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PURPOSE: Abdominal pain is a cardinal sign of functional bowel disorders (FBD), in favor of irritable bowel syndrome (IBS). However, the determinants of abdominal pain severity (APS) are unknown. The present study aimed to search the relationships between APS and demographic, psychological, and clinical parameters in tertiary care FBD outpatients. PATIENTS AND METHODS: In this retrospective study, we included 2043 new outpatients with FBD or functional abdominal pain. They fulfilled the Rome III questionnaire, psychological evaluation, and four 10-points Likert scale for the perceived severity of constipation, diarrhea, bloating, and abdominal pain. Linear regression was performed for each phenotype to model the severity of abdominal pain with demographic, psychological parameters, and symptoms severity. RESULTS: APS was positively associated with bloating severity in all phenotypes, but APS was also associated with other variables according to gender and phenotype. APS was negatively associated with age and positively with depression, constipation severity, and diarrhea severity in female patients. In male patients, APS was associated with state anxiety, constipation severity, and diarrhea severity. APS severity was associated with bloating severity and transit severity in IBS patients, while in non-IBS patients, APS was only associated with bloating severity. CONCLUSION: Perceived abdominal pain severity is always associated with perceived bloating severity in FBD and FAP patients.
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Gastroenteropatias , Síndrome do Intestino Irritável , Dor Abdominal/diagnóstico , Dor Abdominal/epidemiologia , Dor Abdominal/etiologia , Constipação Intestinal/complicações , Constipação Intestinal/diagnóstico , Constipação Intestinal/epidemiologia , Diarreia/diagnóstico , Feminino , Flatulência , Gastroenteropatias/diagnóstico , Humanos , Síndrome do Intestino Irritável/complicações , Síndrome do Intestino Irritável/diagnóstico , Masculino , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
BACKGROUND/AIMS: Although idiopathic fecal incontinence (FI) patients have some psychological characteristics, the personality of FI patients was not described. The present study aims to describe the clinical and personality characteristics of FI patients. PATIENTS AND METHODS: This retrospective observational study included 996 outpatients, 72 with fecal incontinence. They filled out the Rome III diagnostic questionnaire, the personality inventory MMPI-2, the questionnaires for urological and sexual disorders, and Likert scales for bowel disorders perceived symptom severity. The main outcome measures were the presence in FI patients of functional gastrointestinal disorders, the self-reported symptom severity, and the personality profile. RESULTS: Patients were mainly females (72%). FI patients were characterized by higher age (P = 0.015), and by a higher prevalence of functional diarrhea (P = 0.001), urological (P = 0.001), and sexual disorders (P = 0.005). These patients also report higher diarrhea severity (P < 0.001) and lower abdominal pain severity (P = 0.009). The personality of FI patients is distinguished by a higher score for psychopathic deviate (P = 0.006), social responsibility (P = 0.003), Mac Andrew revised scale (P = 0.005), and antisocial practice (P = 0.007), and a lower score for type A behavior (P = 0.005). CONCLUSION: FI patients are characterized not only by older age, and a high prevalence of diarrhea but also by a specific personality profile characterized by an unfavorable comparison with others.
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Incontinência Fecal , Diarreia/epidemiologia , Incontinência Fecal/epidemiologia , Feminino , Humanos , Masculino , Personalidade , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
BACKGROUND AND AIMS: Measuring colonic transit time with radiopaque markers is simple, inexpensive, and very useful in constipated patients. Yet, the algorithm used to identify colonic segments is subjective, rather than founded on prior experimentation. The aim of the present study is to describe a rational way to determine the colonic partition in the measurement of colonic transit time. METHODS: Colonic transit time was measured in seven segments: ascending colon, hepatic flexure, right and left transverse colon, splenic flexure, descending colon, and rectosigmoid in 852 patients with functional bowel and anorectal disorders. An unsupervised algorithm for modeling Gaussian mixtures served to estimate the number of subgroups from this oversegmented colonic transit time. After that, we performed a k-means clustering that separated the observations into homogenous groups of patients according to their oversegmented colonic transit time. RESULTS: The Gaussian mixture followed by the k-means clustering defined 4 populations of patients: "normal and fast transit" (n = 548) and three groups of patients with delayed colonic transit time "right delay" (n = 82) in which transit is delayed in the right part of the colon, "left delay" (n = 87) with transit delayed in the left part of colon and "outlet constipation" (n = 135) for patients with transit delayed in the terminal intestine. Only 3.7 % of patients were "erroneously" classified in the 4 groups recognized by clustering. CONCLUSIONS: This unsupervised analysis of segmental colonic transit time shows that the classical division of the colon and the rectum into three segments is sufficient to characterize delayed segmental colonic transit time.
