Iron deficiency anemia: clinical and etiological features.

BACKGROUND: Iron deficiency is the most common nutritional deficiency worldwide and its resulting anemia appears as a public health problem. Iron deficiency anemia is rather a symptom than a disease in itself, and the identification of its etiology is of paramount importance. AIM:   to study the clinical and etiological features of iron deficiency anemia in an Internal Medicine department. METHODS: We conducted a retrospective descriptive study between 2001 and 2015 at an internal medicine department including patients presenting with iron deficiency anemia and having at least one etiological investigation. RESULTS: The average age was 45.6  16,3 years. Three main mechanisms of iron deficiency anemia were noted: repeated blood loss (94.4%), digestive malabsorption of iron (17.8%) and lack of dietary iron intake (6.6%). The digestive origin dominated the etiologies of iron deficiency anemia with a leading frequency of gastritis (32.2%). An underlying cancer was discovered in six cases. The average duration of follow-up was 9.1 months. An unfavorable outcome (persistence or recurrence of iron deficiency anemia) was associated with an absence or insufficiency of etiological treatment (p << 10-3) and with a duration of iron treatment inferior to 4 months (p = 0.034). CONCLUSION: In case of iron deficiency anemia, the prognosis depends on the quality of the etiological investigation. It can allow the discovery of an underlying cancer. The management of iron deficiency anemia relies on a well-led iron supplementation and an optimal treatment of the incriminated cause.

Autoimmune gastritis: assessment of OLGA and OLGIM staging systems.

BACKGROUND: Autoimmune gastritis present a risk of cancer related to atrophy and intestinal metaplasia. Two recent classifications OLGA (Operative Link on Gastritis Assessment) and OLGIM (Operative Link on Gastritic Intestinal Metaplasia assessment) have been proposed to reveal the high progressive risk forms (stages III and IV). AIM: To evaluate the OLGA and OLGIM staging systems in chronic autoimmune gastritis. METHODS: A descriptive single institution study of 30 cases of autoimmune gastritis. was performed over a 4-year period. The revaluation of atrophy and intestinal metaplasia, of gastric antrum and corpus, allowed to identify respectively the stages of OLGA and OLGIM systems. RESULTS: Our autoimmune gastritis were at high-risk stages in 26,5% of cases  according to two classifications. 95% of low-risk gastritis acoording to OLGA staging presented moderete to severe corpus atrophy. A significant association was present between high-risk gastritis according to OLGA staging and neuroendocrine hyperplasia. Both OLGA and OLGIM systems showed a highly significant positive correlation between them with a mismatch at 2%. CONCLUSIONS: The OLGA and OLGIM staging systems in autoimmune gastritis, allow probably selection of high risk forms of chronic gastritis requiring convenable care.

[Helicobacter pylori gastritis: assessment of OLGA and OLGIM staging systems]. / Gastrites chroniques à hélicobacter pylori: évaluation des systèmes OLGA et OLGIM.

Helicobacter pylori (H pylori) gastritis presents a risk of cancer related to atrophy and intestinal metaplasia. Two recent classifications OLGA (Operative Link on Gastritis Assessment) and OLGIM (Operative Link on Gastritic Intestinal Metaplasia assessment) have been proposed to identify high-risk forms (stages III and IV). The aim of this study is to evaluate the OLGA and OLGIM staging systems in H pylori gastritis. A descriptive study of 100 cases of chronic H pylori gastritis was performed. The revaluation of Sydney System parameters of atrophy and intestinal metaplasia, of gastric antrum and corpus, allowed identifying respectively the stages of OLGA and OLGIM systems. The progressive risk of our H pylori gastritis was 6% according to OLGA staging and 7% according to OLGIM staging. Significant correlation was revealed between age and OLGA staging. High-risk gastritis according to OLGIM staging was significantly associated with moderate to severe atrophy. High-risk forms according to OLGA staging were associated in 80% of the cases to intestinal metaplasia. OLGA and OLGIM systems showed a highly significant positive correlation between them with a mismatch at 5% for H pylori gastritis. The OLGA and OLGIM staging systems in addition to Sydney System, allow selection of high risk forms of chronic gastritis requiring accurate observation.

[Survival in cirrhosis]. / Survie chez le Cirrhotique Tunisien.

BACKGROUND: Assessment of prognosis in patients with cirrhosis is important so as to plan their management. AIM: To determine the survival rates and to identify indicators associated with shorter life expectancy in Tunisians patients with cirrhosis. METHODS: This is a retrospective study of in-patients with cirrhosis during a 5-years period. We studied clinical and biochemical characteristics of all patients and the occurrence of decompensation or complication. The overall survival, mortality rate and causes of death were reviewed. Univariate and multivariate analysis was performed on all variables to identify parameters associated with a lower life expectancy. RESULTS: We studied 222 patients (60% females) with a mean age of 60 years. Mean follow up was 22 months. The overall survival was 52.5% at 5 years. With univariate analysis, 10 variables were associated with a poor prognosis: male gender, decompensation at admission, Child-Pugh C, esophageal varices, hypertensive gastropathy, occurrence of spontaneous bacterial peritonitis, hepatic encephalopathy, hepato-renal syndrome, hepatocellular carcinoma and portal thrombosis. With multivariate analysis, only male gender was independently correlated with survival. CONCLUSION: In our study, male gender was an uncommon parameter that predicts survival in cirrhotic patient. The Child-Pugh score was a good index for assessing the prognosis.

