Gastroenterology and Hepatology

Background and Aims: Hepatitis C testing is still insufficient in France. Beyond defined groups with risk behaviors, hepatitis C testing should now be directed at the general population. The French pharmacies territorial coverage is excellent, and pharmacists are increasingly involved in public health actions (therapeutic education, vaccination against the flu). French Public Health Act on Innovation thank to the “Article 51” allow enables health care teams to propose experiments aimed at improving the diagnostic and/or therapeutic management of a disease. This funding methods and organization is unprecedented. Our aim was to screen for hepatitis C in pharmacies with POCT performed by pharmacists. Methodology: Pharmacist recruitment was done on a voluntary basis from different pharmacies on a population pool of 600,000 inhabitants. Pharmacists received training and education appropriate to the POC testing. At request of the health authorities, screening was only proposed for patients with one or more risk factors (national health agency list). There were planned 10 tests per week per pharmacy over 12 months for a total of 5,000 tests. Expected prevalence was 10%. Patients with positive POCT were tested for HCV viral load real-time and for liver fibrosis assessment by FIBROSCAN. They could be treated with HCV antiviral direct agents. Results: 37 pharmacists representing 32 pharmacies were trained to POCT use and announcement of results during 4 half days session. 9 pharmacies were located in agglomeration, including 5 in working-class areas, 7 in rural area, 7 in seaside area and 2 in middle mountain area. After 18 months of experimentation, 29 pharmacies have completed at least one POCT. We observed a decrease in the number of tests performed during the flu vaccination campaign and COVID pandemia and successive lockdowns; 547 tests were performed including 9 positives or a serological prevalence of 1.6%.; 7 patients had a negative viral…

Aim: The treatment of addiction is well structured in France, with different care and prevention services available, such as addiction treatment and prevention centers, the network of medical microstructures centred on general practitioners, and lower risk consumption rooms. The objectives of our study were to compare the courses of care for hepatitis C provided within one addictology center offering all three of these services, as well as to clarify the role and factors associated with the test and treat strategy. Methods: 573 users were included prospectively from all three of the above-mentioned services: 168 from the addiction treatment and prevention center, 291 from the network of medical microstructures and 114 from the lower risk consumption room. They were consumers of one or several psycho-active substances (illegal substances, alcohol, tobacco). The different hepatitis C courses of care were compared between the three services. The test and treat strategy was evaluated in comparison with conventional strategy in all the users. Results: The users were characterized as being predominantly male (65.4%), with high occurrence of polydrug use (61.2%) and low socioeconomic status (complementary health solidarity 43.8%, precarious housing or homelessness 23.9%, living alone 47.1% and lack of paid employment 72.9%). The course of care for hepatitis C did not differ significantly between the three services: screening performed for 90% with HCV RNA detected in 100% of users, access to treatment varied from 61 to 100%; hepatitis C was cured in all users. The test and treat strategy was used in the majority of cases, particularly those treated at lower risk consumption room (93.8%). This strategy was associated with type of consumption and low socioeconomic status (p

Herbal and dietary supplements (HDS) are used by over 50% of Americans, but commonly their use is not reported to healthcare providers. The aim of this study is to determine the prevalence of HDS use among patients with Chronic Liver Disease (CLD), with a focus on those using supplements known to cause hepatotoxicity. We accessed 61,951 individuals polled in the NHANES database between 2001-2011, which represented a population size of 1,763,482,931. 573 respondents reported a history of CLD (population size of 19,998,331.655). Of those 573 respondents, 41 respondents (population size 1,399,884) endorsed using HDS that are associated with causing hepatotoxicity, which are listed under the NIH complied master list. Our study demonstrates the need for better counseling of patients on the potential risks of these readily available products.

The metallic endoscopic clip was first described for hemostasis in 1975. [1] Endoscopic clips are now frequently used in non-variceal upper gastrointestinal bleeding, and have many different indications. [1] Most clips are not magnetic resonance imaging [MRI]-safe, and are contraindications to MRI. [2] The hemostatic clips usually spontaneously dislodge within 1 to 3 weeks after placement, but some case reports have shown that they can be retained for up to 2 years. [5] Hemostatic clips retention until ulcers healed could promote permanent endoscopic hemostasis of both severe ulcer hemorrhage and very severe hemorrhage related to inpatient ulcer bleeding. [3] Given the short retention time, most physicians rarely advise their patients to abstain from diagnostic procedures that would be contraindicated with a hemostatic clips placed, such as magnetic resonance imaging. [5] Two cases will be reported for retained clips more than 2 years with a review about risks for clip retaining, MRI compatibility, and retrieving retained clips.

