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Background and study aims Prognostic and risk factors for upper gastrointestinal bleeding (UGIB) might have changed overtime because of the increased use of direct oral anticoagulants and improved gastroenterological care. This study was undertaken to assess the outcomes of UGIB in light of these new determinants by establishing a new national, multicenter cohort 10 years after the first. Methods Consecutive outpatients and inpatients with UGIB symptoms consulting at 46 French general hospitals were prospectively included between November 2017 and October 2018. They were followed for at least for 6 weeks to assess 6-week rebleeding and mortality rates and factors associated with each event. Results Among the 2498 enrolled patients (mean age 68.5 [16.3] years, 67.1 % men), 74.5 % were outpatients and 21 % had cirrhosis. Median Charlson score was 2 (IQR 1–4) and Rockall score was 5 (IQR 3–6). Within 24 hours, 83.4 % of the patients underwent endoscopy. The main causes of bleeding were peptic ulcers (44.9 %) and portal hypertension (18.9 %). The early in-hospital rebleeding rate was 10.5 %. The 6-week mortality rate was 12.5 %. Predictors significantly associated with 6-week mortality were initial transfusion (OR 1.54; 95 %CI 1.04–2.28), Charlson score > 4 (OR 1.80; 95 %CI 1.31–2.48), Rockall score > 5 (OR 1.98; 95 %CI 1.39–2.80), being an inpatient (OR 2.45; 95 %CI 1.76–3.41) and rebleeding (OR 2.6; 95 %CI 1.85–3.64). Anticoagulant therapy was not associated with dreaded outcomes. Conclusions The 6-week mortality rate remained high after UGIB, especially for inpatients. Predictors of mortality underlined the weight of comorbidities on outcomes.

BACKGROUND AND AIMS To assess the characteristics, care, treatment response, and outcomes of primary biliary cholangitis (PBC) patients recently followed-up by hepato-gastroenterologists in various French and Belgian healthcare settings. METHODS This retrospective cohort study included patients with PBC who recently visited 79 hepato-gastroenterologists in France and Belgium. Data were collected at the time of diagnosis and at last visit and were compared according to biochemical response (BR) to ursodeoxycholic acid (UDCA) (BR), using Paris I-II criteria, and clinical outcomes. RESULTS A total of 436 patients (mean age at diagnosis 57 years, 88% females, median follow-up 5.2 years) were included. Liver biopsy, transient elastography, or none of these two procedures were performed at baseline in 216 (50%), 194 (45%), and 107 (25%) patients, respectively. Late-stage disease (histological stage III or IV, or transient elastography ≥9.6 kPa, or bilirubin >17 µM and albumin

The aim of this study was to determine the mortality and re-bleeding rates, and the risk factors involved, in a cohort of patients with previous diverticular bleeding (DB).In 2007, data on 2462 patients with lower gastrointestinal (GI) bleeding were collected prospectively at several French hospitals. We studied the follow-up of patients with DB retrospectively. The following data were collected: age, mortality rates and re-bleeding rates, drug intake, surgery and comorbidities.Data on 365 patients, including 181 women (mean age 83.6 ± 9.8 years) were available. The median follow-up time was 3.9 years (IQR 25-75: 1.7-5.4). Of these, 148 patients died (40.5%). Among the 70 patients (19.2%) who had at least one re-bleeding episode, nine died and three underwent surgical procedures. Anticoagulation and antiplatelet therapy was discontinued in 70 cases (19.2%). The independent risk factors contributing to mortality were age 80 years (HR = 3.18 (2.1-4.9);In this cohort, the rates of mortality and DB re-bleeding after a median follow-up time of 3.9 years were 19.2% and 40.5%, respectively. The majority of the deaths recorded were not due to re-bleeding.

