J. Boubaker

Metabolic syndrome is associated with gastroesophageal reflux disease based on a 24-hour ambulatory pH monitoring

Several studies have focused on the relationship between metabolic syndrome and gastroesophageal reflux disease (GERD). They were based on GERD complications, whereas little is known about the association between metabolic syndrome and objectively measured esophageal acid exposure. The aim of our study was to assess the relationship between metabolic syndrome and GERD based on a 24-hour pH testing. It was a cross-sectional study including 100 consecutive patients who underwent a 24-hour pH-metry monitoring and were assessed for the five metabolic syndrome components as well as for body mass index (BMI). Among the 100 patients, 54 had a pathological acid GERD. The 46 GERD-free patients represented control group. Sex distribution was comparable between both groups but GERD patients were older than controls (44.59 vs. 37.63 years, P= 0.006) and more often obese or with overweight (83.3 vs. 60.9%, P= 0.01). Frequency of metabolic syndrome as a whole entity was higher among patients with GERD than those without GERD (50 vs. 19.56%; P= 0.002) with a crude odds ratio of 4.11 (95% confidence interval: 1.66-10.14). Multivariate regression analysis showed that metabolic syndrome as well as an age ≥ 30 years were independent factors associated to GERD but not BMI and sex. Abnormal waist circumference and fasting glucose level ≥ 100 mg/L were the only independent factors among the five components of metabolic syndrome. Metabolic syndrome but not BMI was an independent factor associated to GERD. These results confirm the hypothesis that central obesity is associated to GERD.

Effect of pantoprazole in patients with chronic laryngitis and pharyngitis related to gastroesophageal reflux disease: clinical, proximal, and distal pH monitoring results

Few studies had evaluated the results of proton pump inhibitors on distal and proximal pH recording using a dual-channel probe. The aim of this study was to determine the clinical and pH-metric effect of treatment with pantoprazole 80 mg for 8 weeks in patients with ear, nose, and throat (ENT) manifestations of gastroesophageal reflux disease associated with pathological proximal acid exposure. We conducted a prospective open study. Patients included had to have chronic pharyngitis or laryngitis, and a pathological gastroesophagopharyngeal reflux. All patients received treatment with pantoprazole 80 mg daily for 8 weeks. One week after the end treatment, patients had a second ENT examination and a 24-hour pH monitoring using dual-channel probe. We included 33 patients (11 men, 22 women). A pathological distal acid reflux was found in 30 patients (91%). After treatment, the improvement of ENT symptoms was found in 51.5% of patients. Normalization of 24-hour proximal esophageal pH monitoring was observed in 22 patients (66%). After treatment, the overall distal acid exposure, the number of distal reflux events, and the number of reflux during more than 5 minutes were significantly decreased (respectively: 19.4% vs 7.2% [P < 0.0001], 62.7 vs 28.4 [P < 0.0001], and 10.4 vs 3.9 [P < 0.0001] ). Similarly, in proximal level, the same parameters were significantly decreased after treatment (respectively: 6.8% vs 1.6% [P < 0.0001], 32.6 vs 8.1 [P < 0.0001], and 3.4 vs 0.6 [P= 0.005] ). Treatment with pantoprazole reduced the frequency and severity of gastroesophagopharyngeal acid reflux in patients with chronic pharyngitis and laryngitis.

Circulating antimyenteric autoantibodies in Tunisian patients with idiopathic achalasia.

The physiopathology of idiopathic achalasia is still unknown. The description of circulating antimyenteric autoantibodies (CAA), directed against enteric neurons in sera of patients, suggests an autoimmune process. Recent data showed controversies according to the existence and the significance of CAA. The aims of this study were to investigate whether CAA are detected in Tunisian patients with idiopathic achalasia and to look for associated clinical or manometrical factors with CAA positivity. Twenty-seven patients with idiopathic achalasia and 57 healthy controls were prospectively studied. CAA were assessed by indirect immunofluorescence on intestinal monkey tissue sections. Western blot on primate cerebellum protein extract and dot technique with highly purified recombinant neuronal antigens (Hu, Ri, and Yo) were further used to analyze target antigens of CAA. CAA were significantly increased in achalasia patients compared with controls when considering nuclear or cytoplasmic fluorescence patterns. (33% vs. 12%, P = 0.03 and 48% vs. 23%, P = 0.001 respectively). By immunoblot analysis, CAA did not target neuronal antigens, however 52/53 and 49 kDa bands were consistently detected. CAA positivity was not correlated to specific clinical features. The results are along with previous studies demonstrating high CAA prevalence in achalasia patients. When reviewing technical protocols and interpretation criteria, several discrepancies which could explain controversies between studies were noted.

