Traitement helicobacter pylori
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Helicobacter pylori is a bacterium whose outer structure is helical (hence the name ‘Helicobacter’), provided with flagella, which infects the lining gastrique.80% of peptic ulcers are caused by infections of H. pylori, although in most infected humans, the disease remains asymptomatic.
H. pylori is a bacterium that is common (found in 50% of humans). It lives exclusively in the human stomach and is the only known bacterium that can survive in an environment too acidic. The outer helix may help to tighten the stomach wall in order to colonize and to persist.
Treatment of Infection
It could also reduce the risk of developing cancer of the stomach in case of pre-cancerous lesion.
There are several international guidelines on the management of Helicobacter. European women are known as the Maastricht III Consensus Conference and were published in 2007. The U.S. guidelines were published the same year.
Antibiotic treatment
This infection can be treated conventionally using triple therapy combining a PPI with two antibiotics (inhibitor of the proton pump) to neutralize stomach acid.
Levofloxacin and rifabutin when they are associated with amoxicillin would also have good efficiency. However, these treatments should only be used as a second line. Antibiotic resistance, however, begins to appear with nearly 20% of failed eradication. Another line consists of a sequential treatment with two cycles of 5 successive days with several different antibiotics. This approach seems more effective but more complex than the standard treatment.
Other treatments
There are preventive or therapeutic approaches called natural. The effectiveness of chewing resin Pistachia lentiscus (mastic tree), Mediterranean tree used especially in the Greek island of Chios, was reviewed.
Bismuth salts (heavy metal) can also be used in combination with triple therapy.However, the bismuth is banned in France since the 1970s due to poisoning with kidney problems, and Encephalopathy listed. Bismuth continues to be prescribed with success in many other countries.
In 2002 a vaccine trial had been attempted but it was abandoned because the side effects were too great. These effects were associated with adjuvant (cholera toxin). More immunization was not efficient enough. Only a reduction in bacterial concentration was observed. Researchers are trying to develop non-toxic additives to effectively stimulate the immune response. Mucosal immunization is very complex. The vaccine is still under study and should be released in a few years. This should help treat the infection and prevent it. During the year 2007, researchers have elucidated the mechanisms for the bacterium to evade the immune system.
It is also possible to reduce infection (in cases where different treatments have failed), but not eliminate it by drinking cranberry juice. Some molecules (high molecular weight proanthocyanidins) found in cranberries are effective in preventing the adherence of bacteria to gastric cells. The bacteria are then eliminated naturally when the stomach empties.
Cuban doctors are treating cases of gériadis, ulcers or gastric inflammation and / or intestinal ozonated vegetable oils (natural product due to the embargo), with positive results.
Ingestion (after chewing) broccoli reduces the presence of the bacterium. However, the bacteria will reappear after a few months. Broccoli and other cabbage, and can be used preventively (The experiment was conducted in Japan on 50 patients, half eaten alfalfa sprouts and half of broccoli).
Diseases related to infection
Cons by the presence of helicobacter be protective against cancer of the esophagus. This type of cancer is much rarer than the stomach.
Symptoms and Complications
The most common symptom of gastric and duodenal ulcers is a gnawing or burning pain in the abdomen, specifically between the breastbone and navel, sometimes burning or heartburn. An ulcer can also feel an ache or a violent craving. However, some individuals, especially seniors, feel no pain. Ulcer pain may be intermittent and be exacerbated by food or lack of food. Ulcers can also cause belching (burps) and bloating.
The most common complication of peptic ulcer is bleeding. Although such bleeding is usually too low for you to feel, they can be large enough to make you tired, pale and weak.
If bleeding from peptic ulcer is heavier, blood may appear in the stool or vomit. Stools containing blood have a look tarry, black or red. If you notice any of these signs, seek immediate medical attention. If the bleeding ulcer is important, it can be fatal not to be treated. Remember also that, since NSAIDs are potent analgesics, they can mask the pain of bleeding ulcers.
Rarely, ulcers may cause a hole, called punch in the stomach or intestine. A perforation can cause a sudden and intense pain. Occasionally, an ulcer can cause obstruction of the stomach or duodenum. This can cause bloating, a feeling of fullness after eating, vomiting and weight loss.
Epidemiology
About two thirds of the world population are infected with this bacteria. The infection rate varies from country to country: some 25% in Western countries with large disparities.The rate is higher in the Third World. In the latter, it is common to find children infected, probably because of poor sanitary conditions. United States, by cons, people are mostly elderly people (over 50% of infected people beyond 60 years, against about 20% of those under age 40) and the poorest people .
