[Geriatric units at the beginning of the 2020 COVID-19 epidemic in France]. / Les unités de gériatrie au début de l'épidémie du Covid-19 de 2020 en France.

The COVID-19 epidemic that started in November in China became a national epidemic from March 16, 2020 with the declaration of population containment in order to reduce the spread of the virus in France. From March 17 to March 27, 2020, the monitoring unit of the French society of geriatrics and gerontology decided to conduct a survey to analyze the implementation of the mobilization of geriatric units, given that this epidemic had shown that it resulted in excess mortality mainly among the elderly. The survey was able to bring together the response of 34 services, nine of which were located in a high epidemic cluster zone. Dedicated acute geriatric units for patients infected with COVID-19 were present in eight facilities, only outside the cluster zones. Nine geriatric follow-up and rehabilitation services were dedicated, an additional telemedicine activity concerned 35% of the facilities, and family listening and tablet communication facilities concerned 36% of the facilities. This survey is a snapshot of an initial moment in the epidemic. It provides an opportunity to describe the context in which this epidemic occurred in terms of geriatric policy, and to assess the responsiveness and inventiveness of these services in meeting the needs of the elderly.

[Smoking, smoking cessation and Crohn's disease]. / Tabagisme, sevrage tabagique et maladie de Crohn.

CONTEXT: Smoking whose prevalence is higher in patients with Crohn's disease (CD) worsens its evolution. Ulcerative colitis mostly affect non- or ex-smokers; smoking may improve the course of the disease. OBJECTIVES: Systematic literature review of data on the relationship between smoking, smoking cessation and Crohn'disease. DOCUMENTARY SOURCES: Medline, on the period 1980-2015 with the keywords "Crohn's disease" or "inflammatory bowel disease" and "smoking" or "smoking cessation"; limits "Title/Abstract"; the selected languages were English or French. STUDY SELECTION: Among 1315 articles, 168 abstracts have given rise to a dual reading to select 69 studies (case-control, retrospective, reviews or meta-analysis). Data were extracted using a reading gate. RESULTS: Smoking increases the risk of complications, recurrences and resort of surgery, corticosteroids or immunosuppressants. These deleterious effects are more common in women. Stopping smoking improves the course of the disease and represents an essential component of its management. LIMITS: Heterogeneity of the studies collected according to the type, population characteristics, definition of smoking status and the validation of smoking cessation. CONCLUSION: Smokers suffering from CD must routinely be made aware of the disadvantages of smoking, benefits of abstinence and helped to quit smoking.

Risk of colorectal high-grade dysplasia and cancer in a prospective observational cohort of patients with inflammatory bowel disease.

BACKGROUND & AIMS: There is an unclear risk of colonic high-grade dysplasia (HGD) and colorectal cancer (CRC) among patients with inflammatory bowel disease (IBD) treated with immunosuppressants. We analyzed data on CRC development among patients with IBD enrolled in the observational cohort Cancers et Surrisque Associé aux Maladies Inflammatoires Intestinales En France (CESAME). METHODS: We followed and collected data from 19,486 patients with IBD (60.3% with Crohn's disease, 30.1% receiving thiopurine therapy) enrolled in CESAME from May 2004 and June 2005, and followed them until December 2007. When the study began, 2841 patients (14.6%) were characterized as having long-standing extensive colitis (ie, >10 years and involving ≥50% of the colon). Early lesions (HGD and CRC) were defined as those diagnosed within 10 years after diagnosis of IBD. RESULTS: Thirty-seven patients developed CRC during the follow-up period, and 20 developed colorectal HGD. The standardized incidence ratios of CRC were 2.2 for all IBD patients (95% confidence interval [CI]: 1.5-3.0; P < .0001), 7.0 for patients with long-standing extensive colitis (95% CI: 4.4-10.5; P < .001), and 1.1 for patients without long-standing extensive colitis (95% CI: 0.6-1.8; P = .84). Among patients with long-standing extensive colitis, the multivariate adjusted hazard ratio for colorectal HGD and cancer was 0.28 for those who received thiopurines compared with those who never received thiopurine therapy (95% CI: 0.1-0.9; P = .03). Twenty-two patients developed early lesions; 7 of these were related to IBD, based on histologic analysis. CONCLUSIONS: Patients with IBD and long-standing extensive colitis are at increased risk for CRC, although the risk is lower among patients receiving thiopurine therapy. Patients without long-standing extensive colitis have a risk for CRC similar to that of the general population, but they can develop IBD-related lesions within 10 years after diagnosis of IBD.

Effects of prolonged oral nutritional support in malnourished cirrhotic patients: results of a pilot study.

