EMC - Hépato-Gastroenterologie最新文献

{"title":"Motricité du côlon et du rectum","authors":"P. Ducrotté (Professeur des Universités, praticien hospitalier),&nbsp;G. Gourcerol (Interne des Hôpitaux)","doi":"10.1016/j.emchg.2005.01.007","DOIUrl":"https://doi.org/10.1016/j.emchg.2005.01.007","url":null,"abstract":"<div><p>The large bowel has two main functions: the absorption of water and electrolytes unabsorbed in the small bowel and the storage of stools between bowel movements. Colonic motor patterns are both tonic and phasic contractions. Phasic contractions are, in most of the cases, short clustered and non propagated contractions, separated by long periods of motor rest, especially at night. However, the most characterized colonic motor patterns are high-amplitude propagated contractions, occurring mainly at awakening and after meals and promoting aboral movements of the colonic content. Colonic nervous structures are both intrinsic and extrinsic. Intrinsic structures are the two plexuses of the enteric nervous system but also intestitial cells of Cajal. Extrinsic innervation plays a major role in modulating intrinsic nervous control, mainly after the meals that remain the major stimulant of colonic motility. Rectum and anal sphincters are essential for both defecation and continence. Their physiology involves smooth and striated muscles. The nervous control of recto-anal motility depends again from both intrinsic et extrinsic structures. Sensory nerves are key factor for continence.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 3","pages":"Pages 177-188"},"PeriodicalIF":0.0,"publicationDate":"2005-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.01.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92036053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prédisposition héréditaire au cancer colorectal et inactivation de la fonction de réparation des mésappariements de l'ADN","authors":"S. Olschwang ,&nbsp;(pour les experts rédacteurs du rapport confié au ministre de la Santé le 31 décembre 2003 : C. Bonaiti-Pellié, F. Eisinger, J. Feingold, T. Frébourg, S. Grandjouan, C. Lasset, P. Laurent-Puig, F. Lecuru, B. Millat, H. Sobol, G. Thomas),&nbsp;F. Eisinger","doi":"10.1016/j.emchg.2005.03.002","DOIUrl":"10.1016/j.emchg.2005.03.002","url":null,"abstract":"<div><p>The hereditary non-polyposis colorectal cancer (HNPCC) syndrome is an inherited condition characterized by clinical and genealogical criteria (Amsterdam criteria), caused by germline mutations in <em>MMR</em> genes in about 70% of cases. In this situation, tumor cells exhibit an MSI phenotype that is evidenced by genotyping of a reference panel of 5 monucleotidic sequences. Gene carriers are at high-risk of developing colorectal, endometrial, urothelial and small intestine carcinomas, and at moderate risk of ovary, stomach and biliary tract carcinomas. Genetic counseling is based on the presence of a carcinoma belonging to one of these locations, diagnosed before the age of 40, or before 60 years in case of MSI phenotype or an affected first degree relative. Identification of germline MMR gene is an important step for recommendations of subsequent surveillance and follow-up, focused on main cancer risks, i.e. colorectum and endometrium.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 3","pages":"Pages 214-222"},"PeriodicalIF":0.0,"publicationDate":"2005-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.03.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87386476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physiopathologie de l’hypertension portale : mise à jour","authors":"C. Chagneau-Derrode (Praticien hospitalier),&nbsp;C. Silvain (Professeur des Universités, praticien hospitalier)","doi":"10.1016/j.emchg.2005.01.010","DOIUrl":"10.1016/j.emchg.2005.01.010","url":null,"abstract":"<div><p>Portal hypertension is characterised by a hyperdynamic circulation secondary to a systemic arteriolar dilation that occurs despite activated vasopressor system. One of the major consequences is the development of portal-systemic collateral vessels. Portal pressure, varicose pressure and portal blood flow can be measured. Techniques for indirect measurement are not yet validated. Nitric oxide plays a central role in the reduction of systemic vascular resistances however other vasoactive mediators such as endothelin, angiotensin and prostaglandins also are involved. The molecules that can induce intrahepatic release of nitric oxide or inhibition of endothelin receptors are very promising in a new therapeutic approach of portal hypertension.