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Biomedical subjects

E Lerebours

Publications and source records attributed to E Lerebours.

At least 55 records · Page 3Linked to original sources
PubMed1997

[Gallbladder involvement in Crohn disease].

We report the case of a young woman with Crohn's disease involving the entire digestive tract and with associated lesions of the liver, pancreas and gallbladder. This latter lesion led to acute cholecystitis which required cholecystectomy. The histo-pathological examination showed granulomas with multinucleated giant cells in the lamina propria. This observation illustrates a severe and extended form of Crohn's disease involving the entire digestive tract as well as the liver, the pancreas and the gallbladder.

Acute Disease↗
PubMed1997

Digestive manifestations in an immunocompetent adult with varicella.

A case of varicella with pancreatic pain as a first manifestation, a typical papulovesicular rash, pulmonary and hepatic and esophageal localizations occurring in an immunocompetent adult is reported. Treatment with intravenous acyclovir resulted in a prompt improvement and recovery in less than 4 days.

Adult↗
PubMed1996

Intravenous cyclosporine in attacks of ulcerative colitis: short-term and long-term responses.

The present study reports the results of intravenous cyclosporine in 32 patients with refractory and/or severe attacks of ulcerative colitis (UC). Twenty of 32 patients responded to intravenous cyclosporine; cyclosporine was clinically effective and improved colonic lesions. However, one colonic perforation and one postoperative death were observed in two patients with severe endoscopic colitis who had failed to reach clinical remission with high-dose corticosteroids and cyclosporine. Moreover, after a median follow-up of 190 days, only one-third of the patients avoided colectomy. No predictive factor of response to cyclosporine was identified. This study confirms that cyclosporine is effective in severe UC but suggests that its use could be associated with serious complications in patients with severe lesions who had failed to settle with corticosteroids and cyclosporine.

Adolescent↗
PubMed1996

Does chronic supplementation of the diet with dietary fibre extracted from pea or carrot affect colonic motility in man?

The aim of the present study was to assess, in healthy volunteers and under physiological conditions, the acceptability, clinical tolerance and effects on colonic motility of chronic supplementation of the usual diet with new dietary fibre sources. Three studies were carried out, one after a period of habitual diet, and two after randomized 3-week periods of supplementation with fibre extracted either from pea hulls or carrots, added to the meals as a fine powder. The 24 h motility was recorded on an unprepared colon at five levels to determine the initiation site and the number of high amplitude propagated contractions (HAPC) and to quantify motor activity every 30 min, particularly in the two periods following lunch and breakfast. With the habitual diet the motility pattern was an irregular alternation of quiescence and sporadic non-propagated contractions. HAPC always started from the ascending colon and occurred mainly after breakfast. With either type of fibre the 24 h motor profiles, the 24 h variations and the number of HAPC were not significantly modified but a more distal initiation of HAPC was found. The colonic postprandial motor response was more diffuse after dietary enrichment with carrot fibre than after enrichment with pea-hull fibre. In healthy volunteers the long-term addition of fibre extracted from pea hulls and carrots to the usual diet was easy and well-tolerated without clinical side-effects, but with limited colonic motor effects. However, the more distal initiation of HAPC observed could be deleterious.

Adult↗
PubMed1996

Placebo-controlled clinical trial of mesalazine in the prevention of early endoscopic recurrences after resection for Crohn's disease. Groupe d'Etudes Thérapeutiques des Affections Inflammatoires Digestives (GETAID).

