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Guillo L, Savoye G, Amiot A, Gilletta C, Nachury M, Dib N, Bourreille A, Roblin X, Caillo L, Allez M, Picon L, Hébuterne X, Seksik P, Chupin A, Buisson A, Brixi H, Altwegg R, Simon M, Amil M, Laharie D, Bouguen G, Serrero M, Elgharabawy Y, Peyrin-Biroulet L. Prevalence of and Factors Associated With Extraintestinal Manifestations and Their Remission in Inflammatory Bowel Disease: The EXTRA-Intestinal Manifestation Prospective Study From the Groupe d'Etude Thérapeutique des Affections Inflammatoires du Tube Digestif. Clin Transl Gastroenterol 2023; 14:e00607. [PMID: 37523417 PMCID: PMC10749700 DOI: 10.14309/ctg.0000000000000607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/23/2023] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION Extraintestinal manifestations (EIMs) of inflammatory bowel disease (IBD) are challenging clinical situation. No prospective study assessed remission risk factors of EIMs. The aim of this study was to prospectively investigate the epidemiology, risk factors of EIM occurrence, and EIM remission in a large IBD cohort. METHODS We conducted a cross-sectional study in 30 French referral centers. Between May 2021 and June 2021, all consecutive patients attending to hospital appointment were systematically invited to fill out a questionnaire. RESULTS A total of 1,971 consecutive patients with IBD were analyzed. There were 1,056 women (53.8%), and the median age of patients was 41 years (31-54). The median disease duration was 11 years (1-18). Overall, 544 (27.6%) had at least 1 EIM. In 20.2% of cases, patients had multiple EIMs. The most frequent EIMs were rheumatological (19%) and dermatological (10%) manifestations. Immunosuppressant treatment (odds ratio [OR] = 2.56; P < 0.001) was a risk factor of EIM, while the Montreal A3 classification (OR = 0.61, P = 0.023) and male gender (OR = 0.61, P < 0.001) were associated with a lower risk of EIM occurrence. IBD current clinical remission (OR = 2.42; P < 0.001) and smoking cessation (OR = 2.98; P < 0.001) were associated factors of EIM remission. Conversely, age at IBD diagnosis (OR = 0.98; P < 0.018) was associated with a lower risk of EIM remission. DISCUSSION One quarter of patients had at least 1 EIM. Beyond factors associated with the presence of EIMs, patients with IBD current clinical remission and smoking cessation are more likely to achieve EIM remission, while increasing age at IBD diagnosis is associated with decreased chance of remission.
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Affiliation(s)
- Lucas Guillo
- Department of Gastroenterology, University Hospital of Marseille Nord, University of Aix-Marseille, Marseille, France
| | - Guillaume Savoye
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Aurélien Amiot
- Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, EC2M3-EA7375, University of Paris Est Créteil, Créteil, France
| | - Cyrielle Gilletta
- Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
| | - Maria Nachury
- Université de Lille, Inserm, CHU Lille, U1286–INFINITE–Institute for Translational Research in Inflammation, Lille, France
| | - Nina Dib
- Hepato-Gastroenterology Department, Angers University Hospital, Angers, France, HIFIH Laboratory, UPRES 3859, SFR 4208, Angers University, Angers, France
| | - Arnaud Bourreille
- Department of Gastroenterology, Institut des Maladies de l'Appareil Digestif (IMAD), CIC Inserm 1413, Nantes University Hospital, Nantes, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Ludovic Caillo
- Department of Gastroenterology, University Hospital of Nimes, Nimes, France
| | - Matthieu Allez
- Department of Gastroenterology, Hôpital Saint Louis, Assistance Publique–Hôpitaux de Paris, INSERM U1160, Université Paris Cité, Paris, France
| | - Laurence Picon
- Department of Gastroenterology, Tours University Hospital, Tours, France
| | - Xavier Hébuterne
- Gastroenterology and Clinical Nutrition, CHU of Nice, University Côte d'Azur, Nice, France
| | - Philippe Seksik
- Department of Gastroenterology, Centre de Recherche Saint-Antoine, Sorbonne Université, INSERM, APHP, Hôpital Saint-Antoine, Paris, France
| | - Antoine Chupin
- Department of Gastroenterology, Georges-Pompidou European Hospital, Paris, France
| | - Anthony Buisson
- Université Clermont Auvergne, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastroentérologie, Inserm U1071, M2iSH, USC-INRA 2018, Clermont-Ferrand, France
| | - Hédia Brixi
- Department of Gastroenterology, Reims University Hospital, Reims, France
| | - Romain Altwegg
- Department of Gastroenterology, Saint-Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - Marion Simon
- Department of Gastroenterology, Institut Mutualiste Montsouris, Paris, France
| | - Morgane Amil
- Departement of Gastroenterology, Les Oudairies Hospital, La Roche-sur-Yon, France
| | - David Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-Gastroentérologie et Oncologie Digestive, Université de Bordeaux, Bordeaux, France
| | - Guillaume Bouguen
- Department of Gastroenterology, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | - Mélanie Serrero
- Department of Gastroenterology, University Hospital of Marseille Nord, University of Aix-Marseille, Marseille, France
| | - Yasmine Elgharabawy
- Groupe d'étude Thérapeutique des Affections Inflammatoire du Tube digestive (GETAID), Paris, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
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Bouhnik Y, Pineton de Chambrun G, Lambert J, Nachury M, Seksik P, Altwegg R, Vuitton L, Stefanescu C, Nancey S, Aubourg A, Serrero M, Filippi J, Desseaux K, Viennot S, Abitbol V, Boualit M, Bourreille A, Giletta C, Buisson A, Roblin X, Dib N, Malamut G, Amiot A, Fumery M, Louis E, Elgharabawy Y, Peyrin-Biroulet L. Adalimumab in Biologic-naïve Patients With Crohn's Disease After Resolution of an Intra-abdominal Abscess: A Prospective Study From the GETAID. Clin Gastroenterol Hepatol 2023; 21:3365-3378.e5. [PMID: 36731588 DOI: 10.1016/j.cgh.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND & AIMS The management of intra-abdominal abscesses complicating Crohn's disease (CD) is challenging, and surgery with delayed intestinal resection is often recommended. The aims of this study were to estimate the success rate of adalimumab (ADA) in patients with CD with an intra-abdominal abscess resolved without surgery, and to identify predictive factors for success. METHODS A multicenter, prospective study was conducted in biologic-naïve patients with CD with resolved intra-abdominal abscess treated with ADA with a 2-year follow-up. The primary endpoint was ADA failure at week (W) 24 defined as a need for steroids after W12, intestinal resection, abscess recurrence, and clinical relapse. Secondary post-hoc endpoint was the long-term success defined as the survival without abscess relapse or intestinal resection at W104. The factors associated with ADA failure at W24 and W104 were identified using a logistic and a Cox regression, respectively. RESULTS From April 2013 to December 2017, 190 patients from 27 GETAID centers were screened, and 117 were included in the analysis. Fifty-eight patients (50%) were male, and the median age at baseline was 28 years. At W24, 87 patients (74%; 95% confidence interval [CI], 65.5%-82.0%; n = 117) achieved ADA success. Among the 30 patients with ADA failure, 15 underwent surgery. At W104, the survival rate without abscess recurrence or surgery was 72.9% (95% CI, 62.1%-79.8%; n = 109). Abscess drainage was significantly associated with ADA failure at W24 (odds ratio, 4.18; 95% CI, 1.06-16.5; P =0 .043). Disease duration (hazard ratio [HR], 1.32; 95% CI, 1.09-1.59; P = .008), abscess drainage (HR, 5.59; 95% CI, 2.21-14.15; P = .001), and inflammatory changes in mesenteric fat (HR, 0.4; 95% CI, 0.17-0.94; P = .046) were significantly associated with ADA failure at W104. CONCLUSION Provided that the abscess was carefully managed before initiating medical treatment, this study showed the high efficacy of ADA in the short and long term in biologic-naïve patients with CD complicated by an intra-abdominal abscess. CLINICALTRIALS gov, Number: NCT02856763.
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Affiliation(s)
- Yoram Bouhnik
- Paris IBD Center, Groupe Hospitalier Privé Ambroise Paré - Hartmann, Neuilly sur Seine, France.
| | | | - Jérôme Lambert
- Department of statistics, INSERM U717 Saint-Louis Hospital, Paris, France
| | - Maria Nachury
- University Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Philippe Seksik
- Département de Gastroentérologie, Hôpital Saint Antoine, Sorbonne Université, Inserm, CRSA, AP-HP, Paris, France
| | - Romain Altwegg
- Department of Gastroenterology, Hôpital Saint-Éloi, CHU, Montpellier, France
| | - Lucine Vuitton
- Department of Gastroenterology, Besançon University Hospital, Besançon, France
| | - Carmen Stefanescu
- Paris IBD Center, Groupe Hospitalier Privé Ambroise Paré - Hartmann, Neuilly sur Seine, France
| | - Stéphane Nancey
- Department of Gastroenterology, Lyon-Sud Hospital, Lyon University, Lyon, France
| | - Alexandre Aubourg
- Department of Gastroenterology, Tours University Hospital, Tours, France
| | - Mélanie Serrero
- Department of Gastroenterology, Hôpital Nord, Marseille University, Marseille, France
| | - Jérôme Filippi
- Department of Gastroenterology, Nice University Hospital, Nice, France
| | - Kristell Desseaux
- Department of statistics, INSERM U717 Saint-Louis Hospital, Paris, France
| | - Stéphanie Viennot
- Department of Gastroenterology, University Hospital of Caen, Caen, France
| | - Vered Abitbol
- Department of Gastroenterology, AP-HP. Centre- Université de Paris, Hôpital Cochin, Paris, France
| | - Madina Boualit
- Department of Gastroenterology, Valenciennes General Hospital, Valenciennes, France
| | - Arnaud Bourreille
- CHU Nantes, Institut des Maladies de l'Appareil Digestif, Department of Gastroenterology, CIC Inserm 1413, Nantes University, Nantes, France
| | - Cyrielle Giletta
- Department of Gastroenterology, Toulouse University Hospital, Hôpital Rangueil, Toulouse, France
| | - Anthony Buisson
- Université Clermont Auvergne, Inserm U1071, M2iSH, CHU Clermont-Ferrand, 3iHP, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Nina Dib
- Department of Gastroenterology, Angers University Hospital, Angers, France
| | - Georgia Malamut
- Department of Gastroenterology, AP-HP. Centre- Université de Paris, Hôpital Cochin, Paris, France
| | - Aurélien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, Creteil University, Creteil, France
| | - Mathurin Fumery
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Edouard Louis
- Department of Gastroenterology, Liège University Hospital, Liège, Belgium
| | - Yasmine Elgharabawy
- Groupe Etude Thérapeutiques des Affections Inflammatoires Digestives, GETAID, Paris, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Brabois Hospital, Nancy University, Nancy les Vandoeuvre-lès-Nancy, France
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Amiot A, Chaibi S, Bouhnik Y, Serrero M, Filippi J, Roblin X, Bourrier A, Bouguen G, Franchimont D, Savoye G, Buisson A, Louis E, Nancey S, Abitbol V, Reimund JM, DeWit O, Vuitton L, Mathieu N, Peyrin-Biroulet L, Gilletta C, Allez M, Viennot S, Le Berre C, Dib N, Brixi H, Painchart C, Plastaras L, Altwegg R, Fumery M, Caillo L, Laharie D, Nachury M. Prevalence and Determinants of Fatigue in Patients with IBD: A Cross-Sectional Survey from the GETAID. J Crohns Colitis 2023; 17:1418-1425. [PMID: 36988620 DOI: 10.1093/ecco-jcc/jjad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Indexed: 03/30/2023]
Abstract
BACKGROUND Fatigue is commonly reported by patients with inflammatory bowel disease [IBD], but the determinants of IBD-related fatigue have yet to be determined. AIMS To identify the factors associated with fatigue in a large population of patients with IBD. PATIENTS AND METHODS Fatigue and nine other IBD-related disability dimensions were assessed in a cohort of 1704 consecutive patients with IBD using the IBD-disk questionnaire in a cross-sectional survey of 42 French and Belgian centres. Fatigue and severe fatigue were defined as energy subscores >5 and >7, respectively. Determinants of fatigue were assessed using univariate and multivariate analyses (odds ratios [ORs] are provided with 95% confidence intervals). RESULTS The prevalence rates of fatigue and severe fatigue were 54.1% and 37.1%, respectively. Both fatigue and severe fatigue were significantly higher in patients with active disease than in patients with inactive disease [64.9% vs 44.7% and 47.4% vs 28.6%, respectively; p < 0.001 for both comparisons]. In the multivariate analysis stratified by age, sex, type of IBD and IBD activity, fatigue was associated with age >40 years (OR = 0.71 [0.54-0.93]), female sex (OR = 1.48 [1.13-1.93]) and IBD-related sick leave (OR = 1.61 [1.19-2.16]), and joint pain (OR = 1.60 [1.17-2.18]), abdominal pain (OR = 1.78 [1.29-2.45]), regulating defecation (OR = 1.67 [1.20-2.32]), education and work (OR = 1.96 [1.40-2.75]), body image (OR = 1.38 [1.02-1.86]), sleep (OR = 3.60 [2.66-4.88]) and emotions (OR = 3.60 [2.66-4.88]) subscores >5. CONCLUSION Determinants of fatigue are not restricted to IBD-related factors but also include social factors, sleep and emotional disturbances, thus supporting a holistic approach to IBD patient care.
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Affiliation(s)
- Aurelien Amiot
- Department of Gastroenterology, Hopitaux Universitaires Bicêtre, AP-HP, Université Paris Saclay, INSERM, Centre for Research in Epidemiology and Population Health, Le Kremlin Bicêtre, France
| | - Sayma Chaibi
- Department of Gastroenterology, Henri Mondor Hospital, Paris Est-Créteil Val de Marne University, Creteil, France
| | - Yoram Bouhnik
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Melanie Serrero
- Hôpital Nord, Centre d'investigation Clinique Marseille Nord, Université Méditerranée, Marseille, France
| | - Jerome Filippi
- Department of Gastroenterology and Clinical Nutrition, CHU of Nice, University Côte d'Azur, Nice, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Anne Bourrier
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, UPMC Université Paris 6, Paris, France
| | - Guillaume Bouguen
- Department of Gastroenterology, CHU Rennes and University of Rennes, NUMECAN Institute, Rennes, France
| | - Denis Franchimont
- Department of Gastroenterology, Hôpital Erasme, Laboratoire de Gastroenterologie experimentale, ULB, Brussels, Belgium
| | - Guillaume Savoye
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Anthony Buisson
- Department of Hepato-Gastroenterology, University Hospital Estaing of Clermont Ferrand, Université d'Auvergne, Clermont-Ferrand, France
| | - Edouard Louis
- Department of Gastroenterology, Liège University Hospital, CHU Liège, Belgium
| | - Stephane Nancey
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon and INSERM U1111, University Claude Bernard Lyon 1, Lyon, France
| | - Vered Abitbol
- Department of Gastroenterology, Cochin University Hospital, Paris, France
| | - Jean-Marie Reimund
- Service d'Hépato-Gastroentérologie et d'Assistance Nutritive, Hôpitaux Universitaires de Strasbourg et INSERM U1113, Université de Strasbourg, Strasbourg, France
| | - Olivier DeWit
- Cliniques Universitaires Saint-Luc, UCL, Brussels, Belgium
| | - Lucine Vuitton
- Department of Gastroenterology, Besancon University Hospital, Besancon, France
| | - Nicolas Mathieu
- Department of Hepato-Gastroenterology and Digestive Oncology, Grenoble Alpes University Hospital, Grenoble, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Inserm U1256 NGERE, Lorraine University, Vandoeuvre-les-Nancy, France
| | - Cyrielle Gilletta
- Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
| | - Matthieu Allez
- Department of Gastroenterology, Saint-Louis University Hospital, Paris, France
| | - Stephanie Viennot
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Catherine Le Berre
- Hépato-Gastro-Entérologie et Assistance Nutritionnelle, Inserm CIC 1413, Inserm UMR 1235, Institut des Maladies de l'Appareil Digestif (IMAD), Nantes Université, CHU Nantes, Nantes, France
| | - Nina Dib
- Department of HepatoGastroenterology, Angers University Hospital, Angers, France
| | - Hedia Brixi
- Department of GastroEnterology, Reims University Hospital, Rheims, France
| | - Claire Painchart
- Department of Gastroenterology, Valenciennes General Hospital, Valenciennes, France
| | | | - Romain Altwegg
- Department of Gastroenterology, Hôpital Saint-Eloi, University Hospital of 28 Montpellier, Montpellier, France
| | - Mathurin Fumery
- Service d'Hépato-gastroentérologie, Centre Hospitalier Universitaire Amiens-Picardie Site Sud, Amiens, Hauts-de-France, France
| | - Ludovic Caillo
- Department of Gastroenterology, Nimes University Hospital, Nimes, France
| | - David Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive - Université de Bordeaux, F-33000 Bordeaux, France
| | - Maria Nachury
- Univ. Lille, INSERM, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
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Lelong M, Josien R, Coste-Burel M, Rimbert M, Bressollette-Bodin C, Nancey S, Bouguen G, Allez M, Serrero M, Caillo L, Rouillon C, Blanc P, Laharie D, Olivier R, Peyrin-Biroulet L, Dib N, De Maissin A, Montuclard C, Trang-Poisson C, Vavasseur F, Gallot G, Berthome M, Braudeau C, Chevreuil J, Bourreille A, Le Berre C. The risk of COVID-19 in IBD patients is increased by urban living and is not influenced by disease activity or intravenous biologics. Front Immunol 2023; 14:1243898. [PMID: 37701431 PMCID: PMC10494533 DOI: 10.3389/fimmu.2023.1243898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Abstract
Background Patients with inflammatory bowel disease (IBD) may have a modified immune response to SARS-CoV-2. The objectives were to evaluate the prevalence of COVID-19 in patients treated with infliximab or vedolizumab, to analyze the factors associated with the infection, the impact of treatments and trough levels. Methods Patients with IBD treated with intravenous biologics in 14 French centers were included between March and June 2020 and followed-up for 6 months. Blood samples were collected for serologies and trough levels. The analysis of factors associated with COVID-19 was conducted in a matched 1:1 case-control sub-study with positive patients. Results In total, 1026 patients were included (74.9% infliximab). Over the follow-up period, 420 patients reported the occurrence of COVID-19 symptoms; 342 had been tested of whom 18 were positive. At the end of follow-up, 38 patients had a positive serology. Considering both nasal tests and serologies together, 46 patients (4.5%) had been infected. The risk of COVID-19 was related neither to the use of treatments (whatever the trough levels) nor to disease activity. Infections were more frequent when using public transport or living in flats in urban areas. Conclusions The prevalence rate of COVID-19 in this IBD population treated with intravenous infliximab or vedolizumab was the same as the one in the French population before the start of the vaccination campaign. The risk was increased by urban living and was not influenced by disease activity or biologics. Sanitary barrier measures remain the best way to protect against SARS-CoV-2 in patients with IBD in biological therapy.
