Acute Upper Gastro-Intestinal Bleeding in Morocco: What Have Changed?

Objective. In the present study, we aimed to investigate epidemiological, clinical, and etiological characteristics of acute upper gastro-intestinal bleeding. Materials and Methods. This retrospective study was conducted between January 2003 and December 2008. It concerned all cases of acute upper gastroduodenal bleeding benefited from an urgent gastro-intestinal endoscopy in our department in Morocco. Characteristics of patients were evaluated in terms of age, gender, medical history, presenting symptoms, results of rectal and clinical examinations, and endoscopy findings. Results. 1389 cases were registered. As 66% of the patients were male, 34% were female. Mean age was 49. 12% of patients had a history of previous hemorrhage, and 26% had a history of NSAID and aspirin use. Endoscopy was performed in 96%. The gastroduodenal ulcer was the main etiology in 38%, followed by gastritis and duodenitis in 32.5%. Conclusion. AUGIB is still a frequent pathology, threatening patients' life. NSAID and aspirin are still the major risk factors. Their impact due to peptic ulcer remains stable in our country

Caustic burns and esophagus cancer

La cancérisation des sténoses caustiques de l'oesophage est très rare, le risque serait de 6% et survient en moyenne 41 ans après l'ingestion de caustique. Nous rapportons la première observation marocaine de cancer développé sur une ancienne brûlure caustique de l'oesophage avec un délai de 26 ans tout en insistant sur l'absence des traumatismes liés aux dilatations répétées

Black esophagus : report of three new cases

L'œsophage noir est rarement décrit comme lésion endoscopique. Son diagnostic prête à confusion avec l'oesophagite nécrotique aiguë, l'ingestion d'un caustique et le mélanome malin, mais souvent ces lésions sont associées à un interrogatoire permettant d'éclaircir l'histoire. La majorité des patients nécessitent une biopsie dans le but d'établir le diagnostic définitif et d'expliquer cette apparence noire. Nous décrivons trois observations d'oesophage noir révélées par des hémorragies digestives hautes intenses comparées avec les cas rapportés dans la littérature

Esophageal tuberculosis report of four cases and review of the literature

La tuberculose oesophagienne est extrêmement rare et ne représente que 1 % de toutes les atteintes tuberculeuses thoraciques. Nous rapportons 4 cas de tuberculose oesophagienne chez des sujets immunocompétents, colligés en 3 ans : 3 femmes et 1 homme, d'âge moyen de 30 ans. La symptomatologie clinique était dominée par une dysphagie médio-thoracique rapidement progressive. Le bilan radiologique et endoscopique a pu déterminer une tuberculose oesophagienne secondaire dans 2 cas et d'allure primitive dans les deux autres cas. Le diagnostic de tuberculose oesophagienne était retenu sur les résultats histologiques des prélèvements biopsiques endoscopiques et sur l'évolution favorable sous traitement anti-tuberculeux. L'évolution, appréciée sur les données cliniques biologiques et endoscopiques, était très bonne avec un recul moyen de 20 mois

Auditing HIV testing rates across Europe: results from the HIDES 2 Study

European guidelines recommend the routine offer of an HIV test in patients with a number of AIDS-defining and non-AIDS conditions believed to share an association with HIV; so called indicator conditions (IC). Adherence with this guidance across Europe is not known. We audited HIV testing behaviour in patients accessing care for a number of ICs. Participating centres reviewed the case notes of either 100 patients or of all consecutive patients in one year, presenting for each of the following ICs: tuberculosis, non-Hodgkins lymphoma, anal and cervical cancer, hepatitis B and C and oesophageal candidiasis. Observed HIV-positive rates were applied by region and IC to estimate the number of HIV diagnoses potentially missed. Outcomes examined were: HIV test rate (% of total patients with IC), HIV test accepted (% of tests performed/% of tests offered) and new HIV diagnosis rate (%). There were 49 audits from 23 centres, representing 7037 patients. The median test rate across audits was 72% (IQR 32-97), lowest in Northern Europe (median 44%, IQR 22-68%) and highest in Eastern Europe (median 99%, IQR 86-100). Uptake of testing was close to 100% in all regions. The median HIV+ rate was 0.9% (IQR 0.0-4.9), with 29 audits (60.4%) having an HIV+ rate >0.1%. After adjustment, there were no differences between regions of Europe in the proportion with >0.1% testing positive (global p = 0.14). A total of 113 patients tested HIV+. Applying the observed rates of testing HIV+ within individual ICs and regions to all persons presenting with an IC suggested that 105 diagnoses were potentially missed. Testing rates in well-established HIV ICs remained low across Europe, despite high prevalence rates, reflecting missed opportunities for earlier HIV diagnosis and care. Significant numbers may have had an opportunity for HIV diagnosis if all persons included in IC audits had been tested