Gastroduodenal Ulcer: Helicobacter pylori, NSAIDs, and Treatment | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"L'ulc\u00e8re gastroduod\u00e9nal est une l\u00e9sion muqueuse caus\u00e9e par H. pylori ou les AINS. \u00c9pigastralgie, test respiratoire H. pylori, triple th\u00e9rapie IPP clarithromycine amoxicilline, complications h\u00e9morragie perforation au Qu\u00e9bec.\">\n<meta name=\"keywords\" content=\"ulc\u00e8re gastroduod\u00e9nal, ulc\u00e8re gastrique, ulc\u00e8re duod\u00e9nal, Helicobacter pylori traitement, ulc\u00e8re AINS, IPP ulc\u00e8re, triple th\u00e9rapie H. pylori, ulc\u00e8re h\u00e9morragie, test respiratoire ur\u00e9e, ulc\u00e8re Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n@import 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color: #8a9aaa;\n font-style: italic;\n border-top: 1px solid rgba(77,101,119,.15);\n padding-top: 24px;\n margin-top: 40px;\n line-height: 1.6;\n}\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n\n <span class=\"co-label\">Gastroenterology & Internal Medicine & Family Medicine<\/span>\n <h1>Ulc\u00e8re gastroduod\u00e9nal<\/h1>\n<style>.oc-fiche-cta{margin:8px 0 34px;padding:22px 24px;border:1.5px solid rgba(50,60,82,.15);border-left:4px solid #FF611C;border-radius:12px;background:#F4F6F8;font-family:Poppins,sans-serif}.oc-fiche-cta-t{font-size:18px;font-weight:600;color:#323C52;margin:0 0 4px;line-height:1.35}.oc-fiche-cta-x{font-size:15px;color:#4D6577;margin:0 0 14px;line-height:1.55}.oc-fiche-cta-b{display:flex;flex-wrap:wrap;gap:10px}.oc-fiche-cta-b a{display:inline-flex;align-items:center;justify-content:center;min-height:44px;padding:10px 18px;border-radius:8px;font-size:14px;font-weight:600;text-decoration:none;box-sizing:border-box}.oc-fiche-cta-b .oc-p{background:#FF611C;color:#fff}.oc-fiche-cta-b .oc-p:hover{background:#E04E0C}.oc-fiche-cta-b .oc-s{background:#fff;color:#323C52;border:1.5px solid rgba(50,60,82,.25)}@media (max-width:600px){.co-wrap h1{font-size:24px;line-height:1.25;text-transform:none}.oc-fiche-cta{padding:18px 16px}.oc-fiche-cta-b a{flex:1 1 100%}body .co-wrap > .co-table,body .co-wrap > .co-table tbody,body .co-wrap > .co-table tr,body .co-wrap > .co-table td{display:block;width:100%;box-sizing:border-box}body .co-wrap > .co-table{min-width:0;table-layout:auto}body .co-wrap > .co-table thead{display:none}body .co-wrap > .co-table tr{margin:0 0 10px;border:1px solid rgba(77,101,119,.18);border-radius:8px;overflow:hidden}body .co-wrap > .co-table td{padding:9px 12px;border:0}body .co-wrap > .co-table td:first-child{font-weight:600;color:#323C52;background:rgba(77,101,119,.07)}#ocw{transform:scale(.8);transform-origin:bottom right}}<\/style><div class=\"oc-fiche-cta\" data-oc-cta=\"fiche-haut-consult\"><p class=\"oc-fiche-cta-t\">Obtenir un avis adapt\u00e9 \u00e0 votre situation<\/p><p class=\"oc-fiche-cta-x\">Consultation en clinique ou en t\u00e9l\u00e9consultation, partout au Qu\u00e9bec.<\/p><div class=\"oc-fiche-cta-b\"><a class=\"oc-p\" href=\"https:\/\/cliniqueomicron.ca\/rendez-vous\/\">Make an appointment<\/a><a class=\"oc-s\" href=\"https:\/\/cliniqueomicron.ca\/consultation-en-ligne\/\">Consult online<\/a><a class=\"oc-s\" href=\"tel:+15146063350\">514 606-3350<\/a><\/div><\/div>\n\n\n <div class=\"co-intro\">\n L'ulc\u00e8re gastroduod\u00e9nal (UGD) est une perte de substance localis\u00e9e de la muqueuse gastrique ou duod\u00e9nale \u2014 d\u00e9passant la muscularis mucosae \u2014 r\u00e9sultant d'un d\u00e9s\u00e9quilibre entre les facteurs d'agression (acide chlorhydrique + pepsine + <em>Helicobacter pylori<\/em> + AINS + aspirin) and mucosal defense mechanisms (mucus + bicarbonate + cell turnover + prostaglandins + vascularization). With a lifelong prevalence of 5% to 10% in developed countries %, PUD remains one of the most frequent gastrointestinal conditions\u2014although its incidence has considerably decreased since the discovery of the role of'<em>H. pylori<\/em> by Marshall and Warren (Nobel laureates 2005) and the generalization of eradication treatments. The two main causes\u2014which together account for more than 90 % of cases\u2014are