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La quadrithérapie bismuthée est supérieure au traitement séquentiel pour l’éradication de Helicobacter pylori : résultats d’une étude comparative en routine

Bismuth-containing quadruple therapy is superior to sequential treatment for the eradication of Helicobacter Pylori: Results of a comparative study in daily practice

  • Article Original / Original Article
  • Published:
Acta Endoscopica

Résumé

Objectifs

L’objectif de l’étude est de comparer, en pratique quotidienne, le traitement séquentiel standard (inhibiteur de la pompe à protons [IPP] + amoxicilline puis clarithromycine-métronidazole) à la quadrithérapie bismuthée (oméprazole + bismuth-tétracycline-métronidazole) dans une population non sélectionnée atteinte d’infection à Helicobacter pylori.

Patients et méthodes

Trente-sept patients recevant le traitement séquentiel ont été comparés à 43 patients recevant la quadrithérapie bismuthée. L’objectif principal était le taux d’éradication de H. pylori. Les objectifs secondaires étaient d’analyser le niveau de résistance aux antibiotiques et les effets secondaires du traitement.

Résultats

En intention de traiter, les taux d’éradication obtenus avec la quadrithérapie bismuthée et le traitement séquentiel sont respectivement de 86 % et 67,6 % (p=0,048), et de 90,2 % et 71,4 % en analyse per protocole (p=0,035). Avec le traitement séquentiel, les échecs thérapeutiques sont liés dans 66,7 % des cas à une résistance à la clarithromycine et/ou au métronidazole et, avec la quadrithérapie bismuthée, dans 75 % des cas à une résistance au métronidazole. Aucun effet secondaire lié à l’utilisation du bismuth n’est survenu.

Conclusions

Dans cette étude française réalisée en routine, la quadrithérapie bismuthée s’avère significativement supérieure au traitement séquentiel. Ces résultats en font le traitement de première intention des infections à H. pylori.

Abstract

Purpose

The purpose of the study was to compare, in routine practice, the standard sequential treatment (proton pump inhibitor [PPI] + amoxicillin followed by clarithromycin- metronidazole) to a bismuth-containing quadruple therapy (omeprazole + bismuth-tetracycline-metronidazole) in non-selected patients suffering from an infection due to H. pylori.

Patients and methods

Thirty-seven patients receiving the sequential treatment were compared to 43 patients receiving the quadruple therapy. The primary objective was the eradication rates of H. pylori. The secondary objectives were to analyze the resistance to antibiotics and the occurrence of adverse events.

Results

In the intent-to-treat analysis, the obtained eradication rates with quadruple therapy and sequential treatment were respectively of 86% and 67.6% (p=0.048), and of 90.2% and 71.4% in the per-protocol analysis (p=0.035). With the sequential treatment, the treatment failures were related to a resistance to clarithromycin and/or metronidazole in 66.7% of cases, and, with the quadruple therapy, in 75% of cases to a resistance to metronidazole. No adverse events were related to the use of bismuth.

Conclusions

In this French study that was performed in routine practice, the bismuth-containing quadruple therapy showed a statistically significant superiority compared to the sequential treatment. These results lead to consider the bismuth-containing quadruple therapy as the first-intent treatment of infections due to H. pylori.

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Références

  1. Brown LM. Helicobacter pylori: epidemiology and routes of transmission. Epidemiol Rev 2000;22:283–97.

    Article  CAS  PubMed  Google Scholar 

  2. Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984;1:1311–5.

    Article  CAS  PubMed  Google Scholar 

  3. Khalifa MM, Sharaf RR, Aziz RK. Helicobacter pylori: a poor man’s gut pathogen? Gut Pathog 2010;2:2–12.

    Article  PubMed Central  PubMed  Google Scholar 

  4. The EUROGAST Study Group. An international association between Helicobacter pylori infection and gastric cancer. Lancet 1993;341:1359–62.

    Article  Google Scholar 

  5. Vakil N, Vaira D. Treatment for H. pylori infection: new challenges with antimicrobial resistance. J Clin Gastroenterol 2013;47:383–8.

    Article  CAS  PubMed  Google Scholar 

  6. Malfertheiner P, Megraud F, O’Morain CA, et al. Management of Helicobacter pylori infection—the Maastricht IV/Florence Consensus Report. Gut 2012;61:646–64.

    Article  CAS  PubMed  Google Scholar 

  7. Chey WD, Wong BC; Practice Parameters Committee of the American College of Gastroenterology. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol 2007;102:1808–25.

    Article  CAS  PubMed  Google Scholar 

  8. Mégraud F. Current recommendations for Helicobacter pylori therapies in a world of evolving resistance. Gut Microbes 2013;4:541–8.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Malfertheiner P, Megraud F, O’Morain C, et al. Current European concepts in the management of helicobacter pylori infection: the Maastricht consensus report. The European helicobacter pylori study group (EHPSG). Eur J Gastroenterol Hepatol 1997;9:1–2.

