Service dHepatogastroenterologie

Créteil, France

Service dHepatogastroenterologie

Créteil, France
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Moal V.,Aix - Marseille University | Gerolami R.,Service dHepatogastroenterologie | Ferretti A.,Center Hospitalo University Timone | Ferretti A.,University of Lille Nord de France | And 3 more authors.
Journal of Clinical Microbiology | Year: 2014

Hepatitis E virus (HEV) is a leading cause of waterborne acute hepatitis in developing countries. In Europe, HEV causes a zoonotic disease and is hyperendemic in southern France. Four HEV genotypes (1 to 4) have been defined, and the most used classification divides them into 24 subtypes. Autochthonous European HEV strains belong in majority to genotype 3. Subtypes 3c, 3f, and 3e are representative of the HEV diversity in France. HEV causes chronic hepatitis in solid-organ transplant recipients in Europe, and viral characteristics associated with chronicity are poorly documented. We sequenced 343-nucleotide-long HEV genomic fragments from the serum of eight chronically infected kidney transplant recipients and a near-full-length genome in one case. We identified in four patients (50%) HEV of subtype 3i, not described previously in France. If shorter genomic fragments were used in phylogenetic analyses, these HEV sequences were clustered with open reading frame 2 (ORF2) fragments labeled as subtype 3c. At least five of the eight HEV 3i sequences recovered from humans in our phylogenetic analyses were from chronically infected kidney transplant recipients. These data show that the description of the prevalence and geographical distribution of HEV subtypes may be partially inaccurate and that criteria for classification as 3i and 3c should be clarified. Extended molecular virology analyses are required to improve knowledge of HEV epidemiology and determinants of chronic HEV infection. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

Roulot D.,University of Paris 13 | Buyck J.-F.,Hopital Avicenne | Warzocha U.,University of Paris 13 | Gambier N.,University of Paris 13 | And 3 more authors.
Gut | Year: 2011

Background: Liver stiffness measurement (LSM) has been used to measure fibrosis in patients with various types of chronic liver diseases. However, its usefulness as a screening procedure in apparently healthy people had not been evaluated to date. Methods: 1358 subjects >45 years old from a general population attending for a medical check-up were consecutively enrolled in the study. All subjects were submitted to medical examination and laboratory tests in addition to LSM, performed on the same day by a single operator. Subjects with LSM values >8 kPa were referred to a liver unit for further investigations. Results: 168 subjects were not considered for analysis due to missing data (n=23), LSM failure (n=51) or unreliable LSM values (n=94). Among the 1190 remaining subjects, 89 (7.5%) had LSM >8 kPa including nine patients with LSM >13 kPa. Despite the fact that normal liver tests were observed in 43% of them (38 out of 89), a specific cause of chronic liver disease was found in all cases. Non-alcoholic fatty liver disease (NAFLD) was the likely cause of chronic liver disease in 52 patients, alcoholic liver disease (ALD) in 20, and both causes were associated in seven additional patients. Hepatitis C virus and hepatitis B virus chronic hepatitis was documented in five and four cases, respectively, and primary biliary cirrhosis in one. Liver biopsy was obtained for 27 patients, including the nine patients with LSM >13 kPa, who were diagnosed with liver cirrhosis due to ALD (n=5), chronic hepatitis C (n=3) or chronic hepatitis B (n=1). The 18 remaining biopsies showed liver fibrosis in all cases except one (isolated steatosis), with ALD and NAFLD being present in six and eight cases, respectively. Conclusion: LSM proved to be a useful and specific procedure to screen for cirrhosis in the general population and to detect undiagnosed chronic liver disease in apparently healthy subjects.

Holtmann G.,University of Adelaide | Bigard M.-A.,Service dHepatogastroenterologie | Malfertheiner P.,Otto Von Guericke University of Magdeburg | Pounder R.,University of London
International Journal of Clinical Pharmacy | Year: 2011

Objective The aim of this paper was to develop a guideline on the over-the-counter management of gastroesophageal reflux disease with proton pump inhibitors (i.e. omeprazole). Setting A meeting of internationally renowned gastroenterologists in January 2009, in Berlin, Germany. Methods An expert panel group of gastroenterologists convened to develop a consensus-based algorithm for pharmacists for over-the-counter (OTC) treatment with proton pump inhibitors (PPIs). Key considerations were the short-term safety and efficacy of PPIs, and the extent of the risk to the sufferer, owing to the treatment not being controlled by a physician. Main outcome measures A consensus- based treatment algorithm for the OTC management of gastroesophageal reflux disease and evidence- based guidance on the use of OTC PPIs. Results As defined by the treatment algorithm, the pharmacist should first confirm the diagnosis based on the presence of typical symptoms and secondly, as a result, rule out general practitioner referral. The third step focuses on the nature, severity and frequency of the symptoms-the patients who might have the highest benefit from a short course (14 days) of OTC PPIs are those with less than three episodes of heartburn and/or acid regurgitation per week. Patients who have three or more episodes per week can use the OTC PPIs but should also be encouraged to visit a physician, and those who already have a diagnostic workup can use proton pump inhibitors as rescue treatment if they are known responders. Guidance for pharmacists, in the form of questions and answers, summarises the current published clinical experience with PPIs in terms of their efficacy and safety, and optimal treatment schedule. Conclusions Gastroesophageal reflux disease imposes a considerable burden on sufferers. Owing to their accepted efficacy and safety, PPIs are becoming popular as OTC options for the treatment of gastroesophageal reflux disease symptoms such as heartburn and acid regurgitation. Effective self-management of gastroesophageal reflux disease with OTC PPIs, e.g. omeprazole, could lead to lasting freedom from symptoms and improved quality of life for sufferers. © Springer Science+Business Media B.V. 2011.

