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Biomedical subjects

Gilles Bommelaer

Publications and source records attributed to Gilles Bommelaer.

15 recordsLinked to original sources
PubMed2006

Impact of irritable bowel syndrome (IBS) on health-related quality of life (HRQOL).

AIMS: To assess the impact of irritable bowel syndrome (IBS) on patient-reported health-related quality of life (HRQOL). METHODS: Two HRQOL instruments were administered by telephone interviews to a sample of 253 IBS French patients recruited from the general population. IBS was diagnosed according to the Manning, Rome I and Rome II criteria. Patients with organic diseases were excluded from the study. A generic instrument, the Short Form 36 (SF-36), and an IBS disease-specific instrument, the IBSQOL, were used. RESULTS: Patients with IBS had statistically significant (P<0.05) lower scores for all SF-36 QOL domains compared with the general French population. Women (N=192) reported significantly (P<0.05) poorer HRQOL on both the SF-36 and the IBSQOL scores than men (N=61) for all domains except energy on the SF36 and the sleep on the IBSQOL. HRQOL deteriorated with time since onset of IBS symptoms for some domains such as diet. For both instruments, a positive correlation was observed between low scores and intensity of pain and discomfort. IBS patients with a predominance of diarrhea (N=72) exhibited significantly greater impairment of HRQOL in the emotional domain than IBS persons with constipation predominance (N=65) (P<or=0.05). CONCLUSION: IBS has a significant impact on HRQOL of patients. In addition, specific characteristics such as gender, symptom severity and time since onset of symptoms are predictive of more impaired health-related quality of life.

Adolescent↗
PubMed2005

Significance of patient-controlled sedation during colonoscopy. Results from a prospective randomized controlled study.

BACKGROUND: In France, general anesthesia is given to more than 90% of patients undergoing colonoscopy although in several countries sedation is limited to intolerant patients. This study was carried out to determine whether Patient-Controlled Sedation (PCS) could provide a lighter sedation than general anesthesia adapted to the patient's individual requirement. METHODS: Patients aged from 18 to 80 scheduled for elective colonoscopy were prospectively randomized to receive either standard sedation (control group) or patient-controlled-sedation (PCS). In the control group, patients received a continuous infusion of propofol. Patients in the PCS group were connected to an infusion pump containing propofol and self-administered 20-mg boluses as often as they required. An anesthetist was present throughout the procedure. Patient satisfaction measured on a visual analog scale four hours after colonoscopy was the main outcome criterion. RESULTS: From December 2002 to September 2003, 402 patients underwent elective colonoscopy, 173 of them were eligible and were asked to participate in the study. Seventy-two gave their informed consent and were prospectively randomized. The patients' mean satisfaction scores were not statistically different between the two groups: 84.7 mm (PCS group) vs. 91.5 mm (control group); P = 0.24. Mean doses of propofol (60 mg vs. 248 mg; P <0.001), depth of sedation and time before discharge (1.75 hours vs. 4.45 hours) were significantly lower for patients in the PCS group; nine of them (25.7%) did not use the pump and had total colonoscopy without sedation. There were no statistically significant differences between the two groups regarding total duration of colonoscopy (19.4 min (PCS) vs. 18 min (control)) difficulty and therapeutic procedures (biopsy or polypectomy). Two weeks after the procedure, 96.5% of patients in the PCS group were willing to repeat the examination under the same conditions vs. 72.5% of patients in the control group (P = 0.03). CONCLUSIONS: Our results demonstrate that need of sedation is widely overestimated in France. A subset of our patients is willing to consider colonoscopy without general anesthesia. For them, PCS with propofol is an effective and very well accepted form of sedation.

Adolescent↗
PubMed2005

Rectal instillation of butyrate provides a novel clinically relevant model of noninflammatory colonic hypersensitivity in rats.