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Colo/fisiopatologia , Constipação Intestinal/fisiopatologia , Trânsito Gastrointestinal , Adulto , Análise por Conglomerados , Colo/anatomia & histologia , Diarreia/fisiopatologia , Análise Discriminante , Feminino , Humanos , Síndrome do Intestino Irritável/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doenças Retais/fisiopatologia , Fatores de TempoRESUMO
CONTEXT: Drug induced pancreatitis are rare but potentially serious. Thus, drug withdrawal is warranted. CASE REPORT: A 79-year-old woman who was treated with antituberculosis therapy for 5 weeks was admitted to our unit for pancreatitis. Usual etiologies of pancreatitis were eliminated. Because of vomiting, antituberculosis therapy was withdrawn and symptoms disappeared. Eight days later, the same treatment was reintroduced and the patient presented recurrent pancreatitis; thus, treatment was withheld again followed by disappearance of clinical and biological abnormalities. Two days later, a treatment without isoniazid was reintroduced and no recurrence of symptoms was observed. CONCLUSIONS: We have experienced a case of isoniazid induced pancreatitis. This is a rare cause of pancreatitis but potentially fatal thus recognition of drug induced pancreatitis and definitive withdrawal of the drug is required.
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Antituberculosos/efeitos adversos , Isoniazida/efeitos adversos , Pancreatite/induzido quimicamente , Pancreatite/diagnóstico , Idoso , Antituberculosos/uso terapêutico , Feminino , Humanos , Isoniazida/uso terapêutico , Pancreatite/prevenção & controle , Prevenção Secundária , Tuberculose Pulmonar/tratamento farmacológico , Suspensão de TratamentoRESUMO
BACKGROUND: Colonic response to food (CRF) is abnormal in irritable bowel syndrome (IBS) patients. AIMS: The aim of this study was to compare CRF in patients who complain of abnormal defecation pattern according to the presence or absence of abdominal pain. METHODS: One hundred forty-nine patients and 50 controls were studied: 96 IBS patients (46 IBS-C, 13 IBS-D, 15 IBS-M, and 22 IBS-U not included), 43 patients with functional constipation (group C) and ten with functional diarrhea (group D). Clinical evaluation and visual analog scales about four items (constipation, diarrhea, abdominal bloating and abdominal pain) were filled by all subjects. Colonic transit time (CTT) was measured in fasting conditions and after eating a standard 1,000-cal test meal. CRF was quantified by calculating the variation in number of markers between the two films. RESULTS: The frequency of meal-related symptoms did not vary among the different groups of patients but was significantly higher than in controls. Compared to IBS-C patients, constipated patients of the group C had longer total and segmental colonic transit time, and compared to IBS-D patients, diarrheic patients of the group D had shorter oro-anal and segmental colonic transit time except in the recto-sigmoid area. CRF was different in patients and controls, and differed between IBS and non IBS patients with similar transit abnormalities. Stool output was greater in patients of the group D than in patients of the IBS-D group. CONCLUSION: The different subgroups of IBS patients have different CRF patterns, distinct from subjects with constipation and diarrhea, but without abdominal pain.
