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Background Osteoporosis and osteopenia are common situations in chronic inflammatory bowel disease (IBD), particularly in crohn’s disease. Objectives The objective of our study was to determine the prevalence of these affections during crohn’s disease and to identify the risk factors for osteopenia and osteoporosis. Methods We conducted a descriptive monocentric retrospective study of consecutive patients with crohn’s disease who were hospitalized between January 2016 and December 2018. Results We included 100 patients (64 female and 36 male) with an average age of 37 years [17-68 years]. Among these patients 21% were smokers and among women 20% were in menopause. Bone densitometry was performed in 39 patients. It was found to be pathological in 53.8% of cases. The rate of osteoporosis was 17.9% (7 patients) and the rate of osteopenia was 35.9% (14 patients). Tobacco and a BMI of less than 18 had a statistically significant association with osteopenia (p=0.046; p=0.038 respectively). The presence of a family history of IBD had a statistically significant influence on a pathological bone densitometric investigation (p=0.036). An albuminemia rate of less than 35g/dl had an association at the limit of significance with bone pathology in BMD (p=0.059). Conclusion Osteoporosis and osteopenia are frequent during crohn’s disease. They are in the majority of cases asymptomatic. This makes bone densitometry essential, especially in the presence of a family history of IBD, smoking and malnutrition (BMI less than 18) in order to act early and avoid complications such as fractures. Disclosure of Interests None declared

Background Osteoporosis is a common complication of chronic liver diseases especially associated with Primary biliary cholangitis (PBC). Its occurrence during others autoiummune hepatopathies such us autoimmune hepatitis, primary sclerosing cholangitis has been described. Objectives The aim of our study was to assess the prevalence of osteoporosis in patients with autoimmune hepatopathies. Methods We carried out a retrospective study from January 1996 to December 2018, including all patients with auto-immune hepatopathy [autoimmune hepatitis/Primary biliary cholangitis (PBC)/Primary sclerosing cholangitis (PSC)/overlap syndrome]. Only patients who had bone mineral density (BMD) were selected. Results During the study period, 124 patients were included. The mean age of our patients was 55 years [18-87]. BMD has been realised in 51 patient [32 PBC/5AIH/3PSC/11 overlap Syndrome]. It was normal in 18 cases (35%), whereas 9 patients had osteopenia (18%) and 24 had osteoporosis (47%)[15PBC/2AIH/5overlap/2PSC]. The mean values of L2-L4 T-scores and femur total T-scores were -3.27 and -1.97, respectively., Osteoporotic patients had an average age of 58 years: 1 men, 3 premenopausal, and 20 postmenopausal women. The study of risk factors of osteoporosis has shown that 5patients underwent systemic corticosteroid. A tobacco intoxication has been noted in 1patient. Biochemical analysis indicated a high level of cytolysis (superior to twice normal value) in 14 patient. Cholestasis was noted in 10 patients. The mean values of bilirubin was 23mg/l. Among the 24 patients with osteoporosis, 10 had positif antinuclear antibodies, 17 had positif anti-mitochondrial antibodies and 5 had positif anti-smooth muscle antibodies. Eight of patients were at an advanced stages of liver fibrosis at the moment of diagnosis. Conclusion Our study has shown that autoimmune liver diseases has an influence on bone mineral density as a bone nineral loss was noted in more than half of the cases. It should be considered for all patients with auto immune hepatopathy especially with long duration of corticosteroid treatment. Disclosure of Interests None declared

Background: Autoimmune liver diseases are considered as a group of hepatobiliary injuries mediated by abnormal immunity in subjects with genetic predisposition. It mainly includes autoimmune hepatitis, primary biliary cholangitis,primary sclerosing cholangitis and overlap syndrome. They are oftently associated with different manifestations of autoimmune systemic diseases such as systemic lupus erythematosus, CREST syndrome …. Objectives: The aim of this study was to evaluate the prevalence and the characteristics of systemic diseases associated with autoimmune hepatopathies Methods: We carried out a retrospective study from January 1996 to December 2018 including all patients with autoimmune liver diseases followed in our department: 64primary biliary cholangitis (PBC), 22 autoimmune hepatitis (AIH), 23 overlap syndrome (OS), 15 primary sclerosing cholangitis (PSC). Results: One hundred and twenty four patients were included in our study : 107 women and 17 men with an average age of 55 years [18-87 years]. An immunological disorder was found in 58 cases (48%): [28 PBC/12 AIH/12 OS/6 PSC] with a female predominance (Sex ratio (Men/Women) = 0.09). Systemic diseases included respectively: Sjogren’s syndrome in 20 cases, systemic lupus erythematosus in 7 cases, rheumatoid arthritis in 5 cases, CREST syndrome in 11 cases and autoimmune thyroiditis in 2 cases. The discovery of autoimmune disorder was in most cases concomitant to the diagnosis of the autoimmune liver disease (67%). Our study showed biological assessment perturbation in 20 cases with positivity of : anti-centromere antibodies (11 cases), anti-SSA antibodies (5 cases), anti-cardiolipin antibodies (4 cases) and rheumatoid factor (5 cases) Conclusion: Our study shows a strong prevalence of systemic disease during autoimmune hepatopathies. A systematic screening for clinical and biological immune manifestations are highly recommended in those patients. Disclosure of Interests: None declared