OBJECTIVE: Endoscopic postoperative recurrences occur early after 'curative' surgery for Crohn's disease. Pentasa has been shown to be effective in the maintenance treatment of quiescent Crohn's disease. The aim of this study was to test the efficacy of a 12-week oral intake of Claversal in the prevention of endoscopic recurrences after 'curative' resection for ileal, colonic or ileocolonic Crohn's disease. We conducted a multicentre double-blind controlled trial comparing Claversal (1g tid) with placebo, starting within 15 days after surgery. The macroscopic normality of the two anastomotic segments was assessed at surgery. Patients were clinically and biologically evaluated twice (6-week interval), and colonoscopy was performed at 12 weeks. Endoscopic relapse was defined by any anastomotic ulcerations or stenosis and staged according to a four-grade score. RESULTS: Between May 1989 and May 1991 12 centres included 126 patients, 70 women and 56 men, aged 33 +/- 12 years (range 16-70) in the study. Disease locations were ileal, colonic and ileocolonic in 45, 6 and 49%, respectively. Claversal and placebo groups were similar at inclusion, except for ESR (37 +/- 26 vs. 27 +/- 23 mm/h in the Claversal and placebo groups, respectively; P < 0.05). Nine patients were withdrawn from the study. Adverse reactions occurred only in six patients. Five patients were excluded for protocol violation. Finally, 106 patients could be evaluated at 12 weeks (55 Claversal and 51 placebo). An endoscopic relapse was observed in 50% and 63% of the Claversal and placebo groups, respectively (P = 0.16), with a similar grade distribution. Claversal was well tolerated. CONCLUSIONS: Our study confirms that a large proportion of endoscopic recurrences occur within 3 months of resection in Crohn's disease. There was a slight trend towards greater efficacy of Claversal; it could be worthwhile trying higher dosages and/or 5-ASA compounds with different intestinal release profiles.

Administration, Oral↗
PubMed1996

[Portal thrombosis disclosing antiphospholipid syndrome. 2 cases].

The presence of serum antiphospholipid antibodies is associated with arterial and venous thrombosis. We report two cases of portal vein thrombosis associated with serum antiphospholipid antibodies. In our two patients, systemic lupus erythematosus, chronic liver disease, hepatocellular carcinoma, myeloproliferative disorders and coagulation inhibitor deficiency were excluded after extensive tests were performed to diagnose portal vein thrombosis and after a follow-up period of 6 and 7 years, respectively. The test for serum antiphospholipid antibodies was positive on two occasions in both patients. Both patients were treated with endoscopic sclerotherapy for bleeding esophageal varices and with long term anticoagulant therapy for the prevention of recurrent thrombosis. These two cases suggest that serum antiphospholipid antibodies should be investigated in patients with portal vein thrombosis of unexplained etiology.

Adult↗
PubMed1995

Identifying patients with a high risk of relapse in quiescent Crohn's disease. The GETAID Group. The Groupe d'Etudes Thérapeutiques des Affections Inflammatoires Digestives.

No reliable identification of quiescent Crohn's disease (CD) patients with a high risk of relapse is available. The aim of this study was to develop a prognostic index to identify those patients. Untreated adult patients with quiescent disease (not induced by surgery) included in three phase III clinical trials were analysed retrospectively with respect to time to relapse. Nineteen factors related to biology, disease history, and topography were investigated. A relapse was defined as either a CD Activity Index (CDAI) > or = 200, a CDAI > or = 150 but over the baseline value by more than 100, or acute complications requiring surgery. The inclusion criteria were fulfilled by 178 patients. The median follow up was 23 months. The Cox model retained the following bad prognostic factors: age < or = 25 years, interval since first symptoms > 5 years, interval since previous relapse < or = 6 months, and colonic involvement (p < 0.001). Bootstrapping confirmed the variable selection. Patients were classified into three groups with an increasing risk of relapse (p < 0.001). The worst risk group was composed of patients presenting at least three of the four bad prognostic factors. These results make possible the design of clinical trials in quiescent CD patients with a high risk of relapse.

Adolescent↗
PubMed1995

Which patients taking non-aspirin non-steroidal anti-inflammatory drugs bleed? A case-control study.

