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Methotrexate is an immunosuppressant with multiple, complex and not yet well-known mechanisms of action at the dose used commonly in IBD. The main drug targets concern various enzymes involved in the folate metabolism, in cell proliferation, nucleotide synthesis and in adenosine signaling pathways which all contribute to inflammation. Methotrexate is used as monotherapy in patients with mild to moderate Crohn's disease experiencing steroid dependency and should be administered subcutaneously or intramuscularly at the dose of 25 mg per week associated with folate supplementation. It could be also used with success in Crohn's disease associated with psoriasis or peripheral arthritis. In contrast, methotrexate is not efficient in ulcerative colitis. In addition, its usefulness in association with anti-TNF agents is reflected by its ability to minimize the risk of immunogenic failure and to influence their pharmacokinetics. Given its teratogenic risk, precautions should be taken in patients of childbearing age. [ABSTRACT FROM AUTHOR]

Acute severe ulcerative colitis occurs in up to 25% of patients with ulcerative colitis (UC). Therapeutic approaches have evolved in recent years with the increase in exposure to biotherapies and the increase in the number of treatments approved for moderate-to-severe UC. In this review, we summarize the latest evidence in short- and long-term medical strategies for severe acute colitis. In addition to general principles such as prophylaxis of venous thrombosis, screening for triggers and aggravating factors, and close monitoring, the first-line treatment for severe acute colitis remains intravenous corticosteroids. Second-line therapy includes infliximab and ciclosporin which have similar short- and long-term colectomy rates. Pre-treatment exposure is a cornerstone to guide the choice of short- and long-term therapies in the context of severe acute colitis: in patients exposed to anti-TNF, calcineurin inhibitors may be favored as a bridge therapy to vedolizumab or ustekinumab. In addition, evidence is increasing regarding the use of tofacitinib and anti-JAK in severe acute colitis. Finally, we will present future therapeutic perspectives, including novel combination therapies. A visual abstract summarizing these medical strategies is provided with this review. [ABSTRACT FROM AUTHOR]

An acute severe flare of ulcerative colitis is observed in approximately one patient out of four with a global mortality rate of 1%. Goal of the management of this medico-surgical emergency is based on patient profile, aiming to save life of the most aged and fragile patients and to avoid salvage colectomy in the others. Medical management is standardized, based on short treatment courses starting with intravenous steroids followed by cyclosporine or infliximab in case of failure. Surgery should be discussed at each step. Postoperative morbi-mortality is closely related to the duration of the preoperative management. Drug positioning of new molecules such as védolizumab, ustekinumab and tofacitinib is not well established in acute severe ulcerative colitis. [ABSTRACT FROM AUTHOR]

Résumé: En cas d'anomalies récentes des tests hépatiques, le diagnostic repose essentiellement sur l'anamnèse et le bilan biologique. La ponction biopsie hépatique est rarement indiquée. En cas d'anomalies persistantes des tests hépatiques, l'enjeu est de diagnostiquer une cirrhose. Pour cela, la ponction-biopsie hépatique est le plus souvent inutile. En revanche, elle reste indiquée lorsqu'on suspecte une cause rare, surtout en l'absence de cause de cirrhose. In patients with recent liver blood tests abnormalities, the diagnosis is mainly based on the analysis of medical history and the biological work-up. Liver biopsy is rarely indicated. In case of persistent liver blood tests abnormalities, the challenge is to diagnose cirrhosis. For this purpose, liver biopsy is usually unnecessary. By contrast, liver biopsy remains indicated when a rare cause is suspected, especially in the absence of causal factor for cirrhosis. [ABSTRACT FROM AUTHOR]