[Autoimmune hepatitis in Tunisia. Retrospective multicenter study of 83 cases]. / L'hépatite auto-immune en Tunisie. Étude multicentrique rétrospective de 83 cas.

BACKGROUND: Autoimmune hepatitis (AIH) is a chronic inflammatory condition of the liver of unknown etiology. Its epidemiological and anatomoclinical characteristics and its outcome were unknown in Tunisia. AIM: To analyse epidemiological, anatomoclinical, immunological and histological aspects of AIH and to determine factors predicting relapse after treatment and death of this disease in Tunisia. METHODS: Patients presenting with AIH between January 1996 and December 2004 were evaluated in retrospective multicentric study. The diagnosis of AIH was established according to the criteria of the revised score of the international autoimmune hepatitis group (1999) RESULTS: Eighty three patients were identified (70 female; mean age=49+17.9 years). 63% presented probable AIH and 37% presented definite AIH. Thirty two percent presented with the acute pattern. Eighty three per cent of cases were type I AIH and 5 % of cases were type II HAI. Fifty seven percent of the patients were cirrhotic at presentation. Associated autoimmune diseases was seen in 27 patients, dominated by diabetes, autoimmune thyroiditis and Sjögren's syndrome. An overlap syndrome was diagnosed in 25% of cases; primary biliary Cirrhosis-AIH in 20% of cases and primary sclerosing cholangitis-AIH in 5% of cases. Fifty patients were treated by glucocorticoids as monotherapy or in combination with azathioprine. Complete remission was achieved in 90% of cases. Fourteen percent relapsed within a median time of 12 months. Factors associated with relapse were: treatment with Azathioprine<18 months, absence of lobular necrosis and anti-nuclear antibody (+) profile. Mortality was observed in 17 % of cases. Factors associated with death were encephalopathy as an independent factor and treatment with Azathioprine<18 months. CONCLUSION: In Tunisia, epidemiological and clinical characteristics of AIH were similar to those reported in the literature but with a higher frequency of cirrhosis at presentation. Treatment with Azathioprine < 18 months was the main factor associated with relapse and represented with encephalopathy a factor associated with death.

[Prevalence of axial manifestations among patients with inflammatory bowel disease: a prospective study about 50 cases]. / Prévalence des manifestations axiales au cours des maladies inflammatoires chroniques de l'intestin: à propos d'une étude prospective de 50 cas.

BACKGROUND: Rheumatologic manifestations occurring during inflammatory bowel disease are the most frequent extra intestinal features. They are dominated by spondyloarthropathies, sacro-iliite and peripheral arthritis. AIM: To identify in a group of inflammatory bowel disease, the frequency of axial manifestations, to describe the clinical and the radiological features and to identify the risk factors of their occurrence and/or worseness. METHODS: We have established a transversal prospective study including 50 cases of inflammatory bowel disease seen in the department of the internal medicine in the interior forces security hospital during a period of 5 years between January 2001 and December 2006. RESULTS: The prevalence of axial involvement in the case of inflammatory bowel disease was 26% especially spondyloarthropathies which were diagnosed in 11 cases according to the criteria of European Spondyloarthropathy study Group (ESSG), 8 of them fulfilled the modified criteria of New York for the diagnosis of spondyloarthropathy. Isolated sacro-iliitis was found in 4% of cases. By univariate study, only the age under 35 years with a relative risk of 5,8 and the colic involvement in Chron's disease was significativelly associated with the presence of spondyloarthropathy. CONCLUSION: Systematic checking of spondyloarthropathies in the course of inflammatory bowel disease through a clinical exam and systematic radiological should be recommended especially if we are in front of a man aged more than 35-years-old with a Chron disease involving the colon. This screening offers an early management and avoid ankylosis.

[Bone loss owing to inflammatory bowel disease: prospective study, 50 cases]. / Perte osseuse au cours des maladies inflammatoires chroniques de l'intestin: etude prospective a propos de 50 cas.

AIMS: To evaluate the prevalence of osteoporosis during inflammatory bowel disease (IBD) and to determine the risk factors. METHODS: We conducted a prospective study that includes IBD patients. For all patients, bone mineral density was measured by dual-energy X-rays absorptiometry. RESULTS: Study has included 50 IBD patients; thirty had Crohn's disease and 20 had ulcerative colitis. The average age of our patients was of 36.4 + 9.9 years. A low osseous mineral density was noted in 21 patients (45%) distributed in 13% of osteoporosis and 32% of osteopenia. Only the age superior to 35 years, the duration of evolution of the disease superior to 10 years and intestinal resection constituted a risk factors of osteoporosis. After adaptation on the age and the intestinal resection the duration of evolution superior to 10 years persisted as risk factor of osteoporosis. The other risk factors: sex, type of IBD, denutrition and corticoids were not incriminated in the low osseous mineral density during IBD. CONCLUSION: These results confirm the necessity of the systematic search of the osteoporosis during IBD with the aim of proposing an early and effective treatment.