Plasma carnitine is associated with fatigue in chronic hepatitis C but not in irritable bowel syndrome : Carnitine and fatigue in hepatitis C

International audienceObjectives Fatigue is an important determinant of altered quality of life in patients affected by chronic hepatitis C (CHC) or the irritable bowel syndrome (IBS). In this study, we aimed at determining the contributory role of plasma levels of leptin and carnitine on fatigue in CHC and IBS. Methods We enrolled 70 patients with CHC, 42 with IBS and 44 healthy subjects. Fatigue was evaluated using the Fatigue Impact Scale questionnaire. Body composition was assessed through impedance analysis. Plasma carnitine and leptin were measured. Results Fatigue scores were significantly more elevated in patients with CHC and IBS than in healthy subjects. Patients with CHC, but not with IBS, had significant lower plasma levels of total and free carnitine adjusted for fat mass compared to healthy subjects. In patients with CHC, and not with IBS, fatigue scores were negatively correlated with plasma levels of carnitine. Levels of free carnitine were significantly and independently associated with the severity of fatigue in patients with CHC (OR=2.019, p=0.02, CI 95% [1.01-1.23]).Conclusions In patients with CHC, the severity of fatigue is associated with low level of carnitine, suggesting that an oral supplementation may be effective to relieve fatigue in CHC. The underlying mechanism of fatigue in IBS does not seem to involve carnitine

Influence des symptomes digestifs fonctionnels sur la qualité de vie et la fatigue, au cours de la maladie de Crohn en rémission et le syndrome d'intestin irritable

NICE-BU Médecine Odontologie (060882102) / SudocSudocFranceF

Etude de la fatigue chez les malades porteurs d'une hépatite chronique virale C (thèse)

NICE-BU Médecine Odontologie (060882102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Influence de la composition corporelle et de la stéatose sur la fibrose hépatique au cours de l'hépatite chronique C (thèse)

NICE-BU Médecine Odontologie (060882102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Influence des fermentations coliques sur la motricité du SIO (mise en évidence et mécanismes en physiologie et au cours du reflux gastro-oesophagien)

Les relaxations transitoires du sphincter inférieur de l'œsophage (RT SIO) sont à l'origine de la majorité des épisodes de reflux chez l'homme. Leur modulation repose sur des réflexes vago-vagaux initiés par des stimuli pharyngés et/ou gastriques et l'intervention de plusieurs neuropeptides. Des travaux récents indiquent que les acides gras à chaîne courte (AGCC), peuvent moduler à distance la motricité de l'estomac proximal. Chez des sujets sains nous avons montré que l'instillation colique de lactose augmentait l'incidence postprandiale des RT SIO et que cet effet était reproduit par la perfusion colique d'AGCC. Chez des malades atteints de reflux gastro-œsophagien, nous avons montré qu'une alimentation enrichie en fructooligosaccharides, des glucides indigestibles, augmentait l'incidence des RT SIO, les épisodes et les symptômes de reflux. Enfin, l'administration du SR48692, un antagoniste spécifique des récepteurs NT 1 n'a pas d'effet sur la motricité du SIO chez l'homme.Transient lower esophageal sphincter relaxations are the main mechanism of reflux in man. TLESRs are triggered by pharyngeal and/or gastric stimuli involving the vagus nerve and several neuropetides. Recent findings indicate that short chain fatty acid (SCFAs), the main end products of colonic fermentation, may influence gastric motility. In healthy volunteers, we showed that colonic instillation of lactose increased the number of TLESRs stimulated by a meal and that this effect was reproduced by colonic instillation of SCFAs. In patients with gastroesophageal reflux (GERD), we also showed that colonic fermentation induced by oral administration of fructooligosaccharides (FOS) increased the rate of TLESRs, the number of reflux episodes and the symptoms of GERD. In a third trial, we found that SR 48692, a specific neurotensin 1 receptor antagonist, had no effect on LOS motilty in man.NANTES-BU Médecine pharmacie (441092101) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

Laparoscopic sleeve gastrectomy for morbid obesity

The incidence of obesity is steadily rising, and it has been estimated that 40% of the US population will be obese by the year 2025 if the current trend continues. In recent years there has been renewed interest in the surgical treatment of morbid obesity in concomitance with the epidemic of obesity. Bariatric surgery proved effective in providing weight loss of large magnitude, correction of comorbidities and excellent short-term and long-term outcomes, decreasing overall mortality and providing a marked survival advantage. The Laparoscopic Sleeve Gastrectomy (LSG) has increased in popularity and is currently very “trendy” among laparoscopic surgeons involved in bariatric surgery. As LSG proved to be effective in achieving considerable weight loss in the short-term, it has been proposed by some as a sole bariatric procedure. This editorial focuses on the particular advantages of LSG in the treatment of morbid obesity

