Showing papers by "Alain M. Schoepfer published in 2010"
TL;DR: Fecal calprotectin was the only marker that reliably discriminated inactive from mild, moderate, and highly active disease, which underlines its usefulness for activity monitoring.
506 citations
TL;DR: A 15-day course of treatment with budesonide is well tolerated and highly effective in inducing a histologic and clinical remission in adolescent and adult patients with active EoE.
455 citations
TL;DR: Esophageal dilation is highly effective in providing long-lasting symptom relief and can be performed safely with a high degree of patient acceptance, however, dilation are associated with postprocedural pain in most patients and does not influence the underlying inflammatory process.
269 citations
TL;DR: Long-term treatment with nitroimidazoles or clofazimine appears to be effective in patients with Crohn's disease.
Abstract: We investigated the effectiveness of long-term antibiotic treatment in patients with Crohn's disease.
102 citations
TL;DR: The present study identified selection criteria for primary operative management (OM) and planned NOM for blunt splenic injuries.
Abstract: Non-operative management (NOM) of blunt splenic injuries is nowadays considered the standard treatment. The present study identified selection criteria for primary operative management (OM) and planned NOM.
76 citations
TL;DR: It is found that anaemia is a common complication in patients with IBD and significantly more prevalent in patients from referral centres as compared to patients from gastroenterologic practices.
65 citations
TL;DR: It is suggested that systemic MBL helps to prevent excessive inflammation upon access of normally mild pathogens across the damaged intestinal epithelium, compatible with the increased prevalence of ASCA and complicated disease phenotypes in MBL-deficient patients with CD.
Abstract: Background In Crohn9s disease (CD) the deficiency of mannan-binding lectin (MBL) is associated with an increased prevalence of anti- Saccharomyces cerevisiae antibodies (ASCA) and with complicated phenotypes of the disease. However, the role of MBL in intestinal inflammation is currently unclear. A study was undertaken to analyse local MBL expression in human intestine and the consequences of MBL deficiency in experimental colitis and yeast infection. Methods ASCA were measured by ELISA. MBL was assessed by ELISA and quantitative PCR. Wild type and MBL-deficient mice were administered dextran sulfate sodium (DSS) in the presence or absence of viable Candida albicans or adhesive invasive Escherichia coli (AIEC). Mice were infected with C albicans to assess generation of anti-yeast mannan antibodies. Results MBL expression was virtually undetectable in the intestinal mucosa of both healthy controls and patients with CD, irrespective of macroscopic inflammation, indicating that systemic MBL must be responsible for the reduced risk of complicated disease in MBL-competent patients with CD. MBL-deficient mice showed enhanced DSS colitis upon oral challenge with C albicans or AIEC. C albicans could be recovered from the kidneys of colitic/ C albicans -fed MBL-deficient, but not wild type mice. Infection with C albicans induced high titres of anti- C albicans mannan IgM and IgG in MBL-deficient mice but only a modest and transient IgM response with no class switch to IgG in wild type mice. Cross-reactive ASCA IgM continuously increased in MBL-deficient mice but rapidly declined after transient induction in wild type mice. In MBL-deficient mice, increased C albicans dissemination correlated with reduced early retention in the circulation. Conclusions These results suggest that systemic MBL helps to prevent excessive inflammation upon access of normally mild pathogens across the damaged intestinal epithelium. Lack of this innate defence promotes antibody responses with cross-reactive potential against common mannan epitopes. These interpretations are compatible with the increased prevalence of ASCA and complicated disease phenotypes in MBL-deficient patients with CD.
54 citations
TL;DR: In conclusion, adiponectin levels correlate positively with surrogate markers of hepatic fibrosis (transient elastography, fasting serum bile acids and hyaluronate) and are significantly elevated in cases of cirrhosis.
Abstract: Adiponectin, which plays a pivotal role in metabolic liver diseases, is reduced in concentration in patients with NASH (non-alcoholic steatohepatitis). The aim of the present study was to determine adiponectin concentrations in patients with different forms and stages of chronic liver diseases. Serum adiponectin concentrations were measured in 232 fasting patients with chronic liver disease: 64 with NAFLD (non-alcoholic fatty liver disease), 123 with other chronic liver disease (e.g. viral hepatitis, n =71; autoimmune disease, n =18; alcohol-induced liver disease, n =3; or elevated liver enzymes of unknown origin, n =31) and 45 with cirrhosis. Circulating adiponectin levels were significantly lower in patients with NAFLD in comparison with patients with other chronic liver disease (4.8 + 3.5 compared with 10.4 + 6.3 μg/ml respectively; P <0.0001). Circulating adiponectin levels were significantly higher in patients with cirrhosis in comparison with patients without cirrhosis (18.6 + 14.5 compared with 8.4 + 6.1 μg/ml respectively; P <0.0001). Adiponectin concentrations correlated negatively with body weight (P <0.001), serum triacylglycerols (triglycerides) (P <0.001) and, in women, with BMI (body mass index) (P <0.001). Adiponectin concentrations correlated positively with serum bile acids (P <0.001), serum hyaluronic acid (P <0.001) and elastography values (P <0.001). Adiponectin levels were decreased in patients with NAFLD. In conclusion, adiponectin levels correlate positively with surrogate markers of hepatic fibrosis (transient elastography, fasting serum bile acids and hyaluronate) and are significantly elevated in cases of cirrhosis.
