La nutrition parentérale à domicile (NPAD) a permis d’augmenter la survie et d’améliorer la qualité de vie des patients atteints d’insuffisance intestinale chronique (IIC). Peu de grossesses chez des femmes en NPAD ont été rapportées. L’objectif de ce travail était de décrire les grossesses chez des patientes en NPAD de longue durée pour une IIC bénigne. Cette étude rétrospective multicentrique (trois centres agréés de NPAD français) incluait toutes les grossesses recensées chez des femmes en NPAD. Les caractéristiques démographiques, la pathologie sous-jacente, la nutrition parentérale, les complications maternelles et le devenir du nouveau-né ont été analysés. Entre 1984 et 2014, 1181 patients (femmes, n = 500) en NPAD pour IIC ont été suivis. Parmi eux, 18 grossesses ont été recensées chez 13 patientes (syndrome de grêle court [n = 10], troubles moteurs intestinaux [n = 3]). La durée médiane de suivi était de 14 ± 10,3 ans et la durée de NP avant grossesse était de 10 ans. L’adaptation de la NP était mensuelle avec surveillance et correction rapprochées des carences en micronutriments. Les apports énergétiques étaient régulièrement augmentés pour atteindre 133 % de la dépense énergétique de repos avec une prise de poids maternelle de 10 kg. Dans un centre, un suivi préconceptionnel a été mis en place depuis 2009 pour les femmes ayant exprimé un désir de grossesse. 11 grossesses sur 18 ont eu lieu après 2010. Le terme était de 37 ± 2 SA avec 35 % de prématurité. Lors des grossesses, les complications maternelles ont été une aggravation de la maladie sous-jacente à type de sub-occlusion (n = 7), ou une complication liée à la NP (n = 6) dans la majorité des cas, avec, au total, des complications au cours de 67 % des grossesses. L’accouchement s’est compliqué dans deux cas d’une hémorragie de la délivrance dont une rupture utérine chez une patiente atteinte de pseudo-obstruction intestinale chronique. Les nouveau-nés étaient hypotrophes 4 fois sur 18, un enfant était mort-né (vasculopathie non étiquetée). Avec un suivi de 3,5 ans, 15 enfants sur 17 sont considérés en bonne santé. Cette série, la plus importante rapportée à ce jour, montre que la grossesse est possible chez des femmes en NPAD de longue durée. Le taux de complications, relativement élevé en cas de troubles moteurs intestinaux, suggère que cette population devrait être particulièrement surveillée. L’augmentation croissante des grossesses au cours des 15 dernières années, probablement liée à l’amélioration de la survie, de la qualité de vie en NPAD et à un changement d’attitude des praticiens, incite à alerter l’ensemble des centres de NPAD, et à favoriser la mise en place d’un suivi spécifique rapproché multidisciplinaire (gastroentérologue, nutritionniste, obstétricien) des femmes enceintes mais, également, à envisager des consultations pré-conceptionnelles pour l’ensemble des femmes sous assistance nutritive, en âge de procréer.

P175 Post-operative complications in pediatric inflammatory bowel disease: a population-based study E. Penninck1 *, J. Salleron2, M. Fumery3, G. Savoye4, D. Turck5, J.-L. Dupas6, F. Vasseur7, E. Lerebours4, L. Peyrin-Biroulet8, J.-F. Colombel1, C. Gower-Rousseau7. 1University Hospital, Gastroenterology, Lille, France, 2University Hospital EA 2694, Biostatistics, Lille, France, 3Amiens University and Hospital, Gastroenterology, Amiens, France, 4University Hospital, Gastroenterology, Rouen, France, 5University Hospital, Pediatric Unit, Lille, France, 6University Hospital, Gastroenterology, Amiens, France, 7University Hospital, Epidemiology EA 2694, Lille, France, 8University Hospital, Gastroenterology, Nancy, France