The rate of infection is essentially based on sanitation, and the extent of antibiotic use. However, resistance against some antibiotics have emerged in some strains of H. pylori. For example, one can find in Great Britain some strains resistant to metronidazole.
HELICOBACTER PYLORI
A bacterium that appears to be related to the occurrence of duodenal ulcer and gastritis has been demonstrated. This is a seed and flagellated spiral which acts by causing increased secretion of gastrin, so hyperacidity peptic. This induces the formation hyperacidity in duodenal gastric metaplasia of beaches.The germ can fix it and causes a chronic duodenitis on which to form an ulcer.
Certainly, other risk factors are evident (tobacco, alcohol, stress), but these bacteria would act as a cofactor.
It appears that poultry is the major source del’infection, but other sources have been identified, cattle, water, milk.
A test has been developed by the Institut Pasteur to detect this bacterium called Helicobacter pylori or Campylobacter pylori. This test is based on gene amplification technique using endoscopic biopsy (see endoscopy).
In addition, other methods, serological in particular, are especially developed for the diagnosis.
This search for Helicobacter pylori IgG in serum or whole blood, knowing it takes a few weeks after infection for these test Serologic positivent
These serological tests are not a good way to highlight a reinfection since then, the positivity can be a simple ‘scar’ serological old.
Finally you must know that it is possible to detect the presence of the germ in the air exhaled by a method somewhat unusual: it is the breath test urea labeled with carbon 13.
This germ seems responsible for the duodenal ulcer and especially relapse. The recurrence rate of duodenal ulcer is more frequent when the germ is found at the pylorus. The virulence of this organism is related to its mobility in the mucus and the presence of a toxin it secretes ulcerogenic.
This germ is found
– In 90% of the holders of duodenal ulcer and stomach ulcer
– In 70% of the holders of stomach ulcer induced by anti-inflammatory, non-steroidal.
– In 30% of adults over age 50 carry non-ulcer dyspepsia.
– In 80-90% of patients with chronic gastritis.
– In many patients reach that goal of gastric cancer and gastric malignant lymphoma.
It seems that the eradication of this germ stomach would prevent this type of cancer.
Antibiotic treatment to eradicate Helicobacter pylori is simple and very effective in 90% of cases.
We now know that no gastric cancer can develop in the absence of this organism.
– The germ could be involved in the COT DEATH (qv)
This germ is present especially in developing countries where 60% of the population suffer from the age of 10 years. However, the vast majority of individuals infected with the germ never develop ulcers.
Recent studies have demonstrated the beneficial effects of germ eradication on the healing of the ulcer and rebleeding. Moreover, the destruction of the germ significantly reduced the relapse rate colitis.
TREATMENT
The administration of a tri-antibiotic for 14 days (amoxicillin macrolide or metronidazole for example) associated with antisecretory therapy (eg an inhibitor of proton pump:Lanzor, Mopral, or Ogast Zoltum, Pariet) seems currently the therapeutic approach of choice, taking antibiotics to take after the meal preference.
For example:
clarithromycin 500 mg every morning and evening or
amoxicillin 1 g morning and evening
omeprazole 20 mg every morning and evening or
lanzoprazole 30 mg morning and evening or
Pantoprazole 40 mg morning and evening
metronidazole 500 mg every morning and evening or
tinidazole 500 mg morning and evening
This regimen is to meet for 14 days scruipuleusement
Tobacco would be a factor in the failure of this drug combination.
It also appears that the administration of a tri-antibiotic similar to that employed in duodenal ulcer is also beneficial in the treatment of non ulcer dyspepsia (which would be a factor in gastric carcinogenesis, that is to say, would promote occurrence of cancers of the stomach).
Moreover, it appears that this bacterium is involved in the occurrence of certain cerebrovascular accicents
especially those occurring in atherosclerosis.
Indeed, this bacterium in the gastrointestinal tract is also present in the blood where it is associated with inflammation of the arterial wall especially at ds carotid arteries.
The toxicity of the arterial wall is due to the presence of a gene (cyto-toxin-associated gene-A) CagA.
This reinforces the hypothesis of the role of infectious agents in the weakening of atherosclerotic plaque.
PREVENTION:
It is based on strict hygiene measures because the infectiousness is usually oral-oral or fecal-oral route. It is also worth noting the possibility of nosocomial infection (see CONDITIONS NOSOCOMIAL), particularly the role of endoscope inadequately sterilized between each patient.