Features of colorectal adenomas among young patients with Lynch syndrome according to path_MMR: Results from the PRED-IdF registry.

BACKGROUND: Lynch syndrome (LS) is the most frequent inherited colorectal cancer syndrome. AIM: To assess the burden of adenoma in LS patients under 50 years-old followed in the PRED-IdF network. METHODS: From January 2010 to January 2019, all patients under 50 years of age with a confirmed LS germline mutation were included. The main objective was the description of adenomas characteristics according to path_MMR. RESULTS: We analyzed data from 708 patients (mean age 34.8 ± 8.6), of which 41.8 % were male. Among these patients, 37.6% had path_MLH1, 45.4% path_MSH2, 13.9% path_MSH6, 2.9% path_PMS2, and 1.2% path_EpCAM. The analysis included 1721 (70.9%) follow-up colonoscopies. A total of 682 adenomas were detected, including 140 (20.5%) advanced adenomas. The adenoma detection rates during the first and follow-up colonoscopies were 19.2% and 20.5%, respectively. Most adenomas were <10 mm (57.9%), located in the proximal colon (334, 48.9%), and presented as non-polypoid lesions (493, 72.3%). The median growth time for adenomas was 23 months (range 9-114) irrespective of the path_MMR mutation (p = 0.62). CONCLUSION: LS patients under 50 years of age have a high burden of adenomas, particularly small non-polypoid adenomas located in the proximal colon. These results highlight the need for intensive screening, with a particular focus on the proximal colon.

COLIGENTA treatment of small intestinal bacterial overgrowth. Results of an open study.

PURPOSE: The treatment of small intestinal overgrowth (SIBO) varies according to the center. The present study aimed to evaluate the efficacy of COLIGENTA, an association of colimycin and gentamycin, on SIBO symptomatology and breath test normalization PATIENTS AND METHODS: In this prospective cross-sectional open study, 150 patients with functional bowel disorders and SIBO diagnosed by lactulose hydrogen breath test (LHBT) underwent COLIGENTA oral treatment. A new HLBT was performed 4 weeks after the first HLBT. RESULTS: The patients were mainly female (74%), with a mean age of 47.4 ±â€¯16.2 years and a body mass index of 26.2 ±â€¯5.9 kg/m². After treatment, a decrease of expired hydrogen concentration (P<0.001) was found in the entire population. Improvement of gastrointestinal symptoms was found in 129 patients (86%), while the breath test's normalization was found in 62 patients (42%). Logistic regression showed that normalization of bowel symptoms was not associated with demographics, clinical, or hydrogen breath concentration. In contrast, normalization of LHBT was associated with an increase of breath hydrogen concentration at time 100 min during the first test (P = 0.003; OR=1.072; 95%CI= [1.023-1.123]). CONCLUSION: The present study shows that 10-days of COLIGENTA treatment has a high SIBO clinical improvement rate and can be used as the first or second treatment line.

[Pancreatic adenocarcinoma: 10 years of progress]. / Traitement médical du cancer du pancréas : en 10 ans, enfin des progrès.

Despite the pejorative prognosis of pancreatic adenocarcinoma, significant progress has been made during the past decade at all steps of tumour development. Sporadic preneoplastic lesions are better recognized and a case-by-case prophylactic resection can be proposed. Both the identification and the screening of relatives at risk are in development. Availability of FOLFIRINOX and gemcitabine plus nab-paclitaxel combinations has stopped the long period of failures with gemcitabine doublets. Improvement in chemotherapy may benefit to borderline and locally-advanced forms of this cancer. They are now better evaluated by imaging and often, induction chemotherapy is proposed that allows to achieve a tumor control and then better select patients eligible for surgery in order to avoid unuseful/incomplete resection. The role of radiation therapy and other emerging local treatments merits further assessment. More robust data are needed for prognostic and predictive biomarkers to help in the choice of treatments. Finally, intensification of supportive care and shortened delay to access the treatment should be a major goal to improve the management of this disease.