Prevalence of gastroesophageal reflux in a Tunisian primary care population determined by patient interview.

Although gastresophageal reflux disease (GERD) is highly prevalent in Western countries, we have very little data about it in African countries. The aim of the study is to determine the prevalence and severity of GERD symptoms among Tunisian subjects and report its characteristics, consultation rate, management modes, as well as patients' satisfaction. Five hundred subjects living in Tunisia were interviewed face to face. The study was conducted at seven centers of primary care at Monastir's department by six interviewer doctors. The questionnaire consisted of 30 questions relating to subject attributes, lifestyle factors, medical history, reflux-related symptom characteristics, consultation behavior, previous treatments for GERD, and description of the last episode. Symptoms were defined as 'frequent' if they occurred at least weekly and 'occasional' if they occurred less frequently during the last year. The mean age was 42.3 ± 17.3 years and 75.6% were females. Over the previous year, 60% of the respondents reported suffering any GERD symptom. The prevalence of frequent GERD is 24%. Female gender (odds ratio [OR]: 1.97[1.15-3.37]) and body mass index ≥ 25 (OR: 1.54[1.042-2.29]) were associated with increased risk of GERD symptom. Only 22.3%, sought medical advice about GERD symptoms in the last year. In the univariate and multivariate analysis, work status, frequency and intensity of symptoms, duration of symptom, and association of atypical symptoms were associated with a higher frequency of medical consultation for GERD symptoms. Among the subjects complaining about heartburn, 34% took medications. GERD symptoms are common among Tunisian subjects. Few heartburn sufferers seek medical attention, and most do not take medications for symptomatic control.

[What are the distinctive characteristics of subjects with frequent and occasional gastroesophageal reflux symptoms?]. / Quels sont les caractéristiques distinctives entre les patients ayant un RGO fréquent et les reflueurs occasionnels?

BACKGROUND: The aim of this study was to determine the prevalence and clinical spectrum of gastroesophageal reflux disease (GERD) in Tunisia and to compare the characteristics and disease management of subjects complaining of at least weekly and less frequent gastroesophageal reflux symptoms. METHODS: Five hundred subjects living in Tunisia were interviewed face to face. The questionnaire consisted of 30 questions relating to subject attributes, lifestyle factors, medical history, reflux-related symptom characteristics, consultation behavior, previous treatments for GERD and description of the last episode. RESULTS: The mean age was 42.3±17.3 years and 75.6% were females. Sixty percent of the responders reported at least one GERD symptom. The prevalence of frequent GERD was 24%. Only 22.3% had sought medical advice about GERD symptoms in the last year. Of those who had consulted, 75% of individuals waited over 6 months before consulting a physician. Compared with subjects with occasional gastroesophageal reflux symptoms, those with frequent symptoms suffered from more severe symptoms, (OR: 3.5; CI 95%: 1.9-6.4), had more often sought medical advice (OR: 2.9 CI 95%: 1.6-5.2) and had more often used a drug therapy for GERD (OR: 2.2; CI 95%:1.3-3.8). In the multivariate analysis, work status, frequency and intensity of symptoms, duration of symptoms and association of atypical symptoms were associated with a higher frequency of medical consultation for GERD symptoms. CONCLUSION: GERD symptoms are common in the Tunisian population. The population with frequent GERD exhibits more severe symptoms and greater healthcare use.

[Cholestatic jaundice secondary to portal cavernoma: Case report]. / Ictère cholestatique secondaire à un cavernome porte: à propos d'un cas.

Portal biliopathy is due to compression of the common bile duct by varicose veins constituting portal cavernoma. Usually asymptomatic, it can occasionally be responsible for jaundice or cholangitis. We report a case of portal cavernoma secondary to pylephlebitis complicating acute appendicitis, followed eleven years later by occurrence of cholestatic jaundice. Diagnosis of portal biliopathy was done by imaging and confirmed by endoscopic retrograde cholangiography with insertion of a plastic stent into common bile duct. This stent was periodically changed and allowed regression of jaundice with a 3-year follow-up. Through a review of the literature, both clinical and therapeutic characteristics of portal biliopathy were studied.

[Epidemiology of cholelithiasis in central Tunisia. Prevalence and associated factors in a nonselected population]. / Epidémiologie de la lithiase biliaire dans le centre de la Tunisie.

OBJECTIVES: The prevalence of cholelithiasis is still unknown in Tunisia. The aim of this study was to assess the prevalence and selected risk factors of cholelithiasis METHODS: Two thousand citizens over the age of 19 in a small town in the center of Tunisia were evaluated. Following a structured interview of each subject, an ultrasound examination was performed. Height, weight and blood levels of glucose and cholesterol were determined by standard methods. RESULTS: The response rate was 56% (746 women and 377 men). Of the 1123 persons evaluated, 19 had undergone previous cholecystectomy. Crude prevalence of cholelithiasis was 4% (5.4% in women and 1% in men). Typical biliary colic was the only symptom significantly associated with cholelithiasis (specificity: 97.6%). Presence of gallstones was associated with age (P=0.02), sex (P=0. 00045) and multiparity (P<0.0002). Neither body mass index, diabetes mellitus or hypercholesterolemia were risk factors. CONCLUSION: The prevalence of cholelithiasis in central Tunisia is low. The risk factors are similar to those in occidental surveys.

[Antiphospholipid antibodies in digestive diseases]. / Les anticorps antiphospholipides en pathologie digestive.

DIAGNOSIS AND PROGNOSIS: Antiphospholipids comprise a very heterogeneous group of auto-antibodies including anticardiolipids demonstrated by immunological methods and lupus anticoagulants detected by coagulation tests. Antiphospholipids are encountered in various conditions other than dysimmune disease and are frequently involved in thrombotic manifestations. We discuss here the implications of these antibodies in digestive tract diseases and present an analysis of their diagnostic and prognostic value for optimal therapeutic and monitoring approaches. CLINICAL MANIFESTATIONS: The risk of thrombosis is high in patients with cryptogenetic inflammatory bowel disease. The prevalence of antiphospholipid antibodies (AcAPL) is abnormally high in these patients, but their contribution to the development of thrombosis remains controversial. Patients with liver disease generally exhibit coagulation disorders, with paradoxical thrombotic manifestations. AcAPL are strongly implicated in the development of thrombosis, particularly in patients with alcoholic liver disease, hepatitis C, regenerative nodular hyperplasia, and cirrhosis, independently of the presence of an associated hepatocellular carcinoma. Antiphospholipid syndrome is considered to be the second leading cause of non-tumor-related Budd-Chiari syndrome, after myeproliferative syndromes. Likewise for portal or mesenteric vein thrombosis where antiphospholipid antibodies would be involved in the causal mechanism. UNDERLYING MECHANISMS: Due to the diversity of these antibodies, it is unlikely that a unique mechanism could explain all the different thrombotic manifestations associated with their presence.