Actinomyces bouchesdurhonensis sp. nov. and Actinomyces mediterranea sp. nov., isolated from human stomach and duodenum

We propose here the main characteristics of the new bacteria Actinomyces bouchesdurhonensis strain Marseille-P2825 (CSUR P2825) isolated from a gastric liquid sample of a 60-year-old man and Actinomyces mediterranea strain Marseille-P3257 (CSUR P3257) isolated from a duodenal liquid sample of a 76-year-old woman. Keywords: Culturomics, Taxonogenomics, Gut microbiota, Actinomyces bouchesdurhonensis, Actinomyces mediterrane

CON-COUR study: Interferential therapy in the treatment of chronic constipation in adults: study protocol for a randomized controlled trial

International audienceBackground: The prevalence of chronic constipation is about 15 % in Western countries with a significant impact on quality of life and health care costs. The first-line therapy, based on medical treatment combined with laxatives and dietary rules, is often disappointing. Interferential therapy is a new treatment that has demonstrated its efficiency in the treatment of chronic constipation in children and encouraging results in adults. The primary objective of this study is to assess the efficacy of interferential therapy during 8 weeks in adult patients. The secondary objectives are to assess this new and noninvasive therapy in terms of persistence of the clinical efficacy, colonic transit time, ano-rectal manometry, patient satisfaction and quality of life (QoL), and tolerance. Methods/ Design: Design: multicenter, prospective, randomized, placebo-controlled, double blind, two-parallel groups study. Setting: nine French adult gastroenterology centers. Inclusion criteria: adult patients with a history of chronic constipation refractory to medical treatment for at least 3 months. Treatment groups: (1) interferential-experimental group (effective stimulation); (2) placebo-control group (sham stimulation). Randomization: 1:1 allocation ratio. Evaluation times: inclusion (T0, randomization), baseline assessment (T1), start of stimulation (T2), intermediary assessment (T3, 4 weeks), end of stimulation (T4, 8 weeks), follow-up (T5 and T6, 1- and 6-month). Endpoints: (1) primary: short-term efficacy at T4 (treatment response defined as three or more spontaneous, complete bowel movements per week); (2) secondary: efficacy at T5 and T6, symptoms (Patient Assessment of Constipation Symptoms questionnaire), colonic transit time, anorectal manometry, patient satisfaction (analogical visual scale), patient QoL (Patient Assessment of Constipation Quality of Life Questionnaire), side/unexpected effects. Sample size: 200 individuals to obtain 80 % power to detect a 20 % difference in treatment response at T4 between the two groups (15 % of lost to follow-up patients expected). Discussion: The randomized, double-blind, placebo-controlled design is the most appropriate to demonstrate the efficacy of a new experimental therapeutic (Evidence-Based Medicine Working Group classification). National and international recommendations could be updated based on the findings of this study

Complications of submucosal endoscopy

International audienceSubmucosal endoscopy essentially regroups peroral endoscopic esophageal ă myotomy (POEM) and, more recently, pyloromyotomy and tunnel tumor ă resections. The complication rate of POEM is between 5% and 10%. ă Complications include gas-related complications, mucosal tears, and ă bleeding, and are usually managed conservatively or with non-surgical ă procedures. Only one case of death has been reported. The most commonly ă identified risk factors for complicated procedures in POEM are short ă experience with the technique and sigmoid-type esophagus. The rate of ă gastro-esophageal reflux (GERD) is between 10% and 30% depending on ă the definitions, with a good clinical response to proton pump ă inhibitors. For the techniques other than POEM, the number of cases ă reported is too small to allow identification of the complications, ă which, in addition, probably vary depending on the organ involved. ă The management of gas-related complications is conservative and ă sometimes requiring percutaneous exsufflation (capnoperitoneum) or ă drainage. The endoscopic management of mucosal tears essentially ă involves clip placement and, in case of bleeding, the usual hemostasis ă techniques including stent placement. Importantly, following a rigorous ă and appropriate learning program is essential to minimize the risk of ă complications, particularly for specialists with a short experience in ă the technique. (C) 2016 Elsevier Ltd. All rights reserved

