Factors predictive of alcohol abstention after resident detoxication among alcoholics followed in an hospital outpatient center.

OBJECTIVES: A cohort of patient hospitalized for alcohol detoxification between January 2004 and January 2005 were followed prospectively to search for factors predictive factors of sustained abstinence. PATIENTS AND METHODS: One hundred and fifteen patients (79 males, 36 females, median age 45.9+/-10.7 years), were hospitalized for alcohol detoxification. Demographic, social, and medical data including daily alcohol intake and co-addictions were noted at inclusion and six months later. Patients who did not attend their six-month visit were contacted by phone. RESULTS: Among the 115 included patients, six month follow-up data could be collected for 73. Abstinence rate was 54.8%. Factors predictive of unsuccessful cessation were homelessness (P=0.004), duration of alcohol consumption (P=0.004), smoking (P=0.02), drug substitution (P=0.04) and multiple addictions (P=0.04). At multivariate analysis, multiple addictions was the only independent factor predictive of unsuccessful detoxification. Naltrexone or acamprosate treatments were not associated with a better rate of alcohol detoxification. CONCLUSION: Patient follow-up is problematic due to the large number of dropouts among alcoholics. Early screening in search for factors predictive of unsuccessful detoxification (long duration of alcohol consumption, multiple addiction) would be helpful in elaborating appropriate pluridisciplinary management.

Effects of total enteral nutrition supplemented with a multi-fibre mix on faecal short-chain fatty acids and microbiota.

BACKGROUND AND AIMS: Impaired bowel function is frequent in tube-fed patients, and diarrhoea is associated with decreased faecal short-chain fatty acids (SCFAs) concentrations. The aim of this study was to compare the effects of a multi-fibre-enriched formula (15 g/l) and a fibre-free isoenergetic and isonitrogenous formula on faecal SCFAs and microbiota in long-term enteral nutrition (EN) patients. METHODS: Fifteen patients [11M/4F, aged 53 (40-73)] on total EN for 43 (1-310) months for dysphagia received a fibre-free formula for 7 days, followed in a random order by either the multi-fibre-enriched formula for 14 days and then the fibre-free formula for 14 days or vice versa. Stool samples were taken at the end of each period for measurement of SCFAs levels and different groups of bacteria. Results were compared with non-parametric tests. RESULTS: After the multi fibre EN, there was a significant median increase in total faecal SCFAs (+84%), butyrate (+20%) and acetate (+147%) compared with baseline. A significant increase in the total number of bacteria as determined with the molecular method was found after the multi-fibre EN period compared with the fibre-free EN period. There were no concomitant changes in the dominant groups of intestinal bacteria. CONCLUSION: In long-term EN patients, a polymeric enteral formula supplemented with a mixture of six fibres increases faecal SCFAs and total number of bacteria, which may contribute to an improved bowel function.

[Association of Budd-Chiari syndrome with a coeliac disease in patient native from North Africa]. / Association d'un syndrome de Budd-Chiari et d'une maladie coeliaque chez une malade originaire d'Afrique du Nord.

We report the case of a 46 year-old woman who developed a celiac disease and Budd-Chiari syndrome. No etiology for the Budd-Chiari syndrome was found. The patient was from North Africa. The long term outcome is favourable with a gluten-free diet and antivitamin K treatment.

Sarcopenia is prevalent in patients with Crohn's disease in clinical remission.

BACKGROUND: Patients with Crohn's disease (CD) are prone to osteoporosis. A loss of muscle mass, called sarcopenia, is responsible for an increased risk of disability. Many factors associated with osteopenia also decrease muscle mass. The aim of the present study was to measure the prevalence of sarcopenia in CD patients in remission and uncover its relationship with osteopenia. METHODS: In all, 82 CD patients (43 female/39 male; 36 +/- 14 years; body mass index [BMI] 21.1 +/- 3.4) and 50 healthy volunteers (30F/20M; 39 +/- 13 years; BMI 22.2 +/- 2.5) were studied. Body composition was assessed using dual-energy x-ray absorptiometry. Sarcopenia was defined as an appendicular skeletal muscle index (ASMI) below 5.45 kg/m(2) for women and 7.26 for men. Osteopenia was defined as a T-score for bone mineral density (BMD) (g/cm(2)) below -1.0. RESULTS: In all, 60% of CD patients were found to be sarcopenic and 30% osteopenic, compared to 16% and 4% of controls, respectively (P < 0.01). ASMI was significantly lower in patients than in controls (6.0 +/- 1.1 versus 6.5 +/- 1.2; P < 0.05). Sarcopenic patients had significantly (P < 0.01) lower BMI (20.0 +/- 3.5 versus 22.7 +/- 2.8 kg/m(2)), lean mass (41.5 +/- 9.1 versus 48.1 +/- 9.1 kg), and BMD (1.09 +/- 0.12 versus 1.15 +/- 0.08 g/cm(2)) than nonsarcopenic patients; 91% of sarcopenic patients were also osteopenic. ASMI correlated with BMD (r = 0.46; P < 0.01) and BMI (r = 0.38; P < 0.01). CONCLUSIONS: The prevalence of sarcopenia is high in young CD patients and strongly related to osteopenia. These 2 phenomena may share similar mechanisms. Simultaneous screening for sarcopenia and osteopenia may be useful in CD patients.

Effects of age, malnutrition and refeeding on the expression and secretion of ghrelin.

BACKGROUND & AIMS: Anorexia is frequent in the malnourished elderly. We studied the effects of age, nutritional status and refeeding on the expression and secretion of the orexigenic peptide ghrelin. METHODS: Four groups were prospectively enrolled: 11 undernourished elderly (80+/-6 y, BMI: 17.4+/-1.9 [Mean+/-SD]), nine well-nourished elderly (76+/-9 y, 23.5+/-2.0), 10 undernourished young (26+/-6 y, 15.1+/-1.9) and 10 well-nourished young (34+/-8 y, 22.2+/-2.7). Fasting and postprandial plasma ghrelin and other hormones (every 30 min) were measured at baseline and after a 21-day enteral nutrition in malnourished patients. Gastric ghrelin mRNA levels were measured by RT-PCR at baseline in all subjects. RESULTS: Ghrelin was significantly higher in undernourished (2151+/-871 ng/L) than in well-nourished (943+/-389 ng/L) adults, whereas there were no differences between undernourished (1544+/-758 ng/L) and well-nourished (1154+/-541 ng/L) elderly. Refeeding did not influence ghrelin levels. Gastric ghrelin mRNA levels were similar in all groups. CONCLUSIONS: There is an absence of malnutrition-induced increase of plasma ghrelin levels in elderly subjects. This feature, post-transcriptional, may be important in the lack of adaptation of elderly subjects to malnutrition.