[Autoimmune hepatitis in Tunisia. Retrospective multicentric study about 83 cases]

Autoimmune hepatitis [AIH] is a chronic inflammatory condition of the liver of unknown etiology. Its epidemiological and anatomoclinical characteristics and its outcome were unknown in Tunisia. To analyse epidemiological, anatomoclinical, immunological and histological aspects of AIH and to determine factors predicting relapse after treatment and death of this disease in Tunisia. Patients presenting with AIH between January 1996 and December 2004 were evaluated in retrospective multicentric study. The diagnosis of AIH was established according to the criteria of the revised score of the international autoimmune hepatitis group [1999].Eighty three patients were identified [70 female; mean age = 49 + 17,9 years]. 63% presented probable AIH and 5% of cases were type II HAI. Fifty seven percent of the patients were cirrhotic at presentation. Associated autoimmune diseases was seen in 27 patients, dominated by diabetes, autoimmune thyroiditis and SjOgren's syndrome. An overlap syndrome was diagnosed in 25% of cases; primary biliary Cirrhosis-AIH in 20% of cases and primary sclerosing cholangitis-AIH in 5% of cases. Fifty patients were treated by glucocorticoids as monotherapy or in combination with azathioprine. Complete remission was achieved in 90% of cases. Fourteen percent relapsed within a median time of 12 months. Factors associated with relapse were: treatment with Azathioprine <18 months, absence of lobular necrosis and anti-nuclear antibody [+] profile. Mortality was observed in 17% of cases. Factors associated with death were encephalopathy as an independent factor and treatment with Azathioprine <18 months. In Tunisia, epidemiological and clinical characteristics of AIH were similar to those reported in the literature but with a higher frequency of cirrhosis at presentation. Treatment with Azathioprine <18 months was the main factor associated with relapse and represented with encephalopathy a factor associated with death

[Spontaneous intrahepatic porto-cava shunt associated with chronic pericarditis. A case report]

Introduction: Spontaneous intrahepatic portosystemic shunts are rare vascular anomalies that consist of a communiation between the portal system and the systemic venous circulation. We report a case of a porto-caval shunt associated with chronic pericarditis

Case report: A 47-year-old patient with post pericarditis cirrhosis and without encephalopathy and hypoglycaemia. The shunt was tubular in its initial segment and aneurismal just before joining the vena cava

Discussion: Spontaneous intrahepatic portosystemic shunt is a rare anomaly. Diagnosis can ve made by Doppler ultrasound and helical CT

[Isolated Crohn's disease of the stomach presented as plastic linitis. One case report]

Introduction: Crohn's disease of the stomach is rare. There is nearly always concomitant disease in the small bowel or colon. Gastric involvement occurs rarely as an isolated entity. Upper endoscopy is sensitive for detecting subtle disease but more extended lesions can mimic neoplasms such us linitis

Exegese: A 74-year old female was admitted to hospital with abdominal pain, vomiting and weight loss. Upper endoscopy and radiology aspects was suspicious of gastric linitis. Multiple endoscopic biopsies of the stomach showed one granuloma, chronic inflammation and Helicobacter Pylori. Because of the importance of obstructive syndrome, the patient underwent surgery. The resected stomach concluded to a Crohn's disease

Conclusion: Through this observation, we review clinical characteristics, diagnostic difficulties and treatment options of Crohn's disease of the stomach

[Early gastric cancer - two case reports]

Gastric cancer is a serious disease with a high mortality rate. Early diagnosis of the disease improves its prognosis. We report two cases of early gastric cancer and we specify the clinical, endoscopic, histologic and therapeutic aspects of the disease. This study is about two female patients, respectively, 36 and 70 years old. The diagnosis of early gastric cancer was based on pathologic examination of the resected stomach.The two patients are in remission 2 years and 6 months later, respectively. The diagnosis of early gastric cancer is often made on nonspecific symptoms. Oeso-gastro-duodenoscopy shows gastric mucosal anomalies. Pathologic examination of gastric biopsies confirm the diagnosis of adenocarcinoma. Endoscopic ultrasound is essential; it specifies the submucosal infiltration and evaluates the lymph node invasion. Surgery is the primary treatment but in some cases endoscopic mucosal resection provides good long-term results. Early diagnosis of adenocarcinoma improves the prognosis of the disease, which remains poor nowadays

Traitement des pochites par les probiotiques

the aim of the study was to review the principal effects of probiotics on pouchitis and identify their mechanisms of action. the study was based on a review of all relevant studies published in the literature on the effects of probiotics in pouchitis and their possible mechanisms of action. pouchitis is the major long-term complication after ileal pouch anal anstomosis for ulcerative colitis. The cause is still unknown but is likely to be multifactorial. An imbalance in the usual fecal flora was recently suggested. Most patients with symptoms of pouchitis respond promptly to antibiotics. However, 5-10% of them develop rapidly relapsing symptoms that require protacted therapy. Porbiotics are living microorganisms that ingested in adequate amounts exert beneficial effects. Promising results have been obtained with probiotics mainly in maintenance of remission of chronic pouchitis and also as induction of remission. These results suggest that restoring the microbial imbalance may offer an effective therapeutic alternative to patients with pouchitis

Role de la flore intestinale dans les maladies inflammatoires chroniques de l'intestin et place des probiotiques dans leur prise en charge

The pathogenic role of certain microorganisms of intestinal flora has been demonstrated in experimental colitis in animals and strongly suspected in inflammatory bowel disease in human, especially in Crohn's disease and pouchitis. Probiotics are living non pathogenic microorganisms that, upon oral ingestion exert benefits on human health by modulating enteric flora or by stimulation of local immune system. The aim of this article is to remind the role of intestinal flora in inflammatory bowel disease, the mechanism of inflammation induced by this flora and to review through the literature, the different clinical studies performed with probiotics in human

Pathogenie de l'hepatite auto-immune

the aim of the study was to review the pathogenic mechanisms of auto-immune hepatitis. the study was based on a review of all relevant articles from literature on the mechanisms of auto-immunity in auto-immune hepatitis. the precise mechanisms through which liver damage occurs are not fully understood. Autoimmune hepatitis seems to be a consequence of auto-antigen exposure, genetic predisposition and defective immuregulatory mechanisms. Auto-antigen is presented by class II molecules of the major histocompatibility complex. Cytokines and non specific auto-immune promoters modulate immune reactivity. Cellmediated and antibody-dependent forms of cytotoxicity are probably interactive pathogenic mechanisms. disturbance in the tight balance between auto aggression and self-tolerance, affected by several internal and external factors are likely in auto-immune hepatitis