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Biomedical subjects

L Beaugerie

Publications and source records attributed to L Beaugerie.

At least 73 records · Page 4Linked to original sources
PubMed1995

[Sclerosing peritonitis. A series of 10 cases and review of the literature].

OBJECTIVE AND METHODS: The aim of this study was to describe the main features of sclerosing peritonitis, using a retrospective study in 10 patients. RESULTS: The main causes of sclerosing peritonitis were continual ambulatory peritoneal dialysis (n = 3), peritoneal chemotherapy (n = 2) and liver cirrhosis (n = 2). Sclerosing peritonitis was revealed by acute or chronic bowel obstruction (n = 8). Small bowel X-rays and abdominal tomodensitometry showed a small bowel dilatation with a normal mucosa (n = 7), ascites (n = 5) as well as agglutination and fixation of small bowel loops within a cocoon (n = 3). Surgical viscerolysis was performed in 9 patients and allowed prolonged clinical remission in 4; 3 patients died postoperatively (1 had a cirrhosis and 2 were treated with continuous ambulatory peritoneal dialysis), 1 patient had a complicated postoperative course with recurrent enterocutaneous fistulae. CONCLUSION: Sclerosing peritonitis may be suspected in a patient who presents a combination of bowel obstruction, small bowel dilatation without mucosal disease and ascites. Surgical viscerolysis is a dangerous operation associated with high mortality in patients with renal failure or cirrhosis.

Adult↗
PubMed1994

Linkage analyses of chromosome 6 loci, including HLA, in familial aggregations of Crohn disease. G.E.T.A.I.D.

Segregation analyses of familial aggregations of Crohn disease have provided consistent results pointing to the involvement of a predisposing gene with a recessive mode of inheritance. Although extensively investigated, the role played by human leucocyte antigen (HLA) genes in this inflammatory bowel disease remains elusive and the major histocompatibility complex is a candidate region for the mapping of the Crohn disease susceptibility gene. A total of 25 families with multiple cases of Crohn disease was genotyped for HLA DRB1 and for 16 highly polymorphic loci evenly distributed on chromosome 6. The data were subjected to linkage analysis using the lod score method. Neither individual nor combined lod scores for any family and for any locus tested reached values suggesting linkage or genetic heterogeneity. The Crohn disease predisposing locus was excluded from the whole chromosome 6 with lod scores less than -2. It was excluded from the major histocompatibility complex and from 91% of the chromosome 6 genetic map with lod scores less than -4. The major recessive gene involved in genetic predisposition to Crohn disease does not reside on the major histocompatibility complex nor on any locus mapping to chromosome 6.

Belgium↗
PubMed1994

Classification of the sequelae of bowel resection for Crohn's disease.

A postoperative handicap index designed to predict diarrhoea and malnutrition following bowel resection in patients with Crohn's disease is proposed. The index takes into account the location and extent of resection, and its value can be calculated from operative records. Retrospective (n = 218) and prospective (n = 68) series of patients were studied. Diarrhoea and malnutrition developed in 102 patients (47 per cent) and 13 patients (6 per cent) respectively in the retrospective series, and in 40 (59 per cent) and one (1 per cent) of those in the prospective series. The handicap index correlated with faecal weight and faecal fat in 112 patients tested. Positive and negative predictive values of an index score greater than 20 for the development of diarrhoea, and over 50 for the development of malnutrition, were 0.64 and 0.90, and 0.60 and 0.99 respectively in the retrospective series; values were 0.80 and 0.71, and 0.25 and 1.00 in the prospective series. The postoperative handicap index is a useful tool for predicting the functional consequences of bowel resection for Crohn's disease.

Adult↗
PubMed1994

Etiology and management of toxic megacolon in patients with human immunodeficiency virus infection.