An Involuntary and Unexpected Treatment of Nutcracker Esophagus

International audienceA 76-year-old woman complained of painful dysphagia and loss of weight. Esophagoscopy results were negative, whereas computed tomography (CT) disclosed a 25-mm mediastinal tumor without a connection to the esophagus. A diagnosis of nutcracker esophagus was made on high-resolution esophageal manometry. Peroral endoscopic esophageal myotomy failed to improve the symptoms. Right video thoracoscopy allowed resection of the tumor, which looked like a neurogenic tumor of the posterior mediastinum that developed from the right vagus nerve. The patient's dysphagia dramatically improved postoperatively. Because the pathologic examination disclosed a benign solitary fibrous tumor of the pleura, we hypothesize that the motility disorder would have been resolved by the unilateral vagotomy. (C) 2017 by The Society of Thoracic Surgeon

“Duodenibacillus massiliensis” gen. nov., sp. nov., a new species identified in the human duodenum

International audienceno abstrac

“Tidjanibacter massiliensis” gen. nov., sp. nov., a new bacterial species isolated from the human colon

International audienceno abstrac

“Tidjanibacter massiliensis” gen. nov., sp. nov., a new bacterial species isolated from the human colon

International audienceno abstrac

Autochthonous Infections with Hepatitis E Virus Genotype 4, France

During January–March 2011, diagnoses of hepatitis E virus (HEV) infection increased in Marseille University hospitals in southeastern France. HEV genotype 4, which is described almost exclusively in Asia, was recovered from 2 persons who ate uncooked pork liver sausage. Genetic sequences were 96.7% identical to those recently described in swine in Europe

First European human gastric peroral endoscopic myotomy, for treatment of refractory gastroparesis

We have therefore carried out G-POEM in a 51-year-old diabetic woman who suffered from disabling and refractory clinical gastroparesis; this was confirmed with by gastric emptying scintigraphy that showed an increased gastric emptying half-time

Gastric per-oral endoscopic myotomy with antropyloromyotomy in the treatment of refractory gastroparesis: clinical experience with follow-up and scintigraphic evaluation (with video)

International audienceBACKGROUND AND AIMS: Gastroparesis is a chronic, debilitating condition. We report an experience conducting gastric per-oral endoscopic pyloromyotomy (G-POEM) with objectives to assess clinical efficacy, gastric emptying evolution, and procedural adverse events.ăMETHODS: This was a clinical pilot series on 12 consecutive patients who underwent G-POEM for refractory gastroparesis in our tertiary center between February 2014 and August 2015. Patients included had severe disease as defined by elevated Gastroparesis Cardinal Symptoms Index (GCSI) score and delayed gastric emptying scintigraphy (GES). G-POEM was performed by mucosal incision upstream the pylorus followed by submucosal tunnel and antropyloromyotomy with subsequent access closure. Efficacy was assessed at 5 days, 1 month, and 3 months, based on GCSI score, and individualizing (Likert scale) the main symptoms (nausea, vomiting, abdominal pain, early satiety, and anorexia). GES was performed 2 months after the procedure.ăRESULTS: G-POEM was successfully performed in all 12 patients, yielding a technical success rate of 100%. Significant improvements in GCSI were observed: 3.5 ± .8 versus .9 ± .9 (1 month) and 1.1 ± 1.5 (3 months), respectively (P \textless .001), as well as the severity of main symptoms at 3 months. Clinical efficacy was 85% (10/12). GES normalized in 75% of cases, with improvement of half emptying time (222 ± 90 minutes vs 133 ± 90 minutes; P = .03) and retention at 2 hours (76% ± 20% vs 44% ± 26%; P = .009). There were no adverse events related to the procedure.ăCONCLUSION: We report a single-center study evaluating G-POEM for refractory gastroparesis, demonstrating its feasibility, reproducibility, and safety with promising clinical and scintigraphic efficacy