EMC - Hépato-Gastroenterologie最新文献

{"title":"Colites parasitaires","authors":"P. Rey (Spécialiste des hôpitaux des Armées, chef du service des maladies digestives) ,&nbsp;D. Andriamanantena (Assistant des hôpitaux des Armées) ,&nbsp;C. Bredin (Assistant des hôpitaux des Armées) ,&nbsp;F. Klotz (Professeur titulaire de la chaire de médecine tropicale au Val-de-Grâce)","doi":"10.1016/j.emchg.2005.01.004","DOIUrl":"10.1016/j.emchg.2005.01.004","url":null,"abstract":"<div><p>Parasitic colonic diseases refer to a polymorphic concept; they may present an acute or a chronic expression, often non symptomatic, and they include the amoebosis and the schistosomiasis which are dominant in tropical countries. The colon may be concerned by cosmopolitan or exotic parasites with highly variable incidence and prevalence, simply in transit, or as usual hosts, or trapped in the colonic wall. The consequences range from the epiphenomenona to anatomo-clinical manifestations potentially serious and life threatening. The pathophysiology results from interactions between the host, the external environment and the parasite; the parasite aggression involves immunomediated inflammatory or parasitic enzyme related phenomena. Three groups of parasitic colitis have been identified, with a distinct identity: the common parasitic tropical colitis, the parasitic colitis favoured by immunodepression, and the specific parasitic colonic deadlock with colic tropism. The diagnosis focuses on the anamnesis and seeks for the involved parasite identification by stool analysis when possible, and by the colorectal endoscopy which supports the anatomo-clinical diagnosis. As for the treatment, three antiparasitic classes (5-nitro-imidazole agents, benzimidazole agents, and praziquantel), and more recent molecules (ivermectine, nitazoxanide) are available; less frequently, surgery is indicated, for the complicated forms or in case of unascertained diagnosis.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 2","pages":"Pages 162-175"},"PeriodicalIF":0.0,"publicationDate":"2005-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.01.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74619847","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":"Ponction sous échoendoscopie","authors":"M. Giovannini (Responsable des tumeurs digestives et de l’unité d’endoscopie)","doi":"10.1016/j.emchg.2005.01.005","DOIUrl":"https://doi.org/10.1016/j.emchg.2005.01.005","url":null,"abstract":"<div><p>The development of endoscopic ultrasound (EUS) has allowed better identification of both parietal and lymph node extension of gastrointestinal and pancreatic tumours. Nevertheless, EUS cannot distinguish malignant forms of lymph nodes, pancreatic masses or extrinsic compression of the digestive tract from benign forms. The development since 7 years of the sectorial linear EUS allowed realizing guided biopsies of such lesions. It appears possible to perform a biopsy guided by EUS with both types of equipment (radial or linear, sector-based), but the technique of biopsy with the radial system is more time-consuming and technically more difficult and more dangerous, as it is impossible to completely follow the biopsy needle as it comes out of the operator channel, and to guide it into the lesion. The linear sector-based endoscopic ultrasound equipment includes a small diameter convex electronic probe, fitted on to a standard endoscope. This is an optic fibre device with a 60° field of vision fitted with an operating channel of 2 and 3.8 mm diameter, depending on the particular instrument, through which biopsy forceps, biopsy needle or accessories for therapeutic procedures can pass. Guided biopsies may be carried out with this type of sector-based probe, by following the biopsy needle at the exit of the operator channel and guiding it into the lesion. This is possible because the ultrasound beam is emitted longitudinally in the same axis than the axis of the endoscope and not perpendicularly as in radial ultrasound endoscopes. The principal indications for EUS-guided biopsies are the diagnosis of lymph nodes or mediastinal, coeliac and pelvic masses, of sub-mucosal tumours, of gastric linitis with negative endoscopic biopsies, and of pancreatic tumours. The best results are obtained with lymph nodes and mediastinal masses, anastomotic recurrences, extrinsic compressions of the gastrointestinal tract and pancreatic tumours. Besides, the efficacy of EUS-guided biopsies is higher in lesions of small diameter (&lt; 4 cm). This is due to the fact that larger cancers are the site of necrosis and/or intra-tumour fibrosis, both of which prevent good sampling. If a “micro-biopsy” is obtained, it enables more accurate histological diagnosis to be made and accurate characterisation of the tissue in about 80% of malignancy diagnoses. The results quoted in the literature show an overall sensitivity of the technique varying between 76 and 91%, a specificity of 84 to 100%, and a reliability of 78 to 94%. A prospective study investigating 457 patients from 4 centres (Indianapolis, Copenhagen, Marseilles and Orange in California) showed a sensitivity of the biopsy statistically better for lymph nodes (94%) and extra-luminal tumours (86%) than for parietal lesions (sub-mucosal tumours and large gastric folds) (61% p&lt;0.001).