APH 2000, 58, 145-153:
Views and reviews: Helicobacter pylori: actualités dans les domaines du diagnostic, de la clinique et du traitement.
Keywords: H. pylori, gastroduodenal diseases, diagnosis, treatment, antimicrobial resistance
Helicobacter pylori has been recognized since 1982 as the principal
causative pathogen of chronic gastritis and of gastroduodenal ulcers (70
to>95% of all gastric and duodenal ulcers, respectively).
Moreover, since 1994, H.pylori has also been recognized by WHO as a class
I carcinogen, being implicated in the carcinogenesis of gastric cancers
and in the development of some gastric lymphoma (MALT lymphoma). In
addition to unravelling the pathogenic role of H.pylori in various
gastroduodenal diseases, major progresses have also been accomplished in
the field of diagnosis. Different types of diagnostic tests have
been developed and improved over the last ten years. Several
clinical trials have been performed worldwide. These have allowed to
define specific treatment indications of H.pylori infection and to propose
effective treatment regimens (>80% eradication on an intention-to-treat
basis) which now lead to long-standing and definitive cure of peptic ulcer
disease in case of bacterial eradication.
Moreover, guidelines recently issued by several national and international expert panels have suggested that young subjects less than 45 years old of age presenting with a first episode of unexplored dyspepsia could be successfully managed by a strategy relying only on a noninvasive test such as serology without the necessity of performing endoscopy ("test and treat strategy").
This article gives a brief overview of the recent literature dealing with the diagnostic, clinical and therapeutic aspects of H.pylori infection. Emphasis is put on the hazards and adverse effects that might carry the large scale application of a "test and treat strategy", and in particular on the risk of emergence of antimicrobial resistance.