Volume 66 - 2003 - Fasc.3 - Symposium
Coeliac disease in patients with type 1 diabetes mellitus and auto-immune thyroid disorders
The paper aims to review the prevalence and natural history of coeliac disease in patients with type 1A diabetes mellitus and auto- immune thyroid disorders. These diseases share a similar genetic background. In diabetic children and adults, the prevalence of (mostly asymptomatic) coeliac disease varies form 0.97 to 6.4%. Diabetes is usually diagnosed first. Screening in relatives may also be positive. Recurrent hypoglycaemia in diabetic subjects (indi- rectly) suggest the development of coeliac sprue. Thyroid disor- ders (thyroiditis and Graves' disease) are also usual in coeliac disease. A common etiopathogenic mechanism for the association CD / diabetes / thyroid disorders, with gluten as the driving anti- gen, was postulated. Thus, screening program for coeliac disease are recommended in individuals with type 1A diabetes and/or auto-immune thyroid conditions, as well as in their first-degree relatives. (Acta gastroenterol. belg., 2003, 66, 237-240).
Laparoscopic surgery for cancer : Are we ready ?
Following feasibility studies more and more large prospective reports even randomised trials document the treatment of diges- tive cancer using a laparoscopic approach. While the spectre of port-site recurrences, once so alarming has faded, it has become a challenge for laparoscopic surgeons to provide long-term follow- up. There is good class II and III evidence that staging laparoscopy (SL) has a value for oesophageal, gastric, pancreatic and hepato- biliary cancer as well as for intra-abdominal lymphomas since it adds to primary staging and often alters the clinical stage of the disease and hence the management of the individual patient. For minimally invasive oesophagectomy and gastric cancer surgery several series have demonstrated shorter perioperative morbidity and hospital stay however at present most studies report smaller numbers of selected patients and long term follow up is rare. The laparoscopic resection of pancreatic malignancies is not reported to be feasible, safe or potentially beneficial for the patient while the curative resection of suspected early gallbladder cancer is a poor indication. Nevertheless laparoscopy is documented to be safe and applicable for small malignant liver lesions and the Lacy trial was significantly in favour of laparoscopy-assisted colectomy, predomi- nantly for stage III disease. Bearing in mind that in many fields of digestive cancer surgery, laparoscopy should still be conducted as part of a trial, it is safe to say that "we are ready" for this revolution to arise. (Acta gastroenterol. belg., 2003, 66, 227-230).
Postexposure management of hepatitis A, Treatment, postexposure prophylaxis and B or C : recommendations
Although there is no consensus on the best management of acute hepatitis C or on optimal strategy of follow-up after potential con- tamination, certain guidelines can nevertheless be proposed for the care of these patients in practice. It is now recommended that acute hepatitis C be treated by interferon monotherapy in the presence of a C viremia, detectable by polymerase chain reaction, and an elevation of the transaminases. The earlier the treatment is started after appearance of symptoms, the more effective it is. Management of a potentially contaminated individual consists of screening for the C virus as early as the fifteenth day after the potentially contaminating act and, in the case of virus transmis- sion, starting interferon treatment as soon as elevation of the transaminases appears. No special precautions are to be taken by the person potentially contaminated for avoiding possible secondary C virus transmission during the follow-up period.
In the case of acute hepatitis B, antiviral treatment should not be started, in view of the high percentage of spontaneous recover- ies and the potentially negative effect of treatment on the chances of spontaneous recovery. Post-exposure prophylaxis by anti- hepatitis B immunoglobin injections and/or vaccination should be considered after evaluation of the hepatitis B surface antigen sta- tus of the source and of the vaccination and vaccine-response sta- tus of the exposed person. The classic scheme for selecting the most appropriate postexposure prophylaxis is reminded.
In post-exposure prophylaxis for hepatitis A virus, although there have been no studies comparing the effectiveness of vaccina- tion with that of immunoglobin injections, it is at present proposed to provide only vaccination. The target groups eligible for post- exposure prophylaxis are evoked. (Acta gastroenterol. belg., 2003, 66, 250-253).
Digestive submucosal masses : endoscopic evaluation
The term "submucosal lesion or tumor" is often used generically to refer to any bulging lesion covered by nor- mal- or nearly normal-appearing mucosa and having a smoothly elevated contour that makes its margins less sharply demarcated than lesions that arise from the mucosa (1,2). Usually these lesions are detected inci- dentally as smooth masses on endoscopy or barium stud- ies and fortuitously discovered during the exploration of another pathology. These lesions are rare and their inci- dence at autopsy is only about 0.2 to 0.5% (3,4,5). They are most often small, asymptomatic lesions without degenerative potential. However, lesions that are large or ulcerated may cause symptoms.
Vaccination for viral hepatitis in industrial health
The practice of industrial health medicine, exclusive- ly preventive, concerns the work-force and has a single aim - to protect the health of the worker - on three levels :
- Ensuring that no worker can come to harm on account of working conditions ;
- Early detection of any health problem that might nevertheless appear or be aggravated by working con- ditions ;
- Contributing to the inspection of working conditions and the physical environment in order to eliminate any health risk or avoid any harmful factors being introduced through oversight, carelessness or igno- rance.
Epidemiology of coeliac disease
In this article we review recent worldwide epidemiological data of coeliac disease (CD). An emphasis is made on adult figures as there is reduction of infants cases that is counterbalanced by the increase of CD in older children or adults.
We review data from Europe, USA, South America, Australia, Asia and Africa.
Studies in mixed population and in patients undergoing endoscopy are also mentioned. The prevalence of the disease varies between 1/100-500 in different continents.
It is possible that the low incidence of CD in some regions is due to the decrease of the prevalence of classic form of the disease. (Acta gastroenterol. belg., 2003, 66, 234-236).
Long term protection after hepatitis A and B vaccination : an update
Viral hepatitis continues to be a cause of considerable morbidity and mortality in the world. On worldwide basis, approximately 1.4 million cases of hepatitis A are reported every year. The true incidence, however, has been estimated to be 3 to 10 times higher.
Regarding hepatitis B, more than a third of the world's population has been infected. The World Health Organization has estimated (2002) that there are 367 million chronic carriers of hepatitis B worldwide, and approximately 1 million deaths per year as a conse- quence of chronic complications and acute fulminant disease.
Hepatitis B vaccines have been licensed since 1982, hepatitis A vaccine since 1992. In 1996, a combined hepatitis A and B vaccine became available. An update on the long term protection conferred by hepatitis A and hepatitis B vaccines is given in the following para- graphs.