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Affiliation(s)
- Margaux Lelong
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastro-Entérologie et Assistance Nutritionnelle, Institut national de la santé et de la recherche médicale (Inserm) CIC 1413, Nantes, France
| | - Régis Josien
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Laboratoire d’Immunologie Biologique, Centre d’ImmunoMonitorage Nantes-Atlantique (CIMNA), Nantes, France
- Nantes Université, Institut national de la santé et de la recherche médicale (Inserm), Centre Hospitalier Universitaire (CHU) Nantes, CR2TI UMR 1064, Nantes, France
| | - Marianne Coste-Burel
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Laboratoire de Virologie, Nantes, France
| | - Marie Rimbert
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Laboratoire d’Immunologie Biologique, Centre d’ImmunoMonitorage Nantes-Atlantique (CIMNA), Nantes, France
| | - Céline Bressollette-Bodin
- Nantes Université, Institut national de la santé et de la recherche médicale (Inserm), Centre Hospitalier Universitaire (CHU) Nantes, CR2TI UMR 1064, Nantes, France
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Laboratoire de Virologie, Nantes, France
| | - Stéphane Nancey
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon 1 and INSERM U1111-CIRI, Lyon, France
| | - Guillaume Bouguen
- Centre Hospitalier Universitaire (CHU) and University of Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), Rennes, France
| | - Matthieu Allez
- Gastroenterology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), INSERM U1160, Université de Paris, Paris, France
| | - Mélanie Serrero
- Department of Gastroenterology, Centre Hospitalier Universitaire (CHU) Marseille, Marseille, France
| | - Ludovic Caillo
- Department of Gastroenterology, Nimes University Hospital, Nîmes, France
| | - Cléa Rouillon
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Pierre Blanc
- Service d’hépatogastroentérologie B, Centre Hospitalier Universitaire (CHU) Montpellier et Université Montpellier, Montpellier, France
| | - David Laharie
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology department, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Raphaël Olivier
- Gastroenterology Department, University Hospital of Poitiers, Poitiers, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Nina Dib
- Department of HepatoGastroenterology, Angers University Hospital, Angers, France
| | - Astrid De Maissin
- Centre Hospitalier Départemental (CHD) La Roche Sur Yon, Department of Gastroenterology, La-Roche-sur-Yon, France
| | - Céline Montuclard
- Department of Endoscopy and Gastroenterology, Valence Public Hospital, Valence, France
| | - Caroline Trang-Poisson
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastro-Entérologie et Assistance Nutritionnelle, Institut national de la santé et de la recherche médicale (Inserm) CIC 1413, Nantes, France
| | - Fabienne Vavasseur
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastro-Entérologie et Assistance Nutritionnelle, Institut national de la santé et de la recherche médicale (Inserm) CIC 1413, Nantes, France
| | - Géraldine Gallot
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Centre de ressources biologiques (CRB), Nantes, France
| | - Mathilde Berthome
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Centre de ressources biologiques (CRB), Nantes, France
| | - Cécile Braudeau
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Laboratoire d’Immunologie Biologique, Centre d’ImmunoMonitorage Nantes-Atlantique (CIMNA), Nantes, France
- Nantes Université, Institut national de la santé et de la recherche médicale (Inserm), Centre Hospitalier Universitaire (CHU) Nantes, CR2TI UMR 1064, Nantes, France
| | - Justine Chevreuil
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Laboratoire d’Immunologie Biologique, Centre d’ImmunoMonitorage Nantes-Atlantique (CIMNA), Nantes, France
| | - Arnaud Bourreille
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastro-Entérologie et Assistance Nutritionnelle, Institut national de la santé et de la recherche médicale (Inserm) CIC 1413, Nantes, France
| | - Catherine Le Berre
- Nantes Université, Centre Hospitalier Universitaire (CHU) Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastro-Entérologie et Assistance Nutritionnelle, Institut national de la santé et de la recherche médicale (Inserm) CIC 1413, Nantes, France
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Dib N, Moussa NB, Varnous S, Guillemain R, Iserin L, Belli E, Cohen S. Long-term outcomes after heart transplantation in adult patients with congenital heart disease: Does initial defect and physiology impact survival? Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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6
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Brunet-Houdard S, Monmousseau F, Berthon G, Des Garets V, Laharie D, Picon L, Fotsing G, Gargot D, Charpentier C, Buisson A, Trang-Poisson C, Dib N, Rusch E, Aubourg A. How are patients' preferences for anti-TNF influenced by quality of life? A discrete choice experiment in Crohn's disease patients. Scand J Gastroenterol 2022; 57:1312-1320. [PMID: 35722732 DOI: 10.1080/00365521.2022.2085057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Anti-TNFs have been shown to significantly improve the health-related quality of life (HRQoL) in Crohn's disease (CD) patients. The purpose of this study was to investigate to what extend the patients' preferences for these intravenous (IV) and subcutaneous (SC) treatments differ based on respondents' quality of life. An online discrete choice experiment (DCE) was conducted to understand patient trade-offs in treatment choice. METHODS Fifty-seven Crohn's disease anti-TNF naïve patients were asked to choose between two different scenarios, considering the following attributes: mode of administration (MODE), total availability for injection (TIME), speed of onset (DELAY), risk of anti-TNF administration despite a contraindication (RISK) and total monthly out-of-pocket expenses (COST). At the same time, patients completed the IBDQ-32 questionnaire. Conditional logit models without and with interaction terms were estimated to evaluate attribute weights. RESULTS Patients preferred to self-administer SC anti-TNF rather than have a primary care nurse do it, whereas the preference for IV route was negative. After adding interaction terms however, the IV route became preferred for patients with impaired HRQoL, this preference having decreased as HRQoL increased. Surprisingly, patients with impaired HRQoL were less willing to spend more time on treatment, and this effect diminished as HRQoL (overall and in each dimension) became higher. CONCLUSIONS HRQoL level changed patients' preferences for the anti-TNF treatment. The results suggest the need to optimise the management of IV infusions in the hospital and reinforce the importance of patient-reported outcome measures (PROMS) as a common practice to improve shared medical decision making.
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Affiliation(s)
- Solène Brunet-Houdard
- Health Economic Evaluation Unit, University Hospital of Tours, Tours, France.,EA7505 Education, Ethics, Health Research Unit, University of Tours, Tours, France
| | - Fanny Monmousseau
- Health Economic Evaluation Unit, University Hospital of Tours, Tours, France.,EA7505 Education, Ethics, Health Research Unit, University of Tours, Tours, France
| | - Geoffrey Berthon
- Health Economic Evaluation Unit, University Hospital of Tours, Tours, France
| | - Véronique Des Garets
- EA6296 VALLOREM Loire Valley Management Research Unit, Loire Valley University Management School, University of Tours, Tours, France
| | - David Laharie
- Department of Gastroenterology, University Hospital of Bordeaux, Pessac, France
| | - Laurence Picon
- Department of Gastroenterology, University Hospital of Tours, Chambray-lès-Tours, France
| | - Ginette Fotsing
- Department of Gastroenterology, University Hospital of Poitiers, Poitiers, France
| | - Dany Gargot
- Department of Gastroenterology, Hospital of Blois, Blois, France
| | - Cloé Charpentier
- Department of Gastroenterology, University Hospital of Rouen, Rouen, France
| | - Anthony Buisson
- Department of Gastroenterology, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Nina Dib
- Department of Gastroenterology, University Hospital of Angers, Angers, France
| | - Emmanuel Rusch
- Health Economic Evaluation Unit, University Hospital of Tours, Tours, France.,EA7505 Education, Ethics, Health Research Unit, University of Tours, Tours, France
| | - Alexandre Aubourg
- Department of Gastroenterology, University Hospital of Tours, Chambray-lès-Tours, France
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7
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Monmousseau F, Mulot L, Rusch E, Picon L, Laharie D, Fotsing G, Gargot D, Charpentier C, Buisson A, Trang-Poisson C, Dib N, DES Garets V, Brunet-Houdard S, Aubourg A. Predictors of each quality of life dimension in Crohn's disease patients initiating an anti-TNF treatment: differentiated effects of patient-, disease-, and treatment-related characteristics. Scand J Gastroenterol 2022; 57:566-573. [PMID: 35188859 DOI: 10.1080/00365521.2021.2025419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS In Crohn's disease (CD), a composite therapeutic target was recently recommended, including both objective measurement (endoscopic remission) and Patient-Reported Outcomes (resolution of abdominal pain and normalization of bowel function). All dimensions of health-related quality of life (HRQoL) are impacted: not only bowel symptoms but also systemic symptoms, emotional wellbeing and social function. Thus, understanding the predictors of each HRQoL dimension would improve patient management. However, analysis of these factors has only been found in a few publications, with some limitations. Therefore, this study aimed to explore the evolution of the HRQoL of CD patients during six months after initiation of anti-TNF and to identify its predictors. METHODS We analyzed data of 56 patients included in a multicenter prospective cohort study (COQC-PIT). HRQoL measures (using IBDQ-32) and data related to patient, disease and treatment characteristics were collected every two months. Generalized estimating equations were used. RESULTS Overall HRQoL was significantly improved 2 months after anti-TNF initiation, and then stagnated. Patient, disease, and treatment characteristics have differentiated impacts on the overall score and on each dimension of quality of life. Subcutaneous anti-TNF had no significant effect on overall HRQoL, improving only emotional function and bowel symptoms. Concomitant use of corticosteroids and/or immunomodulators impaired almost all dimensions. Having children or working altered bowel symptoms. Disease duration and active smoking negatively impact emotional function and systemic symptoms. CONCLUSIONS Each HRQoL dimension, not only bowel symptoms, and their influencing factors should therefore be considered in medical decision-making, especially in months following the initiation of a new treatment such as anti-TNF.
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Affiliation(s)
- Fanny Monmousseau
- Health-Economic Evaluation Unit, University Hospital Center of Tours, France.,EA7505 Education, Ethics, Health, University of Tours, Tours, France
| | - Lucile Mulot
- Health-Economic Evaluation Unit, University Hospital Center of Tours, France
| | - Emmanuel Rusch
- Health-Economic Evaluation Unit, University Hospital Center of Tours, France.,EA7505 Education, Ethics, Health, University of Tours, Tours, France
| | - Laurence Picon
- Gastroenterology Department, University Hospital Center of Tours, France
| | - David Laharie
- Gastroenterology Department, University Hospital Center of Bordeaux, France
| | - Ginette Fotsing
- Gastroenterology Department, University Hospital Center of Poitiers, France
| | - Dany Gargot
- Gastroenterology Department, Hospital Center of Blois, France
| | - Cloé Charpentier
- Gastroenterology Department, University Hospital Center of Rouen, France
| | - Anthony Buisson
- Gastroenterology Department, University Hospital Center of Clermont-Ferrand, France
| | | | - Nina Dib
- Gastroenterology Department, University Hospital Center of Angers, France
| | - Véronique DES Garets
- EA6296 VALLOREM, Loire Valley Management Research Unit, University of Tours, France
| | - Solène Brunet-Houdard
- Health-Economic Evaluation Unit, University Hospital Center of Tours, France.,EA7505 Education, Ethics, Health, University of Tours, Tours, France
| | - Alexandre Aubourg
- Gastroenterology Department, University Hospital Center of Tours, France
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- COQC-PIT Study Group: Dr Laura ARMENGOL DEBEIR, Dr Arnaud BOURREILLE, Juliette EVON, Margaux NISTAR, Geoffrey BERTHON
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8
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Guillo L, Delanaye P, Flamant M, Figueres L, Karam S, Lemoine S, Benezech A, Pelletier AL, Amiot A, Caron B, Stefanescu C, Boschetti G, Bouguen G, Rahier JF, Gornet JM, Hugot JP, Bonnet J, Vuitton L, Nachury M, Vidon M, Uzzan M, Serrero M, Dib N, Seksik P, Hebuterne X, Bertocchio JP, Mariat C, Peyrin-Biroulet L. Kidney function monitoring in inflammatory bowel disease: The MONITORED consensus. Dig Liver Dis 2022; 54:309-315. [PMID: 34866011 DOI: 10.1016/j.dld.2021.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Patients with inflammatory bowel diseases (IBD) are exposed to drug-related nephrotoxicity and kidney-related extra-intestinal manifestations (EIMs). Patients should be monitored but guidance is lacking in current international recommendations. The objective of the Kidney Function Monitoring in Inflammatory Bowel Disease (MONITORED) initiative was to achieve an expert consensus about monitoring kidney function in IBD. METHODS A literature review was first conducted. Then, an expert consensus meeting, involving 28 attendees representing French-speaking gastroenterologists and nephrologists, was held as part of an academic initiative on May 28, 2021. An anonymous Delphi process was used to discuss and vote on statements. Agreement was defined as at least 75% of participants voting for any one statement. RESULTS Experts reached consensus on 11 criteria for referral to the nephrologist. Concerning kidney function monitoring, participants unanimously validated the use of serum creatinine with estimation of the glomerular filtration rate via the MDRD or CKD-EPI equations. A blood ionogram and a urine sample with measurement of a protein-to-creatinine ratio were also broadly agreed validated. Experts recommended performing this monitoring at IBD diagnosis, prior introducing a new treatment, and annually for EIMs screening and evaluation of treatment tolerance. An evaluation 3 months after starting mesalamine and then every 6 months was felt necessary, while for biologics an annually monitoring was deemed sufficient. CONCLUSION The MONITORED consensus proposed guidelines on how to monitor kidney function in IBD. These recommendations should be considered in clinical practice to preserve kidney function and ensure the best approach to our patients.
