Search

Original treatments, including corticosteroids, azathioprine, infliximab, ciclosporin, and interleukin 10 have been occasionally reported in refractory sprue patients with unsatisfactory results.1–8 We report on the clinical and histological efficacy of anti-T chemotherapy (pentostatine) in a patient with a refractory sprue complicated by an ulcerative and stenotic jejunitis. A 38 year old man diagnosed with refractory sprue in June 2002 developed ulcerative jejunitis in July 2003. Diagnosis led on the following: malabsorptive diarrhoea resistant to a gluten free diet (GFD); severe malnutrition (body mass index (BMI) 14.3 kg/m2); albuminaemia 11 g/l; diffuse total villous atrophy associated with jejunal ulcerations and a major intestinal intraepithelial CD3+ CD8− T lymphocyte population (IEL) (fig 1A–C); clonal T cell receptor γ rearrangement; negative circulating antigliadin and antitransglutaminase IgA and IgG antibodies (total IgA and IgG were normal); hyposplenism; …

Background and aims: A previous study suggested that the presence of myenteric plexitis in the proximal resection margins could be predictive of early endoscopic recurrence after ileocolonic or ileal resection for Crohn9s disease (CD). Our aim was to assess the predictive value of plexitis for early clinical CD recurrence. Methods: All consecutive patients with ileocolonic or ileal resection for active CD in Lariboisiere hospital (Paris) between 1995 and 2006 were included. Clinical, surgical, histological and follow up data were extracted from medical charts. Early clinical recurrence was defined as the reappearance of CD clinical manifestations requiring a specific treatment within two years post surgery. Proximal resection margin was analyzed using haematein eosin saffron (HES) staining and immunochemistry targeting mastocytes (anti-CD117 antibody) and lymphocytes (anti-CD3 antibody). Eosinophils were detected by HES staining. Ten cases of ileocolonic resections for cecal carcinoma served as controls. Results: Data were available from 171 postoperative follow up periods in 164 patients with CD. Early clinical recurrence of CD occurred in 28.1%. In multivariate analysis, factors associated with post operative recurrence were active smoking (HR= 1.94; IC95% [1.06; 3.60] ; p= 0.033), submucosal plexitis with ≥3 mastocytes (HR= 1.87; IC95% [1.00; 3.46] ; p= 0.048) and a disease-free resection margin Conclusions: Submucosal plexitis is associated with early clinical recurrence and could be taken into account in studies searching for new treatments strategies in the immediate postoperative period.

Normal gastric emptying is a complex mechanism involving coordinated gastric and duodenal muscular contractions modulated by the autonomic nervous system, myenteric and submucosal plexus, interstitial cells of Cajal (ICC), which are divided into myenteric (ICC-MY) and intramuscular ICC (ICC-IM), and the central nervous system. Gastroparesis can result from a lesion at any level of these physiological processes. In 1997, a 47 year old man was referred to Louis Mourier Hospital with longstanding symptoms of gastroparesis associated with pyrosis and regurgitations with progressive worsening. Physical examination and usual laboratory results were normal. An autoimmune study was negative for every antibody, including anti-HU, anti-YO, anti-RI, antinuclear, anti-RO, anti-SSA, anti-intrinsic factor, antigliadin, antiendomysium, anticardiolipid, antithyroperoxidase, and antithyroglobulin antibodies. Serum antibodies of the herpes class virus, Epstein-Barr virus, and cytomegalovirus were in favour of past infections. Upper gastrointestinal endoscopy with histological analysis was normal. Gastric scintigraphy showed …

Gastric MALT lymphoma (GML) development is closely associated with Helicobacter pylori infection cases.1 The majority of stage IE GML regress following H pylori eradication but assessing cure of the disease requires prolonged follow up. Residual lymphoid infiltrate in post-treatment gastric biopsies can be very difficult to interpret and histological criteria for the diagnosis of minimal residual disease or complete remission are not clearly defined. Molecular follow up by polymerase chain reaction (PCR) for the rearranged immunoglobulin heavy chain variable region shows that persistent monoclonal bands is observed in 44% of cases showing apparent complete histological remission.2 The significance of ongoing PCR monoclonality in the absence of histological disease is still under investigation. Thus histological evaluation of gastric biopsies remains the cornerstone …

