00e8re ligne sont d\u00e9sormais le traitement s\u00e9quentiel de 10 jours : 5 premiers jours IPP double dose + amoxicilline (1gX2\/j) suivis pendant les 5 jours suivants de IPP +clarithromycine (500mgX2\/j) + m\u00e9tronidazole (500 mgX2\/j)). L\u2019autre possibilit\u00e9 est la quadrith\u00e9rapie associant IPP double dose, tetracycline, metronidazole et bismuth. Une formulation gal\u00e9nique r\u00e9unissant en une seule g\u00e9lule, le sous citrate de bismuth, la tetracyvline et le m\u00e9tronidazole sera prochainement disponible en France. Trois g\u00e9lules sont \u00e0 prendre 4 fois par jour pendant 10 jours.<\/p>\n

Les moyens diagnostics ont peu \u00e9volu\u00e9, l\u2019histologie et le test respiratoire \u00e0 l\u2019ur\u00e9e marqu\u00e9e restent les 2 tests recommand\u00e9s. La nouveaut\u00e9 vient de la mise au point de plusieurs techniques d\u2019amplification g\u00e9nique ou PCR. Ces techniques sur biopsies permettent d\u2019avoir en quelques heures non seulement un diagnostic de l\u2019infection mais aussi d\u2019appr\u00e9cier la r\u00e9sistance aux macrolides et aux quinolones. Elle est une alternative tr\u00e8s int\u00e9ressante \u00e0 la culture puisqu\u2019elle n\u00e9cessite des conditions de transport des pr\u00e9l\u00e8vements moins contraignantes que la culture et qu\u2019elle permet d\u2019avoir un r\u00e9sultat en quelques heures au lieu des 5 \u00e0 12 jours n\u00e9cessaires pour la culture.<\/p>\n","protected":false},"excerpt":{"rendered":"

2012 A Courillon-Mallet (Villeneuve-Saint-Georges) Gastroent\u00e9rologie – \u00a02012-08-11 –\u00a0CF – ________________________________ H pylori n\u2019est plus un probl\u00e8me d\u2019avenir dans les pays europ\u00e9ens. La pr\u00e9valence de l\u2019infection diminue et n\u2019est plus que de 9.3% chez des jeunes hommes et femmes incorpor\u00e9s dans la marine nationale en 2010 .Toutefois, si on consid\u00e8re que 25 % de la population […]<\/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":[4],"tags":[23],"class_list":["post-1964","post","type-post","status-publish","format-standard","hentry","category-gastroenterologie","tag-23"],"yoast_head":"\n\u00ab Helicobacter pylori : quoi de neuf ? \u00bb - Abstracts des congr\u00e8s de l'ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/helicobacter-pylori-quoi-de-neuf\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"\u00ab Helicobacter pylori : quoi de neuf ? 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