Introduction: Crohn's disease (CD) is a chronic inflammatory affection of the digestive tract that progresses towards intestinal destruction leading to a stenosing form, and the management of these stenoses is often multidisciplinary, medico-surgical. In the light of the data in the literature, we will study the efficacy of medical treatment and the place of surgery in the management of strictures in crohn's disease. Materials and Methods: This is a retrospective descriptive study over a 5-year period, including all patients with stenotic phenotype Crohn's Disease who are followed in our departement. Results: We included 109 patients with stenotic phenotype crohn's disease. The mean age of our patients was 43 years, there were 70 women and 39 men, with a sex ratio of 1.8. In terms of therapeutic management, 71 patients (65% of the total) received medical treatment as first-line therapy, including 22 patients (20.2%) who received corticosteroids first. Disease-modifying therapy was based on immunosuppressants in 45 patients (41.3%), and 26 patients (23.8%) received anti-TNF in mono or combination therapy. Progression was marked by a good therapeutic response without recourse to surgery in 35 patients (32% of all patients), while 36 patients (33%) did not respond and underwent surgery after failure of medical treatment. 38 patients (35%) underwent surgical treatment in the first instance, post-operative disease-modifying therapy consisted of Anti TNF, in mon or combination therapy, in 16 patients, immunosuppressive therapy in 20, while two patients remained clinically and endoscopically quiescent on no disease-modifying therapy. Discussion: In the absence of symptoms, simple monitoring is required, and consequently no treatment is recommended. But in the case of symptomatic stenosis, the management of small bowel stenosis depends on the intensity of occlusive symptoms, the association with immunosuppressive therapy and morphological criteria assessed ............

Inflammatory bowel disease (IBD) begins usually between 20 and 30. A second peak in incidence between 50 and 70 has been recognized. IBD in the elderly is defined as disease diagnosed after the age of 60. IBD in the elderly are special entity, characterized by their weakness, associated comorbidity, and their sometimes-severe course. The aim of this study was to investigate the epidemiological, clinical, therapeutic and evolutionary particularities of IBD in elderly. This is a retrospective study over a 5-year period from July 2018 to July 2023 on 424 patients followed for IBD. We included patients with documented CD or UC and who are over 60 years of age at the time of diagnosis. Of the 16 patients enrolled, mean age at diagnosis was 69.48 [60-82], sex ratio F/M 1.28, 2 patients were smokers (12.5%), 13 (81.25%) had at least one associated comorbidity. 7 patients had CD (43.75%), 7 had UC (43.75%), and 2 had indeterminate colitis (12.5%). 3 patients underwent surgery (18.75%), 2 for severe acute colitis with subtotal colectomy and ileorectal anastomosis, and 1 for ileal fistulas with ileocecal resection and ileocolic anastomosis. The progression was favorable, with an average number of relapses of 2/year, and an average number of severe relapses of 0.5/year. Maintenance of remission was noted in 15 cases (93.75%). 8 patients were on 5-Aminosalicylates (5ASA) (50%), corticosteroids and immunosuppressives was prescribed in 4 patients (25%), anti-TNFs in 2 patients (12.5%), anti-interleukins 1 patient (6.25%) and 1 patient was in remission on no treatment. In conclusion, the disease localization and phenotype in this study are like those reported in the literature relating to elderly IBD patients, and despite concerns about the risk of acquiring infections and malignancies in this age group, a high rate of corticosteroids and immunosuppressive prescription is noted.

Chronic hepatopathies are cosmopolitan disorders, the most common of which are chronic hepatitis and cirrhosis. Cirrhosis is a pathology of diverse etiologies characterized by diffuse disorganization of the normal hepatic structure due to hepatocyte destruction, with the appearance of regenerative nodules surrounded by fibrosis compressing the hepatic vascularization and causing portal hypertension. We report the case of a patient hospitalized in intensive care for decompensation of chronic hepathopathy during her 4th pregnancy, and we will describe the various consequences of pregnancy on this type of hepathopathy and vice versa via a detailed review of the literature.

