Publications by authors named "Véronique Vitton"

56 Publications

Gastric peroral endoscopic myotomy (GPOEM) for severe gastroparesis after lung transplantation: A promising minimally invasive option.

Clin Transplant 2021 Jul 21:e14434. Epub 2021 Jul 21.

Department of Gastroenterology, Aix-Marseille Université, APHM, Hôpital Nord, Marseille, France.

Background: After lung transplantation (LT), gastroparesis is frequent, occurring in 25-63% of cases and leading to pulmonary infections. In refractory disease, classical management has demonstrated limited efficacy. Gastric peroral endoscopic myotomy (G-POEM) is a recently developed safe and effective procedure that has been performed here on five patients with severe post-LT gastroparesis.

Methods: In all patients, the diagnosis was confirmed by disturbed gastric emptying scintigraphy and GCSI calculation showing severe disease. Upper gastrointestinal endoscopies confirmed the absence of organic lesions. All patients were informed about the procedure and signed informed consent forms. The procedure consisted of performing an endoscopic pyloromyotomy under general anesthesia.

Results: The patients were between 35 and 64 years of age. Four had chronic disease, starting approximately 1 year following LT, and one had acute, severe gastroparesis requiring intubation in the intensive care unit. All patients underwent G-POEM after failure of medical treatment, without any complications. Three of the patients with chronic disease improved; they resumed a normal diet and gained weight. The patient with acute disease was discharged within a few days following the procedure and resumed oral intake.

Conclusion: G-POEM is promising for managing post-LT refractory gastroparesis and should be further evaluated.
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http://dx.doi.org/10.1111/ctr.14434DOI Listing
July 2021

Does faecal calprotectin increase may be linked to lactose intolerance in patients with irritable bowel syndrome?

Minerva Gastroenterol (Torino) 2021 Apr 8. Epub 2021 Apr 8.

Gastroenterology Unit, North Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France.

Background: Irritable bowel syndrome (IBS) is a multifactorial condition without any specific investigation. Faecal calprotectin (FC) may be elevated in IBS without any explanation. In addition, some patients with IBS have symptoms related to lactose intolerance.

Aims: Our main objective was to investigate whether an increase in FC could be related to lactose intolerance in patients with IBS.

Methods: In this retrospective single-center study, all patients with IBS who have underwent a FC test and a lactose respiratory test within a period of less than 6 months were eligible. A FC greater than or equal to 50 μg/g was considered abnormal.

Results: 76 patients (48 females), mean age 38±15 years were included. Symptoms were respectively: bloating in 57%, diarrhea in 76% and abdominal pain in 46% of cases. Among the 76 patients: 22 (29%) had FC ≥ 50 μg/g and 9/22 (41%) had a positive lactose test. No significant relationship could be identified between the increase in FC and the lactose test positivity. The value of the FC was also not related to the subtype of IBS or the positivity of the glucose test.

Conclusions: In our study, the increase in FC was not significantly related to the presence of lactose intolerance. Nevertheless, our work, despite its originality, is limited by its retrospective nature and small number of patients. Future studies including larger numbers of patients may identify the causes of elevated FC in patients with IBS to individualize different subgroups of patients to best adapt therapeutic management.
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http://dx.doi.org/10.23736/S2724-5985.21.02802-6DOI Listing
April 2021

If pneumatic dilation is not enough efficient for post fundoplication dysphagia, is Per Oral Endoscopic Myotomy a good answer to manage it?

Gut 2021 Mar 30. Epub 2021 Mar 30.

Gastroenterology, Hopital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France.

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http://dx.doi.org/10.1136/gutjnl-2021-324238DOI Listing
March 2021

Oesophageal motor disorders and oesophageal endoscopic involvement in patients with systemic sclerosis: a systematic association?

Scand J Gastroenterol 2021 May 9;56(5):508-513. Epub 2021 Mar 9.

Internal Medicine Department, CHU La Timone, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille University, Marseille, France.

Introduction: Although oesophageal motor disorders (OMDs) are frequent in systemic sclerosis (SSc), the frequency of associated endoscopic lesions is unknown. We aimed at assessing the presence of endoscopic lesions in SSc patients with OMD. The secondary objective was to identify the clinical and serological profile of such patients.

Methods: This retrospective study included SSc patients suffering from OMD diagnosed by oesophageal high-resolution manometry (OHRM) and with recent upper gastro-intestinal endoscopy (UGIE). Clinical data collected were age, gender, body mass index, SSc disease duration, tobacco, SSc cutaneous type, non-digestive SSc visceral disorders, oesophageal symptoms, serological profile (autoantibodies), proton pump inhibitor use, time between SSc diagnosis and UGIE.