infection with <em>Helicobacter pylori<\/em> (bacille \u00e0 Gram n\u00e9gatif microa\u00e9rophile h\u00e9lico\u00efdal colonisant la muqueuse gastrique chez 50 % de la population mondiale + mais causant un ulc\u00e8re chez 10\u201315 % des porteurs) + et la prise d'anti-inflammatoires non st\u00e9ro\u00efdiens (AINS) et d'aspirine (inhibition des COX-1 et COX-2 \u2192 r\u00e9duction des prostaglandines cytoprotectrices \u2192 alt\u00e9ration de la barri\u00e8re muqueuse). L'ulc\u00e8re duod\u00e9nal (UD) est plus fr\u00e9quent que l'ulc\u00e8re gastrique (UG) + et survient typiquement chez des patients plus jeunes + avec une hypers\u00e9cr\u00e9tion acide + alors que l'ulc\u00e8re gastrique \u2014 dont environ 5 % des cas cachent un cancer gastrique \u2014 survient plus souvent chez les patients plus \u00e2g\u00e9s sous AINS. La distinction clinique est importante : la douleur \u00e9pigastrique de l'ulc\u00e8re duod\u00e9nal est typiquement soulag\u00e9e par les repas + alors que celle de l'ulc\u00e8re gastrique est aggrav\u00e9e par les repas.\n <\/div>\n\n <h2>Clinical presentation<\/h2>\n <ul class=\"co-list\">\n <li><strong>Ulc\u00e8re duod\u00e9nal (UD) \u2014 pr\u00e9sentation typique :<\/strong> Epigastric pain, burning or cramping, occurring 2-3 hours after meals (hunger pain), nocturnal (waking between 1 am and 3 am - highly suggestive), relieved by meals, antacids, and PPIs, meal-related, associated with acid hypersecretion, periodic (bouts of a few weeks interspersed with remissions).<\/li>\n <li><strong>Ulc\u00e8re gastrique (UG) \u2014 pr\u00e9sentation souvent atypique :<\/strong> epigastric pain + sometimes worsened by meals (unlike peptic ulcer disease) + nausea + anorexia + weight loss + more often asymptomatic (especially NSAID ulcers - \u00absilent\u00bb until complication) + presenting complication can be hemorrhage or perforation<\/li>\n <li><strong>Sympt\u00f4mes d'alarme n\u00e9cessitant une endoscopie urgente :<\/strong> h\u00e9matur\u00e8se (vomissements de sang) + m\u00e9l\u00e9na (selles noires goudronneuses) + dysphagie + odynophagie + amaigrissement significatif + an\u00e9mie ferriprive inexpliqu\u00e9e + masse palpable \u00e9pigastrique + \u00e2ge > 55\u201360 ans avec sympt\u00f4mes nouveaux<\/li>\n <li><strong>Ulc\u00e8re asymptomatique (UGD \u00absilencieux\u00bb) :<\/strong> Frequent under NSAIDs \u2192 revealed by a complication (hemorrhage + perforation) \u2192 reason why any high-risk patient on NSAIDs should receive a gastroprotective PPI<\/li>\n <\/ul>\n\n <h2>Diagnosis<\/h2>\n <ul class=\"co-list\">\n <li><strong>Gastroscopie (FOGD \u2014 fibroscopie \u0153so-gastro-duod\u00e9nale) :<\/strong> Reference examination + direct visualization + biopsies + ulcer characterization (size + location + base + edges) + systematic biopsies of any gastric ulcer (search for malignancy + 5 %of gastric ulcers are excavated cancers) + rapid urease test on biopsy (H. pylori detection + 90\u201395 % sensitivity) + NOT essential for uncomplicated duodenal ulcer in young patient without alarm symptoms if H. pylori confirmed by non-invasive test<\/li>\n <li><strong>Test respiratoire \u00e0 l'ur\u00e9e marqu\u00e9e (test UBT \u2014 Urea Breath Test) :<\/strong> Reference non-invasive test for screening and confirmation of H. pylori eradication \u2192 95% sensitivity % + 95% specificity % + patient must have stopped PPIs for \u2265 2 weeks + antibiotics for \u2265 4 weeks + bismuth for \u2265 4 weeks \u2192 test of choice for confirmation of eradication (4 weeks after end of treatment)<\/li>\n <li><strong>Antig\u00e8nes f\u00e9caux d'H. pylori :<\/strong> Non-invasive test alternative to breath test + similar sensitivity and specificity + useful if breath test is unavailable<\/li>\n <li><strong>S\u00e9rologie H. pylori (IgG anti-H. pylori) :<\/strong> of little practical use because positive even after eradication + does not distinguish between an active infection and an old infection \u2192 DO NOT use to confirm eradication<\/li>\n <\/ul>\n\n <h2>Traitement \u00e9radicateur d'H. pylori<\/h2>\n\n <table class=\"co-table\">\n <thead>\n <tr>\n <th>R\u00e9gime<\/th>\n <th>Medicines<\/th>\n <th>Duration<\/th>\n <th>Taux d'\u00e9radication<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Triple th\u00e9rapie standard (1re ligne si r\u00e9sistance clarithromycine <15 %)<\/td>\n <td>IPP (om\u00e9prazole 20 mg \u00d7 2\/j ou \u00e9quivalent) + clarithromycine 500 mg \u00d7 2\/j + amoxicilline 1 g \u00d7 2\/j<\/td>\n <td>14 days<\/td>\n <td>75\u201385 % (10 jours) \u2192 80\u201390 % (14 jours \u2014 recommand\u00e9)<\/td>\n <\/tr>\n <tr>\n <td>Quadruple th\u00e9rapie avec bismuth (1re ligne alternative ou si r\u00e9sistance clarithromycine \u00e9lev\u00e9e)<\/td>\n <td>IPP + bismuth subcitrate + m\u00e9tronidazole 500 mg \u00d7 3\/j + t\u00e9tracycline 500 mg \u00d7 4\/j (PYLERA\u00ae = combinaison fixe)<\/td>\n <td>10\u201314 jours<\/td>\n <td>85\u201395 % \u2014 traitement de choix si r\u00e9sistance \u00e0 la clarithromycine suspect\u00e9e ou prouv\u00e9e<\/td>\n <\/tr>\n <tr>\n <td>Th\u00e9rapie concomitante (alternative 1re ligne)<\/td>\n <td>IPP + clarithromycine 500 mg \u00d7 2\/j + amoxicilline 1 g \u00d7 2\/j + m\u00e9tronidazole 500 mg \u00d7 2\/j \u2014 tous les 4 pris simultan\u00e9ment<\/td>\n <td>14 days<\/td>\n <td>85\u201392 % \u2014 contourne en partie la r\u00e9sistance \u00e0 la clarithromycine<\/td>\n <\/tr>\n <tr>\n <td>Th\u00e9rapie de sauvetage (2e ligne si \u00e9chec)<\/td>\n <td>IPP + l\u00e9vofloxacine 500 mg \u00d7 1\/j + amoxicilline 1 g \u00d7 2\/j (si r\u00e9sistance \u00e0 la clarithromycine) + ou quadruple avec bismuth si non utilis\u00e9e en 1re ligne<\/td>\n <td>14 days<\/td>\n <td>Variable \u2014 id\u00e9alement antibiogramme sur culture avant 2e ligne<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>IPP dans la pr\u00e9vention des ulc\u00e8res sous AINS<\/h2>\n <ul class=\"co-list\">\n <li><strong>Indications for PPIs for gastroprotection in patients taking NSAIDs:<\/strong> \u00e2ge > 65 ans + ant\u00e9c\u00e9dent d'ulc\u00e8re ou de complications digestives + AINS \u00e0 dose \u00e9lev\u00e9e ou associations d'AINS + association AINS + anticoagulants ou antiagr\u00e9gants + association AINS + cortico\u00efdes + H. pylori positif \u2192 IPP syst\u00e9matique pendant toute la dur\u00e9e du traitement AINS<\/li>\n <li><strong>Aspirine \u00e0 faible dose (antiagr\u00e9gant) :<\/strong> Ulcer and possible digestive bleeding even at 75\u2013100 mg\/day \u2192 PPI recommended if history of ulcer or in patients at high digestive risk<\/li>\n <li><strong>Inhibiteurs s\u00e9lectifs de COX-2 (coxibs \u2014 c\u00e9l\u00e9coxib + \u00e9toricoxib) :<\/strong> less ulcerogenic than non-selective NSAIDs \u2192 but residual risk of ulcer + especially if combined with aspirin or anticoagulants \u2192 PPIs depending on risk profile<\/li>\n <li><strong>Dur\u00e9e de l'IPP :<\/strong> for the entire duration of NSAID use + if chronic NSAID use \u2192 chronic PPI<\/li>\n <\/ul>\n\n <h2>Complications<\/h2>\n <ul class=\"co-list\">\n <li><strong>H\u00e9morragie digestive haute (la plus fr\u00e9quente \u2014 15\u201320 % des UGD) :<\/strong> h\u00e9matem\u00e8se (vomissements de sang rouge ou en marc de caf\u00e9) + m\u00e9l\u00e9na (selles noires goudronneuses naus\u00e9abondes) + ou rectorragie si saignement massif + choc h\u00e9morragique + IPP IV dose \u00e9lev\u00e9e (om\u00e9prazole 80 mg bolus + 8 mg\/h perfusion) + FOGD urgente (<24 h si stable + <12 h si instable) + h\u00e9mostase endoscopique (injection adr\u00e9naline + thermocoagulation + clip h\u00e9mostatique) + classification de Forrest (risque de resaignement)<\/li>\n <li><strong>Perforation (urgence chirurgicale \u2014 5 % des UGD) :<\/strong> Sudden + intense + \u00abstabbing\u00bb abdominal pain + pneumoperitoneum (air under the diaphragm on upright chest X-ray) + abdominal guarding + peritonitis \u2192 emergency laparotomy or laparoscopy + suture of perforation + peritoneal lavage<\/li>\n <li><strong>St\u00e9nose pylorique (complication tardive \u2014 ulc\u00e8re duod\u00e9nal chronique r\u00e9cidivant) :<\/strong> late postprandial vomiting + food + projectile + weight loss + dehydration + hypokalemic alkalosis (vomiting of HCl) \u2192 