Introduction and aim Data on the efficacy and tolerance of interferon-free treatment in chronic hepatitis C (CHC) in elderly patients are limited in phase II-III trials. Material and methods A prospective cohort of adult patients with CHC treated in French general hospitals. Results Data from 1,123 patients, distributed into four age groups, were analyzed. Of these, 278 were > 64 years old (fourth quartile) and 133 were > 73 years old (tenth decile). Elderly patients weighed less, were more frequently treatment-experienced women infected with genotype 1b or 2, while they less frequently had genotype 3 or HIV coinfection, but had more frequent comorbidities and drug consumption. Half of the patients had cirrhosis, whatever their ages. The main treatment regimens were sofosbuvir/ledipasvir (37.8%), sofosbuvir/daclatasvir (31.8%), sofosbuvir/simeprevir (16.9%), sofosbuvir/ribavirin (7.8%); ribavirin was given to 24% of patients. The overall sustained virological response (SVR) rate was 91.0 % (95% CI: 89.292.5%) with no difference according to age. Logistic regression of the independent predictors of SVR were albumin, hepatocellular carcinoma and treatment regimen, but not age. The rate of severe adverse events (66 in 59/1062 [5.6%] patients) tended to be greater in patients older than 64 years of age (21/261,8.1%), but the only independent predictors of SAE by logistic regression were cirrhosis and baseline hemoglobin. Patient-reported overall tolerance was excellent in all age groups, and patient-reported fatigue decreased during and after treatment, independent of age. Conclusions The high efficacy and tolerance of interferon-free regimens is confirmed in elderly patients in real-life conditions.

Summary Background and aims According to clinical trials, the treatment of patients with chronic hepatitis C (CHC) with second-generation direct acting antiviral agents (DAAs) is highly efficient and well tolerated. The goal of this study was to investigate the effectiveness and safety of various combinations of these drugs during their first 2 years of use in the real-world practice of French general hospitals. Methods Data from patients treated with all-oral DAAs in 24 French non-academic hospital centers from March 1, 2014 to January 1, 2016, were prospectively recorded. The sustained virological response 12–24 weeks after treatment (SVR 12-24) was estimated and severe adverse events (SAE) were evaluated and their predictive factors were determined using logistic regression. Results Data from 1123 patients were analyzed. The population was 69% genotype (G) 1, 13% G3, 11.5% G4, 5% G2, 49% with cirrhosis and 55% treatment-experienced. The treatment regimens were sofosbuvir/ledipasvir (38%), sofosbuvir/daclatasvir (32%), sofosbuvir/simeprevir (17%), ombitasvir + paritaprevir + ritonavir (5%) (with dasabuvir 3.5%), and sofosbuvir/ribavirin (8%). Ribavirin was given to 24% of patients. The SVR 12-24 was 91.0% (95% CI: 89.2–92.5%). Sofosbuvir-ribavirin was less effective than other regimens. The independent predictors of SVR 12-24 by logistic regression were body weight, albumin, previous hepatocellular carcinoma and treatment regimen (sofosbuvir/ribavirin vs. others). Sixty-four severe adverse events (SAE) were observed in 59 [5.6%] patients, and were independently predicted by cirrhosis and baseline hemoglobin. Serum creatinine increased during treatment (mean 8.5%, [P Conclusions Second generation DAAs combinations are as effective and well tolerated in a « real-world » population as in clinical trials. Further studies are needed on renal tolerance.

Early reports of endoscopic submucosal dissection (ESD) in Europe suggested high complication rates and disappointing outcomes compared to publications from Japan. Since 2008, we have been conducting a nationwide survey to monitor the outcomes and complications of ESD over time.All consecutive ESD cases from 14 centers in France were prospectively included in the database. Demographic, procedural, outcome and follow-up data were recorded. The results obtained over three years were compared to previously published data covering the 2008-2010 period.Between November 2010 and June 2013, 319 ESD cases performed in 314 patients (62% male, mean (±SD) age 65.4 ± 12) were analyzed and compared to 188 ESD cases in 188 patients (61% male, mean (±SD) age 64.6 ± 13) performed between January 2008 and October 2010. The mean (±SD) lesion size was 39 ± 12 mm in 2010-2013 vs 32.1 ± 21 for 2008-2010 (In this multicenter study, ESD achieved high rates of en bloc resection with a significant trend toward better outcomes over time. Improvements in lesion delineation and characterization are still needed to increase R0 resection rates.

Contexte Peu de donnees sont disponibles sur la pratique de la coloscopie et son rendement diagnostique en Europe. Nous avons mene une etude prospective nationale d’evaluation de la pratique de la coloscopie et des performances diagnostiques de cet examen.

