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Volume 76 - 2013 - Fasc.1 - Original articles

Risk factors associated with recurrent hemorrhage after the initial improvement of colonic diverticular bleeding

We elucidated risk factors contributing to recurrent hemor- rhage after initial improvement of colonic diverticular bleeding. 172 consecutive hospitalized patients diagnosed with colonic diver- ticular bleeding were analyzed. Recurrent hemorrhage after initial improvement of colonic diverticular bleeding is main outcome measure. We analyzed factors contributing to recurrent hemor- rhage risk in univariate and multivariate analyses. The length of the observation period after improvement of colonic diverticular bleeding was 26.4 ± 14.6 months (range, 1-79 months). The cumu- lative recurrent hemorrhage rate in all patients at 1 and 2 years was 34.8% and 41.8%, respectively. By univariate analysis, age > 70 years (P = 0.021), BMI > 25 kg/m2 (P = 0.013), the use of anti- coagulant drugs (P = 0.034), the use of NSAIDs (P = 0.040), history of hypertension (P = 0.011), history of smoking (P = 0.030) and se- rum creatinine level > 1.5 mg/dL (P < 0.001) were found to be sig- nificant risk factors for recurrent colonic diverticular bleeding. By multivariate analysis, age > 70 years (Hazard ratio (HR), 1.905, 95% confidence interval (CI), 1.067-3.403, P = 0.029), history of hypertension (HR, 0.493, 95% CI, 0.245-0.993, P = 0.048) and serum creatinine level > 1.5 mg/dL (HR, 95% CI, 0.288-0.964, P = 0.044) were shown to be significant independent risk factors. Close observation after the initial improvement of colonic diver- ticular bleeding is needed, especially in elderly patients or patients with history of hypertension or renal deficiency. (Acta gastroenterol. belg., 2013, 76, 20-24).


Evolution of colorectal cancer epidemiology in a setting of opportunistic screening. A 20 year national survey in Luxembourg.

Invasive colorectal cancer (CRC) is the second leading cause of cancer death in Luxembourg. There is no organized screening pro- gramme in Luxembourg. This study aims to obtain a precise epide- miological description of the evolution of invasive CRC and high grade intraepithelial neoplasia (HGIEN) from 1990 to 2009, extrac- ted from the database of the Morphologic Tumor Registry. Tumor stages and observed survival rates were also recorded. They were compared to the change in use of colonoscopic procedures. During the 20-year period, 4810 invasive CRC cases and 1180 HGIEN were recorded. Incidence rose from 1990 to 2005 and declined thereafter, especially in women. A sharp rise in HGIEN was noted from 2004 onwards, paralleling the rates of colonoscopies. 76 % of CRC cases were found in advanced stages pT3 and pT4. The pT stage distribu- tion did not change over the observation period. Observed survival rates improved during the study period. Conclusion: Under oppor- tunistic screening conditions, mainly through colonoscopy, the incidence of CRC was declinig in recent years, whereas HGIEN incidence is rising in Luxembourg. Tumor pT staging remained unchanged whereas survival rates improved. We conclude that -opportunistic- screening- is- of- little- benefit- for- CRC- prevention. A national organized screening programme is warranted. (Acta gastroenterol. belg., 2013, 76, 25-33).


Twice a day quadruple therapy for the first-line treatment of Helicobacter pylori in an area with a high prevalence of background antibiotic resistance

