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Yoram Bouhnik

Publications and source records attributed to Yoram Bouhnik.

At least 19 recordsLinked to original sources
PubMed2007

Value of wireless capsule endoscopy in patients with indeterminate colitis (inflammatory bowel disease type unclassified).

BACKGROUND: Wireless capsule endoscopy (WCE) can identify small bowel mucosal lesions not seen with other imaging modalities. This technique can therefore play an important diagnostic role in the evaluation of patients with inflammatory bowel disease type unclassified (IBDU). We report on a multicentric study whose objective was to evaluate the value of WCE to increase diagnostic accuracy in categorizing IBDU. METHODS: Thirty patients with IBDU and negative serology were included. WCE was performed with a standard Pillcam capsule. Outcome measures were classified as suggestive of Crohn's disease (CD) when -3 ulcerations were present. RESULTS: WCE displayed endoscopic features suggestive for CD in 5 patients. In 6 other patients, WCE was negative, but repeated ileocolonoscopy with biopsies performed during follow-up evaluation revealed CD in 5 and ulcerative colitis (UC) in 1 patient. UC was found in a seventh case at colectomy performed just after WCE. Eighteen patients remained with a diagnosis of IBDU 16 months on average after WCE. CONCLUSIONS: WCE is a potentially clinically useful technique for categorizing a subgroup of patients with IBDU, although negative WCE does not exclude further diagnosis of CD. Patients with negative WCE who remain IBDU at follow-up evaluation may belong to an original subgroup of IBD.

Adolescent↗
PubMed2006

The capacity of short-chain fructo-oligosaccharides to stimulate faecal bifidobacteria: a dose-response relationship study in healthy humans.

BACKGROUND: Short-chain fructo-oligosaccharides (scFOS) are well-known for their bifidogenicity. In a large study comprising 200 healthy volunteers, we determined the bifidogenic properties of 7 non-digestible carbohydrates administered at a dose of 10 g/d in the diet; we analysed dose-response relationships of the bifidogenic substrates at doses ranging from 2.5 to 10 g/d in comparison with a placebo. The aim of this presentation is to give more details about the dose-response effects of short-chain fructo-oligosaccharides (scFOS). METHODS: Forty healthy volunteers (18 males, 22 females) eating their usual diets were randomly divided into 5 groups of 8 subjects and received scFOS at a dose of 2.5, 5.0, 7.5 and 10 g/d or a placebo for 7 d. Stools were collected before (day (d) 8) and at the end (day (d) 15) of sugar consumption, and tolerance was evaluated using a daily chart. RESULTS (M +/- SEM): Bifidobacteria counts increase was higher in scFOS than in placebo group for all doses tested [2.5 g/d (from 9.15 +/- 0.59 to 9.39 +/- 0.70; P = 0.02); 5 g/d (from 10.21 +/- 0.21 to 10.67 +/- 0.22; P = 0.03); 7.5 g/d (from 9.28 +/- 0.49 to 9.85 +/- 0.35;P = 0.01); 10 g/d (from 9.00 +/- 0.81 to 10.18 +/- 0.60; P = 0.003)]. A significant correlation between the ingested dose of scFOS and faecal bifidobacteria counts was observed at d15 (r2 = 0.307, P < 0.001). Total anaerobes increased at the dose of 10 g/d. No significant differences were found for Bacteroides, Lactobacillus, enterobacteria or pH in any group. The frequency of digestive symptoms was not different between scFOS at any of the doses tested and placebo. Bloating was significantly more intense during scFOS ingestion at doses of 2.5 and 5 g/d, but not at doses of 7.5 and 10 g/d. Excess flatus, borborygmi and abdominal pain did not differ from the placebo at any of the doses tested. CONCLUSION: This study showed that scFOS is bifidogenic and well tolerated at doses ranging from 2.5 to 10 g/d, and that there is a dose-response relationship in healthy volunteers.

Bifidobacterium↗
PubMed2006

Three-step ileal pouch-anal anastomosis under total laparoscopic approach for acute or severe colitis complicating inflammatory bowel disease.

