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Stanislas Chaussade

Publications and source records attributed to Stanislas Chaussade.

34 records · Page 2Linked to original sources
PubMed2003

[NSAIDs digestive risk: epidemiologic data].

A HIGH RISK: Conventional non-steroidal anti-inflammatory drugs (NSAIDs) produce, by a factor of about 4, a major increase of the secondary GI adverse effect risk (ulcer and bleeding). According to published data, the number of patients to be treated with an NSAID for a duration of more than 2 months, a duration which can result in death, is 1220 (909 to 2500). A LONG TERM RISK: The GI risk induced by an NSAID appears constant over time. Upon discontinuation of treatment with an NSAID, an elevated risk is observed during the first 3 months following the end of treatment.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2003

[Are dyspepsia or gastroesophageal reflux predictive of serious digestive events during treatment with NSAIDs? How should they be treated?].

The prevalence of dyspepsia is high in the general population. Its incidence varies depending on the study and the definition chosen for dyspepsia. Treatment with NSAIDs increases the risk of dyspepsia. The absence of dyspepsia does not eliminate a potential serious GI event during treatment with an NSAID, and patients with dyspepsia do not have an increased risk of GI complications. What about gastro-oesophageal reflux? Symptoms of gastro-oesophageal reflux are frequent during treatment with an NSAID, but the NSAID-related gastro-oesophageal reflux-inducing effect has not been demonstrated. On the contrary, this causal relationship has been established in the occurrence and worsening of lesions of oesophagitis. From the standpoint of management, the existence of dyspepsia or gastro-oesophageal reflux before prescription of an NSAID should be treated and investigated if necessary (patient older than 50). In the event of chronic gastro-oesophageal reflux, endoscopy is necessary to screen for and treat oesophagitis before initiating treatment with NSAID. In case of dyspepsia or gastro-oesophageal reflux developing during treatment with an NSAID, endoscopy is not a systematic procedure to be performed in a first phase. It is indicated in case of non-response to a symptomatic therapy and in case of a GI lesion risk (patient older than 50).

Age Factors↗
PubMed2003

[Risk factors for upper digestive tract toxicity with NSAIDs (excluding Helicobacter pylori)].

UNLABELLED: AN ABSOLUTELY CERTAIN RISK: The non-selective non-steroidal anti-inflammatory drugs increase the risk of gastro-duodenal ulcer by 3 to 5 and the incidence of the symptomatic ulcers is 1 per 100 patients treated per year History before anti Cox-2. HISTORY BEFORE ANTI COX-2: The past history of ulcer increases the risk of relapse by 14 to 17 with non-steroidal anti-inflammatory drugs intake compared to patients without previous ulcer. The severity of the ulcers induced by non-steroidal anti-inflammatory drugs increases with the age. The ulcer risk is constant with the time and thus the prevalence increases with the duration of the treatment. The concomitant treatments by anticoagulants or aspirin increase the risk of digestive events by 2 to 3. A heavy consumption of alcohol is a factor of risk. Smoking is a minor factor. WITH ANTI COX-2: The incidence of the symptomatic ulcers is reduced by 60% among patients treated by Cox-2 specific antagonists. This reduction is identical that the patients have or not risk factors, and thus, the digestive complications are not suppressed when giving non-specific antagonists to the patients with risk factors. Their incidence cannot be negligible among patients cumulating at least two factors and treated by Cox-2 specific antagonists (from 5 to 16% per year). The benefit related to the IN SUMMARY: Cox-2 specific antagonists seems dramatically reduced by the concomitant aspirin intake. Among the patients who have a symptomatic ulcer induced by non-steroidal anti-inflammatory drugs, 81% did not have previous symptoms or risk factors.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2003

[Role of Helicobacter pylori in drug-induced gastrointestinal bleeding].