endoscopic dilatation + or surgery<\/li>\n <li><strong>D\u00e9g\u00e9n\u00e9rescence maligne (uniquement ulc\u00e8re gastrique) :<\/strong> 5% of gastric ulcers are cancers \u2192 systematic biopsies of any gastric ulcer + endoscopic healing control at 6\u20138 weeks<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2119\ufe0f<\/span>\n <span>La confirmation de l'\u00e9radication d'H. pylori est indispensable apr\u00e8s tout traitement \u00e9radicateur \u2014 elle doit \u00eatre r\u00e9alis\u00e9e par un test non invasif (test respiratoire \u00e0 l'ur\u00e9e ou antig\u00e8nes f\u00e9caux) au moins 4 semaines apr\u00e8s la fin des antibiotiques + et au moins 2 semaines apr\u00e8s l'arr\u00eat des IPP. Les IPP faussent les tests en r\u00e9duisant artificiellement la charge bact\u00e9rienne. La s\u00e9rologie IgG anti-H. pylori reste positive longtemps apr\u00e8s l'\u00e9radication et ne peut pas \u00eatre utilis\u00e9e pour confirmer l'\u00e9radication.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Urgence digestive \u2014 composer le 911<\/div>\n <p>Composer le 911 ou se rendre imm\u00e9diatement aux urgences si des vomissements de sang + des selles noires goudronneuses + une douleur abdominale brutale en \u00abcoup de poignard\u00bb + ou un \u00e9tat de choc (p\u00e2leur + sueurs + tachycardie + hypotension) apparaissent \u2014 ces signes \u00e9voquent une h\u00e9morragie digestive haute ou une perforation d'ulc\u00e8re n\u00e9cessitant une prise en charge urgente en endoscopie ou en chirurgie. Pour le diagnostic et le traitement ambulatoire de l'UGD non compliqu\u00e9, Clinique Omicron offre des consultations m\u00e9dicales dans ses points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#c0392b;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Les m\u00e9decins et infirmiers praticiens sp\u00e9cialis\u00e9s (IPS) de Clinique Omicron prescrivent le test respiratoire \u00e0 l'ur\u00e9e (UBT) ou les antig\u00e8nes f\u00e9caux pour le d\u00e9pistage d'H. pylori, initient la triple th\u00e9rapie ou la quadruple th\u00e9rapie selon le profil de r\u00e9sistance local, confirment l'\u00e9radication \u00e0 4 semaines post-antibiotiques, prescrivent l'IPP gastroprotecteur chez les patients \u00e0 risque sous AINS, orientent vers la gastroent\u00e9rologie pour la FOGD si sympt\u00f4mes d'alarme + ou si ulc\u00e8re gastrique (biopsies malignit\u00e9), et assurent le suivi de la cicatrisation. Des consultations sont disponibles dans plusieurs points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#4D6577;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">Le contenu de cette page est fourni \u00e0 titre informatif uniquement et ne remplace pas l'avis d'un m\u00e9decin ou d'un gastroent\u00e9rologue. Tout ulc\u00e8re gastrique doit faire l'objet de biopsies syst\u00e9matiques et d'un contr\u00f4le endoscopique de cicatrisation \u00e0 6\u20138 semaines pour exclure une malignit\u00e9. La s\u00e9rologie IgG anti-H. pylori ne doit pas \u00eatre utilis\u00e9e pour confirmer l'\u00e9radication \u2014 utiliser le test respiratoire ou les antig\u00e8nes f\u00e9caux 4 semaines apr\u00e8s la fin du traitement.<\/p>\n\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Ulc\u00e8re gastroduod\u00e9nal : Helicobacter pylori, AINS et traitement | Clinique Omicron Gastroent\u00e9rologie & M\u00e9decine interne & M\u00e9decine de famille Ulc\u00e8re gastroduod\u00e9nal L’ulc\u00e8re gastroduod\u00e9nal (UGD) est une perte de substance localis\u00e9e de la muqueuse gastrique ou duod\u00e9nale \u2014 d\u00e9passant la muscularis mucosae \u2014 r\u00e9sultant d’un d\u00e9s\u00e9quilibre entre les facteurs d’agression (acide chlorhydrique + pepsine + Helicobacter… <a href=\"https:\/\/cliniqueomicron.ca\/en\/ulcere-gastrique\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Gastroduodenal Ulcer: Helicobacter pylori, NSAIDs, and Treatment | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Ulc\u00e8re gastroduod\u00e9nal | Brossard | Clinique Omicron","_metasync_otto_description":"Ulc\u00e8re gastroduod\u00e9nal Ulc\u00e8re gastroduod\u00e9nal