Résumé: L'objectif de la prise en charge des maladies inflammatoires chroniques de l'intestin (MICI) est d'obtenir une rémission symptomatique et une normalisation des biomarqueurs à court terme, et une cicatrisation endoscopique à moyen terme. Ce niveau d'exigence élevé est devenu accessible avec le développement des biothérapies qui ont révolutionné la prise en charge des MICI depuis le début des années 2000. Les anticorps dirigés contre le tumor necrosis factor (anti-TNF) sont toujours les biothérapies le plus souvent prescrites en première intention dans les MICI dans notre pays. Leur échec constitue une situation clinique devenue courante, que ce soit à la fin de la période d'induction (non-réponse primaire), pendant la phase d'entretien (échec secondaire) ou en cas d'effet secondaire grave. L'échec de l'anti-TNF doit être défini par des éléments objectifs que sont les biomarqueurs, l'imagerie ou l'endoscopie afin de ne pas abandonner trop vite une ligne thérapeutique précieuse. En cas d'échec primaire, il existe peu de données permettant d'orienter le choix de la deuxième ligne qui sera essentiellement basé sur les caractéristiques du patient et de sa maladie. En cas d'échec secondaire, la pharmacocinétique est très utile pour guider le gastro-entérologue dans son choix. Le changement de classe thérapeutique est à privilégier en cas d'échec secondaire malgré des taux plasmatiques de médicament adéquats. En cas de réactions paradoxales cutanées ou de manifestations extra-intestinales cutanées ou articulaires, l'ustékinumab semble être la meilleure option. Les résultats d'études prospectives randomisées comparant directement les traitements entre eux seront bientôt disponibles et permettront de définir les meilleures séquences thérapeutiques à utiliser dans les MICI. The current treatment paradigm in Inflammatory Bowel Disease (IBD) is to target symptomatic remission and normal values of biomarkers in the short term, and mucosal healing in the long term. These high expectations have been made possible by the new therapies available in the last two decades. Monoclonal antibodies directed against the tumor necrosis factor (anti-TNF) remain the most often first-line biological in France. Thus, their failure is a frequent clinical situation. It can be defined as primary non-response when it occurs at the end of the induction period or, a secondary loss of response during the maintenance phase. In some cases, treatment must be stopped because of severe adverse events. Anti-TNF failure must be diagnosed based on objective markers of inflammation such as biomarkers, imaging and endoscopy to avoid excessive drug withdrawal. Concerning primary non-response, few data exist to guide the choice of the second therapeutic line which efficacy is limited. Decision should be made based on the characteristics of the patient and the disease. In case of secondary loss of response, therapeutic drug monitoring is useful to guide the physicians by giving hints on the failure mechanism (low exposure, immunization, immunologic modifications). In case of secondary loss of response despite adequate drug levels, a switch is recommended. In case of paradoxical skin lesions or extra-intestinal skin or joint manifestations, ustekinumab seems to be the better option. Results from prospective randomized studies comparing several biological therapies should be soon disclosed. They will help define the best therapeutic sequences indicated for patients with IBD. [ABSTRACT FROM AUTHOR]

Résumé: Les cibles des lésions anales méritent d'être clarifiées parce qu'elles ne peuvent être évaluées avec les mêmes outils que la maladie luminale. Dans l'état actuel de la pratique ou des publications scientifiques, l'évaluation repose sur une approche pragmatique (nécessité d'une (ré-)intervention chirurgicale), sur des scores mixtes anciens (Perineal Disease Activity Index), des caractéristiques cliniques sommaires (fistule ouverte ou fermée) ou des scores radiologiques plus subtils mais non validés. Les stratégies thérapeutiques médicochirurgicales récentes ont été définies sans que l'on connaisse la quantité d'effet des biothérapies seules ou en combothérapie, et le résultat des stratégies innovantes telles que l'injection in situ de cellules souches. Cette dernière technique bénéficie d'une autorisation de mise sur le marché (AMM) et d'un remboursement alors qu'on ne dispose que d'un nombre encore restreint d'études. Trois catégories de cibles thérapeutiques proposées ont été retenues dans le consensus : symptômes, données d'examen clinique et données IRM. De façon consensuelle, le temps nécessaire pour évaluer cliniquement l'efficacité du traitement était de six mois. La réponse IRM devait comprendre l'absence de collection de 10 mm ou plus à six mois et une diminution franche ou une disparition de l'hyper-intensité du trajet principal à douze mois. The targets of anal lesions need to be clarified because they cannot be assessed with the same tools as luminal disease. In the current state of practice or scientific publications, evaluation is based on a pragmatic approach (need for surgical (re-)intervention), on old mixed scores (Perineal Disease Activity Index), summary clinical characteristics (open or closed fistula) or more subtle but unvalidated radiological scores. Recent medical-surgical treatment strategies have been defined without knowing the effect of biotherapies alone or in combination, and the outcome of innovative strategies such as in situ stem cell injection. The latter technique has a marketing authorisation and reimbursement, although only a limited number of studies are available. Three categories of proposed therapeutic targets were retained in the consensus: symptoms, clinical examination data and MRI data. The consensus was that the time to clinically assess treatment efficacy was 6 months. MRI response should include the absence of a collection of 10 mm or more at 6 months and a clear reduction or disappearance of the hyperintensity of the main pathway at 12 months. [ABSTRACT FROM AUTHOR]

