Alban Benezech

First European human gastric peroral endoscopic myotomy, for treatment of refractory gastroparesis.

We have therefore carried out G-POEM in a 51-year-old diabetic woman who suffered from disabling and refractory clinical gastroparesis; this was confirmed with by gastric emptying scintigraphy that showed an increased gastric emptying half-time.

G-POEM with antro-pyloromyotomy for the treatment of refractory gastroparesis: mid-term follow-up and factors predicting outcome

Gastric peroral endoscopic pyloromyotomy (G‐POEM) was introduced for treating refractory gastroparesis.

Faecal incontinence: Current knowledges and perspectives

Faecal incontinence (FI) is a disabling and frequent symptom since its prevalence can vary between 5% and 15% of the general population. It has a particular negative impact on quality of life. Many tools are currently available for the treatment of FI, from conservative measures to invasive surgical treatments. The conservative treatment may be dietetic measures, various pharmacological agents, anorectal rehabilitation, posterior tibial nerve stimulation, and transanal irrigation. If needed, patients may have miniinvasive approaches such as sacral nerve modulation or antegrade irrigation. In some cases, a surgical treatment is proposed, mainly external anal sphincter repair. Although these different therapeutic options are available, new techniques are arriving allowing new hopes for the patients. Moreover, most of them are non-invasive such as local application of an α1-adrenoceptor agonist, stem cell injections, rectal injection of botulinum toxin, acupuncture. New more invasive techniques with promising results are also coming such as anal magnetic sphincter and antropylorus transposition. This review reports the main current available treatments of FI and the developing therapeutics tools.

CON-COUR study: Interferential therapy in the treatment of chronic constipation in adults: study protocol for a randomized controlled trial.

BackgroundThe prevalence of chronic constipation is about 15 % in Western countries with a significant impact on quality of life and health care costs. The first-line therapy, based on medical treatment combined with laxatives and dietary rules, is often disappointing. Interferential therapy is a new treatment that has demonstrated its efficiency in the treatment of chronic constipation in children and encouraging results in adults. The primary objective of this study is to assess the efficacy of interferential therapy during 8 weeks in adult patients. The secondary objectives are to assess this new and noninvasive therapy in terms of persistence of the clinical efficacy, colonic transit time, ano-rectal manometry, patient satisfaction and quality of life (QoL), and tolerance.Methods/DesignDesign: multicenter, prospective, randomized, placebo-controlled, double blind, two-parallel groups study. Setting: nine French adult gastroenterology centers. Inclusion criteria: adult patients with a history of chronic constipation refractory to medical treatment for at least 3 months. Treatment groups: (1) interferential-experimental group (effective stimulation); (2) placebo-control group (sham stimulation). Randomization: 1:1 allocation ratio. Evaluation times: inclusion (T0, randomization), baseline assessment (T1), start of stimulation (T2), intermediary assessment (T3, 4 weeks), end of stimulation (T4, 8 weeks), follow-up (T5 and T6, 1- and 6-month). Endpoints: (1) primary: short-term efficacy at T4 (treatment response defined as three or more spontaneous, complete bowel movements per week); (2) secondary: efficacy at T5 and T6, symptoms (Patient Assessment of Constipation Symptoms questionnaire), colonic transit time, anorectal manometry, patient satisfaction (analogical visual scale), patient QoL (Patient Assessment of Constipation Quality of Life Questionnaire), side/unexpected effects. Sample size: 200 individuals to obtain 80 % power to detect a 20 % difference in treatment response at T4 between the two groups (15 % of lost to follow-up patients expected).DiscussionThe randomized, double-blind, placebo-controlled design is the most appropriate to demonstrate the efficacy of a new experimental therapeutic (Evidence-Based Medicine Working Group classification). National and international recommendations could be updated based on the findings of this study.Trial registrationCurrent controlled trials NCT02381665 (registration date: February 13, 2015).

Three‐dimensional high‐resolution anorectal manometry: does it allow automated analysis of sphincter defects?