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 3","pages":"Pages 264-268"},"PeriodicalIF":0.0,"publicationDate":"2005-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.01.010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83896407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Apport du pathologiste au diagnostic en hépatologie","authors":"D. Cazals-Hatem,&nbsp;P. Bedossa","doi":"10.1016/j.emchg.2005.03.001","DOIUrl":"10.1016/j.emchg.2005.03.001","url":null,"abstract":"<div><p>Hepatic punch-biopsy (HPB) is an essential investigation for the diagnosis of most liver diseases. It refers to an invasive procedure that must be performed by a trained physician, and which is indicated following consensual decision. Echo-guided biopsies and needle punctures of nodules reduce the risk of serious complications; these remain rare. The histological analysis of a HPB necessitates a tissue fragment sufficiently long (25 mm at least), multilevel incisions, and systematic coloration of iron and collagen. A pathologist familiar with hepatic diseases examines and classifies the elementary lesions, and then elaborates an interpretation of all these lesions taking into consideration the patient's clinical, biological, and radiological data. Anatomoclinical confrontation is necessary for a good understanding of the lesions and definitive diagnosis. Immunohistochemistry is frequently used in the research context; in daily practice, it is useful for the diagnosis of poorly differentiated tumours or metastases. In most lesional syndromes, histology confirms the diagnosis, indicates the aetiology, and guides the prognosis: chronic intrahepatic cholestasis, chronic hepatitis, steatosis and alcohol-induced hepatic disease, metabolic diseases, vascular diseases with hepatic microvascular disorder, unexplained portal hypertension, and tumoural syndromes. Using evaluation scores internationally recognized (METAVIR score for viral hepatitis) allows large-scale prognostic studies and therapeutic follow-up, with histology as the gold standard. In the next future, therapeutic advances (especially antiviral agents) and new markers of hepatic lesions will probably limit the indications of biopsy to well determined pathological contexts. However, to date, biopsy remains the only investigation that allows simultaneous, complete and precise evaluation of all anatomic lesions.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 3","pages":"Pages 284-296"},"PeriodicalIF":0.0,"publicationDate":"2005-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.03.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89577273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traitement endoscopique de la pancréatite chronique","authors":"L. Heyries,&nbsp;J. Sahel","doi":"10.1016/j.emchg.2005.01.009","DOIUrl":"10.1016/j.emchg.2005.01.009","url":null,"abstract":"<div><p>The treatment of chronic pancreatitis has been exclusively surgical for a long time. Recently, endoscopic therapy has become widely used as primary therapeutic option. Initially performed for the drainage of pancreatic cysts and pseudocysts, endoscopy was extended to stenosis of biliary and pancreatic ducts. Pancreatic sphincterotomy which allows access to the pancreatic ducts was first developed, rapidly followed by endoscopic biliary stenting, dilatation of stenosis, and stone extraction. Nevertheless, new improvements were necessary: failures in pancreatic stone extraction justified the development of extra-corporeal shock wave lithotripsy; dilatation of pancreatic strictures was improved by forage with new devices; endosonography allowed guidance for coeliac block, cyst-gastrostomy, cyst-duodenostomy and pancreatico-gastrostomy. Although endoscopic management is increasingly accepted, its indications are still debated.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 3","pages":"Pages 201-213"},"PeriodicalIF":0.0,"publicationDate":"2005-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.01.009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"101696371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obésité : prise en charge, indications et méthodes du traitement endoscopique et chirurgical","authors":"M. Merrouche (Praticien attaché consultant) ,&nbsp;B. Coffin (Professeur des Universités)","doi":"10.1016/j.emchg.2005.01.008","DOIUrl":"10.1016/j.emchg.2005.01.008","url":null,"abstract":"<div><p>Obesity is a serious disease that exposes the patient to numerous complications that result in an alteration of his or her quality and duration of life. Prevalence of obesity is increasing steadily, especially among teenagers: its importance represents a serious public health issue. In Europe, the prevalence of obesity varies from 10 to 25% of the population; in North America, it reaches figures as high as 25% of the inhabitants. Diet measures, medications and behavioural support are proposed to the patients but most of the time they are difficult to maintain in the long term, inconstantly efficacious and iteratively exposed to recurrences, making surgery a credible alternative. First operative procedures have consisted in intestinal by-pass, reducing