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Biomedical subjects

E Louis

Publications and source records attributed to E Louis.

159 records · Page 9Linked to original sources
PubMedDate not supplied

Development of adenocarcinoma in chronic fistula in Crohn's disease.

The authors report the case of a 55 yr-old woman suffering from Crohn's disease since 31 years with stricture and fistulas developed in the ileocolic junction and anorectal portion. Long-standing anorectal fistulas and stricture led to adenocarcinoma and finally fistulisation in the vagina. Diagnosis was made by perineal examination with biopsies under general anaesthesia. Treatment was first posterior pelvectomy with resection of the anterior wall of vagina. Secondarily, radiochemotherapy was administrated. The authors discuss the incidence and risk factors of carcinoma in Crohn's disease with chronic fistulas.

Adenocarcinoma↗
PubMedDate not supplied

Evolution of the prevalence and characteristics of anemia in inflammatory bowel diseases between 1993 and 2003.

INTRODUCTION: Anemia has been considered as an overlooked complication of inflammatory bowel disease. Studies dating back to the 80ties and the 90ties have shown 30% of anemia among inflammatory bowel disease (IBD) patients. More recently, the broader use of immunosuppressive drug and infliximab allowing better mucosal healing as well as a more aggressive treatment of anemia, including the use of safer form of IV iron, may have influenced the prevalence of anemia among IBD patients. Our aim was to asses the prevalence and characteristics of anemia among two cohorts of IBD patients at 10 years interval and to look for associated clinical or demographic factors. METHODS: Using the IBD patients register of one senior gastroenterologist, we identified IBD patients he had consecutively seen and who had blood test at the outpatient clinic during the years 1993 and 2003. Demographic and clinical characteristics, treatment for Crohn's disease, blood test results and treatment of anemia were recorded and compared between these two cohorts. Anemia was defined as an hemoglobin level lower than the normal value of the laboratory of our hospital. RESULTS: 80 and 90 patients were identified in 1993 and 2003, respectively. There was no significant difference between the two cohorts, according to age, gender, disease type, duration or location. There were 27/80 (33.8%) and 15/90 (16.7%) anemic patients in 1993 and 2003, respectively (P = 0.013). The prevalence of severe anemia (hemoglobin level < 10.5 g/100 ml) was similar in the two cohorts (6.3% and 5.6%). Characteristics of the anemia were similar in the two cohorts with a majority of iron deficiency anemia and inflammatory anemia. Ferritin and CRP levels were not significantly different in the two cohorts. The only significant difference was a more frequent use of immunosuppressive treatment and infliximab in 2003 than in 1993 (33.3% vs. 13.8% ; P = 0.0038, RR: 0.41, 0.22-0.77) CONCLUSIONS: Prevalence of mild to moderate anemia has significantly decreased in our population over the last 10 years. The only difference detected between the two cohorts was the increased use of immunosuppressive drug (mainly azathioprine).

Adolescent↗
PubMedDate not supplied

Diagnosis of small bowel malabsorption syndromes in adults.

Patients with malabsorption represent a small proportion of presentations with chronic diarrhea. In spite of some progress, the last twenty years were not very innovating in malabsorption investigations. Supporting history may direct investigations toward either the small bowel or pancreas. Serological testing for celiac disease will determine most cases without invasive investigation, but individuals suspected to have small bowel malabsorption, despite negative celiac serology, should have endoscopic distal duodenal biopsies taken to exclude other rare forms of small bowel enteropathy. This strategy has largely supplanted many older tests of small bowel function.

Adult↗
PubMedDate not supplied

[PPI very long-term treatment: is the problem only economic?].

Proton pump inhibitors are among the most prescribed drugs in Belgium, due to the high prevalence of gastrooesophageal reflux disease and significant impairment of health-related well-being. Short-term and long-term efficacy is superior to that of H2-receptor antagonists. Long-term safety is established. Empirical short-term treatment of symptomatic patients under 50 years of age without alarm signs is acceptable, but endoscopic investigation should always be performed before starting a long-term treatment. Doses for management of low-grade oesophagitis may be tailored to the patient's response. Continuous maintenance of full-dose is recommended for high grade oesophagitis. Surgical alternative is to be discussed with patients. Efficacy and mean cost for insurance plans are comparable. Endoscopic procedures are not yet sufficiently evaluated to be considered. Simple lifestyle advice is still useful. The burden of proton pump inhibitors cost is acceptable if they are prescribed at adequate doses. Cost-effective drugs should be chosen first.

