Search

Anoperineal lesions are not uncommon in Crohn's disease and have a major impact on prognosis and quality of life. Management is complex and must be optimal. First-line treatment involves anti-TNFs, in association with surgical drainage if necessary. Infliximab has demonstrated its efficacy in inducing and maintaining remission or response in perianal Crohn's disease compared with placebo. Since early 2021, the subcutaneous (SC) formulation of infliximab CT-P13 has been available in France, offering patients the option of outpatient administration. GETAID's Bio-LAP-Rem multicenter observational study evaluated the use, efficacy, and safety of SC CT-P13 in patients with perianal Crohn's disease. These real-life data confirm its efficacy in patients with active perianal lesions, and a very low risk of recurrence in patients in remission prior to switch, as well as very high infliximab serum levels. The use of SC infliximab in perianal CD therefore appears safe, even if prospective data are needed to confirm these results. [ABSTRACT FROM AUTHOR]

Copyright of Hépato-Gastro & Oncologie Digestive is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé: Le cancer du canal anal représente 2,7 % des cancers digestifs et son incidence est en constante augmentation. Dans la grande majorité des cas, il s'agit d'un carcinome épidermoïde, qui est associé à l'infection par HPV notamment au génotype 16 dans 90 % des cas. Environ 30-40 % des patients présentent soit une maladie métastatique au diagnostic, soit une évolution vers une maladie avancée non résécable suite à une radiochimiothérapie pour une maladie initialement localisée. La chimiothérapie systémique est donc le traitement de choix. En France, la collaboration de groupes coopérateurs a permis de mener des essais de phase II dans les cancers du canal anal avancés, aboutissant à un changement de paradigme avec une validation prospective des protocoles dans cette situation orpheline. Le premier fruit de ce travail fut l'étude Epitopes-HPV02, qui a permis de valider le schéma modifié du DCF (docétaxel, cisplatine et 5-fluoruracile) comme un nouveau standard. Plus récemment, un réseau international a également validé l'intérêt des taxanes en première ligne. En deuxième ligne, les immunothérapies anti-PD1/PD-L1 semblent prometteuses, surtout en association. Plusieurs essais cliniques sont actuellement en cours. Anal canal carcinoma represents 2.7% of gastrointestinal cancers, and its incidence is steadily increasing. Squamous cell carcinoma is by far the most frequent subtype, and is associated with HPV infection, mostly the genotype 16 in 90% of cases. Approximately 30 to 40% of patients are in an advanced stage, either with metastatic disease at diagnosis or with non resectable recurrence after chemoradiotherapy for an initially localized disease. Systemic chemotherapy is then the standard of choice. In France, a national network was settled and made possible to perform large phase II trials in advanced anal carcinomas. This is a paradigm shift with prospective validation of new strategies in this rare clinical setting thanks to the collaboration of different groups. Its first fruit was the Epitopes-HPV02 trial which validated the modified DCF (docetaxel, cisplatin, and 5-fluorouracil) regimen as a new standard. More recently, an international network has also validated the interest of taxanes in first-line. In second-line, results with anti-PD1/PD-L1 check point inhibitors are encouraging, especially in association, and could be the next standard. Several clinical trials are ongoing [ABSTRACT FROM AUTHOR]

Résumé: Dans les maladies inflammatoires chroniques de l'intestin (MICI), la coloscopie est un examen-clé, répété pendant le suivi, pour l'évaluation de la maladie et de la réponse aux traitements. La coloscopie est aussi un examen indispensable pour la surveillance de la dysplasie dans les colites anciennes et étendues. La préparation colique doit être optimale en respectant les critères connus de qualité pour assurer des examens complets, de qualité, dans les meilleures conditions de sécurité. La description des lésions élémentaires, validées dans la maladie de Crohn et la rectocolite hémorragique, dans le compte-rendu d'endoscopie permet une évaluation précise et facile à partager. L'utilisation des scores les plus courants et/ou validés facilite la connaissance des lésions élémentaires et l'évaluation de l'efficacité des traitements dans le temps. Pour le dépistage de la dysplasie, il est recommandé d'utiliser des endoscopes haute définition et de nouvelle génération ; la chromoendoscopie au bleu reste actuellement le gold standard. In the era of tight control in inflammatory bowel disease management, colonoscopy is a key and repeated tool for disease evaluation and treatment efficacy assessment. Colonoscopy is also essential for screening of dysplasia in extensive and long-standing colitis. Bowel preparation should be optimal with respect to known quality criteria to insure complete, adequate and safe examinations. The description of validated elementary lesions in colonoscopy reports enables a precise and easy to share evaluation of the disease. Standard and validated endoscopic scores facilitate endoscopic description of mucosal lesions and treatment efficacy assessment. Chromoendoscopy with blue dying and high definition new generation endoscopes are recommended for screening of dysplasia in extensive and long-standing colitis. [ABSTRACT FROM AUTHOR]

The giant fibrovascular polyp of the esophagus is a rare, benign and typical entity described in 1957. This lesion is easily identifiable in its macroscopic and microscopic aspects. However, recent studies question the existence of the giant fibrovascular polyp of the esophagus. The demonstration of an amplification of the MDM2 gene poses the diagnosis of well-differentiated liposarcoma. We describe here a case of an esophagus polyp in a 67-year-old man. The diagnosis of giant fibrovascular polyp of the esophagus was initially retained. Secondly, the immunohistochemical and fluorescence in situ hybridization techniques showed amplification of the MDM2 gene and reclassified the lesion to a well-differentiated liposarcoma. The search for an undifferentiated contingent is essential to not ignore a dedifferentiated liposarcoma, which is a high-grade sarcoma with a poorer prognosis., (Copyright © 2019. Published by Elsevier Masson SAS.)

Crohn's disease and ulcerative colitis are chronic, progressive, destructive and disabling conditions. So far therapeutic strategies based only on the relief of symptoms did not change the natural history of inflammatory bowel diseases (BD). In Crohn's disease the concept of deep remission, which includes clinical and inflammatory (endoscopic and biologic) remission, is emerging. In ulcerative colitis, evidence accumulates to recommend achieving and maintaining mucosal healing as assessed by proctosigmoidoscopy. Whether histologic remission is the ultimate therapeutic goal in ulcerative colitis will require further investigation. These new therapeutic targets may be the best way to change disease course (hospitalizations, surgery) and to prevent disability in IBD.

Chronic diarrhea can be defined as the passage of more than 3 loose stools per day during more than 4 weeks. Differential diagnosis include fecal incontinence (stool consistency is normal), rectal syndrome (passage of blood and mucus but no liquid or loose stools) and fecal impaction. The proposed guidelines are based upon a classification of chronic diarrhea that distinguishes colonic, small bowel, pancreatic, endocrine and miscellaneous causes of chronic diarrhea. It also takes into account the frequency of the many causes of chronic diarrhea. One of its main objectives is to ensure the proper diagnosis of severe causes of chronic diarrhea, notably colorectal neoplasia.

Small and large bowels are dose-limiting structures for acute and late toxicity of abdominopelvic radiotherapy. Minor or moderate toxicities are underestimated. Major toxicities may occur years from treatment. Current optimal radiotherapy planning may predict precisely toxicities and new technologies for treatment delivery may prevent and/or reduce the frequency and severity of radiation enteropathy.