the intestinal absorptive surface and causing malabsorption particularly for fat; related weight loss was important and rapid, but these procedures have been regularly associated to severe complications, and were thereafter abandoned. Presently, the current techniques are schematically: adjustable gastroplasty with a calibrated ring, vertical gastroplasty and gastric by-pass. This type of procedure is usually followed by a substantial weight loss, often sustained beyond 2 years, a reduction in complications prevalence. However mortality is not negligible, reaching 0.1-0.5 %; early and late complications are not infrequent leading to re-operation in 10% of cases. “Bariatric” surgery is only indicated in case of morbid obesity, and in absence of contraindications.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 3","pages":"Pages 189-200"},"PeriodicalIF":0.0,"publicationDate":"2005-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.01.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73899581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diarrhée du voyageur","authors":"D. Carré (Spécialiste des Hôpitaux des Armées, service de gastroentérologie),&nbsp;F. Simon (Spécialiste des Hôpitaux des Armées, service de pathologie infectieuse et tropicale),&nbsp;P. Hance (Spécialiste des Hôpitaux des Armées, service de biologie médicale),&nbsp;T. Coton (Spécialiste des Hôpitaux des Armées, service de gastroentérologie),&nbsp;R. Delpy (Assistant des Hôpitaux des Armées, service de gastroentérologie),&nbsp;M. Guisset (Spécialiste des Hôpitaux des Armées, service de gastroentérologie)","doi":"10.1016/j.emchg.2005.04.002","DOIUrl":"https://doi.org/10.1016/j.emchg.2005.04.002","url":null,"abstract":"<div><p>Traveller's diarrhoea is a frequent disease which usually occurs the first week of the trip. Despite the apparent benignity of this affection, travellers may be ill enough to stop their activities. Its related morbidity has led to elaborate advices and recommendations to be considered before departure, and to propose a therapeutic schedule during the trip. In case of persistent diarrhoea after return, minimal medical investigation is mandatory, seeking for potential infectious aetiology.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 3","pages":"Pages 249-263"},"PeriodicalIF":0.0,"publicationDate":"2005-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.04.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92107599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dyspepsie","authors":"L. Peyrin-Biroulet (Interne des Hôpitaux),&nbsp;M.-A. Bigard (Professeur des Universités, chef de service)","doi":"10.1016/j.emchg.2005.01.003","DOIUrl":"https://doi.org/10.1016/j.emchg.2005.01.003","url":null,"abstract":"<div><p><span>Functional dyspepsia is a chronic and polymorphic disorder with a prevalence of approximately 10% in the adult population. Management of this disease represents a considerable economic burden worldwide. Functional dyspepsia is defined as a pain or a sensation of discomfort located in the upper abdomen, according to the Rome II criteria. A dyspepsia subgroup classification based on the predominant symptom has been proposed: dysmotility-like dyspepsia, ulcer-like dyspepsia and non-specific dyspepsia. In patients with alarm symptoms, upper endoscopy<span> has to be performed. In the absence of alarm features, the patient needs to be reassured and psychotherapy must be discussed. Then, empirical therapy with proton pump inhibitors (ulcer-like dyspepsia) or domperidone (dysmotility-like dyspepsia) may improve symptoms in some cases. Efficacy of </span></span><em>Helicobacter pylori</em> eradication in dyspepsia is probably poor; on the other hand, treatment of <em>Helicobacter pylori</em><span> infection could reduce the prevalence of gastric cancer but further investigations are needed to clarify this point. Pathophysiology of dyspepsia remains unclear. The psychological factors are not the only involved in this functional disorder. The identification of the mechanisms that lead to symptom generation should facilitate the development of newer and more effective therapeutic strategies in functional dyspepsia.</span></p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 2","pages":"Pages 105-123"},"PeriodicalIF":0.0,"publicationDate":"2005-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.01.