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Helicobacter pylori doit-il être éradiqué avant de prescrire un traitement à long terme par un inhibiteur de pompe à protons pour une œsophagite par reflux?

ShouldHelicobacter pylori be eradicated before starting a long term proton pump inhibitor treatment for reflux oesophagitis?

  • Published:
Acta Endoscopica

Résumé

Helicobacter pylori (HP) a été retrouvé au niveau de l’œsophage, uniquement sur un épithélium de type gastrique dans l’œsophage de Barrett, et presque exclusivement chez des patients porteurs d’une contamination gastrique par HP. L’infection de l’œsophage de Barrett par HP n’a aucune influence sur sa sévérité, ses complications ou son histoire naturelle. La contamination gastrique par HP n’est pas un facteur de risque de reflux gastro-œsophagien et au contraire la présence de HP au niveau gastrique, l’inflammation de la partie fundique et la gastrite atrophique pourraient jouer un rôle protecteur contre l’œsophagite par reflux. L’éradication de HP chez les patients porteurs d’un ulcère duodénal expose ceux-ci à un risque de développement d’œsophagite par reflux. HP influence l’efficacité du traitement antisécrétoire: les inhibiteurs de pompe à protons et la ranitidine procurent une réduction de l’acidité gastrique supérieure chez les sujets contaminés par HP par rapport aux sujets HP négatifs. Au cours d’un traitement par inhibiteur de pompe à protons, on constate un déplacement de HP de l’antre vers le fundus. Les traitements prolongés par inhibiteur de pompe à protons provoquent une gastrite atrophique chez les sujets positifs pour Helicobacter pylori, ce qui constitue un argument majeur en faveur de l’éradication de HP chez les patients soumis à une inhibition sécrétoire acide de longue durée.

Summary

HP may be found in the oesophagus only on gastric type epithelium in Barrett’s oesophagus, and almost only in patients with gastric HP infection. There is no indication that HP infection of Barrett’s oesophagus has any influence on its severity, complications, or natural history. HP infection of the stomach is not a risk factor for reflux oesophagitis, and the consequence of the presence of HP in the stomach, body inflammation and atrophic gastritis, may protect against reflux oesophagitis. There is a risk for developing reflux oesophagitis after HP eradication in duodenal ulcer patients. HP influences the efficacy of acid-lowering treatment: proton pump inhibitors and ranitidine produce a greater decrease in gastric acidity in subjects with H. pylori infection than those H. pylori negative. During proton pump inhibitor treatment, there is a shift of HP from antrum to body mucosa. Long term proton pump inhibitor treatment induces atrophic gastritis in Helicobacter pylori positive patients, which is the strongest argument in favour of eradicating HP in patients receiving long term potent acid inhibition.

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Author notes

  1. E. de Koster

    Present address: Department of Gastro-enterology, Brugmann University Hospital, Place van Gehuchten 4, 1020, Brussels

Authors and Affiliations

  1. Department of Gastro-enterology, Brugmann University Hospital, Place van Gehuchten 4, 1020, Brussels

    C. L. Jonas, M. Ferhat, P. Denis, M. Buset & M. Deltenre

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de Koster, E., Jonas, C.L., Ferhat, M. et al. Helicobacter pylori doit-il être éradiqué avant de prescrire un traitement à long terme par un inhibiteur de pompe à protons pour une œsophagite par reflux?. Acta Endosc 27, 201–211 (1997). https://doi.org/10.1007/BF02969051

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