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1. Ascites in cirrhotic patients: a comprehensive review

Author: Paul Carrier, Véronique Loustaud-Ratti, Marilyne Debette-Gratien, and Laure Elkrief
Subjects: paracentesis, tips, beta-blockers, low-flow ascites pump, ascites, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract: Ascites is a frequent complication in patients with cirrhosis, associated with a bad prognosis. Ascites is associated with severe complications, such as spontaneous bacterial peritonitis and kidney dysfunction, which must be diagnosed and managed rapidly. First-line management is based on diuretics use. Beta-blockers role remains debated but an early administration could probably decrease complications associated with portal hypertension. Albumin infusion is validated in large volume paracenteses, spontaneous bacterial peritonitis, or kidney dysfunction, but is debated in other situations. Technical progresses allow the worldwide use of TIPS (transjugular intrahepatic portosystemic shunt), but patient selection must be rigorous because of potential severe complications. An alternative treatment, automated low-flow ascites pump, can be offered in patients without TIPS possibility: It is a recent technique, whose patients’ selection and installation conditions were improved, with interesting results. Liver transplantation remains the gold standard, but the lack of grafts, and specific side effects, lead to prefer other methods. In case of acute kidney injury due to hepatorenal syndrome, terlipressin remains the standard of care; continuous infusion is associated with fewer side effects.
Published: 2024
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2. Treatment with bulevirtide in HIV-infected patients with chronic hepatitis D: ANRS HD EP01 BuleDelta and compassionate cohort

Author: Victor de Lédinghen, Claire Fougerou-Leurent, Estelle Le Pabic, Stanislas Pol, Dulce Alfaiate, Karine Lacombe, Marie-Noëlle Hilleret, Caroline Lascoux-Combe, Anne Minello, Eric Billaud, Isabelle Rosa, Anne Gervais, Vlad Ratziu, Nathalie Ganne, Georges-Philippe Pageaux, Vincent Leroy, Véronique Loustaud-Ratti, Philippe Mathurin, Julie Chas, Caroline Jezequel, Sophie Métivier, Jérôme Dumortier, Jean-Pierre Arpurt, Tarik Asselah, Bruno Roche, Antonia Le Gruyer, Marc-Antoine Valantin, Caroline Scholtès, Emmanuel Gordien, Christelle Tual, Amel Kortebi, Fatoumata Coulibaly, Eric Rosenthal, Miroslava Subic-Levrero, Dominique Roulot, Fabien Zoulim, François Raffi, Laurent Alric, Patrick Miailhes, Albert Tran, Christiane Stern, Xavier Causse, Simona Tripon, Ghassan Riachi, Olivier Chazouillères, Armando Abergel, Louis d’Alteroche, Jérôme Gournay, Garance Lagadic, Patrizia Carrieri, Ségolène Brichler, Martin Siguier, Jessica Krause, Juliette Foucher, Souad Ben Ali, Magdalena Meszaros, Anne Varaut, and Valérie Canva
Subjects: Cirrhosis, HDV, HBV, Pegylated interferon, Hepatitis D, HDV RNA, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract: Background & Aims: In France, bulevirtide (BLV) became available in September 2019 through an early access program to treat patients with HDV. The aim of this analysis was to evaluate the efficacy and safety of BLV in patients with HIV and HDV coinfection. Methods: Patients received BLV 2 mg ± pegylated interferon-α (pegIFNα) according to the physician’s decision. The primary endpoint (per-protocol analysis) was the virological response rate at Week 48, defined as the proportion of patients with undetectable serum HDV RNA or a HDV RNA decline >2 log10 IU/ml from baseline. Results: The characteristics of the 38 patients were as follows: 28 male, mean age 47.7 years, and mean baseline HDV RNA viral load 5.7 ± 1.2 log10 IU/ml. Median HIV viral load and mean CD4 count were 32 (30–65) copies/ml and 566 ± 307/mm3, respectively. Eight patients stopped treatment before Week 48. At Week 48, 10 of 19 patients (52.6%) in the 2 mg BLV group and five of seven patients (71.4%) in the 2 mg BLV + pegIFNɑ group had reached virological response (no HDV RNA available in four patients). At Week 48, seven of 19 patients in the 2 mg BLV group and three of six patients in the 2 mg BLV + pegIFNɑ group had a combined response (virological response and normal alanine aminotransferase level). Conclusions: Adults living with HIV coinfected with HDV can be treated by BLV with a virological response in more than 50% of patients. The combination of BLV and pegIFNɑ showed a strong virological response. Impact and implications: Bulevirtide is the only EMA-approved drug for HDV treatment, and we showed that it can be used in adults living with HIV, with an overall good tolerability. Bulevirtide induces a virological response in more than 50% of patients, suggesting that bulevirtide should be considered as a first-line therapy in this specific population. Bulevirtide in combination with pegIFNα could be used in patients without pegIFNα contraindication. No specific drug–drug interaction is reported. Bulevirtide is the only EMA-approved drug for HDV treatment, and we showed that it can be used in adults living with HIV, with an overall good tolerability. Bulevirtide induces a virological response in more than 50% of patients, suggesting that bulevirtide should be considered as a first-line therapy in this specific population. Bulevirtide in combination with pegIFNα could be used in patients without pegIFNα contraindication. No specific drug–drug interaction is reported. Bulevirtide is the only EMA-approved drug for HDV treatment, and we showed that it can be used in adults living with HIV, with an overall good tolerability. Bulevirtide induces a virological response in more than 50% of patients, suggesting that bulevirtide should be considered as a first-line therapy in this specific population. Bulevirtide in combination with pegIFNα could be used in patients without pegIFNα contraindication. No specific drug–drug interaction is reported.
Published: 2024
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3. International survey among hepatologists and pulmonologists on the hepatic hydrothorax: plea for recommendations

Author: Jean-François David Cadranel, Isabelle Ollivier-Hourmand, Jacques Cadranel, Thierry Thevenot, Honoré Zougmore, Eric Nguyen-Khac, Christophe Bureau, Manon Allaire, Jean-Baptiste Nousbaum, Véronique Loustaud-Ratti, Xavier Causse, Philippe Sogni, Bertrand Hanslik, Marc Bourliere, Jean-Marie Peron, Nathalie Ganne-Carrie, Thong Dao, Dominique Thabut, Bernard. Maitre, Nabil Debzi, Ryad Smadhi, Roger Sombie, Raimi Kpossou, Olivier Nouel, Julien Bissonnette, Isaac Ruiz, Mourad Medmoun, Sergio Negrin Dastis, Pierre Deltenre, Florent Artru, Chantal Raherison, Laure Elkrief, and Tristan Lemagoarou
Subjects: Hepatic hydrothorax, Therapeutic pleural puncture, Albumin infusion, Spontaneous bacterial empyema, Talcage pleurodesis, Indwelling pleural catheter, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract: Abstract Background The Hepatic hydrothorax is a pleural effusion related to portal hypertension; its diagnosis and therapeutic management may be difficult. The aims of this article are which follows: To gather the practices of hepatogastroenterologists or pulmonologists practitioners regarding the diagnosis and management of the hepatic hydrothorax. Methods Practitioners from 13 French- speaking countries were invited to answer an online questionnaire on the hepatic hydrothorax diagnosis and its management. Results Five hundred twenty-eight practitioners (80% from France) responded to this survey. 75% were hepatogastroenterologists, 20% pulmonologists and the remaining 5% belonged to other specialities. The Hepatic hydrothorax can be located on the left lung for 64% of the responders (66% hepatogastroenterologists vs 57% pulmonologists; p = 0.25); The Hepatic hydrothorax can exist in the absence of clinical ascites for 91% of the responders (93% hepatogastroenterologists vs 88% pulmonologists; p = 0.27). An Ultrasound pleural scanning was systematically performed before a puncture for 43% of the responders (36% hepatogastroenterologists vs 70% pulmonologists; p
Published: 2023
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4. Clinical outcomes after treatment with direct antiviral agents: beyond the virological response in patients with previous HCV-related decompensated cirrhosis

Author: Georges-Philippe Pageaux, Clovis Lusivika Nzinga, Nathalie Ganne, Didier Samuel, Céline Dorival, Fabien Zoulim, Carole Cagnot, Thomas Decaens, Dominique Thabut, Tarik Asselah, Philippe Mathurin, François Habersetzer, Jean-Pierre Bronowicki, Dominique Guyader, Isabelle Rosa, Vincent Leroy, Olivier Chazouilleres, Victor de Ledinghen, Marc Bourliere, Xavier Causse, Paul Cales, Sophie Metivier, Véronique Loustaud-Ratti, Ghassan Riachi, Laurent Alric, Moana Gelu-Simeon, Anne Minello, Jérôme Gournay, Claire Geist, Albert Tran, Armand Abergel, Isabelle Portal, Louis d’Alteroche, François Raffi, Hélène Fontaine, Fabrice Carrat, Stanislas Pol, and For the French ANRS CO22 Hepather Cohort
Subjects: Hepatitis C virus, Decompensated cirrhosis, Direst-acting antiviral agents, Survival, Hepatocellular carcinoma, Sustained virological response, Infectious and parasitic diseases, RC109-216
Abstract: Abstract Background In HCV-infected patients with advanced liver disease, the direct antiviral agents-associated clinical benefits remain debated. We compared the clinical outcome of patients with a previous history of decompensated cirrhosis following treatment or not with direct antiviral agents from the French ANRS CO22 HEPATHER cohort. Methods We identified HCV patients who had experienced an episode of decompensated cirrhosis. Study outcomes were all-cause mortality, liver-related or non-liver-related deaths, hepatocellular carcinoma, liver transplantation. Secondary study outcomes were sustained virological response and its clinical benefits. Results 559 patients met the identification criteria, of which 483 received direct antiviral agents and 76 remained untreated after inclusion in the cohort. The median follow-up time was 39.7 (IQR: 22.7–51) months. After adjustment for multivariate analysis, exposure to direct antiviral agents was associated with a decrease in all-cause mortality (HR 0.45, 95% CI 0.24–0.84, p = 0.01) and non-liver-related death (HR 0.26, 95% CI 0.08–0.82, p = 0.02), and was not associated with liver-related death, decrease in hepatocellular carcinoma and need for liver transplantation. The sustained virological response was 88%. According to adjusted multivariable analysis, sustained virological response achievement was associated with a decrease in all-cause mortality (HR 0.29, 95% CI 0.15–0.54, p
Published: 2022
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5. Alpha‐fetoprotein and focal nodular hyperplasia: An unconventional couple

Author: Paul Carrier, Anne Guyot, Marilyne Debette‐Gratien, Fabien Fredon, Marie‐Pierre Teissier, François Labrousse, and Véronique Loustaud‐Ratti
Subjects: hepatology, liver imaging, liver tumors, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract: Abstract We report the case of a 36‐year‐old patient who was initially managed for gynecomastia. The first biological analyses showed a moderately elevated alpha‐fetoprotein (AFP) level. After an endocrine etiology was excluded, an abdominal computed tomography scan showed typical focal nodular hyperplasia (FNH) proven by biopsy and showing expression of AFP in FNH cells. After follow‐up for 24 months, the serum AFP and liver radiology remained unchanged. The association between an elevated AFP and FNH is rarely described in the medical literature.
Published: 2021
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6. Abdominal symptoms during Sjogren’s syndrome: a pilot study

Author: Simon Parreau, Jérémie Jacques, Stéphanie Dumonteil, Sylvain. Palat, Sophie Geyl, Guillaume Gondran, Holy Bezanahary, Eric Liozon, Julie Azaïs, Stéphanie Colombie, Marie-Odile Jauberteau, Véronique Loustaud-Ratti, Kim-Heang Ly, and Anne-Laure Fauchais
Subjects: Sjögren’s syndrome, Abdominal symptoms, Gastroparesis, ESSPRI, ESSDAI, Quality of life, Diseases of the musculoskeletal system, RC925-935, Immunologic diseases. Allergy, RC581-607
Abstract: Abstract Background Abdominal symptoms in patients with primary Sjögren syndrome (pSS) are poorly documented. The objective of the study was to describe the abdominal symptoms of patients with pSS and to assess their association with characteristics of the disease. Methods One hundred and fifty patients with pSS were evaluated using a composite global symptom score for abdominal symptoms and their severity. Data concerning the clinical and biological characteristics of pSS and abdominal disorders were also collected. Results Of the patients with pSS, 95% suffered from abdominal symptoms (median global symptom score 7.5 ± 5.5 points out of 30). More than half of the patients experienced abdominal tension (68%), upper abdominal pain (54%), abdominal discomfort (58%) and/or constipation (54%). Regarding the pSS activity, in relation to European League Against Rheumatism (EULAR) Sjögren syndrome disease activity index score items, general and central nervous system involvement wereassociated with a high global symptom score. The EULAR Sjogren Syndrome Patient Reported Index (ESSPRI) symptom score was positively correlated with the global symptom score (p
Published: 2021
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7. Safety and efficacy of the combination simeprevir-sofosbuvir in HCV genotype 1- and 4-mono-infected patients from the French ANRS CO22 hepather cohort

Author: Anne Laurain, Sophie Metivier, Georges Haour, Dominique Larrey, Céline Dorival, Christophe Hezode, Fabien Zoulim, Patrick Marcellin, Marc Bourliere, Jean-Pierre Zarski, Dominique Thabut, Laurent Alric, Nathalie Ganne-Carrie, Paul Cales, Jean-Pierre Bronowicki, Ghassan Riachi, Claire Geist, Xavier Causse, Armand Abergel, Olivier Chazouilleres, Philippe Mathurin, Dominique Guyader, Didier Samuel, Albert Tran, Véronique Loustaud-Ratti, Ventzislava Petrov-Sanchez, Alpha Diallo, Clovis Luzivika-Nzinga, Hélène Fontaine, Fabrice Carrat, Stanislas Pol, and on behalf of the ANRS/AFEF HEPATHER study group
Subjects: Direct acting antivirals, Hepatitis C virus, Real life cohort, Simeprevir, Sofosbuvir, Infectious and parasitic diseases, RC109-216
Abstract: Abstract Background Although real-life results of sofosbuvir/simeprevir have been extensively reported from the United States, data from other geographical areas are limited. In the French observational cohort, ANRS CO22 HEPATHER, 9432 patients were given the new oral antivirals from December 2013 to June 30, 2018. We report the results of sofosbuvir/simeprevir in genotypes 1- and 4-infected patients. Methods Demographics and history of liver disease were collected at entry in the cohort. Clinical, adverse events, and virological data were collected throughout treatment and post-treatment follow-up. The choice of treatment duration or addition of ribavirin was left up to the physician. Results Five hundred ninety-nine HCV (467 genotype 1 and 132 genotype 4) mono-infected, naïve for all oral-DAAs regimen patients were given sofosbuvir/simeprevir with (n = 63) or without ribavirin (n = 536) for 12 or 24 weeks; 56% had cirrhosis (4% decompensated) and 71% had prior treatment failure to interferon-based regimen. 7 patients (1.16%) were lost to follow-up. The overall SVR12 rate was 92.6%. The SVR12 was 90% in GT1a, 94.2% in GT1b and 91.6% in GT4 with no significant difference for genotype, treatment duration or ribavirin addition. Severity of liver disease was not associated with a lower SVR12 rate on multivariate analysis but was associated with a higher rate of severe side effects. Early treatment discontinuations were rare; no new safety signals were reported. Conclusion In this real life, observational, prospective cohort study, the 12-week sofosbuvir/simeprevir+/−ribavirin combination appears to be efficient and safe. Trial registration Trial registration with ClinicalTrials.gov NCT01953458.
Published: 2019
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8. Serum neurotrophin profile in systemic sclerosis.

