Helicobacter pylori (H. pylori) eradication is a continuously challenging issue as antibiotic resistance is evolving and adversely affecting outcomes of previously effective treatments. Continual assessment and modification of therapeutic approaches is necessary. The aim of our study was to evaluate H. pylori eradication rate in Tunisian patients treated by non-bismuth quadruple therapy and to investigate treatment failure factors. We conducted a prospective multicentric study including patients with H. pylori infection. For all patients, concomitant therapy (amoxicillin 1 g, clarithromycin 500 mg and metronidazole 500 mg plus esomeprazole 40 mg) twice daily for 14 days was prescribed. Mutations conferring resistance of H. pylori to clarithromycin were detected using polymerase chain reaction on gastric biopsies. Eradication was assessed using the urea breath test. 414 patients were included. The mean age was 44.7 ± 14.3 with a sex ratio of M/F = 0.53. Mutations conferring resistance of H. pylori to clarithromycin were observed in 76 patients (18.35

The treatment of Helicobacter pylori infection remains a challenge. None of the proposed treatment regimens has resulted in a 100% eradication rate. The aim of our study was to compare the rate of H. pylori eradication after standard or dose-optimized amoxicillin quadruple therapy. We conducted a prospective comparative study collating patients naive to any anti-H. pylori treatment and with chronic H. pylori infection documented by histological examination. Patients were randomly assigned to either standard quadruple therapy or optimized quadruple therapy. Eradication control was performed by urea breath test. Eighty-eight eligible patients were included with 44 in each group.There was no significant difference between the eradication rates of Qo-14 and Qs-14 neither in ITT (84 vs 70.4%; p = 0.127) nor in PP (82.1 vs 77.7%; p = 0.473). Compliance and tolerance appeared similar in each group. Plain language summary: H. pylori is a common bacterium that can cause several digestive infections, including gastric ulcers and gastric cancer. The aim of this study was to compare the rate of H. pylori eradication after a standard dose compared with a double dose of a specific therapy known as amoxicillin quadruple therapy. The results showed no significant difference between the eradication rates of standard or optimized quadruple therapy.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Introduction: Gastro-intestinal bleeding etiological diagnosis could be challenging especially for rare etiologies as it was the case of our patient having an arteriovenous gastric malformation.Case presentation: A 50-years old man consulted for hematemesis. Esophagogastroduodenoscopy didn't show bleeding signs. Angio-scan revealed an arteriovenous gastric malformation. Median laparotomy revealed multiple radiologically unsuspected great omentum arteriovenous malformations and confirmed the existence of this arteriovenous malformation in the posterior part of the lesser curvature guided by per-operative esophagogastroduodenoscopy. Atypical gastrectomy was performed.Discussion: Our case illustrated a rare life-threatening condition with a challenging diagnosis. Arteriovenous gastric malformation accounted for 1 to 2 % of nonvariceal upper gastrointestinal bleeding. Great omentum localization corresponded to an exceptional condition that had been reported in only one adult patient and one childhood case. Its pathogenesis is still unknown. Conclusions: Arteriovenous gastric malformation had to be considered in case of normal endoscopic esophagogastroduodenoscopy.Computed tomography had to be done for both diagnosis and therapeutic purposes.

Perforation of the intestine caused by an ingested foreign object remains a complex challenge in terms of clinical presentation, diagnosis, and treatment. A 55-year-old man presented with complaints of right-sided abdominal pain and functional impairment of the lower limbs. Physical examination revealed an afebrile status and tenderness in the right upper quadrant of the abdomen. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) revealed a duodenal perforation caused by a densely linear foreign body. Additionally, a collection in the psoas muscle and contiguous spondylodiscitis were identified. To address this condition, an endoscopic procedure was performed to extract the toothpick successfully, and a CT-guided fine-needle aspiration was conducted to collect the fluid. Spondylodiscitis was managed with antibiotic therapy and immobilization. Remarkably, significant clinical and radiological improvement was observed within a span of three weeks. This case emphasizes the importance of multidisciplinary care involving interventional treatments as a viable and safe alternative to surgical intervention.

Intrauterine device (IUD) is the mainstay of family planning methods in developing countries. However, it is associated with severe complications such as bleeding, perforation and migration to adjacent organs. Although perforation of the uterus is not rare, migration to the sigmoid colon is exceptional. We here report a case of IUD migration into sigmoid colon; this was removed via low endoscopy. The study involved a 45-year-old woman using an IUD who presented with pelvic pain associated with a feeling of pelvic heaviness 6 years later of insertion. Clinical examination was without abnormalities, and computed tomography (CT) scan showed the IUD embedded in the sigmoid colon wall. Diagnostic and therapeutic laparoscopy was performed, which objectified IUD-related intestinal perforation. IUD was partially embedded in the sigmoid colon wall and couldn't be removed. The device was removed during colonoscopy by diathermy loop excision (15 mm in diameter).