L'infection de la voie veineuse centrale (VVC) est la principale complication de la nutrition parentérale. L'objectif de notre travail était de connaître l'écologie de ces infections dans notre centre de nutrition parentérale à domicile et d'évaluer notre protocole de prise en charge.Il s'est agi d'une étude monocentrique, rétrospective réalisée au centre hospitalier universitaire (CHU) de Marseille entre le 1er janvier 2011 et le 31 mai 2012. Les enfants en nutrition parentérale, exclusive ou non, admis pour fièvre en urgence et ayant des hémocultures positives ont été inclus. Les caractéristiques de ces infections ont été analysées.En 17 mois, 29 enfants ont été suivis, 17 ont présenté une infection de leur VVC, 47 bactériémies ont été recensées, soit 5,4 infections pour 1000 jours de VVC. Le nombre moyen d'hémocultures réalisées à l'arrivée était de 2,8. Le germe le plus fréquemment identifié était le Staphylococcus hominis. Les traitements avaient initialement associé une bi-antibiothérapie en hospitalisation et des verrous antibiotiques.Le taux d'infection durant la période étudiée était très élevé. Ce taux a été surévalué du fait des conditions de prélèvement des hémocultures et d'analyse. Enfin, on note que certains enfants ont fait des infections récidivantes sans qu'un facteur prédisposant ait pu être mis en évidence. Le traitement par bi-antibiothérapie était en accord avec les bonnes pratiques et l'écologie bactérienne.Le nombre important d'infections constatées pendant la période étudiée nous a amenés à une évaluation prospective de nos pratiques.Infection of the central venous catheter (CVC) is the main aggravating factor of parenteral nutrition. The aim of this study was to determine the ecology of these infections in our home parenteral nutrition center and to evaluate our care protocol.The present study was monocentric and retrospective, and was conducted in the parenteral nutrition service of the Marseille University Hospital between 1 January 2011 and 31 May 2012. During this period, all the children who presented fever and a positive hemoculture in a medical emergency were taken into account, and the characteristics of the infection were analyzed.After 17 months, 17 children had been subject to an infection in their central catheter: 47 bacteremia were identified, which is equivalent to 5.4 infections for 1000 days of CVC. An average 2.8 hemocultures were performed during this time. The most common bacterium was Staphylococcus hominis. The children affected by a digestive stoma or by a gastrostomy were not subject to more infections and their ecology was not different. All the children were referred to the hospital and treated with an intravenous antibiotic through the CVC.As expected during the time of the study, the infection rate was very high. This finding led us to reassess our prevention protocol. It is also very likely that the number of infections was overestimated due to the protocol for sampling in the hemocultures and their subsequent analysis. Lastly, some children relapsed easily, although no predisposing factor was found in the present study. The therapy chosen was in agreement with the best practices and the ecology recovered.The high number of infections observed during the study encourages a prospective evaluation of current practices.

When interpreting the status of poultry processing establishments subject to performance standards testing, USDA-FSIS employs a round-up rule when fewer than the standard 52 samples per establishment per year are collected. This rule is to ensure that an establishment with fewer than 52 samples is held to a performance standard with a threshold that is not less than that based on the full 52 samples.By estimating population-based sensitivities and specificities for six pathogen reduction performance standards implemented in 2016 (i.e., comminuted chicken, comminuted turkey, and chicken parts standards for both Salmonella and Campylobacter), this study assesses the effect of the round-up rule on correctly classifying commercial poultry establishments as not meeting or meeting the performance standards. Population specificity is greater than 80% for all the performance standards and only modestly affected by reduced sample sizes. Therefore, the round-up rule mitigates against increased misclassification of establishments with low prevalence when sample size is reduced.Population sensitivity is greater than 80% for four of the performance standards but is lower for both comminuted poultry-Campylobacter standards. This sensitivity decreases with reduced sample size and changes sharply as the round up rule is applied.These sensitivity and specificity estimates can serve as benchmarks for future pathogen reduction performance standards, as well as explaining differences with past performance standards.

