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Quénéhervé L, Drui D, Blin J, Péré M, Coron E, Barbara G, Barbaro MR, Cariou B, Neunlist M, Masson D, Bach-Ngohou K. Digestive symptoms in daily life of chronic adrenal insufficiency patients are similar to irritable bowel syndrome symptoms. Sci Rep 2021; 11:8077. [PMID: 33850177 PMCID: PMC8044180 DOI: 10.1038/s41598-021-87158-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/19/2021] [Indexed: 12/13/2022] Open
Abstract
Gastrointestinal symptoms are frequent in acute adrenal insufficiency. Although digestive symptoms can significantly reduce quality of life, they are rarely described in patients with treated chronic adrenal insufficiency (CAI). We aimed to characterize digestive symptoms in CAI patients. We used the section pertaining functional bowel disorders of the Rome IV questionnaire. A questionnaire was published on the website of the non-profit patient association "Adrenals" (NPPA of CAI patients) for five months. Information on demographics, characteristics of adrenal insufficiency, digestive symptoms and quality of life was collected. The relatives of CAI patients served as a control group. We analyzed responses of 33 control subjects and 119 patients (68 primary adrenal insufficiency (PAI), 30 secondary adrenal insufficiency (SAI) and 21 congenital adrenal hyperplasia (CAH)). Abdominal pain at least once a week over the past 3 months was reported by 40%, 47% and 33% of patients with PAI, SAI and CAH respectively versus 15% for the controls (p = 0.01). Symptoms were consistent with the Rome IV criteria for irritable bowel syndrome in 27%, 33% and 33% of patients respectively versus 6% for the controls (p < 0.0001). Quality of life was described as poor or very poor in 35%, 57% and 24% of patients respectively versus 5% for the controls (p < 0.0001). In conclusion, digestive symptoms are frequent and incapacitating in CAI patients and similar to symptoms of irritable bowel syndrome in 30% of CAI patients. Assessment and management of digestive symptoms should be considered a priority for physicians treating patients with CAI.
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Affiliation(s)
- L Quénéhervé
- INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, University of Nantes, Nantes, France
- Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France
| | - D Drui
- Department of Endocrinology, l'Institut du Thorax, CHU Nantes, 44400, Nantes, France
| | - J Blin
- INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, University of Nantes, Nantes, France
- Department of Biology, Laboratory of Clinical Biochemistry, CHU Nantes, 9 Quai Moncousu, 44000, Nantes, France
| | - M Péré
- Biostatistics Unit, Research Board, CHU Nantes, Nantes, France
| | - E Coron
- INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, University of Nantes, Nantes, France
- Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France
| | - G Barbara
- Department of Medical and Surgical Sciences, Centre for Applied Biomedical Research, University of Bologna, IRCCS S. Orsola, Bologna, Italy
| | - M R Barbaro
- Department of Medical and Surgical Sciences, Centre for Applied Biomedical Research, University of Bologna, IRCCS S. Orsola, Bologna, Italy
| | - B Cariou
- Department of Endocrinology, CNRS, INSERM, l'Institut du Thorax, CHU Nantes, Université de Nantes, 44400, Nantes, France
| | - M Neunlist
- INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, University of Nantes, Nantes, France
- Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France
| | - D Masson
- INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, University of Nantes, Nantes, France
- Department of Biology, Laboratory of Clinical Biochemistry, CHU Nantes, 9 Quai Moncousu, 44000, Nantes, France
| | - K Bach-Ngohou
- INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, University of Nantes, Nantes, France.
- Department of Biology, Laboratory of Clinical Biochemistry, CHU Nantes, 9 Quai Moncousu, 44000, Nantes, France.
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Lallemand L, Duchalais E, Musquer N, Jacobi D, Coron E, des Varannes SB, Mirallié E, Blanchard C. Does Sleeve Gastrectomy Increase the Risk of Barret's Esophagus? Obes Surg 2020; 31:101-110. [PMID: 32725593 DOI: 10.1007/s11695-020-04875-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Sleeve gastrectomy (SG) is the most commonly performed bariatric surgical procedure worldwide. However, the impact of SG on Barrett's esophagus (BE) remains unknown. The main objective was to determine the rate of BE 5 years after SG. MATERIALS AND METHODS Patients, operated in 2012 by SG in one center, who preoperatively and postoperatively (5 years) underwent upper gastrointestinal endoscopy (UGIE), 24-h pH monitoring, and esophageal manometry, were included. RESULTS A total of 59 (81.4% of females) patients were included. Preoperative mean age and body mass index were 45.2 ± 11.7 years and 45.2 ± 8.1 kg/m2 respectively. Preoperative 24-h pH monitoring reported gastroesophageal reflux disease (GERD) in 18 (30.5%) patients. The mean total body weight loss at 5 years was 16.1 ± 11.2%. No significant difference was observed between preoperative and postoperative de Meester's score (20.2 ± 27.1 and 21.0 ± 21.5 respectively (p = 0.91)) nor between preoperative and postoperative number of acid reflux episodes per 24 h (65.1 ± < 40.0 and 50.3 ± 40.3 (p = 0.21)). The UGIE revealed 5 patients (8.5%) with endoscopically suspected esophageal metaplasia, without confirmed metaplasia on histologic examination. GERD was diagnosed in 32 patients (54.2%), de novo GERD in 16 (27.1%) patients and esophagitis in 16 (27.1%) patients. At 5 years, 25 patients (42.4%) reported a lack of regular medical follow-up. CONCLUSIONS This study highlights the incidence of postoperative GERD and endoscopic lesions following SG. Even though SG is not contraindicated in case of reflux, GERD patients who undergo SG may be supervised by a close endoscopic surveillance.