Costs and Cost Analysis↗
PubMedDate not supplied

Atypical symptoms of GORD in Belgium: epidemiological features, current management and open label treatment with 40 mg esomeprazole for one month.

UNLABELLED: Frequency of atypical symptoms in patients suffering from gastro-oesophageal reflux disease (GORD) is not well known, and the optimal management of such symptoms has not been well established. Our aims were to set up an observatory of these atypical symptoms of GORD in Belgium and to study the efficacy of one month treatment with esomeprazole 40 mg. PATIENTS AND METHODS: Gastroenterologists participating in this observational survey were asked to register every new outpatient with symptoms of GORD during a period of 20 consecutive working days. All patients who reported predominant presence of atypical manifestations of GORD were documented and characterized more in detail. In patients with dominant chest pain or ENT symptoms, a treatment with esomeprazole 40 mg daily during 4 weeks was proposed. RESULTS: 90 gastroenterologists included 2864 patients consulting for symptoms suggestive of GORD, including 776 (27.1%) with dominant atypical symptoms. Endoscopy (performed in 2800 patients) showed significantly less oesophagitis in atypical than in typical GORD patients (68% vs. 81.1%; P < 0.0001). Management of atypical GORD patients appeared to be very heterogeneous. Overall 516/776 patients were included in the open phase of treatment with esomeprazole 40 mg, but data for analysis are only available in 228 patients. After one month, symptoms had disappeared in 57.1% and significantly improved in 26.6%. CONCLUSION: Atypical GORD represents a large number of consultations in gastroenterology in Belgium. It is associated with less endoscopic lesions than typical GORD. Its management is heterogeneous reflecting the lack of guidelines on this topic. Response rate after esomeprazole 40 mg for one month in this open uncontrolled trial was high. This result warrants confirmation in a placebo-controlled trial.

Adolescent↗
PubMedDate not supplied

[Enterochromaffin-like cells and their receptors: physiological role and physiopathological significance].

The enterochromaffin-like (ECL) cells represent the predominating endocrine cell population in the oxyntic mucosa of the stomach. They are under the influence of gastrin. Recently, a histamine production was shown within the secretory granules of ECL cells. ECL cells appear to play a crucial role in the physiology of gastric acid secretion. There are many unknowns concerning the intervention of other trophic factors in addition to gastrin and concerning the receptors located on the cells. ECL cell hyperplasia is a well documented consequence of hypergastrinemia. The latter can result from a gastrinoma or from a reduction of gastric acid secretion related to pernicious anemia or to long-term treatment with antisecretory drugs.

Animals↗
PubMedDate not supplied

Fundic argyrophil cell hyperplasia in atrophic gastritis: a search for a sensitive diagnostic method.

Hypergastrinemia induces argyrophil cell hyperplasia in oxyntic mucosa (FACH) in patients with non-antral atrophic gastritis, with or without pernicious anemia. This proliferation favours the development of carcinoid tumours. In order to determine the most usual appropriate method to document FACH, we have studied 29 consecutive fundic biopsies from 26 patients with fundic chronic gastritis. The study encompassed gastrinemia levels, standard histology permitting the classification of chronic gastritis, demonstration of FACH by Grimelius stain, immunohistochemical studies using NSE, chromogranin A and by electron microscopy. The FACH was classified for each stain as slight, moderate or severe. The study displayed a relationship between the grade of gastritis and the density of argyrophil endocrine cells in oxyntic mucosa assessed by Grimelius stain (p < 0.0001) and chromogranin A (P < 0.01). There was also a relationship between the serum gastrin level and the density of argyrophil endocrine cells detected by these two stains (p < 0.001). A highly significant correlation was observed between Grimelius stain and chromogranin A (p < 0.0001). On the other hand, no significant correlation was noted with either NSE or electron microscopy. We conclude that Grimelius stain and immunohistochemical studies against chromogranin A were the best methods for the demonstration of FACH in atrophic gastritis. One of these two techniques is sufficient in current practice for defining the patients at risk for subsequent surveillance.

