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See detailDiagnosis of small bowel malabsorption syndromes in adults
Belaiche, Jacques ULg; Louis, Edouard ULg

in Acta Gastro-Enterologica Belgica (2006), 69(1, Jan-Mar), 31-37

Patients with malabsorption represent a small proportion of presentations with chronic diarrhea. In spite of some progress, the last twenty years were not very innovating in malabsorption investigations ... [more ▼]

Patients with malabsorption represent a small proportion of presentations with chronic diarrhea. In spite of some progress, the last twenty years were not very innovating in malabsorption investigations. Supporting history may direct investigations toward either the small bowel or pancreas. Serological testing for celiac disease will determine most cases without invasive investigation, but individuals suspected to have small bowel malabsorption, despite negative celiac serology, should have endoscopic distal duodenal biopsies taken to exclude other rare forms of small bowel enteropathy. This strategy has largely supplanted many older tests of small bowel function. [less ▲]

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See detailEvolution of the prevalence and characteristics of anemia in inflammatory bowel diseases between 1993 and 2003
Vijverman, A.; Piront, Patricia ULg; Belaiche, Jacques ULg et al

in Acta Gastro-Enterologica Belgica (2006), 69(1, Jan-Mar), 1-4

Introduction : Anemia has been considered as an overlooked complication of inflammatory bowel disease. Studies dating back to the 80ties and the 90ties have shown 30% of anemia among inflammatory bowel ... [more ▼]

Introduction : Anemia has been considered as an overlooked complication of inflammatory bowel disease. Studies dating back to the 80ties and the 90ties have shown 30% of anemia among inflammatory bowel disease (IBD) patients. More recently, the broader use of immunosuppressive drug and infliximab allowing better mucosal healing as well as a more aggressive treatment of anemia, including the use of safer form of IV iron, may have influenced the prevalence of anemia among IBD patients. Our aim was to asses the prevalence and characteristics of anemia among two cohorts of IBD patients at 10 years interval and to look for associated clinical or demographic factors. Methods: using the IBD patients register of one senior gastroenterologist, we identified IBD patients he had consecutively seen and who had blood test at the outpatient clinic during the years 1993 and 2003. Demographic and clinical characteristics, treatment for Crohn's disease, blood test results and treatment of anemia were recorded and compared between these two cohorts. Anemia was defined as an hemoglobin level lower than the normal value of the laboratory of our hospital. Results : 80 and 90 patients were identified in 1993 and 2003, respectively. There was no significant difference between the two cohorts, according to age, gender, disease type, duration or location. There were 27/80 (33.8%) and 15/90 (16.7%) anemic patients in 1993 and 2003, respectively (P = 0.013). The prevalence of severe anemia (hemoglobin level < 10.5 g/100 ml) was similar in the two cohorts (6.3% and 5.6%). Characteristics of the anemia were similar in the two cohorts with a majority of iron deficiency anemia and inflammatory anemia. Ferritin and CRP levels were not significantly different in the two cohorts. The only significant difference was a more frequent use of immunosuppressive treatment and infliximab in 2003 than in 1993 (33.3% vs. 13.8%; P = 0.0038, RR :0.41, 0.22-0.77) Conclusions : Prevalence of mild to moderate anemia has significantly decreased in our population over the last 10 years. The only difference detected between the two cohorts was the increased use of immunosuppressive drug (mainly azathioprine). [less ▲]

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See detailMise au point d'une hyperferritinémie
Delwaide, Jean ULg; Giet, Didier ULg; Lamproye, Anne ULg et al

in Revue Médicale de Liège (2006), 61(5-6), 329-333

Hemochromatosis is the most common genetic disorder in persons of northern European descent, and the majority of cases are caused by a mutation in the gene HFE. Genetic testing for hemochromatosis is ... [more ▼]

Hemochromatosis is the most common genetic disorder in persons of northern European descent, and the majority of cases are caused by a mutation in the gene HFE. Genetic testing for hemochromatosis is therefore indicated in all patients with increases in transferrine saturation and ferritin levels. When this genetic testing does not demonstrate a hemochromatosis, other diseases responsible for elevated ferritin levels have to be ruled out, mainly hemolytic anemia, chronic inflammatory disorders, liver diseases such as hepatitis B or C, alcohol abuse, and non alcoholic fatty liver disease. In demonstrated iron overload with absence of classic causes, second-line genetic testing should be considered. [less ▲]