P310 Toxicity of thiopurines in patients with inflammatory bowel disease: Frequency and risk factors

the hospital and during their transition back to ambulatory care. Strategies to bridge this gap have not been formally evaluated. These data assess the outcome of inpatient to ambulatory care transition under our current standard of care. The McMaster University/Hamilton Health Sciences IBD Clinic is exploring a formal transition program led by a dedicated IBD nurse practitioner. Our outcomes will be reassessed following introduction of this pilot program.

P540 Can we predict response to cyclosporine as second line therapy in patients with severe acute colitis of inflammatory bowel disease

the anti-TNFalfa antibody-treated group and the non-antiTNFalfa antibody-treated group. Results: Rutgeerts’ grade 4 was significantly associated with abdominal symptoms, when compared with Rutgeerts’ grades 0 3 (P< 0.0001). Endoscopic recurrence designated as Rutgeerts’ grades 2 4 was associated with non-use of 5-aminosalicylic acid (P= 0.021) and post-operative period (longer than 1.5 year, P= 0.013). Clinical recurrence designated as Rutgeerts’ grades 4 was associated with non-use of 5-aminosalicylic acid (P=0.048), post-operative period (longer than 1.5 year, P= 0.0002) and use of immunomodulators (P= 0.039). The patency of the anastomotic sites in the antiTNFalfa antibody-treated group was better than in the nonanti-TNFalfa antibody-treated group (P= 0.035). Conclusions: Non-use of IFX or 5-aminosalicylic acid and postoperative period was associated with recurrence of smallbowel anastomotic sites in patients with CD.

P165 Pseudotumoral colonic form of Crohn's disease: a series of 16 cases

factors on QoL in IBD patients with and without arthropathies, prospectively over 1 year. Methods: In total, 181 IBD patients were questioned about joint pain. At baseline, 135 patients (77% Crohn’s disease (CD), 34% male) had arthropathies (daily back pain for 3 months and/or peripheral joint pain and/or joint swelling during the last year), another 46 patients (74% CD, 50% male) who had no arthropathies served as controls. QoL was assessed by the shortIBDQ and SF-36 (physical (PCS) and mental (MCS) component summary scores). Harvey Bradshaw Index (HBI) and Simple Clinical Colitis Activity Index (SCCAI) were used to measure IBD activity (active disease if HBI/SCCAI >4). Disease activity and (nocturnal) pain, back and peripheral joints, were scored (11-point numerical rating scale [NRS]). The selfadministered questionnaires were assessed every 3-months. Uniand multivariate (linear mixed model) analyses were performed to investigate which variables (age, gender, type of IBD, IBD duration, IBD activity, 6 NRS scores, smoking and employment) were associated with QoL. Variables with a p < 0.20 were included in multivariate analyses. Because of the strong correlation between the 6 NRS scores, we included 2 of 6 scores in the multivariate analyses. Results: The mean age and mean IBD disease duration of all patients (n = 181) were 43.6±13.7 and 15.6±11.1 years, respectively. Multivariate analysis showed that an increase in NRS of disease activity back and peripheral joints and IBD activity were independently negatively associated with shortIBDQ (all p < 0.001). Increased IBD duration and employment were independently positively associated with shortIBDQ (both p < 0.05). Back and peripheral joint pain, IBD activity and unemployment were independently negatively associated with PCS (all p < 0.001). Disease activity of peripheral joints and IBD were independently negatively (both p < 0.001), and employment and age independently positively associated with MCS (both p < 0.05). Conclusions: An increase in severity of back and peripheral joint pain, disease activity of the back and peripheral joints and IBD activity are independently negatively associated with QoL in IBD patients. Furthermore, employment, increased IBD duration and age are independently positively associated with QoL.