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Affiliation(s)
- L Lallemand
- Chirurgie Cancérologique, Digestive et Endocrinienne (CCDE), Institut des Maladies de l'Appareil Digestif (IMAD), Centre Hospitalo-universitaire de Nantes (CHU) Hôtel-Dieu, Place Alexis Ricordeau, 44093, Nantes, France
| | - E Duchalais
- Chirurgie Cancérologique, Digestive et Endocrinienne (CCDE), Institut des Maladies de l'Appareil Digestif (IMAD), Centre Hospitalo-universitaire de Nantes (CHU) Hôtel-Dieu, Place Alexis Ricordeau, 44093, Nantes, France
- Université de Nantes, quai de Tourville, 44000, Nantes, France
| | - N Musquer
- Service d'Hépato-Gastroentérologie et Assistance Nutritionnelle, Institut des Maladies de l'Appareil Digestif (IMAD), Centre Hospitalo-Universitaire (CHU), Nantes, France
| | - D Jacobi
- Université de Nantes, quai de Tourville, 44000, Nantes, France
- L'Institut du Thorax, Service d'Endocrinologie, Maladies Métaboliques et Nutrition, CHU Nantes, Nantes, France
- L'Institut du Thorax, Inserm UMR-S1087, CNRS, UNIV Nantes, Nantes, France
| | - E Coron
- Université de Nantes, quai de Tourville, 44000, Nantes, France
- Service d'Hépato-Gastroentérologie et Assistance Nutritionnelle, Institut des Maladies de l'Appareil Digestif (IMAD), Centre Hospitalo-Universitaire (CHU), Nantes, France
| | - S Bruley des Varannes
- Université de Nantes, quai de Tourville, 44000, Nantes, France
- Service d'Hépato-Gastroentérologie et Assistance Nutritionnelle, Institut des Maladies de l'Appareil Digestif (IMAD), Centre Hospitalo-Universitaire (CHU), Nantes, France
| | - E Mirallié
- Chirurgie Cancérologique, Digestive et Endocrinienne (CCDE), Institut des Maladies de l'Appareil Digestif (IMAD), Centre Hospitalo-universitaire de Nantes (CHU) Hôtel-Dieu, Place Alexis Ricordeau, 44093, Nantes, France
- Université de Nantes, quai de Tourville, 44000, Nantes, France
| | - C Blanchard
- Chirurgie Cancérologique, Digestive et Endocrinienne (CCDE), Institut des Maladies de l'Appareil Digestif (IMAD), Centre Hospitalo-universitaire de Nantes (CHU) Hôtel-Dieu, Place Alexis Ricordeau, 44093, Nantes, France.
- Université de Nantes, quai de Tourville, 44000, Nantes, France.
- L'Institut du Thorax, Service d'Endocrinologie, Maladies Métaboliques et Nutrition, CHU Nantes, Nantes, France.
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Lilli NL, Quénéhervé L, Haddara S, Brochard C, Aubert P, Rolli-Derkinderen M, Durand T, Naveilhan P, Hardouin JB, De Giorgio R, Barbara G, Bruley des Varannes S, Coron E, Neunlist M. Glioplasticity in irritable bowel syndrome. Neurogastroenterol Motil 2018; 30:e13232. [PMID: 29027719 DOI: 10.1111/nmo.13232] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 09/17/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Growing evidence indicates a wide array of cellular remodeling in the mucosal microenvironment during irritable bowel syndrome (IBS), which possibly contributes to pathophysiology and symptom generation. Here, we investigated whether enteric glial cells (EGC) may be altered, and which factors/mechanisms lead to these changes. METHODS Colonic mucosal biopsies of IBS patients (13 IBS-Constipation [IBS-C]; 10 IBS-Diarrhea [IBS-D]; 11 IBS-Mixed [IBS-M]) and 24 healthy controls (HC) were analyzed. Expression of S100β and GFAP was measured. Cultured rat EGC were incubated with supernatants from mucosal biopsies, then proliferation and Ca2+ response to ATP were analyzed using flow cytometry and Ca2+ imaging. Histamine and histamine 1-receptor (H1R) involvement in the effects of supernatant upon EGC was analyzed. KEY RESULTS Compared to HC, the mucosal area immunoreactive for S100β was significantly reduced in biopsies of IBS patients, independently of the IBS subtype. IBS-C supernatants reduced EGC proliferation and IBS-D and IBS-M supernatants reduced Ca2+ response to ATP in EGC. EGC expressed H1R and the effects of supernatant upon Ca2+ response to ATP in EGC were blocked by pyrilamine and reproduced by histamine via H1R. IBS supernatants reduced mRNA expression of connexin-43. The S100β-stained area was negatively correlated with the frequency and intensity of pain and bloating. CONCLUSION AND INFERENCES Changes in EGC occur in IBS, involving mucosal soluble factors. Histamine, via activation of H1R-dependent pathways, partly mediates altered Ca2+ response to ATP in EGC. These changes may contribute to the pathophysiology and the perception of pain and bloating in patients with IBS.
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Affiliation(s)
- N L Lilli
- Université de Nantes, INSERM, IMAD, The enteric nervous system in gut and brain disorders, Université Bretagne Loire, Nantes, France.,Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
| | - L Quénéhervé
- Université de Nantes, INSERM, IMAD, The enteric nervous system in gut and brain disorders, Université Bretagne Loire, Nantes, France.,Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
| | - S Haddara
- Université de Nantes, INSERM, IMAD, The enteric nervous system in gut and brain disorders, Université Bretagne Loire, Nantes, France.,Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
| | - C Brochard
- Université de Nantes, INSERM, IMAD, The enteric nervous system in gut and brain disorders, Université Bretagne Loire, Nantes, France
| | - P Aubert
- Université de Nantes, INSERM, IMAD, The enteric nervous system in gut and brain disorders, Université Bretagne Loire, Nantes, France.,Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
| | - M Rolli-Derkinderen
- Université de Nantes, INSERM, IMAD, The enteric nervous system in gut and brain disorders, Université Bretagne Loire, Nantes, France.,Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
| | - T Durand
- Université de Nantes, INSERM, IMAD, The enteric nervous system in gut and brain disorders, Université Bretagne Loire, Nantes, France.,Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
| | - P Naveilhan
- Université de Nantes, INSERM, IMAD, The enteric nervous system in gut and brain disorders, Université Bretagne Loire, Nantes, France.,Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
| | - J-B Hardouin
- Université de Nantes, INSERM, SPHERE, Université Bretagne Loire, Nantes, France
| | - R De Giorgio
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Barbara
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - S Bruley des Varannes
- Université de Nantes, INSERM, IMAD, The enteric nervous system in gut and brain disorders, Université Bretagne Loire, Nantes, France.,Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
| | - E Coron
- Université de Nantes, INSERM, IMAD, The enteric nervous system in gut and brain disorders, Université Bretagne Loire, Nantes, France.,Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Nantes, France
| | - M Neunlist
- Université de Nantes, INSERM, IMAD, The enteric nervous system in gut and brain disorders, Université Bretagne Loire, Nantes, France
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4
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Soufflet F, Biraud M, Rolli-Derkinderen M, Lardeux B, Trang C, Coron E, Bruley des Varannes S, Bourreille A, Neunlist M. Modulation of VIPergic phenotype of enteric neurons by colonic biopsy supernatants from patients with inflammatory bowel diseases: Involvement of IL-6 in Crohn's disease. Neurogastroenterol Motil 2018; 30. [PMID: 28857361 DOI: 10.1111/nmo.13198] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 08/07/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Neuroplastic changes in the enteric nervous system (ENS) observed during IBD might participate in physiopathological processes. Vasoactive intestinal polypeptide has been shown to be involved in intestinal inflammation and barrier functions. We aimed to investigate the modulation of VIP expression in colonic biopsies of IBD patient, the ability of soluble factors from biopsies to reproduce in vitro these modulations and identify soluble factors responsible. METHODS VIP and cytokines mRNA expressions were assessed in colonic biopsies of healthy subjects (HS) and IBD patients from inflamed (I) and non-inflamed areas (NI). Supernatants (SUP) of biopsies were applied to primary culture of ENS and VIP and cytokines mRNA expressions were assessed. The role of cytokines in SUP induced changes in VIP expression was evaluated. KEY RESULTS VIP mRNA expression was lower in biopsies of patients with Crohn's disease (CD) than Ulcerative Colitis (UC) but unchanged as compared to HS. VIP mRNA and protein expression were lower in primary culture of ENS incubated with SUP-CD than with SUP-UC. Furthermore, in CD but not UC, SUP-I reduced VIP expression in the ENS as compared to SUP-NI. Next, IL-6 but not IL-5, IL-10, IL-17, IFN-γ or TNF-α reduced VIP expression in the ENS. Finally, in CD, SUP-I incubated with anti-IL-6 antibody increased VIP expression as compared to SUP-I alone. CONCLUSIONS & INFERENCES Mucosal soluble factors from IBD induce VIP neuroplastic changes in the ENS. IL-6 was identified as a putative soluble factor responsible in part for changes in VIP expression in CD.
