Background and aims The aim of this study was to determine the mortality and re-bleeding rates, and the risk factors involved, in a cohort of patients with previous diverticular bleeding (DB).Methods In 2007, data on 2462 patients with lower gastrointestinal (GI) bleeding were collected prospectively at several French hospitals. We studied the follow-up of patients with DB retrospectively. The following data were collected: age, mortality rates and re-bleeding rates, drug intake, surgery and comorbidities.Results Data on 365 patients, including 181 women (mean age 83.6 +/- 9.8 years) were available. The median follow-up time was 3.9 years (IQR 25-75: 1.7-5.4). Of these, 148 patients died (40.5%). Among the 70 patients (19.2%) who had at least one re-bleeding episode, nine died and three underwent surgical procedures. Anticoagulation and antiplatelet therapy was discontinued in 70 cases (19.2%).The independent risk factors contributing to mortality were age > 80 years (HR = 3.18 (2.1-4.9); p < 0.001) and a Charlson comorbidity score > 2 (1.91 (1.31-2.79); p = 0.003). Discontinuation of therapy was not significantly associated with a risk of death due to cardiovascular events. No risk factors responsible for re-bleeding were identified, such as antiplatelet and anticoagulant therapy in particular.Conclusions In this cohort, the rates of mortality and DB re-bleeding after a median follow-up time of 3.9 years were 19.2% and 40.5%, respectively. The majority of the deaths recorded were not due to re-bleeding.

AIMS:The primary objectives of this observatory were: (1) to assess the prevalence of extradigestive symptoms (EDS) (asthma, pharyngeal pain, chronic hoarseness, nocturnal breathlessness, chronic or nocturnal cough, non-cardiac chest pain) which are suspected of being associated with gastro-oesophageal reflux (GERD) in a population consulting in general practice; (2) to compare the diagnostic and therapeutic approach adopted initially and at follow-up to the recommendations of the French-Belgian Consensus Conference on adult GERD (1999).METHODS:The survey was conducted among 578 general practitioners (GPs). All EDS were investigated in patients (≥ 18 y.o.) consulting over 3 days. Only patients considered a priori as having GERD related EDS were included in study. At each visit (initial and at 1 and 4 months), the diagnostic and therapeutic approach was analyzed, scored, and the GP's certainty regarding the accountability of GER in the EDS rated using the visual analogue scale (VAS). The criteria used by GPs to evaluate GER accountability as certain or doubtful were examined.RESULTS:Out of 33,487 consulting patients, 14% presented EDS (cough: 6.7%; ENT symptoms: 7.7%; chest pain: 2.3%). Among patients presenting EDS, 22% (1063) were included in the study based on suspicion of GERD, whereas 45% (481) had neither history nor digestive symptoms typically associated with GERD. The diagnostic approach did not vary whether the patient presented typical EDS associated symptoms (A+) or not (A-): 83.7% of patients (A+) versus 86.5% (A-) immediately received acid reflux treatment; 4.6% (A+) versus 7.9% (A-) underwent additional testing and 5.2% (A+) versus 4.4% (A-) were referred to a specialist. In 87% of cases, acid reflux treatment included a proton pump inhibitor (PPI) (half-dose: 47.2%, standard dose 50.3%, double dose 2.5%); in 8.1% of patients initial acid reflux treatment included an H2 antagonist while in 3.2% of patients treatment included prokinetic drugs. At 4 months of follow-up, GERD accountability was considered certain in 74.7% of the patients included in the assessment (794/1063). The GPs opinion was based on response to acid reflux treatment in 92% of cases, on endoscopy in 6.7% of cases, on pH monitoring in 0.3% of cases and on a specialist's opinion in 6% of cases.CONCLUSION:There is a considerable difference between the recommendations of the French-Belgian Consensus Conference on adult GERD and the practices observed in general medicine. The diagnostic and therapeutic approaches were empirical with recourse to additional exams in less than 10% of cases. The degree of certainty as to GERD accountability was based primarily on response to PPI treatment.