P.176 Evaluation de l’atteinte grêlique proximale de la maladie de Crohn par vidéocapsule endoscopique : étude prospective comparative avec l’entéroscanner et le transit du grèle

Introduction La videocapsule endoscopique (VCE) est une nouvelle technique permettant l’exploration de l’ensemble de l’intestin grele. La maladie de Crohn touche principalement l’ileon terminal, mais l’atteinte grelique proximale est certainement sous estimee par les methodes d’imagerie et d’endoscopie conventionnelles. Buts Evaluer les performances de la VCE pour la detection des lesions greliques proximales asymptomatiques chez des malades consecutifs porteurs d’une maladie de Crohn de localisation ileale, comparer les resultats de la VCE a ceux du transit du grele et de l’enteroscanner, et de determiner l’impact therapeutique decoulant des donnees de la VCE chez ces patients. Patients et Methodes Une etude prospective comparative a ete entamee. Nous avons inclus les cas de maladie de Crohn avec localisation ileale connue, soit sur des donnees endoscopiques soit radiologiques. Les patients prenant des AINS etaient exclus. Tous les patients ont beneficie d’un transit du grele. En l’absence de stenose grelique, un examen par VCE etait pratique, suivi dans les 15 jours d’un enteroscanner. L’atteinte proximale endoscopique etait definie par la presence d’ulcerations aphtoides, superficielles ou creusantes, sur le jejunum ou la partie initiale de l’ileon. Les lesions a type d’œdeme, ou d’erytheme n’ont pas ete considerees comme etant significatives. Resultats Notre etude a porte sur 20 malades (12 hommes, 8 femmes) d’âge moyen 31,6 ans (18 - 60). Onze patients etaient en poussee de leur maladie, et neuf patients etaient sous traitements au moment de l’inclusion dans le protocole. La VCE a confirme l’atteinte distale dans tous les cas, et a montre une atteinte proximale dans neuf cas, interessant soit le jejunum (un cas), le jejunum et l’ileon proximal (six cas) ou l’ileon proximal (deux cas). Les lesions observees etaient essentiellement a type d’ulcerations aphtoides ou superficielles, associees a un aspect erythemateux de la muqueuse. Des ulcerations creusantes n’ont ete trouvees que chez deux patients. Le transit du grele et l’enteroscanner n’ont detecte aucune atteinte jejunale. Une atteinte ileale proximale a ete detectee par le transit du grele chez deux patients, et par l’enteroscanner uniquement chez un patient. Au vu des donnees de la VCE, le diagnostic de maladie de Crohn jejuno-ileale etendue a ete pose dans deux cas, ayant necessite leur mise sous azathioprine en traitement de fond. Conclusion La VCE est plus performante que le transit du grele et l’enteroscanner pour la detection des lesions greliques proximales de la maladie de Crohn. Elle permet de trouver des lesions muqueuses le plus souvent moderees, mais peut avoir un impact therapeutique dans certaines situations.