OBJECTIVES: The aim of this prospective study was to evaluate the acceptance and the effects of nutritional supplementation in malnourished ambulatory patients with liver cirrhosis. METHODS: From June 1999 through June 2000, alcoholic cirrhotic patients with moderate to severe malnutrition as assessed with the Detsky index were included in the study. Patients were instructed to consume, in addition to their regular diet, a commercial solution that provided 500 kcal/day. Physical examination, dietary recalls and laboratory tests were performed at 1, 2 and 3 Month. RESULTS: Twenty-nine patients with a mean age of 52 Years were included. The Child-Pugh grade was A in 6 patients, B in 14 and C in 8. Eighteen patients (62%) completed the 3 Month study protocol. Mean non-alcohol calorie intake increased significantly by 31% at 1 Month and by 48% at 3 Months. At the same time alcohol calorie intake decreased significantly by 68% and 77%, respectively. Subjective improvement in nutritional status was associated with significant improvement of mean Child-Pugh score (P=0.0007) and triceps skinfold thickness (P=0.005). The increase of mid-arm circumference was not significant. CONCLUSION: This study showed that oral supplementation in ambulatory patients with liver cirrhosis is feasible and associated with a significant improvement of nutritional status and biological parameters including the Child-Pugh score. This benefit was associated with a concomitant reduction of alcohol intake.

[Efficacy of hydrostatic balloon dilatation of anastomotic Crohn's disease strictures]. / Efficacité de la dilatation hydrostatique des sténoses anatomiques de la maladie de Crohn.

OBJECTIVES: To estimate the efficacy of hydrostatic balloon dilatation (HD) of anastomotic strictures of Crohn's disease and the impact of medical treatment on the duration of HD effects. METHODS: Sixteen patients with anastomotic stricture (average length: 4.7 cm) were treated by HD and followed-up for a median duration of 24 months. Immunosuppressive treatment was given when a second HD was necessary. RESULTS: HD failed in 3 patients (19%). Thirty-two HD are performed in the other 13 (1 HD: 6; 2 HD: 2; > 2 HD: 5). No severe complication was observed. Eight patients received immunosuppressive treatment started before the first HD in 4 cases or following the second HD in 4 cases. Based on actuarial analysis, clinical and surgical recurrence rates were 39% and 0% at 1 year and 73% and 12% at 2 years, respectively. Time between the first and the second HD were not statistically different (P=0.24) for HD performed with (11.5 +/- 8.8 months; range: 5-30) or without (8.0 +/- 6.9 months; range: 2-17) immunosuppressive treatment. CONCLUSION: HD delays the surgical timing for anastomotic Crohn's disease strictures. Medical treatment associated with HD does not seem to modify the duration of the clinical remission.

[Treatment of Crohn's disease with anti-TNF alpha antibodies (infliximab): results of a multicentric and retrospective study]. / Traitement de la maladie de Crohn par anticorps anti-TNF alpha (infliximab): résultats d'une étude multicentrique et rétrospective.

OBJECTIVE: To evaluate the results of infliximab therapy, an anti-TNF-alpha antibody, in patients with severe and refractory Crohn's disease or with fistulas, treated outside the setting of a therapeutic trial. METHODS: All Crohn's disease patients treated at the Departments of Gastroenterology of the University Hospitals of Bordeaux, Nantes, Poitiers, Rennes and Tours were retrospectively analyzed. RESULTS: Sixty-nine patients were treated with a total of 170 infusions of infliximab, 32 patients being treated for refractory Crohn's disease and 37 for fistulas. The median follow-up was 8 months (extremes 1-20). An objective response was observed in 79% of refractory Crohn's disease patients and 78% of fistulazing patients. A remission was observed in 72% and 70% of the patients respectively. Forty-five percent of patients had relapsed within 4 months (extremes 2-7). Immunosuppressive therapy was associated with a lower relapse rate (18% with versus 56% without, P=0.004). Infliximab resulted in a steroid-sparing effect in 73% of patients. Forty adverse events, none of severe grade, were observed in 22% of the patients, without any influence of steroids or immunosuppressive therapy. CONCLUSION: This study confirms that infliximab is very effective in steroid-dependent and fistulazing Crohn's disease. Infliximab has a steroid-sparing effect and immunosuppressive therapy is associated with a reduced relapse rate. Although the tolerance is good in the short term, long term safety remains to be established by further studies.

[Compared azathioprine efficacy in ulcerative colitis and in Crohn's disease]. / Efficacité comparée de l'azathioprine dans la rectocolite hémorragique et dans la maladie de Crohn.

AIM: To compare the 6-month efficacy and tolerance of azathioprine in 68 patients with steroid-resistant or steroid-dependent chronic ulcerative colitis (n=30) or Crohn's disease (n=38). METHODS: Clinical remission was defined as a Crohn's Disease Activity Index<150 for Crohn's disease and number of non-bloody stools<=3/day for ulcerative colitis, associated with prednisone requirement<=10 mg/day. RESULTS: Seventy-three per cent of patients with ulcerative colitis had distal or left-sided colitis and 84% of patients with Crohn's disease had pancolitis. Azathioprine was discontinued early for side-effect in 8 (26.7%) patients with ulcerative colitis and in 8 (21.1%) patients with Crohn's disease (NS). In patients treated at least 6 months by azathioprine, clinical remission rates were 77.3% and 70% for chronic ulcerative colitis and Crohn's disease (NS). Complete corticosteroids weaning was obtained significantly more often in ulcerative colitis patients than in Crohn's disease patients (59.1% vs 30%; P<0.05). CONCLUSION: Azathioprine seems to be at least as effective and equally tolerated in steroid-resistant or steroid-dependent chronic ulcerative colitis or Crohn's disease patients.