[Gastroentérologie Clinique et Biologique: a century's history of digestive system diseases]. / Gastroentérologie Clinique et Biologique: un siècle d'histoire des maladies de l'appareil digestif.

The journal Gastroentérologie clinique et biologique succeded to Archives des maladies de l'appareil digestif published since 1907 and is one of the world's oldest journals in gastroenterology. Gastroentérologie Clinique et Biologique was created as the discipline was emerging, benefiting from new techniques such as nasogastric intubation, coprologic examinations, the first images from gastrointestinal radiology, as well as the enormous progress made in gastrointestinal surgery. The journal was founded by Albert Mathieu, a remarkable chef d'école at Paris's Saint-Antoine Hospital. The journal showed rapid success, becoming the official organ of several learned societies, in particular the French National Society of Gastroenterology (Société nationale française de gastroentérologie [SNFGE]). Thoroughly updated in the 1970s, Gastroentérologie clinique et biologique has never ceased to evolve, adapting to technical and scientific upheavals, the globalization of knowledge, and the domination of the English language.

Postoperative management of stage II/III colon cancer: a decision analysis.

BACKGROUND & AIMS: Two separate decisions must be made for the management of patients with resected stage II/III colon cancer: whether to begin adjuvant chemotherapy and whether patients should be included in a follow-up protocol consisting of regular monitoring of carcinoembryonic antigen level and of colonoscopy and imaging. The standard management for these patients is adjuvant chemotherapy for stage III patients and follow-up for stage II/III patients with resected colon cancer. METHODS: Decision analysis was used to compare the effectiveness (5-year survival rate) and cost-effectiveness ratio of 7 strategies of treatment and follow-up. RESULTS: The most cost-effective strategies were adjuvant chemotherapy for all patients with stage II/III resected colon cancer, with either no follow-up or follow-up only for patients aged less than 75 years with a seric preoperative carcinoembryonic antigen level of >5 ng/mL (5-year survival, 62.3% or 62.7%; cost per surviving patient, $8254 or $8657, respectively). The order of efficacy of the strategies was insensitive to changes in the values of the studied variables. The method of follow-up does little to improve 5-year survival but adds substantial cost. CONCLUSIONS: The current standard strategy may not be the most cost-effective strategy for the management of patients with resected colon cancer.

Double-blind dose-response multicenter comparison of fedotozine and placebo in treatment of nonulcer dyspepsia.

The efficacy and safety of the peripheral kappa-receptor agonist fedotozine was investigated in a double-blind, placebo-controlled, dose-ranging study involving 146 patients with nonulcer dyspepsia (NUD). After a two-week washout, patients were assigned to one of four groups to receive either placebo or fedotozine three times a day at doses of 10, 30, or 70 mg for six weeks. Analysis of mean symptom intensity scores showed that the 30-and 70-mg doses of fedotozine were superior to placebo in relieving postprandial fullness, bloating, abdominal pain, and nausea. Eructation and early satiety were marginally affected. The 30-mg dose was significantly more effective than placebo in reducing the total symptom score. Eight-two mostly minor adverse effects were recorded, but no significant differences in distribution emerged between placebo and treatment groups. The number of withdrawals declined significantly as a function of increasing dose. These results indicate that 30 mg three times a day is the minimal effective dose of fedotozine in the treatment of NUD symptoms and that this treatment is safe.

[Photodynamic therapy by coloring laser. Can it represent a therapeutic alternative for small epidermoid cancers of the esophagus?]. / La photothérapie dynamique par laser à colorant. Peut-elle représenter une alternative thérapeutique pour les petits cancers épidermoïdes de l'oesophage?