49 citations
TL;DR: In a population of CD patients with complicated disease behavior, CZP induced a response and remission in 54% and 40% of patients, respectively, providing the first evidence of the effectiveness of CZp in perianal fistulizing CD.
Abstract: Switzerland was the first country to approve certolizumab pegol (Cimzia, CZP) for the treatment of patients with moderate to severe Crohn's disease (CD) in September 2007. This phase IV study aimed to evaluate the efficacy and safety of CZP in a Swiss multicenter cohort of practice-based patients.
29 citations
TL;DR: The bacterial aerosol burden during handling of biopsy forceps can be reduced by applying air suction while removing the forceps, and this simple method may reduce transmission of infectious agents during gastrointestinal endoscopies.
Abstract: BACKGROUND AND STUDY AIMS: Bacterial contamination of endoscopy suites is of concern; however studies evaluating bacterial aerosols are lacking. We aimed to determine the effectiveness of air suctioning during removal of biopsy forceps in reducing bacterial air contamination.
PATIENTS AND METHODS: This was a prospective single-blinded trial involving 50 patients who were undergoing elective nontherapeutic colonoscopy. During colonoscopy, endoscopists removed the biopsy forceps first without and then with suctioning following contact with the sigmoid mucosa. A total of 50 L of air was collected continuously for 30 seconds at 30-cm distance from the biopsy channel valve of the colonoscope, with time starting at forceps removal. Airborne bacteria were collected by an impactor air sampler (MAS-100). Standard Petri dishes with CNA blood agar were used to culture Gram-positive bacteria. Main outcome measure was the bacterial load in endoscopy room air.
RESULTS: At the beginning and end of the daily colonoscopy program, the median (and interquartile [IQR] range) bioaerosol burden was 4 colony forming units (CFU)/m (3) (IQR 3 - 6) and 16 CFU/m (3) (IQR 13 - 18), respectively. Air suctioning during removal of the biopsy forceps reduced the bioaerosol burden from a median of 14 CFU/m (3) (IQR 11 - 29) to a median of 7 CFU/m (3) (IQR 4 - 16) ( P = 0.0001). Predominantly enterococci were identified on the agar plates.
CONCLUSION: The bacterial aerosol burden during handling of biopsy forceps can be reduced by applying air suction while removing the forceps. This simple method may reduce transmission of infectious agents during gastrointestinal endoscopies.
24 citations
TL;DR: The authors defined survivors as those who died from underlying disease within 30 days of follow-up or during the hospital stay, and they think this is a wrong interpretation of the collected data as this suggests that ultrasonography is more sensitive for free fluid.
Abstract: Sir We would like to thank Mr Renzulli and colleagues, who put their best efforts into this systematic review of atraumatic splenic rupture (ASR). However, a few points need clarification. The authors defined survivors as those who died from underlying disease within 30 days of follow-up or during the hospital stay. Death within 30 days or in hospital means failure of the treatment unless the patient died from an unrelated cause. Those dying in hospital or within 30 days cannot be included in the survivor group as it will not be possible to judge the efficacy of different treatment modalities and this may have a significant impact on the ASR-related mortality. Considering this 30-day criterion, the statistical analysis of ASR-related death cannot be correctly compared with the type of treatment modality. In discussing diagnostic procedures, the authors have not highlighted the sensitivity and specificity of any diagnostic procedures. Ultrasonography was positive for free fluid in 24·6 per cent of patients compared with computed tomography in 23·0 per cent. We think this is a wrong interpretation of the collected data as this suggests that ultrasonography is more sensitive for free fluid. Similarly, peritoneal lavage was positive in 89 patients (10·5 per cent); does this mean that peritoneal lavage done in almost all patients?1 The data are presented in an ambiguous manner. In the discussion of treatment, the tabulated data do not match the written data. The mortality in the primary non-surgical group (five patients) also needs to be described in detail. Were these deaths in patients who underwent splenectomy because of rebleeding or who completed primary non-surgical treatment? R. N. Khan and V. Jindal Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India (e-mail: vikasjindaldr@yahoo.co.in) DOI: 10.1002/bjs.7052
TL;DR: No significant preferential transmission of the alleles or the haplotypes of the SNPs across generations was inferred and this led us to theorize the unknown advantage of these MBL2 variants and evaluate whether they confer any vital advantage on carrier generation.
Abstract: To The Editor: Mannose binding lectin (MBL) is a pattern recognition molecule of the innate immune system. Single nucleotide polymorphisms (SNPs) in the proximal promoter (L/H and X/Y), the 5′UTR (...