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From March to October 1989, 237 French gastroenterologists included 1,301 patients referred for irritable bowel syndrome in a 9-month epidemiological survey based on questionnaires and monthly auto-evaluation. In the patient population, the high preponderance of women (sex ratio: 2.33), the high prevalence of cholecystectomy (9%), appendectomy (53%) and an association with at least one symptom of non-ulcer dyspepsia (70%) were observed. Fifty per cent of the patients completed the 9-month follow-up period; among them, 60% declared an improvement in their symptoms, but only 30% in their quality of life and independently of the clinical course. This study suggests that symptoms and quality of life in patients consulting for irritable bowel syndrome should be taken into account separately, both in daily practice and in therapeutic evaluation.

Introduction Les probiotiques sont une option therapeutique discutee au cours du SII. Lactobacillus paracasei (LP), parait une souche interessante puisqu’experimentalement il corrige l’hypercontractilite intestinale post-infectieuse ainsi que l’hypersensibilite et les alterations de la permeabilite intestinale liees au stress. But Tester l’efficacite de LP (0,5-2×108 CFU/ml, 2/jour pendant 35 jours) sur les symptomes et la qualite de vie des differents types de malades SII par rapport a un placebo (lait acidifie). Pour etre inclus, les patients SII selon Rome II devaient souffrir d’une douleur abdominale comprise entre 1,5 et 8 sur une EVA 0 - 10 pendant au moins 50 % du temps lors des 15 jours de screening et au moins 2 des 4 jours precedant l’inclusion. Resultats 241 malades (164 femmes), âges de 47 ± 12 ans constituaient la population ITT alors que l’effectif PP etait de 179 malades (117 femmes). En ITT, l’intensite de la douleur abdominale n’etait pas differente entre LP et placebo tant a l’inclusion (4,52 + 2,01 νs 4,86 ± 2,16) qu’a la fin du traitement (3,31 ± 2,25 νs 3,2 ± 2,7) ou lors de la visite de suivi 15 jours apres le traitement (3,5 ± 2,2 νs 3,6 ± 2,6). Le nombre de repondeurs (reduction de plus de 50 % de la douleur initiale) n’etait pas different entre LP et placebo (33,3 νs 41,6 %, OR : 0,69 IC95 : 0,37 - 1,27). Cette absence de difference s’observait dans les differents sous-groupes de SII. Les resultats etaient aussi non differents en analyse PP. L’etude de la qualite de vie revelait que le stress avait moins d’impact sur les symptomes chez les malades ayant recu LP tant a la fin du traitement (p = 0,03) que de la periode de suivi (p = 0,04). Conclusion Un traitement de 35 jours par LP n’apporte pas plus de benefice qu’un lait acidifie dans le soulagement d’une douleur abdominale d’intensite moyenne chez des malades souffrant d’un SII mais reduit la reactivite au stress des malades, confirmant l’effet benefice sur les effets du stress mis en evidence par les donnees experimentales chez les rongeurs.

Introduction La dyschesie ano-rectale (DAR) est frequente chez les patients constipes. Neanmoins, le choix d’un traitement adapte depend des resultats des examens paracliniques. Le but de cette etude etait donc d’evaluer la rentabilite diagnostique de la manometrie anorectale (MAR) et de la defecographie IRM (IRM) chez des patients constipes presentant des signes cliniques de DAR et l’influence de ces examens sur le choix therapeutique. Patients et Methodes Des patients avec DAR (constipation chronique 75 % des evacuations) ont ete inclus prospectivement. Apres un examen clinique du perinee, une MAR (Polygraphe MMS - 3 canaux perfuses) et une IRM (General Electric Healthcare-1.5T) etaient realisees par des operateurs independants. La DAR etait definie en MAR par au moins un des signes suivants : relaxation incomplete du sphincter anal (SA), contraction anale paradoxale lors de la poussee ou de la distension rectale (anisme), RRAI incomplet lors de la distension rectale et en IRM : relaxation incomplete du SA ou contraction anale paradoxale lors de la poussee, contraction paradoxale des releveurs de l’anus en poussee, raccourcissement et beance du SAI en poussee. Les comparaisons statistiques ont ete effectuees au moyen des tests du Chi-2 et du kappa, avec un seuil de significativite de 5 %. Resultats 78 patients consecutifs (74 femmes, 54 ± 14 ans) ont ete inclus, dont 62 avec une constipation > 3 ans et 18 avec une constipation Conclusion La MAR et l’IRM se completent pour definir le traitement des patients avec DAR. Un traitement adapte, choisi en fonction de leurs resultats, ameliore la plupart des patients.

