Pregnancy and breastfeeding in inflammatory bowel disease.

Inflammatory bowel disease (IBD) is frequent in women during their peak reproductive years. Accordingly, a significant number of questions and uncertainties arise from this population regarding the risk of transmission of IBD to the offspring, the impact of the disease and therapies on the fertility, the role of the disease on the course of the pregnancy and the mode of delivery, the impact of the therapy on the pregnancy and fetal development as well as breastfeeding. The safety of medical therapy during pregnancy and lactation is a major concern for both pregnant women and their partners as well as for physicians. As a general rule, it can be stated that the benefit of continuing medical therapy in IBD during pregnancy outweighs the potential risks in the vast majority of instances. This article will review recent developments on this topic consistent with the European Crohn's and Colitis Organization guidelines.

[Gut microflora in liver and intestinal diseases: a revolution in the making]. / Le microbiote dans les maladies du foie et du tube digestif: la révolution annoncée.

After the era of classical bacteriology, the exploratory techniques of the gut microbiota have been revolutionized by the sequencing of microbial 16S rRNA. The data obtained are substantial and have led us to formulate novel hypotheses in multiple domains of medicine. This article briefly outlines these hypotheses with particular regard to the fields of steatohepatitis and inflammatory bowel diseases.

[Hepatitis C and insulin resistance]. / Hépatite C et résistance a l'insuline.

In the course of a chronic infection with the hepatitis C virus, the fibrosis progression rate varies among individuals, and depends on the existence of certain co-factors. In this context, a growing interest has emerged and has focused on insulin resistance. In fact, the hepatitis C virus is now recognized as being responsible for a direct interference with the insulin signalling pathway. This insulin resistance of viral origin, in combination with an eventual insulin resistance associated with an existing metabolic syndrome, can therefore accelerate its evolution to a type II diabetes. Independently of its pathogenesis, insulin resistance occurring in chronic hepatitis C causes a fatty liver, contributes to the progression towards cirrhosis, and narrows the chances of a successful antiviral therapy. It is therefore crucial to recognize it in order to correct it.

Ectopic varices and collaterals development after band ligation treatment in a patient with portal hypertension.

Esophageal and gastric varices may complicate the course of cirrhosis as a direct consequence of portal hypertension. Variceal hemorrhage has been reported to occur in 25-40% of patients with cirrhosis [Gastroenterol Clin North Am 1992;21:149-161]. Occasionally, varices develop at sites other than the esophagus and are detected either when they bleed or incidentally during upper or lower endoscopy [Eur J Gastroenterol Hepatol 2006;18:1155-1160; Digestion 2000;61:149-150]. Endoscopic treatment is often unsuccessful in these cases, and traditional treatment is usually surgical, while it has been suggested that bleeding can also be controlled by a transjugular intrahepatic portosystemic shunt (TIPS) [Endoscopy 1995;27:626-627]. Moreover, esophageal band ligation may interfere with the collateral web. We here report a case of an ectopic duodenal varix and the development of a large collaterals web that appeared after band ligation.