est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels...","_metasync_otto_keywords":"ulcere gastrique, Clinique Omicron, clinique m\u00e9dicale Qu\u00e9bec, m\u00e9decin g\u00e9n\u00e9raliste Montr\u00e9al, Qu\u00e9bec","_metasync_otto_og_title":"Ulcere Gastrique | Clinique Omicron Qu\u00e9bec","_metasync_otto_og_description":"Ulc\u00e8re gastroduod\u00e9nal Ulc\u00e8re gastroduod\u00e9nal est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels...","_metasync_otto_twitter_title":"Ulcere Gastrique | Clinique Omicron","_metasync_otto_twitter_description":"Ulc\u00e8re gastroduod\u00e9nal Ulc\u00e8re gastroduod\u00e9nal est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. 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color: #8a9aaa;\n font-style: italic;\n border-top: 1px solid rgba(77,101,119,.15);\n padding-top: 24px;\n margin-top: 40px;\n line-height: 1.6;\n}\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n\n <span class=\"co-label\">Gastroenterology & Internal Medicine & Family Medicine<\/span>\n <h1>Ulc\u00e8re gastroduod\u00e9nal<\/h1>\n<style>.oc-fiche-cta{margin:8px 0 34px;padding:22px 24px;border:1.5px solid rgba(50,60,82,.15);border-left:4px solid #FF611C;border-radius:12px;background:#F4F6F8;font-family:Poppins,sans-serif}.oc-fiche-cta-t{font-size:18px;font-weight:600;color:#323C52;margin:0 0 4px;line-height:1.35}.oc-fiche-cta-x{font-size:15px;color:#4D6577;margin:0 0 14px;line-height:1.55}.oc-fiche-cta-b{display:flex;flex-wrap:wrap;gap:10px}.oc-fiche-cta-b a{display:inline-flex;align-items:center;justify-content:center;min-height:44px;padding:10px 18px;border-radius:8px;font-size:14px;font-weight:600;text-decoration:none;box-sizing:border-box}.oc-fiche-cta-b .oc-p{background:#FF611C;color:#fff}.oc-fiche-cta-b .oc-p:hover{background:#E04E0C}.oc-fiche-cta-b .oc-s{background:#fff;color:#323C52;border:1.5px solid rgba(50,60,82,.25)}@media (max-width:600px){.co-wrap h1{font-size:24px;line-height:1.25;text-transform:none}.oc-fiche-cta{padding:18px 16px}.oc-fiche-cta-b a{flex:1 1 100%}body .co-wrap > .co-table,body .co-wrap > .co-table tbody,body .co-wrap > .co-table tr,body .co-wrap > .co-table td{display:block;width:100%;box-sizing:border-box}body .co-wrap > .co-table{min-width:0;table-layout:auto}body .co-wrap > .co-table thead{display:none}body .co-wrap > .co-table tr{margin:0 0 10px;border:1px solid rgba(77,101,119,.18);border-radius:8px;overflow:hidden}body .co-wrap > .co-table td{padding:9px 12px;border:0}body .co-wrap > .co-table td:first-child{font-weight:600;color:#323C52;background:rgba(77,101,119,.07)}#ocw{transform:scale(.8);transform-origin:bottom right}}<\/style><div class=\"oc-fiche-cta\" data-oc-cta=\"fiche-haut-consult\"><p class=\"oc-fiche-cta-t\">Obtenir un avis adapt\u00e9 \u00e0 votre situation<\/p><p class=\"oc-fiche-cta-x\">Consultation en clinique ou en t\u00e9l\u00e9consultation, partout au Qu\u00e9bec.<\/p><div class=\"oc-fiche-cta-b\"><a class=\"oc-p\" href=\"https:\/\/cliniqueomicron.ca\/rendez-vous\/\">Make an appointment<\/a><a class=\"oc-s\" href=\"https:\/\/cliniqueomicron.ca\/consultation-en-ligne\/\">Consult online<\/a><a class=\"oc-s\" href=\"tel:+15146063350\">514 606-3350<\/a><\/div><\/div>\n\n\n <div class=\"co-intro\">\n L'ulc\u00e8re gastroduod\u00e9nal (UGD) est une perte de substance localis\u00e9e de la muqueuse gastrique ou duod\u00e9nale \u2014 d\u00e9passant la muscularis mucosae \u2014 r\u00e9sultant d'un d\u00e9s\u00e9quilibre entre les facteurs d'agression (acide chlorhydrique + pepsine + <em>Helicobacter pylori<\/em> + AINS + aspirin) and mucosal defense mechanisms (mucus + bicarbonate + cell turnover + prostaglandins + vascularization). With a lifelong prevalence of 5% to 10% in developed countries %, PUD remains one of the most frequent gastrointestinal conditions\u2014although its incidence has considerably decreased since the discovery of the role of'<em>H. pylori<\/em> by Marshall and Warren (Nobel laureates 2005) and the generalization of eradication treatments. The two main causes\u2014which together account for more than 90 % of cases\u2014are infection with <em>Helicobacter pylori<\/em> (bacille \u00e0 Gram n\u00e9gatif