Acute Intestinal Intussusception (AII) in Adult, unlike in children, is a rare event, most often occurring in the setting of a small bowel tumor of malignant origin. It accounts for 1 to 5% of intestinal obstruction etiologies in Adult. Invaginations have been classified into four categories according to their location: entero- enteric, colo-colic, ileo-colic and ileo-cecal. In Adult, an organic cause is found in 70-90% of cases, whereas in children, intestinal obstruction is most often idiopathic. Treatment is always surgical in Adult. We report a case of acute ileo-caecal intussusception revealing caecal adenocarcinoma in a 40-year-old woman.

Ulcerative colitis and Crohn's disease have an approximately 2-3-fold increased risk of colorectal cancers. The risk factors most frequently associated with the risk of these cancers in inflammatory bowel disease are those indicative of chronic inflammation, primary sclerosing cholangitis, previous dysplasia, and a family history of colorectal cancers. The pace of CRC surveillance in this population will be determined by the presence of these risk factors, and the surveillance modality is based on colonoscopy with chromoendoscopy and targeted biopsies. In the absence of staining, systematic biopsies can be performed.

Endoscopic Retrograde Cholangiopancreatography (ERCP) is an examination combining endoscopy and fluoroscopy that allows for the diagnosis and, especially, the treatment of diseases of the biliopancreatic system, and more specifically, obstructive jaundice of the bile ducts. The timing of ERCP depends on the etiology. The aim of our study is to investigate the evolving kinetics of cholestasis after ERCP.

Upper Gastrointestinal bleeding (UGIB) is a frequent emergency in hepato-gastroenterology, particularly severe in cardiac patients. The aim of this study was to investigate the etiologies, risk factors and management of upper gastrointestinal bleeding in these patients. We conducted a descriptive cross-sectional study in our department, between April 2020 and January 2024, including 56 cardiac patients who presented with UGIB and benefited from endoscopic exploration. The mean age of the patients was 69 years, with a male predominance. Of these, 46,4 % were on anticoagulants alone, 32,1% on antiplatelet agents alone, and 5,3% on a combination of the two. Gastro-duodenal ulcer was the cause of bleeding in 46.4% of patients. Blood transfusion was required in 29 patients (51,8%), and intensive care in 12 patients (21,4%). The evolution was marked by a recurrence during the same hospitalization in 10 patients (17.8%), and 3 patients (5,3%) died during the same hospitalization from hemorrhagic shock. In conclusion, cardiac patients present a higher morbidity and mortality in cases of digestive gastrointestinal bleeding, underlining the importance of rapid and effective management.

Colectomy in IBD may be necessary in several conditions, the main cause being the acute severe colitis (ASC). The aim of this work is to study the role of surgery in the management of IBD, in particular colectomy, and to determine its main indications. This is a retrospective study conducted over a 5-year period from July 2018 to July 2023 involving 424 patients followed up for IBD. We included in our study patients of both sexes, with documented Crohn’s disease (CD) or ulcerative colitis (UC) and who benefited from colectomy, we excluded patients whose follow-up could not be ensured. Of the 45 patients (10.61%) colectomized, the mean age at colectomy was 35 years [18-56], the predominance was female with an F/H sex ratio of 1.25, 34 patients had UC (75.5%) and 11 followed for CD (24.5%). The main indication for surgery was corticoresistant ASC in 31 patients (46.5%). Other indications were: 5 strictures (11.1%), 4 occlusions (8.8%), 3 colonic fistulas (6.6%) and 2 abscesses (4.4%). There were no immediate postoperative deaths. Anastomotic leakage occurred in 4 patients (8.8%) and small bowel stenosis in 2 patients (4.4%). In patients with CD, the flare-up subject to surgery was inaugural in 2 patients (18.18%); the mean period between the onset of symptoms and surgery was 3 years and 2 months. In the case of UC, 10 patients (29.41%) had a flare-up at the start of surgery, with an average delay of 6 years and 1 month. At follow-up, 5 patients (11.1%) had a recurrence or exacerbation of the disease. This was the most frequent indication for a subsequent protectomy or permanent ileostomy during the follow-up period. Collaboration between the gastroenterologist and the surgeon is essential to recognize the optimum time to propose surgery, so as not to increase patient morbidity and mortality.

Hiccups are most often benign and short-lived, but they can also be persistent (> 48h) or even refractory (> 1 month). In these cases, it impairs qualitý of life and can have serious health consequences. We report the case of a patient who consulted for chronic hiccups with absences and in whom the neurological origin was confirmed on brain MRI.