Summary Background and objective Mortality of upper gastrointestinal bleeding seems declining. Whether practice guidelines for the management of peptic ulcer bleeding are followed is unknown. We aimed to update epidemiology of peptic ulcer bleeding and to assess the adherence to guidelines in the French community. Methods Between March, 2005 and February, 2006, a prospective multicenter study was conducted including all patients with communautary upper gastrointestinal bleeding. Data from patients with peptic ulcer bleeding were extracted and analyzed. Results Out of 3203 analyzable patients included, 1140 (35.6%) had a peptic ulcer bleeding and 965 of them a duodenal and/or gastric ulcer. Seven hundred and thirty-five were male (64.5%) and mean age was 66.4 years (±18.8). Overall, 699 patients (61.3%) were taking medication inducing upper gastrointestinal bleeding. Two-hundred and sixty-eight (23.5%) patients had endoscopic therapy, 190 (70.9%) of whom had epinephrine injection alone. Among the 349 patients with high risk stigmata on endoscopy (Forrest IA, IB, IIA), 209 (59.9%) underwent endoscopic therapy. One thousand one hundred and seven patients (97.1%) were given proton-pump inhibitors. One hundred and thirty-four patients (11.8%) experienced haemorrhagic recurrence. Forty-eight patients (4.2%) underwent surgery and 61 (5.4%) died. Conclusions Consistently with previous studies, mortality of upper gastrointestinal bleeding seems declining. Further progress lies above all in prevention but also probably in better adherence to therapeutic guidelines and management of comorbidities.

L’endoscopie en urgence permet le diagnostic etiologique et le traitement hemostatique des hemorragies d’origine haute. Par endoscopie en urgence, on entend generalement une endoscopie realisee dans les 24 premieres heures (cf. Consensus SFED : Endoscopie en urgence). Cependant, en cas d’hemorragie presumee active, l’endoscopie doit etre realisee plus precocement des que l’etat hemodynamique le permet. Elle sera idealement realisee par un operateur experimente, sous anesthesie generale, en salle d’endoscopie, en utilisant un videoendoscope et avec l’aide d’une infirmiere, ou personnel paramedical, formee aux gestes d’hemostase endoscopique. La pose d’une sonde nasogastrique a l’interet discutable et au caractere invasif n’est plus recommandee de facon systematique. Il faut preferer la perfusion par voie intraveineuse d’erythromycine (3 mg/kg ou 250 mg) dans les 30 minutes qui precedent l’endoscopie qui augmente la probabilite que l’estomac soit vide de sang. En cas d’hypertension portale connue ou probable, un traitement vasoactif par voie veineuse doit etre debute le plus tot possible. La somatostatine (Somatostatine®) et ses analogues (octreotide) sont aussi efficaces et mieux toleres que la vaso pressine ou terlipresine (Glypressine®). En cas de persistance de l’hemorragie, malgre le traitement vasoactif, l’endoscopie sera realisee des que possible. Si le traitement vasoactif est actif et le patient stabilise, l’endoscopie sera realisee dans les meilleures conditions pour un geste therapeutique. En cas d’hemorragie ulcereuse, la classification de Forrest est bien correlee aux risques de recidive hemorragique. En l’absence de traitement endoscopique, les risques de recidive hemorragique sont, en cas d’ulceres Forrest Ia (hemorragie en jet), Ib (suintement diffus), IIa (vaisseau visible non hemorragique), IIb (caillot adherent), IIc (taches pigmentees) et III (cratere blanc jaunâtre a fond propre), de respectivement 90, 20, 50, 20, 7 et 3 %. Sauf traitement par les antivitamines K et a fortiori en cas de surdosage, des biopsies gastriques peuvent etre pratiquees lors de l’endoscopie initiale, surtout en l’absence de prise d’anti-inflammatoires non steroidiens, afin de rechercher une infection a Helicobacter pylori, meme si le traitement ne sera le plus souvent instaure qu’une fois la phase aigue passee. En cas d’hemorragie G. Lesur () Hopital Ambroise-Pare, 9, avenue Charles-de-Gaulle, F-92104 Boulogne cedex, France gilles.lesur@apr.aphp.fr e-mail