S64Poster presentations (FC), C-reactive protein (CRP), blood leukocytes, and the Lichtiger Index (clinical score).Methods: UC patients undergoing complete colonoscopy were prospectively enrolled and scored clinically and endoscopically in an independent fashion.Fecal and blood samples were analyzed in UC patients and controls.Results: We enrolled 228 UC patients and 52 controls.Endoscopic disease activity correlated best with FC (Spearman's rank correlation coefficient r = 0.821), followed by the Lichtiger Index (r = 0.682), CRP (r = 0.556), and leukocytes (r = 0.401).FC was the only marker discriminating between different grades of endoscopic activity (grade 0, 20±11 mg/g; grade 1, 44±34 mg/g; grade 2, 111±74 mg/g; grade 3, 330±332 mg/g; grade 4, 659±319 mg/g; P = 0.0018 for discriminating grade 0 vs. 1 and P < 0.001 for discriminating all other grades).FC had the highest overall accuracy (91%) to detect endoscopically active disease (modified Baron Index 2), followed by the Lichtiger Index of 4 (77%), CRP larger than 5 mg/L (69%) and blood leukocytosis (58%).Conclusions: FC better correlated with the endoscopic disease activity than clinical activity, CRP, and blood leukocytes.The strong correlation with endoscopic disease activity suggests that FC represents a useful biomarker for noninvasive monitoring of disease activity in UC patients.

To evaluate the ability of MR colonography (MRC) to detect lesions in severe attacks of ulcerative colitis (UC) and to assess its concordance with rectosigmoidoscopy.

BACKGROUND:Crohn's disease incidence rates have stabilised in industrialised countries since the 1980s. Conversely, a continuing increase in childhood-onset Crohn's disease incidence has been reported.AIM:To confirm trends in inflammatory bowel disease (IBD) incidence in northern France over an extended time period (1988-2007) with a focus on childhood-onset Crohn's disease.METHODS:The IBD patients recorded in the EPIMAD registry between 1988 and 2007 were included. Standardised incidence rates were calculated for Crohn's disease and ulcerative colitis in the entire population, and separately according to age. Evolution of phenotypes at diagnosis was also studied.RESULTS:A total of 12 084 incident IBD cases (7428 Crohn's disease and 4656 ulcerative colitis) were recorded. Crohn's disease incidence rates increased from 5.2 cases/100 000 persons in 1988-1990 to 6.7 in 2006-2007 (+29%), stabilising after a peak at 7.1 in 1997-1999. Crohn's disease incidence rates in the 10-19-year age category increased by 71%, from 6.5 (1988-1990) to 11.1 (2006-2007). The frequency of initial ileo-colonic localisation increased from 52.9% in 1988-1990 to 68.6% in 2006-2007 (P<0.0001). Ulcerative colitis incidence rates decreased during the same period.CONCLUSIONS:From 1988 to 2007, Crohn's disease incidence increased by 29% in northern France and by 71% in the 10-19-year-old age group. Consequently, studies on Crohn's disease risk factors should focus on the population under 20 years of age.

BACKGROUND:Chronic intestinal failure (CIF) is a very rare Crohn's disease (CD) complication.AIM:To determine incidence of CIF treated with home parenteral nutrition (HPN) in adult CD patients and to isolate factors associated with severe CIF.METHODS:This retrospective multicentre study included 38 patients with CD-related CIF treated with HPN for at least 12 months in French HPN centres. Severe CIF was defined by a length of remnant small bowel of less than 100 cm or CIF occurrence within the 15 years following CD diagnosis.RESULTS:Median delay between CD diagnosis and CIF was 15 years. CIF incidence did not decrease over time (1.4/year before 1995 vs. 2.2/year after). Median number of small bowel resections per patient was three (range 1-8). Median small bowel resection, remnant and initial lengths were 160, 80 and 260 cm, respectively. Twenty-four per cent of patients developed stenosis within 1 year after CD diagnosis and 76% developed perforative complications within 2 years. In multivariate analysis, severe CIF, defined as CIF onset <15 years after CD diagnosis, was associated with a more recent CD diagnosis (odds ratio, 0.785; 95% confidence interval, 0.623-0.989). CIF occurred despite frequent use of immunosuppressants. Course of CD remained severe during HPN: immunosuppressants prescription occurred in 11 patients, surgery in six. Six patients died from CD (n = 2), HPN complications (n = 2) or other causes (n = 2).CONCLUSIONS:Chronic intestinal failure requiring HPN is rare during CD. Incidence remained stable over time. Surgical procedures play a minor role in the occurrence of severe chronic intestinal failure compared to CD severity.