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Dor Abdominal/fisiopatologia , Colo/fisiopatologia , Constipação Intestinal/fisiopatologia , Diarreia/fisiopatologia , Ingestão de Alimentos/fisiologia , Síndrome do Intestino Irritável/fisiopatologia , Adulto , Estudos de Casos e Controles , Defecação , Motilidade Gastrointestinal/fisiologia , Trânsito Gastrointestinal , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Fatores de TempoRESUMO
BACKGROUND/OBJECTIVES: Suicidal ideation (SI), a symptom of depression, is known to be associated with irritable bowel syndrome (IBS) but is not known to be associated with other functional gastrointestinal disorders (FGIDs). However, the source of this association is discussed. It could be related to a possible abnormal biochemical pathway implicating neurotransmitters common to both disorders like serotonin or pain and an ill-being associated with a chronic disorder of unknown etiology. The present study aims to search for the FGIDs associated with suicidal ideation. DESIGN: Observational study. METHODS: A total of 1469 patients with FGIDs (71% of women) were included in the present study. They filled the Rome III questionnaire, Beck depression inventory, and state and trait anxiety questionnaires. Data were analyzed using analysis of variance with Bonferroni correction and logistic regression analysis. RESULTS: Suicidal ideation was reported by 15% of patients, associated with increased scales of depression (P < 0.001), state (P = 0.006), and trait anxiety (P = 0.021). Clinically, these patients reported a higher prevalence of IBS-diarrhea subtype (P = 0.045), fecal incontinence (P = 0.020), soiling (P = 0.016), and difficult defecation (P = 0.005), and higher perceived severity for constipation, diarrhea, bloating, and abdominal pain (P < 0.001 for all scales). CONCLUSIONS: This study shows that only functional bowel and functional anorectal disorders are associated with suicidal ideation. This result must be taken into account in the management of these patients.
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Gastroenteropatias , Síndrome do Intestino Irritável , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Constipação Intestinal/diagnóstico , Diarreia/diagnóstico , Diarreia/epidemiologia , Feminino , Gastroenteropatias/complicações , Gastroenteropatias/diagnóstico , Gastroenteropatias/epidemiologia , Humanos , Síndrome do Intestino Irritável/complicações , Síndrome do Intestino Irritável/diagnóstico , Síndrome do Intestino Irritável/epidemiologia , Ideação Suicida , Inquéritos e QuestionáriosRESUMO
BACKGROUND/AIMS: Self-reported lactose intolerance (LI) is frequent in patients with functional bowel disorders (FBD) that could be interpreted as irritable bowel syndrome (IBS). The present study aims to characterize the responses of patients with FBD, without small intestinal bacterial overgrowth (SIBO), and LI, in terms of lactose malabsorption (LM) and lactose sensitivity (LS) according to psychological and clinical features. METHODS: One hundred and fifty-eight consecutive FBD outpatients with LI, and no SIBO, were classified according to the Rome III questionnaire and filled Beck Depression Inventory, and State and Trait Anxiety questionnaires. They underwent a lactose tolerance test in which glycemia during 60 minutes and digestive symptoms for 3 hours were recorded. RESULTS: Abnormal lactose tolerance tests were found in 110 patients (70%), 44 (28%) with LM, 96 (61%) with LS, and 30 (19%) having both LM and LS. LM patients had a higher frequency of functional diarrhea (P = 0.040) and a lower frequency of dysphagia (P = 0.031). LS patients had a higher depression score (P = 0.007), higher frequency of globus (P = 0.042), irritable bowel syndrome (IBS) (P = 0.027) and mixed IBS (P = 0.049), and lower frequency of abdominal pain (P = 0.040). LS was significantly associated with a higher depression score (P = 0.002), and a higher frequency of globus (P = 0.046). CONCLUSIONS: Thirty percent of LI patients have normal lactose absorption and normal LS. In the other 70% of patients, LI could be associated with LM and/or LS.
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BACKGROUND/AIMS: The aim of our study is to evaluate the association between meals and perceived gastrointestinal symptoms in real life in a French cohort of irritable bowel syndrome (IBS) patients. METHODS: This prospective cross-sectional observational study included patients from the French association (association des patients souffrant du syndrome de l'intestin irritable [APSSII]) of IBS. Data were collected on demographics, IBS subtype, dietary food, and meal-induced gastrointestinal symptoms from patient filled self-questionnaires or questionnaires. RESULTS: Eighty-four patients with IBS were included; 82.3% female with a mean age of 46.9 ± 15.7 years. Each transit pattern subtype represented one-third of the population. Forty-five percent of patients had severe IBS according to IBS-Severity Scoring System; mean IBS Quality of Life score was 53.9 ± 18.3. Patients believed that food could trigger or exacerbate gastrointestinal symptoms in 73.3% and 93.4%, respectively. Eighty-nine percent had already tried diets, mostly lactose free diet and low fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols diet in 61.3% and 53.6% of cases. Thirty-nine percent of meals induced gastrointestinal symptoms. Meal-induced gastrointestinal symptoms were associated with severity and subtype but not with quality of life. CONCLUSIONS: This study has confirmed the important link between gastrointestinal symptoms and food. Gastrointestinal symptoms induced by meals are frequent and associated with severity and IBS-diarrhea subtype. Our study also underlines patients' interest in food and diet. More knowledge is needed on food that triggers IBS symptoms but also on diet conditions in order to improve this condition.