Author: Marie-Claude Lise, Agnès Sparsa, Isabelle Marie, Fabrice Lalloué, Kim Ly, Clothilde Martel, Holy Bezanahary, Guillaume Gondran, Véronique Loustaud-Ratti, Jean-Marie Bonnetblanc, Elisabeth Vidal, Marie-Odile Jauberteau, and Anne-Laure Fauchais
Subjects: Medicine, Science
Abstract: BackgroundNeurotrophins (NTs) are able to activate lymphocytes and fibroblasts; they can modulate angiogenesis and sympathic vascular function. Thus, they can be implicated in the three pathogenic processes of systemic sclerosis (SSc). The aims of this study are to determine blood levels of Nerve Growth Factor (NGF), Brain-Derived Neurotrophic Factor (BDNF) and Neurotrophin-3 (NT-3) in SSc and to correlate them with clinical and biological data.MethodsSerum samples were obtained from 55 SSc patients and 32 control subjects to measure NTs levels by ELISA and to determine their relationships with SSc profiles.FindingsSerum NGF levels were higher in SSc patients (288.26 ± 170.34 pg/mL) than in control subjects (170.34 ± 50.8 pg/mL, pConclusionLow BDNF serum levels were not previously documented in SSc, particularly in the diffuse SSc subset and in patients with pulmonary hypertension or anti-Scl-70 antibodies. The negative correlation between NGF and BDNF levels observed in SSc and not in healthy controls could be implicated in sympathic vascular dysfunction in SSc.
Published: 2010
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9. Iohexol plasma and urinary concentrations in cirrhotic patients: A pilot study

Author: Paul Carrier, Alexandre Destere, Baptiste Giguet, Marilyne Debette-Gratien, Marie Essig, Caroline Monchaud, Jean-Baptiste Woillard, and Véronique Loustaud-Ratti
Subjects: Hepatology
Published: 2022

10. A Hybrid Model Associating Population Pharmacokinetics with Machine Learning: A Case Study with Iohexol Clearance Estimation

Author: Alexandre Destere, Pierre Marquet, Charlotte Salmon Gandonnière, Anders Åsberg, Véronique Loustaud-Ratti, Paul Carrier, Stephan Ehrmann, Chantal Barin-Le Guellec, Aurélie Premaud, and Jean-Baptiste Woillard
Subjects: Machine Learning, Pharmacology, Iohexol, Humans, Bayes Theorem, Pharmacology (medical), Algorithms
Abstract: Maximum a posteriori Bayesian estimation (MAP-BE) based on a limited sampling strategy and a population pharmacokinetic model is frequently used to estimate pharmacokinetic parameters in individuals, however with some uncertainty (bias). Recent works have shown that the performance in individual estimation or pharmacokinetic parameters can be improved by combining population pharmacokinetic and machine learning algorithms.The objective of this work was to investigate the use of a hybrid machine learning/population pharmacokinetic approach to improve individual iohexol clearance estimation.The reference iohexol clearance values were derived from 500 simulated profiles (samples collected between 0.1 and 24.7 h) using a population pharmacokinetic model we recently developed in Monolix and obtained using all the concentration timepoints available. Xgboost and glmnet algorithms able to predict the error of MAP-BE clearance estimates based on a limited sampling strategy (0.1 h, 1 h, and 9 h) versus reference values were developed in a training subset (75%) and were evaluated in a testing subset (25%) and in 36 real patients.The MAP-BE limited sampling strategy estimated clearance was corrected by the machine learning predicted error leading to a decrease in root mean squared error by 29% and 24%, and in the percentage of profiles with the mean prediction error out of the ± 20% bias by 60% and 40% in the external validation dataset for the glmnet and Xgboost machine learning algorithms, respectively. These results were attributable to a decrease in the eta-shrinkage (shrinkage for a MAP-BE limited sampling strategy = 32.4%, glmnet = 18.2%, and Xgboost = 19.4% in the external dataset).In conclusion, this hybrid algorithm represents a significant improvement in comparison to MAP-BE estimation alone.
Published: 2022

11. A single Bayesian estimator for iohexol clearance estimation in ICU, liver failure and renal transplant patients

Author: Alexandre Destere, Charlotte Salmon Gandonnière, Anders Åsberg, Véronique Loustaud‐Ratti, Paul Carrier, Stephan Ehrmann, Chantal Barin‐Le Guellec, Pierre Marquet, and Jean‐Baptiste Woillard
Subjects: Pharmacology, Intensive Care Units, Iohexol, Humans, Bayes Theorem, Pharmacology (medical), Kidney Transplantation, Liver Failure, Glomerular Filtration Rate
Abstract: Iohexol clearance has been proposed to estimate the glomerular filtration rate (GFR). A population pharmacokinetics (popPK) model was developed from heterogeneous patients. A Bayesian estimator (MAP-BE) based on a limited sampling strategy (LSS) was derived and evaluated in external patients.Full pharmacokinetic data (7-12 samples) from 172 patients receiving iohexol for measurement of their GFR (unstable and stable ICU patients, liver failure patients and kidney transplant patients) were split into development (n = 136) and validation (n = 36) datasets. A PopPK model was developed in Monolix and was used to develop MAP-BE based on LSS. Its performance for GFR estimation was evaluated in the validation set.A two-compartment model with first-order elimination best described the data. The final model included the type of patients on volume of distribution (Vd), clearance and intercompartmental constants, serum creatinine on clearance and body weight on Vd. The best LSS included samples at 0.1-1-9 h exhibiting a relative mean prediction error (MPE) (RMSE) = -3.7% (14.3%) and better performance than the Bröchner-Mortensen formula (-3.0%/17%). Split by type of patients, the highest interindividual variability and imprecision was observed in unstable ICU patients (MPE (RMSE) = 3.7% (18.8%)) while the best performances were obtained for renal transplant patients (MPE (RMSE) = 1.0% (5.8%)). All LSS that included samples before 9 hours for the third sample were associated with an increased imprecision.A single MAP-BE of iohexol based on a three-sample LSS for four heterogeneous populations was developed and allowed accurate estimation of GFR in kidney transplant patients, slightly biased in stable ICU patients and slightly imprecise in unstable ICU patients.
Published: 2022

12. Towards hepatitis C elimination in France: Scanvir, an effective model to test and treat drug users on dedicated days

Author: Marilyne Debette‐Gratien, Sandrine François, Catherine Chevalier, Sophie Alain, Paul Carrier, Céline Rigaud, Bruno Abraham, Anne‐Laure Burgevin, Laurent Courat, Bernard Debenes, Joseph Koffi, Elisabeth Caux‐Nussbaum, Juliette Zattoni‐Leroy, Gaëlle Feuillet‐Sow, Quentin Dumont, Philippe Nubukpo, and Véronique Loustaud‐Ratti
Subjects: Infectious Diseases, Hepatology, Virology
Abstract: According to the French recommendations, elimination of the hepatitis C virus by 2025 could be a realistic public health goal. Screening policies are being intensified and access to treatment is promoted for patients who escape the usual care pathway. The "Scanvir" program is an original strategy based on dedicated screening days, as part of the "test, treat and cure HCV" event in addiction care centers in a French region, during which innovative screening technologies (RDTs, FibroScan® and point-of-care HCV RNA testing) are brought on site and access to a multidisciplinary team is offered. A total of 392 patients attended the 67 regional Scanvir sessions: 31.6% were HCV Ab positive and 66% of them were HCV RNA positive. Treatment was initiated in 79.3% of the patients. RDTs were accepted by 62% of the PWIDs (including those who already knew their status) and FibroScan® by 99.5% of the patients. 80% of the viremic patients started their treatment on site and are now cured or still under treatment. Advanced fibrosis evaluated by FibroScan® (LSM 8 KPa) was suspected in 13.4% and 14.1% of the global and the HCV population respectively. Scanvir is an efficient strategy of HCV elimination based on dedicated days aimed at increasing cost-effectiveness and offering a multidisciplinary service while saving human care resources. It is an exportable strategy that also offers comprehensive screening of associated chronic liver diseases via the elastometry device and interviews.
Published: 2022

13. EUS-guided biliary drainage with electrocautery-enhanced lumen-apposing metal stent placement should replace PTBD after ERCP failure in patients with distal tumoral biliary obstruction: a large real-life study

Author: F Sanglier, Sophie Geyl, Denis Sautereau, C Ginestet, V Hummel, Martin Dahan, Paul Carrier, Romain Legros, Jérémie Albouys, Hugo Lepetit, Jérémie Jacques, Véronique Loustaud-Ratti, and A Rouchaud
Subjects: medicine.medical_specialty, medicine.medical_treatment, Head of pancreas, Lumen (anatomy), Context (language use), Anastomosis, Endosonography, Neoplasms, Internal medicine, Electrocoagulation, medicine, Humans, Ultrasonography, Interventional, Retrospective Studies, Cholangiopancreatography, Endoscopic Retrograde, Fluorocarbons, Cholestasis, business.industry, Bile duct, Stent, Dioxolanes, Hepatology, digestive system diseases, Surgery, medicine.anatomical_structure, Metals, Drainage, Stents, business, Abdominal surgery
Abstract: In cases of malignant distal biliary obstruction, ERCP is the preferred technique for bile duct drainage. In case of failure, the alternative techniques are percutaneous transhepatic biliary drainage (PTBD) and more recently endoscopic ultrasound-guided biliary drainage. A new type of stent called the electrocautery-enhanced lumen-apposing metal stent (EC-LAMS) has been developed to enable the performance of biliary-enteric anastomosis under EUS-guidance in a single step, without prior bile duct puncture or the need for a guidewire. The aim of our study was to compare the real-life efficacies of PTBD and EUS-BD with the EC-LAMS for cases of ERCP failure in patients with malignant biliary obstruction. We performed a monocentric retrospective study comparing PTBD and EUS-BD with the use of electrocautery-enhanced lumen-apposing metal stent in the context of a malignant distal biliary obstruction after ERCP failure. 95 patients were included (50 in EUS-BD group and 45 in PTBD group). The main etiology of malignant obstruction was adenocarcinoma of the head of pancreas (85%). There was a significant difference in favor of endoscopic ultrasound-guided biliary drainage using electrocautery-enhanced lumen-apposing metal stent for the following criteria: clinical success: 89.3% vs. 45.5%; p
Published: 2021

14. Abdominal symptoms during Sjogren’s syndrome: a pilot study

Author: Stéphanie Colombie, Julie Azaïs, Stéphanie Dumonteil, Marie-Odile Jauberteau, Simon Parreau, S. Palat, Holy Bezanahary, Guillaume Gondran, Anne-Laure Fauchais, Véronique Loustaud-Ratti, Jérémie Jacques, Eric Liozon, Sophie Geyl, and K.H. Ly
Subjects: musculoskeletal diseases, Quality of life, lcsh:Immunologic diseases. Allergy, medicine.medical_specialty, Constipation, Multivariate analysis, Gastroparesis, lcsh:Diseases of the musculoskeletal system, ESSPRI, Disease, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, Internal medicine, medicine, 030203 arthritis & rheumatology, business.industry, medicine.disease, stomatognathic diseases, Abdominal symptoms, Sjögren’s syndrome, 030211 gastroenterology & hepatology, medicine.symptom, lcsh:RC925-935, business, lcsh:RC581-607, Rheumatism, ESSDAI
Abstract: Background Abdominal symptoms in patients with primary Sjögren syndrome (pSS) are poorly documented. The objective of the study was to describe the abdominal symptoms of patients with pSS and to assess their association with characteristics of the disease. Methods One hundred and fifty patients with pSS were evaluated using a composite global symptom score for abdominal symptoms and their severity. Data concerning the clinical and biological characteristics of pSS and abdominal disorders were also collected. Results Of the patients with pSS, 95% suffered from abdominal symptoms (median global symptom score 7.5 ± 5.5 points out of 30). More than half of the patients experienced abdominal tension (68%), upper abdominal pain (54%), abdominal discomfort (58%) and/or constipation (54%). Regarding the pSS activity, in relation to European League Against Rheumatism (EULAR) Sjögren syndrome disease activity index score items, general and central nervous system involvement wereassociated with a high global symptom score. The EULAR Sjogren Syndrome Patient Reported Index (ESSPRI) symptom score was positively correlated with the global symptom score (p p Conclusions The majority of patients with pSS suffered abdominal symptoms. There is currently no therapeutic recommendation because of the lack of information on the underlying pathophysiological mechanisms. Trial registration NCT03157011. Date of registration: July 17, 2017.
Published: 2021

15. Subclinical proximal tubulopathy in hepatitis B: The roles of nucleot(s)ide analogue treatment and the hepatitis B virus

