Aims. - To study mortality and body iron stores in former elite road cyclists.Synthesis of facts. - Mortality and body iron stores were studied in 514 former elite cyclists. Mortality. Twenty-seven deaths (5%) were recorded compared to 38 (7,4%) in a control group. Iron stores. Hyperferritinemia was found in 13% of cyclists and associated with both the metabolic syndrome and previous iron supplementation, especially through parenteral route and in the youngest subjects.Conclusion. - Middle-term mortality of former elite cyclists is unmodified. Previous iron supplementation may be responsible of persisting and long-term damaging iron excess. (c) 2005 Publie par Elsevier SAS.

Summary. Most features of C282Y‐linked haemochromatosis support the implementation of population screening of the disorder in Caucasians. However, the penetrance of C282Y homozygosity is poorly documented and the strategy for population screening remains debated. Nine thousand three hundred and ninety‐six subjects (3367 men, aged 25–40 years, and 6029 women, aged 35–50 years), attending three Health Appraisal Centres, were genotyped and assessed with respect to clinical and biochemical signs of haemochromatosis. Discriminant, logistic regression and graphic analysis were used to predict homozygosity. Results were validated in 135 homozygotes detected through other family and population studies. Fifty‐four subjects (10 men and 44 women) were homozygous for C282Y. All men had abnormal iron status and most had mild clinical symptoms compatible with haemochromatosis. Identification of all homozygous men required a transferrin saturation (TS) threshold of 50% in the study group (90% specificity) and of 40% in the validation group. Homozygous women differed clinically from non‐homozygotes for the presence of distal arthralgias only (18%vs 6%, P < 0·03). Thirteen (29%) were iron‐deficient (serum ferritin < 13 µg/l) and undetectable by biochemical tests. Although the population studied was not fully representative of the general population, our data strongly suggests that, in young men, large‐scale screening for C282Y homozygosity is justified and can be achieved by using TS prescreening. However, in premenopausal women, large‐scale screening remains to be justified with respect to the natural history of haemochromatosis and should be directly genotypic.

BACKGROUND & AIMS:The diagnosis of hemochromatosis is now possible for C282Y homozygous patients using noninvasive molecular genetic tests. The aim of this study was to define noninvasive factors predictive of severe fibrosis (bridging fibrosis or cirrhosis) to avoid unnecessary liver biopsies in such patients. METHODS:Clinical and biological data were recorded at the time of diagnosis in 197 French C282Y homozygous patients, 52 (26%) of whom had severe fibrosis. Variables significantly linked to severe fibrosis using univariate analysis were entered into a multivariate stepwise analysis. These variables were combined to obtain a simple index allowing for prediction of severe fibrosis. RESULTS:Serum ferritin, hepatomegaly, and serum aspartate aminotransferase were selected using multivariate analysis. Their combination applied to the 96 patients with ferritin level of </=1000 microgram/L, normal aspartate aminotransferase values, and absence of hepatomegaly showed that no severe fibrosis was encountered in this subgroup of patients. The results were validated in 113 C282Y homozygous patients in Canada with a good reproducibility of negative prediction but a poor reproducibility of the positive prediction of severe fibrosis. CONCLUSIONS:In C282Y homozygous patients, the diagnosis of severe fibrosis relies on liver biopsy, but absence of severe fibrosis can be accurately predicted in most patients on the basis of simple clinical and biochemical variables.

Aims-To assess the value of histology in diagnosing inflammatory bowel disease (IBD) in colorectal biopsy specimens.Methods-Retrospective, double blind evaluation of colorectal biopsy specimens from 41 patients with colitis (28 with ischaemic colitis and 13 with acute self-limited colitis) and 84 patients with IBD (42 with Crohn's disease and 42 with ulcerative colitis).Results-The features distinguishing IBD from other forms of colitis included distorted architecture, lymphocyte and plasma cell infiltrate, excess of polymorphonuclear leucocytes, polymorphonuclear cryptitis, crypt abscesses, and basal lymphoid aggregates. The features discriminating between Crohn's disease and ulcerative colitis included an irregular or villous surface, distorted architecture, decrease in mucus content, and polymorphonuclear cryptitis. Using multivariate analysis, 90% of patients with Crohn's disease and 71% of those with ulcerative colitis were correctly classified, the former being strongly defined by epithelioid granulomas, microgranulomas and isolated giant cells, and the latter best defined by an irregular or villous surface, decrease in mucus content and crypt atrophy.Conclusions-Examination of colorectal biopsy specimens is a reliable method for diagnosing IBD. In the absence of epithelioid granulomas, microgranulomas and isolated giant cells a diagnosis of Crohn's disease is based on the absence of histological criteria favouring ulcerative colitis. The histological spectrum of indeterminate colitis remains to be clarified.

