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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.)

Résumé: Le diagnostic de gastroparésie repose sur la mesure de la vidange gastrique car la clinique et l'endoscopie ne sont pas suffisamment discriminantes. Néanmoins, la réalisation de cette mesure, son accessibilité, son interprétation et enfin sa place dans la prise en charge des malades n'est pas toujours évidente. Cette revue détaille donc chacun de ces aspects et positionne la place de ces tests ainsi que leurs alternatives dans la prise en charge des malades souffrant de gastroparésie. Neither symptoms nor endoscopy accurately predict delay in gastric emptying. Gastric emptying time measurement is therefore mandatory for the diagnosis of gastroparesis. However, technical aspects, accessibility, interpretation as well as its usefulness in clinical care, may be considered challenging. This review details each of these aspects and positions gastric emptying measurement in routine clinical care of patients with gastroparesis. [ABSTRACT FROM AUTHOR]

Résumé: Le syndrome de rumination a une présentation clinique caractéristique et doit être évoqué en pH-impédancemétrie si le nombre de reflux post-prandiaux atteignant l'œsophage proximal est important. Un hypopéristaltisme œsophagien n'est pas une contre-indication absolue à la chirurgie anti-reflux, ces anomalies étant fréquentes en cas de reflux gastro-œsophagien (RGO) pathologique. Les symptômes ORL sont fréquemment mis sur le compte d'un reflux gastro-œsophagien mais les lésions inflammatoires décrites en laryngoscopie n'ont aucune spécificité et si les inhibiteurs de la pompe à protons (IPP) sont inefficaces, la probabilité que les symptômes soient en rapport avec un RGO est très faible, voire nulle. Les formes manométriques atypiques d'achalasie et les achalasies de type III doivent également inciter à faire un bilan complémentaire par scanner et/ou échoendoscopie œsophagienne. Dans l'évaluation de l'allergie, il n'y a pas lieu de faire des tests diagnostiques n'ayant pas fait la preuve de leur efficacité, comme le dosage d'immunoglobulines G ou E totales. Il est important de réaliser de façon systématique des biopsies coliques chez des patients ayant une diarrhée chronique. Il parait très important d'expliquer au patient les différents mécanismes pouvant être à l'origine des symptômes de l'intestin irritable et le fait qu'ils ne peuvent pas être mis en évidence par des examens de routine. Le régime pauvre en FODMAPs (Fermentable Oligo-, Di-, Mono-saccharides And Polyols) est restrictif et doit être évité chez les patients à risque de troubles du comportement alimentaire. La chirurgie colique peut être discutée dans la constipation de transit sévère sous réserve que l'indication soit posée dans un centre expert. La correction d'un trouble de la statique rectale est un facteur d'amélioration de la constipation terminale. Les troubles du transit associés à l'incontinence fécale sont essentiellement représentés par une diarrhée, une alternance diarrhée-constipation et parfois par une constipation. Il peut être difficile de mettre en évidence à l'interrogatoire une diarrhée du constipé, notamment chez des patients ayant une constipation ancienne, chez les patients neurologiques ou en cas de prise de ralentisseurs de transit. The ruminal syndrome has a characteristic clinical presentation and should be discussed in pH-impedancemetry if the number of postprandial refluxes reaching the proximal esophagus is important. Œsophageal hypoperistalsis is not an absolute contraindication to anti-reflux surgery, as these abnormalities are common in cases of gastroesophageal reflux disease. ENT symptoms are frequently attributed to gastroesophageal reflux disease (GERD), but the inflammatory lesions described in laryngoscopy have no specificity and if PPIs are ineffective, the likelihood of symptoms being related to GERD is very low, or even zero. Atypical manometric forms of achalasia and achalasia type III should also encourage further assessment by CT and/or oesophageal echo-endoscopy. In the evaluation of allergy, there is no need for diagnostic tests that have not been proven effective, such as total immunoglobulin G or E. It is important to routinely perform colon biopsies in patients with chronic diarrhoea. It seems very important to explain to the patient the different mechanisms that may be causing irritable bowel symptoms and the fact that they can not be demonstrated by routine examinations. The diet restrictive in FODMAPs (Fermentable Oligo-, Di-, Mono-saccharides And Polyols) should be avoided in patients at risk of eating disorders. Colonic surgery can be discussed in severe transit constipation provided that the indication is discussed in an expert center. Correction of a rectal statics disorder may improve the terminal constipation. Transit disorders associated with faecal incontinence are mainly represented by diarrhoea, alternating diarrhoea-constipation and sometimes constipation. It may be difficult to detect constipated diarrhoea, especially in patients with ancient constipation, in neurological patients, or when taking intestinal transit retarder agents. [ABSTRACT FROM AUTHOR]

Chronic vomiting is a rare condition that may lead to impairment of the quality of life as well as the nutritional status. In the absence of obvious cause, patient should be screened for gastrointestinal motility disorders. Cyclic vomiting as well as cannabinoid hyperemesis syndrome should also be ruled out. Management of chronic vomiting involves antiemetics and prokinetics as a first line therapy. Gastric electrical stimulation in addition to nutritional support may be discussed in the most severe cases. [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.)

The prevalence of gastroparesis is increasing. Diabetes mellitus and sequelae of œsogastric surgery are the two main causes of gastroparesis. In some patients, gastroparesis seems a postinfectious disease after its sudden onset after a viral infection. In about one third of the patients, gastroparesis is considered as idiopathic. In diabetic patients, gastroparesis impairs glycaemic control. Due to the low positive predictive value of symptoms, a gastric emptying study is often necessary to confirm a suspected diagnosis of gastroparesis. The symptomatic efficacy of erythromycin is higher than that of other prokinetics. This efficacy is higher when erythromycin is given intravenously. Hyperglycaemia impairs this symptomatic effect. Due to a tachyphylaxis phenomenon, the clinical effect of erythromycin decreases with the duration of treatment. In refractory gastroperis, either duodenal or jejunal enteral feeding, or high-frequency gastric electrical stimulation are possible therapeutic options while endoscopic alternatives (intrapyloric botulinum injection or pyloric balloon dilation) give unsatisfactory results., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Jejunoileal gastrointestinal hemorrhage is uncommon and difficult to diagnose. Ileal lipoma is an unusual cause of jejunoileal bleeding. We report the case of a 45-Year-old patient admitted for acute gastrointestinal bleeding. The patient was taking aspirin at admission. A bleeding intussuscepted ileal lipoma was localized with a contrast enhanced helical computed tomography. This diagnosis was confirmed by laparotomy.