Therapy of HP.ppt

HELICOBACTER PYLORI TREATMENT Georges El JAMMAL M.D. Whom to treat ? Certainly gastro-duodenal ulcers Whom to treat ? Dyspepsia Diagnostic gastroscopy recommended by all the experts before treatment in case of : Age 45 years Risk factor for cancer History in favor of organic problems Whom to treat ? Dyspepsia Test then treat (USA) or endoscopy then treat (europe) in case of : Age 45 years No risk factor for cancer History in favor of functionnal problem Whom to treat ? Dyspepsia Eradication yields a benefit in dyspepsia of less than 10% (Mc Coll et al. GUT 2001;48:759-61) Whom to treat ? Dyspepsia Conclusion : Eradicate if : Severe symptoms ? In the context of gastric cancer prevention ? (Raymond et al. Gastroenterol Clin Biol 2003;27:432-439) Whom to treat ? GERD HP has a protector effect on the consequences of GERD ? Dent et al. Eur J Gastroenterol Gepatol 1999;11 (suppl 2):S51-7 Eradication does not increase the risk of esophagitis randomized trial with 18 weeks follow up; Befrits et al. Helicobacter 2000;5:202-5 There is no relation between HP status and esophageal motor disorders Zerbib et al. Am J Physiol 2001;281:G350-6 Whom to treat ? GERD It cannot be recommended to eradicate HP in GERD unless it is needed for another indication European consensus conference on HP recommended eradication of HP before long term therapy for GERD Zerbib et al. Gastroenterol Clin Biol 2003;27:427-431 Whom to treat ? NSAID Gastroduodenal ulcers in NSAID patients Aggravated by HP ? Yes Bianchi-Poro et al. GUT 1996?;39?:22-6 Taha et al. Gastroenterology 1999?;116?:254-8 No Pilotto et al. Eur Gastroenterol Hepatol 1997?;9?:951-6 Bianchi-Poro et al. Digestive liver disease 2000?;32?: 201-8 Whom to treat ? NSAID Data apparied with age?: HP increases risk of hemorragic GD ulcer x 1.79 NSAID increases risk of hemorragic GD ulcer x 4.85 HP + NSAID increases risk of hemorragic GD ulcer x 6.13 Santolaria et al. Aliment Pharmacol Ther 1999?;13?:1511-8 Who