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Affiliation(s)
- Lucas Guillo
- Department of Gastroenterology, University Hospital of Marseille Nord, University of Aix-Marseille, Marseille, France.
| | - Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège (ULiege), CHU Sart Tilman, Liège, Belgium; Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France
| | - Martin Flamant
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Université de Paris, CRI, INSERM F-75018, Paris, France
| | - Lucile Figueres
- Université de Nantes, Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Service de néphrologie-immunologie clinique, CHU de Nantes, France
| | - Sabine Karam
- Division of Nephrology and Hypertension, Saint-George Hospital University Medical Center, Beirut, Lebanon
| | - Sandrine Lemoine
- Service de Néphrologie, dialyse, hypertension et exploration fonctionnelle rénale, Hôpital Edouard Herriot, Lyon, France
| | - Alban Benezech
- Departement of Gastroenterology, Henri Duffaut Hospital, Avignon, France
| | | | - Aurélien Amiot
- Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, EC2M3-EA7375, University of Paris Est Créteil, Créteil, France
| | - Bénédicte Caron
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Carmen Stefanescu
- Department of Gastroenterology, IBD unit, Beaujon Hospital, APHP, Clichy, France
| | - Gilles Boschetti
- Department of Gastroenterology, Hospices Civils de Lyon, Lyon-Sud Hospital, Pierre Bénite, and INSERM U1111 - CIRI, Lyon, France
| | - Guillaume Bouguen
- Department of Gastroenterology, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | | | - Jean-Marc Gornet
- Department of Gastroenterology, Saint-Louis Hospital, APHP, Paris, France
| | - Jean-Pierre Hugot
- Department of Pediatric Gastroenterology, Hôpital Universitaire Robert Debré, Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - Joëlle Bonnet
- Department of Gastroenterology, Saint-Louis Hospital, APHP, Paris, France
| | - Lucine Vuitton
- Department of Gastroenterology, Besancon University Hospital, Besancon, France
| | - Maria Nachury
- Univ, Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Mathias Vidon
- Department of gastroenterology, CHI Créteil, Créteil, France
| | - Mathieu Uzzan
- Department of Gastroenterology, IBD unit, Beaujon Hospital, APHP, Clichy, France
| | - Mélanie Serrero
- Department of Gastroenterology, University Hospital of Marseille Nord, University of Aix-Marseille, Marseille, France
| | - Nina Dib
- Hepato-Gastroenterology Department, Angers University Hospital, Angers, France; HIFIH Laboratory, UPRES 3859, SFR 4208, Angers University, Angers, France
| | - Philippe Seksik
- Department of Gastroenterology, Centre de recherche Saint-Antoine, Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - Xavier Hebuterne
- Gastroenterology and Clinical Nutrition, CHU of Nice, University Côte d'Azur, Nice, France
| | - Jean-Philippe Bertocchio
- Nephrology Department, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Mariat
- Service de Néphrologie, Dialyse, Transplantation Rénale, Hôpital Nord, CHU de Saint-Etienne, EA 3065, Université Jean MONNET, Saint-Etienne, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
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9
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Berger A, Cesbron-Métivier E, Bertrais S, Olivier A, Becq A, Boursier J, Lannes A, Luet D, Pateu E, Dib N, Caroli-Bosc FX, Vitellius C, Calès P. A predictive score of inadequate bowel preparation based on a self-administered questionnaire: PREPA-CO. Clin Res Hepatol Gastroenterol 2021; 45:101693. [PMID: 33852957 DOI: 10.1016/j.clinre.2021.101693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/18/2021] [Accepted: 03/30/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Inadequate bowel preparation before colonoscopy has a 20-30% rate and impedes on the quality of the procedure. The aim of this study was to develop a predictive score of inadequate bowel preparation, using a patient questionnaire on potential risk factors. METHODS In this single center study, consecutive patients with colonoscopy indication were enrolled. The primary outcome was inadequate bowel preparation defined by Boston Bowel Preparation Scale (BBPS) score <7 or a score ≤1 in any of the 3 colonic segments. RESULTS A total of 561 patients were included. Inadequate bowel preparation was seen in 25.0% of cases. Seven risk factors were selected into the prediction model of inadequate bowel preparation: diabetes or obesity, irregular physical activity, cirrhosis, use of antidepressants or neuroleptics, use of opiate medication, history of surgery and history of inadequate bowel preparation. The risk score, named PREPA-CO, had an AUROC of 0.621, adequately predicted bowel cleanliness in 68.3% of cases, with a specificity of 75.8% and a negative predictive value of 80.8%. CONCLUSION We developed a predictive score named "Prepa-Co", allowing the identification of patients at high risk of inadequate bowel preparation. In clinical practice, this score could help tailor the prescription of the preparation to the patient.
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Affiliation(s)
- Arthur Berger
- Univ. Bordeaux, CHU Bordeaux, Department of Gastroenterology and Digestive Endoscopy, Bordeaux, France; Hepato-Gastroenterology Department, Angers University Hospital, Angers, France; HIFIH Laboratory, UPRES 3859, SFR 4208, Angers University, Angers, France.
| | - Elodie Cesbron-Métivier
- Hepato-Gastroenterology Department, Angers University Hospital, Angers, France; HIFIH Laboratory, UPRES 3859, SFR 4208, Angers University, Angers, France
| | - Sandrine Bertrais
- Hepato-Gastroenterology Department, Angers University Hospital, Angers, France; HIFIH Laboratory, UPRES 3859, SFR 4208, Angers University, Angers, France
| | - Anne Olivier
- Hepato-Gastroenterology Department, Angers University Hospital, Angers, France; HIFIH Laboratory, UPRES 3859, SFR 4208, Angers University, Angers, France
| | - Aymeric Becq
- Sorbonne University, Endoscopy Department, Saint Antoine Hospital, Paris, France
| | - Jèrôme Boursier
- Hepato-Gastroenterology Department, Angers University Hospital, Angers, France; HIFIH Laboratory, UPRES 3859, SFR 4208, Angers University, Angers, France
| | - Adrien Lannes
- Hepato-Gastroenterology Department, Angers University Hospital, Angers, France; HIFIH Laboratory, UPRES 3859, SFR 4208, Angers University, Angers, France
| | - Dominique Luet
- Hepato-Gastroenterology Department, Angers University Hospital, Angers, France; HIFIH Laboratory, UPRES 3859, SFR 4208, Angers University, Angers, France
| | - Etienne Pateu
- Hepato-Gastroenterology Department, Angers University Hospital, Angers, France
| | - Nina Dib
- Hepato-Gastroenterology Department, Angers University Hospital, Angers, France; HIFIH Laboratory, UPRES 3859, SFR 4208, Angers University, Angers, France
| | - François-Xavier Caroli-Bosc
- Hepato-Gastroenterology Department, Angers University Hospital, Angers, France; HIFIH Laboratory, UPRES 3859, SFR 4208, Angers University, Angers, France
| | - Carole Vitellius
- Hepato-Gastroenterology Department, Angers University Hospital, Angers, France; HIFIH Laboratory, UPRES 3859, SFR 4208, Angers University, Angers, France
| | - Paul Calès
- Hepato-Gastroenterology Department, Angers University Hospital, Angers, France; HIFIH Laboratory, UPRES 3859, SFR 4208, Angers University, Angers, France
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10
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Tadbiri S, Nachury M, Bouhnik Y, Serrero M, Hébuterne X, Roblin X, Kirchgesner J, Bouguen G, Franchimont D, Savoye G, Buisson A, Louis E, Nancey S, ABitbol V, Reimund JM, DeWit O, Vuitton L, Matthieu N, Peyrin-Biroulet L, Gilletta C, Allez M, Viennot S, Trang-Poisson C, Dib N, Brixi H, Boualit M, Plastaras L, Boivineau L, Fumery M, Caillo L, Laharie D, Amiot A. The IBD-disk Is a Reliable Tool to Assess the Daily-life Burden of Patients with Inflammatory Bowel Disease. J Crohns Colitis 2021; 15:766-773. [PMID: 33246337 DOI: 10.1093/ecco-jcc/jjaa244] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM The inflammatory bowel disease [IBD]-disk is a 10-item self-questionnaire that is used to assess IBD-related disability. The aim of the present study was to evaluate this tool in the assessment of IBD daily-life burden. METHODS A 1-week cross-sectional study was conducted in 42 centres affiliated in France and Belgium. Patients were asked to complete the IBD-disk [best score: 0, worst score: 100] and a visual analogue scale [VAS] of IBD daily-life burden [best score: 0, worst score: 10]. Analyses included internal consistency, correlation analysis, and diagnostic performance assessment. RESULTS Among the 2011 IBD outpatients who responded to the survey [67.8% of the patients had Crohn's disease], 49.9% were in clinical remission. The IBD-disk completion rate was 73.8%. The final analysis was conducted in this population [n = 1455 patients]. The mean IBD-disk score and IBD daily-life burden VAS were 39.0 ± 23.2 and 5.2 ± 2.9, respectively. The IBD-disk score was well correlated with the IBD daily-life burden VAS [r = 0.67; p <0.001]. At an optimal IBD-disk cut-off of 40, the area under the receiver operating characteristic curve [AUROC] for high IBD daily-life burden [VAS >5] was 0.81 (95% confidence interval [CI]: 0.79-0.83; p <0.001). CONCLUSIONS In a large cohort of patients, the IBD-disk score was well correlated with IBD daily-life burden, and it could be used in clinical practice.
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Affiliation(s)
- Sara Tadbiri
- Department of Gastroenterology, Henri Mondor Hospital, Paris Est-Créteil Val de Marne University, Creteil, France
| | - Maria Nachury
- Department of Gastroenterology, CHU Lille, Service des Maladies de l'appareil digestif, Lille, France
| | - Yoram Bouhnik
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Melanie Serrero
- Hôpital Nord, Centre d'investigation Clinique Marseille Nord, Université Méditerranée, Marseille, France
| | - Xavier Hébuterne
- Department of Gastroenterology and Clinical Nutrition, CHU of Nice, University Côte d'Azur, Nice, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Julien Kirchgesner
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, , UPMC Université Paris 6, Paris, France
| | - Guillaume Bouguen
- Department of Gastroenterology, CHU Rennes and University of Rennes, NUMECAN Institute, Rennes, France
| | - Denis Franchimont
- Department of Gastroenterology, Hôpital Erasme, Laboratoire de Gastroenterologie experimentale, ULB, Brussels, Belgium
| | - Guillaume Savoye
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Anthony Buisson
- Department of Hepato-Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Université d'Auvergne, Clermont-Ferrand, France
| | - Edouard Louis
- Department of Gastroenterology, Liège University Hospital, CHU Liège, Belgium
| | - Stephane Nancey
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon and INSERM U1111, University Claude Bernard Lyon 1, Lyon, France
| | - Vered ABitbol
- Department of Gastroenterology, Cochin University Hospital, Paris, France
| | - Jean-Marie Reimund
- Service d'Hépato-Gastroentérologie et d'Assistance Nutritive, Hôpitaux Universitaires de Strasbourg et INSERM U1113, Université de Strasbourg, Strasbourg, France
| | - Olivier DeWit
- Cliniques Universitaires Saint-Luc, UCL, Brussels, Belgium
| | - Lucine Vuitton
- Department of Gastroenterology, Besancon University Hospital, Besancon, France
| | - Nicolas Matthieu
- Department of Hepato-Gastroenterology and Digestive Oncology, Grenoble Alpes University Hospital, Grenoble, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Inserm U1256 NGERE, Lorraine University, Vandoeuvre-les-Nancy, France
| | - Cyrielle Gilletta
- Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
| | - Matthieu Allez
- Department of Gastroenterology, Saint-Louis University Hospital, Paris, France
| | - Stephanie Viennot
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Caroline Trang-Poisson
- CHU Nantes, Institut des Maladies de l'Appareil Digestif [IMAD], Nantes University, Nantes, France
| | - Nina Dib
- Department of HepatoGastroenterology, Angers University Hospital, Angers, France
| | - Hedia Brixi
- Department of GastroEnterology, Reims University Hospital, Rheims, France
| | - Medina Boualit
- Department of Gastroenterology, Valenciennes General Hospital, Valenciennes, France
| | | | - Lucile Boivineau
- Department of Gastroenterology, Hôpital Saint-Eloi, University Hospital of Montpellier, Montpellier, France
| | - Mathurin Fumery
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Ludovic Caillo
- Department of Gastroenterology, Nimes University Hospital, Nimes, France
| | - David Laharie
- Department of HepatoGastroenterology and Digestive Oncology, Centre Medico-chirurgical Magellan, Haut-Leveque Hospital, Université de Bordeaux, Bordeaux, France
| | - Aurelien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, Paris Est-Créteil Val de Marne University, Creteil, France
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11
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Le Berre C, Flamant M, Bouguen G, Siproudhis L, Dewitte M, Dib N, Cesbron-Metivier E, Goronflot T, Hanf M, Gourraud PA, Kerdreux E, Poinas A, Bourreille A, Trang-Poisson C. VALIDation of the IBD-Disk Instrument for Assessing Disability in Inflammatory Bowel Diseases in a French Cohort: The VALIDate Study. J Crohns Colitis 2020; 14:1512-1523. [PMID: 32417910 DOI: 10.1093/ecco-jcc/jjaa100] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel diseases [IBD] are disabling disorders. The IBD-Disability Index [IBD-DI] was developed for quantifying disability in IBD patients but is difficult to use. The IBD-Disk is a visual adaptation of the IBD-DI. It has not been validated yet. The main objectives were to validate the IBD-Disk and to assess the clinical factors associated with a change in the score and its variability over time. METHODS From May 2018 to July 2019, IBD patients from three university-affiliated hospitals responded twice to both IBD-Disk and IBD-DI at 3-12 month intervals. Validation included concurrent validity, reproducibility, and internal consistency. Mean IBD-Disk scores were compared according to clinical factors. Variability was assessed by comparing scores between baseline and follow-up visits. RESULTS A total of 447 patients [71% Crohn's disease, 28% ulcerative colitis] were included in the analysis at baseline and 265 at follow-up. There was a good correlation between IBD-Disk and IBD-DI [r = 0.75, p <0.001]. Reproducibility was excellent [intra-class correlation coefficient = 0.90], as well as internal consistency [Cronbach's α = 0.89]. The IBD-Disk was not influenced by IBD type but was associated with female gender and physician global assessment. Extra-intestinal manifestations, history of resection, elevated C-reactive protein and faecal calprotectin also tended to be associated with higher disability. The IBD-Disk score decreased in patients becoming inactive over time. CONCLUSIONS This study validated the IBD-Disk in a large cohort of IBD patients, demonstrating that it is a valid and reliable tool for quantifying disability for both CD and UC.
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Affiliation(s)
- Catherine Le Berre
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France
| | - Mathurin Flamant
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France.,Centre d'Investigation Clinique, Nantes University Hospital, Nantes, France
| | - Guillaume Bouguen
- Service des Maladies de l'Appareil Digestif, Rennes University Hospital, Rennes, France
| | - Laurent Siproudhis
- Service des Maladies de l'Appareil Digestif, Rennes University Hospital, Rennes, France
| | - Marie Dewitte
- Service des Maladies de l'Appareil Digestif, Rennes University Hospital, Rennes, France
| | - Nina Dib
- Service de Gastroentérologie, Angers University Hospital, Angers, France
| | | | - Thomas Goronflot
- Clinique des Données, Nantes University Hospital, Nantes, France
| | - Matthieu Hanf
- Clinique des Données, Nantes University Hospital, Nantes, France
| | | | - Elise Kerdreux
- Centre d'Investigation Clinique, Nantes University Hospital, Nantes, France
| | - Alexandra Poinas
- Direction de la Recherche Clinique, Nantes University Hospital, Nantes, France
| | - Arnaud Bourreille
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France.,Centre d'Investigation Clinique, Nantes University Hospital, Nantes, France
| | - Caroline Trang-Poisson
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France.,Centre d'Investigation Clinique, Nantes University Hospital, Nantes, France
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12
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Chapuis-Biron C, Kirchgesner J, Pariente B, Bouhnik Y, Amiot A, Viennot S, Serrero M, Fumery M, Allez M, Siproudhis L, Buisson A, Pineton de Chambrun G, Abitbol V, Nancey S, Caillo L, Plastaras L, Savoye G, Chanteloup E, Simon M, Dib N, Rajca S, Amil M, Parmentier AL, Peyrin-Biroulet L, Vuitton L. Ustekinumab for Perianal Crohn's Disease: The BioLAP Multicenter Study From the GETAID. Am J Gastroenterol 2020; 115:1812-1820. [PMID: 33156100 DOI: 10.14309/ajg.0000000000000810] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION New therapeutic options for patients with Crohn's disease (CD) with perianal lesions failing anti-tumor necrosis factor (TNF) agents are needed. We aimed to assess the effectiveness of ustekinumab in perianal CD (pCD) and predictors of clinical success in a real-life multicenter cohort. METHODS We conducted a national multicenter retrospective cohort study in patients with either active or inactive pCD who received ustekinumab. In patients with active pCD at treatment initiation, the success of ustekinumab was defined by clinical success at 6 months assessed by the physician's judgment without additional medical or surgical treatment for pCD. Univariate and multivariable logistic regression analyses were performed to identify predictors of success. In patients with inactive pCD at ustekinumab initiation, the pCD recurrence-free survival was calculated using the Kaplan-Meier method. RESULTS Two hundred seven patients were included, the mean age was 37.7 years, the mean duration of CD was 14.3 years, and the mean number of prior perianal surgeries was 2.8. Two hundred five (99%) patients had previously been exposed to at least 1 anti-TNF and 58 (28%) to vedolizumab. The median follow-up time was 48 weeks; 56/207 (27%) patients discontinued therapy after a median time of 43 weeks. In patients with active pCD, success was reached in 57/148 (38.5%) patients. Among patients with setons at initiation, 29/88 (33%) had a successful removal. The absence of optimization was associated with treatment success (P = 0.044, odds ratio 2.74; 95% confidence interval: 0.96-7.82). In multivariable analysis, the number of prior anti-TNF agents (≥3) was borderline significant (P = 0.056, odds ratio 0.4; 95% confidence interval: 0.15-1.08). In patients with inactive pCD at initiation, the probability of recurrence-free survival was 86.2% and 75.1% at weeks 26 and 52, respectively. DISCUSSION Ustekinumab appears as a potential effective therapeutic option in perianal refractory CD. Further prospective studies are warranted.
