[Diffuse oesophageal spasms: results of a retrospective manometric study]. / Maladie des spasms diffuse de l'asophage: résultats d'une etude manométrique retrospective.

BACKGROUND: Diffuse esophageal spasms is a primary motor disrder of the esophagus of unknown etiology characterized by intermettent peristalsis. This is rare condition which represents 3-5% if primary disorders of the esophagus. Diagnosis and treatment of this entity are difficult. AIMS: To evaluate the frequency and the clinical and the manometric features of diffuse esophageal spasms. METHODS: We conducted a retrospective study related to esophageal manometry performed between January 2000 and December 2011 regardless of the indication. Patients with meeting criteria for diffuse esophageal spasms (> 20 % simultaneous waves with greater than 30 mmHg pressure in the esophagus) were included. RESULTS: Out of 1188 patients, 13 (1,09 %) met the manometric criteria for diffuse esophageal spasms. It was 8 women and 5 men with a median age of 57 years. Dysphagia was the most relevant symptom and chest pain was only noted in 1 patient. The frequency of simultaneous waves was between 20 and 80 %. The pressure of the lower esophageal sphincter was normal in most cases. CONCLUSION: In this Tunisian manometric study, the diffuse esophageal spasms is rare. Dysphagia was the most relevant symptom and the pressure of the lower esophageal sphincter was normal in most cases.

[Interest of serologic markers in inflammatory bowel disease. About 105 cases]. / Interet du dosage des marqueurs serologiques au cours des maladies inflammatoires cryptogenetiques de l'intestin. A propos d'une serie de 105 malades.

BACKGROUND: The serum markers ASCA and pANCA can help the clinician in certain difficult situations of colites in IBD. The aim of this study was to determine the sensitivity and the specificity of each one of these markers and to establish the characteristics of the positive patients for each one. METHODS: We included patients having a Crohn's disease (CD) or an ulcerative colitis (UC). These patients was compared to a control group. RESULTS: 80 CD patients with an average age of 35.62 years, 25 UC cases with an average age of 34.92 years and 79 healthy subjects with an average age of 34.2 years were included. The ASCA were detected in 33.8% of CD cases , 8% of UC cases of RCH and 2.5% of contro group (p < 000.1). The pANCA were detected in 48% of UC cases, 27.5% of CD patients and 1.3% of controls (p < 000.1). The sensitivity and the specificity of the ASCA and the pANCA for the diagnosis respectively of CD and UC were 33.8%, 97.5% and of 48%, 97.8%. During the CD, the positivity of the ASCA was significantly associated with ileal location (p = 0.001), with the sténosant and/or fistulisant phenotyp of the disease (p = 0.006), the young age at the time of the diagnosis of the CD (p = 0.067) and at a greater frequency of surgical treatment (p = 00.7). The pANCA were more frequently found in colic location of CD (p = 0.09). During UC, the positivity of the pANCA was not associated with the sex, age, loca tion of the disease, medical treatment nor chiurgical treatment. CONCLUSION: The ASCA and pANCA are useful during some clinical situations such as differentiation between IBD otherss colitis and to distinguish CD from UC.

Osteoporosis and Crohn's disease.

UNLABELLED: Osteoporosis and osteopenia have been reported frequently in patients with inflammatory bowel disease, most notably Crohn's disease. OBJECTIVES: To determine the prevalence and risk factors of osteoporosis in patients with Crohn's disease. METHODS: Prospective study of 56 patients with Crohn's disease, 34 men and 22 women with a mean age of 32 +/- 10.4 years (18-54 years) and no history of disorders known to influence bone metabolism. Dual-energy X-ray absorptiometry measurements of bone mineral density (BMD) were obtained at the femoral neck and lumbar spine. A multivariate model including those factors significantly associated with low BMD in the univariate analysis was used to identify independent risk factors. RESULTS: Osteoporosis was found in 35.7% and osteopenia in 23.2% of patients. Low BMD was significantly associated with low body mass index (BMI), colonic involvement, and glucocorticoid therapy. Low BMI was an independent risk factor for low BMD. Malnutrition with BMI < or =18 kg/m2 was noted in 21 patients, of whom 76.2% had low BMD values, as compared to 48.6% of the patients whose BMI was >18 kg/m2 (P = 0.03, odds ratio = 3.4). CONCLUSION: Among risk factors for bone loss in patients with Crohn's disease, malnutrition plays a prominent role that deserves attention when planning treatment programs.

[Cryoglobulinemia in chronic hepatitis C virus infection. About 76 cases]. / FRequence de la cryoglobulinemie au cours de l'infection virale chronique C. A propos d'une série de 76 malades.

UNLABELLED: Cryolobulines are immunoglobulins that persist in the serum, precipitate with cold temperature and resolubilize when rewarmed. There are 3 types of cryoglobulinemia. Type II and III define mixed cryoglobulinemia. 40% approximately of patients with chronic hepatitis C virus (HCV) infection had cryoglobulinemia. OBJECTIVE: To evaluate the frequency of cryoglobulinemia in a chronic hepatitis virus (CHV) infection group and determine the characteristics of positive cryoglobulinemia patients. RESULTS: 76 patients were included. There were 53 women an 23 men. The mean age was 59.45 years. Mixed cryoglobulinemia was detected in 65 patients (85.5 %). Cirrhosis, old age and the long duration of CHV infection were the 3 factors associated with cryoglobulinemia positivity. CONCLUSION: Mixed cryoglobulinemia is a frequent manifestation during chronic hepatitis C infection virsus especially in patients with cirrhosis.