Background: The prevalence of Sicca Syndrome (SS) in patients with Chronic Hepatitis C (CHC) ranges from 5% to 33%. A link between hepatitis C virus (HCV) and SS was evoked given the strong association of these two pathologies with mixed cryoglobulinemia (MC) on one hand and with the salivary tropism of HCV on the other hand. Objectives: To study the prevalence and the characteristics of Sicca Syndrome during CHC. Methods: All patients suffering from CHC followed over a period of 11 years (2002 – 2012) were retrospectively included. Only patients having clinical SS (xerostomia and/or xerophthalmia) were selected. We have analyzed all data concerning the patient, the hepatitis and the SS. Results: Two hundred and four patients affected by CHC were included. A clinical SS was found in 17 patients (8.39%). There were 15 women and 2 men with an average age of 45.6 years. A High viral load and an advanced hepatic fibrosis were respectively found in 94 and 88% of cases. Cryoglobulinemia and antinuclear antibodies were found in 37.5% and 53% of patients, respectively. Four patients (3 women and 1 man) had also presented the criteria of Sjogren Syndrome. Their average age was 47 years. MC was positive in all 4 patients whereas anti-SSA and anti-SSB were absent in the 4 patients. Biopsy of accessory salivary glands revealed the presence of a grade 4 lymphocytic sialadenitis according to the Chisholm and Masson classification in 3 patients, while the remaining case had a lymphocyte grade 2 sialadenitis. The evaluation of hepatic fibrosis did not reveal cirrhosis in the 4 cases. Conclusion: The prevalence of Sicca syndrome during hepatitis C is estimated at 8% in our study. It was mainly reported in women with perimenopausal age and seems to be associated with cryoglobulinemia, a high viral load and and an advanced fibrosis. Disclosure of Interests: None declared

Background: Reynolds syndrome is a rare condition defined by the association of primary biliary cholangitis (PBC) with CREST syndrome. The frequency of scleroderma during PBC varies between 3 and 17%. The diagnosis is most often done during systematic search for autoimmune diseases associated with CBP. Objectives: To determine the epidemiological, clinical, paraclinical and evolutionary features of Reynolds syndrome Methods: We report 7 cases of Reynolds syndrome collected in the our department between 1996 and 2014 Results: There were 7 middle-aged women with an average age of 49.2 years (32-61 years old). The diagnosis of CREST syndrome with anti centromeric positive antibodies was retained in 6 cases. Extensive trunk sclerosis associated with diffuse sclerodacty and anti centromeric antibodies was noted in 1 case. An isolated acrosyndrome was noted in 1 case. The hepatic assessment found non icteric cholestasis in 6 patients. Anti-mitochondrial antibodies type M2 were positive in 6 cases. Liver biopsy showed histologic lesions consistent with primary biliary cholangitis PBC in 5 cases. Sjorgen’s syndrome was confirmed histologically in 1 case. Autoimmune diseases (rheumatoid arthritis and lymphocytic thyroiditis) were associated with Reynolds Syndrome in 2 cases. The treatment consisted of ursodeoxycholic acid alone (N = 4), or combined with D-penicillamine (N = 1), azathioprine-associated prednisone (N = 1) or a calcium channel blocker alone (N = 1). The evolution was favorable in 2 cases. In the other 3 patients, worsening of cholestasis and complications such as oedemato-ascitic decompensation and gastrointestinal haemorrhage were noted during the course of the study. One patient died of cataclysmic gastrointestinal bleeding by rupture of oesophageal varices. Conclusion: Reynolds syndrome is a rare entity that should be discussed in the presence of liver function disturbances in patients with CREST syndrome. Conversely, the CREST syndrome should be referred to and sought systematically in case of PBC. Disclosure of interests: None declared

Gastric volvulus is an abnormal rotation of the stomach around his axis. The chronic presenting, as the acute one, is considered as a surgical emergency. We report 4 cases of chronic gastic volvulus. In 2 cases, it was a mesenterico-axial volvulus while in the 2 other cases it was an organo-axial volvulus. The barium enema made the diagnosis in all cases. The volvulus was secondary to a hernia in 3 cases and an agenesis of left diaphragmatic dome with ligament laxity in 1 case. All the patients underwent surgery. The laparoscopic approach was used in two patients.