OBJECTIVES:To compare the advantages of endoscopic ligation and endoscopic sclerotherapy for bleeding esophageal varices, published randomized clinical trials were critically reviewed by meta-analysis. Only ten clinical trials concerning a history of recent or active bleeding esophageal varices were included.METHODS:The methodology, population, treatment and outcomes of each relevant trial were evaluated by duplicate independent review.RESULTS:Endoscopic sclerotherapy compared to banding ligation significantly increased the rate of rebleeding (OR: 1.6; 95% IC: 1.1-2.3) without increasing early mortality compared to endoscopic banding ligation (OR: 1.3; 95% IC: 0.8-1.9). The rate of varice eradication associated with these two types of treatment was not different (OR: 0.9; 95% IC: 0.6-1.3) but was obtained more quickly with endoscopic banding ligation (3.8 +/- 1.6 versus 5.8 +/- 2.2; P < 0.05). The rate of complications was higher after sclerotherapy (OR: 2.5; 95% IC: 1.7-3.7), in those cases with a positive heterogeneity test.CONCLUSIONS:This meta-analysis shows a lower morbidity with endoscopic banding ligation in patients with variceal hemorrhage. The most important advantage of endoscopic banding ligation was the reduction of the rate of rebleeding.

Objectives. - To compare the advantages of endoscopic ligation and endoscopic sclerotherapy for bleeding esophageal varices, published randomized clinical trials were critically reviewed by meta-analysis. Only ten clinical trials concerning a history of recent or active bleeding esophageal varices were included.Methods. - The methodology, population, treatment and outcomes of each relevant trial were evaluated by duplicate independent review.Results. - Endoscopic sclerotherapy compared to banding ligation significantly increased the rare of rebleeding (OR : 1.6; 95 % IC : 1.1-2.3) without increasing early mortality compared to endoscopic banding ligation (OR : 1.3; 95 % IC : 0.8-1.9). The rate of varice eradication associated with these two types of treatment was not different (OR : 0.9; 95 % IC : 0.6-1.3) but was obtained more quickly with endoscopic banding ligation (3.8 +/- 1.6 versus 5.8 +/- 2.2; P < 0.05). The rate of complications was higher after sclerotherapy (OR : 2.5; 95 % IC : 1.7-3.7), in those cases with a positive heterogeneity rest.Conclusions. - This meta-analysis shows a lower morbidity with endoscopic banding ligation in patients with variceal hemorrhage. The most important advantage of endoscopic banding ligation was the reduction of the rate of rebleeding.

The aim of this study was to evaluate the prognosis and the determinants of survival in cirrhotics presenting with variceal bleeding. One hundred and minety one consecutive patients with cirrhosis (alcoholic 93 percent) were enrolled between 1983 and 1988. Treatment was principally but not exclusively based on early endoscopic sclerotherapy. At admission all patients were classified according to Child-Pugh's classification (class A = 16 percent; class B = 53 percent; class C = 31 percent). The rebleeding rates at 48 hours and for the entire hospitalisation were 11 and 30 percent respectively. Actuarial survival rates were 45, 40, and 37 percent at 12, 18, and 36 months, respectively. Prognostic factors, as determined by uni- and multivariate analysis (Cox model), corresponded to Child-Pugh's score, to the five components, and the occurrence of early bleeding recurrence. This study also showed that: i) the role of Child-Pugh's classification on long-term prognosis is determined during the 3 months following index bleeding; ii) early rebleeding is a significant prognostic factor, particularly in Child-Pugh's class B patients; iii) there are few indicators of early rebleeding (serum albumin level, presence of gastric varices at initial endoscopy). Prognosis of variceal bleeding is still severe in cirrhosis but efforts made to prevent early bleeding recurrence seem to be fully justified.

