SummaryBackgroundThe outcome of cholangiopathy developing in intensive care unit (ICU) is not known in patients surviving their ICU stay.AimTo perform a survey in liver units, in order to clarify the course of cholangiopathy after surviving ICU stay.MethodsThe files of the liver units affiliated to the French network for vascular liver disease were screened for cases of ICU cholangiopathy developing in patients with normal liver function tests on ICU admission, and no prior history of liver disease.ResultsBetween 2005 and 2015, 16 cases were retrieved. Extensive burns were the cause for admission to ICU in 11 patients. Serum alkaline phosphatase levels increased from day 11 (2‐46) to a peak of 15 (4‐32) × ULN on day 81 (12‐511). Magnetic resonance cholangiography showed irregularities or frank stenosis of the intrahepatic ducts, and proximal extrahepatic ducts contrasting with a normal aspect of the distal common bile duct. Follow‐up duration was 20.6 (4.7‐71.8) months. Three patients were lost to follow‐up; 2 patients died from liver failure and no patient was transplanted. One patient had worsening strictures of the intrahepatic bile ducts with jaundice. Nine patients had persistent but minor strictures of the intrahepatic bile ducts on MR cholangiography, and persistent cholestasis without jaundice. One patient had normal liver function tests.ConclusionsIn patients surviving their ICU stay, ICU cholangiopathy is not uniformly fatal in the short term or clinically symptomatic in the medium term. Preservation of the distal common bile duct appears to be a finding differentiating ICU cholangiopathy from other diffuse cholangiopathies.

Introduction: la réalisation en urgence d'une endoscopie digestive est la règle au cours des hémorragies digestives hautes (HDH). Afin d'améliorer l'efficacité de l'endoscopie, l'administration d'érythromycine par voie intraveineuse est préconisée 1. Le but de notre étude a été d'évaluer les pratiques concernant l'administration et l'efficacité de l'érythromycine à travers l'observatoire de l'ANGH sur les HDH.

But: Les angiodysplasies coliques sont habituellement responsables d'anémie ferriprive. Le but de ce travail est de décrire les caractéristiques cliniques et les facteurs pronostiques des angiodysplasies coliques responsables d'hémorragie digestive basse (HDB).

Introduction: Les progrès récents concernant l'hémostase endoscopique des ulcères gastro-duodénaux hémorragiques ont conduit à l'élaboration de recommandations de pratique clinique. Le but de notre travail était d'évaluer la prise en charge endoscopique des hémorragies digestives hautes d'origine ulcéreuse et son impact sur le pronostic.

La réalisation d’une endoscopie digestive haute en urgence la nuit ou le week-end est souvent difficile au cours des HDH en raison de l’absence le plus souvent d’une aide spécialisée pour la réalisation des gestes techniques. Le but de notre travail était d’étudier les conditions de réalisations et les facteurs pronostiques des HDH survenant la nuit ou le week-end comparativement au jour et en semaine. De février 2005 à mars 2006, 3 287 patients ont été hospitalisés dans 53 hôpitaux généraux pour une HDH ; les données épidémiologiques et pronostiques ont été prospectivement saisies dans une base de données. Chaque praticien notait l’heure de réalisation de l’endoscopie et si celle-ci était réalisée la nuit ou le week-end. Nous avons retenu les 3 083 patients qui ont eu une endoscopie dont 684 (22,2 %) la nuit ou le week-end (groupe 1) et 2 399 (77,8 %) le jour et en semaine (groupe 2). Il n’existait pas de différence statistique entre les patients des groupes 1 et 2 en ce qui concerne l’âge moyen et le sex ratio. Les patients du groupe 1 étaient plus souvent hospitalisés en réanimation 21 % vs. 11,6 % (p < 0,0001) mais n’avaient cependant pas un score moyen de gravité de Rockall plus élevé 5,2 ± 2,3 vs. 5 ± 2,7 (p = 0,1) ni plus de comorbidités significatives 1,64 ± 1,34 vs. 1,59 ± 1,84 (p = 0,5). Le délai de réalisation de l’endoscopie était significativement plus court pour le groupe 1 0,35 jour vs. 1,03 jour (p < 10-6). Une aide spécialisée était disponible dans 40 % des cas le groupe 1 vs. 85 % des cas dans le groupe 2 (p < 10-6). Il existait une hémorragie active dans 455 (66,5 %) cas dans le groupe 1 vs. 1 288 (53,6 %) cas dans le groupe 2 (p = 0,003) aboutissant à un traitement endoscopique dans 208 (45,7 %) vs. 634 (49,2 %) cas (p = 0,2). Le nombre de décès n’était pas différent entre les groupes 1 et 2 : 59 (8,6 %) vs. 164 (6,8 %) (p = 0,13) alors que le taux de récidive hémorragique était plus important 12,6 % vs. 9,1 % (p = 0,01) dans le groupe 1. Si le délai de réalisation d’une endoscopie est plus court la nuit ou le week-end cela ne s’explique pas par la gravité plus importante des patients mais probablement par leur hospitalisation plus fréquente en réanimation. Le taux de récidive hémorragique est plus important parmi les patients ayant eu une endoscopie la nuit ou le week-end ; les facteurs explicatifs pourraient être l’absence fréquente d’une aide spécialisée.

