[Irritable bowel syndrome : physiopathology and complementary management]. / Syndrome de l'intestin irritable : physiopathologie et prise en charge complémentaire.

For the last ten years, several physiopathological mechanisms impli-cated in the irritable bowel syndrome have been highlighted. These mechanisms answer to some interrogations, but nowadays therapeutic options tend to be unsatisfying. The control of the symptoms is difficult on a long run and very often incomplete. This article proposes a review of the mechanisms implicated in this complex pathology, from which arise complementary management to the « classical ¼ treatment.

Depuis une dizaine d'années, plusieurs mécanismes physiopa­thologiques impliqués dans le syndrome de l'intestin irritable sont mis en avant. Ils permettent de répondre à certaines interrogations, mais à l'heure actuelle les propositions thérapeutiques qui en ressortent sont régulièrement peu satisfaisantes. Le contrôle des symptômes reste difficile au long cours et très souvent incomplet. Cet article propose une revue des mécanismes impliqués dans cette pathologie complexe, dont découleront des prises en charge complémentaires au traitement dit « classique ¼.

[Blurred vision: a rare secondary effect of proton pump inhibitors]. / Vision floue après prises d'inhibiteurs de la pompe a protons.

This paper reports for the first time in detail three clinical cases of patients developping invalidating bilateral blurred vision four to five days after the introduction of omeprazole, esomeprazole, pantoprazole and rabeprazole. This uncommon secondary effect was reversible within the same delay after the withdrawal of these proton pump inhibitors.

[Side effects of proton pump inhibitors (PPIs)]. / Effets indésirables des inhibiteurs de la pompe a protons (IPP).

The proton pump inhibitors (PPIs) are used very widely in the world and generate important health costs. While they bring an undisputed therapeutic benefit, the side effects of the PPIs were recently revalued by population-based case-control studies. There are known frequent minor side effects such as diarrhea or exceptional hypersensitivity reactions. New concerns recently emerged on prolonged use of PPIs: 1) osteoporosis; 2) pneumonia; 3) enteric infection. These new data are summarized here. New set points between the risk/benefit profile of long-term use of PPIs are discussed.

Randomized placebo-controlled trial of ursodeoxycholic acid with vitamin e in nonalcoholic steatohepatitis.

BACKGROUND & AIMS: Nonalcoholic steatohepatitis (NASH) is a frequent liver disease that can progress to cirrhosis and for which there is no recognized therapy. UDCA and vitamin E have been considered separately as therapeutic options and have not been shown to be effective. This study tested their combination. METHODS: Patients with elevated aminotransferase levels and drinking less than 40 g alcohol/week with biopsy-proven NASH were randomly assigned to receive UDCA 12-15 mg.kg-1.day-1 with vitamin E 400 IU twice a day (UDCA/Vit E), UDCA with placebo (UDCA/P), or placebo/placebo (P/P). After 2 years, they underwent a second liver biopsy. Biopsy specimens were collected, blinded, and scored by a single liver pathologist. RESULTS: Forty eight patients were included, 15 in the UDCA/Vit E group, 18 in the UDCA/P group, and 15 in the P/P group; 8 patients dropped out, none because of side effects. Baseline parameters were not significantly different between the 3 groups. Body mass index remained unchanged during the study. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels diminished significantly in the UDCA/Vit E group. Neither the AST nor the ALT levels improved in the P/P group and only the ALT levels in the UDCA/P group. Histologically, the activity index was unchanged at the end of the study in the P/P and UDCA/P groups, but it was significantly better in the UDCA/Vit E group, mostly as a result of regression of steatosis. CONCLUSIONS: Two years of treatment with UDCA in combination with vitamin E improved laboratory values and hepatic steatosis of patients with NASH. Larger trials are warranted.