We report six cases of toxic megacolon in patients with human immunodeficiency virus (HIV). One case, at an early stage of HIV infection, mimicked a severe attack of Crohn's disease, with a negative search for infectious agents. Subtotal colectomy was successfully performed with an uneventful postoperative course. The five other cases concerned patients with acquired immunodeficiency syndrome at a late stage of immunodeficiency. They were related to Clostridium difficile or cytomegalovirus (CMV) intestinal infection in two and three patients, respectively. One case of CMV colitis presented macroscopically and histologically as pseudomembranous colitis. Emergency subtotal colectomy, performed in the first four patients with acquired immunodeficiency syndrome was followed by a fatal postoperative outcome. The last patient treated conservatively by colonoscopic decompression, in association with anti-CMV therapy, had a favorable short-term outcome. From the experience of our series and data from the literature, we discuss the best diagnostic and therapeutic approach to toxic megacolon in patients with HIV.

Adult↗
PubMed1994

[Treatment of Crohn disease in adults].

Corticosteroids are an efficient treatment for active Crohn's disease. The treatment has to be undertaken with a daily intake equivalent to 1 mg/kg per day of prednisolone for a 3 to 7 week period. Immunosuppressive agents are indicated in case of corticodependency or in case of large intestinal resection. Artificial nutrition (enteral or parenteral) is proposed in corticoresistant forms, and is usually followed by an immunosuppressive therapy. Surgical management is reserved for complications, including resistance to all medical therapy. Surgical resection has to be limited in order to avoid a short bowel syndrome. Surgery should not be considered as the ideal therapy as it has been demonstrated that recurrence after surgery increases at distance. 5-aminosalycilates compounds are an alternative therapy in mild attacks. Mesalazine may reduce the recurrence and could be considered as a possible maintenance treatment.

Adult↗
PubMed1994

Drug induced lymphocytic colitis.

Three cases are presented of lymphocytic colitis with chronic diarrhoea concurrent with longterm use of Cyclo 3 Fort, a phlebotonic drug used in France. The histological and immunopathological features of lymphocytic colitis are described. We show that lymphocytic colitis is drug induced, particularly in one patient where the immunopathological features of mucosal immune cell activation were induced by drug rechallenge. It is concluded that lymphocytic colitis may be drug induced, secondary to a chronic activation of the mucosal immune system by one or several components of the drug.

Aged↗
PubMed1993

Absorption of zidovudine in patients with diarrhoea.

Many patients with AIDS have gastrointestinal complaints, including the major clinical disorder of chronic diarrhoea. The pharmacokinetics of zidovudine was studied in 9 male patients with HIV infection and diarrhoea to establish whether drug absorption was impaired in them. The peak plasma concentration and AUC after a single oral dose of 200 mg, were the same as those reported in 6 healthy male volunteers (3.1 vs 4.0 mumol.l-1 and 7.2 vs 5.2 mumol.h.l-1, respectively). Since the bioavailability of zidovudine is not particularly impaired, oral zidovudine therapy can be maintained in patients with diarrhoea.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Isotonic high-sodium oral rehydration solution for increasing sodium absorption in patients with short-bowel syndrome.

We compared the effect of a standard oral rehydration solution and a high-sodium polymeric-glucose solution on sodium absorption in short-bowel syndrome. Six patients with high jejunostomy were tested in a random order with the standard solution or a solution containing maltodextrins (18 g Glucidex 12/L) enriched with 2.5 g NaCl/L. Solutions were administered via a nasogastric tube at a rate of 2 mL/min. Jejunal effluent was collected during an 8-h period. The net 8-h fluid absorption was not significantly different in the two periods. Glucose absorption was greater than 90% of the administered amount for both solutions. Net sodium absorption was greater for the maltodextrin solution than for the standard solution (56 +/- 12 vs 24 +/- 20 mmol, P less than 0.05). We conclude that replacement of glucose with maltodextrins and addition of sodium in the standard oral rehydration solution results in improved sodium absorption in short-bowel syndrome.

Absorption↗
PubMed1991

Modulation of orocaecal transit time by hypnosis.