Background and objective: Mortality of upper gastrointestinal bleeding seems declining. Whether practice guidelines for the management of peptic ulcer bleeding are followed is unknown. We aimed to update epidemiology of peptic ulcer bleeding and to assess the adherence to guidelines in the French community.Methods: Between March, 2005 and February, 2006, a prospective multicenter study was conducted including all patients with communautary upper gastrointestinal bleeding. Data from patients with peptic ulcer bleeding were extracted and analyzed.Results: Out of 3203 analyzable patients included, 1140 (35.6%) had a peptic ulcer bleeding and 965 of them a duodenal and/or gastric ulcer. Seven hundred and thirty-five were male (64.5%) and mean age was 66.4 years (+/- 18.8). Overall, 699 patients (61.3%) were taking medication inducing upper gastrointestinal bleeding. Two-hundred and sixty-eight (23.5%) patients had endoscopic therapy, 190 (70.9%) of whom had epinephrine injection alone. Among the 349 patients with high risk stigmata on endoscopy (Forrest IA, IB, IIA), 209 (59.9%) underwent endoscopic therapy. One thousand one hundred and seven patients (97.1%) were given proton-pump inhibitors. One hundred and thirty-four patients (11.8%) experienced haemorrhagic recurrence. Forty-eight patients (4.2%) underwent surgery and 61 (5.4%) died.Conclusions: Consistently with previous studies, mortality of upper gastrointestinal bleeding seems declining. Further progress lies above all in prevention but also probably in better adherence to therapeutic guidelines and management of comorbidities. (C) 2012 Published by Elsevier Masson SAS.

Little data is available on the upper gastrointestinal bleeding (UGIB) associated resulting from Mallory-Weiss syndrome (MWS). The aim of this study was to describe the characteristics and identify the prognostic factors of UGIB associated with MWS.

Colonic angiodysplasia are usually responsible for iron deficiency anemia. The aim of this study is to describe the clinical features and prognostic factors of colonic angiodysplasia responsible for lower GI bleeding (LGIB).

Background: Though functional gastrointestinal disorders (FGID) are common problem in clinical pediatric practice, little is known about physician perception of these disorders.Aim: To evaluate physician beliefs and attitudes towards FGID.Method: We invited 500 primary care providers (PCP) and NASPGHAN members (PGIs) to participate in a web based study on FGID etiology, pathophysiology, use of diagnostic tests and treatment practices.The responses of PCPs and PGIs were compared using chi-square.Results: 158 PCPs (89% in private practice, 11% hospital based) and 350 PGIs (10% GI fellows, 11% private practice & 79% hospital/academic practice) completed the survey.Diagnostic Criteria: 27% of PCPs and 77% of PGIs knew about Apley's criteria (p<0.0001);9% of PCPs & 26% of PGIs used these in clinical practices (p<0.0001).28% of PCPs compared to 99% of PGIs knew about the Rome criteria (p<0.0001) and 9% of PCPs & 71% of PGIs used these in clinical practice (p<0.0001).Pathophysiology: 53% of PCPs and 70% of PGIs agreed that understanding of the pediatric FGIDs has improved considerably in last 10 yrs (p = 0.002).Investigations: 36% PCPs believe that clinical evaluation alone is sufficient to make a diagnosis of functional abdominal pain (FAP) in the majority of the patients and 66% rarely or never refer these patients to a specialist.45% of PGIs feel comfortable diagnosing FAP on clinical evaluation alone and 69% believe that more than half of the patients end up requiring endoscopic evaluation.PGIs with more than 10 yrs of experience were more likely to diagnose functional abdominal pain on clinical evaluation alone (p<0.01) and were less likely to recommend endoscopic evaluation in children with FGID (p<0.0001)Treatment: behavioral modification therapy is recommended by 13% of PCPs and 30% of PGIs in the majority of patients with FAP (p<0.001).Physicians with less than 5 yrs of experience were more likely to recommend behavioral modification therapy for FAP (p=0.04).Regarding tricyclic antidepressant use, 98% of PCPs & 72% of PGIs never or rarely use this class of drugs to treat FAP (p<0.0001).45% of PCPs and 40% of PGIs believe that treatment of FGIDs has improved in the last decade.Conclusion: PCPs and PGIs have differing views regarding FGID.The majority of PCPs are not aware of the symptom based criteria including the Rome criteria for diagnosing FGID.Behavioral modification therapy for FAP is rarely recommended by both groups.The majority of PGIs do not use tricyclic antidepressants for treatment of FAP.Strategies to increase awareness regarding FGIDs and treatment options amongst PCPs and PGIs are required.