Le dispositif intra-utérin (DIU) reste le pilier principal des mesures de planification familiale dans les pays en développement, néanmoins il est associé à des complications graves telles que les saignements, les perforations et les migrations vers des organes adjacents. Bien que la perforation de l'utérus par un DIU ne soit pas rare, la migration vers le côlon sigmoïde est exceptionnelle. Nous rapportons ici un cas de migration d'un stérilet vers le côlon sigmoïde qui a été retiré par voie endoscopique basse. Il s´agit d´une femme de 45 ans, porteuse d'un stérilet, se présente 6 ans plus tard, avec des douleurs pelviennes à type de pesanteur. L´examen clinique était sans anomalies et l´exploration scannographique avait objectivé le DIU qui était incrusté dans la paroi du colon sigmoïde. Une laparoscopie à visée diagnostique et thérapeutique a été réalisée; elle avait objectivé une perforation intestinale par le dispositif, qui était partiellement incrusté dans le côlon sigmoïde, mais elle avait échoué de l´extraire. Le dispositif avait été retiré lors d´une coloscopie par une anse diathermique (15mm de diamètre).

Helicobacter pylori infection is strongly associated with chronic gastritis and is probably the main course of chronic inflammation in the gastric mucosa. Gradually, H. pylori gastritis will result in gastric atrophy and intestinal metaplasia. Identifying the relationship between intensity of colonization and activity of gastritis helps the clinician in more effective treatment and post-treatment follow-ups. The aim of our work was to analyze the relationship between the density of H. pylori colonization of the gastric mucosa and the severity of histological parameters of gastritis (inflammation activity, gastric atrophy, and intestinal metaplasia). This was a prospective monocentric study conducted from January 2020 to December 2020, collecting patients naive to any anti-H. pylori treatment and having a chronic H. pylori infection documented by histological examination. Epidemiological, endoscopic, and anathomopathological data were collected. Ninety-seven patients with a mean age of 42.6 years [18-65 years] and a sex ratio of M/F = 0.64 were included. The density of H. pylori colonization was mild (+) in 43.3% of patients, moderate (++) in 47.4% of patients, and significant (+++) in 9.3% of patients. Nearly, ten per cent of patients had no gastritis, 33% had mild gastritis, 50.5% had moderate gastritis, and 6.2% had severe gastritis. Gastric atrophy and intestinal metaplasia were found in 44.3% and 10.3% of our population, respectively. Patients with mild H. pylori colonization rates had the highest level of mild activity (59.5%). There was a statistically significant association between the severity of H. pylori infection and gastritis activity (p < .001). Gastric atrophy was significantly associated with the intensity of H. pylori colonization (p = .049). No significant relationship was found between the intensity of colonization and metaplasia (p = .08). Our study shows that there is a statistically significant association between the density of H. pylori and histopathological findings including gastritis activity and intestinal atrophy.

Intrauterine device (IUD) is the mainstay of family planning methods in developing countries. However it is associated with severe complications such as bleeding, perforation and migration to adjacent organs. Although perforation of the uterus is not rare, migration to the sigmoid colon is exceptional. We here report a case of IUD migration into sigmoid colon; this was removed via low endoscopy. The study involved a 45-year-old woman using a IUD who presented with pelvic pain associated with a feeling of pelvic heaviness 6 years later of insertion. Clinical examination was without abnormalities, and CT scan showed the IUD embedded in the sigmoid colon wall. Diagnostic and therapeutic laparoscopy was performed, which objectified IUD-related intestinal perforation. IUD was partially embedded in the sigmoid colon wall and couldn't be removed. The device was removed during colonoscopy by diathermy loop excision (15 mm in diameter).

Cystic lymphangioma is a rare benign malformative tumor of the lymphatic vessels which may occur in various locations. Intra-abdominal cystic lymphangioma is less frequent than cervicoaxillary cystic lymphangioma. Clinical presentation is polymorphic. Diagnosis is based on imaging data but it requires histological confirmation. Surgery is the gold standard treatment. We here report a rare case of acquired intraperitoneal cystic lymphangioma secondary to subtotal colectomy in a female patient with severe evolutive Crohn's disease treated with anti-TNF alpha. The patient presented with irreducible right painful paramedian mass with no impulse on coughing, suggesting the diagnosis of strangulated eventration within a surgical scar from midline laparotomy. She underwent emergency surgery. Surgical exploration showed multi-cystic intraperitoneal mass protrunding through the right paramedian eventration. Anatomo-pathological examination helped to confirm the diagnosis of cystic lymphangioma. Postoperatively, the mass was punctured twice to evacuate the fluid, because of incomplete surgical resection. This is the first reported case of cystic lymphangioma in a patient under anti-TNF alpha. It could be caused by disruption of the immune system and more specifically of the lymphocyte population. This association has not hitherto been established and experimental studies are necessary to accept or refuse this hypothesis.