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Affiliation(s)
- Constance Chapuis-Biron
- Department of Gastroenterology, University Hospital of Besançon, University Bourgogne Franche-Comté, Besançon, France
| | - Julien Kirchgesner
- Department of Gastroenterology, Saint-Antoine Hospital, Assitance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Benjamin Pariente
- Department of Hepatogastroenterology, University Hospital of Lille, Lille, France
| | - Yoram Bouhnik
- Department of Gastroenterology, AP-HP, Hôpital Beaujon, Paris, France
| | - Aurélien Amiot
- Department of Gastroenterology, AP-HP, Hôpital Henri-Mondor, Paris, France
| | - Stéphanie Viennot
- Department of Hepatogastroenterology, University Hospital of Caen, Caen, France
| | - Mélanie Serrero
- Department of Gastroenterology, AP-HM, Hôpital Nord, Marseille, France
| | - Mathurin Fumery
- Department of Hepatogastroenterology, Peritox, University Hospital of Amiens, Amiens, France
| | - Matthieu Allez
- Department of Gastroenterology, AP-HP, Hôpital Saint Louis, Paris, France
| | - Laurent Siproudhis
- Department of Hepatogastroenterology, CHU Pontchaillou, University Hospital of Rennes, Rennes, France
| | - Anthony Buisson
- Department of Hepatogastroenterology, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Vered Abitbol
- Department of Gastroenterology, AP-HP, Hôpital Cochin, Paris, France
| | - Stéphane Nancey
- Department of Gastroenterology, Hospices Civils de Lyon, Lyon Sud Hospital, Lyon, France
| | - Ludovic Caillo
- Department of Hepatogastroenterology, University Hospital of Nimes, Nimes, France
| | | | - Guillaume Savoye
- Department of Hepatogastroenterology, University Hospital of Rouen
| | - Elise Chanteloup
- Department of Gastroenterology, Hôpital Paris Saint Joseph, Paris, France
| | - Marion Simon
- Department of Gastroenterology, Institut Mutualiste Montsouris, Paris, France
| | - Nina Dib
- Department of Hepatogastroenterology, University Hospital of Angers, Angers, France
| | - Sylvie Rajca
- Department of Gastroenterology, AP-HP, Hôpital Louis-Mourier, Paris, France
| | - Morgane Amil
- Department of Hepatogastroenterology, Centre hospitalier La Roche-sur-Yon, La Roche-sur-Yon, France
| | | | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Inserm U954, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Lucine Vuitton
- Department of Gastroenterology, University Hospital of Besançon, University Bourgogne Franche-Comté, Besançon, France
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13
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Martin A, Nachury M, Peyrin-Biroulet L, Bouhnik Y, Nancey S, Bourrier A, Serrero M, Fumery M, Buisson A, Laharie D, Gilletta C, Filippi J, Allez M, Bouguen G, Roblin X, Altwegg R, Dib N, Pineton de Chambrun G, Savoye G, Carbonnel F, Viennot S, Amiot A, Martin A, Gagnière C, Nachury M, Pariente B, Wils P, Peyrin-Biroulet L, Zallot C, Bouhnik Y, Treton X, Stefanescu C, Nancey S, Boschetti G, Seksik P, Beaugerie L, Kirchgesner J, Bourrier A, Sokol H, Serrero M, Fumery M, Yzet C, Brazier F, Laharie D, Rivière P, Poullenot F, Buisson A, Gilletta C, Filippi J, Hebuterne X, Allez M, Gornet JM, Bouguen G, Siproudhis L, Roblin X, Altwegg R, Pineton de Chambrun G, Dib N, Savoye G, Carbonnel F, Meyer A, Viennot S, Lebaut G. Maintenance of Remission Among Patients With Inflammatory Bowel Disease After Vedolizumab Discontinuation: A Multicentre Cohort Study. J Crohns Colitis 2020; 14:896-903. [PMID: 31930285 DOI: 10.1093/ecco-jcc/jjaa005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM It is unclear whether vedolizumab therapy can be discontinued in patients with inflammatory bowel disease [IBD] after achieving steroid-free clinical remission. The aim was to assess the risk of relapse after vedolizumab therapy was discontinued. METHODS This was a retrospective observational study, collecting data from 21 tertiary centres affiliated with the GETAID from January 2017 to April 2019. Consecutive patients with IBD, who were in steroid-free clinical remission for at least 3 months and were treated with vedolizumab for at least 6 months, were included at the time of vedolizumab discontinuation. RESULTS A total of 95 patients [58 with Crohn's disease] discontinued vedolizumab after a median duration of therapy of 17.5 [10.6-25.4] months. After a median follow-up period of 11.2 [5.8-17.7] months, 61 [64%] patients experienced disease relapse. The probabilities of relapse-free survival were 83%, 59%, and 36% at 6, 12, and 18 months, respectively. According to the multivariate analysis, a C-reactive protein level less than 5 mg/L at vedolizumab discontinuation (hazard ratio [HR] = 0.56, 95% confidence interval [CI] [0.33-0.95], p = 0.03) and discontinuation due to patients' elective choice (HR = 0.41, 95% CI [0.21-0.80], p = 0.009) were significantly associated with a lower risk of relapse. Re-treatment with vedolizumab was noted in 24 patients and provided steroid-free clinical remission in 71% and 62.5% at Week 14 and after a median follow-up of 11.0 [5.4-13.3] months, respectively, without any infusion reactions. CONCLUSIONS In this retrospective study, two-thirds of patients with IBD treated with vedolizumab experienced relapse within the first year after vedolizumab discontinuation. Re-treatment with vedolizumab was effective in two-thirds of patients.
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Affiliation(s)
- Antoine Martin
- Department of Gastroenterology, Henri Mondor Hospital, Paris Est-Créteil Val de Marne University, Creteil, France
| | - Maria Nachury
- Department of Gastroenterology, Huriez Hospital, Université of Lille, Lille, France
| | | | - Yoram Bouhnik
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Stephane Nancey
- Department of Gastroenterology, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Pierre-Benite, France
| | - Anne Bourrier
- Department of Gastroenterology, Sorbonne Univeristé, Centre de Recherche Saint-Antoine, Paris, France
| | - Melanie Serrero
- Hôpital Nord, Centre d'investigation clinique Marseille Nord, Université Méditerranée, Marseille, France
| | - Mathurin Fumery
- Department of Gastroenterology, Peritox UMRI-01, Amiens University Hospital, Amiens, France
| | - Anthony Buisson
- Department of Hepato-Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Université d'Auvergne, Clermont-Ferrand, France
| | - David Laharie
- Department of Hepato-Gastroenterology, University Hospital of Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
| | - Cyrielle Gilletta
- Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
| | - Jerome Filippi
- Department of Gastroenterology and Clinical Nutrition, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France
| | - Matthieu Allez
- Department of Gastroenterology, Saint-Louis University Hospital, Paris, France
| | - Guillaume Bouguen
- Department of Gastroenterology, CHU Rennes and University of Rennes, NUMECAN Institute, Rennes, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Romain Altwegg
- Department of Gastroenterology, Hôpital Saint-Eloi, University Hospital of Montpellier, Montpellier, France
| | - Nina Dib
- Department of HepatoGastroenterology, Angers University Hospital, Angers, France
| | | | - Guillaume Savoye
- Department of Gastroenterology, Bicetre University Hospital, Université Paris Sud, le Kremlin Bicêtre, Paris, France
| | - Franck Carbonnel
- Department of Gastroenterology, Bicetre University Hospital, Université Paris Sud, le Kremlin Bicêtre, Paris, France
| | - Stephanie Viennot
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Aurelien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, Paris Est-Créteil Val de Marne University, Creteil, France
| | | | - Antoine Martin
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-EA7375, Paris Est-Créteil Val de Marne University, Creteil, France
| | - Charlotte Gagnière
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-EA7375, Paris Est-Créteil Val de Marne University, Creteil, France
| | - Maria Nachury
- Department of Gastroenterology, Huriez Hospital, Université of Lille, Lille, France
| | - Benjamin Pariente
- Department of Gastroenterology, Huriez Hospital, Université of Lille, Lille, France
| | - Pauline Wils
- Department of Gastroenterology, Huriez Hospital, Université of Lille, Lille, France
| | | | - Camille Zallot
- INSERM U954 and Department of Gastroenterology, Université de Lorraine, Nancy, France
| | - Yoram Bouhnik
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Xavier Treton
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Carmen Stefanescu
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Stephane Nancey
- Department of Gastroenterology, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Pierre-Benite, France
| | - Gilles Boschetti
- Department of Gastroenterology, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Pierre-Benite, France
| | - Philippe Seksik
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, F-75012, ERL 1057 INSERM/UMRS 7203, UPMC Université Paris 6, Paris, France
| | - Laurent Beaugerie
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, F-75012, ERL 1057 INSERM/UMRS 7203, UPMC Université Paris 6, Paris, France
| | - Julien Kirchgesner
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, F-75012, ERL 1057 INSERM/UMRS 7203, UPMC Université Paris 6, Paris, France
| | - Anne Bourrier
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, F-75012, ERL 1057 INSERM/UMRS 7203, UPMC Université Paris 6, Paris, France
| | - Harry Sokol
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, F-75012, ERL 1057 INSERM/UMRS 7203, UPMC Université Paris 6, Paris, France
| | - Melanie Serrero
- Hôpital Nord, Centre d’investigation clinique Marseille Nord, Université Méditerranée, Marseille, France
| | - Mathurin Fumery
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Clara Yzet
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Franck Brazier
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - David Laharie
- Department of Hepato-Gastroenterology, University Hospital of Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
| | - Pauline Rivière
- Department of Hepato-Gastroenterology, University Hospital of Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
| | - Florian Poullenot
- Department of Hepato-Gastroenterology, University Hospital of Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
| | - Anthony Buisson
- Department of Gastroenterology, University of Clermont Ferrand, Clermont-Ferrand, France
| | - Cyrielle Gilletta
- Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
| | - Jérôme Filippi
- Department of Gastroenterology and Clinical Nutrition, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France
| | - Xavier Hebuterne
- Department of Gastroenterology and Clinical Nutrition, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France
| | - Matthieu Allez
- Department of Gastroenterology, Saint-Louis University Hospital, Paris, France
| | - Jean-Marc Gornet
- Department of Gastroenterology, Saint-Louis University Hospital, Paris, France
| | - Guillaume Bouguen
- Department of Gastroenterology, Pontchaillou Hospital and Rennes University, Rennes, France
| | - Laurent Siproudhis
- Department of Gastroenterology, Pontchaillou Hospital and Rennes University, Rennes, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Romain Altwegg
- Department of Gastroenterology, Hôpital Saint-Eloi, University Hospital of Montpellier, Montpellier, France
| | | | - Nina Dib
- Department of Gastroenterology, Angers University Hospital, Angers, France
| | - Guillaume Savoye
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Franck Carbonnel
- Department of Gastroenterology, Bicetre University Hospital, Le Kremlin-Bicetre, France
| | - Antoine Meyer
- Department of Gastroenterology, Bicetre University Hospital, Le Kremlin-Bicetre, France
| | - Stephanie Viennot
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Guillaume Lebaut
- Department of Gastroenterology, Caen University Hospital, Caen, France
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14
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Le Berre C, Bourreille A, Flamant M, Bouguen G, Siproudhis L, Dewitte M, Dib N, Cesbron-Metivier E, Goronflot T, Hanf M, Gourraud PA, Kerdreux E, Poinas A, Trang-Poisson C. Protocol of a multicentric prospective cohort study for the VALIDation of the IBD-disk instrument for assessing disability in inflammatory bowel diseases: the VALIDate study. BMC Gastroenterol 2020; 20:110. [PMID: 32299390 PMCID: PMC7164208 DOI: 10.1186/s12876-020-01246-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 03/27/2020] [Indexed: 12/22/2022] Open
Abstract
Background Inflammatory Bowel Diseases (IBD) affect psychological, family, social and professional dimensions of patients’ life, leading to disability which is essential to quantify as part of Patient-Reported Outcomes (PROs) newly included in the targets to reach in IBD patients. Up to now, the IBD-Disability Index (IBD-DI) was the only validated tool to assess disability, but it is not appropriate for use in clinical practice. The IBD Disk was developed, a shortened and self-administered tool, adapted from the IBD-DI, in order to give immediate representation of patient-reported disability. However, the IBD Disk has not been validated yet in clinical practice. The aims of the VALIDate study are to validate this tool in a large population of IBD patients and to compare it to the already validated IBD-DI. Methods The VALIDate study is an ongoing multicentric prospective cohort study launched in April 2018 in 3 French University Hospitals (Nantes, Rennes, Angers), with an objective to reach a sample of 400 patients over a period inclusion of 6 months. Each patient will fill in the two questionnaires IBD Disk and IBD-DI at baseline, then between 3 and 12 months later, during a follow-up visit. Clinical and socio-demographic data will also be collected. During these two consultations, gastroenterologists and patients will evaluate disease activity thanks to a semi-quantitative 4-grade scale, named respectively PGA (Physician Global Assessment) and PtGA (Patient Global Assessment). This cohort will allow to evaluate the validity of the IBD Disk with respect to the IBD-DI in order to generalize its use for clinical practice. Other psychometric criteria of the IBD Disk will also be analysed as its reliability or its discriminant capacity. Close attention will nonetheless be needed to minimize the number of lost to follow-up patients between baseline and follow-up. Discussion The VALIDate study is the study designed to validate the IBD Disk, a visual tool easily useable in daily practice to assess disability in IBD patients. The results of this trial should enable the diffusion of this tool. Trial registration The trial is registered in ClinicalTrials.Gov with registration number NCT03590639. First posted: July 18, 2018.
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Affiliation(s)
- C Le Berre
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France.
| | - A Bourreille
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France
| | - M Flamant
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France
| | - G Bouguen
- Service des Maladies de l'Appareil Digestif, Rennes University Hospital, Rennes, France
| | - L Siproudhis
- Service des Maladies de l'Appareil Digestif, Rennes University Hospital, Rennes, France
| | - M Dewitte
- Service des Maladies de l'Appareil Digestif, Rennes University Hospital, Rennes, France
| | - N Dib
- Service de Gastroentérologie, Angers University Hospital, Angers, France
| | - E Cesbron-Metivier
- Service de Gastroentérologie, Angers University Hospital, Angers, France
| | - T Goronflot
- Clinique des Données, Nantes University Hospital, Nantes, France
| | - M Hanf
- Clinique des Données, Nantes University Hospital, Nantes, France
| | - P-A Gourraud
- Clinique des Données, Nantes University Hospital, Nantes, France
| | - E Kerdreux
- Centre d'Investigation Clinique, Nantes University Hospital, Nantes, France
| | - A Poinas
- Direction de la Recherche Clinique, Nantes University Hospital, Nantes, France
| | - C Trang-Poisson
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France
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15
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Chapuis-Biron C, Bourrier A, Nachury M, Nancey S, Bouhnik Y, Serrero M, Armengol-Debeir L, Buisson A, Tran-Minh ML, Zallot C, Fumery M, Bouguen G, Abitbol V, Viennot S, Chanteloup E, Rajca S, Dib N, Parmentier AL, Peyrin-Biroulet L, Vuitton L. Vedolizumab for perianal Crohn's disease: a multicentre cohort study in 151 patients. Aliment Pharmacol Ther 2020; 51:719-727. [PMID: 32080886 DOI: 10.1111/apt.15665] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/05/2019] [Accepted: 01/30/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The management of Crohn's disease patients with perianal lesions and anti-TNF failure is challenging. AIMS To assess the effectiveness of vedolizumab in perianal Crohn's disease and the predictors of success in a real-life cohort. METHODS We conducted a nationwide multicentre cohort study in patients with perianal Crohn's disease who received vedolizumab. In patients with active perianal Crohn's disease, the success of vedolizumab was defined by clinical success (no draining fistula at clinical examination and no anal ulcers for primary lesions) at 6 months without medical or surgical treatment for perianal Crohn's disease. Logistic regression analyses were performed to identify predictors of success. In patients with inactive perianal Crohn's disease, recurrence was defined by the occurrence of lesions and/or the need for medical or surgical treatments. RESULTS One hundred and fifty-one patients were included. Among them 102 patients had active perianal disease, 33 (32.4%) males, mean age 39.8 years, mean Crohn's disease duration 14.6 years; 101 (99%) had received at least one anti-TNF. The median follow-up time was 52 weeks. Sixty-eight per cent of patients discontinued therapy after a median time of 33 weeks. Vedolizumab success was reached in 23/102 (22.5%). Among patients with setons at initiation, 9/61(15%) had a successful removal. In multivariable analysis, factors associated with success were the number of prior biologic agents (≥3, odds ratio, OR: 0.20, 95% CI 0.04-0.98) and no antibiotics at initiation (OR: 4.76, 95% CI 1.25-18.19). In 49 patients with inactive perianal Crohn's disease, perianal disease recurred in 15/49 (30.6%), 11/49 (22.4%) needed dedicated treatments. Median time to recurrence was 22 weeks. CONCLUSIONS We identified a low rate of success of vedolizumab in patients with active perianal Crohn's disease, and nearly one third of patients with inactive perianal Crohn's disease had perianal recurrence. Further evaluation is warranted in prospective studies.