Bacq Y.,Service dHepatogastroenterologie | Sentilhes L.,University of Angers | Reyes H.B.,University of Chile | Glantz A.,Gothenburg University | And 7 more authors.
Gastroenterology | Year: 2012

Background & Aims: We performed a meta-analysis to evaluate the effects of ursodeoxycholic acid (UDCA) on pruritus, liver test results, and outcomes of babies born to women with intrahepatic cholestasis of pregnancy (ICP). Methods: We performed a systematic review of 9 published, randomized controlled trials (3 double blinded) that compared the effects of UDCA to other drugs, placebo, or no specific treatment (controls) in patients with ICP. We analyzed data from 454 patients: 207 received only UDCA, 70 received only placebo, 42 received cholestyramine, 36 received dexamethasone for 1 week and then placebo for 2 weeks, 65 received S-adenosyl-methionine, and 34 received no specific treatment. To achieve consistency among end points, a standard questionnaire was sent to all corresponding authors. For each end point, we performed pooled analysis that compared the effects of UDCA with those of all controls and UDCA with those of placebos. Results: In pooled analyses that compared UDCA with all controls, UDCA was associated with total resolution of pruritus (odds ratio [OR], 0.23; 95% confidence interval [CI], 0.07-0.74; P <.01), reduced pruritis (OR, 0.27; 95% CI, 0.13-0.55; P <.0001), normalization of serum levels of alanine aminotransferase (ALT) (OR, 0.23; 95% CI, 0.10-0.50; P <.001), decreased serum level of ALT (OR, 0.24; 95% CI, 0.11-0.52; P <.0001), reduced serum levels of bile acids (OR, 0.37; 95% CI, 0.19-0.75; P <.001), fewer premature births (OR, 0.44; 95% CI, 0.24-0.79; P <.01), reduced fetal distress (OR, 0.46; 95% CI, 0.25-0.86; P <.01), less frequent respiratory distress syndrome (OR, 0.30; 95% CI, 0.12-0.74; P <.01), and fewer neonates in the intensive care unit (OR, 0.49; 95% CI, 0.25-0.98; P =.046). In pooled analyses that compared the effects of UDCA with placebo, UDCA reduced pruritus (OR, 0.21; 95% CI, 0.07-0.62; P <.01), normalized (OR, 0.18; 95% CI, 0.06-0.52; P <.001) or decreased serum levels of ALT (OR, 0.12; 95% CI, 0.05-0.31; P <.0001), and reduced serum levels of bile acids (OR, 0.30; 95% CI, 0.12-0.73; P <.01). Conclusions: Based on a meta-analysis, UDCA is effective in reducing pruritus and improving liver test results in patients with ICP; UDCA therapy might also benefit fetal outcomes. © 2012 AGA Institute.

Charlotte F.,University Pierre and Marie Curie | Naour G.L.,University Pierre and Marie Curie | Bernhardt C.,Service dHepatogastroenterologie | Poynard T.,Service dHepatogastroenterologie | And 2 more authors.
Human Pathology | Year: 2010

In nonalcoholic fatty liver disease the amount of fibrosis for individual histologic stages is unknown. To better understand the fibrotic potential of nonalcoholic fatty liver disease, we compared the amount of fibrosis in nonalcoholic fatty liver disease versus chronic hepatitis C virus patients. The area of fibrosis for equivalent fibrosis stages was measured by micromorphometry in 70 nonalcoholic fatty liver disease and 70 matched, untreated, chronic hepatitis C virus controls. The area of fibrosis correlated with Brunt stage (r = 0.71; P < .001) in nonalcoholic fatty liver disease and METAVIR stage (r = 0.58; P < .001) in chronic hepatitis C virus. Mean area of fibrosis was similar in nonalcoholic fatty liver disease and chronic hepatitis C virus patients (7.77% versus 7.70%). Although chronic hepatitis C virus patients displayed higher area of fibrosis in early disease (no or mild fibrosis), nonalcoholic fatty liver disease and chronic hepatitis C virus patients had similar area of fibrosis in more advanced disease (7.83% versus 8.06%, respectively; P = .86 for bridging fibrosis; and 16.62% versus 12.98%, respectively; PÂ= .29 for cirrhosis). The area of fibrosis was similar in Brunt stage 3 nonalcoholic fatty liver disease and METAVIR stage 2 chronic hepatitis C virus, the usual threshold for initiating therapy. The area of steatosis declined with increasing fibrosis stages confirming the early loss of liver fat with progressive fibrosis in nonalcoholic fatty liver disease. Fibrosis is as abundant in nonalcoholic fatty liver disease as in chronic hepatitis C virus, especially in the advanced stages of the disease. The fibrotic potential of nonalcoholic fatty liver disease is as severe as that of chronic hepatitis C virus. © 2010 Elsevier Inc.

