RESUMO
In the absence of interventional endoscopy the treatment of upper digestive hemorrhage a the brazzaville university hospital is only medicinal. Objective of this work was to identify risk factors for upper gastrointestinal bleeding by conducting a retrospective case-type study conducted over a period of 2 years. The 180 patients included for upper digestive hemorrhage were divided into 2 groups accordind to their progressive modality : deceaded patients (cases) and non-deceased patients (controls). Risk factors for mortality were studied by logistic regression. The mortality linked to upper gastrointestinal bleedind was 36.6%, the risk factors for death were age between 30 and 60 with an OR of 9.79 ; male (OR of 2.03) ; late hospitalization over 24 hours (OR of 6.30) ; blood transfusions (OR of 3.5). The protective factors were hemoglobin greater 7 g/dL (OR of 0.28) ; treatment by proton pump inhibitors (OR of 0.36). In conclusion, reducing the still high mortalty rate in our country requires taking into account the identified risque factors and aquiring endoscopic hemostasis equipement.
En absence d'endoscopie interventionnelle, le traitement des hémorragies digestives hautes (HDH) au CHU de Brazzaville est essentiellement médicamenteux. L'objectif de ce travail était d'identifier les facteurs de risque de mortalité des HDH au CHU de Brazzaville en menant une étude pronostique rétrospective de type cas témoin sur une période de 2 ans. Les 180 patients inclus à l'étude pour une HDH ont été repartis en 2 groupes selon leur modalité évolutive : patients décédés (cas) et patients non décédés (témoins). Les facteurs de risques de mortalité ont été étudiés par régression logistique. La mortalité liée aux hémorragies digestives hautes était de 36,6%, les facteurs de risque de décès étaient l'âge entre 30 et 60 ans avec un OR de 9,79 ; le sexe masculin (OR : 2,03) ; la consultation tardive au-delà de 24 heures (OR : 6,30), les transfusions sanguines (OR : 3,5). Les facteurs protecteurs étaient l'hémoglobine supérieure à 7 g/dL (OR : 0,28) ; le traitement par inhibiteurs de la pompe à protons (OR : 0,36). En conclusion, la réduction de la mortalité encore élevée dans notre pays passe par la prise en compte des facteurs de risques identifiés et par l'acquisition de matériel d'hémostase endoscopique.
RESUMO
BACK GROUND: Helicobacter pylori infection is involved in several gastroduodenal diseases which can be cured by antimicrobial treatment. The aim of this study was to determine the prevalence of H. pylori infection and its bacterial resistance to clarithromycin, fluoroquinolones, and tetracycline in Brazzaville, Congo, by using molecular methods. MATERIAL AND METHODS: A cross- sectional study was carried out between September 2013 and April 2014. Biopsy specimens were obtained from patients scheduled for an upper gastrointestinal endoscopy and were sent to the French National Reference Center for Campylobacters and Helicobacters where they were tested by molecular methods for detection of H. pylori and clarithromycin resistance by real-time PCR using a fluorescence resonance energy transfer-melting curve analysis (FRET-MCA) protocol, for detection of tetracycline resistance by real-time PCR on 16S rRNA genes (rrnA and rrnB), for detection of point mutations in the quinolone resistance-determining regions (QRDR) of H. pylori gyrA gene, associated with resistance to quinolones, by PCR and sequencing. RESULTS: This study showed a high H. pylori prevalence (89%), low rates of clarithromycin and tetracycline resistance (1.7% and 2.5%, respectively), and a high rate of quinolone resistance (50%). CONCLUSION: Therefore, the use of standard clarithromycin-based triple therapy is still possible as an empiric first-line treatment as well as prescription of bismuth-based quadruple therapy, which includes tetracycline, but not a levofloxacin-based triple therapy because of the high rate of resistance to fluoroquinolones.