The aim of this retrospective study was to describe the clinical and prognostic characteristic of bleeding ulcers following gastrotoxic agent use. From 1984 to 1988, 244 patients were admitted in our Intensive Care Unit for bleeding ulcers; 133 (54.5 percent) were using gastrotoxic agents. Patients not taking gastrotoxic agents were compared with patients taking non steroidal antiinflammatory drugs (n = 77) or aspirin (n = 35). Patients receiving non steroidal antiinflammatory drugs differed (P < 0.05) from patients not taking gastrotoxic agents: they were older, had less history of ulcer, hemorrhage, and alcohol abuse. Patients taking aspirin had less severe hemorrhage and took anticoagulant therapy less frequently than patients not taking gastrotoxic agents. Patients taking aspirin were younger, had less severe hemorrhage and had more frequent history of alcohol abuse and ulcer disease than patients taking non steroidal antiinflammatory drugs. There was no difference with regard to endoscopic data and mortality (7 percent). Two thirds of hemorrhages following non steroidal antiinflammatory drugs occurred during the month following the onset or the modification of treatment. The distribution of non steroidal antiinflammatory drugs in the group of patients who bled after non steroidal antiinflammatory drugs differed from that of regional sales. These results suggest that upper gastrointestinal tract bleeding associated with the use of gastrotoxic agent are frequent, particularly in elderly patients, are not associated with poor prognosis, and occur soon after the beginning of treatment.

The aim of this retrospective study was to describe the clinical and prognostic characteristics of bleeding ulcers following gastrotoxic agent use. From 1984 to 1988, 244 patients were admitted in our Intensive Care Unit for bleeding ulcers; 133 (54.5 percent) were using gastrotoxic agents. Patients not taking gastrotoxic agents were compared with patients taking non steroidal antiinflammatory drugs (n = 77) or aspirin (n = 35). Patients receiving non steroidal antiinflammatory drugs differed (P less than 0.05) from patients not taking gastrotoxic agents: they were older, had less history of ulcer, hemorrhage, and alcohol abuse. Patients taking aspirin had less severe hemorrhage and took anticoagulant therapy less frequently than patients not taking gastrotoxic agents. Patients taking aspirin were younger, had less severe hemorrhage and had more frequent history of alcohol abuse and ulcer disease than patients taking non steroidal antiinflammatory drugs. There was no difference with regard to endoscopic data and mortality (7 percent). Two thirds of hemorrhages following non steroidal antiinflammatory drugs occurred during the month following the onset or the modification of treatment. The distribution of non steroidal antiinflammatory drugs in the group of patients who bled after non steroidal antiinflammatory drugs differed from that of regional sales. These results suggest that upper gastrointestinal tract bleeding associated with the use of gastrotoxic agent are frequent, particularly in elderly patients, are not associated with poor prognosis, and occur soon after the beginning of treatment.

The aim of this study was to evaluate the prognosis and the determinants of survival in cirrhotics presenting with variceal bleeding. One hundred and ninety one consecutive patients with cirrhosis (alcoholic 93 percent) were enrolled between 1983 and 1988. Treatment was principally but not exclusively based on early endoscopic sclerotherapy. At admission all patients were classified according to Child-Pugh's classification (class A = 16 percent; class B = 53 percent; class C = 31 percent). The rebleeding rates at 48 hours and for the entire hospitalisation were 11 and 30 percent respectively. Actuarial survival rates were 45, 40, and 37 percent at 12, 18, and 36 months, respectively. Prognostic factors, as determined by uni- and multivariate analysis (Cox model), corresponded to Child-Pugh's score, to the five components, and the occurrence of early bleeding recurrence. This study also showed that: i) the role of Child-Pugh's classification on long-term prognosis is determined during the 3 months following index bleeding; ii) early rebleeding is a significant prognostic factor, particularly in Child-Pugh's class B patients; iii) there are few indicators of early rebleeding (serum albumin level, presence of gastric varices at initial endoscopy). Prognosis of variceal bleeding is still severe in cirrhosis but efforts made to prevent early bleeding recurrence seem to be fully justified.