APH 2000, 58, 145-153:

Views and reviews: Helicobacter pylori: actualités dans les domaines du diagnostic, de la clinique et du traitement.

Y. Glupczynski

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.