Author: Thierry Poynard, Guillaume Lassailly, Juliette Foucher, Manh-Thông Dao, Xavier Duval, Isabelle Hourmand-Ollivier, Séverine Hommel, Vincent Di Martino, Pierre-Henri Bernard, Dominique Larrey, Nathalie Boyer, Anais Labrunie, Marc Bardou, Paul Carrier, Marilyne Debette-Gratien, Marie Essig, Eric Nguyen-Khac, Armand Abergel, Victor de Ledinghen, Véronique Loustaud-Ratti, Claire Vanlemmens, Nathalie Ganne-Carrié, Anne Gervais, Jean-Baptiste Hiriart, Fouchard-Hubert Isabelle, Christine Aurières, Pauline Pinet, Thierry Thevenot, Jérémie Jacques, Philippe Mathurin, Dominique Thabut, Christophe Renou, Daniel Cohen, Marianne Maynard, Valérie Canva, Julien Vergniol, Bertrand Hanslik, Anaïs Brayette, Sophie Alain, Matthieu Schnee, Service d'Hépato-Gastro-Entérologie et Nutrition [CHU Limoges], CHU Limoges, Pôle Universitaire d’Addictologie en Limousin, CH Esquirol [Limoges] (CH Esquirol), Neuroépidémiologie Tropicale (NET), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Plate forme de bioinformatique et biostatistique (CEBIMER), Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Anti-infectieux : supports moléculaires des résistances et innovations thérapeutiques (RESINFIT), CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Génomique fonctionnelle des tumeurs solides = Functional Genomics of Solid Tumors [CRC] (FunGeST), Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité)-École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Groupe de Recherche sur l'alcool et les pharmacodépendances - UMR INSERM_S 1247 (GRAP), Université de Picardie Jules Verne (UPJV)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service des Maladies infectieuses et tropicales [CHU Limoges], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Hepatology, Hopital, Physiopathologie des Maladies Inflammatoires de l'Intestin, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Services de Maladies Infectieuses et Tropicales [CHU Bichat], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Bordeaux [Bordeaux], Service d'Hépato-gastro-entérologie et oncologie digestive (CHU de Bordeaux), CHU Bordeaux [Bordeaux]-Hôpital Haut-Lévêque [CHU Bordeaux], Service d'Hépato-Gastro-Enterologie et Nutrition [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Paris School of Economics (PSE), Université Paris 1 Panthéon-Sorbonne (UP1)-École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École des hautes études en sciences sociales (EHESS)-École des Ponts ParisTech (ENPC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Paris Jourdan Sciences Economiques (PJSE), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Modèles et méthodes de l'évaluation thérapeutique des maladies chroniques (U738 / UMR_S738), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre d'Investigation Clinique 1432 (Dijon) - Module Plurithématique : Périnatalité Cancérologie Handicap et Ophtalmologie (CIC-P803), Université de Bourgogne (UB)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pascal (IP), Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne (UCA)-Institut national polytechnique Clermont Auvergne (INP Clermont Auvergne), Université Clermont Auvergne (UCA)-Université Clermont Auvergne (UCA), Normandie Université (NU), Service d'Hépatologie [CHRU Besançon], Hôpital Haut-Lévêque [CHU Bordeaux], Hôpital Claude Huriez [Lille], CHU Lille, Institute for Translational Research in Inflammation - U 1286 (INFINITE (Ex-Liric)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d’Hépatologie [Hôpital Beaujon], Hôpital Beaujon [AP-HP], Université Paris Cité (UPCité), Centre de recherche sur l'Inflammation (CRI (UMR_S_1149 / ERL_8252 / U1149)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Service d'Hépato-Gastro-Entérologie, CHU Bordeaux [Bordeaux]-Hôpital Saint-André, Service de gastroentérologie (CHD Vendee - Hopital Les Oudairies, La Roche Sur Yon), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Hôpital Saint-Éloi [Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Service d'Hépato-Gastroentérologie [CHU Rouen], Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Ciblage individuel et prévention des risques de traitements immunosupresseurs et de la transplantation (IPPRITT), Épidémiologie et recherches translationnelles sur les maladies rénales et cardiovasculaires (EPREC) (U1018 (Équipe 5)), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Service Néphrologie/Dialyse [AP-HP Ambroise-Paré], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Ambroise Paré [AP-HP], École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPC)-École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPC), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases [IHU ICAN], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Université Paris Cité (UPC), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPC), Service d'Hépato-Gastro-Entérologie [CHU Pitié-Salpêtrière], and Hôpital Charles Nicolle [Rouen]-CHU Rouen
Subjects: Hepatitis B virus, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Population, Renal function, medicine.disease_cause, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Nucleoside analogues, Internal medicine, medicine, Cumulative incidence, Renal insufficiency, education, education.field_of_study, Hepatology, business.industry, Proximal tubulopathy, Incidence (epidemiology), Hazard ratio, Entecavir, Hepatitis B, medicine.disease, 030220 oncology & carcinogenesis, Prospective Study, 030211 gastroenterology & hepatology, business, Biomarkers, medicine.drug
Abstract: International audience; BACKGROUND The recommended monitoring tools for evaluating nucleot(s)ide analogue renal toxicity, such as estimated glomerular filtration rate (eGFR) and phosphatemia, are late markers of proximal tubulopathy. Multiple early markers are available, but no consensus exists on their use. AIM To determine the 24 mo prevalence of subclinical proximal tubulopathy (SPT), as defined with early biomarkers, in treated vs untreated hepatitis B virus (HBV)-monoinfected patients. METHODS A prospective, non-randomized, multicenter study of HBV-monoinfected patients with a low number of renal comorbidities was conducted. The patients were separated into three groups: Naive, starting entecavir (ETV) treatment, or starting tenofovir disoproxil (TDF) treatment. Data on the early markers of SPT, the eGFR and phosphatemia, were collected quarterly. SPT was defined as a maximal tubular reabsorption of phosphate/eGFR below 0.8 mmoL/L and/or uric acid fractional excretion above 10%. The prevalence and cumulative incidence of SPT at month 24 (M24) were calculated. Quantitative data were analyzed using analyses of variance or Kruskal-Wallis tests, whereas chi-squared or Fisher's exact tests were used to analyze qualitative data. Multivariate analyses were used to adjust for any potential confounding factors. RESULTS Of the 196 patients analyzed, 138 (84 naive, 28 starting ETV, and 26 starting TDF) had no SPT at inclusion. At M24, the prevalence of SPT was not statistically different between naive and either treated group (21.1% vs 30.7%, P < 0.42 and 50.0% vs 30.7%, P = 0.32 for ETV and TDF, respectively); no patient had an eGFR lower than 50 mL/min/1.73 m(2) or phosphatemia less than 0.48 mmoL/L. In the multivariate analysis, no explanatory variables were identified after adjustment. The cumulative incidence of SPT over 24 mo (25.5%, 13.3%, and 52.9% in the naive, ETV, and TDF groups, respectively) tended to be higher in the TDF group vs the naive group (hazard ratio: 2.283, P = 0.05). SPT-free survival at M24 was 57.6%, 68.8%, and 23.5% for the naive, ETV, and TDF groups, respectively. The median survival time without SPT, evaluated only in the TDF group, was 5.9 mo. CONCLUSION The prevalence and incidence of SPT was higher in TDF-treated patients compared to naive patients. SPT in the naive population suggests that HBV can induce renal tubular toxicity.
Published: 2020

16. Evaluation of Longitudinal Exposure to Tacrolimus as a Risk Factor of Chronic Kidney Disease Occurrence Within the First-year Post-Liver Transplantation

Author: Paul Carrier, Ephrem Salamé, Annick Rousseau, Marie Essig, Louise Barbier, Jérémie Jacques, Pauline Maurel, Véronique Loustaud-Ratti, Xavier Causse, Christine Silvain, Pierre Marquet, Aurélie Prémaud, and Marilyne Debette-Gratien
Subjects: Adult, Male, medicine.medical_specialty, Time Factors, Renal function, 030230 surgery, Kidney, urologic and male genital diseases, Risk Assessment, Gastroenterology, Disease-Free Survival, Tacrolimus, 03 medical and health sciences, 0302 clinical medicine, Hepatorenal syndrome, Risk Factors, Internal medicine, Humans, Medicine, Renal Insufficiency, Chronic, Risk factor, Aged, Retrospective Studies, Transplantation, business.industry, Hazard ratio, Acute kidney injury, Acute Kidney Injury, Middle Aged, medicine.disease, female genital diseases and pregnancy complications, Liver Transplantation, Calcineurin, Female, 030211 gastroenterology & hepatology, business, Immunosuppressive Agents, Glomerular Filtration Rate, Kidney disease
Abstract: BACKGROUND Renal failure is predictive of mortality in the early postliver-transplantation period and calcineurin inhibitors toxicity is a main challenge. Our aim is to assess the impact of longitudinal tacrolimus exposure (TLE) and other variables on chronic kidney disease (CKD)-free 1-year-survival. METHODS Retrospective data of consecutive patients transplanted between 2011 and 2016 and treated with tacrolimus were collected. TLE and all relevant pre- and post-liver transplantation (LT) predictive factors of CKD were tested and included in a time-to-event model. CKD was defined by repeated estimated glomerular filtration rate (eGFR) values below 60 mL/min/1.73m2 at least for the last 3 months before M12 post-LT. RESULTS Data from 180 patients were analyzed. CKD-free survival was 74.5% and was not associated with TLE. Pre-LT acute kidney injury (AKI) and eGFR at 1-month post-LT (eGFRM1)
Published: 2020

17. Gastric peroral endoscopic myotomy in refractory gastroparesis: long-term outcomes and predictive score to improve patient selection

Author: Amélie Labonde, Guillaume Lades, Antoine Debourdeau, Olivier Ragi, Lauriane Lehmann, Véronique Vitton, Marc Barthet, Romain Legros, Jérémie Albouys, Sophie Geyl, Véronique Loustaud-Ratti, Jacques Monteil, Sandra Gonzalez, Jean-Michel Gonzalez, and Jérémie Jacques
Subjects: Esophageal Achalasia, Gastroparesis, Treatment Outcome, Gastric Emptying, Pyloromyotomy, Patient Selection, Gastroenterology, Humans, Radiology, Nuclear Medicine and imaging, Prospective Studies, Esophageal Sphincter, Lower
Abstract: Limited data exist concerning the long-term efficiency of gastric peroral endoscopic myotomy (G-POEM) as a treatment of refractory gastroparesis. This study evaluated the 3-year results of G-POEM in patients with refractory gastroparesis.This was a prospective multicenter study of all G-POEM operations performed in 2 expert French centers for 46 patients with refractory gastroparesis with at least 3 years of follow-up.Clinical success was 65.2% at 36 months. There was significant improvement in symptom severity. Median Gastroparesis Cardinal Symptom Index decreased from 3.33 to 1.80 (P .0001), with improvement in all subscales. We created a predictive score concerning G-POEM success (G-POEM predictive score) to which points were assigned as follows: nausea subscale 2: predictive of success, 1 point; satiety subscale4: predictive of success, 1 point; bloating subscale3.5: predictive of success, 1 point; percentage of gastric retention at 4 hours on scintigraphy50%: 1 point. A threshold of 2 was identified by receiver operating characteristic curve analysis with an area under the curve of .825 that predicted clinical success with a sensitivity of 93.3% (95% confidence interval [CI], .77-.99), specificity of 56.3% (95% CI, .33-.77), positive predictive value of 80% (95% CI, .67-.93), negative predictive value of 81.8% (95% CI, .59-1.00), and accuracy of 80.4% (95% CI, .69-.92). Patients with a score ≥2 were significantly more likely to be responders at 3 years than were patients with a score 2 (80% and 18%, respectively; P = .0004).The clinical success of G-POEM for refractory gastroparesis was 65.2% at 36 months. Our predictive score offers an easy tool that needs to be confirmed in other studies.
Published: 2021

18. Double-pigtail plastic stent is effective as a rescue therapy after obstruction of choledochoduodenostomy using a lumen-apposing metal stent

Author: Jérémie Albouys, Mathieu Pioche, Romain Legros, Sophie Geyl, Benjamin Redelsperger, Jérémie Jacques, and Véronique Loustaud-Ratti
Subjects: Pigtail, medicine.medical_specialty, business.industry, medicine.medical_treatment, Gastroenterology, Stent, Lumen (anatomy), Surgery, Endosonography, Rescue therapy, Choledochostomy, medicine, Drainage, Humans, Plastic stent, Stents, business, Plastics
Published: 2021

19. Predictive Factors for Hepatocellular Carcinoma in Chronic Hepatitis B Using Structural Equation Modeling: A Prospective Cohort Study

Author: Jean-Pierre Bronowicki, Clovis Lusivika-Nzinga, Jean-Charles Duclos-Vallée, Ghassan Riachi, Anne Minello, Thomas Decaens, Louis d’Alteroche, Fabrice Carrat, Isabelle Portal, François Raffi, Fabien Zoulim, Sophie Metivier, Véronique Loustaud-Ratti, François Habersetzer, Jérôme Gournay, Olivier Chazouillères, Paul Calès, Victor de Ledinghen, Xavier Causse, Stanislas Pol, Céline Dorival, Isabelle Rosa, Dominique Larrey, Tarik Asselah, Marc Bourlière, Claire Geist, Nathanael Lapidus, Laurent Lam, Moana Gelu-Simeon, Laurent Alric, Vincent Leroy, Hélène Fontaine, Armand Abergel, Nathalie Ganne, Dominique Thabut, Philippe Mathurin, Albert Tran, Dominique Guyader, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Saint-Joseph [Marseille], Service d'Hépato-Gastro-Entérologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Pathologies biliaires, fibrose et cancer du foie [CHU Saint-Antoine], Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Interactions Virus-Hôte et Maladies Hépatiques, Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Virologie, Centre de recherche sur l'Inflammation (CRI (UMR_S_1149 / ERL_8252 / U1149)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP), Centre Hépato-Biliaire [Hôpital Paul Brousse] (CHB), Hôpital Paul Brousse-Assistance Publique - Hôpitaux de Paris, CRHU Nancy, Physiopathologie des Maladies Inflammatoires de l'Intestin, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé, Institute for Advanced Biosciences / Institut pour l'Avancée des Biosciences (Grenoble) (IAB), Centre Hospitalier Universitaire [Grenoble] (CHU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang - Auvergne-Rhône-Alpes (EFS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Génomique Fonctionnelle des Tumeurs Solides (U1162), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Nutrition, Métabolismes et Cancer (NuMeCan), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), CHI Créteil, Bordeaux Research In Translational Oncology [Bordeaux] (BaRITOn), Université de Bordeaux (UB)-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM), Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques (HIFIH), Université d'Angers (UA), Centre Hospitalier Régional d'Orléans (CHRO), Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service d'hépatologie [CHU Saint-Antoine], CHU Pointe-à-Pitre/Abymes [Guadeloupe], Institut de recherche en santé, environnement et travail (Irset), Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Institut National de la Santé et de la Recherche Médicale (INSERM)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Université d'Angers (UA), Ciblage individuel et prévention des risques de traitements immunosupresseurs et de la transplantation (IPPRITT), CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), CHU Toulouse [Toulouse], Pharmacochimie et Biologie pour le Développement (PHARMA-DEV), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT-FR 2599), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC), CHU Rouen, Normandie Université (NU), Institut des Maladies de l'Appareil Digestif, Université de Nantes (UN), Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Centre Hospitalier Universitaire de Nice (CHU Nice), Centre méditerranéen de médecine moléculaire (C3M), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier régional Metz-Thionville (CHR Metz-Thionville), Institut Pascal (IP), Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne (UCA)-Institut national polytechnique Clermont Auvergne (INP Clermont Auvergne), Université Clermont Auvergne (UCA)-Université Clermont Auvergne (UCA), Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Hôpital de la Timone [CHU - APHM] (TIMONE), Immunité Innée - Innate Immunity, Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur [Paris], The ANRS CO22 HEPATHER cohort is sponsored and funded by INSERM‐ANRS and conducted in collaboration with Association Française pour l'étude du Foie (AFEF). The cohort received supports from ANR (Agence Nationale de la Recherche), DGS (Direction Générale de la Santé), MSD, Janssen, Gilead, Abbvie, BMS, and Roche., Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Pathologies biliaires, fibrose et cancer du foie [CRSA], Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Côte d'Azur (UCA), Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Service d'Hépato-gastro-entérologie [CHU Saint-Antoine], Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie de Toulouse (ICT-FR 2599), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Institut de Chimie du CNRS (INC)-Institut de Recherche pour le Développement (IRD), Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), and Jonchère, Laurent
Subjects: Male, Liver Cancer, medicine.medical_specialty, Hepatocarcinogenesis, Hepatitis B virus, Carcinoma, Hepatocellular, Epidemiology, medicine.medical_treatment, [SDV]Life Sciences [q-bio], [SDV.CAN]Life Sciences [q-bio]/Cancer, Liver transplantation, Sciences du Vivant [q-bio]/Cancer, medicine.disease_cause, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Hepatitis B, Chronic, [SDV.CAN] Life Sciences [q-bio]/Cancer, Risk Factors, Internal medicine, medicine, Humans, Prospective Studies, Prospective cohort study, Aged, Hepatology, business.industry, Liver Neoplasms, Carcinoma, Hepatocellular, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, medicine.disease, [SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, digestive system diseases, 3. Good health, [SDV] Life Sciences [q-bio], 030220 oncology & carcinogenesis, Hepatocellular carcinoma, Cohort, 030211 gastroenterology & hepatology, Metabolic syndrome, business, Liver cancer
Abstract: International audience; BACKGROUND and AIMS: The factors predicting hepatocellular carcinoma (HCC) occurrence in chronic hepatitis B need to be precisely known to improve its detection. We identified pathways and individual predictive factors associated with HCC in the ANRS CO22 HEPATHER cohort. METHODS: The study analyzed HBV-infected patients recruited at 32 French expert hepatology centers from August 6, 2012, to December 31, 2015. We excluded patients with chronic HCV, HDV and a history of HCC, decompensated cirrhosis or liver transplantation. Structural equation models were developed to characterize the causal pathways leading to HCC occurrence. The association between clinical characteristics (age, gender, body-mass index, liver fibrosis, alcohol consumption, smoking status, diabetes, hypertension, dyslipidemia, alpha-fetoprotein, HBV DNA levels, antiviral therapy) and incident HCC was quantified. RESULTS: Among the 4,489 patients included, 33 patients reported incident HCC. The median follow-up was 45.2 months. Age (β = 0.18 by decade, 95% CI 0.14-0.23), male gender (β = 0.23, 95% CI 0.18-0.29), metabolic syndrome (β = 0.28, 95% CI 0.22-0.33), alcohol consumption (β = 0.09, 95% CI 0.05-0.14) and HBV DNA (β = 0.25, 95% CI 0.17-0.34) had a significant and direct effect on the occurrence of advanced liver fibrosis. Liver fibrosis (β = 0.71, 95% CI 0.55-0.87) predicted, in turn, the occurrence of HCC. CONCLUSIONS: Liver fibrosis mediates the effects of age, gender, alcohol, metabolic syndrome and HBV DNA on the occurrence of HCC. Elderly men with chronic hepatitis B, risky alcohol use, advanced liver fibrosis, metabolic syndrome and high HBV DNA levels should be monitored closely to detect the development of HCC.
Published: 2021