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Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) in patients with a preexisting duodenal stent is particularly challenging and has a low success rate. Endoscopic ultrasound (EUS)-guided biliary drainage (EUS-BD) has been increasingly used as an alternative to percutaneous transhepatic biliary drainage after failed ERCP. EUS-guided choledochoduodenostomy (EUS-CD) and EUS-guided hepaticogastrostomy (EUS-HGS) have been reported to have similar efficacity. Recently, a novel dedicated fully-covered lumen-apposing metal stent (LAMS) has been developed for EUS-CD (Hot AXIOS; Boston Scientific, Massachusetts, United States). It seems that this new device decreases the morbidity of EUS-CD. We present a case in which EUS-CD with LAMS through an uncovered metal duodenal stent was used successfully.
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BACKGROUND: Gastrointestinal angiodysplasias (GIADs) could be responsible for recurrent bleeding and severe anemia. Somatostatin analogs could reduce transfusion requirements in these patients but no randomized controlled study is available. The main objective of the ANGIOPAS phase II double-blinded randomized, noncomparative study was to assess the effectiveness of pasireotide-LAR in reducing transfusion requirements in patients with refractory GIADs bleeding. METHODS: A total of 22 patients with transfusion requirements ⩾6 units of packed red blood cells (pRBCs) during the 6 months prior to inclusion were randomized to receive pasireotide-LAR 60 mg (n = 10) or placebo (n = 12) every 28 days for 6 months. Patients were then followed for an additional 6 months after stopping treatment. RESULTS: The pasireotide-LAR and placebo groups were equivalent for age, sex, comorbidities and transfusion requirement during the reference period (median 13 and 9.5 pRBCs). A 50 and 83% success rate (success defined as a decrease of at least 30% of transfused pRBCs) was observed in the pasireotide-LAR arm in the Intent to Treat (ITT) and per protocol (PP) analysis respectively. The need for transfusion during the intervention period was 3 pRBC units in the pasireotide-LAR group (range 0-26) and 11.5 pRBC units in the placebo group (range 0-23). Overall, three cases with glycemic control impairment were observed in the pasireotide-LAR group including one de novo diabetes. CONCLUSION: This double-blinded noncomparative randomized phase II study suggests, for the first time, the effectiveness of pasireotide-LAR 60 mg every 28 days to decrease the transfusion requirement in patients with recurrent bleeding due to GIADs.
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We report the case of a 36 year-old woman presenting with a giant liver hemangioma revealed by febrile hepatomegaly and weight loss. The patient presented an inflammatory syndrome without hyperleucytose, anemia and a moderate anicteric cholestasis. Plasma concentrations of interleukine-6 were very high whereas interleukine-1 levels were relatively low and TNF levels were normal. Eight weeks of corticosteroid treatment (prednisone 40 mg/d) resulted in disappearance of symptoms after 48 hours and biological anomalies after 6 weeks. Clinical and radiological follow-up, for respectively 36 and 24 months, did not show any relapse of symptoms or evolution of the hemangioma.
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Anti-Inflamatórios/uso terapêutico , Citocinas/sangue , Glucocorticoides/uso terapêutico , Hemangioma/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Prednisona/uso terapêutico , Adulto , Anti-Inflamatórios/administração & dosagem , Biópsia , Feminino , Glucocorticoides/administração & dosagem , Hemangioma/sangue , Hemangioma/diagnóstico , Hemangioma/diagnóstico por imagem , Hemangioma/patologia , Humanos , Interleucina-1/sangue , Interleucina-6/sangue , Fígado/patologia , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Imageamento por Ressonância Magnética , Prednisona/administração & dosagem , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Fator de Necrose Tumoral alfa/análiseRESUMO
INTRODUCTION: Diagnosis of endobronchial metastases is facilitated by immunolabeling techniques on bronchial biopsy samples. CASE: Endobronchial tumors appeared in a 70-year-old woman with an adenocarcinoma of the crypts of Lieberkuhn, diagnosed two years previously. Immunohistochemical examinations made it possible to diagnose endobronchial metastases of the rectal adenocarcinoma. COMMENTS: The endobronchial zone is a relatively rare metastatic site. Metastases associated with rectal adenocarcinoma account for 11-26% of secondary endobronchial lesions. After endoscopic biopsy, immunolabeling techniques help to differentiate between primary adenocarcinoma and endobronchial metastasis. Prognosis is poor.