TWO CO-FACTORS: Helicobacter pylori (Hp) infection and ingestion of NSAIDs are two factors which play a major role in the occurrence of gastric and duodenal ulcers, simple or complicated by perforation and GI bleeding. Hp increases the risk of ulcer in patients receiving an NSAID and the effects of Hp and NSAIDs are additive. Following GI bleeding in a patient receiving a conventional NSAID, the eradication of Hp does not make it possible to protect the patient from another episode of GI bleeding and proves to be a much less effective therapy than continuous therapy with proton pump inhibitors. ROLE OF COX-2 INHIBITORS: COX-2 inhibitors (celecoxib, rofecoxib) are associated with a major decrease in the number of symptomatic and/or complicated ulcers compared to a conventional NSAID. Two randomized studies using doses four times higher than those recommended, have demonstrated that serious GI complications associated with NSAIDs (perforation, GI bleeding) were decreased by half compared to those by use of a conventional NSAID at the usual therapeutic dosage. Considering the patient's previous history of GI disorders prior to initiation of treatment and Hp(+) serology, it appears that decreasing risk of symptomatic or complicated gastro-duodenal ulcer was higher in treatment with Rofexocib in patients who did not have a previous history of ulcer, whatever their Hp status. On the other hand, in the group with a history of GI disorders, the decrease in the risk of ulcer was lower than in patients who were Hp(+). ROLE OF ASPIRIN: The causal relationship between intake of aspirin and Hp appear to be more complex. Thus, it appears that eradication of Hp in patients who presented with GI bleeding and scheduled to resume low-dose aspirin had the same efficacy as a daily dose of 20 mg of omeprazole for a 6-month period.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2003

Loss of parental-specific methylation at the IGF2 locus in human hepatocellular carcinoma.

Significant production of the growth factor IGF2 has been reported in human hepatocellular carcinomas (HCCs). Disturbances associated with changes in methylation at this locus or affecting the 11p15.5 imprinting domain as a whole can be postulated in HCCs. In the present study, the methylation status of differentially methylated regions of the imprinted genes TSSC5, LIT1, and IGF2, which span the 11p15 domain, was analysed in 71 liver tissues from virus-associated and non-virus-associated HCCs compared with six normal liver tissues. Altered methylation of TSSC5 and LIT1 was observed in only 6% and 8% of HCCs, respectively, compared with 89% at the IGF2 locus, suggesting that these loci were not concomitantly dysregulated. These observations suggest that loss of parental-specific methylation at the IGF2 locus may be specifically associated with HCC, whether virus-associated or non-virus-associated, and arising in cirrhotic or non-cirrhotic livers.

Carcinoma, Hepatocellular↗
PubMed2003

Daily soluble aspirin and prevention of colorectal adenoma recurrence: one-year results of the APACC trial.

BACKGROUND & AIMS: Epidemiologic and experimental studies have suggested that aspirin intake reduces the risk for colorectal carcinogenesis. However, the available data are not sufficient to serve as the basis for firm recommendations. METHODS: We randomly assigned 272 patients with a history of colorectal adenomas (at least one more than 5 mm in diameter, or more than 3) to daily lysine acetylsalicylate (160 or 300 mg/day) or placebo for 4 years. The primary end points were adenoma recurrence after 1 and 4 years. These results are those of the year 1 colonoscopy. RESULTS: Among the 238 patients who completed the year 1 colonoscopy, at least one adenoma was observed in 38 patients of the 126 (30%) in the aspirin group and in 46 of the 112 (41%) in the placebo group; relative risk was 0.73 (95% confidence interval [CI]: 0.52-1.04; P = 0.08). At least one adenoma of more than 5 mm diameter was observed in 13 patients (10%) in the aspirin group and 26 (23%) in the placebo group (P = 0.01). The corresponding numbers for adenomas more than 10 mm in diameter were one (1%) and 7 (6%) (P = 0.05). Stepwise regression showed that independent factors associated with lower adenoma recurrence are aspirin treatment (adenoma >5 mm, P = 0.01), absence of personal history of adenoma before the entry colonoscopy (P = 0.01), and initial adenomatous polyp burden less than 10 mm (P = 0.001). CONCLUSIONS: Daily soluble aspirin is associated with a reduction in the risk for recurrent adenomas found at colonoscopy 1 year after starting treatment.

Adenoma↗
PubMed2003

Long-term impact of a restrictive laboratory test ordering form on tumor marker prescriptions.