Background: Hospital staffing is often lower at weekends than on weekdays. Consequently, it may be difficult to perform endoscopies and if necessary an appropriate endoscopic treatment. The aims of this study were to evaluate the characteristics and prognostic factors of upper GI bleeding (UGIB) during weekends versus weekdays. Methods: We conducted a prospective multicenter study from March 2005 to February 2006 in 53 French hospitals that included 3287 patients with UGIB. In a post hoc subanalysis, we analyzed the prognostic factors of UGIB using univariate analysis. Patients who did not undergo endoscopy were excluded (n=204). Results: 3083 patients had an endoscopy, 684 (22.2%) during a weekend (G1) and 2399 (77.8%) during a weekday (G2). There was no statistical difference between the patients of G1 and G2 as regards the mean age and sex ratio. Patients from G1 were more frequently hospitalized in intensive care unit 21% vs. 11.6% (P<0.0001), however, the mean Rockall score was not different between the two groups 5.2 ± 2.3 vs. 5 ± 2.7 (P=0.1), moreover, no more serious comorbidities were observed between the two groups 1.64 ± 1.34 vs. 1.59 ± 1.84 (P=0.5). The mean time to endoscopy was significantly shorter in G1 vs. G2: 0.35 vs. 1.03 days (P <10-6). Specialized help for endoscopy was available in 40% of the cases during weekends vs. 85% of the cases during weekdays (P< 10-6). There was active bleeding (Forrest Ia, Ib, IIa, IIb) in 455 (66.5%) cases in G1 vs. 1288 (53.6%) cases in G2 (P=0.003) resulting in endoscopic treatment in 208 (45.7%) vs. 634 (49.2%) cases (P=0.2). In-hospital mortality was not different between G1 and G2: 59 (8.6%) vs. 164 (6.8%) (P=0.13) while the rate of rebleeding was higher 12.6% vs. 9.1% (P=0.01) in G1 vs. G2. Conclusion: Although the mean time to endoscopy is shorter during weekends vs. weekdays, this cannot be explained by the greater severity of the patients' conditions but probably by their more frequent hospitalization in intensive care. The rate of rebleeding was higher among the patients who had had an endoscopy during the weekend but in-hospital mortality was the same; the explanatory reasons could be the frequent absence of specialized help.