Adenocarcinoma is the most common type of colorectal neoplasia associated with chronic inflammatory bowel disease (IBD), but other types of epithelial and non-epithelial tumors have also been described on the inflamed bowel; among others, neuroendocrine tumors (NETs) which are rare tumors. We report the case of a patient admitted to the emergency department for an acute colitis inaugurated by ulcerative colitis (UC) and in whom a NET of the appendix was discovered on the colonic resection specimen. The prevalence of NETs in IBD patients is high in the literature. Their discovery is most often incidental. The presence of a significant number of neuroendocrine cells in the inflamed mucosa suggests that chronic inflammation is responsible for the development of this type of neoplasia.

Introduction: The development of APL is associated with a more severe prognosis of the disease, and with a significant alteration of the quality of life. For this reason, the advent of biological agents has allowed in a significant number of patients a healing of these APL. Through this work, we illustrate the evolution of these lesions by comparing patients before and after the beginning of biotherapy. Materials and Methods: A retrospective analytical study carried out in our department between January 2015 and January 2021 including all patients receiving biological treatment for CD with APL. Results: Among 355 patients with CD, 45 patients were on biological treatment which 32 (71%) had APL. Among these 32 patients, sex ratio (W/M) was 1.9, mean age was 37 +/- 9.3. The type of anal involvement was as follow: 20 patients (75%) had anal suppurations, 7 patients (20%) had ulcerations and 5 patients (5%) had anal stenosis. In 5% it was an isolated anal Crohn's disease, in 15% it was intestinal disease with APL, in 31% it was colonic disease with APL. 25 patients (78%) were under Infliximab and 7 (21.8%) under Adalumimab. The number of patients with APL before treatment has significantly decreased after treatment with a p=0.002, with an improvement of APL in 20 patients (60%) of under anti-TNF agent. Conclusion: Anti-TNF agents allowed a better management and a favorable evolution of APL in most of our CD patients. However, to overcome the failure of anti-TNF in some of our patients, the availability of other biological molecules on the Moroccan market remains more than desirable.

Acute cholangitis is defined by an infection of the bile ducts due to an obstacle preventing bile flow. It is a diagnostic and therapeutic emergency. Aim of the Study: Report epidemiological, etiological, therapeutic and evolutionary cholangitis. Materials: This is a descriptive prospective study, spanning a period from September 2020 to April 2023. Patients with acute cholangitis were included. Results: We collected 102 cases. The average age was 63 years old with a Sex ratio M/W: 1.37. 18 patients (17.6%) had a history of cholecystectomy. Abdominal ultrasound was sufficient to visualize the obstruction in 32 (32%) patients. The lithiasic origin was revealed in 54 (53%) cases, pancreatic head tumor in 16 (15.7%), cholangiocarcinoma in 17 (16.6%), ruptured hydatid cyst in the biliary tract in 7 (7%). 100 (98%) patients benefited from endoscopic treatment and 2 (2%) benefited from surgical treatment. Endoscopic biliary sphincterotomy was performed in 84 (84%) patients and sphincteroclasia in 9 (9%) patients. Extraction of the stones or hydatid membranes by balloon was performed in 55 (55%) cases. Mechanical lithotricy was necessary in 1 (1%) case. A biliary prosthesis was placed in 52 (52%) patients (Picture 3). The single-stage success rate was obtained in 91 (91%) cases, 8 patients (8%) required a second stage. The early complication rate after endoscopic managment was 10% (n=10) with a death rate of 5% (n=5). Conclusion: Acute cholangitis remains a severe condition requiring urgent treatment. The prognosis has clearly improved after the advent of interventional endoscopy giving satisfactory results. Our study had shown with a technical success rate of 92.7% and a general success rate of 95%.

Digestive manifestations during systemic lupus erythematosus (SLE) are rarely reported in the literature, in particular, hepato-pancreatic manifestations. We report the case of a patient in whom SLE was revealed by acute hepato-pancreatitis with mixed acute hepatitis, acute pancreatitis fulfilling 2 diagnostic criteria (high lipasemia and Balthazar stage C pancreatitis on the abdominal CT scan). The diagnosis was retained on the ACR criteria. The evolution under corticosteroid therapy and resting of the digestive tract was favorable.