    Article  CAS  PubMed  Google Scholar 

  10. Graham DY, Fischbach L. Helicobacter pylori treatment in the era of increasing antibiotic resistance. Gut 2010;59:1143–53.

    Article  CAS  PubMed  Google Scholar 

  11. Glupczynski Y, Megraud F, Lopez-Brea M, et al. European multicentre survey of in vitro antimicrobial resistance in Helicobacter pylori. Eur J Clin Microbiol Infect Dis 2001;20:820–3.

    Article  CAS  PubMed  Google Scholar 

  12. Megraud F, Coenen S, Versporten A, et al. Helicobacter pylori resistance to antibiotics in Europe and its relationship to antibiotic consumption. Gut 2013;62:34–42.

    Article  CAS  PubMed  Google Scholar 

  13. Megraud F. Helicobacter pylori and antibiotic resistance. Gut 2007;56:1502.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Mégraud F. Étude multicentrique de la résistance aux antibiotiques des souches de H. pylori en 2015 (Communication personnelle).

    Google Scholar 

  15. Essa AS, Kramer JR, Graham DY, Treiber G. Meta-analysis: four-drug, three-antibiotic, non-bismuth-containing “concomitant therapy” versus triple therapy for Helicobacter pylori eradication. Helicobacter 2009;14:109–18.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Gisbert JP, Calvet X. Review article: non-bismuth quadruple (concomitant) therapy for eradication of Helicobater pylori. Aliment Pharmacol Ther 2011;34:604–17.

    Article  CAS  PubMed  Google Scholar 

  17. Laine L, Hunt R, El-Zimaity H, et al. Bismuth-based quadruple therapy using a single capsule of bismuth biskalcitrate, metronidazole, and tetracycline given with omeprazole versus omeprazole, amoxicillin, and clarithromycin for eradication of Helicobacter pylori in duodenal ulcer patients: a prospective, randomized, multicenter, North American trial. Am J Gastroenterol 2003;98:562–7.

    Article  CAS  PubMed  Google Scholar 

  18. Malfertheiner P, Bazzoli F, Delchier JC, et al. Helicobacter pylori eradication with a capsule containing bismuth subcitrate potassium, metronidazole, and tetracycline given with omeprazole versus clarithromycin-based triple therapy: a randomized, openlabel, non-inferiority, phase 3 trial. Lancet 2011;377:905–13.

    Article  CAS  PubMed  Google Scholar 

  19. O’Morain C, Borody T, Farley A, et al. Efficacy and safety of single-triple capsules of bismuth biskalcitrate, metronidazole and tetracycline, given with omeprazole, for the eradication of Helicobacter pylori: an international multicentre study. Aliment Pharmacol Ther 2003;17:415–20.

    Article  PubMed  Google Scholar 

  20. Lamouliatte H, Zerbib F, Fotsing G, et al. Le traitement anti Helicobacter pylori par la quadrithérapie bismuthée en routine: le début d’une nouvelle ère. Résultats d’une étude prospective multicentrique. Journées Francophones d’Hépato-Gastroentérologie et d’Oncologie Digestive, Paris, 19-22 mars 2015:P339.

    Google Scholar 

  21. Liu KS, Hung IF, Seto WK, et al. Ten day sequential versus 10 day modified bismuth quadruple therapy as empirical firstline and second-line treatment for Helicobacter pylori in Chinese patients: an open label, randomized, crossover trial. Gut 2014;63:1410–5.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Service d’hépatogastroentérologie et d’oncologie digestive, centre hospitalier universitaire Saint-André, 1 rue Jean Burguet, F-33075, Bordeaux, France

    H. Lamouliatte, F. Zerbib, G. Fotsing & E. Chabrun

  2. Centre national de référence des Campylobacters et Helicobacters, laboratoire de bactériologie, université de Bordeaux 2, Bordeaux, France

    F. Mégraud

  3. Cabinet de gastroentérologie, Biarritz, France

    R. Cayla

  4. Service d’hépatogastroentérologie, hôpital Bagatelle, Talence, France

    S. Cazorla & P. Talbi

Authors
  1. H. Lamouliatte
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  2. F. Zerbib
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  3. G. Fotsing
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  4. E. Chabrun
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  5. F. Mégraud
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  6. R. Cayla
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  7. S. Cazorla
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  8. P. Talbi
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Correspondence to H. Lamouliatte.

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Lamouliatte, H., Zerbib, F., Fotsing, G. et al. La quadrithérapie bismuthée est supérieure au traitement séquentiel pour l’éradication de Helicobacter pylori : résultats d’une étude comparative en routine. Acta Endosc 45, 198–202 (2015). https://doi.org/10.1007/s10190-015-0514-1

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  • DOI: https://doi.org/10.1007/s10190-015-0514-1

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