Background & Aims Little is known about the magnitude of the risk of anal and rectal cancer in patients with anal and/or perineal Crohn's disease. We aimed to assess the risk of anal and rectal cancer in patients with Crohn's perianal disease followed up in the Cancers Et Surrisque Associe aux Maladies Inflammatoires Intestinales En France (CESAME) cohort. Methods We collected data from 19,486 patients with inflammatory bowel disease (IBD) enrolled in the observational CESAME study in France, from May 2004 through June 2005; 14.9% of participants had past or current anal and/or perianal Crohn's disease. Subjects were followed up for a median time of 35 months (interquartile range, 29–40 mo). To identify risk factors for anal cancer in the total CESAME population, we performed a case-control study in which participants were matched for age and sex. Results Among the total IBD population, 8 patients developed anal cancer and 14 patients developed rectal cancer. In the subgroup of 2911 patients with past or current anal and/or perianal Crohn's lesions at cohort entry, 2 developed anal squamous-cell carcinoma, 3 developed perianal fistula–related adenocarcinoma, and 6 developed rectal cancer. The corresponding incidence rates were 0.26 per 1000 patient-years for anal squamous-cell carcinoma, 0.38 per 1000 patient-years for perianal fistula–related adenocarcinoma, and 0.77 per 1000 patient-years for rectal cancer. Among the 16,575 patients with ulcerative colitis or Crohn's disease without anal or perianal lesions, the incidence rate of anal cancer was 0.08 per 1000 patient-years and of rectal cancer was 0.21 per 1000 patient-years. Among factors tested by univariate conditional regression (IBD subtype, disease duration, exposure to immune-suppressive therapy, presence of past or current anal and/or perianal lesions), the presence of past or current anal and/or perianal lesions at cohort entry was the only factor significantly associated with development of anal cancer (odds ratio, 11.2; 95% CI, 1.18-551.51; P = .03). Conclusions In an analysis of data from the CESAME cohort in France, patients with anal and/or perianal Crohn's disease have a high risk of anal cancer, including perianal fistula–related cancer, and a high risk of rectal cancer.

Summary Objectives To evaluate in naive patients with chronic hepatitis C 1- the efficacy and safety of one month interferon alpha (IFN-α) induction regimen; 2- the potential virological benefit of a secondary adjunction of ribavirin among HCV RNA negative patients after 20 weeks of IFN therapy, with or without an initial 4-week IFN induction. Material and methods 151 naive HCV-RNA positive patients presenting with biopsy- proven chronic hepatitis C and elevated ALT were randomised in a 2: 1 ratio in two arms: IFN-α 3 MU thrice a week (tiw) for 24 weeks (non-induced patients); IFN-α 6 MU daily for two weeks, then 3 MU daily for two weeks then 3 MU tiw for 20 weeks (induced patients). At week 24, HCV-RNA negative patients were randomised to receive in addition or not ribavirin 1-1.2 g daily for 24 additional weeks. Induction efficacy was assessed on the early viral response (EVR) defined as undetectable HCV RNA at week 4 then week 20. Ribavirin efficacy was assessed on the proportion of maintained complete response until the end of follow-up, 24 weeks after discontinuation of treatment. Data were analysed on an intent-to-treat basis. Results Efficacy of IFN-δ induction: 104 patients were randomised to the non-induction group, 47 to the induction group. Gender, age, genotype distribution and HCV viral load at baseline did not differ significantly between the two groups. There was one treatment discontinuation because of adverse events in induced patients versus four in non-induced patients (P > 0.05). The 4 week EVR was significantly greater in induced patients in patients with HCV genotype 1, 4 or 5 (47% vs 12%, P = 0.0002) only. There was no impact of induction in patients with HCV genotype 2 or 3. Efficacy of ribavirin: at week 24, 28 and 26 HCV-RNA negative patients were randomised to addition of ribavirin or not, respectively. Patients randomised to secondary additive ribavirin were more often HCV-RNA negative at the end of follow-up than patients treated with IFN-α alone: 18/28 (64%) vs 10/26 (39%); P = 0.06. Among patients randomised to bitherapy, the relapse rate was significantly lower in patients with genotype 2 or 3 (0/12 vs 6/13, P = 0.01) and not in those with genotype 1, 4 or 5 (5/11 vs 3/6, P = 0.99). Conclusion A 4 week IFN-α induction significantly increases the EVR rate in patients with HCV genotype 1, 4 or 5. Late secondary adjunction of ribavirin to IFN-α for 6 months in HCV-RNA negative patients after 6 months of IFN-α significantly decreases the relapse rate in patients with HCV genotype 2 or 3, but not in patients with genotypes 1, 4 or 5.

Education of patients with chronic hepatitis C has been proposed to increase response to therapy with peginterferon and ribavirin. We performed a prospective study to determine the effects of systematic consultation by a nurse on patient adherence and the efficacy of therapy.We analyzed data from 244 patients who received either systematic consultation after each medical visit from a nurse who used a standard evaluation grid and provided information about the disease and treatment (group A [GrA], n = 123) or the conventional clinical follow-up procedure (group B [GrB], n = 121). Treatment lasted 24 to 48 weeks.Characteristics of each group were similar at baseline, including prior treatment (42.6% in GrA and 36.0% in GrB). Overall, GrA had significantly better adherence to treatment than GrB (74.0% vs 62.8%), especially among patients who received 48 weeks of treatment (69.7% vs 53.2%; P.03). Significantly more patients in GrA had a sustained virologic response, compared with GrB overall (38.2% vs 24.8%; P.02), as well as treatment-naive patients (47.1% vs 30.3%; P.05), and those with genotypes 1, 4, or 5 infections (31.6% vs 13.3%; P.007). There were no differences between GrA and GrB in response of patients with genotypes 2 or 3 infections or advanced fibrosis. Prognostic factors for a sustained virologic response (based on bivariate and multivariate analyses) were virologic response at week 12 (odds ratio [OR], 1.9; P.0001), genotypes 2 or 3 (OR, 2.9; P.0001), therapeutic education (OR, 2.5; P.02), and lack of previous treatment (OR, 2.3; P.005).Therapeutic education by a specialized nurse increases the response of patients with hepatitis C to therapy, particularly in difficult-to-treat patients.