But: Décrire les caractéristiques épidémiologiques actuelles des hémorragies digestives basses aiguës (HDBA) ainsi que les pratiques professionnelles, la morbidité et la mortalité hospitalière.

The natural history and complications of non alcoholic chronic pancreatitis (NACP) is poorly understood compared to that of alcoholic chronic pancreatitis (ACP).Patients and Methods - From April 1993 to April 1996, 77 patients with NACP were prospectively evaluated in 17 French centres. This population was compared to a cohort of 417 patients with ACP.Results - No significant difference was observed with respect to mean age between NACP and ACP (43 +/- 20 vs 44 +/- 11 years, respectively). The median patient follow-up time was also comparable: 7 years (1-28) and 6 years (1-34) respectively for NACP and ACP. There were significantly more males in the ACP group (9/1 in ACP group and 1.3/1 in NACP group: P < 10(-7)). Patients with NACP were less likely to have calcifications (58% vs 77%; P = 0.01), pseudocysts (19 vs 47%, P < 0.001), portal vein thrombosis (5 vs 16%, P < 0.02). Importantly, patients with NACP required less surgical procedures than those with ACP (26% vs 44%, P = 0.004). The actuarial death rate at 15 years was 0% in the NACP group compared to 20.5% in those with ACP (no CP related death).Conclusion - NACP has a less severe disease progression, fewer complications and requires less surgical interventions than ACP. The lower actuarial survival rate in patients with ACP correlates with the extra-pancreatic complications encountered in patients with alcohol related diseases and not with the evolution of CP itself.

OBJECTIVE: The aim of this study was to assess predictive factors for the progression to liver cirrhosis in hepatitis C. METHODS: One hundred thirty six patients (79 men; 57 women; mean age 39 years) with transfusion or intravenous drug use-associated hepatitis C virus (HCV) infection were studied. Sex, cause of infection, duration of contamination, and genotype were studied as predictive factors of progression to liver cirrhosis. RESULTS: One hundred twenty three patients presented with chronic hepatitis without cirrhosis and 13 had cirrhosis. At the time of liver biopsy, rates of cirrhosis were: 0% before 40 years, 10% between 40 and 60 years, and 47 % after 60 years. (p < 0.05). Rates of cirrhosis according to the age at: the time of contamination were as follows: 3 % before 30 years; 16 % between 30 and 50 years; 46 % after 50 years even though duration of the disease was comparable in the three groups. In multivariate analysis, two independent factors were associated with liver cirrhosis: age at contamination and duration of infection. CONCLUSION: Duration of infection and especially age at contamination seem better correlated with the probability of cirrhosis than the route of transmission or the genotype 1 b. The results of this study suggest that progression to cirrhosis is slower in cases of contamination before 30 years of age than later on. Age at the time of contamination is an important predictive factor of progression to cirrhosis.