Introduction L’exploration endoscopique des patients operes d’un by-pass gastrique ou ayant une anastomose hepatico-jejunale sur une anse en Y est souvent difficile du fait de la longueur de l’anse afferente et de l’angle fixe au niveau de l’anastomose jejuno-jejunale. L’enteroscopie double ballon permet d’explorer ces patients, en tirant parti de la technique du double ballon et du surtube pour raccourcir l’anse jejunale en Y et ainsi acceder de maniere retrograde a l’estomac exclu. De plus, l’utilisation du surtube rend la progression de l’endoscope plus sure puisque les forces exercees par l’operateur pour avancer l’endoscope sont constamment transmises a la partie distale de l’endoscope. Patients et Methodes Nous avons utilise un enteroscope double ballon (EN450T20. Fujinon Optical Co., Ltd., Saitama, Japon) pour explorer 5 patients avec un bypass gastrique et ayant une indication d’examen endoscopique de l’estomac exclu et deux patients presentant une stenose d’une anastomose hepatico-jejunale sur anse en Y. L’estomac exclu a ete atteint chez 4 des 5 patients et l’anastomose hepatico-jejunale, chez les deux patients. Chez ces deux derniers patients, une dilatation a pu etre realisee au moyen d’un ballonnet hydrostatique, permettant dans un cas, l’evacuation d’un calcul sus-anastomotique responsable d’episodes d’angiocholite. Resultats Le film que nous presentons demontre le principe de cette technique d’exploration endoscopique, illustre les difficultes rencontrees pour catheteriser l’anse en Y et en discute les indications. Conclusion Le principe de l’endoscopie double ballon permet chez ces patients d’elargir le champ des explorations endoscopiques et ouvre de nouvelles possibilites diagnostiques et therapeutiques.

Introduction La technique de progression utilisee pour l’enteroscopie double ballon s’est revelee utile pour la realisation de coloscopies difficiles, notamment chez des patients multioperes. Le but de cette etude etait d’evaluer l’interet de cette technique de CDB, utilisant un nouveau coloscope (EC-450B15. Fujinon Optical Co. Ltd., Saitama, Japon) pour realiser une coloscopie complete chez des patients dont la coloscopie classique avait ete incomplete en raison de difficultes de progression. Patients et Methodes De janvier 2007 a juin 2008, une CDB a ete proposee a tous les patients avec une indication de coloscopie et chez qui l’examen precedent n’avait pu atteindre le caecum. Les patients avec une coloscopie incomplete du fait d’une preparation insuffisante ont ete exclus. La CDB etait realisee par deux operateurs avec l’aide d’un controle radiologique au debut de l’experience et ensuite soit par deux operateurs soit par un operateur et une infirmiere, sous anesthesie generale (Propofol) delivree par un anesthesiste. La preparation colique etait realisee par Colopeg, 2L la veille et 2L le matin de l’examen. Le coloscope EC-450B15 a une longueur totale de 182 cm, une longueur utile de 152 cm, un canal operateur de 2,8 mm, un champ de vision de 140 °, et un diametre de 9,4 mm. Le surtube a un diametre exterieur de 13,2 mm. L’extremite de l’endoscope et du surtube sont equipees de ballons qui peuvent etre gonfles/degonfles au moyen d’une pompe peristaltique. Les donnees cliniques, l’indication et le motif d’echec de la coloscopie, et les resultats de la CDB ont ete enregistres de maniere prospective. Resultats Chez 81 patients (57 femmes, 24 hommes, âge moyen 56 ± 16 ans) une premiere tentative de coloscopie avait ete realisee dans notre unite (n = 44) ou dans un autre service (n = 37) et avait ete incomplete en raison de difficultes de progression liees a des adherences chirurgicales (n = 4), un angle colique fixe (n = 42), un dolichocolon (n = 30), une diverticulose serree (n = 5). La CDB a ete complete chez 78 patients (97,5 %), atteignant le caecum chez 49, l’ileon chez 23 et l’anastomose ileo-colique chez 7. Les deux echecs (progression arretee dans le colon transverse) ont ete observes chez une patiente acromegale et chez un patient avec une maladie de Hirschsprung. Le temps moyen de realisation de la CDB etait de 24 ± 18 min, semblable a la duree moyenne d’une coloscopie classique dans notre unite. Un diagnostic contributif a ete obtenu chez 58 patients (74,4 %). Des biopsies ont ete realisees chez 39 et une polypectomie, chez 16 patients. Aucune complication n’a ete observee. Conclusion La CDB permet d’atteindre le caecum apres une coloscopie incomplete chez pres de 100 % des patients. Contrairement aux autres examens actuellement proposes (colo-scanner ou capsule endoscopique dans le futur), la CDB permet de realiser des biopsies ou des gestes therapeutiques dans les memes conditions qu’une coloscopie classique. Le cout des dispositifs a usage unique doit egalement etre pris en compte dans la perspective d’une utilisation de cette methode en pratique quotidienne.