Background: Though functional gastrointestinal disorders (FGID) are common problem in clinical pediatric practice, little is known about physician perception of these disorders.Aim: To evaluate physician beliefs and attitudes towards FGID.Method: We invited 500 primary care providers (PCP) and NASPGHAN members (PGIs) to participate in a web based study on FGID etiology, pathophysiology, use of diagnostic tests and treatment practices.The responses of PCPs and PGIs were compared using chi-square.Results: 158 PCPs (89% in private practice, 11% hospital based) and 350 PGIs (10% GI fellows, 11% private practice & 79% hospital/academic practice) completed the survey.Diagnostic Criteria: 27% of PCPs and 77% of PGIs knew about Apley's criteria (p<0.0001);9% of PCPs & 26% of PGIs used these in clinical practices (p<0.0001).28% of PCPs compared to 99% of PGIs knew about the Rome criteria (p<0.0001) and 9% of PCPs & 71% of PGIs used these in clinical practice (p<0.0001).Pathophysiology: 53% of PCPs and 70% of PGIs agreed that understanding of the pediatric FGIDs has improved considerably in last 10 yrs (p = 0.002).Investigations: 36% PCPs believe that clinical evaluation alone is sufficient to make a diagnosis of functional abdominal pain (FAP) in the majority of the patients and 66% rarely or never refer these patients to a specialist.45% of PGIs feel comfortable diagnosing FAP on clinical evaluation alone and 69% believe that more than half of the patients end up requiring endoscopic evaluation.PGIs with more than 10 yrs of experience were more likely to diagnose functional abdominal pain on clinical evaluation alone (p<0.01) and were less likely to recommend endoscopic evaluation in children with FGID (p<0.0001)Treatment: behavioral modification therapy is recommended by 13% of PCPs and 30% of PGIs in the majority of patients with FAP (p<0.001).Physicians with less than 5 yrs of experience were more likely to recommend behavioral modification therapy for FAP (p=0.04).Regarding tricyclic antidepressant use, 98% of PCPs & 72% of PGIs never or rarely use this class of drugs to treat FAP (p<0.0001).45% of PCPs and 40% of PGIs believe that treatment of FGIDs has improved in the last decade.Conclusion: PCPs and PGIs have differing views regarding FGID.The majority of PCPs are not aware of the symptom based criteria including the Rome criteria for diagnosing FGID.Behavioral modification therapy for FAP is rarely recommended by both groups.The majority of PGIs do not use tricyclic antidepressants for treatment of FAP.Strategies to increase awareness regarding FGIDs and treatment options amongst PCPs and PGIs are required.

high mortality rate in the outpatient group, a subset of patients may have benefited further from hospitalization.

L’ hémostase par voie endoscopique est le traitement de référence des hémorragies ulcéreuses. En cas d’hémorragie active ou de vaisseau visible non hémorragique, le traitement endoscopique est efficace sur l’hémostase et réduit le recours à la chirurgie et la mortalité [1]. En revanche, l’intérêt du traitement endoscopique est plus discuté en cas de caillot adhérent [2]. Il a été récemment montré que l’oméprazole par voie intraveineuse à fortes doses potentialisait l’effet hémostatique du traitement endoscopique [3]. Certains avaient précédemment suggéré que l’oméprazole par voie intraveineuse était aussi efficace que l’hémostase endoscopique en cas de vaisseau visible non hémorragique [4]. Il est également admis que le risque de récidive hémorragique après traitement endoscopique est particulièrement élevé en cas d’hémorragie initialement active [5]. L’ensemble de ces données amène à poser les questions suivantes : faut-il moduler le traitement des hémorragies ulcéreuses en fonction des constatations endoscopiques initiales ? l’utilisation d’inhibiteurs de la pompe à protons (IPP) à fortes doses modifie-t-elle la stratégie endoscopique ?

PM) than for extensive metabolizers (EM), as the serum concentration of OPZ is expected Io be higher in PM than in EM.There are marked interracial differences in the frequency of the PM phenotype (1-3% of white American vs. 18-23% of Asian population).An aim of the present study was to evaluate the clinical efficacy of an indirect method of predicting CYP-2C19 phenotype.PATIENTS & METHOD: Thirteen patients with reflux esophagitis were enrolled in the study.This study had been approved by the local ethical committee and the written informed consent was obtained from the patients participated.They took OPZ 20 mg daily for 4 weeks, when serum gastrin concentration was measured by RIA before and 30 minutes after breakfast (400 kcal of energy and 15 g of fat).CYP-2C19 genotype was determined by sequencing its exons from the extracted and amplified DNA.RESULTS: Seven patients were EM and 6 were PM Serum gastrin concentration (mean (SD)) before and after breakfast was 80.1 (33.1) and 145.3 (65.5) in EM, and 254.0 (93.1) and 536.7 (186.7) in PM.Cut-off value of 250 pg/ml for postprandial serum gastrin can clearly differentiate between EM and PM CONCLUSION: Postprandial serum gastrin concentration below 250 pg/ml after the patient took 20 mg of OPZ for 4 weeks ("OPZ-gastrin test") can be a reliable predictor for EM of OPZ.