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Gastrite associée auCampylobacter pylori: Essai thérapeutique en double-insu amoxycilline versus placebo

Campylobacter pylori-associated gastritis: A double-blind placebo controlled trial with amoxycillin

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Acta Endoscopica

Résumé

Une étude contrôlée en double aveugle (amoxycilline vs placebo) a été réalisée chez des adultes porteurs d’une gastrite antrale associée à une infection à C. pylori. Dans la première partie de cette étude, les patients ont été traités par sirop d’amoxycilline (2 x1 gr) ou de placebo en deux prises quotidiennes pendant une semaine. Vingt deux patients ont reçu de l’amoxycilline et vingt trois du placebo. Après traitement, l’infection à C. pylori avait disparu chez 91 % (20/22) des patients traités par amoxycilline contre 16 % (4/23) chez les patients traités par placebo (p < 0.001). La gastrite active de l’antre a disparu chez 15/22 (68 %) patients dans le groupe amoxycilline mais chez seulement 2/23 (16 %) patients dans le groupe placebo (p < 0.001). Aucune amélioration significative n’a été observée en ce qui concerne la Symptomatologie et l’aspect endoscopique. Dans la deuxième partie de cette étude (simple aveugle), 19 patients devenus C. pylori négatifs après une semaine de traitement ont ensuite reçu du sirop placebo pendant 2 semaines: une réapparition de l’infection à C. pylori associée à une aggravation très significative de score histologique de la gastrite a été observée chez tous les patients. A l’inverse, 18 patients restés positifs après une semaine ont ensuite été traités en simple aveugle par sirop d’amoxycilline pendant 14 jours: la disparition du C. pylori, objectivée à la fin de cette période chez 13 d’entre-eux (72 %), était corrélée à une nette amélioration du score histologique de la gastrite. Parmi ces 13 patients, 8 ont été recontrôlés après un mois et tous présentaient à nouveau une infection à C. pylori et une aggravation significative des lésions de gastrite à l’histologie.

Ces résultats montrent que le sirop d’amoxycilline à la dose de 2g/jour est efficace dans le traitement de la gastrite active associée à l’infection à C. pylori mais ne permet pas de prévenir les rechutes qui surviennent chez tous les patients dans le mois qui suit l’arrêt du traitement.

Summary

A double-blind, placebo-controlled treatment study was performed in adults with antral gastritis associated with C. pylori. Patients received 20 ml of a placebo or an amoxycillin suspension (1g) two times daily for 8 days. Twenty-two patients received amoxycillin and twenty-three received a placebo. At the end of therapy 91 % (20/22) of patients treated with amoxycillin demonstrated clearance of the organism from the antrum compared to 16 % (4/23) in the placebo group (p < 0.001). Active antral gastritis resolved in 68 % (15/22) of patients in the amoxycillin group versus only 9 % (2/23) in the placebo group (p < 0.001). No significant improvement was observed in the assessment of clinical symptoms and endoscopic appearance. Reappearance of C. pylori and significant aggravation of the histological score was observed after 2 weeks in 100 % (19/19) of patients who demonstrated bacterial clearance after 8 days and had then received placebo for 14 days. Conversely, eighteen patients (not cleared from their bacteria after 8 days) received amoxycillin in single blind for 14 days. CLearance of bacteria associated with improvement or resolution of active gastritis was observed in 72 % (13/ 18) of patients. In this subgroup, 100 % (8/8) of patients observed at follow-up 1 month after stop** therapy were recolonized with C. pylori and again had histological active gastritis.

These results indicate that amoxycillin suspension 2 g daily for 1 or 2 weeks is effective in treating active antral gastritis associated with C. pylori, but not in preventing relapses, which occur in all patients within one month after therapy.

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Authors and Affiliations

  1. Gastroenterology, Brugmann University Hospital, Pl. A. Van Gehuchten 4, B-1020, Brussels, Belgium

    A. Burette, C. Deprez & M. Dereuck

  2. Dept. of Clinical Microbiology, University Hospital, 1020, Brussels, Belgium

    Y. Glupczynski, M. Labbe & M. Deltenre

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  1. A. Burette
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  2. Y. Glupczynski
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  3. M. Labbe
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  4. C. Deprez
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Burette, A., Glupczynski, Y., Labbe, M. et al. Gastrite associée auCampylobacter pylori: Essai thérapeutique en double-insu amoxycilline versus placebo. Acta Endosc 17, 251–261 (1987). https://doi.org/10.1007/BF02968451

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