</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 2","pages":"Pages 150-161"},"PeriodicalIF":0.0,"publicationDate":"2005-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.01.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137407967","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":"Physiologie du pancréas exocrine","authors":"N. Vaysse (Docteur en médecine, docteur en sciences, directeur de recherche, Inserm)","doi":"10.1016/j.emchg.2005.01.002","DOIUrl":"10.1016/j.emchg.2005.01.002","url":null,"abstract":"<div><p>The pancreatic physiology is examined on the basis of recent advances observed these past ten years. A new model for pancreatic duct cell bicarbonate secretion is proposed according to the recently discovered <em>Cystic Fibrosis Transmembrane conductance Regulator</em> mutated in cystic fibrosis. Enzyme activation and inactivation are detailed allowing comprehensive pancreatic secretory function and relationships between trypsinogen and the occurrence of hereditary pancreatitis. Previously, pancreatic secretion was thought to be exclusively controlled by neural reflex mechanisms. Later, it has been proposed to be predominantly regulated by gastrointestinal hormones, with CCK and secretin being the most important regulatory peptides. New data from the research on the localization and role of gastrointestinal peptide receptors in the human pancreas support the current concept of an integrative neurohormonal regulation.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 2","pages":"Pages 59-74"},"PeriodicalIF":0.0,"publicationDate":"2005-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.01.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89229951","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":"Anémies d'origine digestive","authors":"D. Cattan (Professeur des Universités-praticien hospitalier)","doi":"10.1016/j.emchg.2005.01.006","DOIUrl":"https://doi.org/10.1016/j.emchg.2005.01.006","url":null,"abstract":"<div><p>Anaemia induced by digestive diseases refers to those types of anaemia due to iron, cobalamin, or folate deficiencies. The body contents of iron, cobalamin, folate depends on the digestive tract integrity. Inflammatory anaemias (or anaemias of chronic diseases), aregenerative anaemias in relation with digestive cancer bone marrow metastasis, rare haemolytic anaemias observed in the course of digestive cancers are described elsewhere. Iron deficiency is diagnosed in case of a hyposideremia associated either with transferrin elevation or with hypoferritinemia: in case of combined inflammatory syndrome and iron deficiency, a frequent situation in gastroenterology, the elevation of transferrin receptor 1 in the serum is a precious argument. Diagnosis of cobalamin and folate deficiencies need the assessment of vitamin B₁₂ serum level, serum and erythrocytes folate levels, and eventually urinary homocysteinuria and methyl-malonic aciduria appreciations. The etiologic diagnosis of digestive diseases anaemia is suggested in over half of the cases after anamnesis and clinical examination. Investigating the cause of an occult bleeding has been improved by the new technique of the intestinal wireless video-capsule. However, complementary investigations have been impoverished in case of cobalamin deficiency due to the difficulty of obtaining Schilling test (with cristallin or protein-bound cobalamin) with and without Intrinsic Factor concomitant administration. Therefore, in the absence of serum Intrinsic Factor antibodies and in the absence of any evident intestinal malabsorption syndrome, it is now difficult to distinguish pernicious anaemia from the frequent alimentary protein-bound malabsorption syndrome seen in cases of simple achlorhydria with a still good Intrinsic Factor hourly output. This situation will conduct to reintroduce gastric intubation in the vitamin B₁₂ deficiencies routine investigations. The treatment of digestive diseases anaemia is substitutive. The most important treatment is the treatment of the cause since anaemia is a symptom, not a disease.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 2","pages":"Pages 124-149"},"PeriodicalIF":0.0,"publicationDate":"2005-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.01.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137407968","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":"Pathologies digestives dues au sport","authors":"J.-A. Bronstein (Médecin des hôpitaux des Armées, chef de service) ,&nbsp;J.