Anorectal manometry is the most common test used to explore anorectal disorders. The recent three‐dimensional high‐resolution anorectal manometry (3D‐HRAM) technique appears to be able to provide new topographic information. Our objective was to develop an automated analysis of 3D‐HRAM images to diagnose anal sphincter defects and compare the results with those of endoanal ultrasonography (EUS), which is considered to be the gold standard.

Noncontiguous finished genome sequence and description of Streptococcus timonensis sp. nov. isolated from the human stomach

Strain Marseille-P2915T, a Gram-positive, facultative anaerobic and nonmotile coccus, was isolated from the gastric lavage of a patient with severe anaemia. The 16S rRNA and rpoB gene comparison exhibited a sequence identity of 98.7 and 92.6% with Streptococcus infantis strain JCM 10157T, respectively, collocating it within the ‘Streptococcus mitis’ group. On the basis of phenotypic and genomic analysis, we propose the validation of the type strain Streptococcus timonensis sp. nov. Marseille-P2915T (= DSM 103349 = CSUR P2915).

Rectal intussusception: can high resolution three-dimensional ano-rectal manometry compete with conventional defecography?

Three‐dimensional high‐resolution anorectal manometry (3DHRAM), used for exploring anorectal disorders, was recently developed, providing interesting topographic data for the diagnosis of pelvic floor disorders such as excessive perineal descent. The aim of our study was to define a diagnostic strategy based on selected 3DHRAM parameters to identify rectal intussusceptions (RI), considering conventional defecography (CD) as the gold standard.

High-resolution anorectal manometry may probably be worth every penny

We read with great attention “Highresolution anorectal manometry: an expensive hobby or worth every penny?” by Basilisco and Bharucha.1 This paper summarizes the advantages and limits of this recent technique that has focused interest for the past 10 years. Regarding our years of practice in this new technique, we would like to discuss specific important points that have not been addressed by the authors. Although usual parameters of anorectal manometry can be assessed with highresolution anorectal manometry (HRAM), other additional measures should be evaluated with this technique. Numerous studies have demonstrated that HRAM is an innovative tool to diagnose anal sphincter defects and pelvic floor disorders. Two studies have demonstrated that HRAM can diagnose anal sphincter defects with an interesting agreement with endoanal ultrasonography.2-4 Although the method to precisely measure anal sphincter defect should be established and validated, these data suggest a new interesting and useful aspect of HRAM. In our opinion, HRAM could assess in the same time both an anatomic and a functional defect by analyzing the anal sphincter function. The second important aspect of HRAM is its capacity to diagnose pelvic floor disorders. Studies have demonstrated that HRAM may not only diagnose perineal descent5,6 but also rectal intussusception7,8 and rectal prolapse9 taking conventional defecography or magnetic resonance defecography as a gold standard. This aspect of HRAM is probably building a new way to consider and interpret the new data that this innovative tool can offer. Of course, these new “anatomic” data have now to be precisely defined and new classifications of pelvic floor disorders observed with HRAM should be developed. Therefore, if HRAM can compete with endoanal ultrasonography and conventional or magnetic resonance defecography, it is clearly worth every penny.

Noncontiguous finished genome sequence and description of Fusobacterium massiliense sp. nov. isolated from human duodenum

The strain Marseille-P2749T (= CSUR P2749 = DSM 103085) was isolated as part of culturomics study from a liquid duodenum sample from a French man. Bacterial cells were Gram-negative bacilli, fusiform shaped and non–spore forming, and they grew in microaerophilic and anaerobic atmosphere. Its genome is 1 809 169 bp long and contains 1646 protein-coding genes. The DNA G+C content was 27.33 mol%. This strain exhibited a 95.9% sequence similarity with Fusobacterium periodonticum, the phylogenetically closest species with standing in nomenclature. Strain Marseille-P2749T is suggested to be a novel species belonging to the genus Fusobacterium, for which the name Fusobacterium massiliense sp. nov. is proposed.

‘Mediterranea massiliensis’ gen. nov., sp. nov., a new human-associated bacterium isolated from the right and left colon lavage of a 58-year-old patient

We report here the main characteristics of ‘Mediterranea massiliensis’ strain Marseille-P2645T (CSURP2645) that was isolated from stored samples of gut.