Résumé: À l'heure où la pandémie liée au SARS-CoV-2 fait rage, la question de la prise en charge des patients atteints de maladie inflammatoire chronique de l'intestin se pose du fait de l'emploi d'agents immunomodulateurs. Éviter une rechute potentiellement grave de la maladie digestive et ne pas faire courir de risque accru d'infection par le SARS-CoV-2, ces objectifs doivent être conciliés au cas par cas. Whereas SARS-CoV-2 outbreak is still rising, the appropriate management of patients with inflammatory bowel disease is challenging. On the one hand, there is a risk of relapse if treatment are discontinued. On the other hand, there may be an increased infectious risk if treatment are continued. That dilemna should be resolved on a case-by-case basis. [ABSTRACT FROM AUTHOR]

Résumé: Les maladies inflammatoires chroniques de l'intestin (MICI) représentent aujourd'hui une part importante de l'activité de gastro-entérologie dans les centres hospitaliers français. Leur incidence est en constante augmentation et leur prise en charge complexe. Les MICI ont aussi un impact majeur sur la qualité de vie des patients et un coût très important pour la société surtout depuis l'utilisation des biothérapies. Le GETAID (Groupe d'Etudes Thérapeutiques des Affections Inflammatoires du Tube Digestif) a mené en 2016 une enquête nationale dans ses centres affiliés afin de faire un état des lieux de l'organisation de la prise en charge des patients atteints de MICI et d'évaluer sur une semaine la population MICI suivie dans 41 centres hospitaliers français. La première partie de l'enquête a montré que l'ensemble des centres s'étaient organisés pour prendre en charge ces patients sur le plan clinique avec cependant un manque de multidisciplinarité. Il existait dans la majorité des centres une activité de recherche. En revanche, l'activité d'éducation thérapeutique était insuffisamment représentée. Il existait globalement un besoin de personnel de recherche et d'infirmier de coordination MICI pour améliorer la prise en charge des patients atteints de MICI. La deuxième partie de l'enquête a identifié 3 124 passages de patients atteints de MICI sur une semaine en France. La majorité des patients étaient vus en ambulatoire. L'âge moyen de ces patients MICI était assez élevé (42 ans) et beaucoup de patients avaient un diagnostic récent. Un patient sur deux était traité par un anti-TNF. Cette enquête de grande ampleur a permis de mettre en évidence les défis de demain concernant la prise en charge des patients atteints de MICI (vieillissement de la population, croissance importante de la cohorte MICI, ambulatoire) et d'identifier des pistes d'amélioration (temps infirmier de coordination MICI, éducation thérapeutique). Inflammatory bowel disease (IBD) is now a major part of French gastroenterologist clinical practice. Their incidence is increasing and their management remains complex. IBD also has a major impact on the quality of life of patients and a very important cost for society especially since the use of biologics. In 2016, the GETAID (Groupe d'Etudes Thérapeutiques des Affections Inflammatoires du Tube Digestif) conducted a national survey in its affiliated centers in order to analyze the organization of IBD patients care and to evaluate over a week the IBD population followed in 41 French hospitals. The first part of the survey showed that all the centers have dedicated organization for IBD patients, but with a lack of multidisciplinarity. A majority of centers had research activities. On the other hand, patient education was insufficiently represented. There was a general need for IBD research coordination and IBD nurses to improve the management of IBD patients. The second part of the survey identified 3 124 hospital visits of IBD patients in one week in France. The majority of patients were seen in the outpatient clinic. The mean age of IBD patients was 42 years-old and numerous patients were recently diagnosed with IBD. Half of the patients were treated with anti-TNF. This large nationwide survey highlighted the future challenges regarding the management of IBD patients (older patients, increased number of diagnosis, outpatient care) and to identify areas for improvement (IBD nurses, education). [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.)

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.)

