Clinical: Diagnosis and outcome S113 (20%) and L1 (3.3%).Enteroscopic intervention and operation were conducted in 13.3% (clipping 1, balloon dilatation 2 and capsule endoscopy remove 1) and 3.3% (1/30), respectively.Of 27 patients except three who underwent DBE for therapeutic purpose, DBE identified all of 10 cases that had negative results from other modalities.Therapeutic plans were determined in 63.3% (19/30) on the basis of results from DBE. Conclusions: DBE is a useful diagnostic tool for the diagnosis of CD patients with SB involvement.The clinical significance of DBE is emphasized by the fact that adjustment of therapy in up to 60% of these patients.

BACKGROUND:The natural history of Crohn's disease is associated with several factors that affect the prognostic of the patients.AIMS:To determine the most prognostic factors in Crohn's disease, based on a systematic review.METHODS:Literature review.RESULTS:The most important factors to consider in patients with Crohn's disease are the need for immunosuppressive therapy, the need for intestinal resection and disabling disease. Prognostic factors for these events are ileal involvement, perianal disease and initial treatment by corticosteroid. Other factors such young age, CRP level and smoking status, has not been found in all population-based studies. Protective role of anti-TNF drugs is strongly suggested but need to be confirmed in further studies.CONCLUSION:In a selected subgroup of patients with Crohn's disease characterized by the presence of these prognostic markers, the "topdown" strategy can be proposed.

The physiopathology of idiopathic achalasia is still unknown. The description of circulating antimyenteric autoantibodies (CAA), directed against enteric neurons in sera of patients, suggests an autoimmune process. Recent data showed controversies according to the existence and the significance of CAA. The aims of this study were to investigate whether CAA are detected in Tunisian patients with idiopathic achalasia and to look for associated clinical or manometrical factors with CAA positivity. Twenty-seven patients with idiopathic achalasia and 57 healthy controls were prospectively studied. CAA were assessed by indirect immunofluorescence on intestinal monkey tissue sections. Western blot on primate cerebellum protein extract and dot technique with highly purified recombinant neuronal antigens (Hu, Ri, and Yo) were further used to analyze target antigens of CAA. CAA were significantly increased in achalasia patients compared with controls when considering nuclear or cytoplasmic fluorescence patterns. (33% vs. 12%, P = 0.03 and 48% vs. 23%, P = 0.001 respectively). By immunoblot analysis, CAA did not target neuronal antigens, however 52/53 and 49 kDa bands were consistently detected. CAA positivity was not correlated to specific clinical features. The results are along with previous studies demonstrating high CAA prevalence in achalasia patients. When reviewing technical protocols and interpretation criteria, several discrepancies which could explain controversies between studies were noted.

Several studies have focused on the relationship between metabolic syndrome and gastroesophageal reflux disease (GERD). They were based on GERD complications, whereas little is known about the association between metabolic syndrome and objectively measured esophageal acid exposure. The aim of our study was to assess the relationship between metabolic syndrome and GERD based on a 24-hour pH testing. It was a cross-sectional study including 100 consecutive patients who underwent a 24-hour pH-metry monitoring and were assessed for the five metabolic syndrome components as well as for body mass index (BMI). Among the 100 patients, 54 had a pathological acid GERD. The 46 GERD-free patients represented control group. Sex distribution was comparable between both groups but GERD patients were older than controls (44.59 vs. 37.63 years, P= 0.006) and more often obese or with overweight (83.3 vs. 60.9%, P= 0.01). Frequency of metabolic syndrome as a whole entity was higher among patients with GERD than those without GERD (50 vs. 19.56%; P= 0.002) with a crude odds ratio of 4.11 (95% confidence interval: 1.66-10.14). Multivariate regression analysis showed that metabolic syndrome as well as an age ≥ 30 years were independent factors associated to GERD but not BMI and sex. Abnormal waist circumference and fasting glucose level ≥ 100 mg/L were the only independent factors among the five components of metabolic syndrome. Metabolic syndrome but not BMI was an independent factor associated to GERD. These results confirm the hypothesis that central obesity is associated to GERD.

Introduction: Common variable immunodeficiency or primary hypogammaglobulinemia is associated with increased risk of bacterial infection of respiratory and digestive tract, as well as tumor, autoimmune, and granulo-matous disease. Gastro intestinal symptoms are common and often reveal common variable immunodeficiency in young adult. The aim of this review is to describe the gastro intestinal diseases of common variable immunodeficiency, to suggest diagnostic strategies, and to precise available therapeutics.Methods: We conducted a review of literature based on critical analysis of prospective series, therapeutic trials, and retrospective series.Results: Gastro intestinal diseases are frequent (40 to 60%), variable, and often reveal common variable immunodeficiency. The main digestive symptom is chronic diarrhoea, which has various origins: infection, villous atrophy, inflammation, or neoplasia. Giardia is the cause of 30% of digestive infection.Conclusion: An early diagnosis and management in common variable immunodeficiency is essential to treat digestive diseases and prevent recurrence.

Common variable immunodeficiency or primary hypogammaglobulinemia is associated with increased risk of bacterial infection of respiratory and digestive tract, as well as tumor, autoimmune, and granulomatous disease. Gastro intestinal symptoms are common and often reveal common variable immunodeficiency in young adult. The aim of this review is to describe the gastro intestinal diseases of common variable immunodeficiency, to suggest diagnostic strategies, and to precise available therapeutics.

Few studies had evaluated the results of proton pump inhibitors on distal and proximal pH recording using a dual-channel probe. The aim of this study was to determine the clinical and pH-metric effect of treatment with pantoprazole 80 mg for 8 weeks in patients with ear, nose, and throat (ENT) manifestations of gastroesophageal reflux disease associated with pathological proximal acid exposure. We conducted a prospective open study. Patients included had to have chronic pharyngitis or laryngitis, and a pathological gastroesophagopharyngeal reflux. All patients received treatment with pantoprazole 80 mg daily for 8 weeks. One week after the end treatment, patients had a second ENT examination and a 24-hour pH monitoring using dual-channel probe. We included 33 patients (11 men, 22 women). A pathological distal acid reflux was found in 30 patients (91%). After treatment, the improvement of ENT symptoms was found in 51.5% of patients. Normalization of 24-hour proximal esophageal pH monitoring was observed in 22 patients (66%). After treatment, the overall distal acid exposure, the number of distal reflux events, and the number of reflux during more than 5 minutes were significantly decreased (respectively: 19.4% vs 7.2% [P < 0.0001], 62.7 vs 28.4 [P < 0.0001], and 10.4 vs 3.9 [P < 0.0001] ). Similarly, in proximal level, the same parameters were significantly decreased after treatment (respectively: 6.8% vs 1.6% [P < 0.0001], 32.6 vs 8.1 [P < 0.0001], and 3.4 vs 0.6 [P= 0.005] ). Treatment with pantoprazole reduced the frequency and severity of gastroesophagopharyngeal acid reflux in patients with chronic pharyngitis and laryngitis.