This study was performed to evaluate the risk of gallstone formation during long-term treatment with the long-acting somatostatin analog octreotide (SMS 201-995). Twelve patients (8 men, 4 women--mean age 43 years) treated with continuous subcutaneous octreotide infusion for acromegaly (mean duration 26.5 months, mean dose 541 micrograms/day) were included. Bile collection by duodenal intubation was performed before, during, and 45 days after octreotide treatment in 3, 12, and 8 patients, respectively. Abdominal ultrasonography and/or oral cholecystrography were also performed before (n = 9 patients), during (n = 12), and after treatment (n = 10). Bile examination was normal in the 3 patients controlled before treatment but showed that 58.3 percent of the treated patients had cholesterol monohydrate crystals. After discontinuation of octreotide only 25 percent of patients had cholesterol crystals. In 3 patients (25 percent) treated longer than 6 months, cholesterol crystals occurred prior to the occurrence of small radiolucent gallstones: one patient underwent cholecystectomy because of biliary colic, while in the two others, complete dissolution of stones was obtained after 10 months of treatment with ursodeoxycholic acid given in association with octreotide. None of the 9 other acromegalic patients (including 7 treated more than 20 months) developed stones. Cholesterol gallstone formation seems to be increased in acromegalic patients during long-term octreotide treatment but the exact incidence remains to be determined in larger series of patients.

The importance of colonic motor disorders during the irritable bowel syndrome is recognized, but, paradoxically, their description has yet to be perfected. Among the fundamental questions that remain unanswered, three are of prime importance: a) are there one or more specific disturbances in basal colonic motility? b) can specific motor disorders be induced by certain situations, for instance, during stress? c) is there any real relationship between clinical symptoms and coexisting motor disorders? The answers to these questions are full of ambiguities; this may be explained by the difficulty with which methods of investigation are performed as well as the heterogeneous character of the disorders. Presently, recording colonic myoelectric activity over a 24 hour period or more might prove to be useful in increasing our knowledge on motor disorders. It is not at all certain that a specific basal abnormality exists and the results of the effects of stress vary according to the methods used. Segmental hyperactivity in painful constipation, abnormal colonic response to alimentation in the case of painful bloating, and propulsive hyperactivity with absence or decrease in the "sigmoid brake" during painless diarrhea have been noted on basal motor activity recordings during sleep and after meals. Myoelectric disorders, however, are seen in only two-thirds of patients with intestinal functional disorders. "Sensitivity", personality, or other disorders, and particularly, intestinal disorders, can contribute to explain the pathophysiology of "irritable bowels" in which the role of colonic disorders has yet to be shown.