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Affiliation(s)
- F Soufflet
- INSERM, UMR1235, Nantes, France.,Université Nantes, Nantes, France.,Institut des Maladies de l'Appareil Digestif, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France
| | - M Biraud
- INSERM, UMR1235, Nantes, France.,Université Nantes, Nantes, France.,Institut des Maladies de l'Appareil Digestif, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France
| | - M Rolli-Derkinderen
- INSERM, UMR1235, Nantes, France.,Université Nantes, Nantes, France.,Institut des Maladies de l'Appareil Digestif, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France
| | - B Lardeux
- INSERM, UMR1235, Nantes, France.,Université Nantes, Nantes, France.,Institut des Maladies de l'Appareil Digestif, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France
| | - C Trang
- INSERM, UMR1235, Nantes, France.,Institut des Maladies de l'Appareil Digestif, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France.,CIC Inserm 1413, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France
| | - E Coron
- INSERM, UMR1235, Nantes, France.,Université Nantes, Nantes, France.,Institut des Maladies de l'Appareil Digestif, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France.,CIC Inserm 1413, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France
| | - S Bruley des Varannes
- INSERM, UMR1235, Nantes, France.,Université Nantes, Nantes, France.,Institut des Maladies de l'Appareil Digestif, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France.,CIC Inserm 1413, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France
| | - A Bourreille
- INSERM, UMR1235, Nantes, France.,Université Nantes, Nantes, France.,Institut des Maladies de l'Appareil Digestif, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France.,CIC Inserm 1413, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France
| | - M Neunlist
- INSERM, UMR1235, Nantes, France.,Université Nantes, Nantes, France.,Institut des Maladies de l'Appareil Digestif, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France
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5
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Brochard C, Ducancelle A, Pivert A, Bodin M, Ricard A, Coron E, Couffon C, Dib N, Luet D, Musquer N, Rhun ML, Bertrais S, Michalak S, Lunel-Fabiani F, Cesbron-Metivier E, Caroli-Bosc FX. Human papillomavirus does not play a role in the Barrett esophagus: a French cohort. Dis Esophagus 2017; 30:1-7. [PMID: 28881904 DOI: 10.1093/dote/dox088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/07/2017] [Indexed: 12/11/2022]
Abstract
The role of human papillomavirus (HPV) in Barrett's esophagus (BE) has been examined but remains unclear. The purpose of the study is to dispute the connection between HPV and BE in a prospective case-control study. Biopsies were performed above and inside the Barrett's segment for BE patients and in the distal third of the esophagus for control patients for histological interpretation and for virological analysis. Biopsies for virological analysis were placed in a virus transport medium and immediately frozen in liquid nitrogen. Virological analysis involved real-time PCR using the SyBr® green protocol with modified SPF10 general primers. A total of 180 patients (119 control and 61 BE, respectively) were included. In BE patients, 31, 18, and 12 patients had, respectively, no dysplasia, low-grade dysplasia, and high grade dysplasia. Overall, nine were found to be HPV positive: five were control patients and four BE patients. HPV positive status was not associated with BE. No factors were associated with HPV, in particular the degree of BE dysplasia. HPV infection appears unlikely to be significant in the etiology of BE compared with control patients. (ClinicalTrials.gov, Number NCT02549053).
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Affiliation(s)
- C Brochard
- Gastroenterology and Hepatology Department, University Hospital.,INSERM U991, Rennes.,INSERM U913.,Gastroenterology and Hepatology Department
| | | | | | | | - A Ricard
- Gastroenterology and Hepatology Department
| | - E Coron
- INSERM U913.,Gastroenterology, Hepatology and Nutritional Support, University Hospital, Nantes
| | - C Couffon
- Gastroenterology and Hepatology Department
| | - N Dib
- Gastroenterology and Hepatology Department
| | - D Luet
- Gastroenterology and Hepatology Department
| | - N Musquer
- Gastroenterology, Hepatology and Nutritional Support, University Hospital, Nantes
| | - M Le Rhun
- Gastroenterology, Hepatology and Nutritional Support, University Hospital, Nantes
| | - S Bertrais
- HIFIH Laboratory, UPRES 3859, SFR 4208, LUNAM University, Angers, France
| | - S Michalak
- HIFIH Laboratory, UPRES 3859, SFR 4208, LUNAM University, Angers, France.,Pathology Department, University Hospital
| | - F Lunel-Fabiani
- Virology Department.,HIFIH Laboratory, UPRES 3859, SFR 4208, LUNAM University, Angers, France
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6
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Corbillé AG, Clairembault T, Coron E, Leclair-Visonneau L, Preterre C, Neunlist M, Derkinderen P. What a gastrointestinal biopsy can tell us about Parkinson's disease? Neurogastroenterol Motil 2016; 28:966-74. [PMID: 26914487 DOI: 10.1111/nmo.12797] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 01/18/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND The intraneuronal inclusions called Lewy bodies and neurites, which represent the characteristic pathological changes in Parkinson's disease, are found in the enteric neurons in the great majority of parkinsonian patients. This observation led to a substantial amount of research over the last few years in order to develop a minimally invasive diagnostic procedure in living patients based on gastrointestinal (GI) biopsies. PURPOSE In this review, we will begin by discussing the studies that focused on the detection of Lewy bodies and neurites in GI biopsies, then broaden the discussion to the pathological changes that also occur in the enteric glial cells and intestinal epithelial cells. We conclude by proposing that a GI biopsy could represent a unique window to assess the whole pathological process of the brain in Parkinson's disease.