Aims Endoscopy is known for the non-ergonomic positions responsible for joint constraints and a physical workload. Work-related Musculoskeletal disorders (MSDs) are disorders caused or aggravated by working conditions. our work aim to measure the prevalence of MSDs among endoscopist and evaluate risk factors

Aims Social media (SM) are part of our daily lives they allow experience exchange between doctors and offer new training perspectives.

Helicobacter pylori (HP) infection is one of the most prevalent infections worldwide, contributing to inflammation of the gastric mucosa which is of great interest given its involvement in many gastroduodenal pathologies and some extra-digestive diseases. Aim of the Study: Report the incidence of HP from the endoscopy and anatomopathology register. Methods: This is a descriptive retrospective study performed during a period from January 2019 to November 2022, based on data from the endoscopy and anatomopathology register. We included all patients over 16 years of age who underwent esophago-gastroduodenal fibroscopy (EGD) with gastric biopsies performed according to the Sydney protocol. Results: 903 patients were included in our study. The incidence of HP infection was 60% (n=541).The average age was 50 years [17-90], the Sex Ratio W/M: 1.3, the most frequent symptom was represented by epigastralgia. The esophago-gastroduodenal fibroscopy had objectified an erythemato-congestive gastric mucosa in 481 (89%) of the cases, erythemato-whitish in 27 (5%), nodular in 16 (3%) and it was normal in 16 (3%) of the cases. On anatomopathological study, the gastritis was antro-fundal, antral and fundal in respectively 487 (90%), 43 (8%) and 11 (2%) of the cases. The intensity of gastritis was mild in 6.8%, moderate in 92% and severe in 1.2% of patients. Gastritis activity was absent in 6 (1.1%), mild in 74 (13.8%), moderate in 455 (84.1%) and severe in 5 (1%) cases. The density of HP was mild in 75 (14%), moderate in 437 (80.8%), and severe in 28 (5.2%) cases. Intestinal metaplasia was observed in only 9 cases (1.7%), as for dysplasia, it was not identified in any of our patients. Adenocarcinoma was revealed in 9 (1.7%) patients. Conclusion: The results of our study indicate an incidence of 60% (n=541). The association of chronic gastritis was important. Its pathogenic role has been revealed in many gastroduodenal pathologies in particular gastric cancer objectified in our series in 1.7% of cases, hence the interest in researching HP infection and its eradication.

Aims Upper gastrointestinal bleeding (UGIB) is a common cause of hospital admission .Multiple scoring systems have been developed to stratify patients : including Rockall and Glasgow-blatchford.Many clinical studies have validated their predictive values ; yet, their clinical effectiveness and their cut-offs are subjects to debates

Aims The aim of our study is to evaluate the efficacy of the strategy undertaken based on postoperative colonoscopy, and then to identify predictive factors of postoperative recurrence.

Introduction: Upper gastrointestinal bleeding (UGIB) is a frequent cause of medical care. They constitute medical and surgical emergencies that quickly involve the patient’s vital prognosis. The main objective of this work is to study the epidemiological profile of UGIB. Materials and Methods: Our work is a descriptive prospective study including all patients admitted for upper gastrointestinal bleeding from January to December 2020. All patients received specific emergency care as well as upper endoscopy. Results: 72 patients with UGIB were included, 31 men (43.1%) and 41 women (56.9%). The average age is 56.5 ± 6.8 years. UGIB was manifested as isolated melena (40.3%), hematemesis associated with melena (25%). On admission, hemoglobinemia was below 7 g/dl in 51.4% of cases. The history of the patients was dominated by portal hypertension (PHT) (13.7%), taking antiplatelet agents (13.7%) and anticoagulants (11%). The average time for completion of the upper endoscopy is 36.97h ± 8.9. The main diagnoses were ulcer bleeding (34.7%), PHT related bleeding (23.67%), and gastritis (16.6%). Bleeding recurrence and mortality were estimated at 25% and 5.6% of cases respectively. Conclusion: The majority of upper gastrointestinal bleeding occurred in patients over 60 years old. The most common etiologies are ulcer disease and bleeding related to portal hypertension. Gastroscopy is the key examination and constitutes the main stage for diagnostic, etiological, prognostic and therapeutic purposes.

Aims Upper gastrointestinal bleeding (UGIB) is a common medical condition that results in substantial morbidity and mortality.