Anemia, Pernicious↗
PubMedDate not supplied

Experimental models of inflammatory bowel disease.

Etiology of inflammatory bowel disease (IBD) is still unknown. A lot of experimental models of these diseases have been developed during the last years. They can be classified as spontaneous and induced models. Spontaneous models are infectious, genetic or of unknown etiology. Induced models are infectious, immune-mediated, chemical or genetic. All these models share some characteristics with IBD. In general, they are characterized by a chronic inflammation of the gut, and often, this inflammation appears secondary to mucosal abnormalities leading to an abnormal immune and inflammatory response toward luminal material. The most interesting models are thus those that share not only clinical and pathological characteristics with IBD, but also early mucosal abnormalities. From that point of view, the nonsteroidal anti-inflammatory drug (NSAID) enteropathy is probably one of the most interesting model for Crohn's disease (CD). In effect, this model shares an early modification with CD, that is increased intestinal permeability. In animals NSAID enteropathy, the increased intestinal permeability appears early after NSAID administration and is followed by inflammatory lesions. These lesions seem to be secondary to the increased permeability and depend on intraluminal materials, such as alimentary antigens or bacterial fragments. A possible link between the increased permeability and the inflammatory lesions could be an abnormal immune and inflammatory response toward the intraluminal materials. If the increased intestinal permeability in CD was confirmed, the same mechanisms could be implicated in its pathophysiology.

Animals↗
PubMedDate not supplied

[Antineutrophil cytoplasmic antibodies (ANCA) in inflammatory diseases of the digestive tract].

Antineutrophil cytoplasmic antibodies have recently been demonstrated in sera of patients with inflammatory bowel disease. We are reporting here our experience among 94 patients with Crohn's disease and 25 with ulcerative colitis. The indirect immunofluorescence assay with alcohol fixed neutrophils has been used. The presence of antineutrophil cytoplasmic antibodies was significantly associated to the ulcerative colitis 61% VS 17% (p < 0.001). The fluorescence had a perinuclear pattern among all but one suffering from ulcerative colitis. Among the patients suffering from ulcerative colitis there was no relationship between the presence of antineutrophil cytoplasmic antibodies and the activity or the localisation of the disease. Among the 9 patients operated for their ulcerative colitis, 4 were ANCA positive and remained so after proctocolectomy. The existence of antineutrophil cytoplasmic antibodies is useful for the diagnosis of some unclassifiable colitis. Their presence may be used as an argument in favour of some disturbances of the immunoregulation of the disease.

Adult↗
PubMedDate not supplied

Intestinal permeability in Crohn's disease.

We summarize the anatomical and physiological basis and the ways of measuring the intestinal permeability. We review the studies of the intestinal permeability in Crohn's disease. We analyse the involvement of an abnormal intestinal permeability in the pathogenesis of Crohn's disease, as a primary or secondary defect. We discuss the potential usefulness of the measure of intestinal permeability in Crohn's disease activity assessment, relapse prediction and efficacy of treatment.

Biomarkers↗
PubMedDate not supplied

Incidence of inflammatory bowel disease in the province of Liège (Belgium). La Société de Gastroentérologie Liègeoise.

UNLABELLED: Up to now, as there is no national registry of patients with inflammatory bowel disease (IBD) in Belgium, the study of IBD epidemiology in our country is only possible through institutional or regional series. Therefore we conducted a prospective epidemiologic study of IBD in the Province of Liège (1 million inhabitants). METHODS: 29 (out of 47) private and public gastroenterologists completed a standard questionnaire for each patient consulting for the first time with clinical symptoms compatible with IBD between 1/06/1993 and 31/05/1994. RESULTS: During that period 104 cases of IBD were recorded: 56 (54%) Crohn's disease (CD), 36 (35%) ulcerative colitis (UC) including 7 proctitis (19% of UC) and 12 (11%) unclassified colitis. The annual incidence was 5.5 per 100.000 for CD and 3.5 for UC. The sex ratio F/M was 1.7 for CD and 0.7 for UC. The median age at the time of diagnosis was 33.5 yrs for CD and 40 yrs for UC. The highest age specific incidence rate for CD and UC was between 20 and 29 yrs : 13.6 and 6.1, respectively. CONCLUSIONS: This first Belgian prospective study has shown an incidence rate for CD comparable with that seen in north European studies but lower than that seen for UC. These results were similar to those observed in the northern part of France. Belgium appears to be a privileged country to undertake a national register and to study epidemiological aspects of IBD.