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See detailAlcoholisation of a hepatocarcinoma guided by echoendoscopy
Gast, Pierrette ULg; Delwaide, Jean ULg; Gillard, Vincent ULg et al

in Acta Endoscopica (2006), 36(1), 74

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See detailHepatitis C virus genotype 5 in southern Belgium: Epidemiological characteristics and response to therapy
Delwaide, Jean ULg; Gerard, Christiane ULg; Reenaers, Catherine ULg et al

in Digestive Diseases & Sciences (2005), 50(12), 2348-2351

Data are scarce on patients infected with hepatitis C virus of genotype 5, due to the low prevalence of this genotype around the world. To better define the characteristics of these patients, we reviewed ... [more ▼]

Data are scarce on patients infected with hepatitis C virus of genotype 5, due to the low prevalence of this genotype around the world. To better define the characteristics of these patients, we reviewed the files of 16 genotype 5 patients. Mean age was 38 +/- 14. All patients were of European origin. Most of them (75%) had been contaminated by transfusion within a short time period (between 1980 and 1991). There were no intravenous drug addicts. Seven patients received treatment. One patient did not respond to interferon (IFN) monotherapy. Of four patients treated with IFN and ribavirin, three became sustained viral responders. Two patients treated with pegylated IFN and ribavirin became sustained viral responders. In our region, genotype 5 patients seem to have been contaminated within a relatively short time period. Treatment with IFN or pegylated IFN and ribavirin gave a high rate (83%) of sustained viral responses. [less ▲]

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See detailL'anemie chronique dans les maladies inflammatoires de l'intestin: revue de litterature
Vijverman, A.; Belaiche, Jacques ULg; Louis, Edouard ULg

in Revue Médicale de Liège (2005), 60(11), 888-92

Chronic anemia has been considered as an overlooked complication of inflammatory bowel disease (IBD). However it deserves full attention since even mild to moderate anemia has significant impact on ... [more ▼]

Chronic anemia has been considered as an overlooked complication of inflammatory bowel disease (IBD). However it deserves full attention since even mild to moderate anemia has significant impact on quality of life. During the past decade relevant progress has been made in the understanding and treatment of this pathology. In our review, we focus on frequency, mechanisms, diagnosis and treatment of anemia in IBD. [less ▲]

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See detailHepatitis C infection: eligibility for antiviral therapies
Delwaide, Jean ULg; El Saouda, R.; Gerard, Christiane ULg et al

in European Journal of Gastroenterology & Hepatology (2005), 17(11), 1185-1189

Background Current treatments of chronic hepatitis C virus (HCV) are effective, but expensive and susceptible to induce significant side effects. Objectives To evaluate the proportion of HCV patients who ... [more ▼]

Background Current treatments of chronic hepatitis C virus (HCV) are effective, but expensive and susceptible to induce significant side effects. Objectives To evaluate the proportion of HCV patients who are eligible for a treatment. Methods In a database comprising 1726 viraemic HCV patients, the files of 299 patients who presented to the same hepatologist for an initial appointment between 1996 and 2003 were reviewed. Results Patients' characteristics were age 43.1 +/- 15.6 years, 53% male and 92% Caucasian. The main risk factors were transfusion (43%) and drug use (22%). Genotypes were mostly genotype 1 (66%), genotype 3 (12%) and genotype 2 (10%). These characteristics were not different from those of the whole series of 1726 patients. A total of 176 patients (59%) were not treated, the reasons for non-treatment being medical contraindications (34%), non-compliance (25%) and normal transaminases (24%). In addition, 17% of patients declined therapy despite being considered as eligible, mainly due to fear of adverse events. Medical contraindications were psychiatric (27%), age (22%), end-stage liver disease (15%), willingness for pregnancy (13%), cardiac contraindication (7%) and others (16%). Only 123 patients (41%) were treated. A sustained viral response was observed in 41%. The treatment was interrupted in 16% for adverse events. Conclusions The majority of HCV patients are not eligible for treatment. This implies that, with current therapies, only 17% of patients referred for chronic HCV become sustained responders. Some modifications of guidelines could extend the rate of treatment (patients with normal transaminases), but an important barrier remains the patients' and the doctors' fear of adverse events. [less ▲]

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See detailL'echinococcose alveolaire: une zoonose d'apparition recente en Wallonie
Wauters, Odile ULg; Honore, Charles ULg; Detry, Olivier ULg et al

in Revue Médicale de Liège (2005), 60(11), 867-74

Alveolar echinococcosis is a serious parasitic disease, leading to large hepatic lesions. It must be distinguished from cystic echinococcosis, or hydatic cyst, caused by Echinococcus granulosus. Early ... [more ▼]