Our aim was to assess the efficacy of photodynamic therapy in inoperable patients with small esophageal carcinoma. Eleven patients were treated for squamous cell carcinomas ranging in size from 1 to 3 cm2. Hematoporphyrin (between 3 and 5 mg/kg) was injected intravenously and then the tumor irradiated at endoscopy 72 hours later with a dye laser (630 nm) at an energy of 250 joules/cm2. Complete destruction of the lesion was obtained in 6 cases with negative biopsies at 1 month. In all 6 patients, no recurrence was seen after a median follow-up of 4 months (range: 2-38). Partial destruction of the tumor was obtained in 4 cases while treatment was a complete failure in the last patient. Two instances of mild cutaneous photosensitization occurred. Two patients treated for recurrence after radiotherapy, died of esophageal perforation directly related to the procedure. Photodynamic therapy appears to be a possible effective treatment for esophageal squamous cell carcinoma in inoperable patients when other curative treatment modalities are not possible.

Colonic transit time of radiopaque markers and rectoanal manometry in patients complaining of constipation.

Transit time, rectoanal manometry, and symptoms were studied in 61 patients complaining of constipation. A slow transit, in the colonic area of most of the patients, was found in 49. Rectoanal manometry was abnormal in 40. Both examinations were abnormal in 32 patients, colonic transit only in 17, and manometry only in eight. Finally, both examinations were normal in only four subjects. A transit delay was always associated with less than three stools per week, and straining at stool was constant when rectoanal manometric disturbances were shown. Objective abnormalities appear common in patients complaining of constipation and, correlated with symptoms, suggest that clinical study in constipation could be of more value than usually is believed.

Controlled trial of bowel rest in the treatment of severe acute colitis.

In a prospective, randomised clinical trial, 47 patients with severe, acute, non-infective colitis treated with 60 mg intravenous prednisolone daily, received either bowel rest with parenteral nutrition or oral diet. Although those who received 'bowel rest' experienced a reduction in daily stool weight, there were no differences in the operation or mortality rates between the groups. Fourteen of the 27 patients with ulcerative colitis, but none of the 16 patients with Crohn's disease required urgent surgery. Bowel rest did not affect the outcome in severe ulcerative colitis treated with intravenous prednisolone. Ulcerative colitis and Crohn's colitis behaved differently in the acute attack.

[Hereditary visceral myopathy: an entity in idiopathic intestinal pseudo-obstruction]. / Myopathie viscérale héréditaire: une entité au sein des pseudo-obstructions intestinales idiopathiques.

A 17 year-old girl with chronic idiopathic intestinal pseudo-obstruction is reported. Abnormalities of smooth intestinal muscle were shown on light and electron microscopic studies of the excised small intestine and led to the diagnosis of visceral myopathy based on the following features: vacuolar degeneration of intestinal smooth muscle cells with replacement by fibrous preferential involvement of the external longitudinal muscle layer normal myenteric plexus. For the first time similar ultrastructural changes were found on histological study of the colon. Manometric studies revealed a diffuse disease involving the esophagus, small bowel, and bladder. Anorectal abnormalities, never described before, were reported. Family involvement was shown by abnormal esophageal and anorectal manometries in the patient's brother and by paternal history of fatal small intestine occlusion without mechanical obstruction. The prognosis of severe forms of visceral myopathy is generally poor because of the inefficiency of drugs. In this case, after a long period of parenteral nutrition with maintenance of a good nutritional status, a terminal ileostomy (with a special procedure to avoid evagination) associated with a second stage total colectomy allowed to stop parenteral nutrition.

[Temporo-spatial epidemiology of cancer of the pancreas. Study of international and French mortality]. / Epidémiologie temporo-spatiale du cancer du pancréas. Etude de mortalité internationale et française.

The aim of this study was to describe the main geographical and chronological epidemiologic characteristics of the mortality rates for pancreatic cancer (PC) in France and in other countries. The international geographical study shows PC standardized rates ranging from 3.1 to 9.9/100,000 for men and from 2.1 to 7.2/100,000 for women. Higher rates are observed in Northern and Eastern Europe, as well as in North America. In France, mortality rates decrease from the North-East to the South-West of the country. During the period 1950-1980, the median annual increase in PC mortality rates was 3 p. 100 for men, and 2.5 p. 100 for women in the countries studied. The increase was greater where initial PC mortality rates were low. This trend has slowed down during the last ten years (1971-1980). In France, annual PC mortality rates have increased more for men (+ 3.46 p. 100) than for women (+ 1.94 p. 100). There is evidence of an increased PC mortality rate from one generation to another. Cohort analysis points to a significant stabilization of PC mortality rates for women in France.

