Background:Helicobacter pylori (Hp) infection is the most widespread bacterial infection in the world. The infection is generally acquired in childhood, but can persist into adulthood. Eradication therapy has undergone several modifications. The aim of this study was to evaluate the different therapeutic strategies used in the eradication of Helicobacter pylori infection in the Centre Hospitalier Universitaire La Reference Nationale of N’Djaména. Patients and Methods: This was a prospective, descriptive analytical study spread over one year, from September 2021 to September 2022. Patients at least 15 years of age presenting with dyspeptic symptoms, seen consecutively in a hepato-gastroenterology consultation and with a positive stool test for H. pylori infection, were included in the study. Equally, 1/3 of patients were treated with dual or triple therapy. The remaining third received quadritherapy. Results: A total of 268 patients were included in the study (mean age 38.40 ± 14.66 with extremes of 16 and 80 years). Males predominated in 58% of cases. Overall therapeutic efficacy was 88.9%. According to different therapeutic strategies, efficacy was 90.75% for dual therapy with PPI (Rabeprazole) and Amoxicillin. On the other hand, efficacy was 87% and 88.88% for PPI-based triple therapy and dual antibiotic therapy, and for PPI-based quadruple therapy and triple antibiotic therapy. Conclusion:H. pylori infection is a common disease in Chad. Dual therapy with rabeprazole combined with a high dose of amoxicillin over a period of at least two weeks showed similar if not better efficacy than triple or quadruple therapy.
References
[1]
Mignon, M., Marshall, B.J. and Warren, J.R. (2005) Helicobacter pylori Honored. Med Sci (Paris), 21, 993-994. https://doi.org/10.1051/medsci/20052111993
[2]
Sabbagh, P., Mohammadnia-Afrouzi, M., et al. (2019) Diagnostic Methods for Helicobacter pylori Infection: Ideals, Options, and Limitations. European Journal of Clinical Microbiology & Infectious Diseases, 38, 55-66. https://doi.org/10.1007/s10096-018-3414-4
[3]
Geraghty, J., Thumbs, A., Kankwatira, A., et al. (2015) Helicobacter pylori, HIV and Gastric Hypochlorhydria in the Malawian Population. PLOS ONE, 10, e0132043 https://doi.org/10.1371/journal.pone.0132043
[4]
Moussa, A.M., Mayanna, H., Choua, O., et al. (2018) Clinical and Endoscopic Manifestations of Helicobacter pylori Infection in N’Djamena. Annales de l’Université de N’Djamena Série C, 10, 109-127.
[5]
Nadlaou, B., Ali, M.M., Mayanna, H., et al. (2021) Biochemical and Resistance Profile of Helicobacter pylori Isolated in N’Djamena in Chad. Journal of Drug Delivery and Therapeutics, 11, 33-41. https://doi.org/10.22270/jddt.v11i5-S.5013
[6]
Doffou, A.S., Bangoura, A.D., Kouamé, G.D., et al. (2018) Pidemiological and Clinical Profile of Patients with Helicobacter pylori Gastritis Infection in the Digestive Endoscopy Unit of the Yopougon Hospital Center. Revue de Médecine et de Pharmacie, 8, 2226-2903.
[7]
Galal, Y.S., Ghobrial, C.M., Labib, J.R., et al. (2019) Helicobacter pylori among Symptomatic Egyptian Children: Prevalence, Risk Factors, and Effect on Growth. Journal of the Egyptian Public Health Association, 94, Article No. 17. https://doi.org/10.1186/s42506-019-0017-6
[8]
Bello, A.K., Umar, A.B. and Borodo, M.M. (2018) Prevalence and Risk Factors for Helicobacter in Gastroduodenal Diseases in Kanon Nigeria. Asrjets Journal, 17, 41-46.