Alveolar echinococcosis is a serious parasitic disease, leading to large hepatic lesions. It must be distinguished from cystic echinococcosis, or hydatic cyst, caused by Echinococcus granulosus. Early diagnosis may allow surgical removal of the lesions by segmental hepatectomy, the only curative treatment. Parasitostatic medical treatment with albendazole may promote stabilization of the disease. Until recently, Belgium was considered a country at very low risk for alveolar echinococcosis, as no human case was reported, despite up to 51% of fox infection in southern Belgium autopsy series. Recently four patients presented with alveolar echinococcosis at the University Hospital Center of Liege, leading to the fear of a possible alveolar echinococcosis endemy in southern Belgium. Two of these patients underwent curative hepatectomy, but the other two had already pulmonary metastases at diagnosis and received palliative albendazole therapy. This article presents these cases, and reviews the clinical features of this parasitic disease. [less ▲]

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See detailImplication des intolérances et allergies alimentaires dans le syndrome du côlon irritable: quelles sont les evidences?
Ausloos, Floriane ULg; Belaiche, Jacques ULg; Louis, Edouard ULg

in Revue Médicale de Liège (2005), 60(9), 744-9

Irritable Bowel Syndrome (IBS) is a complex and heterogeneous entity that concerns about 1/4 of adults and would be responsible for 50% of gastro-enterology medical consultations. IBS etiopathogenesis and ... [more ▼]

Irritable Bowel Syndrome (IBS) is a complex and heterogeneous entity that concerns about 1/4 of adults and would be responsible for 50% of gastro-enterology medical consultations. IBS etiopathogenesis and physiopathology are not yet fully known. [less ▲]

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See detailA naturalistic study of the determinants of health related quality of life improvement in osteoarthritic patients treated with non-specific non-steroidal antiinflammatory drugs
Rabenda, Véronique ULg; Burlet, N.; Ethgen, Olivier ULg et al

in Annals of the Rheumatic Diseases (2005), 64(5), 688-693

OBJECTIVES: To capture changes in the quality of life (QoL) occurring in patients with osteoarthritis (OA) during treatment with non-specific non-steroidal anti-inflammatory drugs (NSAIDs) and to identify ... [more ▼]

OBJECTIVES: To capture changes in the quality of life (QoL) occurring in patients with osteoarthritis (OA) during treatment with non-specific non-steroidal anti-inflammatory drugs (NSAIDs) and to identify factors that predict such changes. METHODS: A naturalistic, prospective follow up of 783 patients with OA in whom primary care physicians decided to start treatment with non-selective NSAIDs. Short Form-36 (SF-36) and the Western Ontario and McMaster Universities OA index (WOMAC) were assessed at baseline and after 3 months. Baseline results were compared with QoL values in 4800 subjects randomly selected from the general population. Multiple regression analysis was performed to identify determinants of QoL at baseline and measures influencing changes in SF-36 or WOMAC during follow up. RESULTS: All QoL dimensions were significantly (p<0.01) decreased in patients with OA compared with controls. Significant improvement (p<0.05) in four dimensions of the SF-36 (vitality, role emotional, role physical, bodily pain) and in all components of the WOMAC was seen between baseline and month 3. Older age, female sex, longer duration of OA, and a higher number of comorbidities were the major determinants of a poor QoL at baseline. Maximal benefit from non-specific NSAIDs was seen in patients with the most severe impairment in QoL and the shortest duration of OA. CONCLUSION: OA negatively impacts all dimensions of the QoL. Non-specific NSAIDs improve the QoL in patients with OA treated in a "real life setting". The profile of patients receiving maximal benefit from such treatment may be of interest for health providers, enabling them to decide who should preferentially be given cytoprotective treatments or coxibs. [less ▲]

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See detailProfile of soluble cytokine receptors in Crohn's disease
Gustot, T.; Lemmers, A.; Louis, Edouard ULg et al

in Gut (2005), 54(4), 488-495

Introduction: Soluble cytokine receptors (sCRs) modulate the in vivo activity of cytokines. Deficient sCR production could participate in the pathogenesis and course of Crohn's disease ( CD). The aim of ... [more ▼]