BACKGROUND & AIMS: The treatment of irritable bowel syndrome (IBS), characterized by abdominal pain and bloating, is empirical and often poorly efficient. Research lacks suitable models for studying the pathophysiologic mechanisms of the colonic hypersensitivity and new pharmacologic targets. The present study aimed to develop a novel model of colonic hypersensitivity possessing several of the characteristics encountered in patients with IBS. METHODS: Rats received enemas of a butyrate solution (8-1000 mmol/L) twice daily for 3 days. A time course was determined for colonic hypersensitivity (colorectal distention test) and referred cutaneous lumbar hyperalgesia (von Frey hairs). Macroscopic and histologic analyses were performed on colonic mucosa. The efficacy of morphine, U50488H (a kappa opioid agonist), and trimebutine on the 2 pain parameters was determined. Finally, the involvement of peptidergic C-fibers was evaluated using capsaicin-pretreated animals and treatments with calcitonin gene-related peptide (CGRP) and neurokinin 1 receptor antagonists. RESULTS: Butyrate enemas induced a sustained, concentration-dependent colonic hypersensitivity and, to a lesser extent, a referred cutaneous mechanical hyperalgesia, particularly in female rats, but no macroscopic and histologic modifications of the colonic mucosa, as observed in patients with IBS. Both pain parameters were sensitive to morphine, U50488H, trimebutine, neonatal capsaicin treatment, and the CGRP receptor antagonist but not to the neurokinin 1 receptor antagonist. CONCLUSIONS: These results present our noninflammatory model of chronic colonic hypersensitivity as a useful novel tool for studying IBS. The CGRP receptor antagonist-induced reduction of colonic hypersensitivity suggests that CGRP receptors may provide a promising target for treatment of IBS.

Animals↗
PubMed2004

Histological response in patients treated by interferon plus ribavirin for hepatitis C virus-related severe fibrosis.

BACKGROUND: Studies of viral hepatitis C have suggested that fibrosis can regress, at least in patients with sustained virological response. A recent study suggested that cirrhosis was reversible in sustained and non-virological responders. AIM: To study fibrosis progression rate and cirrhosis reversion in patients treated for severe fibrosis with interferon or interferon + ribavirin. PATIENTS AND METHODS: Ninety-nine patients were treated with interferon + ribavirin and 64 with interferon. The Metavir fibrosis score and the semiquantitative fibrosis score (SFS) were used to assess fibrosis. RESULTS: In sustained responders, fibrosis progression rate decreased from 0.26 Metavir unit (interquartile range: 0.19-0.34) to -0.67 (-0.67 to 0) (P < 0.0001) and from 0.81 SFS unit (0.48-1.13) to -1.33 (-3.67 to 0) (P < 0.0001). In non-responders, fibrosis progression rate decreased from 0.25 Metavir unit (0.17-0.33) before treatment to 0 (0-0) during treatment (P = 0.002) and from 0.63 SFS unit (0.49-1.12) to 0 (-2.67-1.33) (P = 0.18). Six out of 18 (33%) sustained virological responders and four of 43 (9%) non-responders regressed from cirrhosis (F4) to severe fibrosis (F3) (P = 0.058). No patient with cirrhosis had a decrease of Metavir fibrosis score of 2 points. CONCLUSION: Interferon can slow fibrosis progression in sustained virological responders with severe fibrosis. In patients with a non-virological response and treated for 12 months the fibrosis progression rate was nil, meaning that only fibrosis stabilization could be obtained in these patients. Then, longer treatment duration (3-4 years) could be evaluated in non-virological responders.

Antiviral Agents↗
PubMed2003

[Medical practices and expectations of general practitioners in relation to hepatitis C virus infection in the Auvergne region].

AIMS: To determine the medical practices and expectations of general practitioners concerning screening and management of hepatitis C in the Auvergne region. METHODS: A survey was sent by mail to 250 general practitioners. They were then contacted by telephone interviews. RESULTS: 94% of general practitioners answered the survey. Each physician diagnosed an average of 0.6 new cases of hepatitis C in 1999, and had a mean of 3.2 patients with HCV in their practice. Screening was performed by 91% of general practitioners if there was a history of blood transfusion, by 87% if there was a history of intravenous drug use, by 92% in case of increased serum amino transferase levels. Screening was less frequent in case of household contact and was only performed by 68% general practitioners or of asthenia by 52% of general practitioners. Liver biopsy seems to be the main obstacle for the management of hepatitis C patients which is due to a refusal of liver biopsy by the patient according to 55% of general practitioners, a fear of complications according to 25% of general practitioners. Sixty percent of general practitioners considered that liver biopsy was performed in less than 50% of patients with hepatitis C. Fifty three percent of general practitioner thought that hepatitis C network could be useful for increasing their knowledge. CONCLUSIONS: Liver biopsy refusal by the patient restricts the management and therapy of patients with hepatitis C infection. Increase formation still requisite by 60 percent of general practitioner.