-L. Caumes (Assistant des hôpitaux des Armées) ,&nbsp;M. Richecœur (Médecin des hôpitaux des Armées) ,&nbsp;A.-S. Lipovac (Médecin des hôpitaux des Armées) ,&nbsp;E. Viot (Résidente) ,&nbsp;J.-M. Garcin (Médecin des hôpitaux des Armées)","doi":"10.1016/j.emchg.2004.12.004","DOIUrl":"10.1016/j.emchg.2004.12.004","url":null,"abstract":"<div><p>Exercise-related gastrointestinal symptoms are not uncommon among athletes. The occurrence of functional disorders including gastroesophageal reflux, bloating, vomiting, dyspepsia, acute diarrhoeal have been reported. The occurrence of gastrointestinal bleeding has also been reported especially in long-distance runners. The mucosal lesions could be related to hemodynamic changes in the splanchnic area. A decrease in splanchnic blood flow has been described during physical exercise. Exertional heat stroke results in a liver failure occurring after a long intensive exercise, often, but not always in a hot environment.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 1","pages":"Pages 28-34"},"PeriodicalIF":0.0,"publicationDate":"2005-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2004.12.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80004732","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":"Tumeurs hépatiques malignes primitives en dehors du carcinome hépatocellulaire","authors":"F. Cholet (Praticien hospitalier) ,&nbsp;J.-B. Nousbaum (Professeur des Universités, praticien hospitalier) ,&nbsp;N. Lagarde (Professeur des Universités, praticien hospitalier) ,&nbsp;B. Turlin (Maître de conférences des Universités, praticien hospitalier)","doi":"10.1016/j.emchg.2004.12.003","DOIUrl":"10.1016/j.emchg.2004.12.003","url":null,"abstract":"<div><p>Malignant primary tumours other than hepatocellular carcinoma are rare. They represent 2% to 3% of the gastrointestinal tract tumours. Unlike hepatocellular carcinoma, they develop most of the time in a non cirrhotic liver. These tumours may derive from the hepatocyte, cholangiocyte, mesenchymatous cells, or endocrine cells. Despite the fact that clinical and imaging features may suggest the nature of the tumour, the final diagnosis is based on the histopathologic examination of a liver biopsy or a surgical fragment.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 1","pages":"Pages 19-27"},"PeriodicalIF":0.0,"publicationDate":"2005-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2004.12.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91420486","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":"Pancréas parasitaire","authors":"P. Rey (Spécialiste des hôpitaux des armées, chef du service des maladies digestives) ,&nbsp;J.-M. Debonne (Professeur agrégé du Val-de-Grâce, chef des services médicaux) ,&nbsp;F. Klotz (Professeur titulaire de la chaire de médecine tropicale)","doi":"10.1016/j.emchg.2004.12.006","DOIUrl":"https://doi.org/10.1016/j.emchg.2004.12.006","url":null,"abstract":"<div><p>The parasitic pancreas is a many-faceted entity, the study of which leads to review many nosologic settings. Internal organ not involved in the cycles of parasitic replication as opposed to what one observes for the liver and the digestive tract, the pancreas can however be concerned by cosmopolitan or exotic various parasites. Parasites as usual hosts of the small intestine or bile ducts can cause pancreatic duct obstruction after migration into the Vater ampulla or Wirsung’s canal; other parasites, from digestive or extra digestive origin, more rarely can cause lesions of the pancreatic parenchyma secondarily to unusual migration or blood infection. A systemic mechanism is more exceptionally involved, as during serious attacks of malaria or induced by the pancreatic toxicity of anti-parasitic drugs. The context of immunodepression may evoke opportunist parasites and the possibility of parasitic transmission by pancreatic transplantation. Anatomic and clinical features are eminently variable, oscillating between epiphenomenon of fortuitous or autopsic discovery until potentially serious demonstrations, as acute pancreatitis being able to engage vital prognosis. The whole set of therapeutic tools consists mainly in anti-parasitic chemotherapies, in combination with endoscopic retrograde cholangio-pancreatography or surgery in selected indications.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 1","pages":"Pages 49-58"},"PeriodicalIF":0.0,"publicationDate":"2005-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2004.12.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136699513","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":"Pathologie hépatogastroentérologique du sportif","authors":"J. Watelet,&nbsp;J.