Introduction Le but de ce travail a ete de decrire et quantifier prospectivement l'ensemble des coloscopies realisees en France et son evolution depuis 1998. Materiels et Methodes une enquete prospective a ete realisee du 15 au 27 novembre 2004 aupres de l'ensemble des gastro-enterologues francais (n=2963). Le recueil des donnees concernait les endoscopies effectuees sur deux jours ouvrables, fixes prealablement. 1101 reponses ont ete adressees soit 7205 endoscopies realisees. L'echantillon etait representatif sur le sexe, l'âge, la region et le type d'exercice. Des extrapolations ont ete realisees sur la base des 2963 gastroenterologues. Resultats 1.049.348 coloscopies totales ont ete realisees en 2004 soit une augmentation de 11,4% depuis 2003. La coloscopie etait totale dans 96% des cas. Les echecs de coloscopie sont en diminution –30,2% par rapport a 2003. Les echecs etaient dus a des difficultes techniques dans 24,9%, une insuffisance de preparation dans 32,7%, un obstacle colique dans 35,5%. L'anesthesie generale est delivree dans 95,2% des cas. Une polypectomie etait associee a 29,2% des coloscopies, chiffre en augmentation, un autre geste therapeutique etait associe dans 2,7%. Les indications principales de la coloscopie etaient: coloscopie de depistage (25,1%), rectorragies (19,8%), troubles fonctionnels intestinaux (12,9%), surveillance apres polypectomie (15,5%), surveillance d'un cancer du colon (6,3%). Les indications de la coloscopie de depistage etaient: antecedents familiaux (74,9%), Hemoccult® positif (11,8%), souhait du patient (13,2%). La coloscopie etait pathologique dans 59,6% des cas. Les principaux diagnostics etaient le polype rectocolique (372.802), diverticulose simple (226.051), tumeurs malignes rectocoliques en excluant les surveillances et les diagnostiques prealables par une R.S.S. (40.000), MICI (35.966). Le nombre total de polypes enleves est de 694.527 (en 2003: 637.628, en 2000: 492.892). En cas de coloscopie de depistage (troubles fonctionnels intestinaux, souhait du patient, antecedents familiaux du premier degre), le pourcentage de polype trouve varie de 35,6% a 25,8% et le pourcentage de cancer trouve varie de 2,97% a 1,3%. Le pourcentage de complications est stable avec moins de perforations 0,03% en 2004 pour 0,07% en 2003. Conclusion le nombre de coloscopies pratiquees en France a augmente. 700.000 polypes coliques ont ete enleves et 40.000 cancers ont ete diagnostiques. Malgre l'augmentation des polypectomies (700.000), le nombre de cancers rectocoliques continue a augmenter (40.000) ce qui signifie que le depistage du cancer du colon n'est pas encore efficace. Structure: Endoscopie et Imagerie digestives

Summary Aims The information given to patients before a medical procedure is usually delivered verbally and in the form of a written document. Viewing a video movie about the procedure might be helpful in improving the quality of patient information and thus contributed to reduce patient anxiety. The aim of this prospective study on the methods used to deliver information to patients scheduled for liver biopsy was to determine, in comparison with standard information delivery, the impact on anxiety and understanding of additional information provided by a video movie. Methods Patients included in this study were scheduled for liver biopsy. Three days before the procedure, a physician informed the patients about liver biopsy and gave them a written information document. After this standard information delivery, the patients were randomly assigned to two groups, to view or not a video movie illustrating liver biopsy and recalling the information provided in the information document. Anxiety was measured after the information visit and just before the biopsy procedure using Spielberger's self-administered STAI-Y questionnaire. Patient understanding of and satisfaction with the information received were evaluated respectively before and after the procedure. Results Among the 67 patients retained for analysis, 33 viewed the information video and 34 did not. The level of anxiety measured at the information visit and before liver biopsy was similar in the two groups (38.8 and 37.4 with video versus 38.9 and 40.1 without video). The patients had an excellent understanding of the information received (12.3/14 with video; 12.7/14 without video) and were well satisfied with the information received. Conclusion The patients understood and were well satisfied with the information received about liver biopsy. Complementary information in the form of a video movie had no effect on patient anxiety.

