Colin R

Epidemiology and course of acute upper gastro-intestinal haemorrhage in four French geographical areas

Objective To compare incidence rates and epidemiological characteristics of acute upper gastrointestinal haemorrhage (AUGIH) in France with those of other European studies. Design Population‐based multi‐centre prospective survey. Setting 29 public hospitals and 96 private specialists in gastroenterology in four administrative areas in France during 1996. Subjects A total of 2133 AUGIH patients 18 years and over were included in the six‐month study. Outcome measures Incidence and mortality. Results The overall incidence in France was 143 cases per 100 000 persons per year, classified as out‐patients (16%), emergency admissions (59%) and in‐patients (25%). The incidence rates increased with age except for in‐patients, and were higher in males. Peptic ulcer (36.6%), varices (13.7%) and erosive disease (12.3%) were the most frequent diagnoses. In 677 patients (31.7%), aspirin, antiinflammatory drugs or corticosteroids were taken on the 7 days before bleeding. The overall mortality (out‐patients excluded) was 14.3% (10.7% for emergency patients and 23% for in‐patients). Mortality was associated with comorbidities (especially malignancies, cirrhosis, asthma or respiratory deficiency), was lower in emergency patients using non‐steroid anti‐inflammatory drugs, and higher in in‐patients using corticosteroids. Conclusions In France, patients with AUGIH are frequently managed as out‐patients. Gastrotoxic drug use is frequently associated with AUGIH and constitutes a strategic opportunity for preventive treatment. Discrepancies between countries are not clearly explained either by demographic factors or by drug use, but this may be related to the emphasis on AUGIH in in‐patients. Eur J Gastroenterol Hepatol 12:175‐181

Hepatic Alterations During Total Parenteral Nutrition in Patients with Inflammatory Bowel pisease: A Possible Consequence of Lithocholate Toxicity

In order to understand the mechanism of hepatic abnormalities appearing during total parenteral nutrition, biliary bile acid composition and liver function tests were examined serially in 15 patients undergoing total parenteral nutrition for inflammatory bowel disease. In all 12 patients who underwent duodenal intubation before initiation of total parenteral nutrition, lithocholic acid accounted for less than 1% of total biliary bile acids. After 11-22 days of total parenteral nutrition, lithocholic acid accounted for 7%-15% of biliary bile acids in 5 patients and less than 1% of biliary bile acids in 10 patients. In the 5 patients with elevated levels of biliary lithocholic acid, serum alkaline phosphatase and aminotransferase activities rose progressively at serial determinations, the increase being significant after 2 wk of total parenteral nutrition. These results suggest that lithocholic acid may be involved in the hepatic lesions observed in patients undergoing total parenteral nutrition.

Colonic transit time of radiopaque markers and rectoanal manometry in patients complaining of constipation

Transit time, rectoanal manometry, and symptoms were studied in 61 patients complaining of constipation. A slow transit, in the colonic area of most of the patients, was found in 49. Rectoanal manometry was abnormal in 40. Both examinations were abnormal in 32 patients, colonic transit only in 17, and manometry only in eight. Finally, both examinations were normal in only four subjects. A transit delay was always associated with less than three stools per week, and straining at stool was constant when rectoanal manometric disturbances were shown. Objective abnormalities appear common in patients complaining of constipation and, correlated with symptoms, suggest that clinical study in constipation could be of more value than usually is believed.

There are some benefits for eradicating Helicobacter pylori in patients with non-ulcer dyspepsia

: The relationship between Helicobacter pylori infection and non‐ulcer dyspepsia is not established.

Gastroesophageal reflux disease in primary care : Prevalence, epidemiology and quality of life of patients

AIM To determine the prevalence of typical symptoms of gastroesophageal reflux disease in a large group of patients consulting their general practitioners (GP) for diverse reasons, as well as the quality-of-life (QoL) of patients with such symptoms. PATIENTS AND METHODS During the same day, participating GPs (N=3 200) systematically asked all of their patients about the presence of heartburn and regurgitation. For all patients who responded positively, the GPs filled in a questionnaire and the patient a specific QoL questionnaire. RESULTS Among 40 982 patients attending GP consultations, 4 124 (10.1%) had one or both symptoms. Prevalence was higher in men (11.1%) than in women (9.3%, P<0.001), and increased with age up to 50-59 yrs then slowly declined. Symptoms were present on a weekly basis in 72.8% of patients. Smoking, frequent or nocturnal occurrence of symptoms, regurgitation, and esophagitis were significantly linked up with a higher occurrence of extra-digestive symptoms (cough, ENT symptoms, chest pain). QoL declined with increasing frequency of symptoms, which especially affected food intake, psychology, well-being and daily life. CONCLUSION In France, typical symptoms of gastroesophageal reflux disease are observed in 10% of the adult population, and markedly alter their QoL.

