Crohn's disease: is there any link between anal and luminal phenotypes?

International audiencePURPOSE: Perianal Crohn's disease (CD) encompasses a variety of lesion similar to luminal disease, which are usually not distinctly assessed. Links between luminal and perianal CD phenotype remains therefore underreported, and we aimed to describe both luminal and perianal phenotype and their relationships. METHODS: From January 2007, clinical data of all consecutive patients with CD seen in a referral center were prospectively recorded. Data recorded until October 2011 were extracted and reviewed for study proposal. RESULTS: A total of 282 patients (M/F, 108/174; aged 37.8 ± 16.2 years) were assessed that included 154 cases (54.6 %) with anal ulceration, 118 cases (41.8 %) with fistula, 49 cases (17.4 %) with stricture, and 94 cases without anal lesion (33.3 %). Anal ulcerations were associated with fistulas (N = 87/154) in more than half of patients (56.5 %) and were isolated in 55 patients (35.7 %). Most of strictures (94 %) were associated with other lesions (N = 46/49). Harvey-Bradshaw score was significantly higher in patients with ulcerations (p \textless 0.001) as compared to those with perianal fistulas (p = 0.15) or with anal strictures (p = 0.16). Proportions of complicated behavior (fistulizing or stricturing) of luminal CD were similar according to anal lesions: anal fistulas were not significantly associated to penetrating Montreal phenotype (N = 4/31 p = 0.13) as well as anal stricture and stricturing Montreal phenotype (N = 3/49, p = 0.53). CONCLUSIONS: The phenotype of luminal disease does not link with the occurrence and the phenotype of perianal Crohn's disease. Anal ulcerations denote a more severe disease on both luminal and perianal locations and should consequently be taking into account in physician decision-makin

Constipation is independently associated with delirium in critically ill ventilated patients

International audienceDelirium is a central nervous system (CNS) dysfunction reported in up to 80 % of intensive care unit (ICU) patients associated with negative short- and long-term outcomes [1, 2]. Gastrointestinal motility disorders are frequent in ICU patients leading to frequent delayed passage of stools [3]. Because there is a bi-directional communication between the CNS and the digestive tract [4], we believed it relevant to test the hypothesis that constipation and delirium are related in ICU patients

Endoscopic mucosal resection with anchoring of the snare tip: multicenter retrospective evaluation of effectiveness and safety

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Ulcérations anales de la maladie de Crohn (histoire naturelle à l'heure des biothérapies)

Les ulcération anales représentent une des particularités de la maladie de Crohn (MC) mais leur histoire naturelle est mal connue. Ce travail, basé sur la plus large cohorte d'ulcérations anales décrite, avait pour objectif de décrire leurs caractéristiques et leur évolution. Les éléments cliniques de 282 malades ont constitué une base prospective monocentrique de lésions anales de la MC (01/01/2007 à 01/10/2011). 154 malades (M/F= 55/99, âge moyen=36+-16 ans) présentaient des ulcérations. Le suivi moyen était de 84+-86 semaines. Les ulcérations étaient associées à une suppuration ou une sténose dans 57% et 26% des cas respectivement. La durée moyenne de cicatrisation des ulcérations a été de 56+-74 semaines. Les biothérapies n'ont pas influencé la cicatrisation. En revanche, le phénotype anal à l'inclusion est apparu comme un facteur déterminant. Le taux de cicatrisation des ulcérations était multiplié par 2 en cas de fistule haute associée, et en cas de MC active à l'inclusion. L'association à une sténose a diminué les chances de cicatrisation par 2,5. Ces constats invitent à des essais plus spécifiquement ciblés sur le traitement des ulcérations anales.RENNES1-BU Santé (352382103) / SudocSudocFranceF

Small-bowel video capsule endoscopic findings of Cronkhite-Canada syndrome

International audienceCronkhite-Canada syndrome (CCS) is a rare, non-familial disorder characterized by multiple gastrointestinal polyps and ectodermal changes. This article presents the first small-bowel video sequences of CCS using video capsule endoscopy (VCE)

Risk Factors for Acute Fulminant Pancreatitis in Patients Admitted to the Intensive Care Unit: A Retrospective Study

International audienceBackground/Objectives The term acute fulminant pancreatitis (AFP) has been proposed to define the most severely ill patients and those who are likely to die before they develop persistent organ failure. The objective of our study was to determine the risk factors for developing AFP in patients admitted to the intensive care unit (ICU). Methods This was a retrospective study conducted between January 2007 and May 2019 in a ICU. Patients >= 18 years old admitted to the ICU within 3 days of the onset of abdominal pain related to acute pancreatitis were included. We defined AFP according to the modified Marshall scoring system for organ dysfunction based on a score >= 2 involving at least 2 organ systems for at least 48 hours or <= 48 hours if the patient died during the first 7 days of hospitalization. Results Sixty-three patients were analyzed (AFP group, n=27 - non-AFP group, n=36). In multivariate analysis, AFP was associated with a lower level of fluid loading before ICU admission (OR [95%CI] = 0.89 [0.82; 0.97], p<0.001) and a higher modified Marshall score (OR [95%CI] = 2.31 [1.53; 3.49], p<0.001). On day 7, mortality was higher in the AFP group (48% vs. 3%, p<0.001), and 29% of patients with AFP died within 48 hours of admission to the ICU before developing persistent organ failure. Conclusions A lower level of fluid resuscitation prior to admission to the ICU and a higher modified Marshall score on ICU admission were independently associated with higher risks of developing AFP