BACKGROUND Helicobacter pylori (Hp) is considered an important factor for many gastric and extra-gastric diseases.European (Maastricht III Consensus) and American (American College of Gastroenterology) guidelines recommend therapeutic strategies for Hp eradication and suggest antimicrobial susceptibility test eradication after two consecutive unsuccessful treatments, due to increasing antibiotic resistance.Aim of this study was to determine the efficacy of a therapeutic strategy for the Hp eradication in our setting.METHODS We studied 2428 consecutive patients (1025 men; mean age 55, range age 18-92) with gastric histology positive for Hp infection, without penicillin allergy from April 2006 to June 2010, undergone 13-C Urea Breath Test (UBT) at least 8 weeks after the end of eradication first(I)-line therapy (PPI b.d + amoxicillin 1g b.d.+ clarithromycin 500mg b.d. for 7 days).For UBT positive patients a second(II)-line therapy (PPI b.d.+ amoxicillin 1g b.d.+ tinidazole 500mg b.d. for 14 days) was suggested with a control UBT at least 8 weeks from the end of eradication therapy.Third(III) choice treatment was empirical with PPI b.d.+ amoxicillin 1g b.d.+ levofloxacin 250mg b.d. for 14 days.RESULTS 2428 patients were treated with I-line therapy;326 patients received II-line and 19 patients III-line therapy.Almost all patients completed the treatment, except 13 patients (0,5%) in the first line (11 negative and 2 positive) and 9 patients (2.7%) during the second line (all eradicated) therapy due to side effects (2 and 1 patients allergic to penicillin respectively in I and II line).The "per protocol" eradication rates for I, II and III line therapy were respectively 75% (CI95% 0.73-0.76),85% (CI95% 0,81-0.89)and 89 % (CI95% 0.75-1.03).The cumulative percentage of patients eradicated after two treatments was 97,8% (CI95% 0.97-0.98),while after three treatments was 99.3% (CI95% 0.98-1).CONCLUSIONS The study shows that the used 7-days amoxicillin and clarithromycin based I-line therapy has an eradication rate comparable or superior to other studies and that the II-line treatment can still be a triple therapy with amoxicillin and tinidazole.The third-line treatment (even if in a small number of patients) was successful without the need to perform antimicrobial susceptibility test.

Introduction. - In severe attacks of ulcerative colitis (UC) treated with intravenous corticosteroids, a fulminant colitis index (FCI) greater or equal to 8 has been associated with a greater likelihood of colectomy (72 vs 16% with an FCI < 8). This retrospective study aimed to assess the accuracy of such an association in infliximab-treated patients with moderate-to-severe bouts of UC.Patients and methods. - The study was based on the medical files of 43 patients who had received at least one infusion of infliximab to treat moderate-to-severe UC (partial Mayo Clinic score). Remission and clinical response were also assessed using the partial Mayo score. The accuracy of an FCI greater or equal to 8 to predict the likelihood of colectomy was assessed by calculating the sensitivity, specificity, positive and negative predictive values, Yule's Q coefficient, Youden's index and statistical significance (Chi(2) test).Results. - After treatment with infliximab, 10 patients were in remission (23.3%), 21 (48.8%) had a clinical response, four (9.3%) had treatment failure (without, however, requiring colectomy) and eight (18.6%) had a colectomy. Calculation of the above-mentioned indicators revealed that an FCI greater or equal to 8 was not an indicator of the risk of colectomy in this patient population, and found that only an FCI greater or equal to 16 was statistically significant. However, low values for sensitivity, positive predictive value and Youden's index preclude the clinical application of this latter result.Conclusion. - In patients treated with infliximab for moderate-to-severe UC attacks, the FCI is not a predictor of colectomy. In such patients, the factors predictive of a response to treatment or likelihood of colectomy, currently acknowledged with corticosteroid treatment, need to be further assessed for infliximab treatment. (C) 2010 Published by Elsevier Masson SAS.

