Biomedical subjects

Jalel Boubaker

Publications and source records attributed to Jalel Boubaker.

At least 19 recordsLinked to original sources

PubMed2006

[Gastrointestinal stromal tumor: epidemiology and outcome study in 40 cases].

The aim of this study was to analyze epidemiology and outcome of 40 patients with gastrointestinal stromal tumor (GIST) expressed CD 117. All epidemiological data (age, sex, location) and survival data were analyzed retrospectively. The tumors occurred in 17 men and 23 women. Stomach was the most common site of localization (47.5%). Of the 37 patients without Gleevec treatment, 18 benignant cases (66.6%) showed long-term survival (2 to 8 years) and 9 malignant cases (33.3%) were diagnosed. 10 cases were still being in followed (< 2 years). Gastric tumor's survival was better than extragastric tumor's survival without statistically significance (p>0.05). Our experience confirms that GIST is an aggressive tumor. 33.33% of them are malignant with recurrence or metastatic potential. Additionnally, epidemiologic factors (age, sex and location) do not have a predictive value.

Adult↗

PubMed2006

[Findings of 24-hour esophageal pH monitoring in patients with respiratory and otorhinolaryngologic manifestations of gastroesophageal reflux disease].

We conducted a retrospective study on 24-hour esophageal pH monitoring performed to patients with non allergic asthma, chronic cough and chronic pharyngitis or laryngitis. We studied 168 patients. On 24-hour esophageal pH monitoring, gastroesophageal reflux was detected in 67 cases (40%), more frequently in patients with chronic cough and asthma than in patients with chronic pharyngitis or laryngitis. A statistically significant increase in all the pHmetric parameters, except for the number of reflux episodes, was found in asthmatic patients compared to patients with chronic pharyngitis or laryngitis. Comparison of the pHmetric parameters in patients with gastroesophageal reflux disease revealed that the number of reflux episodes of morethan five minutes and the duration of longest reflux episodes were higher in asthmatic patients than in patients with chronic cough. Gastroesophageal reflux disease is more frequent in asthma and chronic cough than in chronic pharyngitis or laryngitis. Reflux episodes in chronic cough are shorter than these in asthma. This difference should explain the different severity between the two situations.

Adult↗

PubMed2006

[The pathophysiology of irritable bowel syndrome].

The irritable bowel syndrome (IBS) is a frequent gastrointestinal disorder (10 -15% of the population). It is characterized by chronic abdominal pain with modification in the bowel habits. The diagnosis is based of ROME II criteria. The pathophysiology of the SII remains unknown . It result from visceral hypersensitivity with anomalies of the digestive motility. These anomalies are secondary of dysfunction of the brain - gut axis modulated by environmental and the psychosocial factors. The understanding of the pathophysiological mechanisms of the SII and in particular the function of the brain-gut axis will permit a better handling of the patients. Indeed, the present knowledge of the neurotransmitter implied in the communication between the central nervous system and the digestive tract are currently the basis of the new therapies aimed to modulate the mechanisms implicated in the causation of the several symptoms of IBS. These novel pharmacotherapy should reduce the indirect societal and costs of IBS.

Brain↗

PubMed2006

[Microscopic colitis. A 20 cases series].

Microscopic colitis are defined as a chronic inflammation of a normal macroscopic colonic mucosa. We report 20 cases of microscopic colitis. Chronic diarrhea revealed the diagnosis in 95% of cases. Endoscopic examination was normal in 95% of patients. We diagnosed collagenous colitis in 65% of cases and lymphocytic colitis in 35% of cases. The treatment was based on sulphasalazine in 16 patients, on 5 aminosalicylic acid in 1 case, on gluten free diet in 2 cases and a symptomatic treatment was prescribed to one patient. A clinical remission was observed in 41.2% of patients taking sulphasalazine.

Adult↗

PubMed2006

[Predictive factors of failure of intravenous corticosteroid treatment in acute severe colitis of Crohn's disease and ulcerative colitis].

