Spectrum of autoantibodies in Tunisian adult type 1 diabetes mellitus.

As an autoimmune disease, type 1 diabetes mellitus (T1DM) is characterized by the presence of several autoantibodies. The aim of this study was to examine a broad spectrum of antibodies in Tunisian adult T1DM and to compare their prevalence with a healthy control group. Two hundred sixty-one diabetics and 100 healthy blood donors were enrolled in this study. Indirect immunofluorescence was performed for the detection of islet cell, antiendomysial, antinuclear, antimitochondrial, antismooth muscle, antireticulin, and antikeratin antibodies. Enzyme-linked immunosorbent assay was used for measuring anticardiolipin, antigliadin, antitransglutaminase, and antithyroperoxidase antibodies. Latex agglutination was used for the detection of rheumatoid factors. As expected, islet cell antibodies were the most frequent (33.7%). Antigliadin, antithyroperoxidase, and antikeratin antibodies were relatively frequent (18%, 15.3%, and 10.3%, respectively) and were statistically more prevalent in diabetics than in controls. There was no correlation between diabetes duration and any autoantibody, except for islet cell antibodies that were more frequent at the onset of diabetes. Several autoantibodies nonspecific of diabetes are frequent in diabetic patients, which may be associated with or predictors of some autoimmune diseases, and can also reflect a special profile of autoimmunity in diabetics in comparison to healthy controls.

[Alpha heavy chain disease. A Tunisian case]. / Maladie des chaines lourdes alpha. A propos d'un cas tunisien.

Alpha heavy chain disease is a rare affection in the West and reported mainly in developing countries with the improvement of hygienic conditions, the disease become rare in Tunisia, the last case was reported in 1991. The aim of the study is to report a new Tunisian case and to describe clinical, endoscopical and histological characteristics of the disease. The patient in a 37 years old male, presented with chronic diarrhoea associated with malabsorption syndrome. The diagnosis of alpha heavy chain disease was confirmed by histological examination of the resected intestine after surgery for intestinal obstruction. The patient received chemotherapy. The follow up is of two months.

[The overlap syndrome of autoimmune hepatitis and primary biliary cirrhosis. Clinical and therapeutic analysis of 5 cases]. / Syndrome de chevauchement hépatite auto-immune-cirrhose biliaire primitive. Analyse clinique et thérapeutique de 5 observations.

Autoimmune hepatitis and primary biliary cirrhosis are two different liver diseases. The aim of this study is to relate the clinical, serologic and histologic features of patients presenting the overlap syndrome, and to evaluate their response to therapy. This is a retrospective study concerning patients presenting overlap syndrome diagnosed between january 1998 and December 2001. Five patients fulfilled the diagnosis criteria of overlap syndrome. The optimal type of treatment of the overlap syndrome was not known. Treatment with UDCA or immunosuppressor alone are not efficient. Combination of these drugs should be evaluated in further studies.

[Peptic pyloroduodenal strictures treated by endoscopic balloon dilation and eradication of helicobacter pylori. Results of a prospective study]. / Traitement de la stenose ulcereuse pyloro-bulbaire par dilatation endoscopique et eradication de Helicobacter pylori. Resultats d'une etude prospective de 16 cas.

Endoscopic dilatation of pyloro-duodenal peptic stenosis is a safe and efficient procedure that constitutes an alternative choice to surgical management. Our aims is to evaluate efficiency of endoscopic balloon dilatation associated with Helicobacter pylori eradication. During a period of 3 years (January 1999-December 2001). 16 patients were included in this study. Successful endoscopic dilatation was obtained in 15 of them (93, 75%). No severe complications (perforations) happened. All patients were infected by Helicobacter pylori. The mean follow-up was 13 months. Endoscopic balloon dilatation associated with Helicobacter pylori eradication is a safe and efficient treatment of pyloro-duodenal peptic stenosis.

[Prevalence of Helicobacter pylori infection in normal or asymptomatic patients]. / Prevalence de l'infection a Helicobacter pylori chez les sujets normaux ou asymptomatiques.

The propose of this prospective study was to assess the prevalence of Helicobacter pylori infection in asymptomatic subjects in year 2000. Ninety eight patients not suffering from upper gastrointestinal symptoms were enrolled in this study. The mean age was 39 years. Helicobacter pylori was present in 81 patients (82.7%). Helicobacter pylori infection increase with age. It was maximal between 30 and 50 years. Helicobacter pylori prevalence is still high in Tunisia as well as in most developing countries. Improvement of hygiene conditions will decrease this prevalence.

