Éradication d Helicobacter Pylori (évaluation d un traitement non conventionnel)

L éradication d Helicobacter Pylori (HP) fait l objet d une recommandation française del Afssaps datant de 2005, préconisant en première intention une trithérapie de 7 à 14 joursassociant clarithromycine (1g/j), amoxicilline (2g/j, dose modérée) et un inhibiteur de lapompe à proton à double dose (IPPDD). Outre sa durée imprécise (7 à 14 jours), cetterecommandation rencontre 30% d échecs en France, du fait d une résistance croissante d HPà la clarithromycine. En alternative à cette recommandation, deux trithérapies originales de 7jours ont été expérimentés dans cette étude : le protocole CNJ, identique à la recommandationhormis l utilisation d amoxicilline à forte dose (3g/j) ; le protocole GB, associantmétronidazole à forte dose (1.5g/j) en remplacement de la clarithromycine, amoxicilline àforte dose (3g/j) et IPPDD.Les dossiers de 93 patients HP positifs de l hôpital de Coulommiers, traités par le protocoleCNJ, le protocole GB ou la recommandation, ont été analysés rétrospectivement. Les résultats de notre étude ne sont pas significatifs, mais montrent la tendance suivante : letraitement le plus efficace pour éradiquer HP est le protocole GB (77.6% de succèsd éradication), suivi du protocole CNJ (75%) puis de la recommandation (69.7%). Cesrésultats tendraient à démontrer que, pour éradiquer HP, le métronidazole à forte dose est plusefficace que la clarithromycine, et que l amoxicilline est plus efficace à forte dose qu à dosemodérée.Par ailleurs, cette étude a permis une analyse des pratiques concernant la prise en charge despatients diagnostiqués HP positifs à l hôpital de Coulommiers. Des propositionsd amélioration ont été formulées.Helicobacter Pylori (HP) Eradication is the subject of a french recommendation fromAFSSAPS in 2005, recommending as first-line treatment a tritherapy from 7 to 14 days, withclarithromycin (1 g/d), amoxicillin (2 g/d, moderate dose), and a double dose proton pumpinhibitor (DDPPI). In addition to its imprecise term (7-14 days), this recommendation meets30% failures in France, because of increasing clarithromycin resistance in HP. As analternative to this recommandation, two original 7 days tritherapies have been tried in thisstudy : the CNJ protocol, identical to the recommendation except of high-dose amoxicillin (3g/d) use ; and the GB protocol, associating high-dose metronidazole (1.5 g/d) instead ofclarithromycin, high-dose amoxicillin (3 g/d) and a DDPPI.93 HP positive patients records, treated in Coulommiers hospital by the CNJ protocol, the GBprotocol or the recommendation, have been retrospectively analyzed.Our study s results are not significant, but show the following trend: the most effectivetreatment in eradicating HP is the GB protocol (77.6% of eradication success), followed bythe CNJ protocol (75%), then the recommandation (69.7%). These results would demonstratethat, to eradicate HP, high-dose metronidazole is more effective than clarithromycin, andhigh-dose amoxicillin is more effective than moderate-dose.Moreover, this study permitted a professional practice evaluation relating to the managementof HP positive diagnosed patients at Coulommiers hospital. Improvement proposals have beenmade.PARIS12-CRETEIL BU Médecine (940282101) / SudocSudocFranceF

Enquête rétrospective sur l'évolution des pathologies liées à Helicobacter pylori et sa fréquence au Centre Hospitalier de Coulommiers

REIMS-BU Santé (514542104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Effects of Age on Treatment of Chronic Hepatitis C with Direct Acting Antivirals

Introduction and aim: Data on the efficacy and tolerance of interferon-free treatment in chronic hepatitis C (CHC) in elderly patients are limited in phase II-III trials. Material and methods: A prospective cohort of adult patients with CHC treated in French general hospitals. Results: Data from 1,123 patients, distributed into four age groups, were analyzed. Of these, 278 were > 64 years old (fourth quartile) and 133 were > 73 years old (tenth decile). Elderly patients weighed less, were more frequently treatment-experienced women infected with genotype 1b or 2, while they less frequently had genotype 3 or HIV coinfection, but had more frequent comorbidities and drug consumption. Half of the patients had cirrhosis, whatever their ages. The main treatment regimens were sofosbuvir/ledipasvir (37.8%), sofosbuvir/daclatasvir (31.8%), sofosbuvir/simeprevir (16.9%), sofosbuvir/ribavirin (7.8%); ribavirin was given to 24% of patients. The overall sustained virological response (SVR) rate was 91.0 % (95% CI: 89.292.5%) with no difference according to age. Logistic regression of the independent predictors of SVR were albumin, hepatocellular carcinoma and treatment regimen, but not age. The rate of severe adverse events (66 in 59/1062 [5.6%] patients) tended to be greater in patients older than 64 years of age (21/261,8.1%), but the only independent predictors of SAE by logistic regression were cirrhosis and baseline hemoglobin. Patient-reported overall tolerance was excellent in all age groups, and patient-reported fatigue decreased during and after treatment, independent of age. Conclusions: The high efficacy and tolerance of interferon-free regimens is confirmed in elderly patients in real-life conditions

High Risk of Anal and Rectal Cancer in Patients With Anal and/or Perianal Crohn’s Disease

International audienceBackground & AimsLittle is known about the magnitude of the risk of anal and rectal cancer in patients with anal and/or perineal Crohn’s disease. We aimed to assess the risk of anal and rectal cancer in patients with Crohn’s perianal disease followed up in the Cancers Et Surrisque Associé aux Maladies Inflammatoires Intestinales En France (CESAME) cohort.MethodsWe collected data from 19,486 patients with inflammatory bowel disease (IBD) enrolled in the observational CESAME study in France, from May 2004 through June 2005; 14.9% of participants had past or current anal and/or perianal Crohn’s disease. Subjects were followed up for a median time of 35 months (interquartile range, 29–40 mo). To identify risk factors for anal cancer in the total CESAME population, we performed a case-control study in which participants were matched for age and sex.ResultsAmong the total IBD population, 8 patients developed anal cancer and 14 patients developed rectal cancer. In the subgroup of 2911 patients with past or current anal and/or perianal Crohn’s lesions at cohort entry, 2 developed anal squamous-cell carcinoma, 3 developed perianal fistula–related adenocarcinoma, and 6 developed rectal cancer. The corresponding incidence rates were 0.26 per 1000 patient-years for anal squamous-cell carcinoma, 0.38 per 1000 patient-years for perianal fistula–related adenocarcinoma, and 0.77 per 1000 patient-years for rectal cancer. Among the 16,575 patients with ulcerative colitis or Crohn’s disease without anal or perianal lesions, the incidence rate of anal cancer was 0.08 per 1000 patient-years and of rectal cancer was 0.21 per 1000 patient-years. Among factors tested by univariate conditional regression (IBD subtype, disease duration, exposure to immune-suppressive therapy, presence of past or current anal and/or perianal lesions), the presence of past or current anal and/or perianal lesions at cohort entry was the only factor significantly associated with development of anal cancer (odds ratio, 11.2; 95% CI, 1.18-551.51; P = .03).ConclusionsIn an analysis of data from the CESAME cohort in France, patients with anal and/or perianal Crohn’s disease have a high risk of anal cancer, including perianal fistula–related cancer, and a high risk of rectal cancer