La Presse Médicale Formation最新文献

{"title":"Sommaire","authors":"","doi":"10.1016/S2666-4798(25)00050-3","DOIUrl":"10.1016/S2666-4798(25)00050-3","url":null,"abstract":"","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"6 2","pages":"Article 100644"},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143687709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ours redaction","authors":"","doi":"10.1016/S2666-4798(25)00049-7","DOIUrl":"10.1016/S2666-4798(25)00049-7","url":null,"abstract":"","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"6 2","pages":"Article 100643"},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143687708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colite aiguë grave","authors":"David Laharie,&nbsp;Gaëlle Tyrode","doi":"10.1016/j.lpmfor.2025.100632","DOIUrl":"10.1016/j.lpmfor.2025.100632","url":null,"abstract":"<div><div>Un épisode de colite aiguë grave (CAG) est observé chez un quart des personnes atteintes de rectocolite hémorragique (RCH) et peut correspondre à la poussée inaugurale de la maladie.</div><div>La mortalité de la colite aiguë grave (CAG) sur RCH est de l’ordre de 1 %, elle est avant tout liée à l’âge du patient et aux comorbidités associées.</div><div>Avec une efficacité de 60 %, la corticothérapie intraveineuse demeure le traitement médical de première ligne de la CAG.</div><div>Les inhibiteurs de calcineurine (ciclosporine) et l’infliximab constituent les deux alternatives médicamenteuses à la colectomie en urgence en cas de CAG cortico-résistante.</div><div>En raison d’une mortalité élevée, les patients les plus âgés et les plus fragiles doivent être confiés rapidement confiés au chirurgien.</div><div>Le positionnement des nouveaux traitements médicaux de la RCH non grave est à confirmer dans le cadre de la CAG.</div></div><div><div>An episode of acute severe ulcerative colitis (ASUC) occurs in a quarter of patients having ulcerative colitis and may be the first attack of the disease.</div><div>The current mortality rate for ASUC is approximately 1%, it is primarily related to age and co-morbidities.</div><div>With a success rate of 60%, intravenous corticosteroids remain the first-line medical treatment for ASUC.</div><div>Calcineurin inhibitors (ciclosporin) and infliximab are the two second-line medical therapies for ASUC patients refractory to intravenous steroids.</div><div>Because of the high mortality rate, elderly and/or frail patients should be rapidly referred to the surgeon.</div><div>Positioning of new medical treatments for non-severe UC remains to be confirmed in the context of ASUC.</div></div>","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"6 2","pages":"Article 100632"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143687628","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":"MICI : tous concernés !","authors":"Mathurin Fumery","doi":"10.1016/j.lpmfor.2025.100634","DOIUrl":"10.1016/j.lpmfor.2025.100634","url":null,"abstract":"<div><div>Les maladies inflammatoires chroniques de l’intestin (MICI), incluant la maladie de Crohn (MC) et la rectocolite hémorragique (RCH), sont devenues un enjeu majeur de santé publique en raison de leur incidence croissante, qui touchera 0,6 % de la population française d’ici 2025. Alors que le nombre de facteurs environnementaux pourrait être important, des mesures préventives ambitieuses semblent justifiées. La prise en charge, complexe et multidisciplinaire, implique gastro-entérologues, médecins généralistes et spécialistes divers, notamment pour gérer la surveillance des traitements, les manifestations extra-digestives ou les complications. Les avancées thérapeutiques récentes visent des objectifs de plus en plus ambitieux comme la rémission profonde. Ce numéro spécial a pour but de diffuser des connaissances pratiques pour mieux accompagner les patients face à ces pathologies.</div></div><div><div>Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), had become a major public health challenge due to their increasing incidence, projected to affect 0.6% of the French population by 2025. While the number of environmental factors involved may be significant, this justifies the implementation of ambitious preventive measures. The management of IBD is complex and multidisciplinary, involving gastroenterologists, general practitioners, and various specialists, particularly for monitoring treatments, managing extra-intestinal manifestations, or addressing complications. Recent therapeutic advances aim for increasingly ambitious goals, such as deep remission. This special issue aims to disseminate practical knowledge to better support patients facing these diseases.</div></div>","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"6 2","pages":"Article 100634"},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143687713","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":"Endoscopie et maladie inflammatoire chronique intestinale","authors":"Clara Yzet,&nbsp;Franck Brazier,&nbsp;Mathurin Fumery","doi":"10.1016/j.lpmfor.2025.100633","DOIUrl":"10.1016/j.lpmfor.2025.100633","url":null,"abstract":"<div><div>La rémission endoscopique est l’objectif actuel à atteindre dans les MICI.</div><div>Les scores endoscopiques d’activité permettent d’uniformiser les pratiques.</div><div>Le traitement endoscopique des manifestations sténosantes est efficace et sûr.</div><div>La surveillance endoscopique est primordiale pour le dépistage des lésions dysplasique dans les MICI.