[Efficiency of endoscopic treatment with intra gastric balloon in severe to morbid obesity]

Obesity raises such a healthcare matter throughout the world. Its management is not only complex but also most often multidisciplinary. The medico-dietary treatment is of inconstant efficiency and the surgical treatment, though more efficient, presents a considerable morbidity-death rate. The endoscopic treatment through intra-gastric balloon avails a seducing alternative namely accounting for surgery preparation. To assess the efficiency of the endoscopic treatment through gastric balloon, both in the short and long term, and this is accounting for weight loss as well as tolerance. We have carried out a retrospective study including the patients suffering from severe to morbid obesity and who had a gastric balloon implemented in our Endoscopy Unit between November 2005 and December 2007. Twenty one patients were included. The average age was 32,19 +/- 12,65 years with extremes of 16 and 52 years. Fifteen patients suffered from morbid obesity. The patients' average weight was 134, 52 +/- 26,46 kg [extremes 88 and 194 kg]. Some co-morbidity was found out with 15 patients. Te balloon implementation [Héliosphère[registered sign]] was carried out with no incidents in all patients. Six months after the balloon implementation, the average weight loss was17,5% and the average loss of overweigh was 37%. In biological level, we noted a normalisation of fasting glycaemia in 28,6 % of cases, of the cholesterolemia in 100 %, of the triglyceridemia in 33,33%, of the uraemia in 42,8% and hepatic tests in 50 % of the cases. The metabolic syndrome disappeared in 28,57 % of cases. The assessment after a 5-year-period was marked by the need to surgical treatment in 4 patients and this is due to the loss of efficiency of endoscopic treatment. A bad tolerance of gastric balloon was observed in 34 % of the cases, dominated by sicknesses. Only one patient presented incoercible sicknesses with ionic troubles as well as deshydrating requiring the precocious extraction of the balloon after 48 hours of its implementation. The endoscopic treatment through intra gastric balloon is well tolerated but efficiently limited in time. It might be recommended in preparation for a surgical treatment or in case of contre- indication or surgery refusal

[Factors predicting mortality in infected hospitalized cirrhotics patients: about 97 cases]

Infections are frequent in cirrhotic patients. They are potentially severe, modifying pejoratively the natural history of the cirrhosis and are suppliers of a heavy mortality. To determine the predictive factors of hospital mortality in cirrhotic infected patients. We conducted a retrospective study including 97 cirrhotic patients hospitalized in the department of gastroenterology of Charles Nicolle's hospital, for a first infectious episode and not having received antibiotics in the previous 15 days. Clinico-biological, bacteriological, therapeutic and evolutionary data were collected. Scores were adopted and calculated such as the score of Child-Pugh, the score MELD [The Model for End-Stage Liver Disease] and the score SOFA [Sequential Organ Failure Assessment]. These data allowed a descriptive study and an uni and multi-varied analysis. The median age of the studied population was of 59 +/- 12 years with a sex ratio of 0.83. The diabetes was the comorbidity most frequently associated with the cirrhosis [26.8% of the cases] Viral aetiology of the cirrhosis was dominant [3/4 of the cases] especially the virus C [62.5% of the cases]. The clinical presentation of the infection was polymorphic with presence of symptoms connected to the infection and the other connected to the progression of the liver disease. The fever was absent in 3/4 of the cases. The identified infections were, in order of frequency, urinary, infection of ascite, bronchopulmonary, cutaneous and gynecological. The responsible germs were especially bacilli gram negative of intestinal origin. The estimated scores of gravity were: a score of Child-Pugh C in 60% of the cases, an average score MELD in 18 +/- 8 points and a score average SOFA in 8 +/- 4 points. Multivariate study found that only encephalopathy, bilirubin level more than 40 micro mol/l and creatinin level more than 120 micro mol/l was independent factors predicting mortality. Infection in cirrhotic patients was a severe and mortal complication. The hepatic encephalopathy, the hyper bilirubinemia and the renal failure are predictive of the hospital mortality. The use of the scores of gravity: Child-Pugh, MELD and SOFA would an important help for the decision to admit in intensive care unit any infected cirrhotic patient

[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

[Nephrogenic ascites: an exceptional diagnosis. about one case]

Nephrogenic ascites is a clinical entity that manifests as refractory and exsudative ascites with unknown etiology in patients with end stage renal disease and often undergoing hemodialysis. This entity presents in practice many diagnostic and therapeutic difficulties. The aim of this study is to focus on these difficulties through a new observation. We report one case of nephrogenic ascites in chronic renal failure related to an idiopathic neurologic bladder. It's a 38 years old patient on hemodialysis for three years who consulted for exsudative ascites with a low rate of leucocytes. We conclude that nephrogenic ascites is rare. Its diagnosis is an exclusion diagnosis based on exclusion of other causes of ascites, particularly exsudative forms with low leucocytes rate. Its management is based essentially on renal transplantation and its prognosis is very poor

[Prevalence of malnutrition in gastroenterology hospitalized patients: a 70 patients prospective study]

Malnutrition is a common problem in gastroenterology hospitalized patients. Its frequency varies considerably with the studied population and nutritional screening tools. The purpose of this study was to assess the prevalence of malnutrition in gastroenterology hospitalized patients. A prospective study was carried between January 2005 and March 2005 including 70 patients. The nutritional state of the patients was assessed according to the subjective global assessment scale [SGA]. anthropometric measurements and serum albumin level. Moderately and severely malnutrition was found for 54 patients [77 percent]. Statistical analysis found positive correlation between body mass index [BMI] and SGA C [p=0 .002] and between albumin level and SCA [p<0.005]. The median nutritional risk index [NRI] was 89.5 +/- 13 with significantly positive correlation with the other parameters [BMI, Albumin and SGA] respectively p=0.03, p=0.003 and p=0.004. Malnutrition is common in gastroenterology patients. The assessment of patient's nutritional state according to the subjective global assessment had a positive correlation with the others nutritional screening tools

Place de la ligature elastique dans la prevention secondaire de l'hemorragie digestive par rupture de varices oesophagiennes. Etude prospective de 102 cas

The aim of this study was to assess the efficacy and morbidity of endoscopic variceal ligation for the prophylaxis of rebleeding from oesophageal varices. This work is a prospective study including 102 patients having had at] least one episode of variceal bleeding. The mean age is 52,5 years. Oesophageal varices were eradicated in 83,3% of cases after an average of 3,5 sessions. Recurrence of oesophageal varices after eradication was observed in 22% after an average follow-up of 7 months. 10 patients died before eradication of oesophageal varices from causes unrelated to the technique. The endoscopic variceal ligation is effective for eradication of oesophageal varices, with a low morbidity. This technique appears to be a method of choice in the prophylaxis of rebleeding from oesophageal varices

densite minerale osseuse au cours de la maladie de Crohn: Apport de l'osteodensitometrie chez 53 patients

Fifty-three patients with Crohn disease were included in A prospective study. Bone mineral density was measured at the Femoral neck and lumbar spine by dual-energy X-ray absorptiometry. Ten variables were analyzed in search of an association with bone demineralization; Age, sek, nutritional state, smoking, duration of the disease, hormonal status, inflammatory syndrome, site of disease ileal, colic or ileocolic, accumulated doses of corticoids and intestinal resection. A bone demineralization was observed in 58,5% of cases. The ileum location and the corticotherapie were predictives of bone demineralization. Crohn disease is a disease at high risk of bone demineralization. Predictors of the bone loss were smoking, long duration of the disease, ileal site and systematic corticotherapy