Crohn's Disease (CD) is an auto-inflammatory disease, which may involve the entire gastro-intestinal tract. CD is diagnosed on several clinical, biological, endoscopic and histological criteria. First line therapy is based on oral or iv steroids. In case of steroids dependence or resistance, several types of immunosuppressive or immunomodulating therapies are available: classical antimetabolites (thiopurines or methotrexate) or monoclonal antibodies against TNFα, against interleukin 12/23 or against integrin. Nonetheless, Crohn's disease may remain active despite the use of several lines of therapy. In such cases, autologous hematopoietic cell transplantation (AHCT) is an effective therapeutic option in highly selected CD patients with specific criteria. The MATHEC-SFGM-TC Good Clinical Practice Guidelines (GCPG) were developed by a multidisciplinary group of experts including gastroenterologists, hematologists and members of the reference center for stem cell therapy in auto-immune diseases (MATHEC), including members of the French groupe d'étude thérapeutique des affections inflammatoires du tube digestif(GETAID) under the auspices of the French speaking Society of bone marrow transplantation and cellular therapy (SFGM-TC). The aim of the present guidelines is to define the eligibility criteria for CD patients when candidates to AHCT, the procedures for mobilization of hematopoietic stem cell (HSC), conditioning regimen and standardized follow-up after AHCT including monitoring of gastroenterological treatments during AHCT and thereafter throughout all follow-up., (Copyright © 2020 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Malnutrition is common in oncology. However, it is often detected too late and nutritional support is sub-optimal. The patient's opinion, although often sought in therapeutic decisions in oncology, does not appear to be frequently taken into account in dietetic management. In NutriCancer2012 study, we interviewed patients, relatives and doctors about their perceptions of the impact of malnutrition and its quality of care. Of the 2209 patients questioned, majority said they were concerned about nutrition with 75% considering it essential to take appropriate nutritional care but only 19% self-reported link between malnutrition and fatigue. Physicians underestimated impact of malnutrition on patient's "quality of life". Doctors referred to the lack of human resources and knowledge in nutrition, and more than 80% wished the creation of nutrition teams. Sensitization of the general public and patients (and relatives) as soon as the cancer diagnosis could lead to better malnutrition's screening. Better nutrition training for physicians and creation of nutrition team could optimize management and improve efficacy during cancer treatments., (Copyright © 2017 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

During the last decade, anti-TNF agents and emergence of new therapeutic concepts have dramatically changed inflammatory bowel disease (IBD) management, especially at their early phase. Salicylates remain the therapeutic basis in ulcerative colitis while their efficacy in Crohn's disease has not been confirmed. A rapid step-up approach is considered for managing IBD at early phase providing early immunomodulators--such as immunosuppressant and anti-TNF--in case of poor disease course. Some specific situations (severe, extended or complicated forms) require the most efficient first-line therapy that is combination between anti-TNF and immunosuppressant. A close follow-up not only based on clinical symptoms, but also on objective inflammatory tools (endoscopy, cross-sectional imaging, biomarkers), is needed to adjust medical therapy rapidly in order to prevent complications and surgery.

The brief intervention lasts from 5 to 20 minutes and uses motivational interview techniques. This brief intervention is addressed not at alcohol-dependent patients (approximately 1.5 million people in France) but at those whose consumption is harmful or at risk (estimated at approximately 4 million people in France), especially men. The efficacy of the brief intervention is demonstrated by numerous randomized studies and meta-analyses. A mean reduction of one glass of an alcoholic beverage a day results, with consumption returning to a moderate rather than at-risk level for approximately 30%. This efficacy has been demonstrated for a duration of at least 4 years. Given that evidence also supports the behavioral changes, these findings should be taken into account by healthcare providers.

Purpose: To describe the clinical features and laboratory findings of patients with fascioliasis in southwestern France., Methods: Retrospective review of medical records of all patients diagnosed with fascioliasis in Bordeaux university hospital center from 1981 to 2004. Diagnosis must have been confirmed by serology or direct identification of fluke eggs., Results: We identified and analysed 37 cases. All patients had eosinophilia. Early diagnosis relied mainly on serum assays. Twenty-five patients were treated with a single dose of triclabendazole; five of them required a second double-strength dose., Conclusion: Fascioliasis appears in southwestern France as sporadic cases with a clinical presentation that is mainly gastrointestinal. It can be treated with oral triclabendazole.