Introduction: Soluble cytokine receptors (sCRs) modulate the in vivo activity of cytokines. Deficient sCR production could participate in the pathogenesis and course of Crohn's disease ( CD). The aim of the study was to examine the profile of sCRs in CD patients and their modulation by infliximab and corticosteroids. Methods: We prospectively examined active CD patients (aCD) treated with either infliximab (n=21) or corticosteroids (n=9), CD patients in clinical remission (rCD, n=20), ulcerative colitis patients (UC, n=24), and healthy subjects (HS, n=15). Cultures of colonic biopsies were also examined from CD inflamed (n=8), CD non-inflamed (n=7), and healthy mucosa (n=8). Levels of tumour necrosis factor alpha (TNF-alpha), soluble TNF receptor I (sTNFRI), soluble TNF receptor II (sTNFRII), interleukin 1 beta (IL-1 beta), soluble IL-1 receptor I (sIL-1RI), soluble IL-1 receptor II (sIL-1RII), IL-6, soluble IL-6 receptor (sIL-6R), and sgp130 were measured using ELISA. Results: Higher levels of sTNFRI (p<0.05, p<0.01), sTNFRII (p<0.01, p<0.01), sIL-1RI (p<0.05, NS), IL-6 (p<0.01, p<0.01), and sIL-6R (p<0.05, NS) were observed in aCD compared with rCD and HS. Interestingly, sIL-1RII (p<0.05, p<0.01) and sgp130 (p<0.01, p<0.01) were profoundly decreased in aCD compared with rCD and HS, and were negatively correlated with CRP. Deficient production of sIL-1RII was specific to CD ( not observed in ulcerative colitis), and was further confirmed at the mucosal level. Infliximab decreased sTNFRII at one and four weeks (p<0.05) and enhanced sIL-6R levels at one week (p<0.05). Corticosteroids increased sIL-1RII levels at one week (p<0.05). Conclusion: CD is associated with dysregulated production of sCRs. Deficiency in sIL-1RII and sgp130 may be essential to CD pathogenesis. Their replacement through the use of fusion proteins could represent future alternative therapeutic strategies for CD. [less ▲]

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See detailAltered expression of type I insulin-like growth factor receptor in Crohn's disease
El Yafi, F.; Winkler, Rose ULg; Delvenne, Philippe ULg et al

in Clinical & Experimental Immunology (2005), 139(3), 526-533

The fibrotic and antiapoptotic effects of insulin-like growth factors (IGF) are mediated by type I IGF receptor (IGF-1R). IGFs could play a role in intestinal stricturing and in the maintenance of ... [more ▼]

The fibrotic and antiapoptotic effects of insulin-like growth factors (IGF) are mediated by type I IGF receptor (IGF-1R). IGFs could play a role in intestinal stricturing and in the maintenance of inflammation in Crohn's disease (CD). We aimed to describe IGF-1R expression in CD intestinal lesions, to compare it to other intestinal inflammatory diseases and to correlate it with fibrosis and apoptosis. IGF-1R expression and apoptosis (active caspase-3) were studied by immunohistochemistry. Surgical intestinal specimens [17 CD, nine controls, six diverticulitis and four ulcerative colitis (UC)] were used. IGF-1R was expressed transmurally mainly by inflammatory cells (IC) and smooth muscle cells, both in diseased intestine and controls. IGF-1R positive IC were increased in the mucosa and the submucosa of CD (P < 0.007), and in involved areas compared to uninvolved areas (P = 0.03). In UC, the number of IGF-1R positive IC was only increased in the mucosa, and was not different from controls in the submucosa. In diverticulitis, the number of IGF-1R positive IC did not differ from controls. In CD submucosa, IGF-1R expression in IC was inversely correlated with apoptosis in uninvolved areas (P = 0.01). Expression of IGF-1R in submucosal fibroblast-like cells, subserosal adipocytes and hypertrophic nervous plexi was specific for CD. We have shown a transmural altered expression of IGF-1R in CD. This may suggest a role for IGF-1R in the maintenance of chronic inflammation and stricture formation in CD. [less ▲]

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See detailSentinel lymph node mapping in colon cancer: a feasability study
Laurent, S.; Detroz, Bernard ULg; Detry, Olivier ULg et al

in Acta Gastro-Enterologica Belgica (2005, January), 68(1), 15

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See detailEndemy of alveolar echinococcosis in Southern Belgium?
Honore, Charles ULg; Detry, Olivier ULg; Wauters, Odile ULg et al

in Acta Gastro-Enterologica Belgica (2005, January), 68(1), 72

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See detailHCV genotypes 2 and 3: the predominant genotypes at the horizon 2020?
Delwaide, Jean ULg; Gerard, Christiane ULg; Vaira, Dolorès ULg et al

in Acta Gastro-Enterologica Belgica (2005, January), 68(1), 25

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See detailEvolution over a 10 year period of the epidemiological profile of 1,726 newly diagnosed HCV patients in Belgium.
Gerard, Christiane ULg; Delwaide, Jean ULg; Vaira, Dolorès ULg et al

in Journal of Medical Virology (2005), 76(4), 503-10

In order to evaluate the future burden of hepatitis C, there is a need to quantify the evolution with time of some crucial parameters such as disease frequency and age, modes of infection and infecting ... [more ▼]

