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Hépato-Gastro & Oncologie Digestive

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News on the management of Helicobacter pylori infection in 2021 Volume 28, issue 2, Février 2021

Figures

  • Figure 1
  • Figure 2

Tables

Authors
Francis Mégraud et le Groupe d’Etudes Français des Helicobacter 6 7
1 Hôpital Ambroise-Paré, AP-HP, Service Hépato-Gastroentérologie, 92104 Boulogne-Billancourt
2 Centre hospitalier Annecy Genevois, Service d’hépato-gastroentérologie, 1 Avenue de l’Hôpital, 74370 Epagny Metz-Tessy
3 U1070 INSERM, Université de Poitiers
4 Université Paris Saclay, Hôpital Bicêtre, APHP, Laboratoire de bactériologie, Le Kremlin-Bicêtre
5 Laboratoire CERBA, 95310 Saint-Ouen-L’Aumône
6 CHU de Bordeaux, CNR des Campylobacters et des Hélicobacters, 33076 Bordeaux cedex
7 Univ. Bordeaux, INSERM, BaRITOn, U1053, F-33000 Bordeaux
8 CHRU Trousseau-Chambray, Service d’hépato-gastroentérologie, 37170 Chambray Les Tours
9 Hôpitaux Universitaires Henri Mondor, EA7375, Université Paris Est-Créteil, AP-HP, Service de gastroentérologie, 94000 Créteil
10 Université de Paris, Laboratoire de Bactériologie, Hôpital Cochin, AP-HP, Paris
* Correspondance

Invasive methods for the diagnosis of H. pylori are the most sensitive and specific. Despite the availability of bacterial culture in public and private laboratories, the examination is rarely performed simply because the vast majority of patients who undergo endoscopy do not have symptoms or pathology suggestive of bacterial gastritis. The discovery of H. pylori is therefore most often fortuitous on anatomo-pathological samples. According to the French Helicobacter Study Group (GEFH), two empirical quadritherapies are also possible: 10-day bismuth quadritherapy and concomitant quadritherapy combining amoxicillin-metronidazole and clarithromycin with a PPI. With regard to quadritherapy without bismuth, it seems important to respect a long prescription period of 14 days, amoxicillin doses of 3 g/d (or 50 mg/kg/d) and the prescription of definite PPIs, such as esomeprazole and rabeprazole. After empirical treatment with metronidazole in high dosage and/or prolonged therapy, the prescription of this antibiotic is associated with a risk of eradication failure. The GEFH ensures a multidisciplinary consultation meeting composed of clinicians, bacteriologists and pharmacists for cases of difficult H. pylori eradication. Since the HAS and GEFH recommendations of 2017, the demand for bacteriological examination by gastroenterologists has increased by 68%. Hetero-resistance linked to several strains of the bacterium is not easily detected during an antibiotic susceptibility test. This detection is easier with real-time PCR, which detects the mutations conferring resistance to clarithromycin.