[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

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

[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

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

[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

Inhibiteurus selectifs de la cyclo-oxygenase-2 et tube digestif

The use of non steroidal anti-inflammatory drugs [NSAIDS] is tempered by the development of side effects primarily in the gastro-intestinal tract. These effects result mainly from inhibition of the enzyme cyclo-oxygenase [COX]-1. Two NSAIDS [celecoxib and rofecoxib] COX-2 specific inhibitors had considerably lower ulcerogenic rates and lower serious gastro intestinal side effects when compared with other NSAIDs used in rhumatoid arthritis and osteoarthritis. However, the exact place of COX-2 specific inhibitors remain to be determined as compared with the association of other NSAIDs and proton pump inhibitors in the elderly. The efficacy of COX-2 specific inhibitors in digestive tumors is still unclear