BACKGROUND: A two- or three-step procedure is mandatory for restorative proctocolectomy in patients presenting with severe or acute colitis complicating inflammatory bowel disease (IBD). The aim of this study was to analyze the feasibility of a total laparoscopic approach for consecutive subtotal colectomy (STC) and secondary ileal pouch-anal anastomosis (IPAA). STUDY DESIGN: All patients underwent a three-step procedure that included first, a laparoscopic STC with ileostomy and sigmoidostomy; second, a laparoscopic proctectomy and IPAA, and third, closure of the temporary ileostomy. RESULTS: Eighteen consecutive patients (7 women and 11 men), with a mean age of 39+/-14 years (range 15 to 59 years) were included. Mean lengths of the procedures were 252+/-59 minutes for STC, and 286+/-46 minutes for IPAA, respectively. Two patients (11%) after laparoscopic IPAA required conversion into laparotomy. No patient died postoperatively. Four patients had reoperations after laparoscopic IPAA for intraperitoneal hemorrhage by laparotomy (n=2) and by a transanal approach for anastomotic leakage (n=2). The overall morbidity rate was 33% (12 of 36 procedures). Mean hospital stay was 8+/-2 days after STC, and 10+/-2 days after IPAA. After a mean follow up of 13 months, all patients underwent intestinal continuity restoration. CONCLUSIONS: Our study suggests that a total laparoscopic approach is feasible and safe in inflammatory bowel disease patients with acute or severe colitis, not only for STC but also for IPAA after STC, with no mortality and an acceptable morbidity rate.

Acute Disease↗
PubMed2006

Efficacy of infliximab in Crohn's disease. Results of a retrospective multicenter study with a 15-month follow-up.

OBJECTIVES: To evaluate prescription practices and response to infliximab treatment for Crohn's disease (CD). PATIENTS AND METHODS: The files of CD patients treated with at least one infusion of infliximab treated in gastroenterology units belonging to university teaching hospitals of the Parisian hospitals group (Assistance Publique-Hôpitaux de Paris (AP-HP) during the year 2000 were analyzed retrospectively. RESULTS: One hundred and thirty-seven patients (36.0 +/- 12.7 years, 92 females) from 12 centers were studied. Indication for treatment was fistulae or perianal disease in 39% of patients, active Crohn's disease in 45% and mixed conditions in 16%. Mean follow-up was 15.2 +/- 7.2 months. The overall response rate was 85%. No predictive factor of sustained remission could be identified. The mean time to relapse was to 3.9 +/- 3.1 months. Thirty-eight patients were on maintenance therapy at the end of the follow up; 37% exhibiting progressive lost of response to treatment. Immunosuppressive therapy was added to infliximab in 78% of cases but response to infliximab was not modified by addition of immunosuppressive drugs. Adverse events, most frequently minor, were noted in 23% of the patients. CONCLUSION: This retrospective study confirms the efficacy and safety of infliximab in CD.

Adult↗
PubMed2006

Herpes simplex virus type 1 colitis in a patient with common variable immunodeficiency syndrome.

We report on a case of herpes simplex virus (HSV) type 1 colitis in a 69-year-old patient with common variable immunodeficiency syndrome. A treatment with polyvalent immunoglobulins was discontinued in April 2001. In March 2004 she developed chronic diarrhoea related to rectosigmoidal and caecal ulcerations. In November 2004, HSV was recovered in tissue culture from colonic biopsies. Valaciclovir was then started, leading the patient to clinical remission at day 4, and continued for a 6-week course (without any secondary antiviral prophylaxis). Colonic biopsies were negative for HSV by tissue culture and PCR within 3 weeks of antiviral treatment. Intravenous polyvalent immunoglobulin infusions were readministered within the third week of antiviral treatment. She has declared no clinical event since this period. Three months after the antiviral treatment was achieved, a rectosigmoidoscopy showed an ad-integrum macroscopic and histological mucosal healing whereas PCR was negative for HSV in the colonic tissue. As a large proportion of patients with common variable immunodeficiency syndrome present not only as a humoral immunodeficiency but also as a defect in the cellular immunity compartment (with T-cell deficits), HSV, as well as cytomegalovirus, should be investigated in patients with common variable immunodeficiency syndrome presenting colitis.

