[Does Barrett's esophagus regress after effective treatment of gastro-esophageal reflux?]. / L'endobrachy-oesophage régresse-t-il après traitement efficace du reflux gastro-oesophagien?

Regression and disappearance of Barrett's esophagus are a rare event of which there are only three well documented cases in the literature. Two cases are described in this study.

[Drug-induced esophagitis and its complications. Retrospective study of 30 case reports and review of 650 published cases (1970-1987)]. / L'oesophagite médicamenteuse et ses complications. Etude rétrospective de 30 observations et revue de 650 cas publiés (1970-1987).

Prevalence and incidence of drug-related esophagitis are probably underestimated. The condition can often be diagnosed on the basis of history alone. Tetracyclines and emepronium bromide were implicated in most published cases. Endoscopy usually shows erosions in the upper two thirds of the esophagus. These esophageal lesions generally heal after the medication has been stopped. Complications such as stricture, hemorrhage or perforation are very rare.

[Is the measurement of carcinoembryonic antigen still indicated in digestive cancers?]. / Le dosage de l'antigène carcino-embryonnaire est-il encore indiqué dans les cancers digestifs?

Carcinoembryonic antigen (CEA) is not useful for detecting asymptomatic cancer. Its sensitivity and specificity are not high. For some cancers, antigen levels at the time of diagnosis provide more precise prognosis than staging alone. Regular determination of CEA is useful as a method of surveillance after surgery for cancer in the colon and in the rectum. Unfortunately the clinical gain of detecting postoperative relapses is low since curative surgical treatment is usually impossible.

[Screening for colorectal tumors using fecal occult blood studies]. / Dépistage des tumeurs colorectales par la recherche de sang occulte dans les selles.

Guaiac tests such as Hemoccult are widely used but are affected by several factors. Occult blood testing does uncover subclinical colorectal cancer often at early stage, but a favorable effect on survival remains to be proven. The sensitivity for the detection of malignancies is from moderate to good, but it is poor for benign polyps. Predictive value of a positive test for cancer ist about 8-12%. Thus, most of the individuals with a positive test would not need colonic investigations. Recommendations relating to the testing for of occult blood could change rapidly with the new immunologic techniques or with new data on mortality coming from controlled clinical trial now being conducted.

[Non-ulcer dyspepsia and Campylobacter pylori]. / Dyspepsie non ulcéreuse et Campylobacter pylori.

Dyspepsia, defined as chronic vague upper abdominal symptoms, is a common condition. The pathogenesis of this syndrome remains poorly understood. The etiologic role of Campylobacter pylori and associated gastritis remain controversial though this organism colonizes the gastric antrum in one third to one half of patients with non-ulcer dyspepsia. Recent studies raise the prospect that treatment with bismuth improves gastritis and is successful in treating symptoms in the Campylobacter pylori positive and negative patients. To determine if Campylobacter pylori causes dyspepsia requires proof that long term eradication of the organism heals gastritis and abolishes symptoms.

[Inflammatory diseases of the digestive system and pregnancy: clinical case and review of the literature]. / Maladies inflammatoires du tube digestif et grossesse: cas cliniques et revue de la littérature.

This paper reports the fertility with Inflammatory Bowel Disease (IBD), effects of IBD on pregnancy and conversely, effects of treatment on the mother and the child. Fertility is minimally, if at all, compromised. The foetus is likely to survive in spite of active disease. There is no good evidence for an effect of pregnancy on Ulcerative Colitis and Crohn disease. Sulfasalazine and steroids should be used in IBD during pregnancy much as they are in the non pregnant azathioprine and metronidazole are contraindicated. IBD is not a reason for a young woman to avoid pregnancy and does not constitute an indication for abortion.

Peripheral venous pulsatility detected by Doppler method for diagnosis of right heart failure.

This study shows that peripheral venous flow detected by Doppler ultrasound becomes synchronously pulsatile with heart beats as soon as central venous pressure (CVP) is above 7 mm Hg. CVP was above 7 mm Hg in 13 among 46 patients. Clinical signs of right heart failure were detectable in only 7 of these 13 patients (sensitivity 54%), whereas peripheral venous flow was pulsatile in 12 of them (sensitivity 92%). In 4 patients with a normal CVP, peripheral venous flow was also pulsatile; all of them suffered from valvular heart disease with left ventricle ejection fraction below 60% in 3 of them. The detection of a pulsative peripheral venous blood flow constitutes an early sign of right heart failure, more sensitive than clinical evaluation, and probably even more than CVP.