{"id":2113,"date":"2018-10-20T18:40:32","date_gmt":"2018-10-20T16:40:32","guid":{"rendered":"https:\/\/angh.net\/abstracts\/diagnostic-et-traitement-de-linfection-a-helicobacter-pylori-au-centre-hospitalier-dannecy-genevois-apport-de-la-pcr-et-de-la-culture-pour-le-diagnostic-premiers-resultats-des-traitemen\/"},"modified":"2021-10-06T14:19:47","modified_gmt":"2021-10-06T12:19:47","slug":"diagnostic-et-traitement-de-linfection-a-helicobacter-pylori-au-centre-hospitalier-dannecy-genevois-apport-de-la-pcr-et-de-la-culture-pour-le-diagnostic-premiers-resultats-des-traitemen","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/diagnostic-et-traitement-de-linfection-a-helicobacter-pylori-au-centre-hospitalier-dannecy-genevois-apport-de-la-pcr-et-de-la-culture-pour-le-diagnostic-premiers-resultats-des-traitemen\/","title":{"rendered":"Diagnostic et Traitement de l’infection \u00e0 Helicobacter Pylori au Centre hospitalier d\u2019Annecy Genevois. Apport de la PCR et de la culture pour le diagnostic. Premiers r\u00e9sultats des traitements orient\u00e9s."},"content":{"rendered":"

2018<\/strong><\/p>\n

F. Heluwaert,, L. Tracanelli, M. Abousalihac , L. Renaud, A. Montchaud , E. Thimonier, I. Lienhart, J. Pofelski, E\u00a0. Maillard, M. Baconnier , P. Oltean, M. Serrier, P. Capony, S. Bland<\/em><\/p>\n

Gastroent\u00e9rologie\u00a0<\/strong>– \u00a02018-05-18 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Les recommandations actuelles de la prise en charge de l\u2019infection \u00e0 H. pylori reposent sur
\nl\u2019instauration d\u2019un traitement orient\u00e9 par les donn\u00e9es de l\u2019antibiogramme ou de la PCR.<\/p>\n

patients et methodes
\nUn patient \u00e9tait consid\u00e9r\u00e9 comme infect\u00e9 par H. pylori si la culture ou la PCR \u00e9taient positives. Les pr\u00e9l\u00e8vements \u00e0 vis\u00e9e bact\u00e9riologique \u00e9taient :
\nTransport\u00e9s sur milieu Portagerm* Pylori jusqu\u2019au laboratoire de l\u2019h\u00f4pital.
\nb\u00e9n\u00e9ficiaent d’une recherche par PCR RIDAGENE RBiopharm (d\u00e9tecte ADN H. pylori et mutations conf\u00e9rant r\u00e9sistance \u00e0 la clarithromycine)
\nE\u00e9taient mis en culture sur milieu sp\u00e9cifique et \u00e9tude de la sensibilit\u00e9 des souches d\u00e9termin\u00e9e par E-test pour la clarithromycine, la l\u00e9vofloxacine, la rifampicine et la t\u00e9tracycline.<\/p>\n

Sur ce recueil monocentrique \u00ab\u00a0vraie vie\u00a0\u00bb, de janvier 2017 \u00e0 mars 2018, 1585 endoscopies avec biopsies gastriques \u00e0 vis\u00e9e bact\u00e9riologique (PCR +\/- culture) et anatomopathologique (antre + fundus) ont \u00e9t\u00e9 r\u00e9alis\u00e9es. 358 patients avaient une PCR et\/ou culture positive.
\nLa pr\u00e9valence de l\u2019infection \u00e0 H. Pylori \u00e9tait de 22,58% (358\/1585).<\/p>\n

les resultats de la culture\/PCR\/histologie de la recherche d’H pylori sont decrits sur le tableau 1 (cf)<\/p>\n

les taux de resistances primaires sont decrits sur le tableau 2 (cf)<\/p>\n

La concordance entre les r\u00e9sultats de la PCR et de la culture \u00e9tait de 95,63% (263\/275).
\nLa r\u00e9alisation de la PCR apparait suffisante sans culture pour les traitements de 1\u00e8re ligne.
\nla PCR seule permet de proposer un traitement \u00ab orient\u00e9 \u00bb de 1\u00e8re ligne dans 95,33% des cas (245\/257)<\/p>\n

Pour les souches H. Pylori CLARITHROMYCINE SENSIBLE (n=97), un TRAITEMENT ORIENTE par ESOMEPRAZOLE 40 mg x 2\/j + AMOXICILLINE 1 gr x 2\/j + CLARITHROMYCINE 500 mg x 2\/j pendant 14 jours permet avec une excellente tol\u00e9rance 94,84 % d’\u00e9radication en premi\u00e8re ligne.
\nPour les souches H. Pylori CLARITHROMYCINE RESISTANTE ou en cas d’ ALLERGIE \u00e0 la PENICILLINE (n=41), un TRAITEMENT par PYLERA* 3 gel x 4\/j + OMEPRAZOLE 20 mg x 2\/j pendant 10 jours permet 90,24% d’\u00e9radication avec un arret pour intolerance dans 7,1% des cas.<\/p>\n

En conclusion
\nla pr\u00e9valence H. Pylori toute endoscopieest de 22,58%
\nApport de la PCR en pratique courante pour le diagnostic ++
\nConfirmation des taux de r\u00e9sistances primaires \u00e0 la clarithromycine (19,2%) et \u00e0 la l\u00e9vofloxacine (11,1%)
\nR\u00e9v\u00e9lations de taux importants de r\u00e9sistance primaire \u00e0 la l\u00e9vofloxacine sur les souches CLARI R (22,8%)<\/p>\n

Indications de traitement domin\u00e9es par la dyspepsie non ulc\u00e9reuse (75%)
\n7,8 % des patients n\u00e9cessiteront une surveillance endoscopique malgr\u00e9 \u00e9radication<\/p>\n

Excellente concordance PCR\/culture (95,6%) et contribution majeure pour guider des traitements de premi\u00e8re ligne dans un contexte de routine+++
\nEfficacit\u00e9 attendue des souches CLARI RESISTANTE ou en cas d\u2019 allergie \u00e0 la p\u00e9nicilline par PYLERA * (90%)
\nPremiers r\u00e9sultats excellents (95%) du sch\u00e9ma EAC 14 sur les souches CLARI SENSIBLE<\/p>\n[download id=\u00a0\u00bb2252″]\n","protected":false},"excerpt":{"rendered":"

2018 F. Heluwaert,, L. Tracanelli, M. Abousalihac , L. Renaud, A. Montchaud , E. Thimonier, I. Lienhart, J. Pofelski, E\u00a0. Maillard, M. Baconnier , P. Oltean, M. Serrier, P. Capony, S. Bland Gastroent\u00e9rologie\u00a0– \u00a02018-05-18 –\u00a0CO – ________________________________ Les recommandations actuelles de la prise en charge de l\u2019infection \u00e0 H. pylori reposent sur l\u2019instauration d\u2019un traitement […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","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":[29],"class_list":["post-2113","post","type-post","status-publish","format-standard","hentry","category-gastroenterologie","tag-29"],"yoast_head":"\nDiagnostic et Traitement de l'infection \u00e0 Helicobacter Pylori au Centre hospitalier d\u2019Annecy Genevois. Apport de la PCR et de la culture pour le diagnostic. 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