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Affiliation(s)
- A-G Corbillé
- Inserm, U913, Nantes, France.,Nantes University, Nantes, France.,Department of Neurology, CHU Nantes, Nantes, France
| | - T Clairembault
- Inserm, U913, Nantes, France.,Nantes University, Nantes, France
| | - E Coron
- Inserm, U913, Nantes, France.,Nantes University, Nantes, France.,Institut des Maladies de l'Appareil Digestif, CHU Nantes, Nantes, France
| | | | - C Preterre
- Inserm, U913, Nantes, France.,Department of Neurology, CHU Nantes, Nantes, France
| | - M Neunlist
- Inserm, U913, Nantes, France.,Nantes University, Nantes, France.,Institut des Maladies de l'Appareil Digestif, CHU Nantes, Nantes, France
| | - P Derkinderen
- Inserm, U913, Nantes, France.,Nantes University, Nantes, France.,Department of Neurology, CHU Nantes, Nantes, France
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7
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Coron E, David G, Lecleire S, Jacques J, Le Sidaner A, Barrioz T, Coumaros D, Volteau C, Vedrenne B, Bichard P, Boustière C, Touchefeu Y, Brégeon J, Prat F, Le Rhun M. Antireflux versus conventional self-expanding metallic Stents (SEMS) for distal esophageal cancer: results of a multicenter randomized trial. Endosc Int Open 2016; 4:E730-6. [PMID: 27556085 PMCID: PMC4993873 DOI: 10.1055/s-0042-106960] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Self-expanding metal stents (SEMS) are commonly used in the palliation of dysphagia in patients with inoperable esophageal carcinoma. However, they predispose to gastroesophageal reflux when deployed across the gastroesophageal junction. The aims of this study were to: 1) assess the influence of the antireflux valve on trans-prosthetic reflux (primary outcome); and 2) compare the results of SEMS with and without antireflux valve in terms of reflux symptoms, quality of life (QOL), improvement of dysphagia and adverse events (secondary outcomes). PATIENTS AND METHODS Thirty-eight patients were enrolled in nine centers. Carcinomas were locally advanced (47 %) or metastatic. After randomization, patients received either a covered SEMS with antireflux valve (n = 20) or a similar type of SEMS with no antireflux device but assigned to standard proton pump inhibitor therapy and postural advice (n = 18). Trans-prosthetic reflux was assessed at day 2 using a radiological score based on barium esophagography performed after Trendelenburg maneuver and graded from 0 (no reflux) to 12 (maximum). Monthly telephone interviews were conducted for Organisation Mondiale de la Santé (OMS) scoring from 0 (excellent) to 5 (poor), QOL assessment (based on the Reflux-Qual Simplifié scoring system) from 0 (poor) to 100 (excellent), dysphagia scoring from 0 (no dysphagia) to 5 (complete dysphagia) and regurgitation scoring from 0 (no regurgitation) to 16 (maximum). RESULTS No difference was noted in terms of age, sex, size of lesion, prosthesis length or need for dilation prior to SEMS placement. No difficulty in placing SEMS nor complications were noted. Radiological scores of reflux were found to be significantly lower in patients with an antireflux stent compared to the conventional stent and associated measures. The regurgitation scores were significantly decreased in patients with antireflux stents during the first 2 months after stent placement and thereafter, they were similar in the two groups. QOL and dysphagia were improved in both groups. Survival rates were comparable in the two groups. CONCLUSIONS No difference was observed between the two types of SEMS regarding the palliation of dysphagia and improvement of QOL. However, SEMS with an antireflux valve were more effective in preventing trans-prosthetic gastroesophageal reflux but at the cost of an increased likehood of minor adverse events (migrations and/or obstruction of the SEMS).
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Affiliation(s)
- E. Coron
- Institut des Maladies de l’Appareil Digestif, Centre Hospitalier Universitaire, Nantes cedex, France,CIC-INSERM, Centre Hospitalier Universitaire, Nantes cedex, France,Corresponding author Pr Emmanuel Coron Institut des Maladies de l’Appareil DigestifCHU Hotel Dieu1 Place Alexis Ricordeau 44093 Nantes CedexFrance
| | - G. David
- Institut des Maladies de l’Appareil Digestif, Centre Hospitalier Universitaire, Nantes cedex, France,CIC-INSERM, Centre Hospitalier Universitaire, Nantes cedex, France
| | - S. Lecleire
- Service d’Hépatogastroentérologie, Centre Hospitalier Universitaire, Rouen, France
| | - J. Jacques
- Service d’Hépatogastroentérologie, Centre Hospitalier Universitaire, Limoges, France
| | - A. Le Sidaner
- Service d’Hépatogastroentérologie, Centre Hospitalier Universitaire, Limoges, France
| | - T. Barrioz
- Service d’Hépatogastroentérologie, Centre Hospitalier Universitaire, Poitiers, France
| | - D. Coumaros
- Service d’Hépatogastroentérologie, Centre Hospitalier Universitaire, Strasbourg, France
| | - C. Volteau
- Département de Biostatistiques, Centre Hospitalier Universitaire, Nantes, France
| | - B. Vedrenne
- Service d’Hépatogastroentérologie, Centre Hospitalier Universitaire, Mulhouse, France
| | - P. Bichard
- Service d’Hépatogastroentérologie, Centre Hospitalier Universitaire, Grenoble, France
| | - C. Boustière
- Service d’Hépatogastroentérologie, Hopital Saint-Joseph, Marseille, France
| | - Y. Touchefeu
- Institut des Maladies de l’Appareil Digestif, Centre Hospitalier Universitaire, Nantes cedex, France,CIC-INSERM, Centre Hospitalier Universitaire, Nantes cedex, France
| | - J. Brégeon
- CIC-INSERM, Centre Hospitalier Universitaire, Nantes cedex, France
| | - F. Prat
- Service d’Hépatogastroentérologie, Hopital Cochin, Paris, France
| | - M. Le Rhun
- Institut des Maladies de l’Appareil Digestif, Centre Hospitalier Universitaire, Nantes cedex, France,CIC-INSERM, Centre Hospitalier Universitaire, Nantes cedex, France
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Coron E. [French comment on article: Confocal laser endomicroscopy: a novel method for prediction of relapse in Crohn's disease]. Endoscopy 2016; 48:414. [PMID: 27022850 DOI: 10.1055/s-0042-104086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Håkansson B, Montgomery M, Cadiere GB, Rajan A, Bruley des Varannes S, Lerhun M, Coron E, Tack J, Bischops R, Thorell A, Arnelo U, Lundell L. Randomised clinical trial: transoral incisionless fundoplication vs. sham intervention to control chronic GERD. Aliment Pharmacol Ther 2015; 42:1261-70. [PMID: 26463242 DOI: 10.1111/apt.13427] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 08/08/2015] [Accepted: 09/21/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Until recently only two therapeutic options have been available to control symptoms and the esophagitis in chronic gastro-oesophageal reflux disease (GERD), i.e. lifelong proton pump inhibitor (PPI) therapy or anti-reflux surgery. Lately, transoral incisionless fundoplication (TIF) has been developed and found to offer a therapeutic alternative for these patients. AIM To perform a double-blind sham-controlled study in GERD patients who were chronic PPI users. METHODS We studied patients with objectively confirmed GERD and persistent moderate to severe GERD symptoms without PPI therapy. Of 121 patients screened, we finally randomised 44 patients with 22 patients in each group. Those allocated to TIF had the TIF2 procedure completed during general anaesthesia by the EsophyX device with SerosaFuse fasteners. The sham procedure consisted of upper GI endoscopy under general anaesthesia. Neither the patient nor the assessor was aware of the patients' group affiliation. The primary effectiveness endpoint was the proportion of patients in clinical remission after 6-month follow-up. Secondary outcomes were: PPI consumption, oesophageal acid exposure, reduction in Quality of Life in Reflux and Dyspepsia and Gastrointestinal Symptom Rating Scale scores and healing of reflux esophagitis. RESULTS The time (average days) in remission offered by the TIF2 procedure (197) was significantly longer compared to those submitted to the sham intervention (107), P < 0.001. After 6 months 13/22 (59%) of the chronic GERD patients remained in clinical remission after the active intervention. Likewise, the secondary outcome measures were all in favour of the TIF2 procedure. No safety issues were raised. CONCLUSION Transoral incisionless fundoplication (TIF2) is effective in chronic PPI-dependent GERD patients when followed up for 6 months. Clinicaltrials.gov: CT01110811.
