[Role of intestinal flora in inflammatory bowel disease and probiotics place in their management]. / Role de la flore intestinale dans les maladies inflammatoires chroniques de l'intestin et place des probiotiques dans leur prise en charge.

The pathogenic role of certain microorganism of intestinal flora has been demonstrated in experimental colitis in animals and strongly suspected in inflammatory bowel disease in human, especially in Crohn's disease and pouchitis. Probiotics are living non pathogenic microorganisms that, upon oral ingestion exert benefits on human health by modulating enteric flora or by stimulation of local immune system. The aim of this article is to remind the role of intestinal flora in inflammatory bowel disease, the mechanism of inflammation induced by this flora and to review through the literature, the different clinical studies performed with probiotics in human.

[Pouchitis treatment by probiotics]. / Traitement des pochites par les probiotiques.

OBJECTIVES: The aim of the study was to review the principal effects of probiotics on pouchitis and identify their mechanisms of action. METHODS: The study was based on a review of all relevant studies published in the literature on the effects of probiotics in pouchitis and their possible mechanisms of action. RESULTS: Pouchitis is the major long-term complication after ileal pouch anal anstomosis for ulcerative colitis. The cause is still unknown but is likely to be multifactorial. An imbalance in the usual fecal flora was recently suggested. Most patients with symptoms of pouchitis respond promptly to antibiotics. However, 5-10% of them develop rapidly relapsing symptoms that required protacted therapy. Porbiotics are living microorganisms that ingested in adequate amounts exert beneficial effects. Promising results have been obtained with probiotics mainly in maintenance of remission of chronic pouchitis and also as induction of remission. CONCLUSION: These results suggest that restoring the microbial imbalance may offer an effective therapeutic alternative to patients with pouchitis.

[Abdomino-pelvic actinomycosis. Report of 2 cases]. / Actinomycose abdomino-pelvienne. A propos de deux cas.

Actinomycosis is a chronic, granulomatous, suppurative and fistulasing infection related to a gram-positive bacteria (actinomyces israeli). Cervico-facial actinomycosis is the most common localization. The prevalence of abdomino-pelvic actinomycosis is increasing mainly with the increase of the use of intrauterin device. Its clinical presentation is variable and may mimic cancer or tuberculosis. The diagnosis of abdomino-pelvic actinomycosis is hard and most of the cases are detected during surgical exploration. We report two cases of abdomino-pelvic actinomycosis; in the first case, the disease was extended to the caecum and the abdominal wall. The skin biopsies made the diagnosis of actinomycosis, avoiding surgery. In the second case, the diagnosis of actinomycosis is made post operatively because of high suspicion of pelvic cancer. Through these two observations, we review pathogenesis of the disease, its clinical aspects and its diagnostic and therapeutic means.

[Pathogenesis of autoimmune hepatitis]. / Pathogenie de l'hepatite auto-immune.

OBJECTIVES: The aim of the study was to review the pathogenic mechanisms of auto-immune hepatitis. METHODS: The study was based on a review of all relevant articles from literature on the mechanisms of auto-immunity in auto-immune hepatitis. RESULTS: The precise mechanisms through which liver damage occurs are not fully understood. Auto-immune hepatitis seems to be a consequence of auto-antigen exposure, genetic predisposition and defective immuregulatory mechanisms. Auto-antigen is presented by class II molecules of the major histocompatibility complex. Cytokines and non specific auto-immune promotors modulate immune reactivity. Cell-mediated and antibody-dependent forms of cytotoxicity are probably interactive pathogenic mechanisms. CONCLUSION: Disturbance in the tight balance between auto-aggression and self-tolerance, affected by several internal and external factors are likely in auto-immune hepatitis.