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Lair-Mehiri L, Stefanescu C, Vaysse T, Laharie D, Roblin X, Rosa I, Treton X, Abitbol V, Amiot A, Bouguen G, Dib N, Fumery M, Pariente B, Carbonnel F, Peyrin-Biroulet L, Simon M, Viennot S, Bouhnik Y. Real-world evidence of tofacitinib effectiveness and safety in patients with refractory ulcerative colitis. Dig Liver Dis 2020; 52:268-273. [PMID: 31732444 DOI: 10.1016/j.dld.2019.10.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Phase III trials demonstrated effectiveness of tofacitinib, an oral Janus kinase inhibitor, to induce and maintain remission in patients with moderate-to-severe active ulcerative colitis (UC). AIMS We report the real-world effectiveness and safety of tofacitinib in patients with UC in France. METHODS From February 2017 to December 2018, we performed a national French cohort study, which included all consecutive patients with an active UC refractory to anti-TNF and vedolizumab, who received tofacitinib. Outcomes were survival without colectomy, survival without tofacitinib discontinuation and steroid-free clinical remission at weeks 14, 24 and 48. RESULTS Thirty-eight patients were included, with a median follow-up of 41.5 (18.5-56.8) weeks. Survival without colectomy was 77% [95% confidence interval (95%CI): 59.3-87.9] at week 24 and 70% (95%CI: 50.9-82.8) at week 48. Survival without treatment discontinuation was 70% (95%CI: 52.6-82.3) at week 24. Steroid-free clinical remission was observed in 13 (34%) patients at week 48. Adverse events occurred in 14 (37%) patients, including 6 severe adverse events and three herpes zoster infections. CONCLUSION In a highly refractory UC population, one third of patients treated with tofacitinib achieved steroid-free clinical remission at week 14 and 70% of patients avoided colectomy at one year, with an acceptable safety profile. These data confirm tofacitinib effectiveness in UC, especially after multiple biologic failures.
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Affiliation(s)
- Loriane Lair-Mehiri
- AP-HP, Hôpital Beaujon, Service de gastro-entérologie-MICI, Inserm et Université Paris Diderot, Clichy, France
| | - Carmen Stefanescu
- AP-HP, Hôpital Beaujon, Service de gastro-entérologie-MICI, Inserm et Université Paris Diderot, Clichy, France
| | - Thibaut Vaysse
- AP-HP, Hôpital du Kremlin-Bicêtre, Service de gastro-entérologie, Université Paris Sud, France
| | - David Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'hépato-gastro-entérologie, Univ. Bordeaux, Pessac, France
| | - Xavier Roblin
- CHU de Saint-Etienne, Hôpital Bellevue, Saint-Etienne Cedex 2, France
| | - Isabelle Rosa
- Centre Hospitalier Intercommunal de Créteil, Service de gastro-entérologie, Créteil, France
| | - Xavier Treton
- AP-HP, Hôpital Beaujon, Service de gastro-entérologie-MICI, Inserm et Université Paris Diderot, Clichy, France
| | - Vered Abitbol
- AP-HP, Hôpital Cochin, Service de gastro-entérologie, Paris, France
| | - Aurélien Amiot
- AP-HP, Hôpital Henri Mondor, Service de gastro-entérologie, Université Paris Est-Créteil, Créteil, France
| | - Guillaume Bouguen
- CHU de Rennes, Hôpital Pontchaillou, Service d'hépato-gastro-entérologie, Rennes, France
| | - Nina Dib
- CHU d'Angers, Service d'hépato-gastro-entérologie, Angers, France
| | - Mathurin Fumery
- CHU Amiens-Picardie, Service d'hépato-gastro-entérologie-Rond point du Pr Cabrol et Peritox, UFR Médecine, Amiens, France
| | - Benjamin Pariente
- CHRU de Lille, Hôpital Claude Huriez, Service des maladies de l'appareil digestif, Lille Cedex, France
| | - Franck Carbonnel
- AP-HP, Hôpital du Kremlin-Bicêtre, Service de gastro-entérologie, Université Paris Sud, France
| | | | - Marion Simon
- Institut Mutualiste Montsouris, Service d'hépato-gastro-entérologie, Paris, France
| | - Stéphanie Viennot
- CHU de Caen Normandie, Hôpital Clemenceau, Service d'hépato-gastro-entérologie, Caen, France
| | - Yoram Bouhnik
- AP-HP, Hôpital Beaujon, Service de gastro-entérologie-MICI, Inserm et Université Paris Diderot, Clichy, France.
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Maritano J, Vergara M, Dib N, Preuss W, Naranjo R, Hernández P, Deramond J, Corona G, Gutiérrez P. Management of patients treated with platelet antiagregant or oral anticoagulants drugs intervened with local anesthesia in dentoalveolar surgery. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Maritano J, Vergara M, Dib N, Preuss W, Naranjo R, Hernández P, Deramond J, Briones R, Corona G, Gutiérrez P. Hyperbaric oxygen therapy as coadjuvant treatment in patients with BONJ. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ghelani R, Maclean E, Adra M, Anderson S, Arora A, Aylward C, Bindra H, Carter C, Denning M, Dib N, Egan S, Ganis L, Illing H, Kerwat DR, Knight M, Maden S, Murphy M, Myers S, Mootein G, Penicott H, Rooney MC, Seehra H, Shams F, Yauwan D, Yogarajah R, Zhu H. Identifying avoidable switchboard delays in England's NHS hospitals: phase one of the national SWITCH project. Acute Med 2019; 18:210-215. [PMID: 31912051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Inter-hospital communication frequently requires mediation via a switchboard. Identifying and eliminating switchboard inefficiencies may improve patient care. METHODS All 175 acute hospital switchboards in England were contacted six times. Call contents and duration were recorded. No clinician calls or bleeps were connected. RESULTS The mean delay before contacting a switchboard operative was 55±46 seconds. 115 hospitals (66%) used automated switchboards; 34 of these (30%) had infection control messages. Robot operators introduced an additional 40 second delay versus humans (mean 70.3±28 versus 29.8±23 seconds, p<0.0001). Multivariate analysis identified robot operators (HR 5.1, p<0.0001) and infection control messages (HR 2.9, p=0.003) as predictors of delays over 60 seconds. CONCLUSIONS There are significant avoidable delays in contacting switchboard operatives across England. Quality improvement is underway.
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Affiliation(s)
- R Ghelani
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
| | - E Maclean
- William Harvey Research Institute, Queen Mary University of London, Mile End Road, Bethnal Green, London, E1 4NS
| | - M Adra
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
| | - S Anderson
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
| | - A Arora
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
| | - C Aylward
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
| | - H Bindra
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
| | - C Carter
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
| | - M Denning
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
| | - N Dib
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
| | - S Egan
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
| | - L Ganis
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
| | - H Illing
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
| | - D R Kerwat
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
| | - M Knight
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
| | - S Maden
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
| | - M Murphy
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
| | - S Myers
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
| | - G Mootein
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
| | - H Penicott
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
| | - M C Rooney
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
| | - H Seehra
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
| | - F Shams
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
| | - D Yauwan
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
| | - R Yogarajah
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
| | - H Zhu
- The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR
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20
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Rudler M, Bureau C, Carbonell N, Mathurin P, Saliba F, Mallat A, Massard J, Golmard JL, Bernard-Chabert B, Dib N, Thabut D. Recalibrated MELD and hepatic encephalopathy are prognostic factors in cirrhotic patients with acute variceal bleeding. Liver Int 2018; 38:469-476. [PMID: 29164762 DOI: 10.1111/liv.13632] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 11/02/2017] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Early TIPS placement must be considered in patients with Child-Pugh B and active bleeding at endoscopy or in patients with Child-Pugh C 10-13 and variceal bleeding. However, active bleeding at endoscopy is a subjective criterion. Moreover, a previous study has shown that a MELD-based score accurately predicted 6-week mortality and helped to stratify patients. Using a prospective series of patients included in a multicentre study before the era of early TIPS, we aimed (i) to identify factors associated with 6-week mortality, focusing on the prognostic value of active bleeding; and (ii) to assess whether a recalibrated MELD-based score accurately predicted 6-week mortality. METHODS Ancillary study of the prospective multicentre Baveno IV study, including patients with acute variceal bleeding. RESULTS Two hundred and nineteen patients were analysed (Child-Pugh A/B/C = 18/45/37%). The overall actuarial likelihood of survival on day 42 was 84%. The variability for the diagnosis of active bleeding at endoscopy was high (range, 41.4% to 84.6% among the centres). Active bleeding at endoscopy was not associated with 6-week mortality in the entire population or in Child-Pugh B patients. In a multivariate analysis, independent factors associated with mortality were liver function, infection, HE and HCC. The recalibrated MELD-based score was accurate in predicting 6-week mortality (AUROC = 0.787). The recalibrated MELD-based score demonstrated better performance compared to the MELD score. CONCLUSION The recalibrated MELD-based score accurately predicted mortality in our prospective cohort. Active bleeding at endoscopy had no prognostic value in cirrhotic patients presenting with acute variceal bleeding. Standardizing active bleeding assessment at endoscopy is warranted.
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Affiliation(s)
- Marika Rudler
- AP-HP, UPMC, Department of Hepatogastroenterology, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie University, Paris, France
| | - Christophe Bureau
- Service d'Hépato-Gastroentérologie, CHU de Toulouse, Toulouse, France
| | - Nicolas Carbonell
- Service d'Hépatologie, APHP, UPMC, Hôpital Saint-Antoine, Paris, France
| | - Philippe Mathurin
- Service des Maladies de l'Appareil digestif, Hôpital Huriez, Lille, France
| | - Faouzi Saliba
- Service d'Hépatologie, Hôpital Paul-Brousse, APHP, Paris, France
| | - Arianne Mallat
- Service d'Hépatologie, APHP, Hôpital Henri Mondor, Créteil, France
| | - Julien Massard
- AP-HP, UPMC, Department of Hepatogastroenterology, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie University, Paris, France
| | - Jean-Louis Golmard
- Service de Biostastiques, APHP, UPMC, Hôpital de la Pitié-Salpétrière, Paris, France
| | | | - Nina Dib
- Service d'Hépato-Gastroentérologie, CHU d'Angers, Angers, France
| | - Dominique Thabut
- AP-HP, UPMC, Department of Hepatogastroenterology, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie University, Paris, France
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21
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Brochard C, Ducancelle A, Pivert A, Bodin M, Ricard A, Coron E, Couffon C, Dib N, Luet D, Musquer N, Rhun ML, Bertrais S, Michalak S, Lunel-Fabiani F, Cesbron-Metivier E, Caroli-Bosc FX. Human papillomavirus does not play a role in the Barrett esophagus: a French cohort. Dis Esophagus 2017; 30:1-7. [PMID: 28881904 DOI: 10.1093/dote/dox088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/07/2017] [Indexed: 12/11/2022]
Abstract
The role of human papillomavirus (HPV) in Barrett's esophagus (BE) has been examined but remains unclear. The purpose of the study is to dispute the connection between HPV and BE in a prospective case-control study. Biopsies were performed above and inside the Barrett's segment for BE patients and in the distal third of the esophagus for control patients for histological interpretation and for virological analysis. Biopsies for virological analysis were placed in a virus transport medium and immediately frozen in liquid nitrogen. Virological analysis involved real-time PCR using the SyBr® green protocol with modified SPF10 general primers. A total of 180 patients (119 control and 61 BE, respectively) were included. In BE patients, 31, 18, and 12 patients had, respectively, no dysplasia, low-grade dysplasia, and high grade dysplasia. Overall, nine were found to be HPV positive: five were control patients and four BE patients. HPV positive status was not associated with BE. No factors were associated with HPV, in particular the degree of BE dysplasia. HPV infection appears unlikely to be significant in the etiology of BE compared with control patients. (ClinicalTrials.gov, Number NCT02549053).
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Affiliation(s)
- C Brochard
- Gastroenterology and Hepatology Department, University Hospital.,INSERM U991, Rennes.,INSERM U913.,Gastroenterology and Hepatology Department
| | | | | | | | - A Ricard
- Gastroenterology and Hepatology Department
| | - E Coron
- INSERM U913.,Gastroenterology, Hepatology and Nutritional Support, University Hospital, Nantes
| | - C Couffon
- Gastroenterology and Hepatology Department
| | - N Dib
- Gastroenterology and Hepatology Department
| | - D Luet
- Gastroenterology and Hepatology Department
| | - N Musquer
- Gastroenterology, Hepatology and Nutritional Support, University Hospital, Nantes
| | - M Le Rhun
- Gastroenterology, Hepatology and Nutritional Support, University Hospital, Nantes
| | - S Bertrais
- HIFIH Laboratory, UPRES 3859, SFR 4208, LUNAM University, Angers, France
| | - S Michalak
- HIFIH Laboratory, UPRES 3859, SFR 4208, LUNAM University, Angers, France.,Pathology Department, University Hospital
| | - F Lunel-Fabiani
- Virology Department.,HIFIH Laboratory, UPRES 3859, SFR 4208, LUNAM University, Angers, France
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22
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Abitbol Y, Laharie D, Cosnes J, Allez M, Nancey S, Amiot A, Aubourg A, Fumery M, Altwegg R, Michetti P, Chanteloup E, Seksik P, Baudry C, Flamant M, Bouguen G, Stefanescu C, Bourrier A, Bommelaer G, Dib N, Bigard MA, Viennot S, Hébuterne X, Gornet JM, Marteau P, Bouhnik Y, Abitbol V, Nahon S. Negative Screening Does Not Rule Out the Risk of Tuberculosis in Patients with Inflammatory Bowel Disease Undergoing Anti-TNF Treatment: A Descriptive Study on the GETAID Cohort. J Crohns Colitis 2016; 10:1179-85. [PMID: 27402916 DOI: 10.1093/ecco-jcc/jjw129] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/26/2016] [Indexed: 12/13/2022]
Abstract
AIM to describe the characteristics of incident cases of tuberculosis [TB] despite negative TB screening tests, in patients with inflammatory bowel disease [IBD] undergoing anti-TNF treatment, and to identify the risk factors involved. METHODS A retrospective descriptive study was conducted at GETAID centers on all IBD patients undergoing anti-TNF treatment who developed TB even though their initial screening test results were negative. The following data were collected using a standardized anonymous questionnaire: IBD, and TB characteristics and evolution, initial screening methods and results, and time before anti-TNF treatment was restarted. RESULTS A total of 44 IBD patients [including 23 men; median age 37 years] were identified at 20 French and Swiss centers at which TB screening was performed [before starting anti-TNF treatment] based on Tuberculin Skin Tests [n = 25], Interferon Gamma Release Assays [n = 12], or both [n = 7]. The median interval from the start of anti-TNF treatment to TB diagnosis was 14.5 months (interquartile range [IQR] 25-75: 4.9-43.3). Pulmonary TB involvement was observed in 25 [57%] patients, and 40 [91%] had at least one extrapulmonary location. One TB patient died as the result of cardiac tamponade. Mycobacterium tuberculosis exposure was thought to be a possible cause of TB in 14 cases [32%]: 7 patients [including 6 health care workers] were exposed to occupational risks, and 7 had travelled to endemic countries. Biotherapy was restarted on 27 patients after a median period of 11.2 months [IQR 25-75: 4.4-15.2] after TB diagnosis without any recurrence of the infection. CONCLUSION Tuberculosis can occur in IBD patients undergoing anti-TNF treatment, even if their initial screening results were negative. In the present population, TB was mostly extrapulmonary and disseminated. TB screening tests should be repeated on people exposed to occupational risks and/or travelers to endemic countries. Restarting anti-TNF treatment seems to be safe.