microa\u00e9rophile h\u00e9lico\u00efdal colonisant la muqueuse gastrique chez 50 % de la population mondiale + mais causant un ulc\u00e8re chez 10\u201315 % des porteurs) + et la prise d'anti-inflammatoires non st\u00e9ro\u00efdiens (AINS) et d'aspirine (inhibition des COX-1 et COX-2 \u2192 r\u00e9duction des prostaglandines cytoprotectrices \u2192 alt\u00e9ration de la barri\u00e8re muqueuse). L'ulc\u00e8re duod\u00e9nal (UD) est plus fr\u00e9quent que l'ulc\u00e8re gastrique (UG) + et survient typiquement chez des patients plus jeunes + avec une hypers\u00e9cr\u00e9tion acide + alors que l'ulc\u00e8re gastrique \u2014 dont environ 5 % des cas cachent un cancer gastrique \u2014 survient plus souvent chez les patients plus \u00e2g\u00e9s sous AINS. La distinction clinique est importante : la douleur \u00e9pigastrique de l'ulc\u00e8re duod\u00e9nal est typiquement soulag\u00e9e par les repas + alors que celle de l'ulc\u00e8re gastrique est aggrav\u00e9e par les repas.\n <\/div>\n\n <h2>Clinical presentation<\/h2>\n <ul class=\"co-list\">\n <li><strong>Ulc\u00e8re duod\u00e9nal (UD) \u2014 pr\u00e9sentation typique :<\/strong> Epigastric pain, burning or cramping, occurring 2-3 hours after meals (hunger pain), nocturnal (waking between 1 am and 3 am - highly suggestive), relieved by meals, antacids, and PPIs, meal-related, associated with acid hypersecretion, periodic (bouts of a few weeks interspersed with remissions).<\/li>\n <li><strong>Ulc\u00e8re gastrique (UG) \u2014 pr\u00e9sentation souvent atypique :<\/strong> epigastric pain + sometimes worsened by meals (unlike peptic ulcer disease) + nausea + anorexia + weight loss + more often asymptomatic (especially NSAID ulcers - \u00absilent\u00bb until complication) + presenting complication can be hemorrhage or perforation<\/li>\n <li><strong>Sympt\u00f4mes d'alarme n\u00e9cessitant une endoscopie urgente :<\/strong> h\u00e9matur\u00e8se (vomissements de sang) + m\u00e9l\u00e9na (selles noires goudronneuses) + dysphagie + odynophagie + amaigrissement significatif + an\u00e9mie ferriprive inexpliqu\u00e9e + masse palpable \u00e9pigastrique + \u00e2ge > 55\u201360 ans avec sympt\u00f4mes nouveaux<\/li>\n <li><strong>Ulc\u00e8re asymptomatique (UGD \u00absilencieux\u00bb) :<\/strong> Frequent under NSAIDs \u2192 revealed by a complication (hemorrhage + perforation) \u2192 reason why any high-risk patient on NSAIDs should receive a gastroprotective PPI<\/li>\n <\/ul>\n\n <h2>Diagnosis<\/h2>\n <ul class=\"co-list\">\n <li><strong>Gastroscopie (FOGD \u2014 fibroscopie \u0153so-gastro-duod\u00e9nale) :<\/strong> Reference examination + direct visualization + biopsies + ulcer characterization (size + location + base + edges) + systematic biopsies of any gastric ulcer (search for malignancy + 5 %of gastric ulcers are excavated cancers) + rapid urease test on biopsy (H. pylori detection + 90\u201395 % sensitivity) + NOT essential for uncomplicated duodenal ulcer in young patient without alarm symptoms if H. pylori confirmed by non-invasive test<\/li>\n <li><strong>Test respiratoire \u00e0 l'ur\u00e9e marqu\u00e9e (test UBT \u2014 Urea Breath Test) :<\/strong> Reference non-invasive test for screening and confirmation of H. pylori eradication \u2192 95% sensitivity % + 95% specificity % + patient must have stopped PPIs for \u2265 2 weeks + antibiotics for \u2265 4 weeks + bismuth for \u2265 4 weeks \u2192 test of choice for confirmation of eradication (4 weeks after end of treatment)<\/li>\n <li><strong>Antig\u00e8nes f\u00e9caux d'H. pylori :<\/strong> Non-invasive test alternative to breath test + similar sensitivity and specificity + useful if breath test is unavailable<\/li>\n <li><strong>S\u00e9rologie H. pylori (IgG anti-H. pylori) :<\/strong> of little practical use because positive even after eradication + does not distinguish between an active infection and an old infection \u2192 DO NOT use to confirm eradication<\/li>\n <\/ul>\n\n <h2>Traitement \u00e9radicateur d'H. pylori<\/h2>\n\n <table class=\"co-table\">\n <thead>\n <tr>\n <th>R\u00e9gime<\/th>\n <th>Medicines<\/th>\n <th>Duration<\/th>\n <th>Taux