[Primary biliary cirrhosis and autoimmune hepatitis overlap syndrome: therapeutic features in 5 patients]. / Syndrome de chevauchement hépatite auto-immune--cirrhose biliaire primitive. Analyse thérapeutique de 5 observations.

UNLABELLED: Autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC) are two different liver diseases, however diagnosis criteria of these two affections can be found in a same patient. The aim of this study is to relate the clinical, serologic and histologic features of patients presenting the overlap syndrome, AIH-PBC, defined by the presence of at least of two main criteria of each disease and to evaluate their response to therapy. PATIENTS AND METHODS: This was a retrospective study concerning patients presenting overlap syndrome diagnosed between January 1998 and December 2001. These patients had been treated with ursodesoxycholic acid (AUDC) or prednisone and azathioprine or a combination of these three products. Clinical and biological criteria were used to assess response to therapy. RESULTS: Five patients fulfilled the diagnostic criteria of overlap syndrome. All patients were females, the median age was 38 years (range: 19-65 years). Three patients were treated by UDCA, a clinical and biological response was noted in only one patient. Two patients were treated by prednisone and azathioprine without any remission. Three patients were treated by a combination of these three products with a good response in two cases. CONCLUSION: Optimal treatment for overlap AIH-PBC syndrome remains to be determined. Treatment with UDCA or immunosuppressor alone is not efficient. A combination of these drugs should be evaluated in further studies.

[Association of celiac disease and Crohn's disease. A case report]. / Association maladie coeliaque et maladie de Crohn. A propos d'une observation.

Crohn's disease and celiac disease are two chronic digestive diseases. The pathological mechanisms that lead to them are not known. Their association is rare leading to diagnostic and etiopathogenic problems. The aim of this study is to report clinical, endoscopical and histopathological characteristics of this association and to discuss the etiopathogenic links between these two diseases. The association of celiac disease and Crohn's disease is possible although rare. Many etiopathological mechanisms were suggested to explain such an association. In the case of celiac disease, the association with Crohn's disease is suggested by the characteristics of the diarrhea, the anoperineal lesions and will be confirmed by ileocolonoscopy and biopsy. In contrary, the diagnosis of celiac disease associated with Crohn's disease is frequently suggested by the endoscopy of upper gastrointestinal tract systematically practiced and will be confirmed by biopsy and serological celiac disease tests.

[Prevalence of Helicobacter pylori infection in duodenal ulcer. Data of a prospective study apropos of 78 NSAID-negative patients with duodenal ulcer]. / Prévalence de l'infection à Helicobacter pylori dans la maladie ulcéreuse duodénale. Résultats d'une étude prospective à propos de 78 ulcéreux duodénaux AINS negatifs.

The aim of our study was to evaluate, the prevalence of Helicobacter pylori infection in duodenal ulcer tunisian patients not using non steroidal anti inflammatory drugs. Seventy eight patients having a non complicated duodenal ulcer and not using non steroidal anti inflammatory drugs were enrolled in this prospective study carried out between February 2000 and January 2001. Six gastric biopsies were undertaken in all patients; five for an histologic analysis and one for urease test. A serum sample was taken for a Helicobacter pylori serology. Patients were considered infected if two tests were positive. Helicobacter pylori infection was present in 77 patients (98.7%). Helicobacter pylori infection is still high among patients with a non complicated duodenal ulcer and not using non steroidal anti inflammatory drugs suggesting an empirical Helicobacter pylori eradication therapy in this group of patients.

[Selective cyclooxygenase-2 inhibitors and the digestive tract]. / Inhibiteurs selectifs de la cyclo-oxygenase-2 et tube digestif.

The use of non steroidal anti-inflammatory drugs (NSAIDs) is tempered by the development of side effects primarily in the gastro-intestinal tract. These effects result mainly from inhibition of the enzyme cyclo-oxygenase (COX)-1. Two NSAIDs (celecoxib and rofecoxib) COX-2 specific inhibitors had considerably lower ulcerogenic rates and lower serious gastro-intestinal side effects when compared with other NSAIDs used in rheumatoid arthritis and osteoarthritis. However, the exact place of COX-2 specific inhibitors remain to be determined as compared with the association of other NSAIDs and proton-pump inhibitors in the elderly. The efficacy of COX-2 specific inhibitors in digestive tumors is still unclear.