20. BDNF levels and liver stiffness in subjects with alcohol use disorder: Evaluation after alcohol withdrawal

Author: Paul Carrier, Véronique Loustaud-Ratti, Murielle Girard, Philippe Nubukpo, Neuroépidémiologie Tropicale (NET), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Pôle Universitaire d’Addictologie en Limousin, CH Esquirol [Limoges] (CH Esquirol), Service d'Hépato-Gastro-Entérologie et Nutrition [CHU Limoges], and CHU Limoges
Subjects: Adult, Male, 0301 basic medicine, medicine.medical_specialty, media_common.quotation_subject, Liver fibrosis, Medicine (miscellaneous), Alcohol, Alcohol use disorder, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Neurotrophic factors, Liver stiffness, Internal medicine, mental disorders, medicine, alcohol withdrawal, Humans, media_common, liver fibrosis, business.industry, Brain-Derived Neurotrophic Factor, Addiction, Middle Aged, medicine.disease, Fibrosis, Substance Withdrawal Syndrome, 3. Good health, Alcoholism, Psychiatry and Mental health, Clinical Psychology, liver stiffness, 030104 developmental biology, Endocrinology, BDNF, Liver, chemistry, Elasticity Imaging Techniques, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Biomarkers, 030217 neurology & neurosurgery, Homeostasis
Abstract: International audience; Background: Brain-derived neurotrophic factor (BDNF) plays a key role in the processes of withdrawal and addiction in alcohol use disorder (AUD), and is also involved in liver homeostasis. The role of BDNF in liver damage and its link with liver stiffness are not known. We hypothesize that serum BDNF levels are linked to changes in hepatic elasticity, both of which depend on variations in alcohol consumption.Objectives: We aimed to study the evolution of BDNF levels and changes in the liver stiffness (LS) of AUD subjects, within two months following withdrawal.Methods: We measured LS by FibroScan® (as an indicator of the degree of liver fibrosis), gamma glutamyl transferase (GGT) levels (as a nonspecific but sensitive marker of liver status) and serum BDNF levels of 62 alcohol-dependent subjects without previously identified liver complications. Measures were obtained at the time of withdrawal (M0) and two months later (M2). Results: BDNF levels increased after alcohol withdrawal and small variations of LS were observed. BDNF values increased significantly according to fibrosis stages measured by LS (p = .028 at M0), and were predicted by GGT levels in a regression model (p = .007 at M0 and p = .003 at M2).Conclusion: In AUD, BDNF levels were associated with measured LS when divided into fibrosis risk categories. Changes in LS and BDNF levels after alcohol withdrawal may be related to changes in homeostatic mechanisms, in addition to those of liver status.
Published: 2021

21. EUS-Guided Biliary Drainage With Electrocautery-Enhanced Lumen-Apposing Metal Stent Placement Should Replace Ptbd After ERCP Failure In Patients With Distal Tumoral Biliary Obstruction: Retrospective Study

Author: R Legros, V Hummel, Paul Carrier, C Ginestet, F Sanglier, Jérémie Jacques, D. Sautereau, Sophie Geyl, Martin Dahan, Véronique Loustaud-Ratti, Hugo Lepetit, A Rouchaud, and Jérémie Albouys
Subjects: Stent placement, medicine.medical_specialty, Biliary drainage, business.industry, Medicine, Lumen (anatomy), Retrospective cohort study, In patient, business, Surgery
Published: 2021

22. International French-speaking multicentre practice survey on hepatic hydrothorax (HH) : Results of the 'Hep Hep' study among 529 hepatogastroenterologist (HG) or pneumologist (PN) respondents

Author: Nathalie Ganne-Carrié, Eric Nguyen-Khac, Laure Elkrief, Isabelle Ollivier, Jean-Baptiste Nousbaum, Chantal Raherison, Marc Bourlière, Jean-François Cadranel, Véronique Loustaud-Ratti, Christophe Bureau, Xavier Causse, Manon Allaire, Jean-Marie Péron, Philippe Sogni, Bernard Maitre, Thong Dao, Bertrand Hanslik, Tristan Le Magoarou, Thierry Thevenot, Cadranel Jacques, Groupe Hospitalier Public du Sud de l'Oise [Creil] (GHPSO), Theranoscan [CHU Tenon] (GRC 4), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Service de Pneumologie = Pneumologie - Oncologie Thoracique - Maladies Pulmonaires Rares [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service d'Hépatologie [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Groupe de Recherche sur l'alcool et les pharmacodépendances - UMR INSERM_S 1247 (GRAP), Université de Picardie Jules Verne (UPJV)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Toulouse [Toulouse], Service d'Hépato-Gastro-Entérologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Soins Primaires, Santé Publique, Registre des cancers de Bretagne Occidentale (SPURBO), Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Ciblage individuel et prévention des risques de traitements immunosupresseurs et de la transplantation (IPPRITT), CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Centre Hospitalier Régional d'Orléans (CHRO), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Saint-Joseph [Marseille], Génomique fonctionnelle des tumeurs solides = Functional Genomics of Solid Tumors [CRC] (FunGeST), Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité)-École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Service d'Hépato-Gastro-Enterologie et Nutrition [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Bordeaux population health (BPH), and Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: medicine.medical_specialty, Hepatic hydrothorax, business.industry, Internal medicine, [SDV]Life Sciences [q-bio], Medicine, business, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2021

23. Liver elastometry and alcohol withdrawal: Median-term follow-up in a psychiatric unit

Author: Natacha Ouedraogo, Philippe Nubukpo, Paul Carrier, Véronique Loustaud-Ratti, Murielle Girard, Marilyne Debette-Gratien, Service d'Hépato-Gastro-Entérologie et Nutrition [CHU Limoges], CHU Limoges, Pôle Universitaire d’Addictologie en Limousin, CH Esquirol [Limoges] (CH Esquirol), Neuroépidémiologie Tropicale (NET), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), and CCSD, Accord Elsevier
Subjects: medicine.medical_specialty, Health (social science), media_common.quotation_subject, Liver fibrosis, Alcohol, Toxicology, Biochemistry, 03 medical and health sciences, Behavioral Neuroscience, chemistry.chemical_compound, Liver disease, 0302 clinical medicine, Medicine, Psychiatric hospital, Humans, Alcohol consumption, Prospective Studies, Prospective cohort study, Psychiatry, media_common, Motivation, business.industry, General Medicine, Abstinence, medicine.disease, 030227 psychiatry, Substance Withdrawal Syndrome, Clinical trial, Alcoholism, Neurology, chemistry, Liver, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Cohort, Every Two Months, Elasticity Imaging Techniques, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Alcohol withdrawal, business, Liver stiffness, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract: International audience; The measurement of liver stiffness (LS) shows promise as a follow-up tool after alcohol withdrawal, but it has mainly been studied in the early phase or in patients with severe liver disease. A 6-month ancillary study of a specific psychiatric cohort of alcoholic patients without known liver disease followed after withdrawal was conducted (Clinical Trial NCT01491347). Clinical and biological data and LS values were collected every 2 months. A total of 129 patients were included in the study; 93 had an LS assessment within the first 7 days, and 37 had all four LS measurements. Only seven (7.5%) patients had an initial LS > 12.1 kPa, the threshold used to define severe fibrosis. Abstinence was not associated with changes inLS at the various median-term follow-up periods. However, LS of abstinent subjects decreased significantly relative to that of non-abstinent subjects between M0 and M2. CAP™ values were not associated with abstinence. The systematic median-term follow-up of withdrawn patients does not appear to be contributory. However, LS could help to detect relapse in the first 2 months after withdrawal for subjects treated in a psychiatric hospital for dependence. It thus could serve as a motivation tool. Prospective studies with various and higher baseline LS values are warranted for simultaneous longitudinal assessment, including for very short- and long-term LS after withdrawal.
Published: 2020

24. Letter to the Editor: Post-Liver Transplantation Sinusoidal Obstruction Syndrome and Immunosuppressive Drugs: Causality of Mycophenolate Mofetil or Tacrolimus?

Author: Ephrem Salamé, Véronique Loustaud-Ratti, Louise Barbier, Anne de Muret, Hélène Barraud, Alicia Anneraud, Paul Carrier, Mattias Tallegas, and Marilyne Debette-Gratien
Subjects: 0301 basic medicine, Graft Rejection, medicine.medical_specialty, Letter to the editor, medicine.medical_treatment, Hepatic Veno-Occlusive Disease, Azathioprine, Liver transplantation, Mycophenolate, Gastroenterology, Tacrolimus, Liver disorder, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, Hepatology, business.industry, Vascular disease, Mycophenolic Acid, medicine.disease, Liver Transplantation, Transplantation, 030104 developmental biology, Pharmaceutical Preparations, 030211 gastroenterology & hepatology, business, Immunosuppressive Agents, medicine.drug
Abstract: We read with great interest Poli et al's case report describing a post-Liver Transplantation (LT) Sinusoidal Obstruction Syndrome (SOS) induced by Mycophenolate Mofetil (MMF). This case led us to make two comments.SOS is considered a rare liver disorder in the post-LT setting. Acute rejection, CMV reactivation, advanced age, and underlying vascular disease may be triggers for SOS2 . Finally, immunosuppressive drugs have been implicated, i.e. azathioprine historically and MMF and tacrolimus more recently, even rarely.
Published: 2020

25. Double-clip traction for colonic endoscopic submucosal dissection: a multicenter study of 599 consecutive cases (with video)

Author: Jérémie Jacques, Véronique Loustaud-Ratti, Mathieu Pioche, Romain Legros, Florian Rostain, Pierre Bordillon, Thierry Ponchon, Denis Sautereau, Jérémie Albouys, Hugo Lepetit, Thimotée Wallenhorst, Jérôme Rivory, Martin Dahan, and Sophie Geyl
Subjects: Curative resection, medicine.medical_specialty, business.product_category, Endoscopic Mucosal Resection, Perforation (oil well), Pilot Projects, Resection, 03 medical and health sciences, 0302 clinical medicine, Traction, Medicine, Humans, Radiology, Nuclear Medicine and imaging, Prospective Studies, Adverse effect, business.industry, Dissection, Gastroenterology, Endoscopic submucosal dissection, Surgical Instruments, Surgery, Treatment Outcome, Multicenter study, 030220 oncology & carcinogenesis, Rubber band, Procedure Duration, 030211 gastroenterology & hepatology, business
Abstract: Background and Aims Colonic endoscopic submucosal dissection (ESD) is particularly challenging and limited to a few expert centers. We recently conducted a pilot study on improvement of colonic ESD with systematic use of a countertraction device (double-clip traction with rubber band [DCT-ESD]). Methods A French prospective multicenter study was conducted between March 2017 and September 2019, including all consecutive cases of naive colonic ESD. Since the first case of DCT-ESD in March 2017, all cases of colonic ESD have been performed using the DCT-ESD strategy in the 3 centers involved in the study. Results Five hundred ninety-nine lesions with a mean size of 53 mm were included in this study, resected by 5 operators in 3 centers. The en bloc, R0, and curative resection rates were 95.7%, 83.5%, and 81.1%, respectively. The adverse event rates were 4.9% for perforation and 4.2% for postprocedure bleeding. Between 2017 and 2019, the rates of R0 and curative resections increased significantly from 74.7% in 2017 to 88.4% in 2019 (P = .003) and from 72.6% in 2017 to 86.3% in 2019 (P = .004), respectively. Procedure duration and speed of resection were 62.4 minutes and 39.4 mm2/minute, respectively. No differences were noted between operators. Conclusion DCT-ESD is a safe and reproducible technique, with results comparable with those of the large Japanese teams with speed of resection twice as high as previously reported studies. The DCT strategy is promising, cheap, and seems to be reproducible. Physicians performing colonic ESD should be aware of this promising tool to improve their results in ESD.
Published: 2020

26. Early detection of liver injuries by the Serum enhanced binding test sensitive to albumin post-transcriptional modifications

Author: Souleiman El Balkhi, Mohamad Ali Rahali, Roy Lakis, François Ludovic Sauvage, Marving Martin, Angelika Janaszkiewicz, Roland Lawson, Ruben Goncalves, Paul Carrier, Veronique Loustaud-Ratti, Anne Guyot, Pierre Marquet, Florent Di Meo, and Franck Saint-Marcoux
Subjects: Medicine, Science
Abstract: Abstract Early and sensitive biomarkers of liver dysfunction and drug-induced liver injury (DILI) are still needed, both for patient care and drug development. We developed the Serum Enhanced Binding (SEB) test to reveal post-transcriptional modifications (PTMs) of human serum albumin resulting from hepatocyte dysfunctions and further evaluated its performance in an animal model. The SEB test consists in spiking serum ex-vivo with ligands having specific binding sites related to the most relevant albumin PTMs and measuring their unbound fraction. To explore the hypothesis that albumin PTMs occur early during liver injury and can also be detected by the SEB test, we induced hepatotoxicity in male albino Wistar rats by administering high daily doses of ethanol and CCl4 over several days. Blood was collected for characterization and quantification of albumin isoforms by high-resolution mass spectrometry, for classical biochemical analyses as well as to apply the SEB test. In the exposed rats, the appearance of albumin isoforms paralleled the positivity of the SEB test ligands and histological injuries. These were observed as early as D3 in the Ethanol and CCl4 groups, whereas the classical liver tests (ALT, AST, PAL) significantly increased only at D7. The behavior of several ligands was supported by structural and molecular simulation analysis. The SEB test and albumin isoforms revealed hepatocyte damage early, before the current biochemical biomarkers. The SEB test should be easier to implement in the clinics than albumin isoform profiling.
Published: 2024
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27. Abdominal symptoms during Sjogren's syndrome: a pilot study