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137407966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaccination contre l’hépatite A","authors":"Y. Buisson (Professeur agrégé du Val-de-Grâce),&nbsp;E. Nicand (Biologiste des hôpitaux des Armées)","doi":"10.1016/j.emchg.2004.12.007","DOIUrl":"10.1016/j.emchg.2004.12.007","url":null,"abstract":"<div><p>Hepatitis A epidemiology has greatly changed over the last decades, since the improved life standards and hygiene have lead developed countries to a moderate endemicity level by the increased susceptibility of the populations to hepatitis A virus (HAV) infection. Despite the decrease of hepatitis A incidence, sporadic cases and outbreaks continue to occur, that causes a substantial burden in terms of morbidity, mortality and costs. Since 1992, when inactivated vaccines against HAV have been marketed, public health services may react opportunely. Available for adults and children from one year of age, these vaccines are highly immunogenic after a single dose and well tolerated. A two-dose schedule is recommended at 6 to 18-month intervals, without booster in healthy individuals. Pre-vaccination serologic testing is usually unnecessary until age 45. In France, HAV vaccination is recommended for persons exposed to occupational or particular risks; travelers are the most important target. A comprehensive strategy for elimination could be considered but it would need the implementation of a national system for acute hepatitis surveillance.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 2","pages":"Pages 75-85"},"PeriodicalIF":0.0,"publicationDate":"2005-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2004.12.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91200693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Échinococcose alvéolaire","authors":"S. Bresson-Hadni ,&nbsp;R. Piarroux ,&nbsp;B. Bartholomot ,&nbsp;J.-P. Miguet ,&nbsp;G. Mantion ,&nbsp;D.-A. Vuitton","doi":"10.1016/j.emchg.2005.01.001","DOIUrl":"https://doi.org/10.1016/j.emchg.2005.01.001","url":null,"abstract":"<div><p>Alveolar echinococcosis is caused by the larva of the cestode <em>Echinococcocus</em> (<em>E.</em>) <em>multilocularis</em>. Carnivores, typically foxes, but also domestic dogs and cats are definitive hosts, harbouring the small adult tapeworms in their intestine. Many species of rodents act as intermediate hosts, allowing the liver development of the metacestode (larval stage) of <em>E. multilocularis</em>. Human is an aberrant host for the metacestode. Contamination occurs either by eating vegetables or wild berries tainted by the infected feces of the carnivores, or by touching these animals. This disease is observed only in the temperate northern hemisphere. The main endemic area are Alaska, Japan, China, Russia , Central Asia, Western Turkey and Central Europe. New factors seem to currently modify the epidemiology of alveolar echinococcosis and to cause an extension of the disease in new areas. Increasing fox populations, invasion of cities by foxes, probably contribute to these changes. The role of cellular immunity in the immune response against <em>E. multilocularis larvae</em> has been clearly established. A spontaneous secretion of IL-10 by the peripheral blood mononuclear cells and within the periparasitic granuloma is the immunological hallmark of patients with progressive forms of the disease. Genetic correlates of resistance or susceptibility to human alveolar echinococcosis have been indicated by analysis of human leucocyte antigen markers in a large group of European alveolar echinococcosis patients. Human alveolar echinococcosis is a potentially fatal, chronically progressive hepatic disease, that is characterized by a long asymptomatic period in which development of an invasive-tumour-like multi-vesiculated lesion occur. Vascular and biliary structures as well as adjacent organs may be involved in the parasitic process. There is, in addition, a risk of hematogenous spreading resulting in distant metastases. Unusually for a parasitic helminth infection, it is a life-threatening disease. Efficient drugs able to destroy the larva are currently lacking. A partial surgical resection is the only curative treatment in case of a rather limited disease, a situation which becomes more frequent due to the large use of abdominal ultrasonography. In case of large unresectable lesions, long-term administration of the parasitostatic benzimidazole derivates, albendazole or mebendazole and use of interventional radiology procedures are now able to stabilize the patients. Liver transplantation had been undertaken in some patients with very severe alveolar echinococcosis, mainly due to biliary complications. This ultimate therapeutic option must be preceded by a meticulous evaluation to identify extra-hepatic extension and need to be associated with long term benzimidazole therapy. Finally, the better comprehension of the immunopathogenesis of this disease allows to consider therapeutic immunomodulation for alveolar echinococcosis in the f","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 2","pages":"Pages 86-104"},"PeriodicalIF":0.0,"publicationDate":"2005-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.01.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137407969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}