The ability of hypnosis to modulate the orocaecal transit time of 10 g lactulose was tested in six healthy volunteers. Orocaecal transit time was measured by the hydrogen breath test during three periods in random order. During the control period the subjects remained throughout the test in a semirecumbent position without moving. During the hypnotic relaxation period subjects were hypnotised before lactulose ingestion and were instructed to experience relaxation till the orocaecal transit time had elapsed. During the acceleration suggestion period subjects were hypnotised before lactulose ingestion and were repeatedly instructed to imagine the acceleration of lactulose through the intestine until transit time had elapsed. The mean orocaecal transit time was significantly longer during the hypnotic relaxation period (mean (SEM) 133 (8) min) than during the control period (93 (13) min). The mean orocaecal transit time during the acceleration suggestion period was 105 (26) minutes and was not significantly different from the mean transit time during the control period. The individual values during the acceleration suggestion period were scattered. We conclude that lactulose orocaecal transit time is delayed during hypnotic relaxation.

Adult↗
PubMed1991

[Clinical tolerance, intestinal absorption, and energy value of four sugar alcohols taken on an empty stomach].

Sugar alcohols are incompletely digested in the human small intestine. The residual amounts reaching the colon are digested by colonic bacteria or excreted in stools. Clinical tolerance and energy value of sugar alcohols are related to their respective rates of digestion in the small intestine and the colon. Six healthy volunteers were tested in 5 periods during which they ingested 10 g lactulose, and then, in a random order, an iso-osmotic solution of 20 g isomalt, sorbitol, maltitol, and lactitol. The fraction of sugar alcohols absorbed in the small intestine was evaluated by comparing the amounts of hydrogen excreted in breath for 8 h after the ingestion of lactulose and of sugar alcohols. Energy value of sugar alcohols was determined knowing the amounts absorbed in the small intestine and digested in the colon. Tolerance to the sugar alcohols was good in all volunteers, and not different between sugar alcohols. The mean percentage of malabsorption in the small intestine was significantly higher for lactitol (84 +/- 14 percent, m +/- SEM) than for maltitol and isomalt (44 +/- 7 and 40 +/- 7 percent), its energy value (2.3 +/- 0.3 kcal/g) was significantly lower than the energy value of maltitol (3.1 +/- 0.1 kcal/g, P less than 0.05); whereas those of sorbitol and isomalt were close (2.7 +/- 0.2 and 2.8 +/- 0.1 kcal/g, respectively). In spite of these differences, our results suggest that in our experimental conditions, bacterial digestion of the sugar alcohols reaching the colon was complete, and did not affect their clinical tolerance.

Adult↗
PubMed1990

Adaptive hyperphagia in patients with postsurgical malabsorption.

The specific nutritional consequences of malabsorption after small-bowel surgery were studied in a consecutive series of 48 ambulatory patients who had had small-bowel resection (n = 43) or bypass (n = 5) and in 10 patients who had an ileal pouch (n = 10). The patients received a 3-day standardized oral regimen providing daily 30 kcal/kg of ideal body weight (IBW). Throughout the study, 41 patients had malabsorption (fecal fat greater than 5%); 17 had fecal fat less than 5% and served as controls. The malabsorption patients absorbed 70% of protein and 71% of fat. Twenty-one were normonourished and 20 had features of mild energy malnutrition, vs. 15 and 2 controls, respectively. Compared with controls, malabsorption patients had decreased body weight and triceps skin-fold but no features of protein malnutrition. their mean daily food intake at home was significantly enhanced (39.6 +/- 13.1 kcal/IBW kg) vs. controls (28.8 +/- 5.8 kcal/IBW kg, P less than 0.001). In the malabsorption group, caloric intake was higher in the normonourished patients than in those with mild malnutrition. This study shows that a chronic malabsorption has limited nutritional consequences. The patients compensate for their absorptive handicap by increasing their oral intake.

Absorption↗
PubMed1990

Digestion and absorption in the human intestine of three sugar alcohols.

