Background: Pediatric-onset Crohn's disease (CD) may represent a more severe form of disease. The aim of this study was to describe long-term outcome and identify associated risk factors of complicated behavior in a large population-based pediatric-onset CD cohort. Patients and methods: Cases included all patients recorded in the EPIMAD registry diagnosed with definite or probable CD between January 1988 and December 2004, under the age of 17 years at the time of diagnosis, with at least two years of follow-up. Results: Five hundred and thirty-five patients were included. Median follow-up was 11.1 years[IQR, 7.3-15.0]. At the end of follow-up, 8% (n = 44) of patients had pure ileal disease (L1), 8% (n = 44) had pure colonic disease (L2), and 83% (n = 439) had ileocolonic disease (L3). L4 disease and perianal disease were observed in 42% (n = 227) and 16% (n = 85) of patients, respectively. At the end of follow-up, 58% (n = 308) of patients presented complicated disease behavior (B2, 39% and B3, 19%), and 42% (n = 163) of patients with inflammatory behavior at diagnosis had evolved to complicated behavior. During followup, 86% of patients (n = 466) received at least one course of corticosteroids, 67% (n = 357) of patients had been exposed to immunosuppressants and 35% (n = 187) of patients received at least one anti-TNF agent. Forty-three percent (n = 230) of patients underwent at least one intestinal resection. The overall mortality rate was 0.93% and the SMR was 1.6[0.5-3.8] (p = 0.20). Five cancers were reported with a crude cancer incidence rate of 1.1% and an SIR of 3.3[1.2-7.0] (p = 0.01). In a multivariate Cox model, ileal (HR, 1.87 [1.09-3.21], p = 0.022) or ileocolonic (HR, 1.54[1.01-2.34], p = 0.042) and perianal lesions at diagnosis (HR, 1.81[1.13-2.89], p = 0.013) were significantly associated with complicated behavior. Conclusion: About 80% of patients with pediatric-onset CD presented extensive ileocolonic disease during follow-up. The majority of patients evolved to complicated behavior. Surgery, cancer and mortality were observed in 43%, 0.9% and 0.9% of patients, respectively. (c) 2018 Editrice Gastroenterologica Italiana S. r. l. Published by Elsevier Ltd. All rights reserved.

Background and study aims: The mortality rate from upper gastrointestinal bleeding (UGIB) remains high, at 5%-10%. The aim of the current study was to describe the epidemiological characteristics, prognostic factors, and actual practice in a cohort of patients with UGIB admitted to French general hospitals.Methods: From March 2005 to February 2006, a prospective multicenter study was conducted at 53 French hospitals. A total of 3298 patients admitted for UGIB were enrolled consecutively. Patient data were collected up to the date of discharge from hospital.Results: Data were available for 2130 men and 1073 women (mean age 63 +/- 18 years), one-third of whom were taking drugs that would increase the risk of UGIB. The two main causes of bleeding were peptic ulcers (38%) and esophagogastric varices (EGV) or portal hypertensive gastropathy (24.5%). Mean Rockall score was 5.0 +/- 2.3. Endoscopy was performed on 96% of patients (within 24 hours in 79%), and 66% of those with ulcers and 62.5% of the EGV patients underwent hemostatic therapy when indicated. Rebleeding occurred in 9.9% of the patients, and 8.3% died. Independent predictors of rebleeding were: need for transfusion (odds ratio [OR] 19.1; 95% confidence interval [95%CI] 10.1-35.9); hemoglobin<10g/dL (OR: 1.7; 95%CI 1.1-3.3); Rockall score (OR: 1.4 for each 1 point score increase; 95%CI 1.0-1.9), systolic blood pressure <100mmHg (OR: 1.9; 95%CI 1.4-2.5), and signs of recent bleeding (OR: 2.4; 95%CI 1.7-3.5). Independent predictors of mortality were: Rockall score (OR: 2.8; 95%CI 2.0-4.0), co-morbidities (OR: 3.6 for each additional co-morbidity; 95%CI 2.0-6.3), and systolic blood pressure <100mmHg (OR: 2.1; 95%CI 1.8-2.8). Rockall score, blood pressure and co-morbidities were taken as continuous variables meaning that the OR was 1.4 for every point increase, it was the same for blood pressure.Conclusion: UGIB still occurs mainly as a result of peptic ulcers and portal hypertension in France, and causes significant rates of mortality. There is scope for improvement via better prevention (better use of UGIB-facilitating drugs), endoscopic therapy, and management of co-morbidities.

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.

Les hémorragies digestives hautes (HDH) représentent l'une des principales urgences en hépato-gastroentérologie. L'objectif principal de cette étude est de décrire les caractéristiques épidémiologiques actuelles des HDH communautaires et également les pratiques professionnelles, la morbidité et la mortalité hospitalière.

L'électrocoagulation au plasma argon (APC) est utilisée en endoscopie pour le traitement des rectites radiques, des ectasies vasculaires antrales, des angiodysplasies, des ulcères hémorragiques, de l'obstruction des stents, des polypes et des résidus tissulaires après mucosectomie. La complication principale, la perforation, est considérée comme peu fréquente et pourrait être sous estimée avec 1 perforation observée au cours de 86séances pour le traitement d'angiodysplasies dans un travail récemment publié (1).

