Présentation clinique et histoire naturelle des Maladies Inflammatoires Chroniques de l'Intestin diagnostiquées après l'âge de 60 ans

Le vieillissement de la population fait des maladies inflammatoires chroniques de l'intestin (MICI) d'apparition tardive un problème d'actualité. Les données de la littérature concernant l'épidémiologie et l'histoire naturelle des MICI chez les sujets de plus de 60 ans sont mal connues. Objectifs : Etudier en population générale les caractéristiques au diagnostic, l'évolution, et les traitements reçus par les sujets atteints de MICI d'apparition tardive. Patients et méthodes : Cette étude a utilisé les données issues du registre EPIMAD, qui recense prospectivement tous les cas incidents de MICI dans 4 départements français, des sujets âgés de 60 ans et plus, entre 1988 et 2006 Résultats : 841 patients ont été inclus, dont 44% de maladie de Crohn (MC) et 56% de rectocolite hémorragique (RCH). Au cours de la MC, la répartition des formes iléales (L1) / coliques (L2) / iléo-coliques (L3) était de 10/65/25% des cas. Les types inflammatoire (B1) / sténosant (B2) / pénétrant (B3) représentaient 78/17/5% des cas. Seuls 14% des patients présentaient une progression du phénotype au cours du suivi. Les patients recevaient des ' corticoïdes, des immunosuppresseurs (1S) et des anti-TNFŒ dans 41%, 23% et 7% des cas. Une résection intestinale était pratiquée chez 28% et une stomie définitive chez 7% des patients. Un type compliqué (B2 ou B3) était un facteur de risque de résection (HR=2.6), alors que la corticothérapie était protectrice (HR=0,5). Au cours de la RCH, la répartition des formes rectales (El) / coliques gauches (E2) / coliques étendues (E3) était de 29/45/26% des cas. Chez 84% des sujets, la topographie ne s'étendait pas au cours du suivi. Les patients recevaient des corticoïdes, des IS et des anti-TNFŒ dans 33%, 12% et 1% des cas. Une colectomie était pratiquée chez 7% des patients. Le risque chirurgical était augmenté en cas de corticothérapie préalable (HR-2,2). Conclusion : Notre étude a mis en évidence des caractéristiques spécifiques des MICI lorsqu'elles débutent après l'âge de 60 ans, tant dans leur présentation clinique que dans leur évolution.ROUEN-BU Médecine-Pharmacie (765402102) / SudocSudocFranceF

Abdominopelvic CT-scan in emergency departments for patients with suspected complications of Crohn’s disease: a single tertiary center experience

International audienceBackground: Crohn's disease (CD) is a chronic disorder with frequent complications. The objective of this study was to assess the predictive factors of finding a complication of CD using abdominopelvic CT-scan in patients with a visit to the emergency department. Methods: Patients with at least one visit to the gastroenterology department of our University hospital during the year with a CD were retrospectively included. All visits to the emergency department of the hospital during the follow-up of these patients were identified. Results: A total of 638 patients were included and 318 (49.8%) had at least one visit to the emergency department since the beginning of their follow-up. Abdominopelvic CT-scan was performed in 141 (23.7%) of the 595 visits for digestive symptoms. Only 4.3% of these CT-scans were considered as normal; there was luminal inflammation without complication in 24.8%, abscess, fistula or perforation in 22.7%, mechanical bowel obstruction in 36.9% and diagnosis unrelated to CD in 11.3%. In univariate analysis, stricturing phenotype (OR, 2.48; 95% CI, 1.16-5.29; p = 0.02) and previous surgery (OR, 2.90; 95% CI, 1.37-6.14; p = 0.005) were predictive factors of finding a complication of CD using abdominopelvic CT-scan, whereas no independent predictive factor was statistically significant in multivariate analysis. Conclusion: In CD patients consulting in emergency department, CT-scan examination was performed in 24% of visits for digestive symptoms and complications of CD were found in 60%. Complications were more frequent in patients with stricturing phenotype and previous surgery

Dietary n-3 PUFA May Attenuate Experimental Colitis

International audienceBackground. Inflammatory bowel diseases (IBD) occurred in genetically predisposed people exposed to environmental triggers. Diet has long been suspected to contribute to the development of IBD. Supplementation with n-3 polyunsaturated fatty acids (PUFA) protects against intestinal inflammation in rodent models while clinical trials showed no benefits. We hypothesized that intervention timing is crucial and dietary fatty acid pattern may influence intestinal environment to modify inflammation genesis. The aim of this study was to evaluate the dietary effect of PUFA composition on intestinal inflammation. Methods. Animals received diet varying in their PUFA composition for four weeks before TNBS-induced colitis. Colon inflammatory markers and gut barrier function parameters were assessed. Inflammatory pathway PCR arrays were determined. Results. n-3 diet significantly decreased colon iNOS, COX-2 expression, IL-6 production, and LTB4 production but tended to decrease colon TNFα production () compared to control diet. Tight junction protein (claudin-1, occludin) expressions and MUC2 and TFF3 mRNA levels were not different among groups. n-9 diet also decreased colon IL-6 production (). Conclusions. Dietary n-3 PUFA influence colitis development by attenuating inflammatory markers. Further research is required to better define dietary advice with a scientific rationale

