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Background: Osteoporosis and osteopenia are frequently reported during chronic inflammatory bowel diseases, particularly in Crohn disease (CD)., Aim: To determine the frequency of osteoporosis and osteopenia of patients with CD and to study associated risk factors., Methods: A forward-looking study was performed about 56 cases of CD, 34 men and 22 women, aged 32 + 10.4 years (18-54 years), with no other disorders affecting osseous metabolism. A biphotonic X-rays absorptiometry densitometry (DEXA) was performed at femoral neck and lumbar spine. A multivariate statistical analysis was performed to check for risk factors in osseous mineral density., Results: Osteoporosis and osteopenia are noticed with respective frequency of 35.7 % and 23.2 %. A statistically significant association is found between low osseous density on one hand and physical mass index (IMC), localisation on large bowel of the disease and corticotherapy on the other hand. The IMC was a risk factor independent from the two other factors. Under nutrition, with IMC < 18 kg / m C, was observed at 21 patients. It was associated to a pathological densitometry in 76.2 % of cases, versus 48.6 % in patients having an IMC > 18 kg/m (p = 0.03, Odds ratio = 3.4)., Conclusion: Among risk factors involved in the osteoporosis during CD, the nutritional status plays an important role which must be taken into account in the treatment of these patients.

Background: The serum markers ASCA and pANCA can help the clinician in certain difficult situations of colites in IBD. The aim of this study was to determine the sensitivity and the specificity of each one of these markers and to establish the characteristics of the positive patients for each one., Methods: We included patients having a Crohn's disease (CD) or an ulcerative colitis (UC). These patients was compared to a control group., Results: 80 CD patients with an average age of 35.62 years, 25 UC cases with an average age of 34.92 years and 79 healthy subjects with an average age of 34.2 years were included. The ASCA were detected in 33.8% of CD cases , 8% of UC cases of RCH and 2.5% of contro group (p < 000.1). The pANCA were detected in 48% of UC cases, 27.5% of CD patients and 1.3% of controls (p < 000.1). The sensitivity and the specificity of the ASCA and the pANCA for the diagnosis respectively of CD and UC were 33.8%, 97.5% and of 48%, 97.8%. During the CD, the positivity of the ASCA was significantly associated with ileal location (p = 0.001), with the sténosant and/or fistulisant phenotyp of the disease (p = 0.006), the young age at the time of the diagnosis of the CD (p = 0.067) and at a greater frequency of surgical treatment (p = 00.7). The pANCA were more frequently found in colic location of CD (p = 0.09). During UC, the positivity of the pANCA was not associated with the sex, age, loca tion of the disease, medical treatment nor chiurgical treatment., Conclusion: The ASCA and pANCA are useful during some clinical situations such as differentiation between IBD otherss colitis and to distinguish CD from UC.

Unlabelled: The study was aimed to evaluate the frequency and types of articular manifestations in a group of Crohn's disease patients, and to determine the risk factors., Subjects and Methods: We included 68 Crohn's disease patients. All patients had a complete rheumatological examination. Radiographs of the sacroiliac joints and lumbar spine were performed. 40 men and 28 women with a mean age of 31 years were included. Articular manifestations were observed in 41 patients. Twenty two patients suffered of peripheral articular manifestations: arthralgias in 18 patients and arthritis in 10 cases. Peripheral articular manifestation were significatly associated to ileal location of intestinal disease. Their frequency was of 41.3% in ileal location group versus 13.6% in colic location group (p = 0.02). Axial manifestations were observed in 32 patients: ankylosing spondylitis was diagnosed in 11 cases, undifferentiated spondylarthropathy in 7 patients, sacroiliitis in 10 cases, inflammatory back pain in 3 patients and enthesopathy in 1 case. The male sex and long duration of intestinal disease were two independants factors associated to axial manifestations.

Microscopic colitis are defined as a chronic inflammation of a normal macroscopic colonic mucosa. We report 20 cases of microscopic colitis. Chronic diarrhea revealed the diagnosis in 95% of cases. Endoscopic examination was normal in 95% of patients. We diagnosed collagenous colitis in 65% of cases and lymphocytic colitis in 35% of cases. The treatment was based on sulphasalazine in 16 patients, on 5 aminosalicylic acid in 1 case, on gluten free diet in 2 cases and a symptomatic treatment was prescribed to one patient. A clinical remission was observed in 41.2% of patients taking sulphasalazine.

The irritable bowel syndrome (IBS) is a frequent gastrointestinal disorder (10 -15% of the population). It is characterized by chronic abdominal pain with modification in the bowel habits. The diagnosis is based of ROME II criteria. The pathophysiology of the SII remains unknown . It result from visceral hypersensitivity with anomalies of the digestive motility. These anomalies are secondary of dysfunction of the brain - gut axis modulated by environmental and the psychosocial factors. The understanding of the pathophysiological mechanisms of the SII and in particular the function of the brain-gut axis will permit a better handling of the patients. Indeed, the present knowledge of the neurotransmitter implied in the communication between the central nervous system and the digestive tract are currently the basis of the new therapies aimed to modulate the mechanisms implicated in the causation of the several symptoms of IBS. These novel pharmacotherapy should reduce the indirect societal and costs of IBS.

Objectives: The study was aimed to evaluate osteoporosis prevalence in a group of Tunisian patients with inflammatory bowel disease (IBD), to determine its risk factors, and to describe its mechanisms., Subjects and Methods: We included 67 IBD patients, 43 patients with Crohn's disease (CD) and 24 with ulcerative colitis (UC). Bone mineral density was measured at the lumbar spine and left femoral neck by dual-energy X-ray absorptiometry. We used T score to express bone loss (osteopenia: -2.5 SD 2 years and active disease tended to be associated with lumbar osteoporosis; the ORs were respectively 4.87 [0.92-25.80] (P=0.06), 4.21 [0.87-20.57] (P=0.06), and 2.33 [0.78-6.67] (P=0.13). No association was found with cumulated dose of steroids even when considering only CD. Patients with osteoporosis showed significant increased CrossLaps and interleukin-6 levels that indicate both high bone resorption and inflammatory activity., Conclusions: Osteoporosis is frequent in IBD patients, especially in CD patients. Female gender, malnutrition (body mass index <20 kg/m2), disease course (> 2 years) and active disease would be risk factors of bone mineral loss in IBD. Osteoporosis is associated with enhanced bone resorption, that seems be linked to excessive intestinal inflammation.

The aim of our study was to determine the prevalence of corticosensibility, corticodependency, and corticoresistance in patients with Crohn's disease. Ninety four treatments with corticoids were prescribed to the patients during the follow-up. The rates of corticosensibility, corticodependency, and corticoresistance were 66%, 16%, 18%. Corticodependency and corticoresistance are frequent in Crohn's disease. Corticodependency is more frequent in young patients and when corticoids were previously taken. A high CDAI was the only factor associated with a higher risk of corticoresistance.