Jean-Jacques Raynaud

Is the Colonic Response to Food Different in IBS in Contrast to Simple Constipation or Diarrhea Without Abdominal Pain

BackgroundColonic response to food (CRF) is abnormal in irritable bowel syndrome (IBS) patients.AimsThe aim of this study was to compare CRF in patients who complain of abnormal defecation pattern according to the presence or absence of abdominal pain.MethodsOne hundred forty-nine patients and 50 controls were studied: 96 IBS patients (46 IBS-C, 13 IBS-D, 15 IBS-M, and 22 IBS-U not included), 43 patients with functional constipation (group C) and ten with functional diarrhea (group D). Clinical evaluation and visual analog scales about four items (constipation, diarrhea, abdominal bloating and abdominal pain) were filled by all subjects. Colonic transit time (CTT) was measured in fasting conditions and after eating a standard 1,000-cal test meal. CRF was quantified by calculating the variation in number of markers between the two films.ResultsThe frequency of meal-related symptoms did not vary among the different groups of patients but was significantly higher than in controls. Compared to IBS-C patients, constipated patients of the group C had longer total and segmental colonic transit time, and compared to IBS-D patients, diarrheic patients of the group D had shorter oro-anal and segmental colonic transit time except in the recto-sigmoid area. CRF was different in patients and controls, and differed between IBS and non IBS patients with similar transit abnormalities. Stool output was greater in patients of the group D than in patients of the IBS-D group.ConclusionThe different subgroups of IBS patients have different CRF patterns, distinct from subjects with constipation and diarrhea, but without abdominal pain.

Isoniazid-Induced Recurrent Pancreatitis

CONTEXT Drug induced pancreatitis are rare but potentially serious. Thus, drug withdrawal is warranted. CASE REPORT A 79-year-old woman who was treated with antituberculosis therapy for 5 weeks was admitted to our unit for pancreatitis. Usual etiologies of pancreatitis were eliminated. Because of vomiting, antituberculosis therapy was withdrawn and symptoms disappeared. Eight days later, the same treatment was reintroduced and the patient presented recurrent pancreatitis; thus, treatment was withheld again followed by disappearance of clinical and biological abnormalities. Two days later, a treatment without isoniazid was reintroduced and no recurrence of symptoms was observed. CONCLUSIONS We have experienced a case of isoniazid induced pancreatitis. This is a rare cause of pancreatitis but potentially fatal thus recognition of drug induced pancreatitis and definitive withdrawal of the drug is required.

Place du ballon gastrique dans la prise en charge de l’obésité morbide en 2012

Le ballon gastrique induit des modifications de la regulation du comportement alimentaire. Le ballon entraine a court terme une perte de poids moyenne de 15 kg (extremes : 0-25 kg) et une amelioration des comorbidites liees a l’obesite. Plusieurs modeles sont actuellement disponibles dont le mode de remplissage et la duree d’utilisation sont variees. Le ballon induit des effets secondaires immediats frequents a type de nausees et vomissements ainsi que des douleurs abdominales, mais aussi des complications rares qui peuvent etre severes. L’apprentissage des techniques de pose et de depose doit se faire dans des centres d’experts. Les donnees disponibles suggerent que l’effet du ballon diminue a distance du retrait mais qu’un effet persiste chez au moins un tiers des patients initialement repondeurs. La pose du ballon n’est envisageable que dans le cadre d’une prise en charge multidisciplinaire.

Traitement par coagulation au plasma argon (APC) d’un sarcome de Kaposi duodénal

RésuméQuatre formes de sarcome de kaposi (SK) sont actuellement identifiées (classique, endémique, post-transplantation et épidémique, c’est-à-dire liée au VIH). La forme dite post-transplantation est rare et liée à une immunodépression iatrogène (traitement immunosuppresseur).Nous présentons le cas clinique d’un patient de 73 ans, traité depuis 1999 par corticoïdes et Azathioprine (100 mg/J) pour une fibrose pulmonaire idiopathique et qui a présenté au cours de l’évolution une réactivation virale B et un sarcome de Kaposi digestif. L’arrêt du traitement immunosuppresseur associé à un traitement local par électrocoagulation au plasma argon des lésions de SK a permis l’évolution rapide vers la guérison.SummaryIatrogenic Kaposi’s sarcoma is a rare entity, which usually appears in transplants or in patients undergoing immunosuppressive treatment.We present the case of a 73-year old man treated with 20mg/day of corticoids and 100mg/day of Azathioprine for an Idiopathic Pulmonary Fibrosis diagnosed in 1999 complicated with a reactivation of Hepatitis B virus and a digestive Kaposi’s sarcoma.The discontinuation of immunosuppressive therapy together with a local therapy by APC can be proposed as an appropriate treatment policy. To our knowledge this is the first case of a digestive KS treated by argon plasma coagulation (APC).