In order to evaluate the future burden of hepatitis C, there is a need to quantify the evolution with time of some crucial parameters such as disease frequency and age, modes of infection and infecting genotypes of patients presenting for the first time at consultation. The yearly evolution of these parameters was analyzed retrospectively in a cohort of 1,726 patients living in Belgium, who were diagnosed as hepatitis C virus (HCV) carriers by polymerase chain reaction (PCR) between 1992 and 2002. The epidemiological profile of HCV patients showed significant changes during this period. The number of new patients increased with time. The proportion of patients under 50 increased linearly at a rate of 3% per year. The rate of newly presenting patients infected by transfusion before 1990 decreased, but only by 2.7% per year. The proportion of intravenous (IV) drug users increased by 2.5% per year. Patients presenting "undefined" risk factors increased by 2.1% per year. Nosocomial acquisition of HCV infection exhibited a disturbing relative stability in time whereas dialysis tended to disappear as a cause of infection. There was a significant linear annual decrease of 2.3% in the frequency of genotype 1b, which was counterbalanced by a significant increase of 0.7% for genotype 1a and 1.1% for genotype 4. Genotypes 2 and 3 did not vary significantly with time. Such figures are useful for evaluating the epidemiological changes of C virus infection and for anticipating the future economical cost of hepatitis C treatment in the next few years. [less ▲]

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See detailEndemic alveolar echinococcosis in southern Belgium?
Detry, Olivier ULg; Honore, Charles ULg; Delwaide, Jean ULg et al

in Acta Gastro-Enterologica Belgica (2005), 68(1, Jan-Mar), 1-4

Until now, Belgium has been considered as a low-risk country for alveolar echinococcosis. However it was recently demonstrated by necropsy series that, in some parts of southern Belgium (Wallonia), up to ... [more ▼]

Until now, Belgium has been considered as a low-risk country for alveolar echinococcosis. However it was recently demonstrated by necropsy series that, in some parts of southern Belgium (Wallonia), up to 51% of the red foxes (Vulpes vulpes) may be infected by E. multilocaris. The authors, working in a university hospital in southern Belgium, described in 2002 the first autoctuthonous Belgian case of hepatic alveolar echinococcosis. More importantly, in 2004, they diagnosed three other patients with alveolar echinococcosis. One underwent surgical resection, but two others had bilateral pulmonary involvement at time of definite diagnosis. Palliative albendazole therapy was initiated. These patients had been diagnosed with hepatic mass from unknown origin for several months. The previous experience with the first case allowed the authors to consider and to confirm alveolar echinococcosis diagnosis, made by pathology and/or serological tests and imaging. These four patients with alveolar echinococcosis were living either in the Liege or the Luxembourg province. Considering the high prevalence of E. multilocaris infection of red foxes and the recent increase of the fox population due to rabies vaccination in southern Belgium, and also the presence of E. multilocaris infection of red foxes in northern Belgium, it is likely that not only Wallonia, but also maybe the whole Belgium, may face endemic alveolar echinococcosis in the next years. [less ▲]

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See detailDevelopment of adenocarcinoma in chronic fistula in Crohn's disease
Laurent, Stanislas; Barbeaux, A.; Detroz, Bernard ULg et al

in Acta Gastro-Enterologica Belgica (2005), 68(1, Jan-Mar), 98-100

The authors report the case of a 55 yr-old woman suffering from Crohn's disease since 31 years with stricture and fistulas developed in the ileocolic junction and anorectal portion. Long-standing ... [more ▼]

The authors report the case of a 55 yr-old woman suffering from Crohn's disease since 31 years with stricture and fistulas developed in the ileocolic junction and anorectal portion. Long-standing anorectal fistulas and stricture led to adenocarcinoma and finally fistulisation in the vagina. Diagnosis was made by perineal examination with biopsies under general anaesthesia. Treatment was first posterior pelvectomy with resection of the anterior wall of vagina. Secondarily, radiochemotherapy was administrated. The authors discuss the incidence and risk factors of carcinoma in Crohn's disease with chronic fistulas. [less ▲]

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