Endoscopic resection of a rectal gastrointestinal stromal tumor using the submucosal tunneling endoscopic resection (STER) technique

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Outcomes of Perianal Fistulising Crohn's Disease Following Anti-TNF alpha Treatment Discontinuation

International audienceBackground Discontinuation of antitumour necrosis factor (TNF)alpha therapy with perianal fistulising Crohn's disease remains controversial due to the risk of severe relapse without any clear evidence. Aim The aim of this study was to assess the rate and type of perianal and luminal relapses following anti-TNF alpha discontinuation. Methods All patients treated with anti-TNF alpha for perianal fistulising Crohn's disease with subsequent discontinuation of therapy were retrospectively reviewed from a prospective database (1998-2016). Cumulative probabilities of relapse-free survival were estimated by actuarial analysis. Results After a median follow-up of 62 months, 24 of the 45 patients experienced perianal relapse. A new surgical drainage was needed in 19 (79%) patients. The cumulative probabilities of perianal relapse at 1 and 5 years were 24% and 55%, respectively. Ileal localization (L1) at diagnosis, persistence of an external fistula opening, second line anti-TNF alpha use, or prior dose optimization was associated with perianal relapse, whereas continuation of immunosuppressive agents decreased this risk (HR = 0.3). Luminal relapse occurred in 42% of patients at 5 years. The cumulative probability of global relapse at 5 years was 67%. Retreatment with anti-TNF alpha allowed further remission in 23 of 24 (96%) patients. Conclusion Half of patients with perianal fistulising Crohn's disease relapse within 5 years after anti-TNFa discontinuation. Immunosuppressant continuation may decrease this risk. The high risk of relapse (perianal and luminal) may suggest a benefit in pursuing biologics over a longer period in patients with perianal fistulas

Impact of anesthetics on pyloric characteristics measured using the EndoFLIP ® system in patients with gastroparesis

Abstract Background Pyloric distensibility has been reported as a predictive measure in gastroparesis. Measures can be obtained either during endoscopy under anesthesia or in unsedated patients. However, the impact of anesthetic drugs on the results of pyloric characteristics remains unknown. The objective of the present study was to determine the impact of anesthetics on pyloric characteristics measured using EndoFLIP® in patients with gastroparesis. Methods Consecutive patients with gastroparesis from three French tertiary centers were retrospectively analyzed. Patients with a previous history of pyloric intervention were not considered for analysis. Medical records were reviewed for the potential use of anesthetic drugs during EndoFLIP® measurement. Key Results One hundred twenty‐five patients were included in the present study [median age: 55.0 years (43.0–66.0)]. Thirty‐four patients (27.2%) had pyloric assessment without general anesthesia and 91 patients (72.8%) with general anesthesia. Pyloric pressure at 40 mL of distension was higher in patients with general anesthesia in comparison with patients without general anesthesia [18.7 (13.0–25.6) mmHg vs. 15.4 (11.9–20.7) mmHg; p = 0.044)]. In multivariate analysis, suxamethonium chloride administration was associated with decreased pyloric distensibility (OR: 3.9; 95% CI: 1.3–11.4; p = 0.013) while ephedrine was rather associated with increased pyloric distensibility (OR: 0.3; 95% CI: 0.1–0.9; p = 0.036). Conclusions and Inferences This study is the first to have found an impact of general anesthesia on pyloric measurement using the EndoFLIP®. Therefore, further studies are needed to confirm these findings, if possible, prospective studies

Chronic hepatic cytolysis revealing a pheochromocytoma.

International audienceWe report here the first case of chronic cytolysis that led to the diagnosis of pheochromocytoma, in a 48-year-old woman with a recent onset of hypertension. The etiological research ruled out the common causes of raised transaminase levels, and led to the discovery of a left adrenal pheochromocytoma. The sustained normalization of liver function tests after the removal of the tumour strongly suggests that hepatocyte injury was due to catecholamine hyperproduction. The present original clinical case, linking pheochromocytoma and liver dysfunction, raises important mechanistic questions concerning the relationship between catecholamines and liver function. It may also have clinical implications. Indeed, pheochromocytoma should be considered as a possible cause in case of unexplained transaminase increase associated with the recent onset of hypertension