[Anorectal motility in idiopathic constipation. Study of 200 consecutive patients]. / Motricité anorectale dans la constipation idiopathique. Etude de 200 patients consécutifs.

The aim of our work was to study anorectal motility and tension of the rectal wall in 200 constipated adult patients. Anorectal manometry was normal in 88 patients (group A), showed abnormal amplitude of the anorectal inhibitory reflex in 33 patients (group B) and hypertonia and ultraslow waves in 70 patients (group C). These anomalies were: a) reproducible in the 20 patients studied twice; b) observed in patients with enterocolitis, thus not specific of constipation; c) associated with an increased frequency of fecal evacuation difficulties. Despite normal values of tension of the rectal wall: a) the threshold of conscious perception of distension was increased in 14 p. 100 of patients; b) a paradoxical relationship between the anorectal inhibitory reflex and rectal tension was observed in group B patients. Our results support the concept of outlet obstruction due to anorectal dysfunction and suggest the possibility of neurologic and or ischemic mechanisms in group B patients.

Fruit characters as a basis of fruit choice and seed dispersal in a tropical forest vertebrate community.

Interactions between a large community of vertebrate frugivore-granivores (including 7 species of large canopy birds, 19 species of rodents, 7 species of ruminants, and 6 species of monkeys), and 122 fruit species they consume, were studied for a year in a tropical rainforest in Gabon.The results show how morphological characters of fruits are involved in the choice and partitioning of the available fruit spectrum among consumer taxa. Despite an outstanding lack of specificity between fruit and consumer species, consideration of simple morphological traits of fruits reveals broad character syndromes associated with different consumer taxa. Competition between distantly related taxa that feed at the same height is far more important than has been previously supposed. The results also suggest how fruit characters could have evolved under consumer pressure as a result of consumer roles as dispersers or seed predators. Our analyses of dispersal syndromes show that fruit species partitioning occurs more between mammal taxa than between mammals and birds. There is thus a bird-monkey syndrome and a ruminant-rodent-elephant syndrome. The bird-monkey syndrome includes fruit species on which there is no pre-dispersal seed predation. These fruits (berries and drupes) are brightly colored, have a succulent pulp or arillate seeds, and no protective seed cover. The ruminant-rodent-elephant syndrome includes species for which there is pre-dispersal predation. These fruits (all drupes) are large, dull-colored, and have a dry fibrous flesh and well-protected seeds.

[Digestive hemorrhage under anticoagulant treatment. Retrospective analysis of a series of 178 consecutive cases]. / Les hémorragies digestives sous traitement anticoagulant. Analyse rétrospective d'une série de 178 cas consécutifs.

The aim of this study was to describe the clinical characteristics, prognosis and epidemiological pattern of gastrointestinal bleeding occurring in patients receiving anticoagulant therapy. From 1971 to 1981, among 3,194 consecutive patients admitted to a gastrointestinal unit because of acute gastrointestinal bleeding, 178 were under anticoagulant therapy (i.e. antivitamin K and heparin or heparin derivative in respectively 85 and 13 p. 100 of the cases). Fourteen percent of these 178 patients had also taken gastrotoxic drugs before the bleeding occurred. Indications for anticoagulant therapy were as follows: ischemic heart disease (21 p. 100), arrhythmias (20.3 p. 100), venous thrombosis and pulmonary embolism (15.8 p. 100), arteritis (10.8 p. 100), aortic, coronary or peripheral arterial grafts (8.4 p. 100), prophylaxis of venous thrombosis (8.4 p. 100), valve prosthesis (7.3 p. 100). The lesion responsible for bleeding was found in 80 p. 100 of the cases. Surgical hemostasis was required in only 4 patients. Ten patients died (2 postoperatively). During the study period, the incidence of bleeding associated with anticoagulant therapy in the group of patients admitted to the unit with gastrointestinal hemorrhage increased from 1.5 p. 100 to 8.0 p. 100. This fact appeared to be closely related to new indications (valve prosthesis, arterial grafts, prophylaxis of venous thrombosis) and to an increased incidence of gastrointestinal bleeding especially in association with acenocoumarol treatment. These results show that, although occurring in a high risk population, gastrointestinal bleeding related to anticoagulant therapy generally has a favorable outcome. They also suggest that a prospective epidemiological study may be of interest to determine the reasons for the increasing incidence and to propose preventive measures.