L’association d’une pancréatite chronique calcifiante et d’une tumeur endocrine du pancréas est rare. Les remaniements pancréatiques rendent le diagnostic difficile. Au travers de ce cas, nous faisons une revue de la littérature et décrivons la sémiologie scanographique. Patient de 50 ans porteur d’une pancréatite chronique calcifiante diagnostiquée en 1987 d’origine exogène bénéficiant de contrôles scanographiques lors des événements sentinelles (poussée de pancréatite, douleurs) en 1989, 1993, 1994 et altération de l’état général en 2001. Le scanner montre des calcifications, une dilatation du canal de Wirsung, un pseudokyste céphalique, une zone hypodense caudale, une thrombose segmentaire avec circulation collatérale veineuse correspondant à la pancréatopathie. Evolution sur les scanners de contrôle de l’hypodensité caudale devenant une masse de 80 mm de diamètre en 1994 avec une exploration chirurgicale en faveur d’une masse inflammatoire. Le diagnostic de carcinome endocrine du pancréas était réalisé après ponction d’une masse hypervascularisée avec des zones de nécrose et de calcifications en 2001 associée à une hypercalcémie, hypercalcitoninémie et hypersécrétion de PTHrp. La revue de la littérature retrouve trois cas de tumeur endocrine sur pancréatite chronique préexistante. Intérêt du scanner comparatif dans le suivi des pancréatites chroniques.

Au cours des maladies inflammatoires chroniques de l'intestin, une pancreatite aigue (PA) peut compliquer l'evolution de la maladie [1-4]. Elle est le plus souvent secondaire A a un traitement par azathioprine, 6-mercaptopurine, derives salicyles, sulfasalazine ou metronidazole [3]. Les corticoides ne sont que tres rarement signales comme une cause possible de pancreatite [3, 5]. Nous rapportons une observation de PA recidivante au cours d'une maladie de Crohn suggerant la responsabilite de la corticotherapie.

Background—Cap polyposis is a rare disease characterised by mucoid and bloody diarrhoea, with polyps covered by a cap of mucoid and fibrinopurulent exudate. The pathogenesis is not known.Aims—To pour some light on cap polyposis pathogenesis, by examining the mucus of patients and analysing the expression of five mucin genes, MUC2, MUC3,MUC4, MUC5AC, and MUC5B.Patient and methods—The study was performed on biopsy specimens taken from a patient with recurrent cap polyposis. Histochemical examination, electron microscopy, and mRNA in situ hybridisation were used.Results—The mucus of cap polyposis differed in three respects from that of normal adult colon: abnormal ultrastructure of the mucus in the goblet cells, predominance of non-sulphated mucins, abnormal expression of the MUC4, MUC3, andMUC5AC genes.Conclusions—Most of these abnormalities have been reported for other pathological situations, suggesting that the abnormalities observed in the mucus of this patient with cap polyposis are probably secondary phenomena rather than primary. However, the mucin abnormalities detected, which reflect deregulation of the expression of three apomucin genes, abnormal glycosylation, and abnormalities of the secretion process, are also probably involved in the clinical manifestations of cap polyposis.

The case is reported of a 42 year old woman who presented with the characteristic clinical, sigmoidoscopic, and histological features of cap polyposis occurring in the postoperative course of pelvic surgery. Pathogenesis of cap polyposis is unknown. In this patient, abnormal colonic motility was not a likely aetiological factor as suggested in previous cases. Despite some arguments favouring an infectious origin or participation, no specific viral or bacterial agent was identified. Cap polyposis remains a poorly recognised condition, which may be confused with inflammatory bowel disease.

The distribution of heparan sulphate proteoglycans (HSPG) has been investigated in normal human glomeruli, membranous glomerulonephritis, mesangial IgA disease, and anti‐glomerular basement membrane disease. HSPG was localized using anti‐bovine HSPG antibody and 10 nm gold‐labelled secondary antibody on paraformaldehyde‐fixed, Lowicryl K4M resin‐embedded kidneys. HSPG was present in all glomeruli and there was a zonation of its distribution in that it was predominantly on the epithelial aspect of the glomerular basement membrane (GBM) and mesangium with little in the central regions of the mesangial matrix. In the cases of immune complex glomerulonephritis, no HSPG was found in the electron‐dense deposits. These findings contrast with our previous studies using the same technique in which type IV collagen and fibronectin were found predominantly on the endothelial aspect of the GBM.

The relationship between the immune complex deposits of mesangial IgA nephropathy and the basement membrane components, type IV collagen and fibronectin, has been investigated by an indirect immunogold technique in four cases of mesangial IgA disease. Using paraformaldehyde-fixed, Lowicryl K4M resin-embedded kidney, IgA, IgM and C3 were localized in the mesangial electron-dense deposits with 10 and 20 nm gold-labelled secondary antibodies. In the same glomeruli, type IV collagen and fibronectin were rarely present within the electron-dense deposits, although both were distributed throughout the remainder of the mesangial matrix with the exception of the subepithelial regions. These two components were also present within the glomerular basement membrane and localized mainly on the endothelial aspect. A similar distribution of the basement membrane components was seen in a control kidney processed in the same way. This technique gives reproducible results and has demonstrated for the first time the relationship between the mesangial immune complex deposits of mesangial IgA nephropathy and the basement membrane components of the matrix in which they are found.

We compared the rectal microflora of 16 patients with surgically excluded colorectum with 16 healthy controls. The cause of diversion was inflammatory bowel disease (n = 10), colon cancer (n = 3), miscellaneous (n = 3). Six patients had a diversion colitis. In the excluded colorectum, the total bacterial count was only slightly lower than controls but the variety of the flora was significantly reduced. This reduction was confined to strict anaerobes, mainly the genus Eubacterium and Bifidobacterium. Among aerobes, enterobacteria were more often isolated than in controls. This altered microflora of excluded colorectum could be involved in the mucosal damage observed in some cases.