Biomedical subjects
Jean-Charles Grimaud
Publications and source records attributed to Jean-Charles Grimaud.
[Proof of information delivered to patients].
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[Irritable bowel syndrome and healthcare consumption. An observational study in private gastroenterology].
AIM: Little data is available on the management of irritable bowel syndrome (IBS) in daily practice. The purpose of our study was to study the relationship between the severity of IBS and healthcare consumption. METHODS: During a cross-sectional epidemiological study undertaken by 330 private gastro-enterologists, the severity of IBS symptoms experienced by patients was quantified with Francis' score (limits 0-500) to study the relationship with the healthcare consumption. RESULTS: Data obtained from 1407 patients (mean age: 52.3 +/- 15 years, females: 68%) were analysed. Symptoms were usually long-lasting (mean duration: 134.1 +/- 128.4 months); they had required on average 5.7 +/- 4.5 medical visits in the past year including 2.3 +/- 2.1 visits to a gastroenterologist. The mean number of additional investigations performed by patient was 1.3 +/- 1.4. Ninety one percent of them took at least one medication. The mean severity score was 268.5 +/- 85.2. Patients' distribution according to severity showed that 47.3% of the patients had symptoms of moderate severity and 44.9% of high severity. There was a significant relationship between, in one hand, severity of symptoms and, in the other hand, the number of visits (P<0.001), the number of additional investigations (P<0.001) and the number of prescribed medications (P<0.001). CONCLUSION: There was a positive relationship between the severity of symptoms and the healthcare consumption in private gastroenterological practice. The data confirm the significant burden of IBS in France.
Serum measurements of pancreatitis associated protein in active Crohn's disease with ileal location.
BACKGROUND AND AIMS: Pancreatitis-associated protein (PAP) is a pancreatic stress protein also expressed in the ileum but not in the colon. Its serum concentration is increased in patients with small bowel inflammation due to untreated celiac disease. We searched to determine whether PAP could be a serum marker for ileal location of active Crohn's disease (CD). METHODS: A multicenter prospective study was conducted, including 54 healthy controls and 124 patients with CD of whom 38 had quiescent ileal or ileocolonic disease (group A), 45 had active ileal or ileocolonic disease (group B), 18 had quiescent colon-only CD (group C), and 28 had active colonic disease (group D). Active disease was defined by a Crohn's disease activity index > 150 and serum C-reactive protein (CRP) > 10 mg/mL. Location of lesions was assessed by endoscopy. PAP was assayed in serum, the upper threshold for normal values being 50 ng/mL. RESULTS: In group B, 27 patients (60%) had elevated serum PAP, compared to one in group A (2.5%), one in group C (5.3%), three in group D (10.7%) and none in the control group (P<0.01). By contrast, serum levels of C-reactive protein did not differ between patients with active CD and either ileal location (group B) or pure colonic location (group D) (38 +/-10.5 vs 41.6 +/- 6.4 mg/mL, NS). Within group B, serum PAP concentration was correlated with none of the epidemiological, clinical or biological data available. Increased serum level of PAP diagnosed ileal location in active CD with a sensitivity of 60%, a specificity of 94%, a positive predictive value of 84% and a negative predictive value of 81%. CONCLUSION: Elevated serum PAP (> 50 ng/mL ) is significantly associated with disease activity and ileal location
[Endoscopic and histological findings of colonic pseudo-lesions induced by Fleet Phospho-Soda (R)].
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[Endoscopic management of biliary and pancreatic ascariasis in Viet-Nam. Report of a series of 91 cases].
AIM: Ascariasis is the most widespread helminthiasis in the world. Biliary and pancreatic involvement, frequently encountered in endemic areas, is a serious public health problem. Surgical management is often required. The purpose of our work was to assess the feasibility of emergency endoscopic treatment of biliary and pancreatic ascariasis in the Viet Duc hospital (Hanoi, Vietnam), and to evaluate outcome. METHODS: A prospective study conducted over a 3-year period included 91 patients with biliary and pancreatic ascariasis. Diagnosis was based on clinical findings and abdominal ultrasound and was confirmed by endoscopic procedures. RESULTS: The 91 patients, 21 males and 70 females, mean age 41 +/- 17 years, underwent endoscopic procedures to retrieve the worm. The procedure was successful in 89 patients (97.8%). Mild pancreatitis occurred in four patients who underwent biliary sphincterotomy. The mean hospital stay was 3.1 days. CONCLUSION: Endoscopic management of ascariasis is feasible, with a very low morbidity and a high rate of success. With this treatment, hospital stay is greatly shortened.