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Copyright of Hépato-Gastro & Oncologie Digestive is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Hépato-Gastro & Oncologie Digestive is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé: Le gluten est une protéine contenue dans le blé largement utilisée dans l'industrie alimentaire pour ses propriétés de texture et de goût. L'hypersensibilité au gluten non cœliaque (HGNC) est un syndrome défini par l'apparition de symptômes intestinaux et extra-intestinaux secondaires à l'ingestion de gluten et régressant après un régime sans. L'HGNC a une présentation clinique similaire à la maladie cœliaque mais s'en distingue par l'absence d'atteinte histologique de la muqueuse intestinale. La cause de l'HGNC est indéterminée mais une activité du système immunitaire inné et une augmentation de la perméabilité intestinale ont été observées. Le diagnostic est fait après exclusion d'une allergie au blé et d'une maladie cœliaque par la recherche d'anticorps spécifiques et des biopsies duodénales. Il peut être confirmé par un challenge au gluten, rarement effectué dans la pratique clinique. Contrairement à la maladie cœliaque, le risque de complications malignes et de malabsorption est absent et permet un régime avec une quantité de gluten adaptée aux symptômes. Malgré des traitements en cours d'étude, le régime sans gluten est le seul traitement recommandé de la maladie cœliaque et l'HGNC. La surveillance clinique, biologique et histologique préconisée pour la maladie cœliaque n'est pas nécessaire en cas d'HGNC. Gluten is a protein contained in wheat and widely used in the food industry for its texture and taste properties. It causes a spectrum of diseases that concerns 5% of the world's population. Non-celiac gluten sensitivity (NCGS) is a syndrome defined by the occurrence of intestinal and extra-intestinal symptoms in the days and weeks following intake of gluten that resolves after its discontinuation. NCGS has a clinical presentation similar to celiac disease but differs by the absence of histological involvement of the intestinal mucosa. The pathogenesis of NCGS is undetermined but innate immune system activity and increased intestinal permeability have been observed. The diagnosis is made after excluding wheat allergy and celiac disease by looking for specific antibodies and duodenal biopsies. It can be confirmed by a gluten challenge, which is rarely performed in clinical practice. Unlike celiac disease, the risk of malignant complications and malabsorption is absent in NCGS allowing a diet with a quantity of gluten adapted to symptoms. Despite treatments being studied, the gluten-free diet is the only recommended treatment for celiac disease and NCGS. The biological and histological monitoring recommended in celiac disease is not necessary in the case of NCGS. [ABSTRACT FROM AUTHOR]

Résumé: Les états précancéreux gastriques et les cancers superficiels de l'estomac sont des lésions de diagnostic endoscopique difficile et constituent un vrai défi dans le dépistage et la prise en charge. Ainsi, la société européenne d'endoscopie digestive (ESGE, European Society of Gastrointestinal Endoscopy) a récemment établi des recommandations de bonne pratique clinique, dont le respect est indispensable pour assurer un examen endoscopique de qualité. L'utilisation d'endoscopes haute définition avec chromoendoscopie (vitale ou électronique) et fort grossissement optique est recommandée suite aux nombreux travaux ayant montré leur supériorité par rapport à l'analyse en lumière blanche. L'apport de la chromoendoscopie et du zoom permet une analyse précise de l'architecture glandulaire et de la microvascularisation, guidant la réalisation des biopsies ciblées sur des lésions néoplasiques. En cas de diagnostic de cancer superficiel de l'estomac, la dissection sous-muqueuse est désormais la technique de résection de référence pour les lésions infra-centimétriques, conformément aux recommandations européennes et japonaises. The precancerous gastric lesions and early gastric cancer are challenging lesions to detect by upper GI-endoscopy. Thus, the European Society of Digestive Endoscopy (ESGE) has recently established recommendations for good clinical practice and respect of which is essential to ensure quality of endoscopic examination. High definition endoscopy with chromoendoscopy (vital or virtual) is better than high definition white-light endoscopy alone for this purpose. Virtual chromoendoscopy with magnification allows pit pattern and vascular pattern analysis, thus targeting neoplastic lesions and guiding biopsies. Biopsies should also be taken from at least two topographic sites (antrum and corpus) and labelled in two separate vials. In case of early gastric cancer detection, endoscopic submucosal dissection (ESD) must be proposed as the first-line treatment, in respect with European and Japanese guidelines. [ABSTRACT FROM AUTHOR]