OBJECTIVE: To identify risk factors for gastrointestinal bleeding (GIB) among users of non-aspirin, non-steroidal anti-inflammatory drugs (NANSAIDs). DESIGN: Case-control study. PARTICIPANTS: A total of 120 patients aged over 60 years and using NANSAIDs were hospitalized between January 1988 and September 1992 for GIB related to erosions or ulceration of the gastroduodenal mucosa. A group of 100 general practitioners selected two controls matched for age and sex, receiving NANSAIDs and without GIB, for each patient. METHODS: The same questionnaire was used to interview patients and controls about their medical history, use of NANSAIDs and other drugs, alcohol and tobacco use, recent stress and nutritional status. RESULTS: The adjusted odds ratios (OR) for the risk factors related to the pattern of NANSAID use were 3.39 [95% confidence interval (CI) 1.77-6.47] when the intake of NANSAIDs was followed by decubitus, 3.00 (95% CI 1.54-5.85) when NANSAIDs were taken before a meal, 6.05 (95% CI 2.10 17.43) with a high dose of NANSAIDs, 5.87 (95% CI 2.00-17.25) with recent NANSAID use, 3.35 (95% CI 1.47-7.64) with NANSAIDs associated with aspirin use, 3.46 (95% CI 1.15-10.36) with more than one NANSAID, and 10.70 (95% CI 1.06-108.07) when NANSAIDs were associated with corticosteroids. The patient-related risk factors and their OR were 9.94 (95% CI 3.29-24.28) for irregular food intake, 3.94 (95% CI 1.45-10.69) for previous peptic ulcer, 3.71 (95% CI 1.26-10.89) for recent weight loss, 4.44 (95% CI 1.48-13.30) for heavy alcohol abuse, 2.92 (95% CI 1.36-6.26) for recent stress and 5.26 (95% CI 1.19-23.33) for a past history of GIB. CONCLUSION: This study identified a group at 'high risk' for GIB which would benefit from the development of a prophylactic therapy.

Adrenal Cortex Hormones↗
PubMed1995

Influence of antibiotics and food intake on liver glutathione and cytochrome P-450 in septic rats.

Experimental sepsis in rats induces a restriction in spontaneous food intake and a drop in liver glutathione, cytochrome P-450 (P-450) and aminopyrine demethylase (AD) activity. The present study was designed to assess the effects of antibiotics alone or when combined with food deprivation on these variables. Eighty-nine male Sprague-Dawley rats were assigned to six groups: control (C), acute infection (experimental pyelonephritis, I), acute infection with antibiotics and food given ad lib. (IA), control with antibiotics (CA), acute infection with antibiotics pair-fed to I (IAR), and sham-operated pair-fed to I (SR). Liver glutathione, P-450 and AD activities were reduced by 45.2, 79.8 and 41.2% respectively in group I. Glutathione and AD significantly increased only in those infected rats given antibiotics and allowed free access to food. P-450 did not normalize within the study period in infected rats receiving antibiotics and food repletion. The risk of drug hepatotoxicity in acute septic states is therefore closely related to the nutritional status. From this point of view, nutritional support is almost as important as treatment of infection.

Aminopyrine N-Demethylase↗
PubMed1994

Treatment of Crohn's disease by lymphocyte apheresis: a randomized controlled trial. Groupe d'Etudes Thérapeutiques des Affections Inflammatoires Digestives.

BACKGROUND/AIMS: Several uncontrolled trials suggest that lymphapheresis improves the clinical course of patients with Crohn's disease; this study was designed to assess the efficacy of lymphapheresis in preventing early relapses of Crohn's disease in patients in clinical remission after steroid treatment for an acute attack. METHODS: Twenty-eight patients in clinical remission at the end of 3-7 weeks of steroid therapy were included in this randomized multicenter prospective trial. Before starting steroid tapering, patients were randomly assigned either to the lymphapheresis group (9 procedures within 4-5 weeks) or to the control group. The primary judgement criterion was the cumulated recurrence rate after steroid discontinuation. RESULTS: All the patients treated by lymphapheresis (12 of 12) were successfully withdrawn from prednisolone and only 10 of 15 in the control group (NS). At the end of the 18-month follow-up period, the cumulated relapse rate was 83% in the lymphapheresis group and 62% in the control group. CONCLUSIONS: Although there was a trend towards a diminished incidence of corticosteroid dependence, lymphapheresis did not prevent the occurrence of early relapses.

Adolescent↗
PubMed1994

Nizatidine as maintenance treatment of duodenal ulcer. Clinical results.

In assessing treatments for chronic diseases such as duodenal ulcer (DU), measuring the patient's quality of life (QoL) is as important as objective measures of treatment efficacy. This study was part of a larger study assessing the QoL of patients with DU treated with nizatidine. The aim of this part of the 12-month study was to assess the clinical efficacy and the influence of maintenance therapy with nizatidine on the long-term treatment of patients with healed DU. The trial, which was open, randomized and controlled, was conducted in 177 centres throughout France. A total of 581 patients of 18 years or over with endoscopically confirmed DU were assigned to two groups. The active treatment group received nizatidine 150 mg/day for one year and the control group had no regular treatment. Both groups had free access to antacid tablets, use of which was recorded. Symptomatic relapse was treated with nizatidine 300 mg/day for 6 weeks. Clinical assessments were made every 2 months, at which times patients also recorded their symptoms. The relapse rate in the nizatidine-treated group was significantly lower than in the control group at 6 months (4.5% versus 15.3%; p < 0.0001). At 12 months the difference was still significant (8.0% versus 33.5%; p < 0.001). Antacid consumption was significantly greater in controls than in the nizatidine-treated group (44.7% versus 29.7%; p < 0.001). It is concluded that nizatidine is a safe and effective therapy for preventing DU recurrence in patients with endoscopically confirmed healed ulcers.