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Affiliation(s)
- B Håkansson
- Department of Surgery, Ersta Hospital, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden
| | - M Montgomery
- Department of Surgery, Ersta Hospital, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden
| | - G B Cadiere
- Department of Surgery and Gastroenterology, Park Leopold Clinic, CHIREC, Brussels, Belgium
| | - A Rajan
- Department of Surgery and Gastroenterology, Park Leopold Clinic, CHIREC, Brussels, Belgium
| | | | - M Lerhun
- CHU Hotel Dieu Institut des Maladies de l' Appareil Digestif, Nantes, France
| | - E Coron
- CHU Hotel Dieu Institut des Maladies de l' Appareil Digestif, Nantes, France
| | - J Tack
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - R Bischops
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - A Thorell
- Department of Surgery, Ersta Hospital, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden
| | - U Arnelo
- Department of Surgery, Centre for Digestive Diseases, Karolinska University Huddinge Hospital, Karolinska Institutet, Stockholm, Sweden
| | - L Lundell
- Department of Surgery, Centre for Digestive Diseases, Karolinska University Huddinge Hospital, Karolinska Institutet, Stockholm, Sweden
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De Vries P, Supply E, Chevalier J, Aubert P, Loisel S, Marcorelles P, Coron E, Neunlist M. SFRP CO-08 – Conséquence d’une antibiothérapie néonatale sur la barrière intestinale du raton. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)72246-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sauk J, Coron E, Kava L, Suter M, Gora M, Gallagher K, Rosenberg M, Ananthakrishnan A, Nishioka N, Lauwers G, Woods K, Brugge W, Forcione D, Bouma BE, Tearney G. Interobserver agreement for the detection of Barrett's esophagus with optical frequency domain imaging. Dig Dis Sci 2013; 58:2261-5. [PMID: 23508980 PMCID: PMC3732518 DOI: 10.1007/s10620-013-2625-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 02/26/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Optical frequency domain imaging (OFDI) is a second-generation form of optical coherence tomography (OCT) providing comprehensive cross-sectional views of the distal esophagus at a resolution of ~7 μm. AIM Using validated OCT criteria for squamous mucosa, gastric cardia mucosa, and Barrett's esophagus (BE), the objective of this study was to determine the inter- and intra-observer agreements by a large number of OFDI readers for differentiating these tissues. METHODS OFDI images were obtained from nine subjects undergoing screening and surveillance for BE. Sixty-four OFDI image regions of interest were randomly selected for review. A training set of 19 images was compiled distinguishing squamous mucosa from gastric cardia and BE using previously validated OCT criteria. The ten readers then interpreted images in a test set of 45 different images of squamous mucosa (n = 15), gastric cardia (n = 15), or BE (n = 15). Interobserver agreement differentiating the three tissue types and BE versus non-BE mucosa was determined using multi-rater Fleiss's κ value. The images were later randomized again and four readers repeated the test 3 weeks later to assess intraobserver reliability. RESULTS All ten readers showed excellent agreement for the differentiation of BE versus non-BE mucosa (κ = 0.811 p < 0.0001) and for differentiating BE versus gastric cardia versus squamous mucosa (κ = 0.866, p < 0.0001). For the four readers who repeated the test, the median intraobserver agreement (BE vs. non-BE) was high (κ = 0.975, IQR: 0.94, 1.0). CONCLUSIONS Trained readers have a high interobserver agreement for differentiating BE, squamous, and gastric cardia mucosa using OFDI.
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Affiliation(s)
- J Sauk
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts,Gastroenterology Division, Massachusetts General Hospital; Boston, Massachusetts
| | - E Coron
- Department of Gastroenterology and Hepatology; University Hospital; Nantes, France
| | - L Kava
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts
| | - M Suter
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts
| | - M Gora
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts
| | - K Gallagher
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts
| | - M Rosenberg
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts
| | - A Ananthakrishnan
- Gastroenterology Division, Massachusetts General Hospital; Boston, Massachusetts
| | - N Nishioka
- Gastroenterology Division, Massachusetts General Hospital; Boston, Massachusetts
| | - G Lauwers
- Department of Pathology, Massachusetts General Hospital; Boston, Massachusetts
| | - K Woods
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts,Gastroenterology Division, Massachusetts General Hospital; Boston, Massachusetts,Digestive Diseases, Interventional Endoscopy, Emory University School of Medicine; Atlanta, Georgia
| | - W Brugge
- Gastroenterology Division, Massachusetts General Hospital; Boston, Massachusetts
| | - D Forcione
- Gastroenterology Division, Massachusetts General Hospital; Boston, Massachusetts
| | - BE Bouma
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts
| | - G Tearney
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts,Department of Pathology, Massachusetts General Hospital; Boston, Massachusetts
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Paillusson S, Lebouvier T, Pouclet H, Coron E, Bruley des Varannes S, Damier P, Neunlist M, Derkinderen P. Système nerveux entérique et maladie de Parkinson. Rev Med Interne 2012; 33:335-8. [DOI: 10.1016/j.revmed.2012.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 01/05/2012] [Indexed: 12/13/2022]
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Pouclet H, Lebouvier T, Coron E, Des Varannes SB, Neunlist M, Derkinderen P. A comparison between colonic submucosa and mucosa to detect Lewy pathology in Parkinson's disease. Neurogastroenterol Motil 2012; 24:e202-5. [PMID: 22292943 DOI: 10.1111/j.1365-2982.2012.01887.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lewy bodies and neurites (LN), the two pathological hallmarks of Parkinson's disease (PD), are found in the enteric nervous system (ENS). Previously, we have shown that whole mounts of submucosa obtained after microdissection of colonic biopsies can be used for the detection of LN in the submucosal plexus (SMP) of PD patients. Recent reports suggest that Lewy pathology may extend beyond the submucosa to involve the digestive mucosa. The aim of the present research was to determine whether the analysis of the mucosa obtained after microdissection may help improve the sensitivity of colonic biopsies to detect Lewy pathology in the colon of PD patients. METHODS Nine PD patients and 10 controls were included. Four biopsies were taken from the sigmoid/descending colon junction during the course of a rectosigmoidoscopy (short colonoscopy) in PD patients and during a total colonoscopy for colorectal screening in controls. Biopsies were microdissected, the mucosa was separated from the submucosa and both structures were analyzed by immunohistochemistry. Immunohistochemical analysis was performed using antibodies against phosphorylated alpha-synuclein to detect LN and neurofilaments NF200 kDa to label the neuronal structures. KEY RESULTS Lewy neurites were present in the SMP of four patients and in the mucosa of three patients. Remarkably, among the patients who displayed LN within their mucosa, one was devoid of Lewy pathology in his SMP. No LN were observed in the mucosa and the SMP of controls. CONCLUSIONS & INFERENCES The parallel analysis of colonic mucosa, along with the SMP, can help detect Lewy pathology in PD.