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Affiliation(s)
- Yael Abitbol
- Departement of Hepato-Gastroenterology, Centre Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France
| | - David Laharie
- Department of Hepato-Gastroenterology, Hôpital Haut-Lévêque, Pessac, France
| | - Jacques Cosnes
- Department of Hepato-Gastroenterology, Hôpital Saint Antoine, Paris, France
| | - Matthieu Allez
- Department of Hepato-Gastroenterology, Hôpital Saint Louis, France
| | - Stéphane Nancey
- Department of Hepato-Gastroenterology Hôpital Lyon-Sud, Hospices Civils de Lyon, Lyon, France
| | - Aurélien Amiot
- Department of Hepato-Gastroenterology, Hôpital Mondor, Créteil, France
| | - Alexandre Aubourg
- Department of Hepato-Gastroenterology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Mathurin Fumery
- Department of Hepato-Gastroenterology, Hôpital Nord, Amiens, France
| | - Romain Altwegg
- Department of Hepato-Gastroenterology, Hôpital Saint-Eloi, Montpellier, France
| | - Pierre Michetti
- Department of Hepato-Gastroenterology, Hôpital La Source-Beaulieu, Lausanne, Suisse
| | - Elise Chanteloup
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, Paris, France
| | - Philippe Seksik
- Department of Hepato-Gastroenterology, Hôpital Saint Antoine, Paris, France
| | - Clotilde Baudry
- Department of Hepato-Gastroenterology, Hôpital Saint Louis, France
| | - Mathurin Flamant
- Department of Hepato-Gastroenterology, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Guillaume Bouguen
- Department of Hepato-Gastroenterology, Hôpital Pontchaillou, Rennes, France
| | - Carmen Stefanescu
- Department of Hepato-Gastroenterology, Hôpital Beaujon, Clichy, France
| | - Anne Bourrier
- Department of Hepato-Gastroenterology, Hôpital Saint Antoine, Paris, France
| | - Gilles Bommelaer
- Department of Hepato-Gastroenterology, Hôpital Hôtel Dieu, Clermont Ferrand, France
| | - Nina Dib
- Department of Hepato-Gastroenterology, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Marc André Bigard
- Department of Hepato-Gastroenterology, Hôpital de Brabois, Nancy, France
| | - Stephanie Viennot
- Department of Hepato-Gastroenterology, Hôpital Côte de Nacre, Caen, France
| | - Xavier Hébuterne
- Department of Hepato-Gastroenterology, Hôpital de l'Archet, Nice, France
| | - Jean-Marc Gornet
- Department of Hepato-Gastroenterology, Hôpital Saint Louis, France
| | - Philippe Marteau
- Department of Hepato-Gastroenterology, Hôpital Saint Antoine, Paris, France
| | - Yoram Bouhnik
- Department of Hepato-Gastroenterology, Hôpital Beaujon, Clichy, France
| | - Vered Abitbol
- Department of Hepato-Gastroenterology, Hôpital Cochin, Paris, France
| | - Stéphane Nahon
- Departement of Hepato-Gastroenterology, Centre Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France
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23
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Thabut D, Rudler M, Dib N, Carbonell N, Mathurin P, Saliba F, Mallet A, Massard J, Bernard-Chabert B, Oberti F, Cales P, Golmard JL, Bureau C. Multicenter prospective validation of the Baveno IV and Baveno II/III criteria in cirrhosis patients with variceal bleeding. Hepatology 2015; 61:1024-32. [PMID: 25179168 DOI: 10.1002/hep.27407] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 08/28/2014] [Indexed: 12/16/2022]
Abstract
UNLABELLED The criteria for defining failure to control bleeding in cirrhosis patients were introduced at the Baveno II/III meetings and were widely used as endpoints in clinical trials. Because they lacked specificity, the Baveno IV criteria were proposed in 2005 and slightly modified in 2010 (Baveno V). These criteria included a new index for patients undergoing transfusion, called adjusted-blood-requirement-index (ABRI=number of blood units/(final-initial hematocrit+0.01)), with a cutoff value of 0.75. In this multicenter prospective study, we sought to 1) validate the Baveno IV/V criteria; 2) compare them to the Baveno II/III criteria; 3) assess ABRI performance using a standardized calculation. The key inclusion criteria were: 1) variceal bleeding; 2) cirrhosis; 3) no need to modify the transfusion policy. The patients were classified according to the Baveno IV, V, and II/III criteria. The gold standard for failure during a 5-day period was the clinical judgment of three independent experts, blinded to the Baveno assessments. A total of 249 patients were included. The experts' agreement in clinical judgment of the failure was 80%. Failure occurred in 20.5% of patients; the c-statistics were 0.72 versus 0.64 and 0.65 for Baveno IV versus Baveno II/III and Baveno V criteria (P=0.001 for both). ABRI did not improve the diagnostic performance of the Baveno IV criteria. The Baveno IV, but not Baveno II/III, criteria independently predicted survival. CONCLUSION The Baveno IV criteria demonstrated a higher accuracy than the Baveno II/III and Baveno V criteria for assessing failure to control bleeding and predicted survival independently. Together, our results show that ABRI is not a useful metric, and the Baveno IV criteria should replace the Baveno II/III criteria.
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Affiliation(s)
- Dominique Thabut
- Service d'Hépato-Gastroentérologie, Hôpital de la Pitié-Salpétrière, APHP, UPMC, Paris, France
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24
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Dib N, Kiciak A, Pietrzak P, Ferenc K, Jaworski P, Kapica M, Tarnowski W, Zabielski R. Early-effect of bariatric surgery (Scopinaro method) on intestinal hormones and adipokines in insulin resistant Wistar rat. J Physiol Pharmacol 2013; 64:571-577. [PMID: 24304571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 08/30/2013] [Indexed: 06/02/2023]
Abstract
Bariatric surgery consists in duodenal exclusion from the food passage in obese patients with coexistent type 2 diabetes. Nowadays bariatric surgery is considered the most effective method of glycemic index normalization and insulin resistance reduction. Recent results on obese and non-obese rats showed remission of type 2 diabetes symptoms within few days after the surgery. The aim of the present work was to analyze the mechanisms of neuro-hormonal regulation responsible for early normalization of metabolic syndrome after bariatric surgery. In present study the concentration of selected intestinal hormones and adipokines in blood plasma and gastrointestinal tissues were analyzed. Study was conducted on Wistar rats. Animals were divided into three groups (each n=6): control (SH) shame-operated rats; animals in which visceral fat tissue was extracted (LP); and rats in which Scopinaro bariatric surgery was performed (BPD). Immunochemistry analysis of blood plasma showed decrease of insulin concentration in BPD and LP and increase of polypeptide YY (PYY) in BPD group as compared to the control. In duodenal mucosa homogenates the tendency to reduce insulin in LP and BPD group, and increase PYY and visfatin in BPD group was observed. Histometry analysis showed reduction of mucosa thickness in excluded segments of gastrointestinal tract in BPD group as compared to the SH and LP. Concluding, model studies on rats allowed better understanding of mechanisms important for early normalization of glycemic index and insulin resistance reduction in rats.
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Affiliation(s)
- N Dib
- Department of General, Oncological and Gastrointestinal Surgery, Orlowski Hospital MCPE, Warsaw, Poland.
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25
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Boursier J, de Ledinghen V, Zarski JP, Rousselet MC, Sturm N, Foucher J, Leroy V, Fouchard-Hubert I, Bertrais S, Gallois Y, Oberti F, Dib N, Calès P. A new combination of blood test and fibroscan for accurate non-invasive diagnosis of liver fibrosis stages in chronic hepatitis C. Am J Gastroenterol 2011; 106:1255-63. [PMID: 21468012 DOI: 10.1038/ajg.2011.100] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Precise evaluation of the level of liver fibrosis is recommended in patients with chronic hepatitis C (CHC). Blood fibrosis tests and Fibroscan are now widely used for the non-invasive diagnosis of liver fibrosis. Detailed fibrosis stage classifications have been developed to provide an estimation of the liver fibrosis stage from the results of these non-invasive tests. Our aim was to develop a new and more accurate fibrosis stage classification by using new scores combining non-invasive fibrosis tests. METHODS In all, 729 patients with CHC (exploratory set: 349; validation set: 380) had liver biopsy for Metavir fibrosis (F) staging, and 6 fibrosis tests: Fibroscan, Fibrotest, FibroMeter, Hepascore, FIB-4, APRI. RESULTS Exploratory set: Fibroscan and FibroMeter were the independent predictors of different diagnostic targets of liver fibrosis. New fibrosis indexes combining FibroMeter and Fibroscan were thus developed for the diagnosis of clinically significant fibrosis (CSF-index) or severe fibrosis (SF-index). The association of CSF- and SF-indexes provided a new fibrosis stage classification (CSF/SF classification): F0/1, F1/2, F2 ± 1, F2/3, F3 ± 1, F4. Validation set: CSF/SF classification had a high diagnostic accuracy (85.8% well-classified patients), significantly higher than the diagnostic accuracies of FibroMeter (69.7%, P<0.001), Fibroscan (63.3%, P<0.001), or Fibrotest (43.9%, P<0.001) classifications. CONCLUSIONS The association of new fibrosis indexes combining FibroMeter and Fibroscan provides a new fibrosis stage classification. This classification is significantly more accurate than Fibrotest, FibroMeter, or Fibroscan classifications, and improves the accuracy of the non-invasive diagnosis of liver fibrosis stages to 86% without any liver biopsy.
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26
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Roquin G, Peres M, Lerolle N, Dib N, Mercat A, Croue A, Augusto JF. First Report of Lamotrigine-Induced Drug Rash with Eosinophilia and Systemic Symptoms Syndrome with Pancreatitis. Ann Pharmacother 2010; 44:1998-2000. [DOI: 10.1345/aph.1p350] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To report a case of lamotrigine-induced drug rash with eosinophilia and systemic symptoms (DRESS) syndrome with pancreatitis as the initial visceral involvement. Case Summary: A 75-year-old man was admitted to the local hospital for generalized tonic-clonic seizures. Results of the clinical examination and neurologic investigations were unremarkable. Lamotrigine treatment was initiated and the patient was discharged a few days later. Forty days after lamotrigine initiation, he developed an exanthematous maculopapular rash with fever, peripheral lymphadenopathies, and hypereosinophilia. Lamotrigine hypersensitivity was suspected and the drug was suspended on day 45. On day 47, the patient presented with acute abdominal pain with an elevated lipase level. Acute pancreatitis was confirmed on computed tomography scan. The patient's condition worsened and he was transferred to the intensive care unit with multiorgan failure. The diagnosis of lamotrigine-induced DRESS syndrome was confirmed by a compatible skin histology and concomitant human herpesvirus-6 infection. Discussion: This observation has 2 points of interest. First, pancreatic toxicity of lamotrigine has been rarely reported in the literature. Secondly, pancreatitis is uncommon at the early stage of DRESS syndrome. Only 1 other case of DRESS syndrome, secondary to allopurinol, reports pancreatitis along with an Epstein-Barr virus infection. The Naranjo probability scale indicated a probable causality between lamotrigine and DRESS syndrome in this patient. Conclusions: This is the first reported case of lamotrigine-induced DRESS syndrome with pancreatitis as the initial visceral involvement. Clinicians should be aware of this mode of presentation of DRESS syndrome.
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Affiliation(s)
- Guillaume Roquin
- Resident in Gastroenterology, Service d'Hépato-Gastro-Entérologie, CHU Angers, Angers, France
| | - Marine Peres
- Anesthesiology, Service de Réanimation Médicale et Médecine Hyperbare, CHU Angers; Faculté de Médecine, Université d'Angers, Angers
| | - Nicolas Lerolle
- Intensive Care Medicine and Nephrology, Service de Réanimation Médicale et Médecine Hyperbare; Faculté de Médecine, Université d'Angers
| | - Nina Dib
- Gastroenterology, Service d'Hépato-Gastro-Entérologie
| | - Alain Mercat
- Intensive Care Medicine and Pneumology, Service de Réanimation Médicale et Médecine Hyperbare; Faculté de Médecine, Université d'Angers
| | - Anne Croue
- Anatomopathology, Département de Pathologie, Cellulaire et Tissulaire, CHU Angers
| | - Jean-François Augusto
- Nephrology and Intensive Care Medicine, Service de Néphrologie-Dialyse-Transplantation, CHU Angers; Faculté de Médecine, Université d'Angers
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Veillon P, Gallois Y, Moal V, Fouchard-Hubert I, Charles I, Larcher F, Dib N, Boursier J, Oberti F, Laafi J, Guéchot J, Balan V, Calès P, Lunel-Fabiani F. Assessment of new hyaluronic acid assays and their impact on FibroMeter scores. Clin Chim Acta 2010; 412:347-52. [PMID: 21075099 DOI: 10.1016/j.cca.2010.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 11/04/2010] [Accepted: 11/04/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND We compared three hyaluronic acid (HA) assays and analyzed the impact of their variations on FibroMeter scores. METHODS In a test group of 165 patients, HA levels were assessed with the commonly used ELISA assay from Corgenix, a new ELISA assay from Teco and an immunoturbidimetry assay from Wako, this latter tested across three different instruments. Five different FibroMeter scores were calculated. RESULTS Correlation across the three assays (r(s) between 0.969 and 0.995) was very good. Means of differences (d) were lower when the immunoturbidimetry assay was compared on different instruments: d between -3.4 and 2.0 μg/L. However, a higher value for HA measurement was observed with Corgenix assay, compared to the other two assays (Teco and Wako): d between 27.1 and 36.4 μg/L. The assessment also demonstrated that HA variations had very little impact on FibroMeter scores: 0.0117 for virus and 0.0416 for alcoholic fibrosis scores, and between 0.58 and 1.71 for the area of fibrosis (expressed in percentage). CONCLUSIONS The two new assays found lower values of HA, as compared to the Corgenix assay. However, these differences had very little impact on FibroMeter scores and had no impact on clinical evaluation of liver fibrosis.
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Affiliation(s)
- Pascal Veillon
- Virology Department, Angers University Hospital, Angers, France
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Calès P, Boursier J, Chaigneau J, Lainé F, Sandrini J, Michalak S, Hubert I, Dib N, Oberti F, Bertrais S, Hunault G, Cavaro-Ménard C, Gallois Y, Deugnier Y, Rousselet MC. Diagnosis of different liver fibrosis characteristics by blood tests in non-alcoholic fatty liver disease. Liver Int 2010; 30:1346-54. [PMID: 20666992 DOI: 10.1111/j.1478-3231.2010.02314.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS Our aim was to develop an accurate, non-invasive, blood-test-based method for identifying the main characteristics of liver fibrosis in non-alcoholic fatty liver disease (NAFLD). METHODS Fibrosis was staged according to NASH-CRN and Metavir systems in 226 patients with NAFLD. A fully automated algorithm measured the fractal dimension (FD) and the area of fibrosis (AOF). Independent predictors of diagnostic targets were determined using bootstrap methods. RESULTS (i) Development. Significant fibrosis defined by NASH-CRN F ≥2 was diagnosed by weight, glycaemia, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and prothrombin index [area under the receiver operating characteristic (AUROC)=0.867]; significant fibrosis defined by Metavir F ≥2 was diagnosed by weight, age, glycaemia, AST, ALT, ferritin and platelets (FibroMeter AUROC=0.941, P<0.005). AOF was estimated by the combination of hyaluronic acid, glycaemia, AST, ALT, platelets and prothrombin index ((a) R(2) =0.530), while FD was estimated by hyaluronic acid, glycaemia, AST/ALT, weight and platelets ((a) R(2) =0.529). (ii) Evaluation. Although NASH-CRN was a better system for fibrosis staging, Metavir staging was a better reference for blood test. Thus, the patient rate with predictive values ≥90% by tests was 97.3% with Metavir reference vs. 66.5% with NASH-CRN reference (P<10(-3)). FibroMeter showed a significantly higher AUROC than the NAFLD fibrosis score for significant fibrosis, but not for severe fibrosis or cirrhosis, with both staging systems. Relationships between fibrosis lesions were well reflected by blood tests, e.g., the correlation between histological area and FD of fibrosis (r(s) =0.971, P<10(-3)) was well reflected by the relationship between respective blood tests (r(s) =0.852, P<10(-3)). CONCLUSIONS Different characteristics of fibrosis in NAFLD can be diagnosed and quantified by blood tests with excellent accuracy.
