[Gastroesophageal reflux disease in obese patients†; current management]. / Reflux gastro-œsophagien chez le ­patient obèse†; prise en charge actuelle.

Gastroesophageal reflux disease (GERD) has a high prevalence in the obese population with a direct correlation between increased BMI and GERD. This correlation is multifactorial, with also more complicated forms (esophagitis and metaplasia) present in obese patients, even in the absence of frank reflux symptoms. Therapeutic success largely depends on weight loss, and bariatric surgery is the cornerstone of treatment for both diseases. Roux-en-Y gastric bypass is the intervention of choice for obese patients suffering from GERD, while sleeve gastrectomy can on the contrary induce increased reflux in the long term. Classic anti-reflux surgery (fundoplication) can also be offered to these patients, while being aware of the high risk of recurrent symptoms for BMI > 30-35 kg/m2.

La prévalence du reflux gastro-œsophagien (RGO) est élevée dans la population obèse avec une corrélation directe entre l'augmentation de l'IMC et le RGO. Cette corrélation est multi­factorielle, avec également des formes plus compliquées (œsophagite et métaplasie) présentes chez les patients obèses, même en l'absence de symptomatologie franche de reflux. Le succès thérapeutique passe largement par la perte de poids et la chirurgie bariatrique en est la pierre angulaire. Le bypass gastrique en Roux-en-Y est l'intervention de choix pour les patients obèses souffrant de RGO, alors que la sleeve gastrectomie peut au contraire péjorer la situation au long cours. La chirurgie antireflux (fundoplicature) peut aussi être proposée chez ces patients, en étant conscient du risque élevé de récidive des symptômes en cas d'IMC > 30-35 kg/m2.

Abdominal Mondor disease mimicking acute appendicitis.

INTRODUCTION: Mondor disease (MD), a superficial thrombophlebitis of the thoraco-epigastric veins and their confluents is rarely reported in the literature. The superior epigastric vein is the most affected vessel but involvement of the inferior epigastric vessels or their branches have also been described. There is no universal consensus on treatment in the literature but most authors suggest symptomatic treatment with non-steroid anti-inflammatory drugs (NSAIDs). CASE REPORT: We report the case of a marathon runner who presented with right iliac fossa pain mimicking the clinical symptomatology of an acute appendicitis. The history and the calculated Alvarado score were not in favor of an acute appendicitis. This situation motivated multiple investigations and we finally arrived at the diagnosis of MD. DISCUSSION: Acute appendicitis (AA) is the most common cause of surgical emergencies and one of the most frequent indications for an urgent abdominal surgical procedure around the world. In some cases, right lower quadrant pain remains unclear in spite of US, CT scan, and exclusion of urological and gynecological causes, thus we need to think of some rare pathologies like MD. CONCLUSION: MD is often mentioned in the differential diagnosis of breast pathologies but rarely in abdominal pain assessment. It should be mentioned in the differential diagnosis of the right lower quadrant pain when the clinical presentation is unclear and when acute appendicitis has been excluded. Awareness of MD can avoid misdiagnosis and decrease extra costs by sparing unnecessary imaging.