P0796 NEW DIRECT ACTING ANTIVIRALS FOR HEPATITIS C TREATMENT: FIRST RESULTS IN A REAL-LIFE SETTING IN FRANCE A. Pariente, A.-J. Remy, J.-P. Arpurt, I. Rosa-Hezode, C. Renou, R. Arotcarena, G. Macaigne, H. Lison, F. Bourhis, X. Causse, A. Pauwels, S. de Montigny-Lenhardt, V. Jouannaud, H. Labadie, E. Maringe, J.-H. Salloum, E. Gagea, H. Hagege, B. Lesgourgues, on behalf of Association Nationale des Gastroenterologues des Hopitaux generaux (ANGH). Service d’Hepatogastroenterologie, Centre Hospitalier, Pau, Service d’Hepatogastroenterologie, Centre Hospitalier, Perpignan, Service d’Hepatogastroenterologie, Centre Hospitalier, Avignon, Service d’Hepatogastroenterologie, Centre Hospitalier Intercommunal, Creteil, Service d’Hepatogastroenterologie, Centre Hospitalier, Hyeres, Service d’Hepatogastroenterologie, Centre Hospitalier, Lagny-Marne la Vallee, Service d’Hepatogastroenterologie, Centre Hospitalier, Creil, Service d’Hepatogastroenterologie, Centre Hospitalier, Chambery, Service d’Hepatogastroenterologie, Centre Hospitalier Regional, Orleans la Source, Service d’Hepatogastroenterologie, Centre Hospitalier, Gonesse, Service d’Hepatogastroenterologie, Centre Hospitalier, Aubagne, Service d’Hepatogastroenterologie, Centre Hospitalier, Montfermeil, Service d’Hepatogastroenterologie, Centre Hospitalier Delafontaine, Saint-Denis, Service d’Hepatogastroenterologie, Centre Hospitalier, Beaune, Service d’Hepatogastroenterologie, Centre Hospitalier, Meaux, Service d’Hepatogastroenterologie, Centre Hospitalier, Cholet, France E-mail: alex.pariente@free.fr

Introduction: Antimicrobial peptides act as innate defense of organisms ranging from plants to insects to humans. They are surface acting agents secreted by all epithelial cells including intestine, which kill microbes. Such peptides possess activities against bacteria, viruses and fungi. As pharmacological induction of these antimicrobial peptides could have potential therapeutic utility, a search for novel molecules that induces production of epithelial antimicrobial peptides has long been sought. Recently, L-isoleucine and its analogues have been found to induce antimicrobial peptides in epithelial surfaces of intestine. So, L-isoleucine might have therapeutic potentials in the management of infectious diarrhea. Aim: The aims of this study were to examine if addition of L-isoleucine to currently recommended (WHO) oral rehydration solution (ORS) reduces the stool weight and/or duration of acute diarrhea. Methods: This was a double blind randomized clinical trial in 51 male children aged 6 to 36 months attending the ICDDRB hospital with acute diarrhea; 26 children received Lisoleucine (2 g/L) added ORS (study) and 25 received ORS without L-isoleucine(control). Other managements were similar. The children remained in the study until recovery from diarrhea but up to a maximum of 5 days. Time to resolution of diarrhea and stool weight were the primary outcomes. Results: Baseline clinical characteristics of the children were comparable between the groups. There was a trend in reduction of stool weight (g) from day 2 ( day1 to day3, study vs. control, stool wt, mean ±SD, 560±240 vs. 563±409, p= 0.93; 407±284 vs. 515±316, p=0.24; 363±284 vs. 651±445, p=0.03 respectively) in the groups receiving ORS with L-isoleucine and the difference was significant on day3. ORS intake (ml) also showed similar trend (day1 to day3 mean ±SD, 410±169 vs. 564±301, p= 0.14; 330±245 vs. 401±226, p=0.33; 312±233 vs. 454±260, p=0.09 respectively), however, the differences were not statistically significant. Duration of diarrhea (hr) was similar in both groups (study vs. control, mean ±SD, 74±38 vs. 75 ±42, p=0.96). Conclusion: Lisoleucine supplemented ORS reduces stool weight and ORS intake in children with acute diarrhea. Further large study is warranted to establish the beneficial effect of L-isoleucine supplemented ORS.