d'\u00e9radication<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Triple th\u00e9rapie standard (1re ligne si r\u00e9sistance clarithromycine <15 %)<\/td>\n <td>IPP (om\u00e9prazole 20 mg \u00d7 2\/j ou \u00e9quivalent) + clarithromycine 500 mg \u00d7 2\/j + amoxicilline 1 g \u00d7 2\/j<\/td>\n <td>14 days<\/td>\n <td>75\u201385 % (10 jours) \u2192 80\u201390 % (14 jours \u2014 recommand\u00e9)<\/td>\n <\/tr>\n <tr>\n <td>Quadruple th\u00e9rapie avec bismuth (1re ligne alternative ou si r\u00e9sistance clarithromycine \u00e9lev\u00e9e)<\/td>\n <td>IPP + bismuth subcitrate + m\u00e9tronidazole 500 mg \u00d7 3\/j + t\u00e9tracycline 500 mg \u00d7 4\/j (PYLERA\u00ae = combinaison fixe)<\/td>\n <td>10\u201314 jours<\/td>\n <td>85\u201395 % \u2014 traitement de choix si r\u00e9sistance \u00e0 la clarithromycine suspect\u00e9e ou prouv\u00e9e<\/td>\n <\/tr>\n <tr>\n <td>Th\u00e9rapie concomitante (alternative 1re ligne)<\/td>\n <td>IPP + clarithromycine 500 mg \u00d7 2\/j + amoxicilline 1 g \u00d7 2\/j + m\u00e9tronidazole 500 mg \u00d7 2\/j \u2014 tous les 4 pris simultan\u00e9ment<\/td>\n <td>14 days<\/td>\n <td>85\u201392 % \u2014 contourne en partie la r\u00e9sistance \u00e0 la clarithromycine<\/td>\n <\/tr>\n <tr>\n <td>Th\u00e9rapie de sauvetage (2e ligne si \u00e9chec)<\/td>\n <td>IPP + l\u00e9vofloxacine 500 mg \u00d7 1\/j + amoxicilline 1 g \u00d7 2\/j (si r\u00e9sistance \u00e0 la clarithromycine) + ou quadruple avec bismuth si non utilis\u00e9e en 1re ligne<\/td>\n <td>14 days<\/td>\n <td>Variable \u2014 id\u00e9alement antibiogramme sur culture avant 2e ligne<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>IPP dans la pr\u00e9vention des ulc\u00e8res sous AINS<\/h2>\n <ul class=\"co-list\">\n <li><strong>Indications for PPIs for gastroprotection in patients taking NSAIDs:<\/strong> \u00e2ge > 65 ans + ant\u00e9c\u00e9dent d'ulc\u00e8re ou de complications digestives + AINS \u00e0 dose \u00e9lev\u00e9e ou associations d'AINS + association AINS + anticoagulants ou antiagr\u00e9gants + association AINS + cortico\u00efdes + H. pylori positif \u2192 IPP syst\u00e9matique pendant toute la dur\u00e9e du traitement AINS<\/li>\n <li><strong>Aspirine \u00e0 faible dose (antiagr\u00e9gant) :<\/strong> Ulcer and possible digestive bleeding even at 75\u2013100 mg\/day \u2192 PPI recommended if history of ulcer or in patients at high digestive risk<\/li>\n <li><strong>Inhibiteurs s\u00e9lectifs de COX-2 (coxibs \u2014 c\u00e9l\u00e9coxib + \u00e9toricoxib) :<\/strong> less ulcerogenic than non-selective NSAIDs \u2192 but residual risk of ulcer + especially if combined with aspirin or anticoagulants \u2192 PPIs depending on risk profile<\/li>\n <li><strong>Dur\u00e9e de l'IPP :<\/strong> for the entire duration of NSAID use + if chronic NSAID use \u2192 chronic PPI<\/li>\n <\/ul>\n\n <h2>Complications<\/h2>\n <ul class=\"co-list\">\n <li><strong>H\u00e9morragie digestive haute (la plus fr\u00e9quente \u2014 15\u201320 % des UGD) :<\/strong> h\u00e9matem\u00e8se (vomissements de sang rouge ou en marc de caf\u00e9) + m\u00e9l\u00e9na (selles noires goudronneuses naus\u00e9abondes) + ou rectorragie si saignement massif + choc h\u00e9morragique + IPP IV dose \u00e9lev\u00e9e (om\u00e9prazole 80 mg bolus + 8 mg\/h perfusion) + FOGD urgente (<24 h si stable + <12 h si instable) + h\u00e9mostase endoscopique (injection adr\u00e9naline + thermocoagulation + clip h\u00e9mostatique) + classification de Forrest (risque de resaignement)<\/li>\n <li><strong>Perforation (urgence chirurgicale \u2014 5 % des UGD) :<\/strong> Sudden + intense + \u00abstabbing\u00bb abdominal pain + pneumoperitoneum (air under the diaphragm on upright chest X-ray) + abdominal guarding + peritonitis \u2192 emergency laparotomy or laparoscopy + suture of perforation + peritoneal lavage<\/li>\n <li><strong>St\u00e9nose pylorique (complication tardive \u2014 ulc\u00e8re duod\u00e9nal chronique r\u00e9cidivant) :<\/strong> late postprandial vomiting + food + projectile + weight loss + dehydration + hypokalemic alkalosis (vomiting of HCl) \u2192 endoscopic dilatation + or surgery<\/li>\n <li><strong>D\u00e9g\u00e9n\u00e9rescence