Adult↗
PubMed2002

[Prognostic factors for response to treatment and recurrence of uncomplicated symptomatic gastroesophageal reflux in ambulatory care medicine].

OBJECTIVE: To investigate the prognostic factors of symptom resolution or failure and relapse in patients presenting with symptomatic gastroesophageal reflux (GERD) and treated in the usual conditions of primary care. METHOD: Controlled, non-comparative study consisting of a 4-week treatment phase (omeprazole 10 mg/day) and a 12-week follow-up phase. Initial symptom resolution was defined as no heartburn in the week preceding the assessment at the end of treatment. Following initial symptom resolution, relapse was defined as the occurrence of moderate or severe heartburn and/or acid regurgitation, and/or ingestion of antisecretory agents or prokinetics, or the existence of symptoms justifying upper gastrointestinal endoscopy. The prognostic factors were investigated using a step-by-step multivariate regression logistics, taking into account all the demographic, clinical and therapeutic parameters available. RESULTS: The rate of symptom resolution was of 58% (2775 patients assessed in the intent-to-treat analysis). Failure was associated with the following factors: administration of non-steroid antiinflammatories before/during the study (Odds Ratio [OR] = 1.42, p = 0.015), initial severity of heartburn (OR = 1.37, p < 0.001), previous anti-secretory treatment (OR = 1.32, p = 0.001) and initial severity of acid regurgitation (OR = 1.18 p = 0.002). The relapse rate Owas of 26% (2214 patients assessed) with the following associated factors: previous anti-secretory treatment (OR = 1.98, p < 0.001), duration of GERD history (OR = 1.55, p < 0.001), previous administration of prokinetics (OR = 1.46, p < 0.001), distribution of GERD pain throughout the 24 hr period, body mass index and age of patients, with lower Odds Ratio; these last three factors inciting more reserve as to the results. CONCLUSION: In the presence of these factors, assessment of GERD permits adaptation of the initial management and the eventual relay to a maintenance treatment in patients at risk of failure or relapse.

Adult↗
PubMed2002

PAV-1, a new rat hepatic stellate cell line converts retinol into retinoic acid, a process altered by ethanol.

During liver fibrogenesis or long term culture, hepatic stellate cells (HSCs) evolved from "quiescent" to activated phenotype called "myofibroblast-like", a transition prevented by retinoic acid (RA). Little is known about RA generation by HSCs. Our study aimed to check the ability of these cells to produce RA from retinol (Rol) and the alterations of this metabolic step by ethanol. To study this metabolic pathway, primary cultures of HSCs represent the most physiological model but technically suffer several drawbacks. To circumvent these problems, an immortalized rat HSC line (named PAV-1) has been established. We validated PAV-1 cell line as a convenient model to study retinoids metabolism by HSCs. Then, we showed that PAV-1 cells express Rol-binding proteins (RBPs), enzymes and nuclear receptors involved in RA signaling pathway. We also demonstrated in situ generation of functional all-trans-RA (ATRA), using transient transfections with a RA-sensitive reporter gene, in situ modulation of tissue transglutaminase (tTG) activity and HPLC experiments. This production was Rol dose-dependent; 4-methylpyrazole, citral, and ethanol-inhibited which argues in favor of an enzymatic process.In conclusion, we first demonstrate in situ RA generation from Rol in a newly immortalized rat HSC line, named PAV-1. Inhibition of RA production by ethanol in PAV-1 and recent data, suggesting fundamental role of RA to prevent fibrosis development in the liver, allow us to hypothesize that Rol metabolism could be a primary target for ethanol during development of hepatic fibrosis.

Acyclic Monoterpenes↗
PubMed2002

Prevalence of irritable bowel syndrome in the French population according to the Rome I criteria.

