[Clinicobiological and morphological profiles of primary sclerosing cholangitis in Tunisia]

Primary sclerosing cholangitis [PSC] is a chronic cholestatic disease strongly associated, in the western series, to inflammatory bowel disease [IBD] and particularly to chronic ulcerative colitis. North African data are rare. To study the epidemiological, clinicobiological and morphological profile of PSC in Tunisia. A retrospective multicenter study extended over a period of 14 years [1995-2009], including all patients suffering from PSC, hospitalized in the four participants departments. We collected epidemiological, clinico-biological, histopathologic and morphological data for each patient. We brought together 33 patients [22 men and 11 women], middle aged 44 years. The disease was symptomatic in 73% of cases. Laboratory tests showed cholestasis [100%] associated with hyperbilirubinemia [72%] and a moderate cytolysis [78%]. Morphological analysis of bile ducts by cholangioMRI or endoscopic retrograde cholangio-pancreatography objectified diffuse damage of the biliary tract in 61% of cases. Association with IBD was found in 33% of cases [Crohn's Disease: 27%, chronic ulcerative colitis: 6%]. An association with autoimmune hepatitis was found in 6% of cases and primary biliary cirrhosis in 3% of cases. PSC is rare in Tunisia and affects men more often than women. The association with IBD is less frequent than in literature. It concerns essentially Crohn's disease. These data require confirmation by prospective multicenter studies

[Tunisian version validation of quality life's questionnaire for chronic inflammatory disease of intestine]

The systematic evaluation of the quality of life is essential in the management of patients with chronic bowel disease [IBD] inflammatory diseases. Translate in Tunisian Arabic dialect the English version of "inflammatory bowel disease questionnaire" [UK- IBDQ] and validated by studying its psychometric validity, discriminative ability, reliability and sensitivity to change. 80 Tunisian patients with IBD completed the Tunisian version of the IBDQ [T- IBDQ], a visual analog scale, the SF- 36, the Harvey- Bradshaw index for Crohn's disease, and the index Simple clinical colitis activity for ulcerative colitis. The T- IBDQ included in the final version 5 fields. The internal validity of the items was satisfactory for all patients. TIBDQ was correlated with scores of SF- 36, visual analog scale scores and indices of activity of IBD. T- IBDQ distinguish between active disease and inactive disease. He was also sensitive to changes in disease activity. We validated in this work a Tunisian dialect Arabic version of the IBDQ: T- IBDQ. Its validity, discriminative ability, reliability and sensitivity to change were demonstrated

rare cause of dysphagia in a pregnant woman: herpes simplex esophagitis

Herpes simplex esophagitis [HSE] has rarely been reported in immunocompetent individuals. In a search of Medline until October 2012, we found only one case of HSE in a pregnant female. We present the first case of HSE in a healthy 36-year-old female at 27 weeks gestation who recovered without antiviral therapy

Oxidative stress markers in intestinal mucosa of Tunisian inflammatory bowel disease patients

Inflammatory bowel diseases [IBDs], Crohn's disease [CrD] and ulcerative colitis [UC], are chronic gastrointestinal inflammatory disorders. The precise etiology of IBD remains unclear, and it is thought that interactions among various factors, including, genetic factors, the host immune system and environmental factors, cause disruption of intestinal homeostasis, leading to dysregulated inflammatory responses of the gut. As inflammation is intimately related to formation of reactive intermediates, including, reactive oxygen species, oxidative stress has been proposed as a mechanism underlying the pathophysiology of IBD. The purpose of this study is to examine the lipid peroxidation, protein oxidation and anti-oxidative profile in Tunisian IBD. Malondialdehyde [MDA], conjugated dienes [CD], protein thiol levels, as well as the catalase [CAT] activity were evaluated in intestinal biopsies of 17 patients affected by IBD [12 CrD and 5 UC] and 12 healthy control individuals. Oxidative stress was confirmed in these two types of disease biopsies as compared to controls. MDA and CD levels were significantly increased in both UC and CrD patients' biopsies as compared to controls' biopsies [P < 0.001]. CAT activity was similar in UC and CrD biopsies' and was not significantly increased in IBD patients' biopsies compared with controls' biopsies [P > 0.05]. A non-significant decrease in thiol [SH] level was observed in both UC and CrD patients' biopsies compared with controls' biopsies [P > 0.05]. Increased levels of MDA and CD in IBD patients' biopsies underline the implication of oxidative stress in the physiopathology of IBD

[Emotional disorders and inflammatory bowel disease]

The co-occurrence of emotional disorders [alexithymia, depression and anxiety] and inflammatory bowel disease [IBD] is reported in the literature. There are several possible explanations for this co morbidity. To evaluate the prevalence of alexithymia, anxiety and depression among patients with IBD and to compare them with a control group of healthy individuals and to discuss the relation between emotional disorders and IBD. We built a case - control study of 50 patients with IBD [ulcerative colitis [UC] and Crohn's disease [CD]]. The control group compounded 50 subjects without IBD and paired according sex, age, and school level. Alexithymia was assessed with the 20-item version of the Toronto Alexithymia Scale [TAS -20]. Participants completed the Hospital Anxiety and Depression Scale [HADS], which is a 14-item self-report scale providing separate subscale scores for anxiety [HADS-A] and depression [HADS-D]. Among the group of patients, the rates of anxiety, depression and alexithymia were, respectively, 52%, 44% and 54%. In this group, there were significantly more anxious, depressed, and alexithymic subjects than in the control group [p respectively, 0, 007, 0, 015 and 0, 002]. The anxiety and the depression were more frequent among patients who had active disease or symptoms than those in remission [p respectively, 0, 011 and 0, 035]. The comorbidity of emotional disorders and IBD seems to be frequent. Therefore, clinicians should look for those disorders in patients with IBD, by using specific scales. The adjunction of emotional disorder treatment, if needed, would allow optimizing the management of MICI

