SNFGE SNFGE
 
Thématique :
- Colo-proctologie
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Frank ZERBIB
Coup de coeur :
 
 
Gut
  2018/07  
 
  2018 Jul;67(7):1239-1246.  
  doi: 10.1136/gutjnl-2016-311685.  
 
  Dynamics of Helicobacter pylori infection as a determinant of progression of gastric precancerous lesions: 16-year follow-up of an eradication trial.  
 
  Mera RM, Bravo LE, Camargo MC, Bravo JC, Delgado AG, Romero-Gallo J, Yepez MC, Realpe JL, Schneider BG, Morgan DR, Peek RM Jr, Correa P, Wilson KT, Piazuelo MB  
  https://www.ncbi.nlm.nih.gov/pubmed/28647684  
 
 

Abstract

OBJECTIVE:

To evaluate the long-term effect of cumulative time exposed to Helicobacter pylori infection on the progression of gastric lesions.

DESIGN:

795 adults with precancerous gastric lesions were randomised to receive anti-H. pylori treatment at baseline. Gastric biopsies were obtained at baseline and at 3, 6, 12 and 16 years. A total of 456 individuals attended the 16-year visit. Cumulative time of H. pylori exposure was calculated as the number of years infected during follow-up. Multivariable logistic regression models were used to estimate the risk of progression to a more advanced diagnosis (versus no change/regression) as well as gastric cancer risk by intestinal metaplasia (IM) subtype. For a more detailed analysis of progression, we also used a histopathology score assessing both severity and extension of the gastric lesions (range 1-6). The score difference between baseline and 16 years was modelled by generalised linear models.

RESULTS:

Individuals who were continuously infected with H. pylori for 16 years had a higher probability of progression to a more advanced diagnosis than those who cleared the infection and remained negative after baseline (p=0.001). Incomplete-type IM was associated with higher risk of progression to cancer than complete-type (OR, 11.3; 95% CI 1.4 to 91.4). The average histopathology score increased by 0.20 units/year (95% CI 0.12 to 0.28) among individuals continuously infected with H. pylori. The effect of cumulative time of infection on progression in the histopathology score was significantly higher for individuals with atrophy (without IM) than for individuals with IM (p<0.001).

CONCLUSIONS:

Long-term exposure to H. pylori infection was associated with progression of precancerous lesions. Individuals infected with H. pylori with these lesions may benefit from eradication, particularly those with atrophic gastritis without IM. Incomplete-type IM may be a useful marker for the identification of individuals at higher risk for cancer.

 

 
Question posée
 
Quel est l’impact à long terme de l’éradication de Helicobacter pylori sur l’évolution de la gastrite chronique ?
 
Question posée
 
Il s’agit d’une étude randomisée (éradication vs placebo) en Colombie dont les résultats à 16 ans sont disponibles chez 456 patients. Les résultats confirment un effet bénéfique de l’éradication essentiellement chez les patients sans métaplasie intestinale. Une métaplasie incomplète était associée à un risque plus élevé de cancer gastrique.
 
Commentaires

Cette étude sud-américaine confirme des données asiatiques. Une fois la métaplasie intestinale installée, l’éradication influence peu l’évolution des lésions à très long terme. Tout le problème est de savoir si ces données sont transposables à des populations occidentales à risque de caner gastrique plus faible. 

 
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