Author: Simon, Parreau, Jérémie, Jacques, Stéphanie, Dumonteil, Sylvain, Palat, Sophie, Geyl, Guillaume, Gondran, Holy, Bezanahary, Eric, Liozon, Julie, Azaïs, Stéphanie, Colombie, Marie-Odile, Jauberteau, Véronique, Loustaud-Ratti, Kim-Heang, Ly, and Anne-Laure, Fauchais
Subjects: Male, Gastroparesis, Gastrointestinal Diseases, Nausea, Pilot Projects, Middle Aged, Abdominal Pain, Sjogren's Syndrome, Abdomen, Multivariate Analysis, Humans, Female, Prospective Studies, Symptom Assessment, Constipation
Abstract: Abdominal symptoms in patients with primary Sjögren syndrome (pSS) are poorly documented. The objective of the study was to describe the abdominal symptoms of patients with pSS and to assess their association with characteristics of the disease.One hundred and fifty patients with pSS were evaluated using a composite global symptom score for abdominal symptoms and their severity. Data concerning the clinical and biological characteristics of pSS and abdominal disorders were also collected.Of the patients with pSS, 95% suffered from abdominal symptoms (median global symptom score 7.5 ± 5.5 points out of 30). More than half of the patients experienced abdominal tension (68%), upper abdominal pain (54%), abdominal discomfort (58%) and/or constipation (54%). Regarding the pSS activity, in relation to European League Against Rheumatism (EULAR) Sjögren syndrome disease activity index score items, general and central nervous system involvement wereassociated with a high global symptom score. The EULAR Sjogren Syndrome Patient Reported Index (ESSPRI) symptom score was positively correlated with the global symptom score (p 0.01). Multivariate analysis showed a significant association between a high global symptom score and SSA seronegativity, gastroparesis, and ESSPRI score (p 0.01 for each).The majority of patients with pSS suffered abdominal symptoms. There is currently no therapeutic recommendation because of the lack of information on the underlying pathophysiological mechanisms.NCT03157011 . Date of registration: July 17, 2017.
Published: 2020

28. Sofosbuvir and the risk of kidney dysfunction

Author: Marie Essig, Marilyne Debette-Gratien, Paul Carrier, Malika Bettayeb, and Véronique Loustaud-Ratti
Subjects: Hepatology, Sofosbuvir, Sustained Virologic Response, business.industry, MEDLINE, Kidney dysfunction, Bioinformatics, Kidney, Antiviral Agents, Text mining, medicine, business, medicine.drug
Published: 2020

29. Phase 3, Multicenter Open‐Label study to investigate the efficacy of elbasvir and grazoprevir fixed‐dose combination for 8 weeks in treatment‐naïve, HCV GT1b‐infected patients, with non‐severe fibrosis

Author: Véronique Loustaud-Ratti, Armand Abergel, Nicolas Andant, A. Mallat, Marie Dodel, Isabelle Fouchard-Hubert, Stanislas Pol, Maud Reymond, Brigitte Chanteranne, Bruno Pereira, François Bailly, Dominique Larrey, Albert Tran, Didier Samuel, Frederic Faure, Vincent Di Martino, J. Gournay, Benjamin Buchard, Tarik Asselah, Géraldine Lamblin, Leon Muti, Camille Teilhet, Service d'Hépatologie Gastro-entérologie [CHU Clermont-Ferrand], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Centre de recherche sur l'Inflammation (CRI (UMR_S_1149 / ERL_8252 / U1149)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Unité de recherche Maladies Métaboliques et Micronutriments (U3M), Institut National de la Recherche Agronomique (INRA), Hospices Civils de Lyon (HCL), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut des Maladies de l’Appareil Digestif [CHU Nantes], Université de Limoges (UNILIM), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques (HIFIH), and Université d'Angers (UA)
Subjects: Adult, Cyclopropanes, Male, medicine.medical_specialty, Elbasvir, Asia, Genotype, [SDV]Life Sciences [q-bio], Fixed-dose combination, Hepacivirus, Antiviral Agents, Gastroenterology, Therapy naive, 03 medical and health sciences, 0302 clinical medicine, Fibrosis, Quinoxalines, Internal medicine, Ribavirin, medicine, Clinical endpoint, Humans, ComputingMilieux_MISCELLANEOUS, Aged, Benzofurans, Sulfonamides, Hepatology, business.industry, Imidazoles, Middle Aged, medicine.disease, Amides, Hepatitis C, 3. Good health, Europe, Grazoprevir, 030220 oncology & carcinogenesis, Drug Therapy, Combination, Female, 030211 gastroenterology & hepatology, Carbamates, business, Viral load
Abstract: BACKGROUND Genotype 1b is the most common HCV genotype worldwide, accounting for the largest proportion of infections in Europe, Russia, Latin America and Asia. Reducing treatment duration can improve adherence, reduce drug exposure and cost. Accordingly, we evaluated the efficacy of 8 weeks fixed-dose combination of grazoprevir-elbasvir in treatment-naive patients, with non-severe fibrosis. METHODS HCV mono-infected and treatment naive patients with non-severe fibrosis (Fibroscan®
Published: 2020

30. Double-clip traction could be superior to the pocket-creation method with cylindrical cap for colonic ESD: a randomized study in an ex vivo model

Author: Jérémie Jacques, Véronique Loustaud-Ratti, Martin Dahan, Hugo Lepetit, Sophie Geyl, Paul Carrier, Jérémie Albouys, Romain Legros, Mathieu Pioche, Anne Guyot, and Aurélie Charissoux
Subjects: medicine.medical_specialty, Randomization, Endoscopic Mucosal Resection, Perforation (oil well), Endoscopic mucosal resection, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Traction, medicine, Clinical endpoint, Animals, Humans, business.industry, En bloc resection, Surgical Instruments, Treatment Outcome, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Surgery, Cattle, Radiology, business, Colorectal Neoplasms, Ex vivo, Abdominal surgery, Gravitation
Abstract: In Western countries, debates between ESD vs piece-meal EMR as the best treatment for large colorectal adenomas persist regarding the difficulty of ESD the colon, and the safety and relatively good results of piece-meal endoscopic mucosal resection (EMR). Pocket-creation method (PCM) and double-clip countertraction (DCT) are two strategies recently published to facilitate ESD in this challenging situation. This is a randomized animal study to compare PCM and DCT strategies for colonic ESD on ex vivo models (bovine colon) performed by 3 operators novice in ESD. Hybridknife type T was used to inject normal saline tinted with a small amount of blue dye in all procedures. Randomization was stratified according to the use of gravity assist. Primary endpoint was the difference in resection speed between PCM and DCT strategies. Resection speed was significantly higher in the DCT group than in the PCM group (56.3 vs. 31.6 mm2/min, p = 0.01). Technical success rate, defined as en bloc resection in under 60 min, was significantly better in the DCT group than in the PCM group (100% vs. 84.4%, p = 0.024), perforation rate was lower (0% vs. 18.8%, p = 0.012), and difficulty score was better (2.4 vs. 6.2, p
Published: 2020

31. A simple clinical score to promote and enhance ferroportin disease screening

Author: Caroline de Kerguenec, Fabrice Laine, Séverine Cunat, Patricia Aguilar-Martinez, Xavier Causse, Lénaïck Détivaud, Bernard Drenou, Edouard Bardou-Jacquet, Gilles Pelletier, Olivier Loréal, Véronique Loustaud-Ratti, Houda Hamdi-Rozé, Yves Deugnier, Si Nafa Si Ahmed, Amandine Landemaine, Stéphane Durupt, Christophe Bureau, Martine Ropert, Nathalie Ganne-Carrié, Jeff Morcet, CHU Pontchaillou [Rennes], Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Ciblage individuel et prévention des risques de traitements immunosupresseurs et de la transplantation (IPPRITT), CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Centre Hospitalier Régional d'Orléans (CHRO), Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA), CHU Toulouse [Toulouse], Hôpital Paul Brousse, Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Génomique fonctionnelle des tumeurs solides = Functional Genomics of Solid Tumors [CRC] (FunGeST), Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université de Paris (UP)-École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université de Paris (UP), Hospices Civils de Lyon (HCL), Nutrition, Métabolismes et Cancer (NuMeCan), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), None, Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité)-École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Jonchère, Laurent, and Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité)-École pratique des hautes études (EPHE)
Subjects: Male, medicine.medical_specialty, Multivariate analysis, Iron Overload, [SDV]Life Sciences [q-bio], Iron, Ferroportin, Logistic regression, Likelihood ratios in diagnostic testing, genetic testing, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Medicine, Humans, Mass Screening, Cation Transport Proteins, 030304 developmental biology, Genetic testing, Aged, 0303 health sciences, Hepatology, biology, medicine.diagnostic_test, business.industry, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, Middle Aged, medicine.disease, [SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, 3. Good health, Ferritin, [SDV] Life Sciences [q-bio], Logistic Models, diagnostic score, ROC Curve, Research Design, Cohort, biology.protein, 030211 gastroenterology & hepatology, Female, Hemochromatosis, Metabolic syndrome, business
Abstract: International audience; Background & aims - Ferroportin disease is a rare genetic iron overload disorder which may be underdiagnosed, with recent data suggesting it occurs at a higher prevalence than suspected. Costs and the lack of defined criteria to prompt genetic testing preclude large-scale molecular screening. Hence, we aimed to develop a readily available scoring system to promote and enhance ferroportin disease screening. Methods - Our derivation cohort included probands tested for ferroportin disease from 2008 to 2016 in our rare disease network. Data were prospectively recorded. Univariate and multivariate logistic regression were used to determine significant criteria, and odds ratios were used to build a weighted score. A cut-off value was defined using a ROC curve with a predefined aim of 90% sensitivity. An independent cohort was used for cross validation. Results - Our derivation cohort included 1,306 patients. Mean age was 55±14 years, ferritin 1,351±1,357 μg/L, and liver iron concentration (LIC) 166±77 μmol/g. Pathogenic variants (n = 32) were identified in 71 patients. In multivariate analysis: female sex, younger age, higher ferritin, higher LIC and the absence of hypertension or diabetes were significantly associated with the diagnosis of ferroportin disease (AUROC in whole derivation cohort 0.83 [0.78-0.88]). The weighted score was based on sex, age, the presence of hypertension or diabetes, ferritin level and LIC. An AUROC of 0.83 (0.77-0.88) was obtained in the derivation cohort without missing values. Using 9.5 as a cut-off, sensitivity was 93.6 (91.7-98.3) %, specificity 49.5 (45.5-53.6) %, positive likelihood ratio 1.8 (1.6-2.0) and negative likelihood ratio 0.17 (0.04-0.37). Conclusion - We describe a readily available score with simple criteria and good diagnostic performance that could be used to screen patients for ferroportin disease in routine clinical practice. Lay summary - Increased iron burden associated with metabolic syndrome is a very common condition. Ferroportin disease is a dominant genetic iron overload disorder whose prevalence is higher than initially thought. They can be difficult to distinguish from each other, but the limited availability of genetic testing and the lack of definitive guidelines prevent adequate screening. We herein describe a simple and definitive clinical score to help clinicians decide whether to perform genetic testing.
Published: 2020

32. An unexpected diagnosis of undetermined biliary stenosis via endoscopic ultrasound

Author: Sophie Geyl, Rebecca Rodrigues, Romain Legros, Jérémie Albouys, Mathieu Pioche, Jérémie Jacques, and Véronique Loustaud-Ratti
Subjects: Endoscopic ultrasound, medicine.medical_specialty, Cholestasis, medicine.diagnostic_test, business.industry, Gastroenterology, MEDLINE, Constriction, Pathologic, Endosonography, Biliary stenosis, medicine, Drainage, Humans, Radiology, business
Published: 2020

33. A hematoma caused by an excessively superficial injection: go under the red bleb!

Author: Jérémie Albouys, Sophie Geyl, Aurélie Charissoux, Mathieu Pioche, Romain Legros, Jérémie Jacques, and Véronique Loustaud-Ratti
Subjects: Reoperation, medicine.medical_specialty, Hematoma, business.industry, Gastroenterology, medicine.disease, Surgery, Injections, Blister, medicine, Humans, Bleb (medicine), business
Published: 2020

34. EFFECT OF IMPLEMENTING A REGIONAL REFERRAL NETWORK ON SURGICAL REFERRAL RATE OF BENIGN POLYPS FOUND DURING A COLORECTAL CANCER SCREENING PROGRAM: A POPULATION-BASED STUDY

Author: Martin Dahan, Jérémie Jacques, Véronique Loustaud-Ratti, Mickael Crespi, Sophie Geyl, Tessa Tabouret, Paul Carrier, Rebecca Rodrigues, Sylvaine Durand-Fontanier, Abdelkader Taibi, Denis Sautereau, Romain Legros, Jérémie Albouys, Christelle De Carvalho, and Sébastien Kerever
Subjects: medicine.medical_specialty, Adenoma, Referral, Colorectal cancer, Population, Colonoscopy, Colonic Polyps, Context (language use), 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, Mass Screening, education, Referral and Consultation, Early Detection of Cancer, education.field_of_study, Hepatology, medicine.diagnostic_test, business.industry, General surgery, Network on, Gastroenterology, medicine.disease, Colorectal surgery, Benign polyps, Population based study, Colorectal cancer screening, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Colorectal Neoplasms, business
Abstract: Surgical management is too often performed as the first-line treatment for large, benign colorectal polyps. We report the management of benign lesions detected by organised colorectal cancer (CRC) screening.Population-based study in 2012, 2016, and 2017, analyzing the evolution of surgical management of benign polyps of≥2cm diameter discovered in the context of organised CRC screening after the implementation of a regional referral network for the management of superficial colorectal lesions.A total of 1571 patients underwent colonoscopy following a positive test during the study period, among which 981 colonoscopies yielded at least one lesion. The adenoma detection rate was lower in 2012 (Guaiac test) than in 2016 and 2017 (fecal immunochemical test) (40% vs. 60% vs. 57%, P0.0001). The surgery rate for benign lesions decreased from 14.6% in 2012 to 7.7% in 2016 and 5% in 2017 (P=0.017). The risk factors for surgery for benign lesions were year 2012 (odds ratio [OR]=3.35, P=0.022), high-grade dysplasia (OR=2.49, P=0.04), in situ carcinoma (OR=5, P=0.003), size≥20mm (OR=17.39, P0.0001), and private sector (OR=6.6, P=0.0002). The morbidity rate of surgery for benign polyp≥2cm was 20.4% at 1month and its cost was sixfold higher than that of endoscopy.The establishment of a regional referral network for the management of large colorectal polyps reduces the rate of surgical management of such lesions.
Published: 2020

35. Efficacy and safety of elbasvir/grazoprevir for 8 or 12 weeks for hepatitis C virus genotype 4 infection: A randomized study

