Appropriateness of colonoscopies in a Tunisian endoscopy center: factors and EPAGE-I/II criteria comparison.

Background: There is a growing demand for colonoscopy, worldwide, resulting in increased rate of inappropriate referrals. This "overuse" of colonoscopies has become a major burden for health care.

Objectives: to assess the appropriateness of colonoscopies performed at the endoscopy unit of the university hospital of Sousse and to compare these results of appropriateness according to the European Panel of Appropriateness of Gastrointestinal Endoscopy (EPAGE) I and EPAGE II criteria.

[Not Available].

Introduction: Treatment of complex perianal fistulas in Crohn's disease remains a challenge especially after the failure of Infliximab.

Aim: Update on the different therapeutic alternatives for anal fistula in Crohn's disease after failure of Infliximab.

Methods: A research in the medical literature on PubMed and Google Scholar was carried out.

Enhancing proficiency in ascites puncture through procedural simulation: an audit type study investigating medium-term skill retention.

Introduction: Medical simulation has become an essential teaching method for all health professionals. It not only allows to acquire technical and non-technical knowledge, but also helps the maintenance of acquired knowledge in the medium and long term. Ascites puncture is part of the basic technical procedures learned by medical students during their internship.

Exploring work productivity loss in patients with inflammatory bowel disease.

Aim: We aimed in this study to evaluate the impact of inflammatory bowel disease (IBD) on patients' professional life and to determine predictors of severe work productivity loss (WPL).

Materials & Methods: A cross sectional study including patients with a confirmed diagnosis of IBD. Work productivity was evaluated with the work productivity and activity impairment score.

Predictive factors of recurrence in spontaneous bacterial peritonitis in Tunisian patients with cirrhosis.

Introduction: Recurrent spontaneous bacterial peritonitis (SBP) in patients with cirrhosis is associated with poor prognosis.

Aim: To assess the prevalence and the risk factors for recurrence and to evaluate its impact on the prognosis.

Materials & Methods: We conducted a retrospective study including patients with cirrhosis having a first episode of SBP.

Massive hematochezia due to jejunal varices successfully treated with coil embolization.

We report a case of hematochezia with hemodynamic instability due to jejunal varices in a cirrhotic patient with no prior history of surgery. The patient was managed with coil embolization via the portal vein. After which, the patient did not present any hemorrhage recurrence and maintained a stable hemoglobin level.

Predictors of postoperative recurrence in a cohort of Tunisian patients with Crohn's disease.

Background: The aim of our study was to evaluate the frequency and risk factors of clinical postoperative recurrence in Tunisian patients with Crohn's disease (CD).

Methods: Clinical data of 86 patients with CD who underwent ileocolonic resection at University Hospital of Sahloul in Tunisia were retrospectively reviewed. Continuous data are expressed as median (interquartile range), and categorical data as frequencies and percentages.

Spectrum of acute hepatitis and its clinical outcome in a central region in Tunisia.

Introduction: given the lack of studies on acute hepatitis (AH) in Tunisia, we carried out this study to find the etiological spectrum and clinical profile of AH and to investigate the impact of viral etiology on the outcomes of AH.

Methods: retrospective descriptive study collecting all patients with AH from 2010 to 2017. The data were compared between two groups (viral AH and non-viral AH).

Synchronous Hepatocellular Carcinoma in a Patient with Primary Gastric Cancer: An Exceptional Association.

Hepatocellular carcinoma (HCC) is the most frequent type of liver cancer. Liver cirrhosis of any etiology is considered the main risk factor for the development of HCC. However, HCC in noncirrhotic livers remains an uncommon finding.

Cirrhotic cardiomyopathy.

The presence of cardiocirculatory dysfunction in liver cirrhosis has been described since 1960 and it was exclusively attributed to alcoholic cardiomyopathie. Only in the last two decades, the term of cirrhotic cardiomyopathy (CCM) was introduced to describe cardiac dysfunction in patients with cirrhosis. This entity is currently underdiagnosed because the disease is usually latent and manifests when the patient is under stress.

Effect of low dose albumin administration in spontaneous bacterial peritonitis on renal function and survival.

Background And Study Aims: Current guidelines favour albumin administration during spontaneous bacterial peritonitis (SBP). However, its use is limited in clinical practice and low doses are preferred. The aim of our study was to determine the effect of low dose albumin perfusion during SBP on mortality and prevention of hepatorenal syndrome (HRS) in cirrhotic patients.

Effect of long-term proton pump inhibitors on bone mineral density.

Background: Proton pump inhibitors (PPIs) are widespread nowadays. Recent concerns haveemerged about possible bone complications of their long-term use, as lowbone mineral density (BMD) and an increased risk of fractures.

Aim: To evaluate the effect of long-term use of PPIs on boneby estimating the frequency of osteopenia andosteoporosis, and determining the risk factors associated to these complications.

Quality of life in inflammatory bowel disease in Tunisian patients.

Background: The management of the health-related quality of life (HRQL) is increasingly considered as an important treatment goal in chronic diseases including inflammatory bowel diseases (IBD).

Aim: The aim of our study was to determine the impact of IBD on HRQLand identify the factors involved in the deterioration of HRQL in these patients.

Methods: We conducted a case-control study including 108 patients; 66 had Crohn's disease (CD) and 42 had ulcerative colitis (UC).

Prognosis of refractory ascites in cirrhosis.

Background: Ascitic decompensation is a common major complication of cirrhosis and is associated with a poor outcome. In 5-10% of patients, ascites become resistant to treatment (either do not respond to a high dose of diuretics or because these drugs induce complications), which is called refractory ascites (RA). RA is associated with poor survival: 20-50% at 1 year.

Appropriateness of indication for upper gastrointestinal endoscopy in a Tunisian endoscopy unit.

Background: Upper gastrointestinal endoscopy (UGE) is an increasing and reliable procedure. Given the high costs and potential risks, appropriate indication of UGE may be facilitated by referring to qualifying criteria such as those devised by the European Panel (EPAGE). This prospective study evaluates the applicability and efficacy of these criteria in clinical practice.

Complete radiological response after sorafenib treatment for advanced hepato-cellular carcinoma.

Introduction: Sorafenib, an oral multikinase inhibitor, has recentlybeen shown to improve overall survival in patients with advanced hepatocellular carcinoma (HCC) but only a handful of reports of complete remission on sorafenib have been issued.

Case Report: We report an intriguing case of advanced HCC complicating HCV infection with cirrhosis, in which the patient achieved complete remission by prolonged administration of sorafenib.

Conclusion: Identifying factors that could be associated with good response to this therapy are needed.

[Nocturnal gastroesophageal reflux. About a pH metric series].

Background: Nocturnal gastroesophageal reflux has been shown to be associated with the more severe forms of gastroesophageal reflux disease (GERD), particularly with extraesophageal manifestations as well as complications of mucosal damage.

Aim: To determine the frequency of nocturnal gastro esophageal reflux disease on 24-hour esophageal pH monitoring in patients with digestives or extra-digestives symptoms and to evaluate the clinical and pHmetric characteristics of nocturnal reflux in these patients.

Methods: We conducted a retrospective study based on results of 24- hour esophageal pH monitoring during a 11-year period in patients with or without digestive symptoms of gastroesophageal reflux disease.

Quality indicators for colonoscopy in a Tunisian endoscopy unit.

Background: Colonoscopy is a powerful tool for prevention and early diagnosis of colorectal cancer. However, the effectiveness of colonoscopy is dependent on the quality of the procedure, which is assessed by a number of key quality indicators. Among them, cecal intubation and adenoma detection rate are historically the most commonly used indicators of quality of colonoscopy.