Jean-Charles Coche

Severe hepatitis associated with the use of black cohosh: a report of two cases and an advice for caution.

In spite of the fact that severe side effects have been reported, black cohosh [Actaea racemosa (syn. Cimifuga racemosa)] is likely to be one of the most popular herbs used in the treatment of postmenopausal symptoms and menstrual dysfunction. We report the cases of two patients, one with submassive liver necrosis and the other with chronic hepatitis most likely related to the use of two different preparations containing black cohosh. This represents another advice for caution concerning this popular preparation of inconsistent therapeutic value.

Profile of pediatric Crohn's disease in Belgium

AIM A Belgian registry for pediatric Crohns disease, BELCRO, was created. This first report aims at describing disease presentation and phenotype and determining associations between variables at diagnosis and registration in the database. METHODS Through a collaborative network, children with previously established Crohns disease and newly diagnosed children and adolescents (under 18 y of age) were recruited over a 2 year period. Data were collected by 23 centers and entered in a database. Statistical association tests analyzed relationships between variables of interest at diagnosis. RESULTS Two hundred fifty-five patients were included. Median age at diagnosis was 12.5 y (range: 1.6-18 y); median duration of symptoms prior to diagnosis was 3 m (range: 1-12 m). Neonatal history and previous medical history did not influence disease onset nor disease behavior. Fifty three % of these patients presented with a BMI z-score < -1. CRP was an independent predictor of disease severity. Steroids were widely used as initial treatment in moderate to severe and extensive disease. Over time, immunomodulators and biological were prescribed more frequently, reflecting a lower prescription rate for steroids and 5-ASA. A positive family history was the sole significant determinant for earlier use of immunosuppression. CONCLUSION In Belgium, the median age of children presenting with Crohns disease is 12.5 y. Faltering growth, extensive disease and upper GI involvement are frequent. CRP is an independent predictive factor of disease activity. A positive family history appears to be the main determinant for initial treatment choice.

A phase II study of preoperative oxaliplatin, capecitabine, and external beam radiotherapy in patients with locally advanced rectal adenocarcinoma. : Abstract #3552

3552 Background: Local recurrence after surgery is a cause of treatment failure in pts with locally advanced rectal cancer (LARC). Preoperative RT decreases local recurrence but not distant spread. Oxaliplatin (OX) and capecitabine (CAP) are both highly active cancer drugs for advanced colorectal cancer and have radiosensitizing properties. Therefore, adding CAP and OX to preoperative RT should improve its efficacy in terms of local control and prevention of metastases. Methods: This study was designed to investigate the efficacy (based on pathological response rate) and safety of preoperative chemo-RT in patients with LACR (T3-T4 and/or N+ staged by endorectal ultrasound). RT was administered for 5 weeks, 5 days a week (1.8 Gy/fraction, total dose 45 Gy, 3D conformation technique) in combination with OX 50 mg/m2 intravenously, weekly for 5 weeks and oral CAP 825 mg/m2 twice a day, each day of radiation. Surgery was performed 6–8 weeks after completion of RT. Results: Since December 2002, 37 out of the 40...

Long-term Outcomes with Anti-TNF Therapy and Accelerated Step-up in the Prospective Pediatric Belgian Crohn's Disease Registry (BELCRO)

Background: Accelerated step-up or anti–tumor necrosis factor (TNF) before first remission is currently not recommended in pediatric Crohns disease. Methods: Five-year follow-up data from a prospective observational cohort of children diagnosed with Crohns disease in Belgium were analyzed. Disease severity was scored as inactive, mild, or moderate to severe. Remission or inactive disease was defined as sustained if lasting ≥2 years. Univariate analyses were performed between anti-TNF–exposed versus naive patients and anti-TNF before versus after first remission and correlations assessed with primary outcomes average disease severity and sustained remission. Results: A total of 91 patients (median [IQR] age 12.7 [10.9–14.8] yrs, 53% male) were included. Disease location was 12% L1, 23% L2, and 64% L3 with 76% upper gastrointestinal and 30% perianal involvement. Disease severity was 25% mild and 75% moderate to severe. Of 66 (73%) anti-TNF–exposed patients, 34 (52%) had accelerated step-up. Anti-TNF use was associated with age (13.1 [11.5–15.2] versus 11.8 [8.7–13.8] yrs; P < 0.05), L2 (29% versus 8%; P = 0.04), and average disease severity (1.7 [1.4–1.9] versus 1.4 [1.3–1.6]; P < 0.001). Duration of anti-TNF correlated with average disease severity (r = 0.32, P = 0.002). Accelerated step-up was also associated with age (13.3 [12.1–15.9] versus 12.5 [10.2–14.1]; P = 0.02) and average disease severity (1.8 [1.6–1.9] versus 1.6 [1.3–1.8]; P = 0.002). Duration of sustained remission was similar in all patients, and no serious infections, cancer, or deaths were reported. Conclusions: Anti-TNF therapy and accelerated step-up in older patients with more severe disease leads to beneficial long-term outcomes.

Paediatric Crohn Disease: Disease Activity and Growth in the BELCRO Cohort After 3 Years Follow-up.

Objective: The Belgian registry for paediatric Crohn disease (BELCRO) cohort is a prospective, multicentre registry for newly diagnosed paediatric patients with Crohn disease (CD) (<18 years) recruited from 2008 to 2010 to identify predictive factors for disease activity and growth. Methods: Data from the BELCRO database were evaluated at diagnosis, 24 and 36 months follow-up. Results: At month 36 (M36), data were available on 84 of the 98 patients included at diagnosis. Disease activity evolved as follows: inactive 5% to 70%, mild 19% to 24%, and moderate to severe 76% to 6%. None of the variables such as age, sex, diagnostic delay, type of treatment, disease location, disease activity at diagnosis, and growth were associated with disease activity at M36. Paediatricians studied significantly less patients with active disease at M36 compared with adult physicians. Sixty percent of the patients had biologicals as part of their treatment at M36. Adult gastroenterologists initiated biologicals significantly earlier. They were the only factor determining biologicals’ initiation, not disease location or disease severity at diagnosis. Median body mass index (BMI) z score evolved from −0.97 (range −5.5–2.1) to 0.11 (range −3.4–2) and median height z score from −0.15 (range −3.4–1.6) to 0.12 (range −2.3–2.3) at M36. None of the variables mentioned above influenced growth over time. Conclusions: Present treatment strategies lead to good disease control in the BELCRO cohort after 3 years. Logistic regression analysis did not show any influence of disease location or present treatment strategy on disease activity and growth, but patients under paediatric care had significantly less severe disease at M36.