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Affiliation(s)
- Paul Calès
- Service d'Hépato-Gastroentérologie, CHU, Angers, France.
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Calès P, Boursier J, Bertrais S, Oberti F, Gallois Y, Fouchard-Hubert I, Dib N, Zarski JP, Rousselet MC. Optimization and robustness of blood tests for liver fibrosis and cirrhosis. Clin Biochem 2010; 43:1315-22. [PMID: 20713037 DOI: 10.1016/j.clinbiochem.2010.08.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Revised: 08/01/2010] [Accepted: 08/04/2010] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To optimize the performance and feasibility of fibrosis blood tests and evaluate their robustness. DESIGN AND METHODS The derivation population included 1056 HCV patients with liver biopsy and blood markers. Validation populations included 984 patients with various viral hepatitis causes, and Fibroscan and/or liver biopsy and/or blood markers. RESULTS The bootstrap method validated the markers of the original FibroMeter(2G), but not those of Fibrotest and Hepascore, and provided a hyaluronate-free FibroMeter(3G). AUROCs for significant fibrosis were: FibroMeter(2G): 0.853 vs. FibroMeter(3G): 0.851, p=0.489. Compared to FibroMeter(2G), FibroMeter(3G) had a significantly higher patient rate with predictive values ≥90% for significant fibrosis. Accuracy for fibrosis stage classification was: Fibrotest: 37.9%, FibroMeter(2G): 74.9%, and FibroMeter(3G): 86.9% (p<10(-3)). CONCLUSION The bootstrap method validated FibroMeter(2G) and provided a cheaper and more feasible hyaluronate-free FibroMeter(3G) with comparable performance. Compared to binary diagnosis, fibrosis stage classification increased discrimination, with an increased accuracy to 87% for FibroMeter(3G).
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Affiliation(s)
- Paul Calès
- Service d'Hépato-Gastroentérologie, CHU, Angers, France.
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30
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Calès P, Boursier J, Bertrais S, Oberti F, Gallois Y, Fouchard-Hubert I, Dib N, Zarski JP, Rousselet MC. Optimization and robustness of blood tests for liver fibrosis and cirrhosis. Clin Biochem 2010. [PMID: 20713037 DOI: 10.1016/j.clinbiochem.2010.08.010.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To optimize the performance and feasibility of fibrosis blood tests and evaluate their robustness. DESIGN AND METHODS The derivation population included 1056 HCV patients with liver biopsy and blood markers. Validation populations included 984 patients with various viral hepatitis causes, and Fibroscan and/or liver biopsy and/or blood markers. RESULTS The bootstrap method validated the markers of the original FibroMeter(2G), but not those of Fibrotest and Hepascore, and provided a hyaluronate-free FibroMeter(3G). AUROCs for significant fibrosis were: FibroMeter(2G): 0.853 vs. FibroMeter(3G): 0.851, p=0.489. Compared to FibroMeter(2G), FibroMeter(3G) had a significantly higher patient rate with predictive values ≥90% for significant fibrosis. Accuracy for fibrosis stage classification was: Fibrotest: 37.9%, FibroMeter(2G): 74.9%, and FibroMeter(3G): 86.9% (p<10(-3)). CONCLUSION The bootstrap method validated FibroMeter(2G) and provided a cheaper and more feasible hyaluronate-free FibroMeter(3G) with comparable performance. Compared to binary diagnosis, fibrosis stage classification increased discrimination, with an increased accuracy to 87% for FibroMeter(3G).
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Affiliation(s)
- Paul Calès
- Service d'Hépato-Gastroentérologie, CHU, Angers, France.
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Meziane M, Boulaadas M, Eabdenbitsen A, Dib N, Essakalli L, Kzadri M. [Intramasseteric hemangioma operated by intraoral approach]. ACTA ACUST UNITED AC 2010; 111:168-71. [PMID: 20553891 DOI: 10.1016/j.stomax.2010.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 01/30/2010] [Accepted: 04/12/2010] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Hemangiomas are benign vascular tumors, of unknown origin. Skeletal muscle localization account for less than 1% of cases. Masseter muscle localization is most common in head and neck (36%). In this case, treatment is usually surgery via an extra-oral approach which imposes parotidectomy with dissection of facial nerve branches. We report a case of intramasseteric hemangioma operated via an intraoral approach and we describe the benefits of this approach. CASE REPORT A 34-year-old male patient with no prior history of trauma consulted for left masseter swelling having evolved for several years. Clinical examination revealed a soft, painless, well-defined swelling, about 5cm long, with a positive Wattle sign in the left cheek. The CT exam suggested a vascular lesion, located in the deep bundle of the masseter muscle. Preoperative embolization was followed by surgical exeresis via an intraoral approach. The post-operative evolution was uneventful. No recurrence was observed at one year of follow-up. DISCUSSION Intraoral intramasseteric hemangioma exeresis is possible and does not seem to lead to more complications than with the facial approach. It prevents the significant drawbacks due to cutaneous incision, parotidectomy, and dissection of facial nerve branches via a facial approach.
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Affiliation(s)
- M Meziane
- Service d'ORL et de chirurgie maxillofaciale, CHU Rabat-Salé, BP 353, Rabat, Maroc.
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Boursier J, Vergniol J, Sawadogo A, Dakka T, Michalak S, Gallois Y, Le Tallec V, Oberti F, Fouchard-Hubert I, Dib N, Rousselet MC, Konaté A, Amrani N, de Ledinghen V, Calès P. The combination of a blood test and Fibroscan improves the non-invasive diagnosis of liver fibrosis. Liver Int 2009; 29:1507-15. [PMID: 19725892 DOI: 10.1111/j.1478-3231.2009.02101.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Blood tests and liver stiffness evaluation (LSE) by ultrasonographic elastometry are accurate tools for diagnosing liver fibrosis. We evaluated whether their synchronous combination in new scores could improve the diagnostic accuracy and reduce liver biopsy requirement in algorithm. METHODS Three hundred and ninety patients with chronic liver disease of miscellaneous causes were included. Five blood fibrosis tests were evaluated: APRI, FIB-4, Hepascore, Fibrotest and FibroMeter. The reference was fibrosis Metavir staging. RESULTS Diagnosis of significant fibrosis (Metavir F>or=2). The most accurate synchronous combination was FibroMeter+LSE, which provided a significantly higher area under the receiver operating characteristic curve (0.892) than LSE alone (0.867, P=0.011) or Fibrometer (0.834, P<10(-3)). An algorithm using the FibroMeter+LSE combination and then a liver biopsy in indeterminate cases had 91.9% diagnostic accuracy and required significantly fewer biopsies (20.2%) than previously published Bordeaux algorithm (28.6%, P=0.02) or sequential algorithm for fibrosis evaluation (SAFE) (55.7%, P<10(-3)). The Angers algorithm performance was not significantly different between viral hepatitis and other causes. Diagnosis of cirrhosis. The most accurate synchronous combination was LSE+FibroMeter, which provided >or=90% predictive values for cirrhosis in 90.6% of patients vs 87.4% for LSE (P=0.02) and 57.9% for FibroMeter (P<10(-3)). An algorithm including the LSE+FibroMeter combination, and then a liver biopsy in indeterminate cases, had a significantly higher diagnostic accuracy than the SAFE algorithm (91.0 vs 79.8%, P<10(-3)), and required significantly fewer biopsies than the Bordeaux algorithm (9.3 vs 25.3%, P<10(-3)). CONCLUSION The synchronous combination of a blood test plus LSE improves the accuracy of the non-invasive diagnosis of liver fibrosis and, consequently, markedly decreases the biopsy requirement in the diagnostic algorithm, notably to <10% in cirrhosis diagnosis.
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Affiliation(s)
- Jérôme Boursier
- HIFIH Laboratory, IFR 132, University, PRES UNAM, Angers, France
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33
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Calès P, Boursier J, Oberti F, Hubert I, Gallois Y, Rousselet MC, Dib N, Moal V, Macchi L, Chevailler A, Michalak S, Hunault G, Chaigneau J, Sawadogo A, Lunel F. FibroMeters: a family of blood tests for liver fibrosis. ACTA ACUST UNITED AC 2009; 32:40-51. [PMID: 18973845 DOI: 10.1016/s0399-8320(08)73992-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
FibroMeters are blood tests for liver fibrosis with several specificities: two main diagnostic targets (fibrosis stage and area of fibrosis); adaptation to specific causes; and results confirmed by an expert system. Thus, FibroMeters comprise six different tests: one for staging and one for quantitation of liver fibrosis in each of the three main causes of chronic liver disease-chronic viral hepatitis, alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD). FibroMeters display a high overall diagnostic accuracy and are the only tests to correctly classify 100% of HCV patients without fibrosis or with cirrhosis. They have 90% predictive values in a higher proportion of patients than with other usual blood tests. A 90% correct classification is available in 100% of HCV patients with the following reliable diagnostic intervals: F0/1, F1/2, F2+/-1, F3+/-1. In real-life conditions, the reproducibility of FibroMeters is higher than that of liver biopsy or ultrasonographic elastometry. FibroMeters are robust tests with the most stable diagnostic performance across different centers. Optional tests are also available, such as a specific one for cirrhosis, which has a diagnostic accuracy of 93.0% (AUROC: 0.92) and a 100% positive predictive value for diagnosis of HCV cirrhosis. Determination by FibroMeters of the area of fibrosis - the only direct, non-invasive, quantitative measurement of liver fibrosis - are especially useful for following-up cirrhosis as it correlates well with clinical events. FibroMeters are also very accurate in HVB or HIV-HCV co-infected patients. The tests specific for ALD and NAFLD also have a high diagnostic accuracy (AUROCs: 0.96 and 0.94, respectively, for significant fibrosis).
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Affiliation(s)
- P Calès
- Laboratoire HIFIH, IFR 132, Université, Angers; Service d'Hépato-gastroentérologie, CHU, Angers.
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Benhammou A, Meziane M, Dib N, Nazih N, Boulaadas M, Essakali L, Kzadri M. Tumeurs brunes maxillomandibulaires révélant un adénome parathyroïdien. ACTA ACUST UNITED AC 2009; 126:216-20. [DOI: 10.1016/j.aorl.2009.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 05/04/2009] [Indexed: 10/20/2022]
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Dib N, Benhammou A, Meziane M, Harmouch A, Nazih N, Essakali L, Kzadri M, Sefiani S. [Papillary adenocarcinoma on ectopic thyroid tissue]. ACTA ACUST UNITED AC 2009; 126:65-70. [PMID: 19296927 DOI: 10.1016/j.aorl.2009.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 02/09/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To report a case of papillary adenocarcinoma occurring on ectopic thyroid tissue in the hyoid bone region. MATERIAL AND METHODS A 57-year-old patient consulted for a cervical mass appearing 1 year before, with no signs of compression. The thyroid function was normal. RESULTS The examination showed a firm tumefaction, fixed on the hyoid bone, with undetermined limits, measuring approximately 8 cm. The thyroid gland was in the normal pretracheal position. The cervical tomodensitometry objectified an osteolytic process centered on the hyoid bone with a fleshy zone of tissue density and calcifications. Cervical MRI provided a more precise assessment of the extension of the mass and confirmed the integrity of the other structures, in particular the endo-larynx. The tumor was totally resected via a cervical approach. The pathologic study suggested a papillary adenocarcinoma on ectopic thyroid tissue. The treatment was completed by a total thyroidectomy with normal histological results. CONCLUSIONS Papillary adenocarcinoma on ectopic thyroid is a very rare situation. Its diagnosis is histological. Its treatment is primarily surgical, sometimes associated with radioiodine I-131 therapy.
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Affiliation(s)
- N Dib
- Service d'ORL et de chirurgie cervicofaciale, hôpital des spécialités, CHU de Rabat-Salé, Rabat, Maroc.
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Boursier J, Konaté A, Gorea G, Reaud S, Quemener E, Oberti F, Hubert-Fouchard I, Dib N, Calès P. Reproducibility of liver stiffness measurement by ultrasonographic elastometry. Clin Gastroenterol Hepatol 2008; 6:1263-9. [PMID: 18995217 DOI: 10.1016/j.cgh.2008.07.006] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 07/09/2008] [Accepted: 07/10/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Fibroscan is a noninvasive device that assesses liver fibrosis by liver stiffness evaluation (LSE) with ultrasonographic elastometry. We evaluated LSE reproducibility and its influencing factors. METHODS LSE was performed by 4 experienced physicians (>100 LSEs) in 46 patients with chronic liver disease at 4 different anatomic sites. Additional LSEs were performed for ancillary aims, so that 534 LSEs were available. RESULTS Overall interobserver agreement for LSE results was considered as excellent, with intraclass coefficient correlation (Ric) of 0.93. Low LSE level, nonrecommended sites, LSE interquartile range >25%, and body mass index > or =25 independently decreased agreement. Thus, agreement was fair (Ric = 0.53) for LSE <9 kilopascals and excellent (Ric = 0.90) beyond. The best measurement site for LSE reproducibility was the median axillary line on the first intercostal space under the liver dullness upper limit, with the patient lying in dorsal decubitus. When LSE results were categorized into fibrosis Metavir stages, interobserver discordance was noticed in about 25% of the cases and was the highest for F2 and F3 stages and the lowest for F4. Intraobserver (Ric = 0.94), intersite (Ric = 0.92-0.98), and interequipment (Ric = 0.92) agreements for LSE results were excellent. Preliminary standard ultrasonography or probe pressure changes did not improve interobserver agreement. CONCLUSIONS The best measurement site for LSE is the one generally used for liver biopsy. Reproducibility of LSE is globally excellent but is fair in patient with low liver stiffness. The fibrosis diagnosis by ultrasonographic elastometry in low stages or categorized into fibrosis Metavir stages must be interpreted with caution.
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Affiliation(s)
- Jérôme Boursier
- University of Angers, IFR 132, HIFIH Laboratory, UPRES 3859, Angers, France
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Verny C, Amati-Bonneau P, Letournel F, Person B, Dib N, Malinge MC, Slama A, Le Maréchal C, Ferec C, Procaccio V, Reynier P, Bonneau D. Mitochondrial DNA A3243G mutation involved in familial diabetes, chronic intestinal pseudo-obstruction and recurrent pancreatitis. Diabetes Metab 2008; 34:620-6. [PMID: 18955007 DOI: 10.1016/j.diabet.2008.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 06/06/2008] [Accepted: 06/24/2008] [Indexed: 12/22/2022]
Abstract
AIMS To report on a family with five members who carry the A3243G mutation in mitochondrial tRNA for leucine 1 (MTTL1) and present with diabetes, chronic intestinal pseudo-obstruction (CIPO) and recurrent pancreatitis, and to screen for this mutation in a cohort of 36 unrelated patients with recurrent pancreatitis. METHODS The mutation was quantified in several tissue samples from patients. Respiratory chain activity was studied in muscle biopsies and fibroblast cultures. In addition, the thymidine phosphorylase gene (TP) involved in mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) and three genes involved in chronic pancreatitis - PRSS1, SPINK1 and CFTR - were sequenced in affected patients. Finally, the MTTL1 gene was examined in 36 unrelated patients who had recurrent pancreatitis, but no mutations in the PRSS1 and SPINK1 genes. RESULTS Heteroplasmy for the mtDNA A3243G mutation was found in all tissue samples from these patients, but no mutations were found in the genes coding for thymidine phosphorylase, PRSS1, SPINK1 and CFTR. Also, none of the 36 unrelated patients with recurrent pancreatitis were carrying any MTTL1 mutations. CONCLUSION The mtDNA A3243G mutation associated with the gastrointestinal manifestations observed in the affected family should be regarded as a possible cause of CIPO and unexplained recurrent pancreatitis. However, the mutation is probably only weakly involved in cases of isolated recurrent pancreatitis.