Aged↗
PubMed2005

[Diagnostic tools in inflammatory bowel diseases].

The two major inflammatory bowel diseases, Crohn's disease (CD) and ulcerative colitis (UC), represent clinicopathologic entities that traditionally have been diagnosed on the basis of a combination of clinical, radiologic, endoscopic, and histologic features. The presence of an inflammatory syndrome associated with typical clinical manifestations must lead to perform endoscopic examinations. Ileocolonoscopy plays an integral role in establishing the diagnosis, excluding other etiologies, distinguishing Crohn's disease from ulcerative colitis, defining the patterns, extent, and activity of mucosal inflammation, and obtaining mucosal tissue for histologic evaluation of inflammatory bowel disease. Small bowel follow through is still a major examination. However, the role of CT and MRI (using enteroclysis) in the imaging of inflammatory bowel disease has also increased in importance. Capsule endoscopy could be a valuable diagnostic tool in patients with suspected Crohn's disease that has not been confirmed using standard imaging techniques. Serum perinuclear antineutrophil cytoplasmic antibodies (pANCA) and anti-Saccharomyces cerevisiae antibodies (ASCA) have recently been added to our diagnostic armamentarium. Serology may prove to be useful in predicting the evolution of indeterminate colitis. Substantial progress could come from the improving of serologic and genetic tests in the future.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed2005

A randomized, double-blind, controlled withdrawal trial in Crohn's disease patients in long-term remission on azathioprine.

BACKGROUND & AIMS: An open study reported that patients with Crohn's disease in remission who have taken azathioprine for longer than 3.5 years are at low risk of relapse when azathioprine is discontinued. To confirm this observation, we performed a multicenter, double-blind, noninferiority withdrawal study. METHODS: Patients who were in clinical remission on azathioprine for > or = 42 months were randomized to continue azathioprine or to receive an equivalent placebo for 18 months. The primary end point was clinical relapse at 18 months. RESULTS: Forty patients were randomly assigned to receive azathioprine and 43 to receive placebo. Characteristics of patients at entry were similar in the 2 study groups. At 18 months, 3 patients had a relapse in the azathioprine group, and 9 had a relapse in the placebo group. Kaplan-Meier estimates of the relapse rate at 18 months were 8% +/- 4% and 21% +/- 6%, respectively. The hypothesis that placebo was inferior to azathioprine was not rejected (P = .195). Among the baseline variables, C-reactive protein level > 20 mg/L, time without steroids < 50 months, and hemoglobin level < 12 g/dL were found to be predictive of relapse in the multivariate analysis. CONCLUSIONS: This study shows that azathioprine withdrawal is not equivalent to continued therapy with azathioprine for maintenance of remission in patients with Crohn's disease who have been in remission on azathioprine for > or = 3.5 years. Thus, azathioprine maintenance therapy should be continued beyond 3.5 years.

Adult↗
PubMed2004

Small-bowel diseases: prospective evaluation of multi-detector row helical CT enteroclysis in 107 consecutive patients.

PURPOSE: To prospectively evaluate multi-detector row helical computed tomographic (CT) enteroclysis for the depiction of small-bowel diseases. MATERIALS AND METHODS: The study group included 107 patients who were suspected of having small-bowel tumor (n = 8), active inflammatory small-bowel disease (n = 18), unexplained gastrointestinal bleeding (n = 36), refractory celiac sprue (n = 14), and low-grade small-bowel obstruction (n = 31). A nasoenteric tube was positioned into the duodenojejunal junction by using fluoroscopic guidance and water was infused with a pressure-controlled pump. After intravenous administration of 120 mL of iodinated contrast material, multi-detector row helical CT enteroclysis images were obtained with 4 x 2.5 mm collimation (four detector rows and 2.5-mm section thickness). Multi-detector row helical CT enteroclysis findings were analyzed by two readers working in consensus. Findings were compared with the results of endoscopy, enteroscopy, videocapsule endoscopy, histopathologic analysis, or clinical follow-up. RESULTS: Multi-detector row helical CT enteroclysis was well tolerated in 106 patients; one patient complained of abdominal pain after the examination. Multi-detector row helical CT enteroclysis allowed the diagnosis of small-bowel masses (n = 21), active Crohn disease (n = 9), small-bowel tuberculosis (n = 2), small-bowel lymphoma complicating celiac disease (n = 4), and confirmed low-grade small-bowel obstruction (n = 12). Multi-detector row helical CT enteroclysis demonstrated normal findings in 60 patients. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of multi-detector row helical CT enteroclysis were 100%, 95%, 97%, 94%, and 100%, respectively. CONCLUSION: Multi-detector row helical CT enteroclysis allows depiction of small-bowel diseases in patients suspected of having small-bowel conditions.