Multivariate logistic regression was performed with adjustment for potential confounders including age, sex and diagnosis of synchronous adenomas.Results: CRC was diagnosed in 57 (38%) individuals, 34% of female and 43% of male patients.There were no association between age, sex and colorectal cancer.109 patients had at least one adenoma and these were 4 times more likely to be diagnosed with colorectal cancer compared with patients without adenomas (OR=3.59;95%CI 1. 09-11.84;P=0.04).No significant effects were found for former smokers, however current smokers were at 60% decreased odds of CRC compared with never smokers (OR=0.40;95%CI 0.16-0.99;P=0.05).For females, the odds of colorectal cancer decreased by 85% in current smokers as compared to never smokers (OR=0.15;95%CI 0.04-0.60;P=0.008) after adjusting age and adenomas.For males, there was no relationship between smoking and colorectal cancer.Conclusion: A decreased risk for CRC has been identified in females with a serrated neoplasia predisposition who currently smoke and is independent of age and the presence of a synchronous adenoma.

BACKGROUND:The aim of the study was to assess perianal fistulas by magnetic resonance imaging (MRI) in patients with severe fistulizing Crohn's disease (CD) using maintenance antitumor necrosis factor alpha (TNF-α) therapy and to correlate MRI changes with clinical outcome.METHODS:Perineal MRI before and after a 1-year scheduled anti-TNF-α maintenance therapy was performed in 20 patients (14 females; mean age = 33.7). The Van Assche score (i.e., number of fistulas, localization, and extension, importance of T2 hyperintensity, presence of abscess) was calculated. Fistula track contrast enhancement was also used. Clinical outcome was defined as no response, response, or remission.RESULTS:Response and remission were observed in respectively 40% and 35% of cases. The Van Assche score varied from 13.8 (7-20) to 6.13 (0-12) in patients with a response or remission (P < 0.05). The T2 hyperintensity follow-up value decreased in patients in response or remission (P < 0.01). T2 hyperintensity disappeared or decreased in 14 out of 15 patients in clinical response or remission as compared to one among the five nonresponding patients (P < 0.01). The decrease in Van Assche score and hyperintensity value was not significantly different in patients in remission compared to those with response. Only one patient in clinical remission had a persisting contrast enhancement on MRI, whereas contrast enhancement persisted in all other patients not in remission (P = 0.002).CONCLUSIONS:The clinical benefit of maintenance anti-TNF-α therapy in perianal CD is associated with a significant improvement of the Van Assche score, particularly T2 hyperintensity. The disappearance of contrast enhancement was the only semiological MR feature associated with remission.

BACKGROUND:Capsule endoscopy (CE) is an effective method for investigating the small bowel, especially in cases of obscure gastrointestinal bleeding (OGIB), although the long-term outcome of patients with a negative CE is generally not known. PATIENTS AND METHODS:For 49 patients with OGIB and a negative CE, their referring physicians filled out a follow-up questionnaire to assess bleeding recurrence and any repeat investigations after negative video capsule endoscopy (VCE). RESULTS:A minimum follow-up duration of one year (median: 15.9 months) was available for 35 patients with an overall rebleeding rate of 23% (n=8). Of these eight patients, four women presented with recurrence prior to new investigations. In the four remaining patients, repeat endoscopy work-ups after negative CE were performed and revealed previously missed lesions with bleeding potential, mainly in the stomach. Overall, 13 patients, with or without rebleeding, had repeat endoscopy work-ups after a negative CE, leading to a definitive diagnosis in nine patients, with lesions located in the stomach and colon in eight of them. CONCLUSION:Patients with OGIB and a negative CE had a low rate of rebleeding. This study highlights the importance of the initial endoscopy work-up, and suggests that CE be proposed after a minimum of two gastroscopies and one complete colonoscopy.