Background Chronic hepatitis C (CHC) is assimilated to a systemic disease because of his multiple extrahepatic manifestations notably rheumatological. Objectives The aim of this study was to determinate the prevalence and the characteristics of rheumatological manifestations (RM) associated with CHC. Methods A retrospective study including all patients suffering from CHC followed over a period of 11 years (2002–2012). Were excluded all patients co-infected by hepatitis B virus or by human immunodefficiency virus and those having decompensated cirrhosis. Different RM were collected and analysed according to the epidemiological, clinico-biological, immunological, virological and histological data of the CHC. Results Two hundred and four patients affected by CHC were included, meanly aged by 52 years [22–66 years]. The sex-ratio was 0,46. MR were noted in 76 patients (37,25%) dominated by inflammatory polyarthralgia of big joints (88,25%). Non erosive arthritis was observed in a woman and was localised to the proximal interphalangeal articulation of the index. Myalgia were noted in 11 cases (14,47%) among them, 2 appeared under antiviral treatment. Sicca Syndrome was observed in 17 cases (22,36%). RM were associated to other extrahepatic manifestations of CHC in 69,7% of cases, notably to mixed cryoglobulinemia (MC) (60%) and to antinuclear antibodies (21,6%). Anti DNA, anti SSA, anti SSB, rheumatoid factor and anti CCP were absent in all cases. A partial to total amelioration of RM was noted in almost patients under antiviral treatment and sometimes associated to symptomatic measures. In univariate analyse, only feminal sexe and presence of MC were significatly correlated to the presence of MR. Conclusions During CHC, MR are frequent, dominated by arthralgia, myalgia and sicca syndrome. Authentic arthritis are rare and constitute a diagnostic problem essentially when they inaugurate the disease. MC is the immunological factor the most associated with RM. Treatment of MR still antiviral. Disclosure of Interest None declared

Background The link between Coeliac disease (CD) and low bone mass has been established in several large international studies. Objectives To determinate the prevalence and risk factors of osteopenia and osteoporosis in a Tunisian population of coeliac patients. Methods We carried a retrospective study from January 1991 to December 2015 including all cases of CD diagnosed in the departement of Gastroenterology B in Rabta9s Hospital. We retained all patients having a bone mineral density (BMD). We used the WHO criteria for the diagnosis of osteoporosis and osteopenia. Results During the period of the study, 78 cases of CD were included. Thirty among them, performed a BMD: 25 women and 5 men with an average age of 35.8 years. Malnutrtion was found in 14 patients with a BMI Conclusions Our study showed that approximately ¾ of coeliac patients had a low bone mass. Osteoporosis was found in 33% of our patients and was associated to a marked villous atrophy. Disclosure of Interest None declared