Objective: Today, with the availability of direct-acting antivirals (DAAs), the value of therapeutic patient education (TPE) in chronic hepatitis C needs to be redefined, as these drugs have made treatment simple. The study presented here in sought to define what role TPE plays today in hepatitis C management along with what factors are associated with such programs being used. Methods: We included 786 patients mono-infected with hepatitis C virus (HCV) who underwent treatment with DAAs. 284 of whom benefited from a TPE program (36.1%). The characteristics of HCV and how it was treated were compared retrospectively between TPE+ and TPE- patients. The TPE program was overseen by a nurse. Results: The following factors were associated with TPE on multivariate analysis: migrant status (OR=3.63, 95%CI: 2.24-5.96, p

Objective: to identify the main digestive manifestations related to SARS-CoV-2 in Togo and to determine their impact on the prognosis of the disease. Patients and method: This was a cross-sectional study with retrospective and prospective collection, with descriptive and analytical aims, conducted from May 1, 2020 to April 30, 2021 at the national center for the management of infectious diseases of Lome. Patients of both sexes and of any age, tested positive for SARS-CoV-2 by PCR on nasopharyngeal and oropharyngeal samples and hospitalized at the national center for infectious disease management of Lome were included in this study. Digestive manifestations were divided into gastrointestinal manifestations and hepatobiliary manifestations. The threshold of significance of the tests was retained for a p value less than or equal to 0.05. Results: out of 876 patients hospitalized during the study period, 215 presented with digestive manifestations, corresponding to a prevalence of 24.54%. the predominance was male, with a male/female sex ratio of 1.74. the mean age was 46.07+/-16.14 [02 months – 82 years]. gastrointestinal manifestations were found in 11.98% of cases. abdominal pain was the most frequent digestive symptom (15.35%). hepatobiliary manifestations were represented by cytolysis syndrome (44.19%) and cholestasis syndrome (36.28%). digestive manifestations were associated with renal failure (p=0.03) and thrombocytosis (p

Background: Hernia repair surgery is a procedure frequently performed today, both in elective or outpatient settings as in an emergency context. Hernia is defined as a condition in which part of an organ or its fascia protruded through the wall of the cavity containing it. Quite often in the emergency department incarcerated hernias are found, and in most cases, the content of the hernia sac is the omentum or small intestine. In very rare instances, the appendix can be found inside the hernia sac. When the appendix is found in the hernia sac it is called an “Amyand Hernia”, regardless if it is inflamed or not, with the incidence of appendicitis in an inguinal hernia being 0.07-0.13%. Preoperative diagnosis of an Amyand hernia is a clinical and often a Radiological challenge, being in many cases misdiagnosed as an incarcerated inguinal hernia. Usually, the diagnosis of Amyand’s hernia is an incidental finding during surgical repair of an inguinal hernia. There is still no real consensus on the ideal surgical treatment approach for this pathology. Clinical Case: A 72-year-old man, with a known reducible right inguinal hernia awaiting surgical repair presented to the Emergency Department with acute abdominal pain, nausea, vomiting and a painful right groin mass. He was diagnosed with an incarcerated right inguinal hernia and taken to the operating room for emergency surgery. An open approach was performed with a transverse right inguinal incision and the inflamed appendix was identified inside the inguinal sac. The patient was submitted to an appendectomy and subsequently, using the Bassini technique, had the incarcerated inguinal hernia corrected. Conclusion: Preoperative clinical and imaging diagnosis of amyand´s hernia is rare and difficult. More prospective studies should be carried out in order to standardize the treatment of this pathology. The diagnosis of Amyand´s hernia should be in…

Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease characterized by a combination of symptoms, clinical and histological findings, where men and women are affected equally, with a small predominance in women. Various treatment strategies have been advocated, ranging from conservative management to a variety of surgical procedures. Can laparoscopic ventral rectopexy be a good alternative for patients who do not respond to conservative treatment? Given the rarity of this pathology, we chose to present the case.

Aim: Chronic hepatitis C is more severe in elderly patients. In France, Direct Acting Antiviral therapy must be implemented via multidisciplinary team meetings in regional reference centers. This study aimed to define the impact of age on hepatitis C characteristics and medical care types across three groups: 70-yo. Methods: All patients with treated hepatitis C virus mono-infection during 8 to 24 weeks were included. Group comparison was based on 21 hepatitis C characteristic and medical care variables. Results: Male predominance decreased in >50-yo (59.7% vs. 72.5%, p 70-yo (36.2%, p 50-yo (27.8% vs. 51.9%, p=0.02) and increase in transfusion and nosocomial infection to 30% in >70-yo. Advanced fibrosis increased in >50-yo (57.5% vs. 41.5%, p 70-yo affected. Psychiatric comorbidity incidence was halved in >70-yo (7.1% vs. 14.8%, p

HCV can cause psychiatric disorders. It is crucial to re-evaluate them with direct-acting antiviral treatment (DDAs), since the interferon-based treatments of the past were capable of causing identical psychiatric adverse effects. A system of multidisciplinary team (MDT) meetings was implemented in France in December 2014 in regional reference centers with the aim of controlling the prescription and administration of these new treatments, along with optimizing how the patients undergoing these treatments are followed up. Our study sought to compare the characteristics and type of medical care received for chronic hepatitis C in patients with (PSY+ group) and without (PSY- group) psychiatric disorders using data from MDT meetings in the Alsace area of France collected from 2015 to 2019. All included patients were mono-infected and treated with DAAs in successive rounds between 2015 and 2019, as per recommendations from the French Hepatology Society. We compared the two groups (PSY+ and PSY-) based on 21 variables regarding the characteristics and medical care of hepatitis C. Psychiatric disorders were observed in 15% of patients. On multivariate analysis, a positive correlation was found between them and drug use (OR: 2.35; 95%CI: 1.40-3.98; p=0.001), excessive alcohol consumption (OR: 1.92; 95%CI: 0.98-3.69; p=0.05), smoking (OR: 1.81; 95%CI: 1.09-2.98; p=0.02), and incidence of drug interactions (OR: 3.94; 95%CI: 2.15-7.17; p