P.387 Les anomalies du métabolisme osseux au cours de la cirrhose

Introduction Il est etabli que la cirrhose biliaire primitive s’associe a des troubles du metabolisme osseux et plus particulierement a une osteoporose dans 15 a 50 % des cas. De meme, il a ete recemment constate que ces anomalies sont egalement retrouvees au cours de la cirrhose et ce independamment de son etiologie avec une frequence variant entre 20 et 50 %. But du travail Determiner chez un groupe de patients ayant une cirrhose : – La frequence des differentes anomalies du metabolisme osseux a savoir l’osteoporose et l’osteopenie – Les facteurs de risque cliniques ou biologiques associes a ces anomalies. Patients et Methodes Nous avons mene une etude prospective incluant les patients ayant une cirrhose d’etiologie virale ou alcoolique. Nous avons exclus les malades menopausees, les patients ayant une cirrhose biliaire primitive et ceux ayant une cirrhose d’origine metabolique ou auto immune. Nous avons realise une densitometrie osseuse a tous les patients inclus de meme qu’un bilan phosphocalcique sanguin, urinaire et hepatique. Resultats 25 patients ont ete inclus. Il s’agissait de 14 hommes et de 11 femmes d’âge moyen 52,16 ans (extremes : 21-84 ans). Nos patients avaient un indice de masse corporelle moyen de 25,9 kg/m 2 , un taux de tabagisme et d’alcoolisme estimes respectivement a 36 % et a 16 %. La duree moyenne de la maladie etait de 4 ans (extremes : 1-9 ans). L’etiologie post-virale C et le score B de Child-Pugh predominaient chez nos patients et uniquement 2 avaient une cirrhose degeneree. L’osteodensitometrie etait normale chez 5 patients (20 %). Une osteopenie et une osteoporose ont ete observees chez respectivement 11 (44 %) et 9 (36 %) des cirrhotiques avec une densite osseuse moyenne de 0,981 g/cm 2 au niveau de la 2 eme et 4 eme vertebre lombaire et de 0,905 g/cm 2 au niveau du col femoral. Aucune caracteristique clinique n’etait associee a un risque statistiquement significatif d’une anomalie du metabolisme osseux. Seuls des parametres biologiques etaient predictifs de survenue d’osteopenie ou d’osteoporose, representes par l’hypocalcemie, la cytolyse et l’uree urinaire. Conclusion Les troubles du metabolisme osseux sont frequents au cours de la cirrhose et peuvent etre responsables d’une morbidite surajoutee. La realisation systematique d’une osteodensitometrie chez ces patients pourrait contribuer a une meilleure prise en charge.

Facteurs de risque de perte osseuse chez les patients atteints de maladie de Crohn

RésuméButsÉtudier le degré de la baisse de la densité minérale osseuse (DMO) ainsi que les facteurs de risque de perte osseuse chez les patients atteints de maladie de Crohn (MC).MéthodesNous avons mené une étude rétrospective ayant porté sur des patients atteints de MC, hospitalisés dans le service entre 2004 et 2006, et qui avaient bénéficié d’une mesure de leur DMO.RésultatsNous avons inclus 40 patients atteints de MC, 26 hommes et 14 femmes, d’âge moyen 35 ans (extrêmes: 15–60 ans). La maladie évoluait depuis une moyenne de 66,2 mois (extrêmes: 2–240 mois) et était de siège iléocolique dans 55% des cas. La majorité des patients (90 %) avaient déjà reçu des corticoïdes. Une ostéoporose a été diagnostiquée dans 32,5 % des cas et une ostéopénie dans 47,5 % des cas. L’indice de masse corporelle (IMC) était le facteur de risque dominant pour l’ostéoporose. En effet, L’IMC était de 21,6 (17,2–27,8) chez les sujets sains et de 17,7 (12,9–21) chez les ostéoporotiques (p = 0,0004). Par ailleurs, la DMO corticale, exprimée en gramme par centimètre carré, était plus basse quand la maladie évoluait depuis plus d’un an que lorsque celle-ci était plus récente (1,061 ± 0,085 versus 0,93 ± 0,123, p = 0,02). Enfin, une corrélation significative a été notée entre une durée globale de corticothérapie de plus de six mois et la baisse de la DMO au niveau de l’os cortical (p = 0,004, odds ratio = 5,5).ConclusionLa dénutrition ressort comme le principal facteur de risque de perte osseuse dans notre population de patients atteints de MC et à moindre degré l’ancienneté de la maladie. Un dépistage de la perte osseuse est préconisé chez les patients atteints de MC surtout s’ils présentent des facteurs de risque de perte osseuse, et ce, en vue d’une prise en charge précoce.AbstractIntroductionPatients with Crohn’s disease (CD) are at greater risk of developing osteoporosis and osteopenia than healthy controls. The aim of the study was to determine the prevalence and risk factors of osteoporosis in patients with CD.MethodsForty patients were consecutively included, 26 men and 14 women, with a mean age of 35.1 ± 11.2 years (15–60 years). Dual-energy X ray absorptiometry measurements of bone mineral density (BMD) were obtained at the femoral neck and at the lumbar spine.ResultsOsteoporosis was found in 32.5% and osteopenia in 47.5% of patients. Median body mass index (BMI) was lower in patients with osteoporosis than in those without osteoporosis (17.67 versus 21.8, P = 0.001). Neither disease duration nor steroid use were associated with bone loss.ConclusionMalnutrition seems to be a major risk factor of bone loss in patients with CD. It should be taken into consideration when planning treatment programs.