Primary gastric low-grade B-cell lymphoma of mucosa-associated lymphoid tissue may regress with conservative treatment such as anti-Helicobacterpylori therapy or monochemotherapy. The aims of the present study were to analyze the predictive factors of response to anti-H. pylori treatment, to assess the effects of an adjuvant therapy in responding patients, and to evaluate an alternative therapy in nonresponding patients.From 1995 to 2000, 48 H. pylori-infected patients with localized primary gastric low-grade B-cell lymphoma of mucosa-associated lymphoid tissue were treated with anti-H. pylori therapy. Endoscopic and endoscopic ultrasonography features and histological grading of large cells' proportion were analyzed. Eradication of H. pylori and tumoral response were assessed at 2 and 6 months, respectively. From 1996, patients in remission at 6 months were randomized to receive either chlorambucil p.o. for 6 months or no treatment. Patients who did not respond to H. pylori eradication received chlorambucil p.o. for 1 yr.Among the 48 treated patients, 33 (69%) were in complete (n = 28) or in partial (n = 5) remission, and 15 (31%) were in treatment failure at 6 months. H. pylori was eradicated in 47 patients. The response was not correlated with the endoscopic features or with the histological grade. In contrast, it was related to ultrasonographic features: remission was achieved in 76% of patients when no perigastric lymph node was detected versus only 33% when endoscopic ultrasonography showed presence of lymph nodes (p = 0.025). All responding patients remained in remission (median 34 months) whatever the treatment they received (no treatment or chlorambucil). Remission could be achieved with chlorambucil in 58% of the nonresponding patients to anti-H. pylori treatment.The major negative predictive factor of the tumoral response to anti-H. pylori treatment in patients with primary gastric low-grade B-cell lymphoma of mucosaassociated lymphoid tissue was the presence of perigastric lymph nodes on endoscopic ultrasonography. In responding patients, remission remained stable, suggesting that adjuvant chemotherapy was not useful. In patients who failed to respond to H. pylori eradication, monochemotherapy with chlorambucil proved to be efficient, but new therapeutic modalities should be evaluated to improve the control of the tumoral process.

The tyrosine kinase receptor KIT plays a major role in gastrointestinal stromal tumors (GISTs) oncogenesis. Indeed, 95% of GISTs express KIT protein, and about 70% exhibit activating mutations of the KIT gene. However, little is known about KIT overexpression mechanisms in these tumors, and the correlation with KIT mutations. GISTs with mutations within exon 11 (n=12) or 9 (n=1) of KIT were compared with GISTs without KIT mutations in exons 9, 11, 13, and 17 (n=10), two of them had PDGFRA mutations. KIT amplification was studied by real-time PCR of KIT and beta-ACTIN genes, and by fluorescence in situ hybridization (FISH) using KIT and chromosome 4 centromere specific probes. KIT transcripts and protein expression were quantified by reverse transcription real-time PCR and Western blot respectively. Genomic analysis revealed a single mutated GIST with KIT amplification. KIT protein and RNA levels were highly variable in GISTs but closely correlated (r=0.82, P

International audience; BACKGROUND & AIMS: Plasma citrulline, a nonprotein amino acid produced by enterocytes, was suggested as a marker of remnant enterocyte mass in patients with short bowel. Our objective was to evaluate citrulline as a marker of severity and extent of villous atrophy in patients without intestinal resection. METHODS: Forty-two patients with celiac disease and 10 patients with non-celiac villous atrophy disease were studied by plasma postabsorptive citrulline and biological dosages, biopsies of proximal (duodenojejunal) small bowel and distal ileum (n = 25), or measurement of vitamin B(12) absorption (n = 4). Nine patients were reevaluated after following a gluten-free diet for 1 year. Controls were 51 healthy subjects and 10 severely malnourished patients with anorexia nervosa with no intestinal mucosal abnormalities. RESULTS: Plasma citrulline concentration was lower (P < 0.001) in patients with villous atrophy (24 +/- 13 micromol/L) than in healthy subjects (40 +/- 10 micromol/L) and patients with anorexia nervosa (39 +/- 9 micromol/L). Three thresholds were individualized