Factors associated with adenoma detection rate and diagnosis of polyps and colorectal cancer during colonoscopy in France: results of a prospective, nationwide survey.

INTRODUCTION: Colonoscopy can prevent deaths due to colorectal cancer (CRC) through early diagnosis or resection of colonic adenomas. We conducted a prospective, nationwide study on colonoscopy practice in France. METHODS: An online questionnaire was administered to 2,600 French gastroenterologists. Data from all consecutive colonoscopies performed during one week were collected. A statistical extrapolation of the results to a whole year was performed, and factors potentially associated with the adenoma detection rate (ADR) or the diagnosis of polyps or cancer were assessed. RESULTS: A total of 342 gastroenterologists, representative of the overall population of French gastroenterologists, provided data on 3,266 colonoscopies, corresponding to 1,200,529 (95% CI: 1,125,936-1,275,122) procedures for the year 2011. The indication for colonoscopy was CRC screening and digestive symptoms in 49.6% and 38.9% of cases, respectively. Polypectomy was performed in 35.5% of cases. The ADR and prevalence of CRC were 17.7% and 2.9%, respectively. The main factors associated with a high ADR were male gender (p=0.0001), age over 50 (p=0.0001), personal or family history of CRC or colorectal polyps (p<0.0001 and p<0.0001, respectively), and positive fecal occult blood test (p=0.0005). The prevalence of CRC was three times higher in patients with their first colonoscopy (4.2% vs. 1.4%; p<0.0001). CONCLUSIONS: For the first time in France, we report nationwide prospective data on colonoscopy practice, including histological results. We found an average ADR of 17.7%, and observed reduced CRC incidence in patients with previous colonoscopy.

[Gastroesophageal reflux in the French general population: national survey of 8000 adults]. / Le reflux gastro-oesophagien dans la population générale française: résultats d'une enquête sur 8,000 sujets adultes.

OBJECTIVES: To assess the population-based prevalence in France of gastroesophageal reflux disease (GERD) and to report its characteristics, consultation rate, modes of management, as well as patients' satisfaction. METHODS: This epidemiological quantitative mail survey sent to a sample of 8000 persons representative of the French adult population comprised 46 questions about GERD, its risk factors, management, last episode, and satisfaction with treatment. GERD was defined in accordance with the guidelines of the 1999 consensus conference as the existence of typical symptoms (heartburn, acid regurgitation) and frequent GERD as occurring at a frequency of at least once a week. RESULTS: The overall prevalence of GERD in France is 31.3%. The prevalence of frequent GERD is 7.8% (6% among those younger than 50 years, 10% among those older than 50). Most subjects with frequent GERD (86%) had seen a doctor for it, often long after the first occurrence of symptoms - 26% had waited for more than one year before consulting - while 14% had never discussed it with a doctor, mainly because they considered it not serious and treated it themselves. Of those who had consulted, 58% had undergone an endoscopy. Most subjects (85%) had treated their last episode of frequent GORD, most often by their doctor's prescription treatment (68%), less often by self-treatment or a medication recommended by the pharmacist or both (17%). The prescription treatment was most often used alone (61%) and only rarely combined with self-treatment or a pharmacist's recommendation (7%). Two thirds of the subjects had used a single medication, and one-third a combination of drugs. Single medications were mainly proton-pump inhibitors (PPIs) (45%) and antacids/alginates (46%). Combinations were essentially made up of PPIs (83%), most often combined with antacids/alginates (61%). Two-thirds of subjects reported that they were entirely satisfied with their treatment, but symptoms had persisted in 24% of treated subjects. DISCUSSION: Prevalence of frequent GERD increases with age. Sex, obesity, and consumption of tobacco and alcoholic beverages do not appear to affect it markedly. The proportion of subjects with frequent GERD with no regular medical follow-up and resorting to self-treatment is substantial. Only two thirds are totally satisfied with their treatment. CONCLUSION: Nearly 3.5 million French adult subjects currently suffer from frequent GERD, and many do not - or wait unduly to - see a doctor, despite symptom frequency. Better management of frequent GERD in France remains desirable in order to improve symptom relief and surveillance of possible complications.

Value of microsatellite instability typing in detecting hereditary non-polyposis colorectal cancer. A prospective multicentric study by the Association Aquitaine Gastro.

AIM OF THE STUDY: To detect hereditary non-polyposis colorectal cancer (HNPCC) patients with a strategy combining clinical selection (patient age at onset of cancer less than 50 years or family history of HNPCC tumors) and microsatellite instability typing plus immunohistochemistry, leading to mismatch repair (MMR) germline mutation analysis. METHODS: Tumors were screened for microsatellite instability (MSI) and for hmlh1 and hmsh2 immunohistochemical expression. Germline mutation analysis was performed to search for MLH1 and MSH2 mutations in patients with MSI-High and MSI-Low tumors. RESULTS: 197 adenocarcinomas were studied: 164 patients were< or =50 years old, 33 were older than 50 years but had a family history of HNPCC tumors. Fifty tumors (25.4%) were MSI-High, 10 were MSI-Low (5.1%), and 130 were MS-Stable (66%). MSI typing was inconclusive in 7 (3.5%). Immunohistochemistry screening was performed on 165 tumors: sensitivity was 63.6%, specificity was 99%. Germline mutation analysis was performed in 33/60 MSI-High or Low tumors: 23 mutations were noted (70% of the tested patients). CONCLUSION: This proposed strategy of determining microsatellite instability in young colorectal cancer patients or in patients with a family history of HNPCC tumors led to an increased frequency in the detection of MMR germline mutations.