We conducted a retrospective study on 78 cases of acute severe colitis (Crohn's disease in 51 cases, ulcerative colitis in 27 cases). Diagnosis of acute severe colitis was based on presence of Truelove's criteria and/or endoscopical gravity lesions. Failure of corticoid treatment was observed in 35 patients (45%). In overall patients, predictive factors of failure of intravenous corticoid treatment in univariate analysis are diagnosis of ulcerative colitis, number of bloody stool higher than 6/day. level of C-reactive protein lower than 25 mg/l. visibility of muscular mucosa at colonoscopy, absence of decrease in erythrocyte-sedimentation rate for more than 50% of initial value at day 3 of treatment, absence of decrease in C-reactive protein for more than 50% of initial value at day 3 of treatment, and a lower duration of corticoid treatment. In multivariate analysis, independent predictive factors of failure of corticoid treatment are a number of bloody stool higher than 6/day (p=0.01 adjusted OR [CI95%]: 10.2 [1.15 - 72.06]) and a value of initial C-reactive protein lower than 25 mg/l (p < 0.0001 adjusted OR [CI95%] : 3.25 [2.95 - 4.31]). In Crohn's disease, the only independent predictive factor of failure of corticoid treatment is an absence of decrease of C-reactive protein level for more than 50% of initial value at day 3 of treatment (p = 0.001 adjusted OR [CI95%] : 0.79 [0.45-0.95]). Existence of these predictive factors allows the early identification of patients who would be suitable for second-line therapy.

Adolescent↗

PubMed2006

[Postoperative recurrence in Crohn's disease. Risk factors and methods of prevention].

Postoperative recurrences art frequent in Crohn's disease. Early recurrent lesions in the neoterminal ileum after ileocoIonic anastomosis is the most important risk factor for symptomatic recurrence of Crohn's disease after curative surgical resection. Others risk factors are ileocolonic anastomosis, perforating indication of surgery and smoking status. Many drugs have been evaluated for the prevention of clinical postoperative recurrence: Antibiotics, particularly metronidazole ornidazole, and a little benefice of mesalamine. Azathioprine and 6 mercaptopurine have been recently evaluated; with a not clear clinical effect for prevention of clinical recurrence after resection in Crohn's disease. Several authors have proposed an empiric strategy for the prevention of recurrence after curative resection, based essentially on existence and severity of early endoscopic recurrence.

Algorithms↗

PubMed2005

CARD15/NOD2 in a Tunisian population with Crohn's disease.

Crohn's disease (CD) is a heterogeneous disorder. A genetic linkage to chromosome 16 (IBD1) has been previously observed and replicated in unrelated populations. Recently, in this region, NOD2/CARD15 has been identified as a susceptibility gene. The aim of this report is to determine whether this gene is implicated in CD in a Tunisian population. One hundred thirty patients with CD and 90 healthy individuals were genotyped for the three common NOD2 variants (C2104T in exon 4, G2722C in exon 8, and 3020insC in exon 11). Furthermore, the 11 exons of the NOD2 gene were sequenced in 20 patients with CD. Results showed that the frequency of the CARD15 variants in the Tunisian population is significantly lower than that observed in the European and American population. Direct sequencing of CARD15 did not permit us to identify a characteristic mutation in our population. No association was confirmed between CD and the NOD2 gene in our Tunisian population. Furthermore, the NOD2/CARD15 gene has a variable association with CD in different populations. These results indicate the genetic variation of CD in different ethnic groups.

Adolescent↗

PubMed2005

[Frequency of esophageal motor disorders in patients with dysphagia and normal upper gastro-intestinal endoscopy. A manometric study of 289 cases].

289 esophageal manometries performed for 7 years to patients with dysphagia and normal upper gastro-intestinal endoscopy were analyzed, excluding patients with systemic sclerosis and preoperative manometries for gastroesophageal reflux disease. Esophageal motor disorders are frequent in patients with non obstructive dysphagia. Esophageal manometry is important to perform in these patients. Specific treatment is required in patients with achalasia. Systemic sclerosis and gastroesophageal reflux disease should be suspected in patients with esophageal hypomotility.