[Large gastric diverticulum]

Gastric diverticula are infrequent anatomic abnormalities that are usually asymptomatic. We report a case of large gastric diverticulum and discuss disgnostic and therapeutic challenges. A 63-year-old man was admitted with vague epigastric discomfort. Physical examination and laboratory investigations were normal. Endoscopy revealed and erosive gastropathy and a pouch arising from the posterior aspect of the greater curve, 8 cm form the hiatus. Barium meal confirmed the presence of a 5 cm diameter diverticulum arising from the gastric fundus. Careful examination of the whole stomach at gastroscopy is recommended for not missing a diverticulum

Health- related quality of life in patients with inflammatory bowel disease: a tunisian study

Inflammatory bowel disease [IBD] impairs healthrelated quality of life [HRQOL]. To describe HRQOL in Tunisian patients with IBD and to compare it with a reference population. HRQOL was assessed with the Tunisian versions of the Medical Outcomes Study Short Form 36 [SF 36] and the Inflammatory Bowel Disease Questionnaire [IBDQ-32]. Sixty two IBD patients were included [23 CD, 39 UC]. The control group consisted of 62 healthy subjects. We have shown that HRQOL in Tunisian patients with IBD, measured with the SF-36, is lower than that of a Tunisian reference population without significant differences. Using the IBDQ-32, we found lower scores in women, in patients with CD, with material deprivation, and with active disease.Factors such as the experience of previous relapses or hospitalisations, disease duration, previous resective surgery, remission duration, maintenance therapy, marital status and smoking status do not have a significant impact on HRQOL in these patients. Most patients with established inflammatory bowel disease showed only minor impairment of their HRQOL. However, women and the patients suffering from active and Crohn's disease as well as the materially deprived patients are most at risk.. Better clinical care and psychological counseling for these more vulnerable groups may improve their quality of life

Cutaneous manifestations of inflammatory bowel disease

Cutaneous manifestations are relatively common complications of inflammatory bowel disease, although they vary widely. At the time of inflammatory bowel disease diagnosis, the mean incidence of these manifestations is around 10%. The aim of this article was to review some of the noteworthy skin disorders associated with inflammatory bowel disease. An electronic research of the medical literature was carried out on the web sites [PubMed], [ScienceDirect] and [Interscience Wiley]. The cutaneous manifestations associated with inflammatory bowel disease were divided into 3 groups based on the nature of the association: granulomatous cutaneous disease, reactive skin eruptions and other associated dermatoses. In this review, focus has been given on granulomatous cutaneous disease and reactive skin eruptions. Patients presenting with inflammatory bowel disease should be examined for cutaneous manifestations. For most of these cutaneous manifestations, the primary therapeutic target remains the bowel

[Histological features of celiac disease in south Tunisia: a study of 114 paediatric cases]

To report the histological features of celiac disease in a paediatric population originating from south Tunisia. A retrospective study of a series of duodenal biopsies from 114 children with celiac disease diagnosed over a period of 6 years [from January 1999 to December 2004]. The diagnosis was confirmed by histological results, serological studies and clinical response to gluten free diet. The average age of patients was of 6.2 years [range 6 months-15 years]. Sex ratio was 0.71. Symptoms were dominated by chronic diarrhea [48%], weight loss [50%] and anemia [20.1%]. Histological findings showed an intraepithelial lymphocytosis [Marsh type 1] in 12.2% of cases, type 2 was present in 1.7% of cases and type 3 [villous atrophy] in 86% of cases. A treatment with a gluten-free diet was indicated for all patients, only the cases who haven't presented a clinical amelioration [11 cases] have beneficed a control biopsie; a villous atrophy was persistent in 80% of this patients. Histological features in duodenal biopsies for the diagnosis and the follow-up of patients with coeliac disease. This allows an appropriate treatment and prevents further complications

Giant lipoma of the transverse colon: a case report and review of the literature

Colonic lipomas are benign adipose tumors which are usually submucosal. Small lesions are asymptomatic and may be detected incidentally. Large lipomas can cause symptoms. We report a case of symptomatic giant colonic lipoma. A 67-year old woman was admitted to hospital with persistent abdominal pain, for which a barium enema showed a large polypoid mass occluding the lumen of the transverse colon. Colonoscopy revealed a tumor narrowing the bowel lumen of about 5 cm in diameter with a sessile appearance and ulcerated overlying mucosa. The possibility of colonic malignancy could not be precluded and an operative resection was performed. Pathological examination revealed a colonic lipoma. Twelve months after the surgery, the patient was free of symptoms. Awareness of the possibility of colonic lipomas is important for clinicians in terms of evaluation of therapeutic regimen