OBJECTIVE:The aim of this study was to assess predictive factors for the progression to liver cirrhosis in hepatitis C.METHODS:One hundred thirty six patients (79 men; 57 women; mean age 39 years) with transfusion or intravenous drug use-associated hepatitis C virus (HCV) infection were studied. Sex, cause of infection, duration of contamination, and genotype were studied as predictive factors of progression to liver cirrhosis.RESULTS:One hundred twenty three patients presented with chronic hepatitis without cirrhosis and 13 had cirrhosis. At the time of liver biopsy, rates of cirrhosis were: 0% before 40 years, 10% between 40 and 60 years, and 47% after 60 years. (p < 0.05). Rates of cirrhosis according to the age at the time of contamination were as follows: 3% before 30 years; 16% between 30 and 50 years; 46% after 50 years even though duration of the disease was comparable in the three groups. In multivariate analysis, two independent factors were associated with liver cirrhosis: age at contamination and duration of infection.CONCLUSION:Duration of infection and especially age at contamination seem better correlated with the probability of cirrhosis than the route of transmission or the genotype 1b. The results of this study suggest that progression to cirrhosis is slower in cases of contamination before 30 years of age than later on. Age at the time of contamination is an important predictive factor of progression to cirrhosis.

Background/Aim-The period of refeeding in patients with acute pancreatitis is critical because they may have pain relapse, A multicentre, multidimensional, prospective study was performed to assess the frequency and the risk factors of pain relapse in these patients.Methods-Patients were included if they had acute pancreatitis severe enough to stop oral feeding for more than 98 hours, Clinical, biochemical, radiological, and therapeutic data were prospectively recorded and analysed by unidimensional and multidimensional analysis, The moment to refeed patients was chosen by the clinician but the diet was the same in all centres.Results-A total of 116 patients were included with a Ranson's bioclinical score greater than or equal to 3 in 35% and a Balthazar's CT score greater than or equal to D in 42%. The cause of acute pancreatitis was biliary in 47% and alcohol misuse in 31%, During the oral refeeding period, 21% of the patients had pain relapse, This occurred on days 1 and 2 in 50% of patients. The duration of the painfull period was longer in patients who relapsed than in others (p<0.002). Pain relapse occurred in 39% of patients with a serum lipase concentration >3x the upper limit of the normal range the day before refeeding and in 16% of other patients (p<0.03). Patients with higher Balthazar's CT scores had pain relapse more often than the others (p<0.002). None of the therapeutic procedures significantly modified the frequency of pain relapse. Using multidimensional analysis, Balathazar's CT score, period of pain, and serum lipase concentration the day before refeeding were independently associated with an increased risk of pain relapse. At a threshold of 0.5, a logistic score: had a 37% sensitivity, 95% specificity, and 83% accuracy to predict pain relapse, Pain relapse nearly doubled total hospital stay and hospital stay after the first attempt at oral refeeding.Conclusion-Pain relapse occurred in one fifth of the patients with acute pancreatitis during oral refeeding and was more common in patients with necrotic pancreatitis and with longer periods of pain.The results of this study can he used to predict high risk patients and are a first step in the prevention of pain relapse.

The efficacy of colchicine combined with ursodeoxy-cholic acid (UDCA) and UDCA alone in the treatment of patients with nonadvanced primary biliary cirrhosis (PBC) was evaluated in a 2-year controlled study, Seventy-four patients with PBC who had been treated previously with UDCA (at least 8 months) but still had ab normal Liver test results, especially elevated alkaline phosphatase activity, were randomized to be administered colchicine (1 mg/d, 5 days per week) (n = 37) or a placebo (n = 37), In addition, the patients were treated with UDCA (13-15 mg . kg(-1) . day(-1)). The patients underwent clinical examination and liver tests every 6 months and upper endoscopy and liver biopsy at entry and at 2 years. Procollagen type III aminoterminal peptide (PIIINP), hyaluronic acid, and sulfobromophthalein (BSP) elimination kinetics were determined at entry and after 2 years, After 2 years of treatment, relative to UDCA, colchicine combined with UDCA did not significantly improve symptoms, laboratory findings (serum bilirubin level, alkaline phosphatase and alanine transaminase [ALT] activities, immunoglobulin [Ig] M level), serum markers of fibrosis, or histological features, except lobular inflammation, Colchicine did tend to slightly reduce the progression of esophageal varices; however, the difference was not significant, BSP elimination kinetics (45-minute retention percentage) was significantly improved when treated with colchicine, During the 2-year study, the only clinical complications were variceal bleeding in one patient administered colchicine and two administered the placebo. Two patients died from nonliver causes, One severe adverse effect (peripheral neuromyopathy) was observed in a colchicine-treated patient, In conclusion, this study suggests that colchicine appears to provide a slight advantage relative to UDCA alone in patients with nonadvanced PBC.