Adult↗
PubMed1993

Ileal involvement in toxic epidermal necrolysis (Lyell syndrome).

Intestinal involvement in toxic epidermal necrolysis (TEN) has been identified only rarely. This report describes a case of TEN with ileal manifestations characterized by a profuse diarrhea with malabsorption, protein-losing enteropathy, and radiologically by multiple stenosis. After healing of the cutaneous lesions, total parenteral nutrition was initiated, resulting in a decreased diarrhea. However, after one month of total parenteral nutrition, malabsorption and protein-losing enteropathy continued and the radiological lesions were still present with an aspect consistent with a sclerotic process. A surgical resection of the pathological ileal segment was performed with end-to-end anastomosis. Pathological examination of the resected segment showed a necrosis of the ileal mucosa with a pattern similar to that of the epidermal necrosis. No sclerosis was observed. It seems that a prolonged total parenteral nutrition could have induced a complete healing of intestinal lesions. This case report is the first clinical, radiological, and histological study of an ileal involvement in TEN.

Diarrhea↗
PubMed1993

Oral mesalamine (Pentasa) as maintenance treatment in Crohn's disease: a multicenter placebo-controlled study. The Groupe d'Etudes Thérapeutiques des Affections Inflammatoires Digestives (GETAID)

BACKGROUND: Mesalamine provides a new therapeutic approach in treating Crohn's disease. METHODS: To assess the efficacy and safety of slow-release mesalamine (Pentasa; Ferring AS, Vanløse, Denmark) in maintaining remission in Crohn's disease, 161 patients with inactive disease were randomized to receive either Pentasa (2 g/day) or placebo in a 2-year double-blind, multicenter trial. Two strata were defined according to the duration of their remission: < 3 months (n = 64) or 3-24 months (n = 97), presumed to be high and a low relapse risk strata, respectively. RESULTS: The probability of relapse was higher in the short-remission placebo group than in the three other groups (P < 0.003), showing there was a significant benefit from Pentasa in the high relapse risk stratum. In this stratum, the 2-year ongoing remission rate was of 29% +/- 9% and 45% +/- 11% (mean +/- SD) in the placebo and Pentasa groups, respectively. The incidences of side effects were similar in both groups. CONCLUSIONS: Pentasa (2 g/day for 2 years) is a safe and effective maintenance treatment for Crohn's disease when given within 3 months of achieving remission.

Administration, Oral↗
PubMed1993

[Maintenance treatment of Crohn's disease using orally administered mesalazine (Pentasa). A controlled multicenter study. The Study Groups on the Treatment of Inflammatory Digestive Disorders].

BACKGROUND: Mesalamine provides a new therapeutic approach in treating Crohn's disease. METHODS: To assess the efficacy and safety of slow-release mesalamine (Pentasa) in maintaining remission in Crohn's disease, 161 patients with inactive disease were randomized to receive either Pentasa (2 g/day) or placebo in a 2-year double-blind, multicenter trial. Two strata were defined according to the duration of their remission: < 3 months (n = 64) or 3-24 months (n = 97), presumed to be high and low relapse risk strata, respectively. RESULTS: The probability of relapse was higher in the short-remission placebo group than in the three other groups (p < 0.003), showing there was a significant benefit from Pentasa in the high relapse risk stratum. In this stratum, the 2-year on-going remission rate was of 29% +/- 9% and 45% +/- 11% (mean +/- SD) in the placebo and Pentasa groups, respectively. The incidences of side effects were similar in both groups. CONCLUSION: Pentasa (2 g/day for 2 years) is a safe and effective maintenance treatment for Crohn's disease when given within 3 months of achieving remission.

Administration, Oral↗