Deep remission on magnetic resonance imaging impacts outcomes of perianal fistulizing Crohn’s disease

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Cancer in Elderly Onset Inflammatory Bowel Disease: A Population-Based Study

IF 10.383International audienceOBJECTIVES:Cancer may be a complication of inflammatory bowel disease (IBD) or its treatment. In elderly onset IBD patients the risk of malignancy is of particular concern. We studied this risk in a population-based cohort of elderly onset IBD patients.METHODS:In a French population-based cohort, we identified 844 patients aged >60 years at IBD diagnosis from 1988 to 2006, including 370 Crohn's disease (CD) and 474 ulcerative colitis (UC). We compared incidence of cancer among IBD patients with that observed in the French Network of population-based Cancer Registries (FRANCIM). Confidence interval (CI) was estimated assuming a Poisson-specific law for rare events. Results were expressed using the standardized incidence ratios (SIRs) and their CI 95%.RESULTS:Median age at IBD diagnosis was 70 (65-76) years in CD and 69 (64-74) in UC. Median follow-up was 6 (2-11) years for both diseases with a number of person-years of 5,598. Among the 844 elderly onset IBD cases, 98 (11.6%; 42 CD and 56 UC) developed a cancer after IBD diagnosis (67 men and 31 women) corresponding to an overall SIR of 0.97 (0.80-1.18). These cancers occurred at a median age of 77 years (71-80) and 75 years (71-81) in patients with CD and UC, respectively. Median time between IBD diagnosis and cancers was 78 months (40-121). There was no significant increased risk of colorectal cancer in IBD (SIR=1.03 (0.62-1.70), CD (SIR=1.20 (0.57-2.52) nor in UC (SIR=0.91 (0.45-1.82) without significant protective role of 5-aminosalicylic acid (hazard ratio (HR)=0.7 (0.2-2.6)). No significant risk for other intestinal cancers was found, especially for small bowel carcinoma. An increased risk of malignant lymphoproliferative disorders was found in all IBD and in CD: SIR=2.49 (1.25-4.99) and SIR=3.09 (1.16-8.23), respectively. An increased risk of myeloproliferative disorders was found in all IBD (SIR=2.18 (1.09-4.35)). Thiopurines exposure, using a time-dependant Cox model, was not found as associated with an increased risk to develop cancer, HR=0.90 (0.48-1.68).CONCLUSIONS:There is no increased risk for developing intestinal cancer among patients with elderly onset IBD in this population-based cohort. There are increased risks of developing lymphoproliferative and myeloproliferative disorders in all IBD. Thiopurines exposure was not found as associated with an increased risk to lymphoproliferative disorders. These data reinforce the difference between elderly onset IBD as compared with patients with younger age at IBD onset

A randomized double-blind feasibility study comparing cetirizine and diphenhydramine in the prevention of paclitaxel-associated infusion-related reactions : the PREMED-F1 study

Purpose. Cetirizine is a less sedative alternative to diphenhydramine for the prevention of infusion-related reactions (IRR) to paclitaxel. However, its use remains controversial. In this study, we assessed feasibility for a future definitive non-inferiority trial comparing cetirizine to diphenhydramine as premedication to prevent paclitaxel-related IRR. Methods. This was a single center randomized prospective feasibility study. Participants were paclitaxel-naive cancer patients scheduled to start paclitaxel chemotherapy. They were randomly assigned to receive either intravenous diphenhydramine 50 mg + oral placebo (control) or intravenous placebo + oral cetirizine 10 mg (intervention) for their first two paclitaxel treatments. The percentage of eligible patients completing a first paclitaxel treatment and the recruitment rate were assessed (feasibility outcomes). Drowsiness was measured at baseline and at selected time points using the Stanford Sleepiness Scale (SSS) (safety outcome). IRR events were also documented (efficacy outcome). Results. Among 37 eligible patients, 27 were recruited and randomized (control 13; intervention 14) and 25 completed the study. The recruitment rate was 4.8 participants/month, meeting the primary feasibility target. Drowsiness was the main adverse effect associated with the premedication. The increase in drowsiness compared to baseline (ΔSSS) was greater in the diphenhydramine group compared to the cetirizine group (median ΔSSS 2 (IQR 3.25) vs median ΔSSS 0 (IQR 1), p < 0.01) when measured one hour after the premedication administration. One participant had an IRR and no unexpected serious adverse event occurred. Conclusion. The trial methods were feasible in terms of recruitment, retention and safety. Cetirizine was significantly less sedating than diphenhydramine. IRR were infrequent and a larger trial is warranted to confirm non-inferiority for IRR prevention

Impact of age at diagnosis on natural history of patients with elderly-onset ulcerative colitis: A French population-based study

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How are patients’ preferences for anti-TNF influenced by quality of life? A discrete choice experiment in Crohn’s disease patients

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Predictors of each quality of life dimension in Crohn’s disease patients initiating an anti-TNF treatment: differentiated effects of patient-, disease-, and treatment-related characteristics

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