Acquisitions thérapeutiques 1999 : Helicobacter pylori, ulcère gastro-duodénal et AINS

Le traitement d'éradication de choix d'une infection à Helicobacter pylori reste l'association d'un inhibiteur de la pompe à protons (IPP) à deux antibiatiques (clarithromycine et amoxicilline), les trois médicaments étant donnés durant sept jours en deux doses journalières. Les inhibiteurs sélectifs de la COX-2 semblent entraîner moins d'effets indésirables digestifs que les AINS non sélectifs. L'oméprazole et le misoprestol ont prouvé leur efficacité dans la prophylaxie primaire des ulcères sur AINS. Dans la prophylaxie secondaire et dans le traitement des ulcères sur AINS, seul l'oméprazole est recommandé. Le rôle d'H. pylori dans les ulcères gastro-duodénaux sur AINS reste controversé

Acquisitions thérapeutiques 1998 : Ulcère gastro-duodénal, Helicobacter pylori et AINS

L'efficacité de l'oméprazole 20 mg i dans la guérison d'ulcères ou d'érosions sur AINS constitue l'acquisition thérapeutique majeure dans le domaine de l'ulcère gastro-duodénal pour 1998. L'éradication d'Helicobacter pylori entraîne un ralentissement de la guérison des ulcères sur AINS et n'en diminue pas le taux de récidive

Predictive factors in the long term outcome in gastro-oesophageal reflux disease: six years follow up of 107 patients

There is little information concerning the long term outcome of patients with gastro-oesophageal reflux disease (GORD). Thus 109 patients with reflux symptoms (33 with erosive oesophagitis) with a diagnosis of GORD after clinical evaluation and oesophageal testing were studied. All patients were treated with a stepwise approach: (a) lifestyle changes were suggested aimed at reducing reflux and antacids and the prokinetic agent domperidone were prescribed; (b) H2 blockers were added after two months when symptoms persisted; (c) anti-reflux surgery was indicated when there was no response to (b). Treatment was adjusted to maintain clinical remission during follow up. Long term treatment need was defined as minor when conservative measures sufficed for proper control, and as major if daily H2 blockers or surgery were required. The results showed that one third of the patients each had initial therapeutic need (a), (b), and (c). Of 103 patients available for follow up at three years and 89 at six years, respective therapeutic needs were minor in 52% and 55% and major in 48% and 45%. Eighty per cent of patients in (a), 67% in (b), and 17% in (c) required only conservative measures at six years. A decreasing lower oesophageal sphincter pressure (p < 0.001), radiological reflux (p = 0.028), and erosive oesophagitis (p = 0.031), but not initial clinical scores, were independent predictors of major therapeutic need as shown by multivariate analysis. The long term outcome of GORD is better than previously perceived