Épidémiologie et prise en charge des ulcères gastro-duodénaux au Centre Hospitalier de la Région Annécienne (CHRA)

Une enquête rétrospective a été réalisée auprès de 111 patients ayant eu un diagnostic d ulcère gastro-duodénal (UGD) au CHRA entre le 01/09/2005 et le 31/08/2006. Le but de cette étude était de recenser les facteurs épidémiologiques des UGD et d évaluer l efficacité de leur prise en charge (recherche, traitement éradicateur d Helicobacter pylori) afin d envisager des solutions pour améliorer le pronostic de cette pathologie. Nos résultats montrent que cette pathologie reste fréquente et grave. Les facteurs de risque (anti-inflammatoires non stéroïdiens ; Helicobacter pylori) ne sont pas suffisamment recherchés et pris en compte pour le traitement préventif et curatif des ulcères. Un protocole de soins des UGD pour les médecins ayant la charge des patients après le diagnostic d ulcère sera mis en place début 2007 au CHRA.A retrospective investigation was carried out near 111 patients who had been diagnosis with ulcers at CHRA between the 01/09/2005 and the 31/08/2006. The aim of this study was to identify the epidemiologic factors of the ulcers and to evaluate the effectiveness of their treatment procedure (research, Helicobacter pylori eradication) in order to consider solutions to improve the prognosis of this pathology. Our results show that this pathology remains frequent and serious. Risk factors (non-steroidal anti-inflammatory drugs ; Helicobacter pylori) are not sufficiently searched for and taken into account for preventive and curative treatment of ulcers. A ulcer treatment procedure for the doctors who take care of the patients after the diagnosis of ulcer will be set up at the beginning of 2007 at the CHRA.GRENOBLE1-BU Médecine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Faibles perturbations des transaminases en médecine générale (analyse des pratiques et étude prospective descriptive des principales étiologies dans la région annécienne de mars à octobre 2010)

GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Panic attack with suicide: an exceptional adverse effect of infliximab.

International audienceNo abstract availabl

Natural history of acute colonic diverticular bleeding: a prospective study in 133 consecutive patients.

International audienceBACKGROUND: Bleeding recurrence rate after spontaneous haemostasis of colonic diverticular haemorrhage varies in the literature, and a small minority of patients will require endoscopic, radiological or surgical intervention. AIM: To study the natural history of colonic diverticular bleeding in consecutive patients. METHODS: We studied prospectively consecutive patients admitted for colonic diverticular bleeding from 1997 to 2005. Data on age, gender, 30-day mortality, therapeutic modality for bleeding management and subsequent rebleeding were collected. RESULTS: One hundred and thirty-three patients (mean age 75.7 years) were recruited. Bleeding stopped spontaneously in 123 patients (92.4%). A more interventional approach was necessary in 10 patients. Thirty-day mortality rate for first bleeding was 2.25%. Out of the 123 patients managed conservatively and submitted to an average follow-up of 47.5 months, 17 (13.8%) presented at least one recurrent diverticular bleeding. Spontaneous haemostasis was obtained in all recurrent cases except one, who died. The estimated bleeding recurrence rate was 3.8% at 1 year, 6.9% at 5 years and 9.8% at 10 years. CONCLUSIONS: The low estimated rebleeding rate and the fact that rebleeding can be treated conservatively in most cases suggest that an aggressive approach with intervention is not justified

MacDuffie syndrome and primary sclerosing cholangitis: an exceptional association.

International audienceNo abstrac

[Factors associated with hyperhomocysteinemia in inflammatory bowel disease: prospective study in 81 patients]

International audienceBACKGROUND: A high prevalence (52%) of hyperhomocysteinemia is observed in Crohn disease (CD), however it is not well documented in ulcerative colitis (UC). Furthermore, in the different works studying hyperhomocysteinemia the associated factors are different. AIM: Prospective evaluation of hyperhomocysteinemia in inflammatory bowel disease (IBD) patients, of the risk factors and the determination of a potential risk of colorectal carcinoma in case of hyperhomocysteinemia. PATIENTS AND METHODS: IBD patients followed in our department were prospectively recruited between November 2003-September 2004. To be included patients should have passed a coloscopy in the two years. Patients with kidney failure or drugs supposed, to interfere with homocystéine metabolism (folates, vitamin B12, methotrexate) were excluded from the study. The following parameters were analysed: age, sex, clinical activity indexes (CDAI for Crohn disease and CAI for ulcerative colitis), length-extent and type of the disease (CD or UC), smoking, plasma homocystein concentration, folates and vitamin B12. RESULTS: Eighty-one patients (60 CD, 21 UC, mean age 43.8 +/- 17.3) were included, 30 had an active disease at inclusion and 16 were smokers. The prevalence of high homocystein concentration was 55.6%. In univariate analysis a low rate of folates was the only risk factor for a high homocystein concentration (74 vs. 52.8%; P = 0.018). Smoking was almost an associated factor. In multivariate analysis, a low rate of folate was the only risk factor of hyperhomocysteinemia, OR = 3.59 [1.27-10.17]. Five endoscopic lesions considered as precancerous were described; these patients had all a hyperhomocysteinemia. CONCLUSION: The prevalence of hyperhomocysteinemia is high in UC and in CD. A low folate rate is the only risk factor observed in our study. There is a possible link between colorectal cancer and hyperhomocysteinemia. A high Plasma homocystein concentration must be search in inflammatory bowel disease patients and a substitutive treatment of folates and vitamin B12 is necessary in case of hyperhomocysteinemia

[Cytomegalovirus and cryptogenic inflammatory bowel disease]

International audienceCMV infection has been reported in association with some flares of IBD. Its prevalence varies with the method of diagnosis and the severity of IBD. Although the link between CMV and IBD is not clear, the immunomodulator properties of the virus may play a role in the evolution of IBD. Besides the necessity of immunosuppression to treat IBD, inflammation per se can maintain in situ viral replication. Antiviral treatment can be useful in some situations. New molecular methods will permit earlier and more sensitive diagnosis of CMV infection and a better evaluation of treatment efficacy

Management of Severe Bleeding in Patients Treated with Direct Oral Anticoagulants

International audienceThe use of prothrombin complex concentrates and the role of plasma concentration of anticoagulants in the management of bleeding in patients treated with direct oral anticoagulants are still debated. Our aim was to describe management strategies and outcomes of severe bleeding events in patients treated with direct oral anticoagulants.METHODS:We performed a prospective cohort study of 732 patients treated with dabigatran, rivaroxaban, or apixaban hospitalized for severe bleeding, included prospectively in the registry from June 2013 to November 2015.RESULTS:Bleeding was gastrointestinal or intracranial in 37% (212 of 732) and 24% (141 of 732) of the cases, respectively. Creatinine clearance was lower than 60 ml/min in 61% (449 of 732) of the cases. The plasma concentration of direct oral anticoagulants was determined in 62% (452 of 732) of the cases and was lower than 50 ng/ml or higher than 400 ng/ml in 9.2% (41 of 452) and in 6.6% (30 of 452) of the cases, respectively. Activated or nonactivated prothrombin complex concentrates were administered in 38% of the cases (281 of 732). Mortality by day 30 was 14% (95% CI, 11 to 16).CONCLUSIONS:Management of severe bleeding in patients treated with direct oral anticoagulants appears to be complex. The use of prothrombin complex concentrates differs depending on bleeding sites and direct oral anticoagulant plasma concentrations. Mortality differs according to bleeding sites and was similar to previous estimates