Adult↗
PubMedDate not supplied

Familial Crohn's disease: a study of 18 families.

UNLABELLED: The high frequency of familial Crohn's disease (CD) suggests a genetic predisposition. The most recent data from epidemiology and molecular biology are consistent with a multifactorial, polygenic inheritance with a possible genetic heterogeneity. The aim of our study was, first to compare familial and sporadic CD on the basis of the type and location of the disease, and age at diagnosis, and second, to evaluate among families, the concordance rate for the type and location of the disease. PATIENTS AND METHODS: 18 families with 2 (n = 16) and 3 (n = 2) affected first degree relatives were studied. They were compared to a population of 154 sporadic CD coming from the same gastroenterology unit. RESULTS: Age at diagnosis was the same in sporadic and familial CD. There was an increased frequency of ileal (p = 0.02), and fibro stenotic (p = 0.005) CD and a decreased frequency of colonic (p = 0.006) and inflammatory (p = 0.02) disease, in familial CD. There was a significant increase in concordance rate for fibrostenotic disease (p < 0.001) and a decrease for inflammatory disease (p < 0.01), among the families. The observed concordance rate for the location of the disease was not significantly different from the expected one. In conclusion, these data suggest that CD may be heterogenous and that different clinical patterns may be determined either by genetic or environmental factors.

Adult↗
PubMedDate not supplied

Corticosteroid treatment in active Crohn's disease.

Despite recent improvements in the management of Crohn's disease, steroids are still the most efficacious treatment in flare ups of the disease. However they have significant side effects and are only effective in the short term. There is no consensus regarding initial dose or duration of corticotherapy. With 1 mg/Kg a day of oral prednisolone given for 3 to 7 weeks, 92% of the patients achieve clinical remission. Topical acting oral corticosteroids such as budesonide seem to represent an important therapeutic advance due to their better tolerance. The promising results of budesonide in mild and moderate flare ups need to be confirmed and its indication in severe disease beside high dose prednisolone has to be clarified.

Administration, Oral↗
PubMedDate not supplied

Incidence of inflammatory bowel disease in the area of Liège: a 3 years prospective study (1993-1996).

UNLABELLED: A first prospective epidemiological study of IBD was conducted in the area of Liège. The duration of the study was short taking into account the small size of the population (1 million inhabitants). Therefore we carried out a 3 years prospective study. METHOD: Private and public gastroenterologists completed a questionnaire for each new case they diagnosed between 01.06.1993 and 31.05.1996. RESULTS: During that period 270 IBD patients were identified: 137 (51%) had Crohn's disease (CD), 111 (41%) had ulcerative colitis (UC) including 32 proctitis (29% of UC) and 22 (8%) had unclassified colitis. The mean annual incidence per 10(5) was 4.5 for CD and 3.6 for UC. The female/male ratio was 1,6 for CD and 0,5 for UC. The median age at the time of diagnosis was 30 years for CD and 39 years for UC. The mean time between the onset of symptoms and the diagnosis was 6,5 months for CD and only 4,8 months for UC. Family history of IBD was found in 15% of patients with CD and in 7% of UC. CONCLUSIONS: These data show a high incidence of IBD in the area of Liege. These results confirm those reported during the first year of the prospective study which were similar to those observed in North-western France. Contrary to the other countries of Northern Europe, the incidence of UC is lower than the one of CD. Belgium appears to be a privileged country to undertake a national register and to study epidemiological aspects of IBD.

Adult↗