Bilateral Sub-deltoid Bursitis in a Patient Receiving Infliximab for Crohn's Disease.

BACKGROUND: Infiximab has been shown to be effective in inducing and maintaining remission of intestinal bowel diseases. Infiximab has been associated with many adverse events. Articular manifestations are commonly reported, but they are of variable clinical expression and aetiology. Among them, inflammatory bursitis has rarely been described. OBJECTIVE: Herein a case of inflammatory bursitis in a patient with Crohn's disease after switching to biosimilar infliximab is reported. CASE REPORT: A 41-year-old man with Crohn's disease evolving from 3 years was referred to infliximab therapy at a dose of 5mg/kg because of an aggressive resistant perineal fistula. After 14 infusions of infliximab, the treatment was switched to infliximab biosimilar using the same dose and frequency of administration. Forty-eight hours after the second infusion, he developed an acute onset of muscle pain and stiffness on both of his shoulders. A musculoskeletal ultrasound was performed and revealed a hypoechoic widening of both subacromial bursae. It was more severe on the left side. DISCUSSION: The diagnosis of non-infective sub-acromial bursitis secondary to infliximab infusion was made as the patient's symptoms resolved rapidly without any antibiotics. Infliximab was definitively stopped and adalimumab was introduced. CONCLUSION: Musculoskeletal side effects of infliximab infusion are uncommonly reported. Among them, bursitis has been reported in only a few cases. Ultrasonography can help early diagnosis of bursitis. The time of occurring of this reaction regarding infliximab infusion, screening of Antibodies to Infliximab (ATI) and clinical outcome after drug discontinuation are the main helpful arguments.

Autoimmune gastritis: assessment of OLGA and OLGIM staging systems.

BACKGROUND: Autoimmune gastritis present a risk of cancer related to atrophy and intestinal metaplasia. Two recent classifications OLGA (Operative Link on Gastritis Assessment) and OLGIM (Operative Link on Gastritic Intestinal Metaplasia assessment) have been proposed to reveal the high progressive risk forms (stages III and IV). AIM: To evaluate the OLGA and OLGIM staging systems in chronic autoimmune gastritis. METHODS: A descriptive single institution study of 30 cases of autoimmune gastritis. was performed over a 4-year period. The revaluation of atrophy and intestinal metaplasia, of gastric antrum and corpus, allowed to identify respectively the stages of OLGA and OLGIM systems. RESULTS: Our autoimmune gastritis were at high-risk stages in 26,5% of cases  according to two classifications. 95% of low-risk gastritis acoording to OLGA staging presented moderete to severe corpus atrophy. A significant association was present between high-risk gastritis according to OLGA staging and neuroendocrine hyperplasia. Both OLGA and OLGIM systems showed a highly significant positive correlation between them with a mismatch at 2%. CONCLUSIONS: The OLGA and OLGIM staging systems in autoimmune gastritis, allow probably selection of high risk forms of chronic gastritis requiring convenable care.

[Helicobacter pylori gastritis: assessment of OLGA and OLGIM staging systems]. / Gastrites chroniques à hélicobacter pylori: évaluation des systèmes OLGA et OLGIM.

Helicobacter pylori (H pylori) gastritis presents a risk of cancer related to atrophy and intestinal metaplasia. Two recent classifications OLGA (Operative Link on Gastritis Assessment) and OLGIM (Operative Link on Gastritic Intestinal Metaplasia assessment) have been proposed to identify high-risk forms (stages III and IV). The aim of this study is to evaluate the OLGA and OLGIM staging systems in H pylori gastritis. A descriptive study of 100 cases of chronic H pylori gastritis was performed. The revaluation of Sydney System parameters of atrophy and intestinal metaplasia, of gastric antrum and corpus, allowed identifying respectively the stages of OLGA and OLGIM systems. The progressive risk of our H pylori gastritis was 6% according to OLGA staging and 7% according to OLGIM staging. Significant correlation was revealed between age and OLGA staging. High-risk gastritis according to OLGIM staging was significantly associated with moderate to severe atrophy. High-risk forms according to OLGA staging were associated in 80% of the cases to intestinal metaplasia. OLGA and OLGIM systems showed a highly significant positive correlation between them with a mismatch at 5% for H pylori gastritis. The OLGA and OLGIM staging systems in addition to Sydney System, allow selection of high risk forms of chronic gastritis requiring accurate observation.

[Nocturnal gastroesophageal reflux disease in asthmatics patients: a pHmetric study about 81 cases]. / Particularites du reflux gastro-oesophagien nocturne chez les patients asthmatiques: analyse d'une serie pH metrique a propos de 81 cas.

AIMS: To determine the frequency of gastroesophageal reflux disease on 24-hour esophageal pH monitoring in asthmatics patients and to evaluate the clinical and pHmetric characteristics of nocturnal reflux in these patients. METHODS: We conducted a retrospective study based on results of 24-hour esophageal pH monitoring during a 10-year period in asthmatics patients with or without digestive symptoms of gastroesophageal reflux disease. RESULTS: We studied 81 patients (37 men, 44 women; mean age: 32 years). Gastroesophageal reflux was found in 42 patients (52%). Nocturnal reflux was observed in 35 patients (43%), mostly in association with pathological reflux in the total period (32 cases). Presence of digestive symptoms was the only associated factor to gastroesophageal reflux during 24-hour, in nocturnal or in diurnal period. Compared to the diurnal period, the nocturnal period was characterized by fewer number of reflux episodes (22.69 + 23 vs 70.16 + 56.15; p<0.001), more longer duration of reflux episodes (25.92 + 23.34 minutes vs 15.52 + 16.27 minutes; p=0.02), fewer respiratory symptoms (2.24 + 1.89 vs 6.18 + 4.12; p=0.01) and better symptomatic correlation (13/17:76% vs 9/24:37%; p=0.02). CONCLUSION: Gastroesophageal reflux disease is frequent in asthma. Nocturnal reflux is associated with overall reflux on the 24 hour examination. Nocturnal period is characterized by more longer reflux episodes and better symptomatic correlation.