Résumé: Les polypes de petite taille (< 10 mm) sont les lésions les plus fréquemment rencontrées lors d'une coloscopie de dépistage. On distingue les micropolypes ou « diminutive polyps (< 5 mm), des petits polypes ou « small polyps » (6-9 mm) dont le risque de dégénérescence dans la littérature est estimé à 0,5-2 %. Malgré l'amélioration des techniques de caractérisation endoscopique optique, les polypes de petite taille doivent faire l'objet d'une résection endoscopique. Les stratégies de « resect and discard » (résection-destruction) ou de « predict and leave behind » (diagnostic sans résection), stratégies sans analyse histologique, doivent être réservées aux centres experts présentant un degré de confiance élevé en prédiction histologique fondée sur l'analyse optique. Il existe de nombreuses techniques endoscopiques pour l'exérèse de ces polypes, dont l'efficacité est variable. On estime que les taux de résections incomplètes varient de 7 % à 10 %, et qu'elles sont responsables d'environ 10 % à 27 % des cas de cancer d'intervalle. La société européenne d'endoscopie digestive (ESGE) a établi en 2012 des recommandations pour la prise en charge des polypes de petite taille, mises à jour en 2017. L'exérèse à l'anse froide est la technique de référence pour ces lésions, car elle est associée à un taux élevé de résection complète, à une meilleure analyse histologique et à un faible taux de complication. En cas de positionnement difficile, l'utilisation de la pince à biopsie froide pourra être utilisée pour les très petits polypes (< 4 mm). L'utilisation de la pince à biopsie chaude doit être proscrite car elle a un faible taux d'ablation complète et augmente le risque de complication post-exérèse. Polyps smaller than 10 mm are the most common lesions encountered during screening colonoscopy and are associated with low risk of colorectal cancer. These lesions are classified according to their size as diminutive polyps (< 5 mm) or small polyps (6-9 mm). Despite improvement in real time characterisation techniques, small polyps must be endoscopically resected. Strategies such as "resect and discard" or "diagnosed and leave behind" are dedicated to expert centres with a high degree of confidence in optical diagnosis. Many endoscopic techniques are available for polyps resection, whose effectiveness is variable in the literature. Incomplete resection rates range from 7% to 10% and are responsible for up to 27% of interval cancer. The European Society of Digestive Endoscopy established in 2012 (updated in 2017) recommendations for the resection of small polyps. Cold snare resection is the gold standard for these polyps because it is associated with a high rate of complete resection, a better histological analysis and a low rate of complications. In case of difficult positioning, the use of the cold biopsy forceps can be used for very small polyps (<4 mm). The use of hot biopsy forceps should be proscribed as it is associated with a low rate of complete resection and post resection complications. [ABSTRACT FROM AUTHOR]