Introduction La campagne Francaise de depistage du cancer colorectal est basee sur un test de detection de saignement occulte pour une population âgee de 50 a 74 ans. Une coloscopie est indiquee en cas de test positif. Le volume des preparations actuelles peut etre un frein au depistage. Une solution de volume reduit pourrait alors renforcer l’acceptabilite des patients et ameliorer ainsi ce depistage. Materiels et methodes Une etude randomisee, conduite dans 25 centres francais, a compare 2 litres de macrogol + electrolytes + ascorbate (MEA) a 4 litres de macrogol + electrolytes (ME). Les patients en ambulatoire, âges de 18 a 85 ans, etaient tires au sort pour boire 2 litres de MEA (n = 210) ou 4 litres de ME (n = 205) la veille au soir de la coloscopie. Une prise complementaire de liquide clair etait autorisee. Des experts independants analysaient en aveugle, sur DVD, la qualite de lavage dans le sous-groupe des 50-74 ans. Le succes du lavage etait base sur la visualisation complete de la muqueuse de 5 segments predefinis. Les criteres de jugement secondaires incluaient l’echelle d’Aronchik pour l’efficacite et les evaluations d’acceptabilite et de securite d’emploi. Resultats Les 50-74 ans (n = 269) representaient la population majoritaire (65 %) de l’essai (n = 135 avec MEA, n = 134 avec ME). L’indication de la coloscopie etait principalement liee au depistage du cancer (61 %). La preparation par MEA etait reussie pour 95,6 % des patients vs 94 % avec le ME (NS). Ces resultats etaient confirmes par le score d’Aronchick : 95,6 % de patients avaient un lavage correct a excellent pour MEA et 94,8 % pour ME (NS). 87 % des coloscopies realisees avec MEA etaient conformes aux recommandations de la SFED concernant le temps de retrait de l’endoscope. Davantage de patients sous MEA que sous ME trouvaient la solution facile a ingerer (86,4 % vs 72,1 %, p = 0,005) et un plus grand nombre encore souhaitait reprendre le MEA (88,8 % vs 54,4 %, p vs 22,4 % du groupe ME (p Les effets indesirables (EI) etaient comparables dans les 2 groupes (77 % avec MEA vs 85 % avec ME, NS). Les EI les plus frequents etaient : inconfort anal, douleurs et distension abdominales, nausees et vomissements. 3 EI serieux etaient rapportes sous MEA et 4 sous ME. Aucun de ces EI n’etait relie a la preparation. Conclusion MEA permettait de voir la totalite de la muqueuse chez 96 % des patients âges de 50 a 74 ans. L’association d’une bonne acceptabilite et d’un bon profil de tolerance fait de cette solution a faible volume une preparation de choix pour la campagne francaise de depistage du cancer colorectal.