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Affiliation(s)
- C Verny
- Département de neurologie, centre hospitalier universitaire, 49033 Angers, France
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Dib N, Quelin F, Ternisien C, Hanss M, Michalak S, De Mazancourt P, Rousselet MC, Calès P. Fibrinogen angers with a new deletion (gamma GVYYQ 346-350) causes hypofibrinogenemia with hepatic storage. J Thromb Haemost 2007; 5:1999-2005. [PMID: 17883696 DOI: 10.1111/j.1538-7836.2007.02713.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION This study reports a family with chronically abnormal blood liver function tests (LFT) and congenital hypofibrinogenemia. The proposita had cirrhosis initially related to alcohol abuse and chronic viral hepatitis C (HCV), but abnormal LFT persisted even when alcohol intake was stopped and despite HCV treatment was efficient based on serum RNA negative testing. RESULTS Needle biopsy specimens of the proposita and her brother showed eosinophilic intra-cytoplasmic inclusions that reacted strongly with fibrinogen antisera on direct immunofluorescence. Electron microscopic examination showed that the rough endoplasmic reticulum was filled with inclusions that consisted of densely packed, curved tubular structures arranged in a fingerprint-like pattern. Coagulation studies revealed low functional and antigenic fibrinogen concentrations suggestive of hypofibrinogenemia. Amplification and DNA sequencing showed a heterozygous deletion of the a7690 to g7704 nucleotides of the gamma chain gene in the 3'end of exon 8 (g 7690_7704del14; Genbank access M10014); this deletion encompassed the splicing site at position 7703 and predicts in a new putative consensus splicing sequence (AATGgtatgtt). RNA was extracted from a liver specimen from the proposita's brother. The cDNA obtained by reverse transcription polymerase chain reaction confirmed the usage of a newly generated donor site at position 7688 of the genomic sequence resulting in an in-frame heterozygous 5 amino acid deletion (GVYYQ 346-350; p.G372_Q376del) and that this mutation is responsible for a new splicing site at position 7688 of the genomic sequence. CONCLUSION we suggest that the molecular defect in fibrinogen Angers results in an impaired assembly and causes defective secretion and hepatic storage of fibrinogen.
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Affiliation(s)
- N Dib
- Department of Hepato-Gastroenterology, University Hospital, Angers
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Affiliation(s)
- Jérôme Boursier
- Laboratoire HIFIH, UPRES EA 3859, IFR 132, Université, Service d'Hépato-Gastroentérologie, CHU, Angers Cedex 9
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Stewart DJ, Hilton JD, Arnold JMO, Gregoire J, Rivard A, Archer SL, Charbonneau F, Cohen E, Curtis M, Buller CE, Mendelsohn FO, Dib N, Page P, Ducas J, Plante S, Sullivan J, Macko J, Rasmussen C, Kessler PD, Rasmussen HS. Angiogenic gene therapy in patients with nonrevascularizable ischemic heart disease: a phase 2 randomized, controlled trial of AdVEGF121 (AdVEGF121) versus maximum medical treatment. Gene Ther 2006; 13:1503-11. [PMID: 16791287 DOI: 10.1038/sj.gt.3302802] [Citation(s) in RCA: 198] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The demonstration that angiogenic growth factors can stimulate new blood vessel growth and restore perfusion in animal models of myocardial ischemia has led to the development of strategies designed for the local production of angiogenic growth factors in patients who are not candidates for conventional revascularization. The results of recent clinical trials of proangiogenesis gene therapy have been disappointing; however, significant limitations in experimental design, in particular in gene transfer strategies, preclude drawing definitive conclusions. In the REVASC study cardiac gene transfer was optimized by direct intramyocardial delivery of a replication-deficient adenovirus-containing vascular endothelial growth factor (AdVEGF121, 4 x 10(10) particle units (p.u.)). Sixty-seven patients with severe angina due to coronary artery disease and no conventional options for revascularization were randomized to AdVEGF121 gene transfer via mini-thoracotomy or continuation of maximal medical treatment. Exercise time to 1 mm ST-segment depression, the predefined primary end-point analysis, was significantly increased in the AdVEGF121 group compared to control at 26 weeks (P=0.026), but not at 12 weeks. As well, total exercise duration and time to moderate angina at weeks 12 and 26, and in angina symptoms as measured by the Canadian Cardiovascular Society Angina Class and Seattle Angina Questionnaire were all improved by VEGF gene transfer (all P-values at 12 and 26 weeks < or =0.001). However, if anything the results of nuclear perfusion imaging favored the control group, although the AdVEGF121 group achieved higher workloads. Overall there was no significant difference in adverse events between the two groups, despite the fact that procedure-related events were seen only in the thoracotomy group. Therefore, administration of AdVEGF121 by direct intramyocardial injections resulted in objective improvement in exercise-induced ischemia in patients with refractory ischemic heart disease.
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Affiliation(s)
- D J Stewart
- Division of Cardiology, St Michael's Hospital, 30 Bond Street, Rm. 6050 Queen Wing, Toronto, Ontario, Canada.
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Abstract
Portal hypertension is one of the main consequences of cirrhosis. It results from a combination of increased intrahepatic vascular resistance and increased blood flow through the portal venous system. The condition leads to the formation of portosystemic collateral veins. Esophagogastric varices have the greatest clinical impact, with a risk of bleeding as high as 30% within 2 years of medium or large varices developing. Ascites, another important complication of advanced cirrhosis and severe portal hypertension, is sometimes refractory to treatment and is complicated by spontaneous bacterial peritonitis and hepatorenal syndrome. We describe the pathophysiology of portal hypertension and the current management of its complications, with emphasis on the prophylaxis and treatment of variceal bleeding and ascites.
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Affiliation(s)
- Nina Dib
- Department of Hepato-Gastroenterology, University Hospital, and HIFIH Laboratory, Université d'Angers, Angers, France
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Dib N, Konate A, Oberti F, Calès P. [Non-invasive diagnosis of portal hypertension in cirrhosis. Application to the primary prevention of varices]. ACTA ACUST UNITED AC 2006; 29:975-87. [PMID: 16435503 DOI: 10.1016/s0399-8320(05)88170-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
One of the major complications of cirrhosis is the occurrence of portal hypertension and esophageal varices. At present, universal endoscopic screening of esophageal varices is recommended in association to primary prophylaxis in patients at high risk of variceal bleeding. But this screening is invasive and could be not cost-effective. Besides, pre-primary phrophylaxis is not effective and hampared by side effects. So, non invasive diagnosis of portal hypertension might be useful. This one could depend on non invasive measurement of hepatic venous pressure gradient, but its application to screening is not well-documented and its use in treatment monitoring is debated. A second way could be non invasive diagnosis of large esophageal varices because of prognostic and economic issues. Indirect echographic markers of portal hypertension and esophageal varices (ascites, portal vein diameter > or = 13 mm, spleen length, maximal and mean velocimetry of portal vein flow, respectively < 20 cm/s and < 12 cm/s) could be useful. Among this parameters, spleen length is an independent predictive marker of esophageal varices. Besides, several direct or indirect blood markers of fibrosis have been tested. Platelet count is repeatedly a predictive marker of esophageal varices in multivariate analysis. The other predictive factors of esophageal varices could be: prothrombin time, splenomegaly, spider naevi, Child-Pugh class, bilirubinemia, platelet count/spleen diameter ratio and Fibrotest, but these data require validation. In summary, in regard to actual results, non invasive diagnosis of portal hypertension might be useful in esophageal varices screening, but the substitutes to endoscopy have limited place actually in clinical practice, and exclusive non invasive diagnosis of portal hypertension is not applicable; the only test that seems to be useful in clinical practice is conventional endoscopy awaiting the results of videocapsule.
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Affiliation(s)
- Nina Dib
- Laboratoire HIFIH, UPRES EA 3859, IFR 132, Université et Service d'Hépato-Gastroentérologie, CHU, Angers
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43
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Abstract
Chronic ischemic gastritis is an unusual entity that is rarely distinguished from other forms of intestinal ischemia. On the basis of a case encountered and a subsequent review of the literature, the main features of this rare condition are described here. A better understanding and awareness of the disease should improve the diagnosis and ultimately also the prognosis.
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Affiliation(s)
- V Quentin
- Department of Gastroenterology, University Hospital, Angers, France
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44
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Abstract
We report the coexistence of Wilson's disease and genetic haemochromatosis in one family. The diagnosis of genetic haemochromatosis was established in a 52-year-old man. Among his siblings, one 57-year-old sister and one 55-year-old brother had decreased copper and ceruloplasmin levels in serum and increased urinary copper excretion. The sister shared the same human leucocyte antigen haplotypes and was homozygous for the HFE mutation C282Y, like the propositus. However, she had normal liver iron content and increased liver copper content. Her dietary copper intake was probably excessive. The association of Wilson's disease and genetic haemochromatosis is rare and has only been described twice. The onset of Wilson's disease after 50 years of age is rare; Wilson's disease should be considered in any patient with unexplained chronic liver disease; an excess in liver copper content might be induced by excessive dietary input in a susceptible individual.
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Affiliation(s)
- Nina Dib
- Department of Hepato-Gastroenterology, University Hospital, Angers, France
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45
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Dib N, Person B, Calès P. [Gastrointestinal tract hemorrhage]. Rev Prat 2005; 55:1363-8. [PMID: 16138605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Nina Dib
- Service d'Hépato-Gastro-Entérologie, CHU, 49933 Angers
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Roy PM, Person B, Souday V, Kerkeni N, Dib N, Asfar P. Percutaneous radiologic gastrostomy versus nasogastric tube in critically ill patients. Clin Nutr 2005; 24:321-5. [PMID: 15784495 DOI: 10.1016/j.clnu.2004.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2004] [Accepted: 11/22/2004] [Indexed: 10/25/2022]
Abstract
AIMS To examine the feasibility of percutaneous radiologic gastrostomy in critically ill patients and to assess the rates of complications, esophagitis and gastroesophageal reflux when compared with nasogastric tube. METHOD Sixty patients admitted to a medical intensive care unit and who were supposed to require gastric tubing for at least 14 days were randomized to have a nasogastric tube or a percutaneous radiologic gastrostomy. Patients with gastrostomy contraindication or gastric tubing for more than 2 days were excluded. RESULTS No major complication requiring invasive treatment was observed. The nasogastric tube was more prone to failure as defined by the impossibility to place or to replace the allocated tube (P = 0.04) and to tube dysfunction (P<0.001), whereas gastrostomy was associated with increased incidence of minor local complications (P<0.001). Ten days after allocation, the rates of esophagitis (15%) and gastroesophageal reflux (24%) were not significantly different between the two groups. CONCLUSION In selected critically ill patients, percutaneous radiologic gastrostomy carried a low risk of severe complication but we found no benefit in terms of esophagitis and gastroesphageal reflux between early performed gastrostomy and the nasogastric tube.
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Affiliation(s)
- Pierre-Marie Roy
- Emergency Department, Angers University Hospital, 4 rue Larrey, Angers 49033, France.
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Abstract
Ganglioneuromatous polyposis is a very rare intestinal disease which differs from isolated polypoid ganglioneuroma and from diffuse ganglioneuromatosis. Its clinical, endoscopic, microscopic and evolutive features are poorly known. We report three cases of colonic ganglioneuromatous polyposis that illustrated an uncommon diffusion pattern in two men and one woman aged 63-72 who presented with chronic diarrhea. Endoscopic features suggesting the diagnosis were diffuse polyposis predominating in the cecum and right colon, with hyperhemic flat lesions enhanced after indigocarmin instillation. Histological study of the biopsies, and of colectomy specimens, showed a diffuse mucosal ganglioneuromatous proliferation with a few adenomatous polyps. Search for multiple endocrine neoplasia (MEN) type 2b was negative. In conclusion, this polypoid type of diffuse ganglioneuromatosis can be suspected in patients with chronic diarrhea by the special endoscopic aspect of the colonic polyposis. Pathologists should be aware of the distinctive features; diagnosis requires search for adenomas and/or neoplasia by total colopsy in addition to search for MEN 2b.
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Le Tallec V, Abgueguen P, Pichard E, Chennebault JM, Bellec V, Delbos V, Rousselet MC, Dib N, Boyer J. [Hepatosplenic localization of cat scratch disease in immunocompetent adults. Two cases]. Gastroenterol Clin Biol 2003; 27:225-9. [PMID: 12658133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The infective agent responsible for cat scratch disease, Bartonella henselae, is a rare cause of hepatic granulomatosis in immunocompetent adults. Clinical features include a prolonged fever or more typical symptoms such as lymphadenopathy associated with painful hepatomegaly and a fever following a cat scratch or bite. Images of micronodular hepatosplenic lesions on abdominal ultrasonography or computed tomography scan along with epithelioid granulomas in a liver biopsy can suggest this diagnosis. It is established with a serology by indirect immunofluorescence or by ELISA and/or the presence of Bartonella henselae DNA evidenced by PCR in the liver biopsy. We report two cases of hepatosplenic localizations of cat scratch disease in a 41-year-old woman and a 44-year-old man presenting asthenia and fever associated with a biological inflammatory syndrome and elevated liver enzymes.
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Affiliation(s)
- Véronique Le Tallec
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire, 4, rue Larrey, 49033 Angers cedex 01
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Fearon WF, Luna J, Samady H, Powers ER, Feldman T, Dib N, Tuzcu EM, Cleman MW, Chou TM, Cohen DJ, Ragosta M, Takagi A, Jeremias A, Fitzgerald PJ, Yeung AC, Kern MJ, Yock PG. Fractional flow reserve compared with intravascular ultrasound guidance for optimizing stent deployment. Circulation 2001; 104:1917-22. [PMID: 11602494 DOI: 10.1161/hc4101.097539] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Determination of fractional flow reserve (FFR) has been proposed as a means to assess stent deployment. In this prospective, multicenter trial, we evaluate the use of FFR to optimize stenting by comparing it with standard intravascular ultrasound (IVUS) criteria. METHODS AND RESULTS Eighty-four stable patients with isolated coronary lesions underwent coronary stent deployment starting at 10 atm and increased serially by 2 atm until the FFR was >/=0.94 or 16 atm was achieved. IVUS was then performed. FFR was measured with a coronary pressure wire with intracoronary adenosine to induce hyperemia. The diagnostic characteristics of an FFR <0.94 to predict suboptimal stent expansion by IVUS, defined in both absolute and relative terms, were calculated. Over a range of IVUS criteria, the highest sensitivity, specificity, and predictive accuracy of FFR were 80%, 30%, and 42%, respectively. Receiver operator characteristic analysis defined an optimal FFR cut point at >/=0.96; at this threshold, the sensitivity, specificity, and predictive accuracy of FFR were 75%, 58%, and 62%, respectively (P=0.03 for comparison of predictive accuracy, P=0.01 for concordance between FFR and IVUS). The negative predictive value was 88%. Significantly better diagnostic performance was achieved in a subgroup that received higher doses (>30 microgram) of intracoronary adenosine during pressure measurements, suggesting that FFR might be overestimated in the other group. CONCLUSIONS A fractional flow reserve <0.96, measured after stent deployment, predicts a suboptimal result based on validated intravascular ultrasound criteria; however, an FFR >/=0.96 does not reliably predict an optimal stent result. Higher doses of intracoronary adenosine than previously used to measure FFR improve these results.
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Affiliation(s)
- W F Fearon
- Stanford University Medical Center, Stanford, CA, USA.
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Paydarfar D, Krieger D, Dib N, Blair RH, Pastore JO, Stetz JJ, Symes JF. In vivo magnetic resonance imaging and surgical histopathology of intracardiac masses: distinct features of subacute thrombi. Cardiology 2001; 95:40-7. [PMID: 11385191 DOI: 10.1159/000047342] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We evaluated intracardiac masses in vivo, in situ and histologically to determine tissue properties revealed by magnetic resonance (MR) imaging. In 15 consecutive patients scheduled for cardiotomy, the cardiac chambers were studied preoperatively with MR imaging and echocardiography. Visual examination of one or more chambers was performed during cardiotomy for mitral valve replacement, aneurysmectomy, atrial septal repair and atriotomy. Six thrombi (1 atrial appendage, 5 ventricular) and 2 atrial myxomas were removed and subjected to histological analysis. All masses were detected preoperatively by MR imaging. The smallest was a subacute 3-mm mural clot in the left ventricle and was undetected by transesophageal and transthoracic echocardiography. The 3 subacute clots had homogeneously low MR signals, did not enhance with gadolinium and exhibited magnetic susceptibility effects; histopathology confirmed these clots to be avascular and laden with dense iron deposition related to hemoglobin breakdown products. The 3 organized clots had intermediate and heterogeneous MR signals and multiple areas of gadolinium enhancement. The 2 myxomas had low MR signals and gadolinium enhancement in the core and septal attachment; these areas had dense neovascular channels. Subacute thrombi appear to have MR features that are distinct from organized thrombi and myxomas, and MR images of subacute thrombi contrast sharply with normal cardiac structures, enabling detection of thin mural clots that may be echographically occult. These findings may be of value, because a subacute clot may be more likely than an organized thrombus to give rise to an embolus.
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Affiliation(s)
- D Paydarfar
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA 01655, USA.
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