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Coron E, Mosnier JF, Ahluwalia A, Le Rhun M, Galmiche JP, Tarnawski AS, Matysiak-Budnik T. Colonic mucosal biopsies obtained during confocal endomicroscopy are pre-stained with fluorescein in vivo and are suitable for histologic evaluation. Endoscopy 2012; 44:148-53. [PMID: 22271025 DOI: 10.1055/s-0031-1291534] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND STUDY AIMS Confocal laser endomicroscopy (CLE) with intravenous infusion of fluorescein allows noninvasive, real-time in vivo visualization of gastrointestinal mucosa at ~ × 1000 magnification ("virtual biopsy"). Conventional biopsies obtained during these procedures serve as the reference and established diagnostic standard. The aim of the present study was to assess whether the standard histologic biopsies that are obtained during CLE retain fluorescein in the tissues and allow the visualization of mucosal structures without any additional staining. PATIENTS AND METHODS CLE optical imaging of the mucosa was performed in 16 patients who were undergoing CLE colonoscopy. Standard conventional biopsies were also obtained from both normal colonic mucosa and colonic polyps. De-paraffinized mucosal sections were examined under a fluorescence microscope for the presence and distribution of fluorescein, and then underwent immunostaining for expression of vascular endothelial growth factor (VEGF). RESULTS Standard mucosal biopsy sections from patients undergoing CLE displayed a strong fluorescence and showed well-delineated mucosal structures. In colonic adenomas, there was a 4.6-fold increased vascular permeability compared with normal mucosa (P<0.001), indicated by fluorescein leakage to the extravascular space. Immunostaining demonstrated an aberrantly increased expression of VEGF in the epithelium of colonic adenomas but not in the epithelium of normal mucosa or hyperplastic polyps. CONCLUSIONS This study shows for the first time that standard colonic biopsies obtained during CLE retain fluorescein, show excellent delineation of mucosal structures without additional staining, allow the evaluation of mucosal microvasculature and vascular permeability, and are suitable for immunostaining.
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Affiliation(s)
- E Coron
- Institut des Maladies de l'Appareil Digestif - INSERM U913, CIC 04 et Service d'Hépato-Gastroentérologie, Hôtel Dieu, CHU de Nantes, France
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Farhat S, Chaussade S, Ponchon T, Coumaros D, Charachon A, Barrioz T, Koch S, Houcke P, Cellier C, Heresbach D, Lepilliez V, Napoleon B, Bauret P, Coron E, Le Rhun M, Bichard P, Vaillant E, Calazel A, Bensoussan E, Bellon S, Mangialavori L, Robin F, Prat F. Endoscopic submucosal dissection in a European setting. A multi-institutional report of a technique in development. Endoscopy 2011; 43:664-70. [PMID: 21623560 DOI: 10.1055/s-0030-1256413] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND STUDY AIMS Endoscopic submucosal dissection (ESD) is a technique for "en bloc" resection of superficial tumors of the gastrointestinal tract. In France, experience with this technique is still limited. We wanted to assess the development of ESD in France, with special attention to short term outcomes. PATIENTS AND METHODS Members of the Société Française d'Endoscopie Digestive (SFED) who declared performing ESD reported their cases prospectively on a voluntary basis. Demographic, clinical, and technical data, and the results of immediate complications were collected. Case reports were completed prospectively by each investigator before pooled analysis. RESULTS A total of 188 consecutive case reports were collected from 16 centers. The median case mix per center was 6 patients (range 1-43). The lesion sites treated by ESD were the stomach (n = 75), esophagus (n = 27), duodenum (n = 1), cecum (n = 2), right colon (n = 3), transverse colon (n = 5), sigmoid (n = 3), and rectum (n = 72). The median size of the lesions was 26 mm (range 2-150 mm). En bloc resection was achieved in 77.1% of cases, with complete R0 resection in 72.9%. Histopathology results showed high grade dysplasia or superficial cancer in 71.2%. The median duration of ESD was 105 minutes (range 20-450 minutes). The short term morbidity was 29.2% including 34 cases of perforation (18.1%), and 21 hemorrhages (11.2%) during the 24 hours following ESD, 89% of which were managed conservatively or endoscopically. CONCLUSION In this early experience, the feasibility of ESD appeared to be good but R0 resection and complication rates did not match those reported by Japanese authors and must be improved by an extended practice.
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Sacher-Huvelin S, Coron E, Gaudric M, Planche L, Benamouzig R, Maunoury V, Filoche B, Frédéric M, Saurin JC, Subtil C, Lecleire S, Cellier C, Coumaros D, Heresbach D, Galmiche JP. Colon capsule endoscopy vs. colonoscopy in patients at average or increased risk of colorectal cancer. Aliment Pharmacol Ther 2010; 32:1145-53. [PMID: 21039676 DOI: 10.1111/j.1365-2036.2010.04458.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Colon capsule endoscopy (CCE) is a new, non-invasive technology. AIM To conduct a prospective, multicentre trial to compare CCE and colonoscopy in asymptomatic subjects enrolled in screening or surveillance programmes for the detection of colorectal neoplasia. METHODS Patients underwent CCE on day one and colonoscopy (gold standard) on day two. CCE and colonoscopy were performed by independent endoscopists. RESULTS A total of 545 patients were recruited. CCE was safe and well-tolerated. Colon cleanliness was excellent or good in 52% of cases at CCE. Five patients with cancer were detected by colonoscopy, of whom two were missed by CCE. CCE accuracy for the detection of polyps ≥ 6 mm was 39% (95% CI 30-48) for sensitivity, 88% (95% CI 85-91) for specificity, 47% (95% CI 37-57) for positive predictive value and 85% (95% CI 82-88) for negative predictive value. CCE accuracy was better for the detection of advanced adenoma, in patients with good or excellent cleanliness and after re-interpretation of the CCE videos by an independent expert panel. CONCLUSIONS Although well-tolerated, CCE cannot replace colonoscopy as a first line investigation for screening and surveillance of patients at risk of cancer. Further studies should pay attention to colonic preparation (Clinicaltrial.gov number NCT00436514).