OBJECTIVE: To evaluate the long-term impact of an intervention designed to reduce the ordering of three tumor markers frequently prescribed for gastroenterologic diseases (carcinoembryonic antigen, alpha-fetoprotein, carbohydrate antigen 19-9). METHODS: A prospective study with time series analysis in a teaching hospital. Local clinical guidelines were developed and implemented through a new order form, designed as a reminder to the physician, restricting the ordering of laboratory tests. Ratios between the number of markers ordered and number of admissions were recorded during a 3-month period before and after intervention in the whole hospital and monthly on a 4-year period in two wards of the hospital (Department of Gastroenterology and Department of Internal Medicine). To evaluate the appropriateness of tumor marker orders, audits were performed on a sample of order forms, before and after (1 month and 2 years after) the implementation of the new order form. RESULTS: The analysis of covariance showed a significant effect of the intervention in the hospital (p < .01), and in the Departments of Gastroenterology (p < .01) and Internal Medicine (p < .007). The decrease of tumor marker orders ranged from 25% (Internal Medicine Department) to 55% (whole hospital). A similar decrease was observed for the three studied markers. The appropriateness of prescriptions increased from 54.6% before to 73.6% after the implementation of the new order form, but decreased to 52.9% 2 years after intervention. CONCLUSIONS: Providing a reminder to clinicians through a specific order form represents an inexpensive and easy way to implement guidelines on use of laboratory tests.

Biomarkers, Tumor↗
PubMed2003

CT, endoscopic sonography, and a combined protocol for preoperative evaluation of pancreatic insulinomas.

OBJECTIVE: This study aimed to determine the value of CT, endoscopic sonography, and a combined protocol for preoperative detection of insulinomas. MATERIALS AND METHODS: All patients treated in our institution for surgically proven insulinoma between 1987 and 2000 were retrospectively reviewed. Thirty patients with 32 pancreatic insulinomas underwent preoperative CT and endoscopic sonography and were included in the study. These 30 patients also underwent dual-phase thin-section multidetector CT (group 1: n = 15), dual-phase multidetector CT without thin sections (group 2: n = 8), or sequential CT (group 3: n = 7). CT scans were interpreted separately and retrospectively by three radiologists in consensus. Sensitivity values for CT, endoscopic sonography, and a combined protocol were determined. RESULTS: The overall diagnostic sensitivity for dual-phase helical CT was 94.4% for group 1, 57.1% for group 2, and 28.6% for group 3. Endoscopic sonography showed proven insulinomas in 30 of 32 cases (sensitivity, 93.8%). Differences between dual-phase thin-section CT and endoscopic sonography were not statistically significant. The overall diagnostic sensitivity for combined biphasic thin-section helical CT and endoscopic sonography was 100%. CONCLUSION: The most effective method for revealing insulinomas is a combined imaging protocol that consists of both dual-phase thin-section multidetector CT and endoscopic sonography.

Adolescent↗
PubMed2003

[Appropiateness of colonoscopy in a gastrointestinal unit in 2001: a prospective study using criteria established by a European panel of experts].

UNLABELLED: Criteria for appropriateness of colonoscopy have been elaborated by an European Panel (EPAGE). OBJECTIVES: 1) To assess the feasibility of EPAGE criteria in clinical practice, 2) to assess colonoscopy appropriateness using EPAGE criteria, 3) to compare colonoscopy appropriateness and findings. PATIENTS AND METHODS: Four hundred and six consecutive examinations were included. The referral indication was judged using a scoring system on the basis of the EPAGE criteria. RESULTS: Appropriateness could be assessed in 94% of the colonoscopies. Fifty-four percent were appropriate, 40% equivocal, and 6% inappropriate. Rate of abnormal colonoscopy was not different between the 3 groups, however endoscopic findings were more severe when the indication was appropriate. In the appropriate group, adenomatous polyps were more frequent (24%) than in the two other groups (13% and 12%; P<0.05) and tended to be larger in size. In the inappropriate group, patients were significantly younger, and no cancer was found. There were 5 colonic cancers in the inappropriate group and 12 in the appropriate group. CONCLUSION: Colonoscopy is generally not overused according to EPAGE guidelines. However, on an individual basis it could be rather difficult to determine colonoscopy appropriateness using a scoring system. Indeed, a third of the indications was judged equivocal and the endoscopic findings were no different whether indication was appropriate or equivocal.

Adult↗
PubMed2002

[Inter-observer agreement on histological diagnosis of colorectal polyps: the APACC study].