Author: George J. Hanna, Laurent Alric, Vincent Leroy, Stanislas Pol, Dominique Larrey, Barbara Haber, Tarik Asselah, Michael N. Robertson, Christophe Hézode, Ernest Asante-Appiah, Deborah D. Brown, Feng-Hsiu Su, Véronique Loustaud-Ratti, Lawrence Serfaty, Eric Nguyen-Khac, Peggy Hwang, Jessie Durrand Hall, Jean-Pierre Bronowicki, Amir Guidoum, Albert Tran, Violaine Ozenne, Rohit Talwani, Si Nafa Si Ahmed, Karin Hagen, Centre de recherche sur l'Inflammation (CRI (UMR_S_1149 / ERL_8252 / U1149)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service d'hépatologie médicale [CHU Cochin], Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Biomécanique cellulaire et respiratoire (BCR), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Centre National de la Recherche Scientifique (CNRS), Ciblage individuel et prévention des risques de traitements immunosupresseurs et de la transplantation (IPPRITT), CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CRHU Nancy, Hôpital Saint-Éloi [Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre méditerranéen de médecine moléculaire (C3M), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Côte d'Azur (UCA), CHU Toulouse [Toulouse], Groupe de Recherche sur l'alcool et les pharmacodépendances - UMR INSERM_S 1247 (GRAP), Université de Picardie Jules Verne (UPJV)-Institut National de la Santé et de la Recherche Médicale (INSERM), Whitehouse Station, Centre de Recherche Saint-Antoine (CRSA), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)
Subjects: Cyclopropanes, medicine.medical_specialty, Elbasvir, Genotype, [SDV]Life Sciences [q-bio], Hepacivirus, Antiviral Agents, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Quinoxalines, Internal medicine, medicine, Clinical endpoint, Humans, Elbasvir, Grazoprevir, Adverse effect, Benzofurans, Sulfonamides, Hepatology, business.industry, Imidazoles, Hepatitis C, Hepatitis C, Chronic, medicine.disease, Amides, Regimen, Grazoprevir, 030220 oncology & carcinogenesis, Drug Therapy, Combination, Egypt, 030211 gastroenterology & hepatology, Carbamates, France, business
Abstract: International audience; Background & Aims Hepatitis C virus (HCV) genotype (GT) 4 infection is prevalent in sub-Saharan Africa and the Middle East, particularly in Egypt. This study evaluated the safety and efficacy of elbasvir/grazoprevir administered for 8 and 12 weeks in participants with HCV GT4 infection. Methods In this partially randomized, open-label multicentre study conducted in France (NCT03111108; Protocol MK5172-096), treatment-naive participants with GT4 infection and F0-F2 fibrosis were randomized 2:1 to elbasvir (50 mg)/grazoprevir (100 mg) for 8 or 12 weeks. Treatment-naive participants with F3-F4 fibrosis and all treatment-experienced participants (F0-F4) were assigned to elbasvir/grazoprevir for 12 weeks. The primary endpoint was sustained virologic response (SVR) 12 weeks after the end of therapy. Results One hundred and seventeen participants were enrolled. Among treatment-naive participants with F0-F2 fibrosis, SVR was achieved by 94% (50/53) and 96% (26/27) of those receiving elbasvir/grazoprevir for 8 or 12 weeks, respectively, and four participants relapsed. In the 12-week arm, 95% (35/37) achieved SVR and two participants relapsed. NS5A resistance-associated substitutions were present at baseline and virologic failure in five of the participants with relapse. Drug-related adverse events occurred in 42% (n = 22) and 50% (n = 32) of participants receiving 8 and 12 weeks of treatment, respectively. No participant discontinued treatment owing to an adverse event. Conclusion These data confirm the efficacy of elbasvir/grazoprevir administered for 12 weeks in treatment-experienced individuals with HCV GT4 infection and those with advanced fibrosis. Treatment-naive individuals with mild fibrosis can be treated effectively with an 8-week regimen.
Published: 2020

36. Origin, HDV genotype and persistent viremia determine outcome and treatment response in patients with chronic hepatitis delta

Author: Isabelle Rosa, Fabien Zoulim, Vincent Thibault, Christophe Hézode, Victor de Ledinghen, Thierry Poynard, Xavier Causse, Sophie Hillaire, Hélène Fontaine, Richard Layese, Jérôme Gournay, Nathalie Ganne, Ghassan Riachi, Emmanuel Gordien, Eric Nguyen-Khac, Sophie Metivier, Olivier Chazouillères, Dominique Roulot, Roland Landman, Paul Calès, Dominique Salmon, Pierre Nahon, Cécile Goujard, Zahia Ben-Abdesselam, Ségolène Brichler, H. Labadie, Jean-François Cadranel, Caroline Lascoux-Combe, Véronique Loustaud-Ratti, Bruno Roche, P. Sellier, Corinne Castelnau, Frédéric Le Gal, Philippe Mathurin, Dominique Guyader, Julie Bottero, Françoise Roudot-Thoraval, Laurent Alric, François Habersetzer, Caroline Scholtes, Jean-Didier Grangé, Sylvie Naveau, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Clinical Epidemiology and Ageing : Geriatrie Soins Primaires et Santé Publique (CEpiA), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Hospices Civils de Lyon (HCL), Hôpital Paul Brousse, Hôpital Beaujon [AP-HP], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Saint-Antoine [AP-HP], Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Jean Verdier [AP-HP], AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris], Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Pontchaillou [Rennes], Génomique Fonctionnelle des Tumeurs Solides (U1162), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Agence Nationale de Recherches sur le Sida et les Hépatites Virales, France REcherche Nord & sud Sida-HIV Hépatites, Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), and Jonchère, Laurent
Subjects: Adult, Liver Cirrhosis, Male, 0301 basic medicine, medicine.medical_specialty, Carcinoma, Hepatocellular, Cirrhosis, Hepatitis D, Chronic, viruses, African origin, HDV persistent viremia, [SDV]Life Sciences [q-bio], Chronic liver disease, Severity of Illness Index, HDV genotype, 03 medical and health sciences, 0302 clinical medicine, Residence Characteristics, Internal medicine, medicine, Humans, Decompensation, Viremia, Retrospective Studies, Deltavir study, Liver infection, Hepatology, business.industry, Liver Neoplasms, virus diseases, Retrospective cohort study, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, Viral Load, biochemical phenomena, metabolism, and nutrition, medicine.disease, [SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, 3. Good health, [SDV] Life Sciences [q-bio], 030104 developmental biology, Cohort, Female, 030211 gastroenterology & hepatology, France, Interferons, Hepatitis Delta Virus, Viral hepatitis, business, Viral load, Liver outcome
Abstract: International audience; Background & aims: HDV infection causes severe chronic liver disease in individuals infected with HBV. However, the factors associated with poor prognosis are largely unknown. Thus, we aimed to identify prognostic factors in patients with HDV infection.Methods: The French National Reference Centre for HDV performed a nationwide retrospective study on 1,112 HDV-infected patients, collecting epidemiological, clinical, virological and histological data from the initial referral to the last recorded follow-up.Results: The median age of our cohort was 36.5 (29.9-43.2) years and 68.6% of our cohort were male. Most patients whose birthplace was known were immigrants from sub-Saharan Africa (52.5%), southern and eastern Europe (21.3%), northern Africa and the Middle East (6.2%), Asia (5.9%) and South America (0.3%). Only 150 patients (13.8%) were French native. HDV load was positive in 659 of 748 tested patients (88.1%). HDV-1 was predominant (75.9%), followed by sub-Saharan genotypes: HDV-5 (17.6%), HDV-7 (2.9%), HDV-6 (1.8%) and HDV-8 (1.6%). At referral, 312 patients (28.2%) had cirrhosis, half having experienced at least 1 episode of hepatic decompensation. Cirrhosis was significantly less frequent in African than in European patients regardless of HDV genotype. At the end of follow-up (median 3.0 [0.8-7.2] years), 48.8% of the patients had developed cirrhosis, 24.2% had ≥1 episode(s) of decompensation and 9.2% had hepatocellular carcinoma. European HDV-1 and African HDV-5 patients were more at risk of developing cirrhosis. Persistent replicative HDV infection was associated with decompensation, hepatocellular carcinoma and death. African patients displayed better response to interferon therapy than non-African patients (46.4% vs. 29.1%, p
Published: 2020

37. Phase III, Multicenter Open-Label Study to Investigate the Efficacy of Elbasvir and Grazoprevir Fixed-Dose Combination for Eight Weeks in Treatment-Naïve, HCV GT1b-Infected Patients, with Non-Severe Fibrosis

Author: Brigitte Chanteranne, Frederic Faure, Stanislas Pol, J. Gournay, Leon Muti, Armand Abergel, Géraldine Lamblin, Isabelle Fouchard-Hubert, Maud Reymond, Camille Teilhet, Benjamin Buchard, Véronique Loustaud-Ratti, A. Mallat, Marie Dodel, Bruno Pereira, Dominique Larrey, Nicolas Andant, Didier Samuel, Vincent Di Martino, Tarik Asselah, Albert Tran, and François Bailly
Subjects: medicine.medical_specialty, Elbasvir, business.industry, Fixed-dose combination, Hepatitis C, medicine.disease, Clinical investigator, Grazoprevir, Informed consent, Internal medicine, Good clinical practice, medicine, business, Viral load
Abstract: Background: Genotype 1b is the most common HCV genotype worldwide, accounting for the largest proportion of infections in Europe, Russia, Latin America and Asia. Reducing treatment duration can improve adherence, reduce drug exposure and cost. Accordingly, we evaluated the efficacy of eight weeks fixed dose combination of grazoprevir-elbasvir in treatment-naive patients, with non-severe fibrosis. Methods: HCV mono-infected and treatment naive patients with non-severe fibrosis (Fibroscan®
Published: 2020

38. European Association for the Study of the Liver and French hepatitis C recent guidelines: The paradigm shift

Author: Véronique Loustaud-Ratti, Paul Carrier, and Marilyne Debette-Gratien
Subjects: medicine.medical_specialty, French, Hepatitis C virus, Population, Guidelines, medicine.disease_cause, European, Pangenotypic, Migrants, 03 medical and health sciences, 0302 clinical medicine, Epidemiology, medicine, National level, 030212 general & internal medicine, education, Intensive care medicine, Screening procedures, Direct acting antiviral drugs, Eradication, education.field_of_study, Hepatology, business.industry, Hepatitis C, medicine.disease, Editorial, Paradigm shift, 030211 gastroenterology & hepatology, business, People who inject drugs
Abstract: The latest Association Francaise pour l'Etude du Foie - French Association for Study of the Liver (AFEF) and European Association for the Study of the Liver (EASL) recommendations announce a change of paradigm, for the management of patients infected with hepatitis C virus (HCV). The AFEF recommendations focus on the elimination of HCV infection on a national level by preventing reinfection, in less than ten years. This goal involves the facilitation of patients' management in a simplified pathway by increasing screening procedures and access to pangenotypic treatments mainly in the "reservoir" population of people who inject drugs and migrants. Even in the complex pathway of patients with previous comorbidities, AFEF takes the option of a therapeutic simplification. The EASL guidelines position themselves on the state of the art with a precise description of all therapeutic options available, without separating simplified and complex pathways even if they take into account the epidemiological evolution of difficult-to-treat populations.
Published: 2018

39. Beyond serum creatinine: which tools to evaluate renal function in cirrhotic patients?

Author: Paul Carrier, Marie Essig, Marilyne Debette-Gratien, and Véronique Loustaud-Ratti
Subjects: 0301 basic medicine, medicine.medical_specialty, medicine.medical_treatment, Urology, Renal function, Liver transplantation, 03 medical and health sciences, chemistry.chemical_compound, Liver disease, 0302 clinical medicine, medicine, Kidney, Creatinine, Hepatology, biology, business.industry, medicine.disease, Transplantation, 030104 developmental biology, Infectious Diseases, medicine.anatomical_structure, chemistry, Cystatin C, biology.protein, 030211 gastroenterology & hepatology, business, Kidney disease
Abstract: In cirrhotic patients, a high serum creatinine value is an independent mortality factor. Similarly, it is predictive of renal insufficiency after liver transplantation. In these cases, chronic kidney disease is also an independent mortality factor. A relevant evaluation of glomerular filtration rate is crucial, particularly in cases of end-stage liver disease or liver transplantation, and is key for the decision to undertake dual liver-kidney transplantation. Serum creatinine or creatinine-based equations are the most used tools in clinical practice but they significantly overestimate renal function. Equilibrium inulin renal clearance remains the gold standard but is time consuming and expensive. Cystatin C and cystatin C-based equations are less influenced by muscle mass or bilirubin value, but their dosage is not standardized and they are expensive. Pharmacological models using exogenous markers, new kidney biomarkers, Doppler coupled with ultrasounds, and kidney histology could be interesting tools but their indications need to be specified.
Published: 2018

40. La gastroparésie peut être à l’origine de symptômes digestifs hauts inexpliqués chez les patients souffrant d’un syndrome de Goujerot-Sjögren

Author: Jérémie Jacques, Véronique Loustaud-Ratti, S. Palat, S. Geyl, S. Parreau, Eric Liozon, Holy Bezanahary, Tessa Tabouret, K.H. Ly, F.X. Lapébie, J. Monteil, A. Cypierre, Anne-Laure Fauchais, and Guillaume Gondran
Subjects: 030203 arthritis & rheumatology, 03 medical and health sciences, 0302 clinical medicine, Gastroenterology, Internal Medicine, 030211 gastroenterology & hepatology
Abstract: Resume Introduction Les symptomes digestifs hauts peuvent concerner jusqu’a 50 % des patients porteurs d’un syndrome de Gougerot Sjogren primitif. Nous rapportons une cohorte retrospective de gastroparesies dans une population atteinte de syndrome de Gougerot Sjogren presentant des symptomes digestifs hauts inexpliques. La gastroparesie etait definie par un temps de demi-vidange gastrique superieur a 113 min ou par un pourcentage de retention gastrique superieur a 10 % a 4 h en scintigraphie. Resultats Onze patients atteints d’un syndrome de Gougerot Sjogren primitif et de gastroparesie etaient inclus. Les patientes etaient exclusivement des femmes, âgees de 48 ± 18 ans, avec un temps moyen de vidange gastrique de 725,18 ± 704,45 min. Soixante quatre pour cent des patientes presentaient des douleurs abdominales ou une pesanteur gastrique. Une atteinte neurologique centrale ou peripherique etait observee dans respectivement 9 % et 27 % des cas. Le delai diagnostique de la gastroparesie etait toujours superieur a 24 mois. Conclusion Une gastroparesie doit etre recherchee par scintigraphie chez tout malade souffrant d’un syndrome de Gougerot Sjogren primitif presentant une dyspepsie inexpliquee. Une atteinte neurologique pourrait expliquer ces troubles mais une etude prospective est necessaire pour une meilleure connaissance de cette affection.
Published: 2018

41. A local structured training program with live pigs allows performing ESD along the gastrointestinal tract with results close to those of Japanese experts