Le lymphangiome kystique est une tumeur bégnine malformative rare des vaisseaux lymphatiques à localisations diverses. La localisation intra-abdominale du lymphangiome kystique est moins fréquente comparée à la localisation cervico-axillaire. Sa présentation clinique est polymorphe. Le diagnostic est évoqué par l'imagerie mais il nécessite une confirmation histologique. Le traitement de choix est chirurgical. Nous rapportons ici un cas rare de lymphangiome kystique intrapéritonéale acquis suite à une colectomie subtotale chez une patiente porteuse de maladie de Crohn à géni évolutif sévère et ayant nécessité l'introduction des anti TNF alpha. La patiente s'est présentée pour une masse para médiane droite douloureuse irréductible et non impulsive à la toux faisant retenir le diagnostic d'une éventration étranglée sur cicatrice de laparotomie médiane et amenant à opérer la patiente en urgence. L'exploration chirurgicale a montré une masse multi-kystique intra péritonéale extériorisée en partie à travers l'éventration paramédiane droite. L'examen anatomo-pathologique a permis de confirmer le diagnostic de lymphangiome kystique. Devant une exérèse chirurgicale incomplète, la patiente a eu deux séances de ponction évacuatrice en post-opératoire. C'est le premier cas de lymphangiome kystique rapporté chez un patient sous Anti-TNF alpha. Ceci pourrait être expliqué par la perturbation du système immunitaire et plus spécifiquement la population lymphocytaire. Cette association n'a pas été jusque-là prouvée et des études expérimentales sont nécessaires pour affirmer ou infirmer cette hypothèse.

BACKGROUND:Diffuse esophageal spasms is a primary motor disrder of the esophagus of unknown etiology characterized by intermettent peristalsis. This is rare condition which represents 3-5% if primary disorders of the esophagus. Diagnosis and treatment of this entity are difficult.AIMS:To evaluate the frequency and the clinical and the manometric features of diffuse esophageal spasms.METHODS:We conducted a retrospective study related to esophageal manometry performed between January 2000 and December 2011 regardless of the indication. Patients with meeting criteria for diffuse esophageal spasms (> 20 % simultaneous waves with greater than 30 mmHg pressure in the esophagus) were included.RESULTS:Out of 1188 patients, 13 (1,09 %) met the manometric criteria for diffuse esophageal spasms. It was 8 women and 5 men with a median age of 57 years. Dysphagia was the most relevant symptom and chest pain was only noted in 1 patient. The frequency of simultaneous waves was between 20 and 80 %. The pressure of the lower esophageal sphincter was normal in most cases.CONCLUSION:In this Tunisian manometric study, the diffuse esophageal spasms is rare. Dysphagia was the most relevant symptom and the pressure of the lower esophageal sphincter was normal in most cases.

BACKGROUND:Celiac disease (CD) is characterized by a malabsorption syndrom. The bone anomalies are one of the principal complications of this disease. The osteoporosis frequency is high: 3.4% among patients having with CD versus 0.2% in the general population. AIM:To study the bone mineral density during the CD, to compare it to a control group and to determine the anomalies of biochemical markers of bone turn over and level of interleukin 6 cytokin (IL6) in these patients. METHODS:All patients with CD have a measurement of bone mineral density by dual-energy x-ray absorptiometry (DXA), a biological exam with dosing calcemia, vitamin D, parathormone (PTH), the osteoblastic bone formation markers (serum osteocalcin, ALP phosphates alkaline), bone osteoclastic activity (C Télopeptide: CTX) and of the IL6. RESULTS:42 patients were included, with a median age of 33.6 years. 52. 8% of the patients had a low level of D vitamine associated to a high level of PTH. An osteoporosis was noted in 21.5% of patients. No case of osteoporosis was detected in the control group. The mean level of the CTX, ostéocalcine and the IL6 was higher among patients having an osteoporosis or ostéopenia compared to patients with normal bone (p = 0,017). The factors associated with an bone loss (osteopenia or osteoporosis) were: an age > 30 years, a weight <50 kg, a level of ALP phosphates alkaline > 90 UI/ml, an hypo albuminemia < 40 g/l and a level of CTX higher than 1.2. CONCLUSION:Our study confirms the impact of the CD on the bone mineral statute. The relative risk to have an osteopenia or an osteoporosis was 5 in our series. The measurement of the osseous mineral density would be indicated among patients having a CD.