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Matysiak-Budnik T, Coron E, Mosnier JF, Le Rhun M, Inoue H, Galmiche JP. In vivo real-time imaging of human duodenal mucosal structures in celiac disease using endocytoscopy. Endoscopy 2010; 42:191-6. [PMID: 20101565 DOI: 10.1055/s-0029-1243838] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Celiac disease is a gluten-induced enteropathy whose diagnosis is based on histological evidence of villous atrophy. The diagnosis may be difficult if the orientation of histological sections is other than optimal. During upper gastrointestinal endoscopy we studied in vivo duodenal mucosa in patients with celiac disease using endocytoscopy, a novel diagnostic technique allowing in vivo real-time visualization of mucosa under x 450 magnification. METHODS Sixteen patients with documented celiac disease and seven controls without celiac disease were studied. Endocytoscopic images obtained from several fields were compared in a blinded fashion to standard histology. RESULTS Endocytoscopy showed three different patterns of in vivo histology: (1) the presence of normal-appearing, long, thin villi, lined with clearly distinguishable surface epithelial cells, considered to be normal duodenal mucosa (n = 15, all controls and eight celiac disease patients); (2) the presence of thick, shortened villi, reflecting partial villous atrophy (n = 4); and (3) the total absence of villi and the presence of enlarged crypt orifices, reflecting total villous atrophy (n = 4). Good concordance between endocytoscopy and standard histology was found in all 16 patients with celiac disease. CONCLUSIONS Endocytoscopy allows in vivo, real-time, noninvasive visualization and characterization of villous architecture and may be a promising method for in vivo evaluation of duodenal mucosa in celiac disease.
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Affiliation(s)
- T Matysiak-Budnik
- Institut des Maladies de l'Appareil Digestif - INSERM U913, CIC 04 et Service d'Hépato-Gastroentérologie, Hôtel Dieu, CHU de Nantes, 44093 Nantes, France.
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Wallace MB, Meining A, Canto MI, Fockens P, Miehlke S, Roesch T, Lightdale CJ, Pohl H, Carr-Locke D, Löhr M, Coron E, Filoche B, Giovannini M, Moreau J, Schmidt C, Kiesslich R. The safety of intravenous fluorescein for confocal laser endomicroscopy in the gastrointestinal tract. Aliment Pharmacol Ther 2010; 31:548-52. [PMID: 20002025 DOI: 10.1111/j.1365-2036.2009.04207.x] [Citation(s) in RCA: 185] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Confocal laser endomicroscopy (CLE) is rapidly emerging as a valuable tool for gastrointestinal endoscopic imaging. Fluorescent contrast agents are used to optimize imaging with CLE, and intravenous fluorescein is the most widely used contrast agent. Fluorescein is FDA-cleared for diagnostic angiography of the retina. For these indications, the safety profile of fluorescein has been well-documented; however, to date, fluorescein is not cleared for use with CLE. AIMS To estimate the rate of serious and total adverse events attributable to intravenous fluorescein when used for gastrointestinal CLE. METHODS We performed a cross sectional survey of 16 International Academic Medical Centres with active research protocols in CLE that involved intravenous fluorescein. Centres using i.v. fluorescein for CLE who were actively monitored for adverse events were included. RESULTS Sixteen centres performed 2272 gastrointestinal CLE procedures. The most common dose of contrast agent was 2.5-5 mL of 10% sodium fluorescein. No serious adverse events were reported. Mild adverse events occurred in 1.4% of individuals, including nausea/vomiting, transient hypotension without shock, injection site erythema, diffuse rash and mild epigastric pain. The limitation is that only immediate post procedure events were actively monitored. CONCLUSIONS Use of intravenous fluorescein for gastrointestinal CLE appears to be safe with few acute complications.
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Affiliation(s)
- M B Wallace
- Department of Medicine, Mayo Clinic, Jacksonville, FL, USA.
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Lebouvier T, Coron E, Chaumette T, Paillusson S, Bruley des Varannes S, Neunlist M, Derkinderen P. Routine colonic biopsies as a new tool to study the enteric nervous system in living patients. Neurogastroenterol Motil 2010; 22:e11-4. [PMID: 19650774 DOI: 10.1111/j.1365-2982.2009.01368.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Better characterization of enteric neuropathies during the course of gastrointestinal diseases could be of great diagnostic and/or therapeutic interest. However, studies using whole mounts of the enteric nervous system (ENS) are restricted to specific diseases requiring surgery and are also limited by the small number of specimens available. Therefore, we here describe a novel method to obtain whole mounts of submucosal plexus in routine colonic biopsies. We show that a single biopsy displays a substantial number of submucosal ganglia and neurons and that it can be reliably used to perform morphometric and neurochemical analysis and Western Blots quantification of neuronal or glial markers. This method of analysis of the human ENS will enable us to gain better insight into the characterization of enteric neuropathies in living patients.
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Touchefeu Y, Le Rhun M, Coron E, Alamdari A, Heymann MF, Mosnier JF, Matysiak T, Galmiche JP. Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of solid pancreatic masses: the impact on patient-management strategy. Aliment Pharmacol Ther 2009; 30:1070-7. [PMID: 19735232 DOI: 10.1111/j.1365-2036.2009.04138.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a safe and accurate technique for diagnosing pancreatic cancer. However, its impact for management of these patients is poorly investigated. AIMS To investigate the diagnostic yield and the therapeutic impact of EUS-FNA in the management of solid pancreatic masses. METHODS One hundred consecutive patients who underwent EUS-FNA for a solid pancreatic mass were included. Aspirates were placed onto glass slides for cytological examination and microbiopsies were fixed in formaldehyde for histology. The impact on clinical management was analysed retrospectively according to different endpoints, such as its impact on indications for chemotherapy, surgery or appropriate follow-up modality. RESULTS Eight procedures were considered failures and two patients were lost to follow-up. A final diagnosis was obtained in 90 patients. The sensitivity, specificity and accuracy of combined cytology and histology for the diagnosis of malignant or potentially-malignant tumours were 78%, 75%, and 78% respectively. The sensitivity and accuracy of cytology alone were significantly higher than those of histology alone (P = 0.0003). By intention-to-diagnose analysis, EUS-FNA directly influenced the management strategy in 62 of 100 patients. CONCLUSIONS In patients with pancreatic mass and suspected malignancy, EUS-FNA provides an accurate diagnosis in approximately 80% of cases. EUS-FNA directly influences the management in two-thirds of patients.