INTRODUCTION: Adenomas are considered as precursors of colorectal adenocarcinomas. After polypectomy, surveillance depends on the histological analysis of the excised polyps. The aim of the study was to evaluate the reproducibility of the histological diagnosis performed by pathologists from participating centers in the APACC study. Their interpretations were compared to those of the study's consensual diagnosis performed by two reference pathologists. METHODS: The agreement proportion and the concordance coefficient (kappa) were estimated for 326 polyps obtained from the first 148 patients included. RESULTS: A concordant diagnosis for the adenomatous nature was shown for 246 of the 255 adenomas (96%). The diagnosis of both the histological type and the degree of dysplasia was concordant for only 92 of the 255 adenomas (36%). Kappa values were 0.67 for the adenomatous nature, 0.46 for the histological types, and 0.26 for the degree of dysplasia. CONCLUSION: A high degree of agreement was obtained for the diagnosis of the adenomatous nature. By contrast, high variations were observed for the interpretations of the histological type and the degree of dysplasia.

Adenoma↗
PubMed2002

[Conservative management of esophageal perforation after pneumatic dilatation for achalasia].

PURPOSE: To assess the results and indications of conservative management of esophageal perforation following pneumatic dilatation for achalasia. PATIENTS AND METHODS: Thirteen esophageal perforations complicating 524 dilatations in 412 patients (3%) were diagnosed by esophagogram. Medical treatment consisted of nasogastric succion, antibiotics and pleural drainage, if necessary. Conservative surgical treatment included left thoracophrenotomy, perforation closure, controlateral myotomy and anterior fundoplication. Surgical decision was based upon clinical and radiological parameters. Functional outcome was assessed by the means of the Eckardt's grading score. RESULTS: Six patients were successfully managed by medical treatment. Seven patients underwent conservative surgery, three of whom after failure of medical treatment. The presence of a pneumomediastinum at initial presentation led to immediate (n=2) or delayed (n=2) surgery in all instances. No patients died. In the surgical group, morbidity consisted of one wound infection, one pleural effusion and one venous thrombosis. One severe chest infection occurred in the medical group. Oral feeding was reintroduced after a median of 10 and 11 days in the surgical and medical groups, respectively. Functional results were satisfactory and similar in both groups. CONCLUSION: Conservative medical or surgical management of oesophageal perforation following pneumatic dilatation is safe, if the diagnosis is done early. Pneumomediastinum at initial presentation seems to predict failure of conservative medical treatment.

Adult↗
PubMed2002

[Patient-doctor relationship in the irritable bowel syndrome. Results of a French prospective study on the influence of the functional origin of the complaints].

UNLABELLED: The attention given by the physician and the quality of the patient-physician relationship mainly determine the outcome of a consultation. Care seeking is a main characteristic of patients with functional bowel disorders, including irritable bowel syndrome (IBS), while patients with suspected organic disease (Org) would rather expect a precise answer about their condition. The aim of this study was thus to evaluate the outcome of the consultation with a gastroenterologist in IBS patients, as compared to a group of patients with suspected organic disease. PATIENTS AND METHODS: A prospective multicenter cross-sectional study "one given week" included 158 patients consulting for the first time 18 gastroenterologists. Patients were consulting for abdominal pain and were classified as IBS or Org on the basis of the physician's clinical impression. Questionnaires including 27 common questions were distributed to the patients and the physicians at the end of the consultation and filled separately. RESULTS: The diagnosis of IBS was done in 110 patients and that of Org in 48. Groups were comparable for the characteristics, the intensity and the frequency of attacks of abdominal pain. The index of satisfaction of the patients was not different between groups (IBS: 8.7 +/- 1.4; Org: 9.1 +/- 1.4; P=0.16). The intensity of abdominal pain was reported in the same range by the patient (IBS: 5.1 +/- 2.9; Org: 4.5 +/- 2.8) and the physician (IBS: 4.6 +/- 2.3; Org: 4.8 +/- 2.6) in both groups. Digestive and extra-digestive symptoms were quoted equally by physicians, whatever the group the patient belonged to. Information given by the physician on diagnosis and therapy were equally well perceived by patients of both groups. However, the physician tended to evaluate the efficacy of the prescribed therapy to be lower in IBS (7.1 +/- 2.0) than in Org patients (8.0 +/- 1.7; P<0.01). CONCLUSION: In this study, the consultation with a gastroenterologist is equally well perceived by IBS and Org patients and it seems to meet the expectancy of the patient in most cases. However, the physician appeared less confident in the efficacy of the therapy proposed to IBS patients.

Adult↗