The digestion and absorption of three sugar alcohols, consumed chronically in three identical daily postprandial doses, were evaluated in six volunteers during three 11-day periods. Each period included a 3-day adaptation period during which sugar alcohol doses were increased, a 4-day equilibration period, a 2-day stool collection period, and a 2-day intubation period. From day 4, the daily administered amounts were either 30 g pure sorbitol, 57 g maltitol containing 30 g sorbitol, or 69 g Lycasin 80/55 (Roquette, Lestrem, France), which is a hydrogenated glucose syrup also containing 30 g sorbitol. The distal ileal output of sugar alcohols and their components was determined by aspiration after a single meal. The mean percentage of sorbitol absorbed in the small intestine was significantly higher in pure sorbitol doses than in those containing maltitol and Lycasin 80/55 (79% +/- 4% vs. 64% +/- 4% and 64% +/- 5%, mean +/- SEM). The mean percentage of total maltitol digested was not different for pure maltitol and maltitol contained in Lycasin 80/55 (90% +/- 2% vs. 86% +/- 2%). Stool excretion of sugar alcohols was negligible, indicating that the sugar alcohols reaching the colon were almost completely digested by the colonic flora. The mean estimated energy values of the sugar alcohols ingested in kcal/g were 3.58 +/- 0.08 for sorbitol, about 3.50 +/- 0.07 for maltitol, and between 3.11 +/- 0.08 and 3.54 +/- 0.08 for Lycasin 80/55. Because the experimental conditions of this study mimicked the usual way of consumption of the three sugar alcohols, little calorie saving can be expected from the chronic consumption of these sugar alcohols in so-called sugar-free products.

Adult↗
PubMed1989

Testing for course patterns in Crohn's disease using clustering analysis.

Using clustering analysis, we sought to identify groups of patients on the basis of the disease course among a population of 177 patients with Crohn's disease and followed for 3 years or more, starting from the first frank exacerbation of the disease. The first 36 values of a monthly clinical score represented the active variables of the clustering analysis. This method yielded 2 course groups, A and B, of 95 and 82 patients respectively. The unfavorable course in group A was characterized by the persistence of the clinically active disease at 3 years, whereas group B individuals achieved complete clinical remission within 2 years of onset on the average. Among the initially known clinical data which could explain the course, only the incidence of an occlusive syndrome was higher in group B, which showed a more favorable course. Although we applied clustering analysis to a patient sample over a period of only 3 years, our results do suggest the existence or 2 primary course groups within the population of patients with Crohn's disease. It would appear that the disease course cannot be predicted from the clinical parameters present at the time of onset, but rather becomes apparent during the course of the first 2 years.

Adult↗
PubMed1989

[Glucose stimulates the absorption of sorbitol through the human jejunal mucosa].

Digestive tolerance of sorbitol in man varies according to whether it is taken in an empty stomach or during the meal. This suggests a regulatory step in the absorption of sorbitol in the small intestine. The mechanism of intestinal transport of sorbitol was studied in vitro in jejunal fragments obtained by endoscopy or by surgery. The intracellular concentration (C) of sorbitol was measured at stationary state in the presence of 10 mmol sorbitol in the incubation medium (M). The ratio C/M was less than 1 (0.66 +/- 0.04, mean +/- SEM) and was not modified by phloridzin (0.63 +/- 0.06) or metabolic inhibitors (0.59 +/- 0.03) but was diminished by ouabain (0.5 +/- 0.05, p less than 0.05). The influx of sorbitol across the luminal membrane increased linearly with increasing concentration of sorbitol in the medium and was more pronounced in the presence of glucose (p less than 0.01). Unlike glucose, addition of sorbitol to the mucosal side did not enhance the absorption of sodium as monitored by the increase in short circuit current in Ussing chambers. A net absorption of sorbitol stimulated by glucose was observed. The absorption of sorbitol can be explained by a simple diffusional component dependent on the concentration gradient of sorbitol and by another yet unidentified mechanism stimulated by glucose.

Biological Transport↗