Unusual case of duodenobiliary fistula complicating Crohn's disease successfully treated with Adalimumab

Crohn's disease [CD] is characterized by transmural inflammation of the gastrointestinal tract, which predisposes to the formation of fistula. Duodenal involvement occurs in less than 5% of cases and often leads to clinically relevant strictures. However, fistula formation in the duodenum is exceptional. Herein, we report an unusual case of duodenobiliary fistula due to CD occurring in a 65-year-old patient who was successfully treated by anti-tumor necrosis factor [TNF] agents. This case report highlights the efficacy of anti-TNF alpha agents in the treatment of a bilioenteric fistula because it increases the probability of clinical remission and mucosal healing and therefore reduces the need for surgical treatment which may be associated morbidity

[Prevalence of helicobacter pylori infection and gastroscopic finding in diabetic patients: case control study]

Current data on the prevalence of Helicobacter pylori infection in dyspeptic diabetic patients are contradictory in the literature. The aim was to assess the prevalence of Helicobacter pylori infection, gastroscopic lesions, and gastric histopathological lesions, in dyspeptic diabetic patients. It was a case-control study collecting 394 dyspeptic patients [194 diabetic and 200 nondiabetic patients]. The average age of patients was 47 years. 144 patients [47%] were male and 150 patients [53%] were female. The two patient groups were matched for age and sex. The prevalence of Helicobacter pylori infection was comparable between the two groups of patients [85% in diabetics versus 90% in the controls]. The frequency of gastroscopic lesions was 50% in diabetics and 55% in controls with no significant difference between the two groups. At histology, the prevalence of chronic gastritis, intestinal metaplasia, and gastric atrophy was 85%, 13% and 39% respectively in the group of diabetic patients. These results were comparable to those found in patients without diabetes. Our work shows no difference between diabetics and non-diabetics on the prevalence of Helicobacter pylori infection, gastroscopic, and gastric histopathological lesions

[ natural history of hepatitis B virus cirrhosis after the first hepatic decompensation in Tunisia]

To define the natural long term course of viral B cirrhosis after the onset of hepatic decompensation and to determine the predictive factors of death. Retrospective longitudinal study including 77 cases of viral B cirrhosis among 192 consecutive patients with cirrhosis, hospitalized between 1997 and 2005 for the first hepatic decompensation. All those patients were followed- up until death or until December 2006. The probability of survival after the first hepatic decompensation was calculated using the Kaplan Meier method. The predictive factors of death were determined through univariate and multivariate analyses with the Cox regression model. Fifty four men and 23 women with an average age of 54 +/- 14.9 years were hospitalized for the first decompensation of the viral B cirrhosis. The 77 patients had been under observation for an average period of 24.2 +/- 21.1 months. During that time 64% among them died. The probability of survival after decompensation was 47% in 2 years and 22% in 5 years. During follow- up, ascites was the most frequent decompensation [85%] followed by hepatic encephalopathy [38%], variceal hemorrhage [34%], jaundice [30%], hepato renal syndrome [27%], hepatocellular carcinoma [21%], and spontaneous bacterial peritonitis [14%]. At univariate analysis four factors were predictive of death: Child Pugh C score [p=0.009], hepatocellular carcinoma [p=0.01], rate of serum gammaglobulin superior to18g / l [p=0.008] and prothrombin time inferior to 50% [p=0.02]. According to the multivariate analysis only the rate of serum gammaglobulin superior to 18g /l was an independent predictive factor of mortality [p=0,001] with IC [95%] [1.623 - 5.88]. In Tunisia, the prognosis of viral B cirrhosis after the first decompensation is bad, because a patient on 5 only was able to survive beyond 5 years. Ascites is the most frequent decompensation. Only the rate of serum gammaglobulin superior to 18g / l is an independent predictive factor of mortality

particularity of helicobacter pylori chronic gastritis in the west center of Tunisia