Introduction La cirrhose biliaire primitive (CBP) est une maladie cholestatique chronique d’origine auto-immune. Elle est le plus souvent diagnostiquee chez la femme mais elle peut survenir egalement chez les sujets de sexe masculin. Le but de ce travail etait de decrire les caracteristiques clinicobiologiques, immunologiques, histologiques et evolutives de la CBP chez l’homme. Patients et methodes Etude retrospective menee sur une periode de 19 ans (janvier 1996–decembre 2014). Nous avons collige tous les cas de CBP et avons recueilli les caracteristiques cliniques, biologiques, immunologiques, histologiques et evolutives de cette maladie chez le sujet de sexe masculin en les comparant a celles de la femme. Resultats Soixante-quinze patients atteints de CBP ont ete inclus durant la periode de l’etude. Six (8 %) cas etaient de sexe masculin (sex-ratio = 0,086). La maladie etait de decouverte plus tardive chez l’homme que chez la femme (58 vs 53 ans). La CBP etait symptomatique dans plus de 80 % des cas et de facon egale chez l’homme et chez la femme. Les signes cliniques et endoscopiques d’hypertension portale etaient presents dans plus des 2/3 des cas chez l’homme contre 1/3 chez la femme. A la biochimie, il n’y avait pas de difference statistiquement significative entre les taux de transaminases et des GGT ou PAL dans les deux sexes. Au bilan immunologique, les anticorps antimitochondries du type M2 etaient presents chez 50 % des sujets de sexe masculin et 60,86 % des patientes. La ponction biopsie du foie a ete realisee chez 3 malades de sexe masculin et chez 54 (78,26 %) patientes. Des signes histologiques compatibles avec la CBP ont ete retrouves dans environ 1/3 des cas dans les 2 sexes. L’association a une autre maladie auto-immune etait manifestement plus frequente chez la femme que chez l’homme (57,97 % vs 33,3 %). Un traitement par acide urso-desoxycholique a la dose de 13–15 mg/kg/j etait instaure chez 2 patients. L’evolution avec ou sans traitement etait marquee par une aggravation clinicobiologique chez 2 (33 %) malades de sexe masculin et chez 17 (25 %) patientes. Le suivi moyen etait de 40,17 mois pour les patients de sexe masculin et de 52,16 mois pour les patientes. Conclusion Dans notre serie, la prevalence de la cirrhose biliaire primitive etait de 2,5 % chez l’homme. Le profil clinicobiologique et immunologique etait similaire dans les deux sexes. Toutefois, nous avons note une evolution plus pejorative chez l’homme.

Introduction Le virus de l’hepatite C (VHC) est un virus dont le tropisme dominant est le foie. Cependant, son implication a ete demontree dans de nombreuses pathologies nommees manifestations extrahepatiques (MEH) liees au VHC. Toutefois, les liens de causalite sont loin d’etre toujours demontres. Le but de ce travail etait de determiner le type et la frequence des MEH au cours de l’hepatite chronique C (HCC) et d’identifier en second lieu les facteurs de risque pouvant etre lies a ces MEH. Patients et methodes Il s’agit d’une etude retrospective etendue sur une periode de 11 ans (2002–2012) colligeant tous les patients suivis pour HCC. Ont ete exclus les patients co-infectes par les virus de l’hepatite B ou le virus de l’immunodeficience humaine et les malades cirrhotiques. Nous avons recueilli les donnees epidemiologiques, clinicobiologiques et therapeutiques des patients, les caracteristiques biochimiques, virologiques et histologiques de l’HCC et nous avons specifie la nature des MEH associees en precisant leurs particularites diagnostiques, therapeutiques et evolutives. Resultats Deux cent quatre patients infectes par le VHC ont ete inclus. L’âge moyen etait de 52 ans (extremes: 22–66 ans). Le sex-ratio etait de 0,46. 197 malades ont recu une bitherapie pegylee. Cent soixante-dix-huit patients (87,2 %) presentaient au moins une MEH. La coexistence d’au moins 2 MEH a ete notee chez 91 malades soit 44,6 %. Les manifestations neuropsychiatriques etaient les plus frequentes et particulierement l’asthenie (78,4 %). Un syndrome depressif a ete objective dans 7 cas. Sur le plan immunologique, la cryoglobulinemie mixte (CM) etait positive chez 41,8 % des cas, il s’agissait d’une CM de type 2 dans 61 % et de type 3 chez les 39 % restants. Concernant les auto-anticorps, les anticorps antinucleaires, les anticorps antimuscle lisse, les anticorps antimitochondrie et les anticorps antithyroidiens etaient presents chez respectivement 16 %, 10,8 %, 1,5 % et 9,6 %. Les manifestations rhumatologiques etaient notees dans 43,13 % des cas a type de polyarthralgies (32,84 %) et un syndrome sec (5,39 %). Les manifestations cutanees etaient dominees par le prurit et l’eczema. Une thrombopenie a ete notee chez 72 patients dont 56 n’etaient pas au stade de cirrhose. Une dysthyroidie a ete notee chez 27 malades et un diabete a ete retrouve dans 6,8 % des cas. Cinq patients ont presente de facon concomitante au diagnostic de l’hepatite C des neoplasies associees: cancer du rein (n = 1), cancer du col uterin (n = 1), cancer de l’estomac (n = 1), cancer colique (n = 1) et un lymphome ganglionnaire (n = 1). Aucun facteur de risque n’a ete correle a l’existence des MEH dans notre serie. Cependant, il semble que la CM constitue un facteur de risque de survenue des autres MEH (p = 0,028). Parmi les MEH sus decrites, 37 (18,13 %) etaient correlees a l’interferon conduisant dans de rares cas a l’arret du traitement (myelite aigue (n = 1), pneumopathie interstitielle (n = 1), retinopathie dysorique (n = 2), et lupus cutane (n = 1)). Conclusion Les resultats de notre etude confirment la frequence elevee de certaines MEH au cours de l’HCC, en particulier la CM, l’asthenie, la dysthyroidie et certaines manifestations cutanees. Un diagnostic et une prise en charge precoces de ces MEH sont necessaires surtout chez les patients sous traitement antiviral car elles peuvent impliquer l’arret de celui-ci.

