Biomedical subjects
Publications and source records attributed to J Belaiche.
Capsule endoscopy is a new technique of exploration which enables to visualize the entire small bowel. Occult or unexplained digestive bleeding currently constitutes on major indication of this technique. The aim of this study is to report the results obtained among 15 patients investigated by capsule endoscopy and to discuss the place of this new technique in the small bowel exploration.
Anal fissure is a common problem which can evolve to chronicity. Chronic anal fissure is thought to be an ischemic ulceration related to sphincter hypertonia. Lateral internal sphincterotomy, the most common treatment for chronic anal fissure, may cause permanent injury to anal sphincter leading to fecal incontinence. To avoid such side effect were developed medications producing a temporary or reversible sphincterotomy reducing the sphincter pressure only until the fissure has healed: nitrates, calcium channel antagonists and botulinum toxin. Authors aimed to summary the state of research on such treatments (efficacy, side effects, recurrence risk) and to clarify the role of these different medical options in the current treatment of chronic anal fissure.
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.
The authors report the case of a patient aged 60-year-old who survived ulcerative colitis complicated by toxic megacolon and disseminated intravascular coagulation. This patient was not known for this ulcerative colitis and was first hospitalised for a suspicion of diverticulitis. The admission symptoms were fever, abdominal pain and bloody diarrhoea. The evolution was defavorable under antibiotics and sulfasalazine. The patient was readmitted 5 days after he left hospital, and the diagnosis of UC was based on colon biopsy made during the first hospitalisation. A treatment with methylprednisolone was started and the patient worsened day by day with apparition of toxic megacolon and disseminated intravascular coagulation. Subtotal colectomy was performed for degradation of general status and coagulation factors. Pathological findings confirmed ulcerative colitis with toxic megacolon. Cytomegalovirus inclusions were demonstrated on the colonic specimen and confirmed by PCR. In this report the authors discuss the etiology of toxic megacolon and disseminated intravascular coagulation in ulcerative colitis surinfected by cytomegalovirus. Mortality of these pathologies is high necessitating rapid diagnosis of cytomegalovirus infection by sigmoid biopsy. Management requires immunosupression interruption and ganciclovir therapy, or surgery in unsuccessful medical treatment.
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).
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.
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The discrepancy between the finding of hypernatremia--a manifestation of extra-cellular fluid depletion--and the presence of edema--a manifestation of increased ECF--is best explained by the patient's inability to mobilize edemas to compensate intra-vascular dehydratation. Treatment must start by the administration of hypotonic solutions, as hypernatremia is dangerous for the brain.
A study of renal tubular acidification in two cirrhotic patients with functional renal failure and partly compensated metabolic acidosis. Unlike renal distal tubular acidosis, but alike what is seen in organic renal failure, renal acidification was nearly normal and could not account per se for the development of metabolic acidosis. The multiple cause of the association in the cirrhotic of hyperchloremia and hypobicarbonatemia are reviewed (respiratory alkalosis, metabolic acidosis due to renal failure, distal tubular acidosis) and the diagnostic procedures outlined.
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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.
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.
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.
From february 1989 till october 1992, we performed 13 orthotopic liver transplantations on 8 patients admitted with the diagnosis of fulminant hepatic failure. The mortality of this affection, despite many treatments is very high, from 60 to 90% at three months according to the literature. Liver transplantation seems to be actually the treatment of choice in many cases. The purpose of this study is to review current concepts about this affection, indications for liver transplantation and results in our small series with a survival rate of 85% at 3 months, 75% at 6 months and 1 year.
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.
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.
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.