-P. Bronowicki","doi":"10.1016/j.emchg.2004.12.001","DOIUrl":"10.1016/j.emchg.2004.12.001","url":null,"abstract":"<div><p>The development of sports practicing is a new fact. The increasing participation of people to popular sport events (marathons, cycling sports…) and the development of recent concepts (triathlon, nature raids…) have generated the occurrence of a digestive symptomatology considered as \"new\" and specifically related to the effort. It affects sportspeople of any level, from simple amateurs to high-level athletes. This entity was initially observed in extreme sports and endurance sports. Although reported as anecdotes (e.g. the death of Philipides in Athens in 490 B.C. due to a hypothetical heat stroke, or Derek Clayton, vomiting at the end of his marathon victory in Antwerp in 1969,) there are numerous examples that have been largely shown by the widespread live broadcasting of sport events (e.g. the hospitalization of the triathlete Mark Allen due to epigastria cramps in Hawaii in 1988, the withdrawal of Sevilla Oscar from competition for the same reasons in the sixteenth stage of the Tour de France 2002, the withdrawal of Pete Sampras and Mary Pierce at Roland Garros due to digestive disorders in 1997…). Despite the difficulty of evaluating the exact prevalence of these digestive disorders, it seems that they may affect up to a quarter of the participants in endurance sports. The symptoms are described according to the localization of the lesion (oesophagus, stomach, intestines), and the degree of severity (primarily hemorrhagic demonstrations such as melaena and bloody diarrhoea). Liver diseases should not be forgotten, primarily exertional heat strokes and viral hepatitis. At least a cause of substandard performances for the athlete (cause of withdrawal in 5 to 15% of the cases during competitions), gastrointestinal disorders can present criteria of seriousness and be life-threatening, necessitating therefore rapid medical management, with a frequency of hospitalization shown to be 0.1 %.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 1","pages":"Pages 1-11"},"PeriodicalIF":0.0,"publicationDate":"2005-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2004.12.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72643867","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":"Néphropathies au cours des maladies hépatiques","authors":"N. Kamar ,&nbsp;S. Thebault ,&nbsp;L. Rostaing ,&nbsp;L. Alric","doi":"10.1016/j.emchg.2004.12.002","DOIUrl":"10.1016/j.emchg.2004.12.002","url":null,"abstract":"<div><p>Liver disease may be directly or indirectly responsible of renal diseases. The most frequent nephropathies observed in patients with liver disease are: IgA nephropathy in alcoholic patients, cryoglobulinemic or non-cryoglobulinemic membranoproliferative glomerulonephritis, as well as membranous glomerulonephritis in patients infected by hepatitis B or C viruses, and finally the hepatorenal syndrome. Complementary investigations should be undertaken in any patient suffering from a liver disease and presenting with an impairment of the renal function in order to implement the most adequate specific therapy.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 1","pages":"Pages 12-18"},"PeriodicalIF":0.0,"publicationDate":"2005-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2004.12.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87818592","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":"Apoptose hépatique","authors":"G. Feldmann (Professeur)","doi":"10.1016/j.emchg.2004.12.005","DOIUrl":"https://doi.org/10.1016/j.emchg.2004.12.005","url":null,"abstract":"<div><p>Apoptosis or programmed cell death occurs in the liver as well as in other organs. In the normal state it is not a frequent event of hepatic cell destruction. Nevertheless morphological and biochemical characteristics of liver apoptosis do not differ from that it is observed in other cells. Between the various hepatic apoptotic pathways the Fas receptor pathway is frequently involved and its intra-cellular signal is amplified by mitochondria. Although hepatic apoptosis may occur through several others pathways, Fas which is abundantly expressed on the plasma membrane of hepatocytes and biliary cells, is very often involved in cell destruction during B or C viral hepatitis, whatever their clinical form, alcoholic hepatitis, primary biliary cirrhosis, cholestasis due to hepatic biliary salt accumulation, or drug hepatitis. In contrast, one of the causes for the resistance of hepatic cancerous cells to apoptosis could be due to an alteration of the Fas receptor. It is the reason why many experimental works are presently performed to inhibit the Fas receptor either at the level of its mRNA or at the level of caspases which are Fas-inductible proteolytic enzymes.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 1","pages":"Pages 35-48"},"PeriodicalIF":0.0,"publicationDate":"2005-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2004.12.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136699512","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}