Introduction La maladie de Wilson est une affection hereditaire autosomique recessive rare due a un defaut d’elimination biliaire du cuivre qui entraine son accumulation dans le foie et le cerveau. Sa presentation clinique est variable et son pronostic est domine par l’atteinte hepatique et neurologique. Le but de ce travail etait de determiner les caracteristiques cliniques, therapeutiques et evolutives de la maladie de Wilson. Patients et methodes Il s’agit d’une etude retrospective qui s’etend sur une periode de 19 ans allant de janvier 1996 a decembre 2015, colligeant tous les patients hospitalises pour maladie de Wilson. Resultats Nous avons inclus 9 patients au cours de la periode d’etude. L’âge moyen au moment du diagnostic etait de 19 ans (extremes : 4–40 ans) avec une legere predominance feminine (sex-ratio H/F = 0,8). Des antecedents familiaux de maladie de Wilson probable etaient notes dans 55,5 % des cas (n = 5). Le mode de revelation etait hepatique chez 4 malades (ictere cholestatique, exploration d’une cytolyse, 2 decompensations œdemato-ascitiques inaugurales), neurologiques chez 2 patients et dans le cadre d’un depistage familial chez 3 sujets apparentes a des cas confirmes de maladie de Wilson. Le diagnostic a ete pose en se basant sur un taux bas de ceruloplasmine ( Conclusion La maladie de Wilson est une affection genetique rare qui se revele le plus souvent par une atteinte hepatique ou neurologique. Dans notre serie, le diagnostic d’hepatopathie etait le plus souvent tardif au stade de cirrhose et associe a des signes neurologiques. L’amelioration du pronostic passe par un diagnostic precoce grâce au depistage familial.

Introduction. Sclerosing cholangitis is characterized by an inflammatory and fibrotic lesion of intra- and/or extrahepatic bile ducts. When a causal mechanism of a bile duct lesion is identified, the sclerosing cholangitis is considered secondary. The vasculitis, including the Behçet disease, is cited as a probable cause of the ischemia and the sclerosing cholangitis. No cases of extrahepatic secondary sclerosing cholangitis have been reported to date.Case Report. We report the first case of secondary sclerosing cholangitis of the extrahepatic bile ducts associated with Behçet disease in a male who is aged 43, with a previous history of the angio-Behçet followed by complications of thrombophlebitis and a cerebral thrombophlebitis, and who has a cholestatic jaundice. The diagnosis has been carried out by the MR cholangiopancreatography which has objectified a moderate distension of the intrahepatic bile ducts upstream of regular stacked parietal thickening of the main bile duct. The patient has been treated successfully with the ursodeoxycholic acid and the placement of a plastic stent.Conclusion. This diagnosis should be mentioned to any patient with vasculitis and who has a cholestatic jaundice.

steatosis is a common injury in chronic hepatitis C, but this association has not been sufficiently studied in chronic hepatitis B. aim: To evaluate the prevalence of hepatic steatosis in chronic hepatitis B and determine its association with various histologic, biochemical, virological, and metabolic diseases, and its effect on fibrosis and therapeutic response.Our study was compiled 133 patients with chronic hepatitis B who received no antiviral therapy and who had a liver biopsy. Our patients were divided into 2 groups: 51 patients (38.3%) had steatosis (Group I), while 82 (61.7%) had no steatosis (Group II).In groupeI, the average age, BMI, cholesterol, triglycerides, and glucose were significantly higher than the group without steatosis in univariate study (P0.05). In multivariate analysis, only high BMI and hypertriglyceridemia were included.No significant difference between the two groups was observed in the rate of transaminases, HBeAg status, viral load (P0.05). Steatosis doesn't influence fibrosis stage and therapeutic response.During chronic hepatitis B, steatosis appears to be the result of metabolic factors of the host rather than the effect of the virus. Hepatic steatosis does not seem to influence the progression of liver fibrosis, or therapeutic response, however, the role of steatosis should be better studied by prospective longitudinal clinical studies on large populations of patients.