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Adenocarcinoma/secundário , Neoplasias Brônquicas/secundário , Neoplasias Retais/patologia , Idoso , Feminino , Humanos , Estadiamento de Neoplasias , Segunda Neoplasia Primária/patologiaRESUMO
Langerhans' cell histiocytosis is a disorder in children or young adults, characterized by clonal proliferation of histiocytic cells, staining for CD1a, with uni or multifocal organ involvement. It's a rare condition in adults. We report a case of Langerhans' cell histiocytosis in an adult with sclerosing cholangitis which rapidly progressed to fatal liver failure and progressive cerebellar atrophy. Langerhans cell histiocytosis is a rare cause of sclerosing cholangititis in adults.
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Cerebelo/patologia , Colangite Esclerosante/etiologia , Histiocitose de Células de Langerhans/diagnóstico , Idoso , Atrofia/etiologia , Colangite Esclerosante/complicações , Evolução Fatal , Humanos , Falência Hepática/etiologia , MasculinoRESUMO
INTRODUCTION: Many drugs may provoke oesophageal disorders. In France, doxycyclin, potassium chloride non-steroidal anti-inflammatories are the most frequent agents incriminated. OBSERVATION: A 27 year-old man consulted for dysphagia and odynophagia due to oesophagitis following administration of bacampicillin. COMMENTS: Several drugs can provoke oesophageal disorders including ulcerations. Predisposing circumstances exist. Ingestion of the drugs with a sufficient quantity of water (60 to 100 ml), whilst standing or sitting should be able to limit this type of event.
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Ampicilina/análogos & derivados , Ampicilina/efeitos adversos , Doenças do Esôfago/induzido quimicamente , Úlcera/induzido quimicamente , Adulto , Ampicilina/administração & dosagem , Antiácidos/uso terapêutico , Doenças do Esôfago/diagnóstico , Doenças do Esôfago/tratamento farmacológico , Gastroscopia , Humanos , Masculino , Faringite/tratamento farmacológico , Resultado do Tratamento , Úlcera/diagnóstico , Úlcera/tratamento farmacológicoRESUMO
Variable immunodeficiency is frequently associated with subtotal villous atrophy, unchanged by gluten free diet. We report two cases of common variable immunodeficiency associated with chronic symptoms of malabsorption due to total villous atrophy. Symptoms of malabsorption disappeared and histological abnormalities improved after a gluten free diet. The association between celiac disease and common variable immunodeficiency should not be considered as fortuitous. Clinicians should be aware of this association and of the low sensitivity of serologic testing in this setting.
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Doença Celíaca/complicações , Doença Celíaca/imunologia , Imunodeficiência de Variável Comum/complicações , Doença Celíaca/dietoterapia , Doença Celíaca/patologia , Imunodeficiência de Variável Comum/patologia , Glutens , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND & AIMS: Pancreatic exocrine insufficiency (PEI) impairs fat absorption, but few data are available on protein absorption. We investigated this question in patients with chronic pancreatitis, both in the absence and presence of enzyme therapy, using a stable isotope sensitive method. METHODS: Eleven patients with sustained PEI and regular enzyme substitution were investigated at hospital, after a washout period without enzyme substitution, and later after reintroduction of substitution. The digestibility and postprandial metabolism of dietary protein were characterized after the ingestion of a semi-synthetic single meal containing 20 g (15)N-labeled casein. RESULTS: At baseline, 20 ± 8% of dietary nitrogen was transferred to the metabolic pools vs. 24.5 ± 7% under enzyme treatment (P = 0.04). After treatment, the transfer of dietary nitrogen tended to increase in plasma amino acids, and increased significantly in plasma proteins and the deamination pool. In contrast, the fecal excretion of dietary nitrogen did not demonstrate any treatment effect. In patients not receiving insulin for diabetes, the treatment stimulated insulin secretion. CONCLUSIONS: Protein malabsorption was mostly undetectable using standard fecal tests. The study of the postprandial fate of dietary protein revealed a moderate increase of its transfer to metabolic pools after enzyme substitution.