Adult↗

PubMed2005

[Technical aspects and indications of anorectal manometry].

Anorectal manometry is an important tool in testing anorectal disorders. Water-filled balloons is the most commonly used. The step-by-step anorectal manometry using a small balloon tube is easy to perform, well standardized and reproducible. Parameters studied by anorectal manometry are the rectoanal inhibitory reflex, anal resting pressure, sustained voluntary contraction of anal canal and rectal sensation. Anorectal manometry is also useful for diagnosis of anismus. The most important indications are anal incontinence, distal constipation and preoperative evaluation before sphincteroplasty or surgical rectocele repair.

Anal Canal↗

PubMed2004

[Inflammatory bowel diseases and lymphoma].

The aims of this review are to precise the incidence of non-Hodgkin's lymphoma and Hodgkin's disease in inflammatory bowel disease and to assess the relationship between immunosuppressive therapy and lymphoma in inflammatory bowel disease. Population-based data show that incidence of lymphoma is not increased in patients with Crohn's disease or ulcerative colitis. There is an increased incidence of non-Hodgkin's lymphoma in inflammatory bowel disease patients on immunosuppressive therapy but overall risk is low in all cohort studies. Relationship between immunosuppression and lymphoma in inflammatory bowel disease is confirmed by frequency of cerebral lymphoma and association with Epstein-Barr virus.

Epstein-Barr Virus Infections↗

PubMed2004

[Fatal miliary tuberculosis following treatment with Infliximab].

We report the first Tunisian case of miliary tuberculosis in a patient who received Infliximab for Crohn's disease with uretrorectal and ano-perineal fistula developed 4 weeks after the start of treatment. We suggest that diagnosis of latent tuberculosis infection is important before treatment with Infliximab is initiated and that antituberculous medication must be prescribed immediately in case of occurrence of unexplained fever after treatment with Infliximab.

Antibodies, Monoclonal↗

PubMed2004

[Multiple lymphomatous polyposis of the gastrointestinal tract: a Tunisian case].

Multiple lymphomatous polyposis is a distinctive primary gastrointestinal lymphoma which endoscopical, histopathological et immunophenotypical characteristics are well known. This lymphoma is rare and its prognosis is bad because of frequency of stage IV patients. We report the case of a 75-year-old male patient with multiple lymphomatous polyposis affecting the rectum, the colon and the stomach associated with an involvement of lymphadenopathies, bone marrow and liver. Treatment by chemotherapy was ineffective and patient dead after 3 sessions of CEOP protocol.

Aged↗

PubMed2004

[Genetics of inflammatory bowel disease].

The Inflammatory Bowel Disease (IBD) are multifactorial diseases involving the interaction of genetic and environmental factors. In genetic terms, the IBD are polygenic and multigenic disorders with incomplete penetrance. In the late decade, investigators have applied the complementary techniques of genome-wide scanning and candidate gene analysis to search susceptibility genes. The IBD susceptibility regions, widely replicated, are in chromosomes 16 (IBD1), 12 (IBD2) and 6 (IBD3). Recently, a significant association have been reported with Crohn's disease and NOD2/ CARD15 gene. This gene is an appropriate candidate gene because its localization and function. More studies is necessary to confirm this association, search an other variants of this gene and other candidate gene. This studies provide best comprehension of the disease pathogenesis and deliver clinical application.

Genetic Predisposition to Disease↗

PubMed2004

[Indications and results of infliximab in Crohn's disease].

Infliximab is a chimeric monoclonal antibody to tumor necrosis factor a. Induction therapy with infliximab is indicated for treatment of refractory Crohn's disease and for reduction in the number of draining fistulas in fistulizing Crohn's disease. Indications for maintenance therapy with infliximab include maintenance of remission in active Crohn's disease who responded to initial induction therapy with infliximab and maintenance of fistula improvement who responded to initial therapy with infliximab. Side effects of infliximab are infusion reactions, immunogenicity, induction of DNA antibodies and infection complications including tuberculosis.