[Treatment of fecal incontinence in adults. Results as a function of clinical and manometric data and the importance of rehabilitation by biofeedback]. / Traitement de l'incontinence fécale de l'adulte. Résultats en fonction des données cliniques et manométriques, et intérêt de la rééducation par apprentissage instrumental.

Twenty-five females and 8 males, 20 to 83 year old, with fecal incontinence, normal rectal capacity and without evidence of active anorectal disease were studied in order to evaluate: a) the incidence of associated constipation; b) the anorectal motility pattern; c) the efficiency of treatment based on clinical data and anorectal motility disorders. Fifteen patients had constipation associated with fecal incontinence and 23 patients presented with at least one anorectal motility abnormality indicating biofeedback therapy. Compliance to therapy was poor since 9 patients did not accept the treatment; among the 24 subjects who accepted the treatment, 18 became continent and 5 were improved. These results were observed after treatment of constipation alone (6 cases) or associated with biofeedback therapy (5 cases), after biofeedback therapy (7 cases), and after surgery alone (3 cases) or followed by biofeedback therapy (2 cases). These results show that: a) constipation is frequently associated with incontinence in the adult; b) treatment of constipation, biofeedback therapy and surgery, used alone or combined according to clinical and anorectal motility data lead to good results in 75 p. 100 of patients.

[Effect of levamisole on the prevention of developmental flare-ups in quiescent Crohn's disease: a prospective multicenter controlled trial in 155 patients]. / Effet du levamisole sur la prévention des poussées évolutives de la maladie de Crohn quiescente: un essai prospectif multicentrique contrôlé sur 155 malades.

The prevention of relapse in quiescent Crohn's disease remains a major therapeutic challenge. The present study is a double blind placebo (P)-controlled, randomized, multicentre cooperative trial designed to test the effectiveness of levamisole (L) in the prophylaxis against flare up in patients with quiescent Crohn's disease. The trial included 2 successive phases: a) phase I:167 patients with inactive disease (but who had not had previous resection of all diseased tissue) were randomly and double blindly assigned to receive either L (150 mg orally once weekly) or P; patients were randomized in 2 strata: those having experienced a recent flare up (within the 3 months preceding their entry into the trial: red strata) versus others (blue strata). Patients were followed up at 3 monthly intervals during 2 years. Initially there was no significant difference between L and P groups as regard to age, sex ratio, duration of disease at the time of randomization, incidence of prior intestinal resection, Crohn's disease topography, clinical activity; biological activity was slightly but significantly higher (P less than 0.05) in the P group. Twelve patients were withdrawn from analysis (lost to follow-up: 2; inadequate respect of the protocol: 10), leaving 155 patients (78 L, 77 P) who completed the study. L did not significantly influence any of the following parameters: incidence of attacks (L: 37 p. 100; P: 35 p. 100), lag time between the entry into the trial and the occurrence of the attack (L: 32.7 +/- 5.2; P: 41.8 +/- 5.8; m +/- SEM; weeks), curves of maintenance in remission (Kaplan-Meier method), outcome rank, severity of attacks. Attempts to analyse separately certain subgroups--subjects with purely colonic (+/- anal) disease, subjects with small bowel localization (+/- anus), patients of the red or blue strata--did not show any statistical difference between L and P. Thirteen patients left the trial for minor intolerance (10 L, 3 P). b) Phase II lasted one further year and involved the patients still in remission and in the trial at the end of phase I (n = 57). Those who had received L during phase I were randomized between continuance of L (L leads to L) vs. a change to P (L leads to P); those who had been on P during phase I were randomized between continuance of P vs. a switch to L.(ABSTRACT TRUNCATED AT 400 WORDS)