Author: Tessa Tabouret, Virginie Valgueblasse, Romain Legros, Claude-Yves Couquet, Aurélie Charissoux, Jérémie Jacques, Véronique Loustaud-Ratti, Denis Sautereau, Marilyne Debette-Gratien, Anne Le-Sidaner, Paul Carrier, and Laura Mesturoux
Subjects: Adult, Curative resection, medicine.medical_specialty, One year follow up, Sus scrofa, Education, Animal training, 03 medical and health sciences, 0302 clinical medicine, Animals, Humans, Medicine, Intestinal Mucosa, Continuous exposure, Aged, Aged, 80 and over, Hepatology, business.industry, Dissection, General surgery, Significant difference, Gastroenterology, Endoscopy, Middle Aged, Surgery, 030220 oncology & carcinogenesis, Models, Animal, 030211 gastroenterology & hepatology, Clinical Competence, France, business, Training program, Learning Curve
Abstract: Background and aims The high specific skill needed by ESD limit its widespread use in Europe and animal training is recommended in Europe to improve the results of ESD that are far from Japanese at present. We create a local training program using live pigs as models, along with our human cases, to provide continuous exposure to the technique. Methods Between February 2013 and December 2015, two young operators performed 55 pig gastric ESDs in parallel with 62 human cases for large superficial cancerous lesions. The number and training dates of pig cases were adapted to those of the human cases to achieve continuous exposure to ESD cases. Results The en bloc, R0, and curative resection rates were 100%, 85.5% (53/62), and 77.5% (48/62), respectively with no recurrence observed during the one year follow up. There was no statistically significant difference in terms of the R0 or curative resection rates among ESDs performed during 2013–2015 (R0: 80% vs. 86.6% vs. 86.4%; Curative: 80% vs. 86.6% vs. 73%). Conclusion A local structured training program using live pig models was used to train endoscopists for ESD in humans with high safety and efficiency, similar to results published by Japanese experts.
Published: 2016

42. Direct‐Acting Antivirals in Hepatitis C Virus‐Associated Diffuse Large B‐cell Lymphomas

Author: Maria Grazia Rumi, Laurent Alric, Francesco Passamonti, Dario Marino, Virginia Valeria Ferretti, Isabel Cano, Michele Merli, Manuel Gotti, Roberta Sciarra, Maria Chiara Tisi, Paolo Grossi, Véronique Loustaud-Ratti, Angela Ferrari, Alice Di Rocco, Carlo Visco, Maria Goldaniga, Chiara Rusconi, Emanuele Cencini, F. Benanti, Antonello Sica, Massimo Gentile, Marco Frigeni, Luca Arcaini, Lucia Farina, Francesco Piazza, Annalisa Arcari, Valentina Zuccaro, Lara Mannelli, Caroline Besson, Mario Pirisi, Universitá degli Studi dell’Insubria = University of Insubria [Varese] (Uninsubria), Università degli Studi di Pavia = University of Pavia (UNIPV), Pharmacochimie et Biologie pour le Développement (PHARMA-DEV), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT-FR 2599), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, Ospedale San Bortolo, Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Azienda Ospedaliera Careggi, Università degli Studi di Roma 'La Sapienza' = Sapienza University [Rome] (UNIROMA), Azienda Unita` Sanitaria Locale, Azienda Unita` Sanitaria Locale, La Spezia, IRCCS Istituto Nazionale dei Tumori [Milano], University of Piemonte Orientale, Partenaires INRAE, Università degli Studi di Padova = University of Padua (Unipd), Université de Limoges (UNILIM), Azienda Unità Sanitaria Locale di Bologna (AUSL), Veneto Institute of Oncology, IOV - IRCCS, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Ospedale Niguarda Ca' Granda Hospital, Università degli Studi di Siena = University of Siena (UNISI), University of Catania [Italy], Università degli Studi di Milano = University of Milan (UNIMI), Fondazione IRCCS Policlinico San Matteo, Service d’Hématologie et d’Oncologie, Centre Hospitalier de Versailles, Le Chesnay, France, Pagès, Nathalie, University of Insubria, Varese, University of Pavia, Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie de Toulouse (ICT-FR 2599), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Institut de Chimie du CNRS (INC)-Institut de Recherche pour le Développement (IRD), Università degli Studi di Roma 'La Sapienza' = Sapienza University [Rome], University of Padova [Padova, Italy], University of Siena (University of Siena), University of Milan, Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), and Université de Toulouse (UT)
Subjects: Male, Cancer Research, Sofosbuvir, Diffuse large B‐cell lymphoma, Hematologic Malignancies, [SDV]Life Sciences [q-bio], Direct‐acting antivirals, Hepatitis C virus, R‐CHOP, Hepacivirus, Direct-acting antivirals, Gastroenterology, chemistry.chemical_compound, 0302 clinical medicine, Antineoplastic Combined Chemotherapy Protocols, 030212 general & internal medicine, Aged, 80 and over, Dasabuvir, Incidence, Hepatitis C, Diffuse large B-cell lymphoma, Middle Aged, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, 3. Good health, [SDV] Life Sciences [q-bio], [SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences, Italy, Oncology, Vincristine, R-CHOP, 030220 oncology & carcinogenesis, Rituximab, Female, Lymphoma, Large B-Cell, Diffuse, medicine.drug, Ledipasvir, Adult, medicine.medical_specialty, Antiviral Agents, Disease-Free Survival, 03 medical and health sciences, Internal medicine, medicine, Humans, Progression-free survival, Cyclophosphamide, Aged, Retrospective Studies, business.industry, Ribavirin, Hepatitis C, Chronic, medicine.disease, chemistry, Paritaprevir, Doxorubicin, Prednisone, business
Abstract: International audience; Background: International guidelines suggest hepatitis C virus (HCV) eradication by direct-acting antivirals (DAAs) after first-line immunochemotherapy (I-CT) in patients with HCV-positive diffuse large B-cell lymphoma (DLBCL), although limited experiences substantiate this recommendation. Moreover, only a few data concerning concurrent administration of DAAs with I-CT have been reported.Subjects, materials, and methods: We analyzed hematological and virological outcome and survival of 47 consecutive patients with HCV-positive DLBCL treated at 23 Italian and French centers with DAAs either concurrently (concurrent cohort [ConC]: n = 9) or subsequently (sequential cohort [SeqC]: n = 38) to first-line I-CT (mainly rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone [R-CHOP]-like).Results: Median age was 61 years, 89% of patients had stage III/IV, and 25% presented evidence of cirrhosis. Genotype was 1 in 56% and 2 in 34% of cases. Overall, 46 of 47 patients obtained complete response to I-CT. All patients received appropriate DAAs according to genotype, mainly sofosbuvir-based regimens (n = 45). Overall, 45 patients (96%) achieved sustained virological response, 8 of 9 in ConC and 37 of 38 in SeqC. DAAs were well tolerated, with only 11 patients experiencing grade 1-2 adverse events. Twenty-three patients experienced hepatic toxicity (grade 3-4 in seven) following I-CT in SeqC, compared to only one patient in ConC. At a median follow-up of 2.8 years, two patients died (2-year overall survival, 97.4%) and three progressed (2-year progression-free survival, 93.1%).Conclusion: Excellent outcome of this cohort of HCV-positive DLBCL suggests benefit of HCV eradication by DAAs either after or during I-CT. Moreover, concurrent DAAs and R-CHOP administration appeared feasible, effective, and ideally preferable to deferred administration of DAAs for the prevention of hepatic toxicity.Implications for practice: Hepatitis C virus (HCV)-associated diffuse large B-cell lymphomas (DLBCLs) represent a great therapeutic challenge, especially in terms of hepatic toxicity during immune-chemotherapy (I-CT) and long-term hepatic complications. The advent of highly effective and toxicity-free direct-acting antivirals (DAAs) created an exciting opportunity to easily eradicate HCV shortly after or in concomitance with first-line immunochemotherapy (usually R-CHOP). This retrospective international study reports the real-life use of the combination of these two therapeutic modalities either in the concurrent or sequential approach (DAAs after I-CT) in 47 patients. The favorable reported results on long-term outcome seem to support the eradication of HCV with DAAs in all patients with HCV-positive DLBCL. Moreover, the results from the concurrent approach were effective and safe and displayed an advantage in preventing hepatic toxicity during I-CT.
Published: 2019

43. Clinical outcomes in patients with chronic hepatitis C after direct-acting antiviral treatment a prospective cohort study

Author: Albert Tran, Victor de Ledinghen, Armand Abergel, Céline Dorival, Olivier Chazouillères, Louis d’Alteroche, Isabelle Rosa, Didier Samuel, Moana Gelu-Simeon, Laurent Alric, Vincent Leroy, Jérôme Gournay, François Habersetzer, Dominique Guyader, Stanislas Pol, Véronique Loustaud-Ratti, Ghassan Riachi, Jean-Pierre Bronowicki, Hélène Fontaine, Anne Minello, Christophe Hézode, Philippe Mathurin, Claire Geist, Nathalie Ganne, Mélanie Simony, Dominique Thabut, François Raffi, Xavier Causse, Patrick Marcellin, Sophie Metivier, Paul Calès, Isabelle Portal, Marc Bourlière, Dominique Larrey, Fabien Zoulim, Fabrice Carrat, Alpha Diallo, Georges Haour, Tarik Asselah, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Département d'hépatologie [CHU Cochin], Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM), ANRS France Recherche Nord & sud Sida-hiv hépatites, Biomécanique cellulaire et respiratoire (BCR), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Centre National de la Recherche Scientifique (CNRS), Physiopathologie du cancer du foie, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM), Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Nutrition-Génétique et Exposition aux Risques Environnementaux (NGERE), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre de recherche sur l'Inflammation (CRI (UMR_S_1149 / ERL_8252 / U1149)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Institute for Advanced Biosciences / Institut pour l'Avancée des Biosciences (Grenoble) (IAB), Centre Hospitalier Universitaire [Grenoble] (CHU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang - Auvergne-Rhône-Alpes (EFS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre Hospitalier Universitaire de Nice (CHU Nice), Interactions Virus-Hôte et Maladies Hépatiques, Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Virologie, Physiopathologie et traitement des maladies du foie, Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Nutrition, Métabolismes et Cancer (NuMeCan), Institut National de la Recherche Agronomique (INRA)-Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Université (SU), Physiopathologie des Maladies Inflammatoires de l'Intestin, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU Rouen, Normandie Université (NU), Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, Image Science for Interventional Techniques (ISIT), Université d'Auvergne - Clermont-Ferrand I (UdA)-Clermont Université-Centre National de la Recherche Scientifique (CNRS), Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques (HIFIH), Université d'Angers (UA), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Génomique Fonctionnelle des Tumeurs Solides (U1162), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Ciblage individuel et prévention des risques de traitements immunosupresseurs et de la transplantation (IPPRITT), CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre Hospitalier Régional d'Orléans (CHRO), Service d'Hépato-gastro-entérologie [CHR Metz-Thionville], Centre hospitalier régional Metz-Thionville (CHR Metz-Thionville), Equipe EPICAD (LNC - U1231), Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Centre Hospitalier Intercommunal de Créteil (CHIC), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Aix Marseille Université (AMU), Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), Service d'hépatologie et de gastroentérologie [Hôpital Saint-Joseph - Marseille], Aix Marseille Université (AMU)-Hôpital Saint-Joseph [Marseille], Physiopathologie du système immunitaire (Inserm U1223), Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Descartes - Paris 5 (UPD5), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire [Grenoble] (CHU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Etablissement français du sang - Auvergne-Rhône-Alpes (EFS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), CHU Toulouse [Toulouse], Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Institut National de la Santé et de la Recherche Médicale (INSERM)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Université d'Angers (UA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur [Paris], CCSD, Accord Elsevier, Institut National de la Recherche Agronomique (INRA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Bordeaux Segalen - Bordeaux 2, Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7), and Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS)
Subjects: Adult, Liver Cirrhosis, Male, medicine.medical_specialty, Carcinoma, Hepatocellular, Cirrhosis, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, Liver transplantation, Antiviral Agents, Gastroenterology, 03 medical and health sciences, Liver disease, Viewpoint, 0302 clinical medicine, Internal medicine, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Aged, Proportional Hazards Models, business.industry, Incidence, Liver Neoplasms, Hazard ratio, General Medicine, Hepatitis C, Hepatitis C, Chronic, Middle Aged, Hepatology, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], Treatment Outcome, Hepatocellular carcinoma, Female, France, business
Abstract: Although direct-acting antivirals have been used extensively to treat patients with chronic hepatitis C virus (HCV) infection, their clinical effectiveness has not been well reported. We compared the incidence of death, hepatocellular carcinoma, and decompensated cirrhosis between patients treated with direct-acting antivirals and those untreated, in the French ANRS CO22 Hepather cohort.We did a prospective study in adult patients with chronic HCV infection enrolled from 32 expert hepatology centres in France. We excluded patients with chronic hepatitis B, those with a history of decompensated cirrhosis, hepatocellular carcinoma, or liver transplantation, and patients who were treated with interferon-ribavirin with or without first-generation protease inhibitors. Co-primary study outcomes were incidence of all-cause mortality, hepatocellular carcinoma, and decompensated cirrhosis. The association between direct-acting antivirals and these outcomes was quantified using time-dependent Cox proportional hazards models. This study is registered with ClinicalTrials.gov, number NCT01953458.Between Aug 6, 2012, and Dec 31, 2015, 10 166 patients were eligible for the study. 9895 (97%) patients had available follow-up information and were included in analyses. Median follow-up was 33·4 months (IQR 24·0-40·7). Treatment with direct-acting antivirals was initiated during follow-up in 7344 patients, and 2551 patients remained untreated at the final follow-up visit. During follow-up, 218 patients died (129 treated, 89 untreated), 258 reported hepatocellular carcinoma (187 treated, 71 untreated), and 106 had decompensated cirrhosis (74 treated, 32 untreated). Exposure to direct-acting antivirals was associated with increased risk for hepatocellular carcinoma (unadjusted hazard ratio [HR] 2·77, 95% CI 2·07-3·71) and decompensated cirrhosis (3·83, 2·29-6·42). After adjustment for variables (age, sex, body-mass index, geographical origin, infection route, fibrosis score, HCV treatment-naive, HCV genotype, alcohol consumption, diabetes, arterial hypertension, biological variables, and model for end-stage liver disease score in patients with cirrhosis), exposure to direct-acting antivirals was associated with a decrease in all-cause mortality (adjusted HR 0·48, 95% CI 0·33-0·70) and hepatocellular carcinoma (0·66, 0·46-0·93), and was not associated with decompensated cirrhosis (1·14, 0·57-2·27).Treatment with direct-acting antivirals is associated with reduced risk for mortality and hepatocellular carcinoma and should be considered in all patients with chronic HCV infection.INSERM-ANRS (France Recherche NordSud Sida-HIV Hépatites), ANR (Agence Nationale de la Recherche), DGS (Direction Générale de la Santé), MSD, Janssen, Gilead, AbbVie, Bristol-Myers Squibb, and Roche.
Published: 2019

44. SAT-490-No Impact of Direct-Acting Antivirals on Recurrent Hepatocellular Carcinoma Tumour Growth in the ANRS CO22 Hepather Cohort

