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Conduite à tenir en cas d’infection àH. pylori et de reflux gastro-œsophagien

What to do in the case ofH. pylori infection and gastrooesophageal reflux disease

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Acta Endoscopica

Résumé

Les interactions entre le reflux gastro-œsophagien (RGO) et l’infection àH. pylori reste un sujet complexe et controversé. L’infection diminue le risque d’œsophagite par reflux en cas de développement d’une gastrite atrophique fundique, responsable d’une diminution de la sécrétion acide. C’est probablement la raison pour laquelle les sujets infectés par des souchesCagA positives, responsables d’une gastrite plus sévère, développent moins fréquemment une œsophagite sévère ou un endobrachyœsophage. L’éradication deH. pylori diminue l’efficacité anti-sécrétoire de l’oméprazole et de la ranitidine, mais cette action ne semble pas avoir de conséquence importante sur le contrôle thérapeutique du RGO. L’infection àH. pylori n’a donc pas que des effets délétères en cas de RGO. Cependant, les résultats de publications récentes renforcent la recommandation d’éradication deH. pylori en cas de RGO prononcée en 2000, à Maastricht, par le consensus d’experts européens. Les principaux arguments sont: l’amélioration éventuelle du RGO sans risquer de l’aggraver, la prévention de l’aggravation de la gastrite fundique àH. pylori sous anti-sécrétoires au long cours, l’interruption du développement éventuel d’un cancer gastrique lié àH. Pylori. La décision d’éradiquerH. pylori en cas de RGO repose sur des éléments décisionnels au rang desquels figurent l’indication d’un traitement prolongé par anti-sécrétoires, l’importance et l’étendue des lésions inflammatoires gastriques liées àH. pylori et l’avis du patient afin de lui permettre de donner son consentement éclairé.

Summary

Interaction between gastrooesophageal reflux disease (GORD) and H. pyloriinfection remains a complex and controversial subject. The infection diminishes the risk of reflux oesophagitis in the case of development of gastric distension by decreasing gastric acid secretions. This is probably why patients infected by CagApositive strains, which are responsible for more severe gastritis, develop oesophagitis or endobrachyoesophagus less frequently. Eradication of H. pyloridiminishes the antisecretory efficacy of omeprazole and ranitidine, however, this does not seem to have an important effect on the therapeutic control of GORD. H. pyloriinfection thus does not have a solely negative effect on GORD. However, results from recent publications support the recommendation in favour of eradication of H. pylori inthe case of GORD made in 2000,at Maastricht, by a consensus of European experts. The principal arguments are: the eventual amelioration of GORD without risk of further aggravation, the prevention of H. pyloriworsening gastric distension with longterm anti-secretory treatment, and the prevention of the development of gastric cancer linked to H. pylori.

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  1. Service de Médecine Interne H, CHU de Nancy - Hôpital Central, 54035, Nancy, France

    J. D. de Korwin

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de Korwin, J.D. Conduite à tenir en cas d’infection àH. pylori et de reflux gastro-œsophagien. Acta Endosc 33, 697–706 (2003). https://doi.org/10.1007/BF03002608

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