[Gastroduodenal ulcer before and after Helicobacter pylori]

Risk factors of Helicobacter pylori infection in Bukavu, Democratic Republic of the Congo: a case-control study

Helicobacter pylori (H. pylori) is the common etiology of gastric tumors. This study aimed to evaluate the risk factors associated with H. pylori infection in the eastern part of the Democratic Republic of the Congo (DR Congo), where these tumors seem to be more frequent than in its western part.

Patients and Methods

Between January and December 2021, the authors conducted a multicenter case-control study in three hospitals in Bukavu City involving 90 individuals with dyspeptic complaints. Risk factors for H. pylori infection were assessed in a participant interview and H. pylori status from stool antigen detection.

Results

Among the risk factors assessed, only history of H. pylori in the family and the habit of adding salt to already-seasoned food were found positively associated with the risk of H. pylori infection (adjusted odds ratio: 7, 95 CI: 2.742-17.867; P<0.0001 and 2.911, 95% CI: 1.010-8.526; P=0.048, respectively). On the other hand, low-temperature food storage seems to be protective with a negative association (adjusted odds ratio: 0.044, 95% CI: 0.009-0.206; P=0.0001).

Conclusion

This study demonstrated again the importance of lifestyle-related factors on the risk of acquisition of H. pylori. These findings call for preventive interventions for this group of individuals.

Rescue therapy with bismuth-containing quadruple therapy in patients infected with metronidazole-resistant Helicobacter pylori strains

BACKGROUND

The emergence of H. pylori strains that are resistant to clarithromycin, metronidazole and fluoroquinolone requires the evaluation of new and effective salvage therapies.

AIMS

To test the efficacy of a new formulation of a bismuth-containing quadruple therapy as a rescue therapy in patients who were infected with a H. pylori strain resistant to metronidazole, clarithromycin and fluoroquinolone or who failed multiple lines of treatment using these three antibiotics.

METHODS

A total of 103 patients with confirmed H. pylori infection with a resistance profile described above were treated with Pylera(®) (3-in-1 capsules containing bismuth subcitrate potassium 140mg, metronidazole 125mg and tetracycline 125mg) 3 capsules four times a day plus omeprazole 20mg two times a day for 10 days in a named patient program. Eradication was confirmed using a urea breath test at least 28 days after the end of treatment. Efficacy and safety were studied.

RESULTS

A total of 103 patients were prospectively included from June 2010 to October 2011. The eradication rate for the intent-to-treat analysis was 83% (CI95%[75-89%]); an 87% eradication rate (CI95%[80-94%]) was found for the per-protocol analysis and 81% (CI95%[80-82%]) for the intent-to-treat analysis in patients with proven resistance to metronidazole. Nine patients discontinued treatment, all due to adverse events. Two serious adverse events (AEs) were reported (memory disorders of unknown significance). Fifty-six (54%) patients reported at least one AE.

CONCLUSION

This bismuth-containing quadruple therapy achieved a remarkable eradication rate as a salvage therapy in patients infected with metronidazole-resistant H. pylori strain, despite the frequent occurrence of mild-to-moderate adverse events.

[Epidemiology of infection Helicobacter pylori in Yaoundé: specificity of the African enigma]

Introduction

L'infection à Hélicobacter pylori concerne la moitié de la population mondiale, principalement dans les pays en voie de développement où l'infection atteint 80% de la population. Le but de notre étude était de déterminer la prévalence de l'infection à Hélicobacter pylori et de mettre en évidence les déterminants de l'infection ainsi que les maladies associées au Cameroun.

Méthodes

L’étude concernait 171 sujets symptomatiques référés pour une fibroscopie œsogastroduodénale au Centre Hospitalier et Universitaire de Yaoundé et au Centre Médical la Cathédrale. L'infection à H.pylori était objectivée par un test rapide à l'uréase kit commercial Pronto Dry^® (Medical Instruments Corporation, Solothurn, Switzerland).

Résultats

La prévalence globale de l'infection à Hélicobacter pylori était de 72,5% (124/171) (Intervalle de Confiance (IC) à 95% 65,2-79,1%) et dans chaque groupe d’âge (moins de 40ans, 40-50ans, plus de 50ans) de 83,1%(64/77), 67,4%(29/43) et 60,8%(31/51) respectivement. En analyse univariée, le risque de l'infection était significativement élevé dans le groupe de moins de 40ans comparé au groupe de 40-50ans (Risque Relatif (RR) 0,42 IC 95% 0,16-1,1, p = 0,04 pour le groupe 40-50ans) et comparé au groupe de plus de 50ans (RR 0,73; 0,57-0,93, p = 0,004 pour le groupe de plus de 50ans). La prévalence de l'infection à H.pylori était de 63,0% (17/27) pour l'ulcère duodénal, 50%(4/8) pour l'ulcère gastrique et 100%(2/2) pour le cancer gastrique.

Conclusion

A prévalence de l'infection à H.pylori au Cameroun est très élevée et significativement liée à l’âge de moins de 40 ans.