Fifty-two non-surgical patients presenting rectal carcinoma were treated initially with palliative laser Nd-YAG. Their mean age was 79 years (49-92). Thirty patients had a severe diarrheic syndrome, associated with tenesmus in 27 cases; 20 patients had repeated hematochezia (5 presenting diarrhea as well); 6 had obstructive signs and one was symptom-free. Thirty lesions were less than 6 cm in size, 12 were between 7 and 10 cm and 10 were greater than 10 cm. Twenty-two lesions were circumferential. During the study period, 444 laser sessions were performed (mean 8.5/patient). Bleeding was stopped in all cases during the first session. Improvement of the diarrheic syndrome, obtained in 24 of the 30 patients, was correlated with the reduction of tumor volume. Tenesmus disappeared after 1 or 2 sessions, regardless of whether the tumor was destroyed or not. Failure was observed in 6 patients with lesions larger than 10 cm. Colostomy was avoided in 4 of the 6 obstructed patients. Negative biopsies were repeatedly obtained after mucosal repair in 9 patients with small lesions (less than 6 cm). Mean follow-up is now 8.2 months for the patients still alive. Complications were: 2 cicatricial stenosis and 3 hemorrhages (one required blood transfusion). Laser Nd-YAG allows palliative but conservative and effective treatment for rectal cancers. Although complete destruction is possible for small lesions, indications with curative intent are currently limited to patients with major contraindications to surgery.

The purpose of this randomized study was to compare the effects of two methods of hemostasis--photocoagulation using YAG Neodyme laser and liquid monopolar electrocoagulation--on acute experimental bleeding ulcers created in the dog stomach with an ulcer-maker. One hundred and fifty-three lesions were made and randomized into 3 groups; 51 lesions were treated with photocoagulation and complete hemostasis was achieved in all cases. Hemostasis was obtained in 80 p. 100 of 51 ulcers treated with liquid electrocoagulation. Control untreated ulcers remained hemorrhagic after 45 min of observation. The mean external muscle injury on day 7 was 55 p. 100 after photocoagulation and 65 p. 100 after liquid electrocoagulation. On day 14, mean external injury was 60 p. 100 after photocoagulation and 75 p. 100 after liquid electrocoagulation (non-significant difference). On day 7, the mean re-epithelization index, expressed as the percentage of the original ulcer diameter, ranged from 8 to 10 p. 100 in each trial group. On day 14, reepithelization covered 78 p. 100 of control ulcers and 72 p. 100 of photocoagulated ulcers (NS). This percentage falls to 47 p. 100 in ulcers treated with liquid electrocoagulation (p less than 0.01 when compared with ulcers treated with photocoagulation). Photocoagulation seemed to be more efficient in ensuring hemostasis and external muscle injury was correlated with the energy delivered. External muscle injury could not be controlled by liquid electrocoagulation. However the difference in the percentages of mean external muscle injury between the two methods was not significant. Therefore, in man, the risk of perforation is certainly slight and not very different whatever the method of hemostasis considered.

This multicentric, double-blind and prospective study, which involved 41 French Gastroenterology Units, was designed to evaluate the efficacy and safety of famotidine, 40 mg at bedtime, compared to single dose ranitidine, 300 mg, in promoting the healing of duodenal ulcer. Two hundred and ninety-six patients with endoscopically proven duodenal ulcer were randomly allocated to 2 treatment groups: 148 were treated with famotidine, and 148 with ranitidine. Patients were treated during 4 weeks and then controlled by endoscopy. Unhealed patients at 4 weeks were treated again by the same drug for 2 weeks and then endoscopically controlled. One hundred and nine patients were evaluable in the famotidine group and 111 in the ranitidine group. Groups were well-matched for age, sex, alcohol and smoking habits, and duration of ulcer disease. At 4 weeks of treatment, 86 of the 109 patients treated with famotidine had healed (79 percent) and 74 of the 111 patients treated with ranitidine healed (67 percent). At 6 weeks of treatment, 104 patients had healed in the famotidine group (95 percent) and 101 in the ranitidine group (91 percent). Results were significantly different between the 2 groups at 4 weeks of treatment only (p = 0.039). Among smoking patients, no statistical difference was observed between the 2 groups at 4 and 6 weeks of treatment. By contrast, in non smoking patients, famotidine appeared more effective (83 percent healed) than ranitidine (67 percent) (p = 0.014) at 4 weeks. Both treatments were well tolerated and severe adverse effects were scarcely observed.(ABSTRACT TRUNCATED AT 250 WORDS)