The Helicobacter pylori [HP] is strongly associated with chronic gastritis. Our study was to determine prevalence of the HP chronic gastritis in the west center of Tunisia and to clarify the clinical and the histological particularities of this infection. It is a prospective study carried out from September 2002 to July 2005 and had included 352 patients. All the patients had an upper endoscopy in which five gastric biopsies were taken for a histological study. The biopsy specimens were fixed in 10% buffered formol and then included in paraffin. The specimens were cut at 4 pm and stained with Hematoxylin Eosin, modified Giemsa and Alcian bleu SAP. The histological examination revealed HP specimens, the lymphoplasmocytic infiltration, the gastritis activity, the gastric atrophy and the intestinal metaplasia according to Sydney system. They were 162 men and 190 women, with a mean age of 48,3 years. The erythematous antral gastritis was the most frequent at endoscopy [26, 7%] The prevalence of HP chronic gastritis was 89% in patients with endoscopic lesions The activity of the gastritis was 89,7% in the antrum and 52,2% in the fundus. The activity mean score in the antrum was 2, 1,8 and 0,3 respectively in the case of duodenal ulcer and gastric adenocarcinoma vs 0,68, 1,1 and 0,16 in gastric fundus. The prevalence of gastric atrophy was 35%. The atrophy was found in the antrum in 98% of cases. The prevalence of intestinal metaplasic was 11%. The HP chronic gastritis is very frequent in the west center of Tunisia. Its prevalence is found elevated since the adolescence. It predominate the gastric antrum. It is often associated with a duodenal ulcer rather than gastric cancer

Predictive factors of surgery in severe attacks of ulcerative colitis

The purpose of our study was to determine clinical, biological or endoscopic factors that predict surgery after a glucocortico steroid treatment failure in severe attacks of ulcerative colitis. Sixty one patients were analyzed. A therapeutic response for glucocorticosteroid was defined as the absence of resort to surgery within the first 30 days after hospitalization. Predictive factors were assessed using univariate and multivariate analysis. Fifteen patients [24,6%] had a medical response. In univariate analysis, predictive factors of surgery were: male sex, tobacco, number of colitis attacks in case history, temperature over 38°C, ery-throcyte sedimentation rate over 30 mm, systolic blood pressure below 11, deep and wide ulcers. During the course, bowel movements/ day over 7, pulse over 90/mn, temperature over 38°C on day 3 after treatment initiation as well as passage of blood on day 5 were identified as predictors of surgery. In multivariate analysis, bowel movements over II day on day 3 of hospitalization was independently predicted a surgery. Bowel movements/ day over 7 on day 3 of hospitalization was the only independently predictive factor of surgery after glu-cortico steroid treatment failure

Stromal tumors of the digestive tract: three small bowel localisation

Stromal tumors of the digestive tract are undifferenciated connective tissue tumors, identified as stemming of [pace-maker] cells of Cajal related to the immunohistochimical characterization of the phenotype. Report three new cases. We report three observations of the small bowel stromal tumors reveal by anemia in one case and mass formation in two cases. The aim of this study was to discuss the anatomo clinical, prognosis and management of these tumors

[Epidemiologic profile of gastric carcinoma: study of 140 cases]

The authors make a retrospective study of a series of 140 patients aged 59 years in average, followed up from 1995 to 2002 for adenocarcinoma of the stomach. Surgical resection was performed in 79 percent of the patients with total gastrectomy in 15.4%, partial gastrectomy in 50.6%. Resection was considered as curative in 66%. Lymph node metastases were present in 42, 9 percent of the patients. Margins of resection were involved in 24, 5% of the specimens. The mean survival rate was 26.5 months, 13 months and 5 months after curative resection, palliative resection and without resection

[Biliary attacks of surgery of the liver hydatid cyst]

The goal of this work was to describe secondary biliary attacks due to liver hydatid cyst surgery and see their different physiopathological mechanisms again. We report three cases of secondary sclerosing cholangitis. There were three women aged 20, 40 and 60 years. respectively. Icterus was the primary sign in the three cases. The three patients were operated on for liver hydatid cyst with a peroperative injection of the scolicide product. The diagnosis of secondary sclerosing cholangitis was based on the thin aspect of the biliary ducts. The generally benign liver hydatid cyst disease may be the cause of a serious and final biliary attack