BACKGROUND: Irritable bowel syndrome (IBS) is a common functional gastro-intestinal disease. In the absence of specific markers, definition and hence diagnosis depend on clinical presentation. Of the various attempts to set criteria for IBS, the most recent are Rome I and Rome II classifications. AIMS: To estimate in a general population the prevalence of IBS using the modified Rome I criteria, and to investigate socio-demographic criteria, symptoms and management. METHODS: A total of 11,131 people aged 18 years and over, representative of the French population, were surveyed. A diagnostic questionnaire based on the modified Rome I criteria was used to identify IBS sufferers, who were then questioned further about the symptoms and medical management of their IBS. RESULTS: Of the 5,299 men and 5,832 women interviewed, 445 had IBS according to the Rome I criteria, a prevalence of 4% (95% CI: 3.6%-4.4%). IBS was more frequent in women (5.3%) than in men (2.5%), with a sex ratio (F/M) of 2.3. In 9.1% of sufferers, onset had occurred less than 12 months ago, a yearly incidence of 3.6 per 1,000 of the population. In 32.3% of IBS sufferers diarrhoea was predominant, and in 34.6% constipation was predominant. Of IBS sufferers 83.7% had consulted a physician for their condition, and 87.6% had taken medication for their IBS symptoms over the previous 12 months. CONCLUSION: The prevalence of IBS observed in this study in France was close to the lower limit in published data (3 to 20%). Our results suggest that the Rome I criteria are not sensitive enough to detect all IBS patients in a population not actively seeking health care intervention for the condition. In this regard, the refined classification (Rome II) which was established after our study was carried-out should be evaluated.

Adolescent↗
PubMedDate not supplied

Prevalence of irritable bowel syndrome (IBS) and variability of diagnostic criteria.

OBJECTIVES: The main objectives of this study were to assess whether the use of different definitions of irritable bowel syndrome (IBS) could influence measurements of its prevalence and characterize the patient population fulfilling these different diagnostic criteria. METHOD: A telephone survey was carried out by contacting 8,221 subjects aged >or=18 Years representative of the French population. A "screening" questionnaire based on three algorithms of IBS classification (Manning, with or without a notion of a minimal duration of symptoms, Rome I and Rome II) was used by specialised inquirers. RESULTS: Twenty three percent of the subjects interviewed stated that they had suffered from abdominal pain during the previous 12 Months. The prevalence of IBS considerably varied, depending on the diagnostic criteria used: 12% based on Manning criteria without reference to the duration of symptoms; 2.5% if the notion of duration of symptoms was added to the Manning criteria, and 2.1% and 1.1% based on the Rome I and Rome II criteria, respectively (the latter including the same notion of duration). In total, 212 subjects (2.6%) met at least one of the criteria including a minimal duration of symptoms, with a predominance for women (sex-ratio close to 2). CONCLUSION: The prevalence of IBS is strongly dependent on the classification algorithm employed. The requirement of a minimum duration of symptoms eliminates IBS in a large number of subjects complaining of abdominal disorders. Once these methodological variations were taken into account, the prevalence of IBS in France was found to be comparable to that published in international literature.

Abdominal Pain↗
PubMedDate not supplied

[Radiofrequency ablation of hepatocellular carcinoma in patients with cirrhosis].

UNLABELLED: Radiofrequency is an effective therapeutic modality for patients with hepatocellular carcinoma. However few data are available with regard to the complication rate, the feasibility and long term survival. AIMS: To assess the response rate and complications of radiofrequency in cirrhotic patients with hepatocellular carcinoma. PATIENTS AND METHODS: Eighteen patients were enrolled. Each nodule was treated subcutaneously. Treatment response was assessed by computed tomography performed at 24 hours in 10 patients and every 3 months in all patients. Necrosis of the tumor was considered complete when hypodensity without enhanced contrast. RESULTS: Thirty hepatocellular carcinoma nodules with a mean tumor size of 30 mm; 15<30 mm and 15 >=30 mm, were treated by 1.3 radiofrequency sessions. Complete necrosis was achieved in 89%, greater for nodules<30 mm (100%) than for nodules >=30mm (80%). After a median follow up of 10.6 months, survival rate was 50%. Death was related to tumor involvement in 28%, to cirrhosis complications in 17% and to non liver-related disease in 5%. Three major treatment-related complications occurred (10%): subcapsular hematoma, sustained severe pain and peritoneal dissemination. All three complications were related to subcapsular location. CONCLUSION: Radiofrequency may be considered as an alternative treatment to percutaneous ethanol injection for hepatocellular carcinoma; however, subcapsular location has to be excluded when considering the observed morbidity. Prospective studies are warranted to evaluate the efficacy and morbidity of this treatment in hepatocellular carcinoma.

Aged↗