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Affiliation(s)
- Y Touchefeu
- Institut des Maladies de l'Appareil Digestif. Department of Gastroenterology and Hepatology, University Hospital, Nantes, France
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Derkinderen P, Lebouvier T, Chaumette T, Coron E, Bruley des Varannes S, Neunlist M, Damier P. Les biopsies coliques obtenues par endoscopie : un outil pour étudier l’atteinte du système nerveux entérique dans la maladie de Parkinson. Rev Neurol (Paris) 2009. [DOI: 10.1016/s0035-3787(09)70005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lebouvier T, Chaumette T, Damier P, Coron E, Touchefeu Y, Vrignaud S, Naveilhan P, Galmiche JP, Bruley des Varannes S, Derkinderen P, Neunlist M. Pathological lesions in colonic biopsies during Parkinson's disease. Gut 2008; 57:1741-3. [PMID: 19022934 DOI: 10.1136/gut.2008.162503] [Citation(s) in RCA: 170] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Coron E, Sebille V, Cadiot G, Zerbib F, Ducrotte P, Ducrot F, Pouderoux P, Arts J, Le Rhun M, Piche T, Bruley des Varannes S, Galmiche JP. Clinical trial: Radiofrequency energy delivery in proton pump inhibitor-dependent gastro-oesophageal reflux disease patients. Aliment Pharmacol Ther 2008; 28:1147-58. [PMID: 18616516 DOI: 10.1111/j.1365-2036.2008.03790.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Radiofrequency (RF) energy delivery is an endoscopic procedure developed for the treatment of gastro-oesophageal reflux disease. AIM To compare RF and a proton pump inhibitor strategy (PPI) in PPI-dependent patients by carrying out a prospective, randomized trial. METHODS Patients with PPI-dependent typical reflux symptoms were randomly allocated to either RF or PPI regimen alone. The primary endpoint, evaluated at 6-month, was defined as the possibility for the patient to stop or to decrease PPI use to <50% of the effective dose required at baseline. RESULTS In the RF group, 18/20 patients stopped (n = 3) or decreased (n = 15) PPI use as compared to eight of 16 in the PPI group (P = 0.01). None of the control patients could stop PPI. Health-related quality of life scores were not different between groups. No significant change in oesophageal acid exposure (OAE) was noted between baseline and 6-months after RF. No severe complication was reported. CONCLUSIONS Radiofrequency energy delivery is a safe and effective therapeutic option, allowing reduction in or discontinuation of PPI therapy in patients with PPI-dependent symptoms, without loss of quality of life. However, in a majority of patients, PPI therapy cannot be completely stopped. The efficacy of RF does not seem to be related to a decrease in OAE.
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Affiliation(s)
- E Coron
- Institut des Maladies de l'Appareil Digestif, CHU Hôtel-Dieu, Nantes
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Affiliation(s)
- J P Galmiche
- Service Hépato-Gastroentérologie, Institut des Maladies de l'Appareil Digestif Nantes, CHU Nantes, F-44093 France.
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Neunlist M, Aubert P, Bonnaud S, Van Landeghem L, Coron E, Wedel T, Naveilhan P, Ruhl A, Lardeux B, Savidge T, Paris F, Galmiche JP. Enteric glia inhibit intestinal epithelial cell proliferation partly through a TGF-beta1-dependent pathway. Am J Physiol Gastrointest Liver Physiol 2007; 292:G231-41. [PMID: 16423922 DOI: 10.1152/ajpgi.00276.2005] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Although recent studies have shown that enteric neurons control intestinal barrier function, the role of enteric glial cells (EGCs) in this control remains unknown. Therefore, our goal was to characterize the role of EGCs in the control of intestinal epithelial cell proliferation using an in vivo transgenic and an in vitro coculture model. Assessment of intestinal epithelial cell proliferation after ablation of EGCs in transgenic mice demonstrated a significant increase in crypt cell hyperplasia. Furthermore, mucosal glial network (assessed by immunohistochemical detection of S-100beta) is altered in colon adenocarcinoma compared with control tissue. In an in vitro coculture model of subconfluent Caco-2 cells seeded onto Transwell filters with EGCs, Caco-2 cell density and [3H]thymidine incorporation were significantly lower than in control (Caco-2 cultured alone). Flow cytometry analysis showed that EGCs had no effect on Caco-2 cell viability. EGCs induced a significant increase in Caco-2 cell surface area without any sign of cellular hypertrophy. These effects by EGCs were also seen in various transformed or nontransformed intestinal epithelial cell lines. Furthermore, TGF-beta1 mRNA was expressed, and TGF-beta1 was secreted by EGCs. Exogenously added TGF-beta1 reproduced partly the EGC-mediated effects on cell density and surface area. In addition, EGC effects on Caco-2 cell density were significantly reduced by a neutralizing TGF-beta antibody. In conclusion, EGCs have profound antiproliferative effects on intestinal epithelial cells. Functional alterations in EGCs may therefore modify intestinal barrier functions and be involved in pathologies such as cancer or inflammatory bowel diseases.
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Affiliation(s)
- M Neunlist
- INSERM U 539, University of Nantes, Hôpital Hôtel Dieu, 44035 Nantes, France.
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Thibault R, Coron E, Sébille V, Sacher-Huvelin S, Bruley des Varannes S, Gournay J, Galmiche JP. Antireflux surgery for non-erosive and erosive reflux disease in community practice. Aliment Pharmacol Ther 2006; 24:621-32. [PMID: 16907894 DOI: 10.1111/j.1365-2036.2006.03024.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Antireflux surgery has been mainly evaluated in tertiary referral centres. Data regarding post-operative outcome in non-erosive reflux disease are lacking. AIM To assess long-term outcome after antireflux surgery performed in a community practice setting. METHODS We selected consecutively 60 non-erosive reflux disease patients and 61 erosive oesophagitis patients with symptomatic gastro-oesophageal reflux disease. After surgery, each subject answered a validated disease-specific health-related quality of life questionnaire and another questionnaire focusing on symptoms, late morbidity and drug use. RESULTS After a 43-month median follow-up, an excellent outcome was reported by less than two-thirds of patients. Quality of life scores were lower in the non-erosive reflux disease group, especially in female patients. Non-erosive reflux disease patients reported more daily symptoms and more reflux-related symptoms (P = 0.04). Proton-pump inhibitor use was higher in non-erosive reflux disease patients (P < 0.005). Multivariate analysis identified four independent predictive factors associated with better outcome, namely male gender, abnormal preoperative acid exposure, a long duration of symptoms and surgical expertise. CONCLUSIONS In community practice, the results of antireflux surgery are inferior to those reported by tertiary centres. Outcome seems poorer in non-erosive reflux disease especially in female patients. Nearly one-third of the non-erosive reflux disease patients continue to take proton-pump inhibitors. These results highlight the need for careful selection of patients before antireflux surgery.
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Affiliation(s)
- R Thibault
- Department of Gastroenterology, Hepatology and Nutritional Support, Institut des Maladies de l'Appareil Digestif, University Hospital, Nantes, France
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