Author: Tarik Asselah, Pol Stanislas, Fabien Zoulim, Isabelle Rosa, A.V. Pichard, Hélène Fontaine, Olivier Chazouillères, Correas Jean Michel, Dominique Larrey, Marc Bourlière, Nathalie Ganne, Véronique Loustaud-Ratti, Jérôme Gournay, Philippe Mathurin, Vincent Leroy, Albert Tran, Jean-Pierre Bronowicki, Didier Samuel, Dorival Celine, Dominique Guyader, Paul Calès, Christophe Hézode, Metivier Sophie, Victor de Ledinghen, Fabrice Carrat, Département d'hépatologie [CHU Cochin], Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Hospices Civils de Lyon, Departement de Neurologie (HCL), Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Bordeaux Research In Translational Oncology [Bordeaux] (BaRITOn), Université de Bordeaux (UB)-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Lille, Épidémiologie clinique des maladies virales chroniques [iPLesp] (CLEPIVIR), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Physiopathologie du système immunitaire (Inserm U1223), and Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)
Subjects: Oncology, medicine.medical_specialty, Hepatology, business.industry, Internal medicine, [SDV]Life Sciences [q-bio], Cohort, Medicine, business, DIRECT ACTING ANTIVIRALS, Recurrent Hepatocellular Carcinoma
Abstract: International audience
Published: 2019

45. Peroral endoscopic pyloromyotomy is efficacious and safe for refractory gastroparesis: prospective trial with assessment of pyloric function

Author: Romain Legros, Philippe Ducrotté, Jérémie Jacques, Denis Sautereau, Sebastien Fontaine, Benoît Marin, S. Palat, Florent Hure, Nour Edine Boubaddi, Anne-Laure Fauchais, Guillaume Gourcerol, Jacques Monteil, Marie-Pierre Clement, Sabrina Crepin, Véronique Loustaud-Ratti, Lauriane Pagnon, Service d'Hépato-Gastro-Entérologie et Nutrition [CHU Limoges], CHU Limoges, XLIM (XLIM), Université de Limoges (UNILIM)-Centre National de la Recherche Scientifique (CNRS), Service de Pharmacologie, toxicologie et pharmacovigilance [CHU Limoges], Service de Médecine interne A et polyclinique médicale [CHU Limoges], Service d'Hépato-Gastroentérologie [CHU Rouen], Hôpital Charles Nicolle [Rouen]-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU), Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau (ADEN), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institute for Research and Innovation in Biomedicine (IRIB), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), UNIROUEN - UFR Santé (UNIROUEN UFR Santé), Normandie Université (NU)-Normandie Université (NU), Neuroépidémiologie Tropicale (NET), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Service de diabétologie, CHU de Toulouse, Toulouse, France, Service de Gastroentérologie, CH Brive-la-Gaillarde, Brive-la-Gaillarde, France., Service de Diabétologie, CHU Limoges, Service de physiologie digestive, urinaire, respiratoire et de l'exercice [CHU Rouen], Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), and Service de médecine nucléaire [CHU Limoges]
Subjects: Male, medicine.medical_specialty, Gastroparesis, medicine.medical_treatment, Pilot Projects, Pyloromyotomy, Sensitivity and Specificity, Functional disorder, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Refractory, Internal medicine, medicine, Humans, Prospective Studies, Radionuclide Imaging, Prospective cohort study, Pylorus, Gastric emptying, business.industry, Retrospective cohort study, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, Recovery of Function, Middle Aged, medicine.disease, 3. Good health, Clinical trial, Treatment Outcome, Gastric Emptying, 030220 oncology & carcinogenesis, Quality of Life, Feasibility Studies, Female, 030211 gastroenterology & hepatology, France, business
Abstract: Background Gastroparesis is a functional disorder with a variety of symptoms that is characterized by delayed gastric emptying in the absence of mechanical obstruction. A recent series of retrospective studies has demonstrated that peroral endoscopic pyloromyotomy (G-POEM) is a promising endoscopic procedure for treating patients with refractory gastroparesis. The aim of this prospective study was to evaluate the feasibility, safety, and efficacy of G-POEM. Methods 20 patients with refractory gastroparesis (10 diabetic and 10 nondiabetic) were prospectively included in the trial. Patients were treated by G-POEM after evaluation of pyloric function using an endoscopic functional luminal imaging probe. Clinical responses were evaluated using the Gastroparesis Cardinal Symptom Index (GCSI), and quality of life was assessed using the Patient Assessment of Upper Gastrointestinal Disorders – Quality of Life scale and the Gastrointestinal Quality of Life Index scores. Gastric emptying was measured using 4-hour scintigraphy before G-POEM and at 3 months. Results Feasibility of the procedure was 100 %. Compared with baseline values, G-POEM significantly improved symptoms (GCSI: 1.3 vs. 3.5; P Conclusion G-POEM was efficacious and safe for treating refractory gastroparesis, especially in patients with low pyloric distensibility.
Published: 2018

46. Rooibos, a fake friend

Author: Paul Carrier, Jérémie Jacques, Véronique Loustaud-Ratti, Marilyne Debette-Gratien, and Muriel Grau
Subjects: Liver injury, medicine.medical_specialty, Hepatology, business.industry, Gastroenterology, medicine.disease, Hepatic toxicity, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Internal medicine, medicine, 030211 gastroenterology & hepatology, business, Acute hepatitis
Abstract: Rooibos is consumed worldwide and its use considered safe. It contains scavengers of free radicals and is so is deemed to be a liver protector. Nevertheless, hepatic toxicity exists even if rare. It is probably underdiagnosed and clinicians should think about it in case of acute hepatitis. We report a case of liver injury attributed to Rooibos.
Published: 2021

47. Different precore/core mutations of hepatitis B interact with, limit, or favor liver fibrosis severity

Author: Pascal Veillon, Evelyne Schvoerer, Joël Gozlan, Hélène Le Guillou-Guillemette, Sylvie Larrat, Françoise Lunel-Fabiani, Adeline Pivert, Vincent Mackiewicz, Véronique Brodard, Véronique Loustaud-Ratti, Vincent Thibault, Emmanuel Gordien, Sophie Alain, Alexandra Ducancelle, Jérôme Boursier, Sandrine Castelain, Sandrine Bertrais, Marianne Coste-Burel, Bénédicte Roquebert, Paul Calès, Sarah Maylin, Stéphane Chevaliez, and Viorica Balan
Subjects: Hepatitis B virus, medicine.medical_specialty, HBsAg, Mutation, Hepatology, business.industry, Gastroenterology, Hepatitis B, medicine.disease, medicine.disease_cause, Virology, 3. Good health, 03 medical and health sciences, Liver disease, 0302 clinical medicine, Fibrosis, 030220 oncology & carcinogenesis, Internal medicine, Medicine, 030211 gastroenterology & hepatology, Hepatic fibrosis, business, Viral hepatitis
Abstract: BACKGROUND AND AIM The impact of basal core promoter (BCP) and precore (PC) mutants of the hepatitis B virus (HBV) on liver disease severity remains controversial. The aim of the present study was to screen BCP and PC mutations in 252 HBV surface antigen (HBsAg) positive carriers in France and to assess relationships between these mutations and severe fibrosis. METHODS Direct sequencing of the precore/core gene was used to detect A1762T/G1764A and G1757A mutations in the BCP and G1896A and G1899A mutations in the PC region. RESULTS The prevalences of A1762T/G1764A, G1757A, G1896A, and G1899A mutations were 34.1%, 38.7%, 54.9%, and 29.3% (P
Published: 2016

48. Ledipasvir-sofosbuvir in patients with hepatitis C virus genotype 5 infection: an open-label, multicentre, single-arm, phase 2 study

Author: Kathryn Kersey, Véronique Loustaud-Ratti, Sophie Metivier, Phillip S. Pang, Deyuan Jiang, Didier Samuel, Tarik Asselah, Armand Abergel, and Hongmei Mo
Subjects: Liver Cirrhosis, Male, Ledipasvir, medicine.medical_specialty, Genotype, Sofosbuvir, Hepatitis C virus, Administration, Oral, Hepacivirus, medicine.disease_cause, Antiviral Agents, Viral Relapse, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Internal medicine, medicine, Humans, 030212 general & internal medicine, Adverse effect, Aged, Fluorenes, business.industry, Hepatitis C, Hepatitis C, Chronic, Middle Aged, Viral Load, medicine.disease, Surgery, Regimen, Treatment Outcome, Infectious Diseases, chemistry, RNA, Viral, Benzimidazoles, Drug Therapy, Combination, Female, 030211 gastroenterology & hepatology, France, business, Viral load, medicine.drug
Abstract: Summary Background Data about the response of hepatitis C virus (HCV) genotype 5 to approved and experimental treatment regimens are scarce. We assessed the efficacy and safety of combination therapy with the NS5A inhibitor ledipasvir and the NS5B polymerase inhibitor sofosbuvir in patients with HCV genotype 5. Methods We did this open-label, multicentre, single-arm, phase 2 trial at five hospitals in France. Eligible patients were at least 18 years old and had chronic infection with HCV genotype 5, with plasma HCV RNA of at least 10 000 IU/mL. We used BLAST analyses of NS5B partial sequences to establish the genotype and subtype at screening. Patients were given a fixed-dose combination tablet of 90 mg ledipasvir and 400 mg sofosbuvir orally once per day for 12 weeks. The primary endpoint was the proportion of patients with a sustained viral response, defined as HCV RNA concentration less than 15 IU/mL at 12 weeks after the end of treatment (SVR12). We analysed efficacy and safety in all patients who received at least one dose of ledipasvir-sofosbuvir. This trial is registered with EudraCT, number 2013-003978-27, and with ClinicalTrials.gov, number NCT02081079. Findings From March 7 to June 10, 2014, we recruited 41 patients, including 21 who were treatment naive and 20 who were treatment experienced. All patients were of white ethnic origins. All 41 patients who started treatment completed the full 12 weeks of treatment and had undetectable HCV RNA at their final treatment visit. In the overall study population, 39 (95%, 95% CI 83–99) of 41 patients achieved SVR12. SVR12 was achieved by 20 (95%, 76–100) of the 21 patients who were treatment naive and 19 (95%, 75–100) of the 20 patients who were treatment experienced. Eight (89%) of nine patients with cirrhosis achieved SVR12, whereas 31 (97%) of the 32 patients without cirrhosis achieved SVR12. The two patients who did not reach SVR12 both had IL28B TT genotype and had viral relapse within 4 weeks of the end of treatment. The most common adverse events were asthenia (16 [39%] patients), headache (11 [27%] patients), and fatigue (four [10%] patients). One patient had a serious adverse event, worsening depression, which we judged to be unrelated to study treatment. Interpretation The oral regimen of ledipasvir-sofosbuvir is an effective and well-tolerated treatment for patients with HCV genotype 5 infection who are treatment naive or treatment experienced. Funding Gilead Sciences.
Published: 2016

49. Encéphalopathie hépatique

Author: Jérémie Jacques, Paul Carrier, Marilyne Debette-Gratien, Rodolphe Sobesky, and Véronique Loustaud-Ratti
Subjects: General Medicine
Published: 2016

50. Grazoprevir plus elbasvir in HCV genotype-1 or -4 infected patients with stage 4/5 severe chronic kidney disease is safe and effective

Author: Victor de Ledinghen, Sophie Hillaire, Emilie Bérard, Anne Minello, Maeva Guillaume, Nassim Kamar, Véronique Loustaud-Ratti, David Saadoun, Brigitte Bernard-Chabert, Valérie Canva, Isabelle Ollivier-Hourmand, Laurent Alric, Vincent Leroy, Anaïs Vallet-Pichard, Marc Bourlière, Isabelle Fouchard-Hubert, Eric Nguyen-Khac, Stanislas Pol, Dominique Trias, Pharmacochimie et Biologie pour le Développement (PHARMA-DEV), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), Chirurgie Générale et Digestive [Purpan], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps (LEASP), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Foch [Suresnes], Département d'hépatologie [CHU Cochin], Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Physiopathologie du système immunitaire (Inserm U1223), Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Descartes - Paris 5 (UPD5), Centre Hospitalier Universitaire de Reims (CHU Reims), Service de Chirurgie digestive, endocrinienne et générale [CHU Limoges], CHU Limoges, Service d'hépatologie et de gastroentérologie [Hôpital Saint-Joseph - Marseille], Aix Marseille Université (AMU)-Hôpital Saint-Joseph [Marseille], Département d'hépato-gastroentérologie, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Service d'hépato-gastro-entérologie, Hôpital Huriez-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d'Hépato-Gastro-Entérologie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Service d'Hépato-Gastroentérologie, CHU Amiens-Picardie, Service d'hépato-gastroentérologie [CHU Grenoble Alpes], Centre Hospitalier Universitaire [Grenoble] (CHU), Immunologie - Immunopathologie - Immunothérapie [CHU Pitié Salpêtrière] (I3), CHU Charles Foix [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Service de Néphrologie - Hypertension Artérielle Dialyse - Transplantation, Centre de Physiopathologie Toulouse Purpan (CPTP), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie de Toulouse (ICT-FR 2599), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut de Recherche pour le Développement (IRD)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut de Recherche pour le Développement (IRD), CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées, Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur [Paris], Centre Hospitalier Universitaire Grenoble Alpes (CHU Grenoble Alpes), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Toulouse [Toulouse]-Hôpital de Rangueil, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT-FR 2599), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Cochin [AP-HP]-Institut National de la Santé et de la Recherche Médicale (INSERM), Physiopathologie du système immunitaire, Immunologie - Immunopathologie - Immunothérapie (I3), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Centre de Physiopathologie Toulouse Purpan ex IFR 30 et IFR 150 (CPTP), and Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)
Subjects: Male, Sustained Virologic Response, medicine.medical_treatment, 030232 urology & nephrology, Comorbidity, Hepacivirus, Severity of Illness Index, Liver disease, 0302 clinical medicine, Medicine, Aged, 80 and over, education.field_of_study, hemodialysis, Imidazoles, Middle Aged, 3. Good health, Drug Combinations, Grazoprevir, Nephrology, HCV, Female, 030211 gastroenterology & hepatology, Hemodialysis, Adult, medicine.medical_specialty, Elbasvir, Genotype, Population, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, elbasvir, 03 medical and health sciences, Quinoxalines, Internal medicine, Humans, Adverse effect, education, Aged, Benzofurans, Retrospective Studies, DAA, business.industry, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, grazoprevir, Hepatitis C, Chronic, medicine.disease, Concomitant, Kidney Failure, Chronic, business, chronic kidney disease, Kidney disease
Abstract: IF 8.429 (2017); International audience; Patients with advanced chronic kidney disease who receive direct-acting antiviral drugs require special consideration regarding comorbid conditions. Here we assessed the efficacy and safety of grazoprevir plus elbasvir in 93 patients infected with HCV genotype 1 or 4 and with advanced chronic kidney disease in a non-randomized, multicenter, nationwide observational survey. Twenty patients with HCV genotype 1a, 51 patients with 1b, four unclassified genotype 1, 17 with genotype 4 and one with genotype 6 received grazoprevir plus elbasvir (100/50 mg) once daily. All patients had severe chronic kidney disease with 70 patients stage G5, including patients on hemodialysis (74.2%), and 23 were stage G4 chronic kidney disease. Severe liver disease (Metavir F3/F4) was found in 33 patients. A sustained virologic response 12 weeks after the end of therapy was achieved in 87 of 90 patients. Two patients had a virologic breakthrough and one had a relapse after treatment withdrawal. Most patients received many concomitant medications (mean 7.7) related to comorbid conditions. Serious adverse events occurred in six patients, including three deaths while on grazoprevir plus elbasvir, not related to this therapy. Thus, once-daily grazoprevir plus elbasvir was highly effective with a low rate of adverse events in this advanced chronic kidney disease difficult-to-treat population with an HCV genotype 1 or 4 infection.
Published: 2018

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