Constipation et cancer : stratégies actuelles

International audienceDigestive disorders, in particular constipation, are symptoms very often reported by cancer patients as having a major impact on their quality of life. An accurate diagnosis of bowel delayed transit and defecation disorders is required to best adapt therapeutic management. Constipation associated with cancer may be related to several causes, which can be placed in three nosological categories that sometimes overlap: chronic constipation prior to cancer and having its own evolution; constipation related to the cancer condition, in particular the occlusive syndrome, and constipation induced by cancer therapies. The stricter application of diet and lifestyle measures is often necessary and sometimes sufficient. Laxative drug treatments come under various galenic forms and administration routes and must be selected according to the clinical features of constipation. Surgical management can be indicated in case of ileus or pelvic static disorders. In the case of refractory constipation induced by opioids and within the framework of palliative care to treat an advanced pathology, a peripheral morphinic antagonist can offer fast symptom relief. A way forward to improve the patients' quality of life could be to identify the contributing factors (in particular, genetic factors) to determine which patients are the more at risk and anticipate their management.Les troubles digestifs, et notamment la constipation, constituent des symptômes très fréquemment décrits par les patients atteints de cancer, avec un retentissement important sur leur qualité de vie. Le diagnostic précis du ralentissement du transit et des troubles de la défécation est nécessaire afin d’adapter au mieux la prise en charge thérapeutique. Les étiologies de constipation associées au cancer sont nombreuses et peuvent être séparées en trois cadres nosologiques, s’intriquant parfois entre eux : la constipation chronique antérieure au cancer et évoluant pour son propre compte, la constipation liée à la maladie cancéreuse avec notamment le syndrome occlusif et la constipation liée aux traitements du cancer. Le renforcement des mesures hygiéno-diététiques est souvent nécessaire et parfois suffisant. Les traitements médicamenteux laxatifs présentent des formes galéniques et voies d’administration différentes et seront choisis en fonction des caractéristiques de la constipation. Une prise en charge chirurgicale peut être indiquée en cas d’occlusion intestinale ou de troubles de la statique pelvienne. En cas de constipation rebelle liée aux opioïdes et dans le cadre d’une prise en charge palliative d’une pathologie avancée, un antagoniste morphinique périphérique peut permettre de soulager rapidement les symptômes. Afin d’améliorer la qualité de vie des patients, l’identification de facteurs favorisants notamment génétiques permettrait de déterminer les patients les plus à risque et ainsi anticiper leur prise en charge

Efficacy and safety profile of LCR35 complete freeze-dried culture in irritable bowel syndrome: A randomized, double-blind study

International audienceAIM: To assess the effects and safety of Lactobacillus casei rhamnosus LCR35 complete freeze-dried culture (LCR35) in patients suffering from irritable bowel syndrome (IBS). METHODS: A randomized, double-blind pilot study was performed in 50 patients complaining of IBS symptoms complying with Rome III criteria. Patients were allocated to receive either LCR35 (n = 25) at a minimum daily dose of 6 × 10(8) colony forming units or placebo (n = 25) for 4 wk. At inclusion, after treatment and 2 wk later, patients completed the IBS severity scale. Change from baseline in the IBS severity score at the end of treatment was the primary efficacy criterion. Changes were compared between groups in the whole population and in IBS subtypes (IBS with predominance of constipation, IBS with predominance of diarrhoea, mixed IBS, unsubtyped IBS). The presence of lactobacillus casei rhamnosus in stools was investigated at inclusion and at the end of treatment. The gastrointestinal quality of life questionnaire and the hospital anxiety and depression (HAD) scale were also completed. RESULTS: Both groups were balanced for baseline characteristics. In 85% of patients, stool analyses showed that lactobacillus casei rhamnosus able to survive in the digestive tract. In the whole population, improvements in the IBS severity score did not differ significantly between treatments with a 25% decrease after 4-wk treatment, and a 15% decrease from baseline 2 wk later in both groups. In IBS subgroups, statistical analysis could not be performed due to small sample size, but a clinical response in favour of LCR35 was observed in IBS patients with predominance of diarrhoea: no change in the symptom severity score was seen with the placebo after 4 wk treatment, whereas a clinically relevant decrease occurred with LCR35 (-37% vs -3%). Furthermore, in spite of an increase in symptom intensity, the IBS severity score was maintained below the baseline value 2 wk later with LCR35 (-19% from baseline), whilst a slight 5% increase from baseline was observed with placebo. In the IBS subgroup with predominance of diarrhoea only, a clinically relevant decrease in abdominal pain severity score (-36%) was observed with LCR35, whereas no change occurred with placebo. In mixed IBS patients, the 20% and 30% decreases in the IBS severity score observed after treatment with LCR35 and placebo, respectively, were maintained 2 wk later in both groups. A clinical response slightly in favour of placebo was observed at the end of the treatment period in IBS patients with predominance of constipation (-41% vs -20%) and unsubtyped IBS patients (-47% vs -17%), with the same value maintained 2 wk later. In both groups, no clinically relevant changes were observed either for the gastrointestinal quality of life index or HAD score. Thus, these results suggest that sub-grouping of IBS patients may be important for optimizing treatment responses by the physician. CONCLUSION: This pilot study suggests that LCR35 could have some efficacy in IBS patients complaining of diarrhoea. These preliminary results need to be confirmed in large

Double Perforation of Marginal Ulcers after One Anastomosis Gastric Bypass with a Biliary Peritonitis

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