Adolescent↗
PubMed2004

Crohn's disease over 20 years after diagnosis in a referral population.

OBJECTIVES: Patients frequently ask questions about the lifetime prognosis of Crohn's disease. The aim of this study was to describe the outcomes of Crohn's disease more than 20 years after diagnosis. METHODS: Data from all patients with Crohn's disease whose diagnosis had been performed before 1st January 1978 were analyzed. All referred patients filled in a medical and health-related quality-of-life questionnaire. RESULTS: Among 273 patients with Crohn's disease diagnosed more than 20 years ago, 141 (52%) patients answered our questionnaire, 45 (16%) patients were alive but did not wish to answer our questionnaire, 51 (19%) could not be traced and 36 (13%) died before July 1998. At the end of follow-up, 25.7 (20.0-59.3) years after diagnosis, 24% had a relapse in the previous 12 months, and 48% and 28% had quiescent disease with and without treatment, respectively. These ratios were not different from those observed three years after Crohn's disease diagnosis. Sixteen patients died within 20 years after CD diagnosis, including 11 from CD-related causes. The risk of death estimated by Kaplan-Meier life-tables analysis was non-significantly higher if death was related to CD. An ileal or colic adenocarcinoma was noted in 6 (3.4%) patients. CONCLUSIONS: Crohn's disease activity does not burn out with time, and roughly one-quarter of the patients had active disease 20 years after diagnosis.

Adolescent↗
PubMed2004

The capacity of nondigestible carbohydrates to stimulate fecal bifidobacteria in healthy humans: a double-blind, randomized, placebo-controlled, parallel-group, dose-response relation study.

BACKGROUND: Nondigestible carbohydrates (NDCHs) are fermented in the colon, where they can selectively promote the growth of bifidobacteria. OBJECTIVE: Our aim was to determine the bifidogenic potential of different NDCHs used in human diets. DESIGN: Two hundred healthy volunteers participated in this double-blind study. During phase 1 (screening), 64 volunteers were randomly assigned to 8 groups of 8 subjects each; for 7 d, they ingested 10 g/d of 1 of the 7 NDCHs tested or of the placebo. During phase 2 (dose-response study), 136 volunteers were randomly assigned to 4 groups of 32 subjects who received 2.5, 5.0, 7.5, or 10 g/d, respectively (8 subjects/dose), of one of the NDCHs that were proven to be bifidogenic during phase 1 and a fifth group of 8 subjects (control subjects) who received the placebo. Stools were recovered before and after NDCH consumption. RESULTS: In phase 1, 4 NDCHs were found to be bifidogenic: short-chain fructooligosaccharides (P=0.008), soybean oligosaccharides (P=0.006), galactooligosaccharides (P <0.0001), and type III resistant starch (P=0.02); lactulose, long-chain inulin, and isomaltooligosaccharides were not bifidogenic. In phase 2, the effects of 7-d treatment on bifidobacteria concentrations were found to differ significantly among the 4 NDCHs (P=0.009 for time x treatment interaction). However, no significant differences were found among doses, and there was no significant dose x time interaction. A low baseline bifidobacteria count was significantly associated with the bifidogenic response to treatment (P <0.001). CONCLUSION: This study showed the different bifidogenic properties among the substrates and underlined the importance of taking into account the baseline bifidobacteria counts when evaluating the effect of the treatment.

Adolescent↗