[9]
Fischbach, W. and Malfertheiner, P. (2018) Helicobacter pylori Infection. Dtsch Arztebl Int, 115, 429-436. https://doi.org/10.3238/arztebl.2018.0429
[10]
Joutei, H.A.H., Hilali, A., Fechtali, T., et al. (2010) Helicobacter pylori Infection in 755 Patients with Digestive Symptoms: Institut Pasteur du Maroc, 1998-2007. EMHJ, 16, 778-782. https://doi.org/10.26719/2010.16.7.778
[11]
Sokpon, M., Salihoun, M., Lahlou, L., et al. (2016) Predictors of Helicobacter pylori (Hp) Infection in Chronic Gastritis: About a Moroccan Study. Journal Africain d’Hépato-Gastroentérologie, 10, 203-207. https://doi.org/10.1007/s12157-016-0687-z
[12]
Ontsira, N.E., Atipo, I.B., Moyen, R., et al. (2017) Molecular Detection of Helicobacter pylori and Its Antimicrobial Resistance in Brazzaville Congo. Helicobacter, 20, 316-320. https://doi.org/10.1111/hel.12204
[13]
Ndjitoyap, N., Antonin, W., Mathurin, K., et al. (2021) Effectiveness of First Line Treatment of Helicobacter pylori in a Sub-Saharan African Country. Health Sciences Disease, 22, 115-118.
[14]
Bang, C.S. (2020) Amoxicillin or Tetracycline in Bismuth-Containing Quadruple Therapy as First-Line Treatment for Helicobacter pylori Infection. Gut Microbes, 11, 1314-1323. https://doi.org/10.1080/19490976.2020.1754118
[15]
Yang, J.C., Lin, C.J., Wang, H.L., et al. (2015) High-Dose Dual Therapy Is Superior to Standard First-Line or Rescue Therapy for Helicobacter pylori Infection. Clinical Gastroenterology and Hepatology, 13, 895-905. https://doi.org/10.1016/j.cgh.2014.10.036
[16]
Ren, L., Lu, H., Li, H.Y., et al. (2014) New Dual Therapy for Primary Treatment of Helicobacter pylori Infection: A Prospective Randomized Study in Shanghai, China. Journal of Digestive Diseases, 15, 622-627. https://doi.org/10.1111/1751-2980.12186
[17]
Sapmaz, F., Kalkan, I.H., Atasoy, P., et al. (2015) A Non-Inferiority Study: Modified Dual Therapy Consisting Higher Doses of Rabeprazole Is as Successful as Standard Quadruple Therapy in Eradication of Helicobacter pylori. American Journal of Therapeutics, 24, e393-e398. https://doi.org/10.1097/MJT.0000000000000316
[18]
O’Connor, A., Gisbert, J.P., O’Morain, C., et al. (2015) Treatment of Helicobacter pylori Infection 2015. Helicobacter, 20, 54-61. https://doi.org/10.1111/hel.12258
[19]
Tai, W.C., Lee, C.H., Chiou, S.S., et al. (2014) The Clinical and Bacteriological Factors for Optimal Levofloxacin Containing Triple Therapy in Second-Line Helicobacter pylori Eradication. PLOS ONE, 9, e105822. https://doi.org/10.1371/journal.pone.0105822
[20]
Lahbabi, M., Loukili, B., Berreho, A., et al. (2012) Eradication of H. pylori in Bulbar Ulcers: Which First-Line Triple Therapy? Results of a Prospective Randomized Study Comparing Metronidazole to Clarithromycin. African Journal of Hepato-Gastroenterology, 6, 18-23.
[21]
Agdal et al. (2015) Therapeutic Strategies in the Eradication of H. pylori. Rabbat LRAM.
[22]
Sardarian, H., Fakheri, H., Hosseini, V., Taghvaei, T., Maleki, I. and Mokhtare, M. (2013) Comparison of Hybrid and Sequential Therapies for Helicobacter pylori Eradication in Iran: A Prospective Randomized Trial. Helicobacter, 18, 129-134. https://doi.org/10.1111/hel.12017
[23]
Apostolopoulos, P., et al. (2020) 10-Day versus 14 Day Quadruple Concomitant Non-Bismuth Therapy for the Treatment of Helicobacter pylori Infection: Results from a Randomized Prospective Study in a High Clarithromycin Resistance Country. Journal of Clinical Gastroenterology, 54, 522-527. https://doi.org/10.1097/MCG.0000000000001328
[24]
Al-Ruthia, Y., Almadi, M.A., Alqahtani, S., et al. (2021) The Cost-Effectiveness of Sequential versus Standard Triple Therapy for Helicobacter pylori Eradication in Saudi Arabia. Saudi Journal of Gastroenterology, 27, 217-222. https://doi.org/10.4103/sjg.sjg_536_20