Adult↗

PubMed2003

[Corticosteroid dependence and resistance in Crohn's disease: prevalence and predictive factors].

The aim of our study was to determine the prevalence of corticosensibility, corticodependency, and corticoresistance in patients with Crohn's disease. Ninety four treatments with corticoids were prescribed to the patients during the follow-up. The rates of corticosensibility, corticodependency, and corticoresistance were 66%, 16%, 18%. Corticodependency and corticoresistance are frequent in Crohn's disease. Corticodependency is more frequent in young patients and when corticoids were previously taken. A high CDAI was the only factor associated with a higher risk of corticoresistance.

Adrenal Cortex Hormones↗

PubMed2003

[The role of major histocompatibility complex genes in the pathogenesis of chronic inflammatory bowel diseases].

Genetic factors, among which the HLA class II coding genes, are implicated in IBD pathogenesis. When considering the ethnic heterogeneity of the studied population and the IBD clinical heterogeneity, UC appears more dependent to HLA genes than CD. UC and HLA genes: HLA DR 4 gene would protect from UC. HLA DR2 gene, particularly the DRB 1 * 1502 allele, is predisposing for more severe forms necessitating a corticotherapy, while DRB 1 * 0301 allele is associated with less needs for surgery. CD and HLA genes: HLA DR 7 gene and the DRB 3 * 0301 allele predispose to CD, while HLA DR 2 and DR 3 genes may be protective factors. Thus, for MC patient, the DRB 1 * 0301/DQB*0201 haplotype might be associated with less occurrence of fistulas or severe forms requiring immunosuppressive therapy.

Colitis, Ulcerative↗

PubMed2003

[Epidemiological, clinical and parasitological data concerning intestinal amebiasis in northern Tunisia].

In order to evaluate the principal characteristics of the intestinal amoebiasis in the north of Tunisia, one retrospective study review all cases diagnosed in principal gastroenterologic sections of the hospitals of Tunis. Twenty height cases of intestinal amoebiasis, 10 of which have an inflammatory bowel disease associated were included. Watery stools containing blood and mucus were the most important symptoms (25 cases). The endoscopic exam showed for all the cases non specific lesions. The diagnosis was based on histologic exam in 21 cases, on the positivity of serologic tests in 3 cases and on the presence of E. histolytica/dispar cysts in stools in 6 cases. In two cases, the diagnosis was made by therapeutic test.

Adolescent↗

PubMed2003

[Osteoporosis and inflammatory bowel disease: prevalence and risk factors in Tunisian patients].

OBJECTIVES: The study was aimed to evaluate osteoporosis prevalence in a group of Tunisian patients with inflammatory bowel disease (IBD), to determine its risk factors, and to describe its mechanisms. SUBJECTS AND METHODS: We included 67 IBD patients, 43 patients with Crohn's disease (CD) and 24 with ulcerative colitis (UC). Bone mineral density was measured at the lumbar spine and left femoral neck by dual-energy X-ray absorptiometry. We used T score to express bone loss (osteopenia: -2.5 SD 2 years and active disease tended to be associated with lumbar osteoporosis; the ORs were respectively 4.87 [0.92-25.80] (P=0.06), 4.21 [0.87-20.57] (P=0.06), and 2.33 [0.78-6.67] (P=0.13). No association was found with cumulated dose of steroids even when considering only CD. Patients with osteoporosis showed significant increased CrossLaps and interleukin-6 levels that indicate both high bone resorption and inflammatory activity. CONCLUSIONS: Osteoporosis is frequent in IBD patients, especially in CD patients. Female gender, malnutrition (body mass index <20 kg/m2), disease course (> 2 years) and active disease would be risk factors of bone mineral loss in IBD. Osteoporosis is associated with enhanced bone resorption, that seems be linked to excessive intestinal inflammation.

Adolescent↗