Introduction Les progres recents concernant l’hemostase endoscopique des ulceres gastro-duodenaux hemorragiques ont conduit a l’elaboration de recommandations de pratique clinique. Le but de notre travail etait d’evaluer la prise en charge endoscopique des hemorragies digestives hautes d’origine ulcereuse et son impact sur le pronostic. Patients et Methodes Une etude prospective multicentrique incluant exhaustivement les patients admis pour une hemorragie digestive haute a ete menee en 2005-2006 par l’Association Nationale des hepato-Gastroenterologues des Hopitaux generaux de France. Les donnees concernant les patients ayant une hemorragie ulcereuse ont ete extraites et les comptes-rendus des patients ayant eu une hemostase endoscopique ont ete recuperes afin de completer la base de donnees. Une analyse univariee et multivariee (regression logistique) des facteurs predictifs de recidive hemorragique et de deces a ete effectuee. Resultats Mille cent quarante patients avaient ete admis pour une hemorragie digestive haute d’origine ulcereuse. Deux cent soixante-huit patients (23,5 %) ont eu un traitement endoscopique a visee hemostatique. Deux cent quatorze patients (79,9 %) ont eu un traitement endoscopique faisant appel a une seule methode d’hemostase : injection de serum adrenaline (n = 190 ; 70,9 %), mise en place de clips (n = 15 ; 5,6 %), ligature (n = 4 ; 1,5 %), coagulation au plasma argon (n = 3 ; 1,1 %), electrocoagulation bipolaire (n = 2 ; 0,8 %). Cinquante-deux patients (19,4 %) ont eu une association de 2 methodes d’hemostase : injection de serum adrenaline et clips (n = 41 ; 15,3 %), injection et electrocoagulation bipolaire (n = 7 ; 2,6 %), injection et coagulation au plasma argon (n = 4 ; 1,5 %). Deux patients (0,8 %) ont eu un traitement endoscopique associant 3 methodes : injection de serum adrenaline, clips et coagulation au plasma argon. La quantite moyenne d’adrenaline injectee etait 8,7 ± 5 mL (min = 1 ; max = 30). Lorsqu’il existait un caillot adherent (n = 188), celui-ci a ete le plus souvent laisse en place (n = 171 ; 91 %). Trois cent quarante-neuf patients avaient une indication validee de traitement endoscopique : hemorragie active (Forrest Ia et Ib) et aspect endoscopique de vaisseau visible non hemorragique (Forrest IIa). Parmi eux, 209 (59,9 %) ont eu une hemostase endoscopique. Il s’agissait le plus souvent d’une monotherapie (n = 158 ; 75,6 %), plus rarement d’une bitherapie endoscopique (n = 50 ; 23,9 %). En analyse multivariee, le risque de recidive hemorragique etait diminue lorsque l’endoscopiste disposait d’une aide specialisee (OR = 0,632 ; p = 0,033 ; IC = 0,414-0,964) et il existait une tendance a une diminution de la mortalite lorsqu’un geste d’hemostase endoscopique etait realise (OR = 0,506 ; p = 0,096 ; IC = 0,227-1,127). Conclusion Il faut intensifier les efforts destines a favoriser la diffusion et l’application des recommandations de pratique clinique. La presence d’une aide specialisee et la realisation d’un geste d’hemostase lors de l’endoscopie initiale sont associes a une diminution respectivement du risque de recidive et de deces.

But La realisation d’une endoscopie digestive haute en urgence la nuit ou le week-end est souvent difficile au cours des HDH en raison de l’absence le plus souvent d’une aide specialisee pour la realisation des gestes techniques. Le but de notre travail etait d’etudier les conditions de realisations et les facteurs pronostiques des HDH survenant la nuit ou le week-end comparativement au jour et en semaine. Patients et Methodes De fevrier 2005 a mars 2006, 3 287 patients ont ete hospitalises dans 53 hopitaux generaux pour une HDH ; les donnees epidemiologiques et pronostiques ont ete prospectivement saisies dans une base de donnees. Chaque praticien notait l’heure de realisation de l’endoscopie et si celle-ci etait realisee la nuit ou le week-end. Resultats Nous avons retenu les 3 083 patients qui ont eu une endoscopie dont 684 (22,2 %) la nuit ou le week-end (groupe 1) et 2 399 (77,8 %) le jour et en semaine (groupe 2). Il n’existait pas de difference statistique entre les patients des groupes 1 et 2 en ce qui concerne l’âge moyen et le sex ratio. Les patients du groupe 1 etaient plus souvent hospitalises en reanimation 21 % vs. 11,6 % (p Conclusion Si le delai de realisation d’une endoscopie est plus court la nuit ou le week-end cela ne s’explique pas par la gravite plus importante des patients mais probablement par leur hospitalisation plus frequente en reanimation. Le taux de recidive hemorragique est plus important parmi les patients ayant eu une endoscopie la nuit ou le week-end ; les facteurs explicatifs pourraient etre l’absence frequente d’une aide specialisee.

D. Larrey1, A. Salse1, G.P. Pageaux1, N. Funakoshi1, D. Ribard2, O. Boutet3, V. Hyrailles4, B. Niang5, E. Vaucher6, J.P. Arpurt7, A.J. Remy8, S. Dahmouni1, N. Kharlova9, J.P. Daures10. 1Liver Unit/School of Medecine, St Eloi Hospital/INSERMU632, Montpellier, 2Liver Unit, Nimes Hospital, Nimes, 3Liver Unit, Bagnols sur Ceze Hospital, Bagnols sur Ceze, 4Liver Unit, Beziers Hospital, Beziers, 5Liver Unit, Ales Hospital, Ales, 6Liver Unit, Narbonne Hospital, Narbonne, 7Liver Unit, Avignon Hospital, Avigon, 8Liver Unit, Perpignan Hospital, Perpignan, 9Clinical Research, Laboratory Roche, Paris, 10Biostatistics Department, IURC, Montpellier, France E-mail: dom-larrey@chu-montpellier.fr