Chronic hepatitis C with normal or abnormal aminotransferase levels: is it the same entity?

Objective The features of hepatitis C virus (HCV) infection with persistently normal serum alanine aminotransferase (ALT) activity levels are not well defined. This study evaluated the characteristics of HCV infection according to the presence or absence of elevated ALT. Methods Demographic data, liver histology and HCV genotype were studied in a group of 80 HCV-RNA-positive subjects with persistently normal ALT (PNALT) (group 1), and compared with a second group of 455 HCV-RNA-positive patients with elevated ALT (group 2). The annual progression of liver fibrosis was also calculated. Results A higher proportion of women was found in group 1: 64% vs 42% in group 2 (P < 0.0002). The HCV genotype 1 was less frequent in group 1: 49% vs 60% in group 2 and genotype 2 was more frequent: 16% in group 1 vs 4% in group 2 (P < 0.002). Cirrhosis was less frequent in group 1 (4% vs 13% in group 2 (P < 0.0001)). Normal liver was more frequent in group 1: 9% vs 1% in group 2 (P < 0.0001). The Knodell score was significantly different between the two groups: 3.2 ± 0.27 vs 7.15 ± 0.22 (P < 0.0001). The progression of liver fibrosis was lower in group 1: 0.053 ± 0.14 units/year vs 0.13 ± 0.24 in group 2 (P < 0.007). Conclusion HCV infection with PNALT is associated with less severe histological liver disease and a lower fibrosis progression rate. This suggests that the natural history of HCV infection in these patients is different from that in patients with abnormal ALT.

Postoperative management of stage II/III colon cancer: A decision analysis

BACKGROUND & AIMS Two separate decisions must be made for the management of patients with resected stage II/III colon cancer: whether to begin adjuvant chemotherapy and whether patients should be included in a follow-up protocol consisting of regular monitoring of carcinoembryonic antigen level and of colonoscopy and imaging. The standard management for these patients is adjuvant chemotherapy for stage III patients and follow-up for stage II/III patients with resected colon cancer. METHODS Decision analysis was used to compare the effectiveness (5-year survival rate) and cost-effectiveness ratio of 7 strategies of treatment and follow-up. RESULTS The most cost-effective strategies were adjuvant chemotherapy for all patients with stage II/III resected colon cancer, with either no follow-up or follow-up only for patients aged less than 75 years with a seric preoperative carcinoembryonic antigen level of >5 ng/mL (5-year survival, 62.3% or 62.7%; cost per surviving patient,

Comparison of the Effects of Continuous and Cyclic Nocturnal Parenteral Nutrition on Energy Expenditure and Protein Metabolism

8254 or

Detection and genotyping of the hepatitis C RNA in tear fluid from patients with chronic hepatitis C

8657, respectively). The order of efficacy of the strategies was insensitive to changes in the values of the studied variables. The method of follow-up does little to improve 5-year survival but adds substantial cost. CONCLUSIONS The current standard strategy may not be the most cost-effective strategy for the management of patients with resected colon cancer.

Duodenojejunal motility after oral and enteral nutrition in humans: a comparative study.

Although cyclic nocturnal total parenteral nutrition is a widely used technique, its metabolic consequences have not been fully investigated. During two successive 7-day periods, 12 patients received randomly either standard continuous (infusion 24 hr/day) or cyclic (infusion between 5 pm and 9 am) total parenteral nutrition (TPN). Calorie and nitrogen intakes were identical during both periods. Energy expenditure was investigated by indirect calorimetry and showed practically no difference between continuous standard (1383 +/- 41 kcal/day-1) and cyclic total parenteral nutrition (1428 +/- 46 kcal/day-1). However, in the cyclic regimen, when compared with continuous infusion, energy expenditure was higher between 5 pm and 9 am and lower between 9 am and 5 pm. At the end of the noninfusion period, the 24-hr profile of the nonprotein respiratory quotient showed a slight decrease in patients receiving the cyclic infusion, in contrast with the stability of the quotient in the standard regimen. However, the nitrogen balance and variations in nutritional status did not differ significantly. In conclusion cyclic TPN is efficient for achieving a positive energy and nitrogen balance and in addition it induces a metabolic profile closer to physiological conditions.