maligne (uniquement ulc\u00e8re gastrique) :<\/strong> 5% of gastric ulcers are cancers \u2192 systematic biopsies of any gastric ulcer + endoscopic healing control at 6\u20138 weeks<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2119\ufe0f<\/span>\n <span>La confirmation de l'\u00e9radication d'H. pylori est indispensable apr\u00e8s tout traitement \u00e9radicateur \u2014 elle doit \u00eatre r\u00e9alis\u00e9e par un test non invasif (test respiratoire \u00e0 l'ur\u00e9e ou antig\u00e8nes f\u00e9caux) au moins 4 semaines apr\u00e8s la fin des antibiotiques + et au moins 2 semaines apr\u00e8s l'arr\u00eat des IPP. Les IPP faussent les tests en r\u00e9duisant artificiellement la charge bact\u00e9rienne. La s\u00e9rologie IgG anti-H. pylori reste positive longtemps apr\u00e8s l'\u00e9radication et ne peut pas \u00eatre utilis\u00e9e pour confirmer l'\u00e9radication.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Urgence digestive \u2014 composer le 911<\/div>\n <p>Composer le 911 ou se rendre imm\u00e9diatement aux urgences si des vomissements de sang + des selles noires goudronneuses + une douleur abdominale brutale en \u00abcoup de poignard\u00bb + ou un \u00e9tat de choc (p\u00e2leur + sueurs + tachycardie + hypotension) apparaissent \u2014 ces signes \u00e9voquent une h\u00e9morragie digestive haute ou une perforation d'ulc\u00e8re n\u00e9cessitant une prise en charge urgente en endoscopie ou en chirurgie. Pour le diagnostic et le traitement ambulatoire de l'UGD non compliqu\u00e9, Clinique Omicron offre des consultations m\u00e9dicales dans ses points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#c0392b;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Les m\u00e9decins et infirmiers praticiens sp\u00e9cialis\u00e9s (IPS) de Clinique Omicron prescrivent le test respiratoire \u00e0 l'ur\u00e9e (UBT) ou les antig\u00e8nes f\u00e9caux pour le d\u00e9pistage d'H. pylori, initient la triple th\u00e9rapie ou la quadruple th\u00e9rapie selon le profil de r\u00e9sistance local, confirment l'\u00e9radication \u00e0 4 semaines post-antibiotiques, prescrivent l'IPP gastroprotecteur chez les patients \u00e0 risque sous AINS, orientent vers la gastroent\u00e9rologie pour la FOGD si sympt\u00f4mes d'alarme + ou si ulc\u00e8re gastrique (biopsies malignit\u00e9), et assurent le suivi de la cicatrisation. Des consultations sont disponibles dans plusieurs points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#4D6577;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">Le contenu de cette page est fourni \u00e0 titre informatif uniquement et ne remplace pas l'avis d'un m\u00e9decin ou d'un gastroent\u00e9rologue. Tout ulc\u00e8re gastrique doit faire l'objet de biopsies syst\u00e9matiques et d'un contr\u00f4le endoscopique de cicatrisation \u00e0 6\u20138 semaines pour exclure une malignit\u00e9. La s\u00e9rologie IgG anti-H. pylori ne doit pas \u00eatre utilis\u00e9e pour confirmer l'\u00e9radication \u2014 utiliser le test respiratoire ou les antig\u00e8nes f\u00e9caux 4 semaines apr\u00e8s la fin du traitement.<\/p>\n\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Ulc\u00e8re gastroduod\u00e9nal : Helicobacter pylori, AINS et traitement | Clinique Omicron Gastroent\u00e9rologie & M\u00e9decine interne & M\u00e9decine de famille Ulc\u00e8re gastroduod\u00e9nal L’ulc\u00e8re gastroduod\u00e9nal (UGD) est une perte de substance localis\u00e9e de la muqueuse gastrique ou duod\u00e9nale \u2014 d\u00e9passant la muscularis mucosae \u2014 r\u00e9sultant d’un d\u00e9s\u00e9quilibre entre les facteurs d’agression (acide chlorhydrique + pepsine + Helicobacter… <a href=\"https:\/\/cliniqueomicron.ca\/en\/ulcere-gastrique\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Gastroduodenal Ulcer: Helicobacter pylori, NSAIDs, and Treatment | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Ulc\u00e8re gastroduod\u00e9nal | Brossard | Clinique Omicron","_metasync_otto_description":"Ulc\u00e8re gastroduod\u00e9nal Ulc\u00e8re gastroduod\u00e9nal est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. 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