Background/Aims : Bismuth-containing quadruple therapy given four times a day is effective in the first-line treatment of Helico- bacter pylori. We aimed to investigate whether twice daily posology could eradicate H.pylori at a comparable rate in an area with a high prevalence of antibiotic resistance. Materials and Methods : The study group consisted of 90 patients with treatment naïve H. pylori. Patients were randomized to BOMT1 group (Bismuth citrate 2 × 600 mg, omeprazole 2 × 20 mg, metronidazole 2 × 500 mg, tetracycline 2 × 500 mg ; for 14 days) and BOMT2 group (Bismuth citrate 2×600 mg, omeprazole 2 × 20 mg, metronidazole 3 × 500 mg, tetracycline 4 × 500 mg ; for 14 days). H. pylori eradication was assessed by both C14-urea breath test and stool antigen test at least 8 weeks after treatment. Results : Demographic characteristics and endoscopy findings of the groups were similar. Eighty-two patients completed the study (BOMT1 = 38 and BOMT2 = 44) including H. pylori eradication assessment. The eradication rates determined by PP and ITT analyses were 86.8% and 73.3% for BOMT1 group, 90.1% and 88.9% for BOMT2 group, respectively. BOMT1 was found to be non-inferior to BOMT2 treatment. Patients in BOMT2 group had a significantly higher rate of drug associated adverse events than BOMT1 (34.1% vs 9.3% ; p = 0.008). Conclusions : Twice a day quadruple therapy is as effective as four times a day quadruple therapy in the first line treatment of H.pylori in a country with high resistance to metronidazole and clarithromycin and is more tolerable. (Acta gastroenterol. belg., 2013, 76, 34-37).


Vitamin D levels in Egyptian HCV patients (Genotype 4) treated with pegylated interferon

Background/Aim : Vitamin D has been shown to play an im- portant immunomodulatory role. Deficiency of vitamin D has been recently associated to the lack of response to interferon therapy in Hepatitis C virus genotype 1 infected patients. This study aims to evaluate serum level of vitamin D and verify whether circulating vitamin D has any independent role in predicting the rates of HCV virologic response after the adminis- tration of pegylated interferon to Egyptian patients infected with genotype 4 HCV. Methods : Fifty patients infected with HCV genotype 4 and not co-infected with neither Hepatitis B virus nor Human Immuno- deffiency Virus were recruited for the study. They were treated with ribavirin-pegylated interferon alpha 2a. Viral titer was deter- mined at baseline, at 12 weeks and at end of treatment (48 weeks). Vitamin D levels and a biochemical profile were obtained for the patients at baseline and at end of treatment. Vitamin D control group consisting of 20 healthy patients of similar age and weight to the study group were recruited to obtain vitamin D levels. Results : Vitamin D levels in HCV infected patients were signifi- cantly lower than in healthy subjects. Responders to ribavirin plus pegylated interferon alpha 2a therapy had significantly higher vitamin D levels than non-responders. Conclusion: Vitamin D deficiency predicts an unfavorable response to interferon-based treatment of HCV. (Acta gastroenterol. belg., 2013, 76, 38-44).


MR Enterography in children with Crohn disease : results from the Belgian Pediatric Crohn Registry (Belcro)

Introduction : Magnetic Resonance enterography (MRE) is an imaging modality avoiding ionizing radiation and the discomfort associated with enteroclysis. The results of MRE at diagnosis in the patients of the Belgian pediatric Crohn registry (Belcro) are compared to endoscopical and histological results. Methods : Results of MRE, endoscopy and histology were ob- tained from the medical charts and assigned to one of the following segments: jejunum, ileum, ascending colon, transverse colon, descending colon or rectosigmoid. MRE images were reviewed in a blinded way by 4 radiologists with specific interest in pediatric MRE. Results : From the Belcro registry, twenty-two patients under- went a MRE during their work-up for Crohn disease. The results of endoscopy, histology and MRE were concordant (either all negative or positive) in the ileum in 16/18 patients and in the recto- sigmoid, descending colon, transverse colon and ascending colon in resp 9, 8, 8 and 8/22 patients. In the non-concordant cases (MRE colon negative but endoscopy and/or histology positive), MRE could not reflect the subtle endoscopic or histologic lesions such as erosions that were described. In 4 cases where ileocaecal valve intu- bation was impossible ileal MRE findings were abnormal. MRE detected ileal stenosis, jejunal lesions and fistula in resp 4/22, 3/22 en 2/22 patients. The 100% and 75% interobserver agreement was resp 50-82% and 77.3-100% according to the different intestinal segments. Conclusions : MRE is a promising imaging modality avoiding radiation in Crohn disease. It should probably become the tech- nique of first choice for the evaluation of extensive small bowel disease in children with Crohn disease. (Acta gastroenterol. belg., 2013, 76, 45-48).