</div><div>Le traitement endoscopique des lésions dysplasiques visibles est possible même pour des lésions de grandes tailles.</div></div><div><div>Endoscopic remission is the the goal to achieve in IBD patients.</div><div>Endoscopic activity scores help standardize practices.</div><div>Endoscopic treatment of stricturing Crohn's disease is effective and safe.</div><div>Endoscopic surveillance is essential for detecting dysplastic lesions in IBD.</div><div>Endoscopic treatment of visible dysplastic lesions is possible even for large lesions.</div></div>","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"6 2","pages":"Article 100633"},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143687630","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":"Manifestations extra-intestinales des MICI","authors":"Lucas Guillo","doi":"10.1016/j.lpmfor.2025.100629","DOIUrl":"10.1016/j.lpmfor.2025.100629","url":null,"abstract":"<div><div>Les manifestations extra-intestinales des MICI concernent près d’un patient sur deux.</div><div>Elles peuvent se déclarer avant la MICI dans un quart des cas.</div><div>Les manifestations articulaires et cutanéo-muqueuses sont les plus fréquentes.</div><div>La coordination avec un spécialiste référent est souvent nécessaire pour un diagnostic et une prise en charge adéquats.</div><div>Les anti-TNF alpha ont démontré leur efficacité dans la majorité des manifestations extra-intestinales.</div></div><div><div>Extraintestinal manifestations of IBD affect nearly one in two patients.</div><div>They may appear before the onset of IBD in about a quarter of cases.</div><div>Joint and cutaneous-mucosal manifestations are the most common.</div><div>Coordination with a referring specialist is often necessary for optimal diagnosis and management.</div><div>Anti-TNF alpha agents have proven effective in managing most extra-intestinal manifestations.</div></div>","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"6 2","pages":"Article 100629"},"PeriodicalIF":0.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143687629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Épidémiologie et histoire naturelle des maladies inflammatoires chroniques de l’intestin","authors":"Nicolas Richard,&nbsp;Guillaume Savoye","doi":"10.1016/j.lpmfor.2025.100631","DOIUrl":"10.1016/j.lpmfor.2025.100631","url":null,"abstract":"<div><div>Les zones où l’augmentation de l’incidence est la plus élevée sont les pays en cours d’industrialisation.</div><div>Les zones avec la plus forte prévalence de maladies inflammatoires chroniques de l’intestin sont l’Amérique du Nord, l’Europe, le Japon et l’Australie.</div><div>Le principal pic d’incidence des MICI se situe entre 20 et 30 ans.</div><div>Les facteurs de risque environnementaux représentent, en l’état actuel de nos connaissances, la principale explication de la répartition hétérogène de ces pathologies.</div><div>L’histoire naturelle de la maladie de Crohn est marquée par le risque d’extension transmurale conduisant à la survenue de fistules, d’abcès et de sténoses au dépend du segment digestif atteint.</div><div>L’histoire naturelle de la RCH est marquée par le risque d’extension rétrograde de l’inflammation.</div></div><div><div>The greatest increases in incidence are observed in industrializing countries.</div><div>Chronic inflammatory bowel disease is most prevalent in North America, Europe, Japan, and Australia.</div><div>The incidence of inflammatory bowel disease peaks between the ages of 20 and 30.</div><div>Based on current knowledge, environmental risk factors primarily explain the heterogeneous distribution of these diseases.</div><div>Crohn's disease is characterized by the risk of transmural extension, which can lead to fistulas, abscesses, and stenoses in the affected digestive tract.</div><div>Ulcerative colitis is characterized by the risk of retrograde inflammation extending further into the colon.</div></div>","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"6 2","pages":"Article 100631"},"PeriodicalIF":0.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143687714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traitement de la rectocolite hémorragique en 2024","authors":"Guillaume Le Cosquer,&nbsp;Cyrielle Gilletta","doi":"10.1016/j.lpmfor.2025.100630","DOIUrl":"10.1016/j.lpmfor.2025.100630","url":null,"abstract":"<div><div>Les traitements de première intention pour les formes légères à modérées incluent les 5-aminosalicylates (5-ASA), administrés en topique et par voie orale.</div><div>Pour les formes modérées à sévères, une corticothérapie est utilisée pour induire la rémission, suivie d’un traitement de fond.</div><div>Le védolizumab et l’infliximab sont les 2 options à privilégier en 1^re ligne de thérapie avancée.</div><div>Après échec des anti-TNF, bien que le védolizumab ait une efficacité, l’ustékinumab semble être plus efficace.</div><div>Les anti-JAK semblent être la meilleure option en 3^e ligne, excepté chez le sujet à risque d’effets secondaires (plus de 65 ans notamment) et chez la femme en âge de procréer (du fait de leur contre-indication en cas de grossesse).</div><div>Les alternatives thérapeutiques en cas colite aiguë grave corticorésistante sont l’infliximab, la ciclosporine, les anti-JAK et la chirurgie.</div><div>La chirurgie reste une option pour les cas de maladies réfractaires et en cas de complications néoplasiques.