Résumé: L'hypersensibilité au gluten non cœliaque est un syndrome imputé à l'ingestion de gluten, distinct de la maladie cœliaque et l'allergie au blé. Elle se manifeste par des symptômes digestifs et extradigestifs semblables à ceux observés au cours de la maladie cœliaque et du syndrome de l'intestin irritable. En revanche, on ne trouve chez ces malades ni lésions intestinales à type d'atrophie villositaire, ni anticorps anti-transglutaminase ou anti-endomysium. La physiopathologie de la sensibilité au gluten non cœliaque n'est pas connue et est controversée. L'imputabilité du rôle du gluten reste à démontrer, car d'autres protéines du blé (les inhibiteurs de l'alpha-amylase et la trypsine) ou les FODMAPs pourraient être responsables des symptômes. L'hypersensibilité au gluten est un diagnostic d'exclusion après avoir éliminé une maladie cœliaque et une allergie au blé. À ce jour, aucun biomarqueur spécifique de l'hypersensibilité au gluten n'a été identifié. Le traitement repose sur le régime sans gluten comme dans la maladie cœliaque ou les allergies au blé. ..LAN-EN Gluten related disorders include celiac disease, wheat allergy and non-celiac gluten sensitivity. Non celiac gluten sensitivity is characterized by intestinal and extra-intestinal symptoms that occur after gluten ingestion, disappear with gluten withdrawal from diet and relapse following gluten challenge. These manifestations are similar to those occuring in celiac disease and irritable bowel syndrom. However, patients with non-celiac gluten sensitivity do not suffer from lesions in the duodenal mucosa and do not develop tissue transglutaminase or endomysium antibodies. The pathogenesis is not yet well understood and the role of gluten is still controversial, with studies suggesting that FODMAPs or other wheat proteins could be responsible for the symptoms. The diagnosis is made after exclusion of celiac disease and wheat allergy. There are no laboratory markers specific to gluten sensitivity. Treatment consists in avoiding gluten to improve symptoms. [ABSTRACT FROM AUTHOR]

Copyright of Hépato-Gastro & Oncologie Digestive is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Celiac disease is an inflammatory enteropathy, autoimmune-like, due to gluten intake in genetically predisposed persons with HLA-DQ2/DQ8 genotyping. Prevalence rates are approaching 1% of population in Europe and USA. Clinical expression of celiac disease is extremely various. Screening is based on detection of serum celiac antibodies and diagnosis is confirmed with duodenal biopsy. Treatment relies on gluten free diet (GFD) with eviction of wheat, barley and rye. GFD allows prevention of osteopenia, autoimmune diseases and malignant complications. The main cause of resistance to GFD because is its bad observance.

Esophagitis is the first cause of dysphagia and food impaction in a young male adult. Eosinophilic esophagitis is a clinical and pathological entity with involvement limited to the oesophagus. Eosinophilic esophagitis is associated with allergy and atopy. Most common in Caucasians, with 3:1 male predominance. Endoscopic findings are unspecific. Clinical and histological diagnosis has to be confirmed by unresponsiveness to proton pump inhibitor. Recommended first therapeutic approach: topical corticoids., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Celiac disease is an enteropathy due to gluten intake in genetically predisposed persons (HLA DQ2/DQ8). Celiac disease occurs in adults and children at rates approaching 1% of population in Europe and USA. Clinical presentation of celiac disease is extremely varied. Anaemia, oral aphthous stomatis, amenorrhea or articular symptoms may reveal celiac disease. Diagnosis relies on evidence of duodenal villous atrophy and specific serum antibodies. Treatment relies on eviction of gluten (wheat, barley, rye). Gluten-free diet allows prevention of malignant complications and osteopenia. The main cause of resistance to gluten-free diet is its bad observance. On the contrary, serious complications of celiac disease, such as clonal refractory celiac sprue and intestinal T cell lymphoma need to be screen.

Gastrointestinal symptoms are common and often reveal primary immunodeficiency. Although they mimic gastrointestinal diseases observed in immunocompetent patients, there have diagnostic and therapeutic specificities that should be known for optimal management of these patients. This review describes the gastrointestinal diseases found in primary immunodeficiency and proposes some diagnostic and therapeutic strategies.

Following the 4th International Conference on Capsule Endoscopy (ICCE, Miami 2005), the main indications for videocapsule endoscopy (VCE) were reviewed. The consensus guidelines were published in Endoscopy in 2005. These propositions for VCE were based on an analysis of evidence reported in the literature published through 2005. A small working group of experts examined each methodology and presented their report at the plenary session. The final conclusions were then published. At the ICCE 2006 held in Paris, this first version of the consensus guidelines was improved and completed.