This paper describes 33 neoplastic colorectal lesions poorly elevated and under 1 cm in maximal diameter. The author names these lesions, usually neglected or missed at endoscopy, "flat adenomas". The macroscopic description includes a central depressed area evidenced at best using indigo-carmine dye. The histological definition was based on the lesion thickness less than twice that of the surrounding colonic or rectal mucosa. As mucosectomy (sub-mucosal injection of serum before snare resection) was not available at this time, the 33 lesions were treated using simple snare resection without complication. From these 33 flat adenomas 14 (42%) presented with high grade dysplasia (severe dysplasia at this time) or intramucosal cancer, 9 (27%) were in the proximal colon and 8 (24%) were associated with other adenomas or cancer. The degree of dysplasia was correlated with the lesion size. © 2012 Springer Verlag France.

The management of patients presenting with familial adenomatous polyposis begins before the age of 15 years and lasts a lifetime. This represents a long-term challenge with major aims: causing as few medical problems as possible and taking into account the quality of life both from a physical and from a psychological point of view. In 2011, colonic surgery can in most cases be less radical with better functional results. Endoscopic treatment may be initiated earlier and be more effective. The price to pay is a real but minor morbidity. The effectiveness of drug treatment of adenomas remains unconfirmed. Oncogenetics simplifies management and may provide a choice of whether or not to pass on the condition to one's children. Unresolved problems concern particularly desmoid tumours and also some rare tumours which are hard to detect (brain, pancreas). © 2011 Springer Verlag France.

Rahier J.-F.,Service dHepatogastroenterologie
Digestive Diseases | Year: 2015

In an era of increasing use of immunomodulator therapy and biologics, opportunistic infections (OI) have emerged as a pivotal safety issue in patients with inflammatory bowel disease (IBD). Clinical studies, registries and case reports warn about the increased risk for infections, particularly OIs. Today, the challenge for a physician is not only to manage IBD, but also to recognize, prevent and treat common and uncommon infections. The 2014 European Crohn's and Colitis Organisation (ECCO) guidelines on the management and prevention of OIs in patients with IBD provide clinicians with guidance on the prevention, detection and management of OIs. Proposals may appear radical, potentially changing the current practice, but we believe that the recommendations will help optimize patient outcomes by reducing the morbidity and mortality related to OIs. In this ongoing process, prevention is by far the first and most important step. Prevention of OIs relies on recognition of risk factors for infection, the use of primary or secondary chemoprophylaxis, careful monitoring (clinical and laboratory work-up) before and during the use of immunomodulators, vaccination and education of the patient. Special recommendations should also be given to patients before and after travel. © 2015 S. Karger AG, Basel.

Vincent M.,service d'hepatogastroenterologie
Acta Endoscopica | Year: 2015

Hemostatic powders are a new technique for endoscopic hemostasis developed primarily for upper gastrointestinal bleeding. They are an attractive method for their ease of use and safety. They have emerged as an alternative to standard hemostatic techniques. The use of Hemospray® is recognized in non-variceal upper gastrointestinal bleeding and especially in case of inaccessible lesions from other hemostasis techniques. But its use is already described for lower gastrointestinal bleeding and in case of bleeding related to interventional endoscopy. © 2014, Springer-Verlag France.

Saurin J.-C.,Service dHepatogastroenterologie
Acta Endoscopica | Year: 2011

Stomach cancer remains present in France (6,000 new cases per year).The background is fully known: atrophic gastritis and gastric intestinal metaplasia. This frequent situation, found in 25% of upper tract endoscopies using RUs, is not currently covered by any monitoring recommendations. However, 1.8% of patients showing these histological anomalies develop a gastric adenocarcinoma within the following 10 years. The increased risk factors for atrophic gastritis are also known, mainly severe atrophic gastritis with extension to the stomach as a whole, family antecedents, nicotine dependence, and above all the presence of dysplasia. The results for two large-scale cohorts (in Hong Kong and Europe) strongly suggest that apart from patients showing dysplasia, who obviously have to be monitored, the presence of one of the various increased risk factors associated with atrophic gastritis justifies regular endoscopic and histological monitoring of the persons concerned. © 2011 Springer Paris.

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