[Esophagitis secondary to jejuno-esophageal reflux after total gastrectomy and Roux-en-Y loop]. / OEsophagite par reflux jéjuno-oesophagien après gastrectomie totale et anse de Roux en Y.

We report a case of esophagitis secondary to jejuno-esophageal reflux after total gastrectomy and 60 cm Roux-en-Y jejunal loop. Both esophagitis and jejuno-esophageal reflux disappeared after lengthening of the Y-loop by 50 cm.

Severe anal condylomata acuminata following high-dose chemotherapy and autologous hematopoietic stem cell transplantation: a case report.

We report the case of a 37 years old male patient who developed severe anal condylomata acuminata after high-dose chemotherapy and autologous hematopoietic stem cell transplantation for follicular non-Hodgkin's lymphoma. Anal warts were particularly disabling, refractory to the treatment and finally imposed diversion colostomy. The role of cellular immunodeficiency observed after high-dose chemotherapy and autologous hematopoietic stem cell transplantation as etiology of anal condylomata is discussed.

Epidemiology of inflammatory bowel disease in Brussels' area (1992-1993).

A prospective epidemiological study on inflammatory bowel diseases (IBD) patients was performed in Brussels' area from April 1st, 1992 to 30th March, 1993. The mean annual incidence for Crohn's diseases (CD) was 4.1/10(5) inhabitants/year among native Belgian people and 6.4/10(5) inhabitants/year for subjects issued from Moroccan families. For ulcerative colitis, the incidence was 3.7/10(5) inhabitants/year for native Belgian people and only 1.2/10(5) inhabitants/year for Moroccan subjects. The male/female sex ratio was 0.4 for CD and 1.9 for UC. At the time of diagnosis, the mean age was 34 years for CD and 38 years for UC. For both diseases, the age peak was between 20 and 29 years. Cigarette smoking was significantly higher in CD (48%) than in UC patients (12%). Family history was about 10% for both diseases.

Jejunal diverticulitis.

A case of perforated jejunal diverticulitis in a 44-yr-old man is described and the literature is reviewed. Jejunal diverticulosis occurs in 0.07% to 2% of the population. Enteroclysis is the best diagnostic test. Diverticulitis with perforation is rare and is associated with high mortality. Treatment is surgical resection of the involved segment. Other complications are bacterial overgrowth, obstruction, and acute hemorrhage. Several theories to explain the physiopathogenesis of the diverticula formation may relate to manometric or histological abnormalities of the small bowel.

[Colonic neuroendocrinology]. / La neuroendocrinologie colique.

The intrinsic innervation of the colon is provided by enteric plexi, of which some axons form the neuro-enterocytic junction and others are interconnecting. The extrinsic innervation depends on the autonomous para- and ortho-sympathetic nervous system and is modulated and administered by the central nervous system. Neurotransmission occurs at the level of the mucosa through acetyl-cholin and VIP, among others. At the level of the sub-mucous ganglia, serotonin and enkephalins would play a role. Acetyl-cholin and, probably VIP are neurotransmitters of the para-sympathetic system; nor-adrenalin, dopamine, NPY and histamine are neurotransmitters of the orthosympathetic system. Prevertebral ganglia, relay of the orthosympathetic system, also have an activity per se, influenced by VIP and substance P. Many neuropeptides of the central nervous system have a presumed and not yet identified role of administration. Various diseases in which the enteric plexi are destroyed, are described.

[Colonic inertia and rectal obstruction (Arbuthnot Lane disease)]. / L'inertie colique et le blocage rectal (maladie d'Arbuthnot Lane).

Colonic inertia and outlet obstruction are a major problem of constipation affecting almost solely women and are characterised by an extreme slowness of colonic transit time (less than 80 percent of the markers eliminated in five days) and by a lack of relaxation and a contraction of pelvic muscles, mainly of the pubo-rectalis, during defecation. This syndrome is associated with a high frequency of gynecological diseases (first described in 1908 by Arbuthnot Lane), galactorrhea, urological abnormalities, abnormal manometric oesophageal recordings, Raynaud's phenomenon, idiopathic oedema, orthostatic hypotension and neurological symptoms. A distinctive abnormality of the colonic myenteric plexus has been described. Medical treatment of the affection is without effect, with the exception, perhaps, of the prescription of naloxone. In the absence of other therapeutic means, subtotal colectomy with ileo-rectal and coeco-rectal anastomosis may give relative improvement.

Medical treatment of Crohn's disease. Controlled trials.

From controlled studies only, the authors state the true position of medical therapeutics for the Crohn's disease when it attacks the small intestine and the colon. Sulfasalazine remains the first rate medicine, essentially when the ileum and colon, or colon alone, becomes affected. Metronidazole seems as effective, indeed slightly more so. Corticotherapy should be kept for patients who do not react to sulfasalazine or whose disease is, at the onset, particularly active. The duration of the corticotherapy should be the shortest possible. Immunosuppressors do not seem to be of any help in acute phase and their effect shows only after several months. Their main interest resides in the possibility of reducing or stopping the corticosteroids treatment. There is not enough information about the other medications that have been the tried to draw any conclusions. The use of pure 5-aminosalicylic acid or associated to another vector such as sulfapyridine, will probably be an important therapeutical progress.