Primary resistance to clarithromycin, metronidazole and amoxicillin of Helicobacter pylori isolated from Tunisian patients with peptic ulcers and gastritis: a prospective multicentre study.

BACKGROUND: The frequency of primary resistance to antibiotics in H. pylori isolates is increasing worldwide. In Tunisia, there are limited data regarding the pattern of H. pylori antibiotic primary resistance. AIM: To evaluate the primary resistance of H. pylori to clarithromycin, metronidazole and amoxicillin and to detect the mutations involved in clarithromycin resistance. MATERIALS AND METHODS: 273 strains isolated from adults and children were enrolled. The primary resistance to clarithromycin, metronidazole and amoxicillin was evaluated by means of E-test minimal inhibitory concentration (MIC). The real-time PCR using Scorpion primers was performed in all cases to assess clarithromycin primary resistance and point mutations involved. RESULTS: No resistance to amoxicillin was detected. For adults, resistance to clarithromycin and metronidazole was found respectively in 14.6% and 56.8%, and respectively in 18.8% and 25% in children. Overall, the rates of global primary resistance to clarithromycin and metronidazole in Tunisia were respectively determined in 15.4% and 51.3%.By the use of Scorpion PCR, the A2143G was the most frequent point mutation observed (88.1%), followed by the A2142G (11.9%); the A2142C was not found and 18 of 42 patients (42.8%) were infected by both the resistant and the susceptible genotype.The association of clarithromycin resistance with gender was not statistically significant, but metronidazole resistant strains were isolated more frequently in females (67.8%) than in males (32.2%) and the difference was significant. As for gastroduodenal diseases, the difference between strains isolated from patients with peptic ulceration and those with non peptic ulceration was not statistically significant. When about the distribution of resistant strains to clarithromycin and metronidazole between the three Tunisian cities (Tunis, Menzel Bourguiba and Mahdia), the difference was not statistically significant. CONCLUSION: Local data regarding the primary resistance of H. pylori to clarithromycin, metronidazole and amoxicillin and the main genetic mutation involved in clarithromycin resistance in vivo (A2143G) are necessary to prove a clear need for a periodic evaluation of antibiotic consumption and new therapeutic strategies in Tunisia in order to avoid the emergence of resistant strains.

[Difficulty in diagnosing acute appendicitis in the presence of acute portal vein thrombosis: the role of CT scan. Report of 2 cases]. / Difficultés du diagnostic d'appendicite aiguë en cas de thrombose portale aiguë: apport du scanner.

Acute appendicitis can cause of portal vein thrombosis. Diagnosis of appendicitis can be difficult because its symptoms may be masked by those of acute portal vein thrombosis. We report 2 cases of appendicitis associated with acute portal vein thrombosis whose diagnosis was delayed by several months. The delayed diagnosis of acute appendicitis in the presence of acute portal vein thrombosis can be avoided by using spiral-computed tomography and careful investigation of signs of appendicitis.

[Prevalence of Helicobacter pylori infection in normal or asymptomatic patients]. / Prevalence de l'infection a Helicobacter pylori chez les sujets normaux ou asymptomatiques.

The propose of this prospective study was to assess the prevalence of Helicobacter pylori infection in asymptomatic subjects in year 2000. Ninety eight patients not suffering from upper gastrointestinal symptoms were enrolled in this study. The mean age was 39 years. Helicobacter pylori was present in 81 patients (82.7%). Helicobacter pylori infection increase with age. It was maximal between 30 and 50 years. Helicobacter pylori prevalence is still high in Tunisia as well as in most developing countries. Improvement of hygiene conditions will decrease this prevalence.

[Association of celiac disease and Crohn's disease. A case report]. / Association maladie coeliaque et maladie de Crohn. A propos d'une observation.

Crohn's disease and celiac disease are two chronic digestive diseases. The pathological mechanisms that lead to them are not known. Their association is rare leading to diagnostic and etiopathogenic problems. The aim of this study is to report clinical, endoscopical and histopathological characteristics of this association and to discuss the etiopathogenic links between these two diseases. The association of celiac disease and Crohn's disease is possible although rare. Many etiopathological mechanisms were suggested to explain such an association. In the case of celiac disease, the association with Crohn's disease is suggested by the characteristics of the diarrhea, the anoperineal lesions and will be confirmed by ileocolonoscopy and biopsy. In contrary, the diagnosis of celiac disease associated with Crohn's disease is frequently suggested by the endoscopy of upper gastrointestinal tract systematically practiced and will be confirmed by biopsy and serological celiac disease tests.