</div></div><div><div>First-line treatments for mild to moderate UC include 5-aminosalicylates (5-ASA), administered topically and orally.</div><div>For moderate to severe forms, corticosteroid therapy is used to induce remission, followed by maintenance treatment.</div><div>Vedolizumab and infliximab represent the best option as first-line advanced therapy.</div><div>After anti-TNF failure, although vedolizumab has shown efficacy, ustekinumab appears to be more efficient.</div><div>JAK inhibitors seem to be the best option in third-line treatment, except for patients at risk of side effects (particularly those over 65) and women of childbearing age (due to their contraindication during pregnancy).</div><div>Therapeutic alternatives for severe acute steroid refractory colitis include infliximab, cyclosporine, JAK inhibitors, and surgery.</div><div>Surgery remains an option for refractory disease cases and in cases of neoplasic complications.</div></div>","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"6 2","pages":"Article 100630"},"PeriodicalIF":0.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143687654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quelle place pour la chirurgie dans la maladie de Crohn et la rectocolite hémorragique en 2025 ?","authors":"Charles Sabbagh","doi":"10.1016/j.lpmfor.2025.100628","DOIUrl":"10.1016/j.lpmfor.2025.100628","url":null,"abstract":"<div><div>Malgré le développement des thérapeutiques médicamenteuses, la chirurgie garde une place de choix dans la prise en charge des maladies inflammatoires chroniques de l’intestin (MICI). Le but de cette mise au point est de préciser la place de la chirurgie dans la prise en charge des maladies inflammatoires chroniques de l’intestin et de préciser les données récentes de la littérature sur ce sujet.</div></div><div><div>Despite advancements in drug therapies, surgery remains a cornerstone in the management of chronic inflammatory bowel diseases (IBD). The aim of this review is to clarify the role of surgery in the treatment of chronic inflammatory bowel diseases and to present recent findings from the literature on this topic.</div></div>","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"6 2","pages":"Article 100628"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143687631","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":"Les objectifs thérapeutiques dans les MICI","authors":"Catherine Le Berre","doi":"10.1016/j.lpmfor.2025.100627","DOIUrl":"10.1016/j.lpmfor.2025.100627","url":null,"abstract":"<div><div>La discordance entre symptômes et inflammation est fréquente en cas de maladie inflammatoire chronique de l’intestin.</div><div>Depuis le consensus STRIDE en 2015, les cibles thérapeutiques sont de plus en plus strictes du fait du développement rapide de nouvelles thérapies nous permettant d’être plus ambitieux.</div><div>La rémission clinique reste l’objectif premier à court terme (1–3 mois), suivie de la normalisation des biomarqueurs à moyen terme (3–6 mois), puis de la cicatrisation endoscopique à long terme (6–12 mois).</div><div>À l’heure actuelle, la cicatrisation histologique dans la rectocolite hémorragique et la cicatrisation transmurale dans la maladie de Crohn ne sont pas considérées comme cibles thérapeutiques formelles, mais plutôt comme des marqueurs de la profondeur de rémission.</div><div>Le développement de technologies non invasives comme l’échographie intestinale permet un suivi plus fréquent et moins contraignant.</div><div>Certaines formes complexes multi-réfractaires imposent probablement d’être moins ambitieux que le consensus STRIDE-II, mais l’objectif ultime reste dans tous les cas la restauration de la qualité de vie du patient et la réduction du fardeau lié à la maladie.</div><div>L’impact d’une telle stratégie sur le cours évolutif naturel de la maladie reste à démontrer dans des essais dédiés (« disease modification trials »).</div></div><div><div>Discordance between symptoms and inflammation is common in patients with inflammatory bowel disease.</div><div>Since the STRIDE consensus in 2015, therapeutic targets have become increasingly stringent due to the rapid development of new therapies enabling us to be more ambitious.</div><div>Clinical remission remains the primary goal in the short term (1–3<!--> <!-->months), followed by biomarker normalization in the medium term (3–6<!--> <!-->months), then endoscopic healing in the long term (6–12<!--> <!-->months).</div><div>At present, histological healing in ulcerative colitis and transmural healing in Crohn's disease are not considered formal therapeutic targets, but rather markers of the depth of remission.</div><div>The development of non-invasive technologies such as intestinal ultrasound enables more frequent and less restrictive follow-up.</div><div>Some complex, “difficult-to-treat” forms probably call for less ambition than the STRIDE-II consensus, but the ultimate goal in all cases remains the restoration of the patient's quality of life and the reduction of the disease-related burden.</div><div>The impact of such a strategy on the natural course of the disease remains to be demonstrated in dedicated disease modification trials.</div></div>","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"6 2","pages":"Article 100627"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143687715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}