Results: 53 selected patients from 210 SSc patients investigated by OHRM in our department were included. Among these patients, 25 (47.2%) had endoscopic lesions: 18 (34.6%) had oesophagitis and 7 (13.5%) had Barrett's oesophagus. The only two parameters significantly associated with endoscopic lesions were a shorter disease duration (6 vs. 11 years;  = .002) and a shorter delay between SSc diagnosis and UGIE (3 vs. 8.5 years;  = .002). No other clinical or biological parameters could help identify the patients at risk of endoscopic lesion.

Conclusion: In our study, only a shorter disease duration and a shorter delay between SSc diagnosis and UGIE were significantly associated with the presence of endoscopic lesions in patients with OMD, but no other parameters were identified. This study highlights the need to perform UGIE in SSc patients with OMD whatever their clinical symptoms.
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http://dx.doi.org/10.1080/00365521.2021.1881813DOI Listing
May 2021

Assessment of long-term results of repeated dilations and impact of a scheduled program of dilations for refractory esophageal strictures: a retrospective case-control study.

Surg Endosc 2021 Mar 1. Epub 2021 Mar 1.

Digestive Endoscopy Unit, North Universitary Hospital, Marseille, France.

Introduction: In patients with benign and refractory esophageal strictures (BES), repeating initial dilations in short intervals could be recommended, but little data are available to validate this strategy. Our aim was to evaluate long-term results of a scheduled program of repeated and sustained esophageal dilations in patients with refractory strictures.

Methods: Patients with BES requiring five or more dilations were retrospectively included and divided in two groups for analysis: a SCHEDULED group (SDG) where patients were systematically rescheduled for the 5 first dilations; ON-DEMAND group (ODG) where patients were dilated only in case of recurrence of the dysphagia. Comparison between SDG and ODG was done with a 1:1 matching analysis and etiology of stricture. Clinical success was defined as the absence of dysphagia for more than a year.

Results: 39 patients with refractory BES were included with post-operative stenosis in 51.2% and post-caustic injury 28.2%; 10 were in SDG and 29 in ODG. In overall analysis (39 patients), the follow-up was 64.4 ± 32 months, success rate was 79.5% and duration of treatment was 27.3 ± 20 months, and mean number of dilations was 11.7 per patient. The need for dilations decreased significantly after 18 months of treatment with an average of 0.56 dilations per semester. Self-expandable metallic stent insertion was associated with an increased rate of complications (5.9% vs 59.1% p = 0.001). In matched analysis (10 ODG vs 10 SDG patients), the duration of treatment was lower in SDG (18.8 vs 41.4 months, p = 0,032) with a higher probability of remission (survival analysis, Log-rank: p = 0,019) and the success rate did not differ between ODG and SDG patients (80% vs 90%; NS).

Conclusion: Overall, long-term esophageal dilations resulted in a 79.5% success rate and the need for further dilatations decreased significantly in both groups after 18-month follow-up. A scheduled dilation program was associated with a higher probability of final success and lower treatment duration.
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http://dx.doi.org/10.1007/s00464-021-08376-3DOI Listing
March 2021

Redo gastric peroral endoscopic myotomy in case of recurrence of gastroparesis after the first GPOEM: It seemed to be a good option!

Gastrointest Endosc 2020 10;92(4):975-976

Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France.

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http://dx.doi.org/10.1016/j.gie.2020.05.002DOI Listing
October 2020

Role of pyloric botulinum injection and endoscopic functional luminal imaging probe in predicting the outcome of gastric peroral endoscopic pyloromyotomy: Why not?

Gastrointest Endosc 2020 09;92(3):798-799

Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France.

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http://dx.doi.org/10.1016/j.gie.2020.04.016DOI Listing
September 2020

Antireflux Mucosectomy Band (ARM-b) in Treatment of Refractory Gastroesophageal Reflux Disease After Bariatric Surgery.

Obes Surg 2020 Nov 16;30(11):4654-4658. Epub 2020 Jul 16.

AP-HM, Hôpital Nord, Service de Gastroentérologie, Aix-Marseille Université, Marseille, France.

Laparoscopic sleeve gastrectomy has become the most commonly used bariatric surgery worldwide. However, there are a proportion of patients who present with a refractory GERD after this procedure. In these patients, when surgical conversion to RYGPB is not possible or declined, we propose to describe the results of an endoscopic antireflux mucosectomy band (ARM-b) technique in 6 LSG patients with refractory GERD. The technical feasibility was 100%; 5 out of 6 patients had a clinical response with a reduction of the GERD-HRQL score of > 50%. Two patients had adverse events: one esophageal stricture and one benign bleeding. ARM-b is feasible and potentially effective to treat patients with refractory GERD after LSG.
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http://dx.doi.org/10.1007/s11695-020-04753-4DOI Listing
November 2020

G-POEM may be an optional treatment for refractory gastroparesis in systemic sclerosis.

Scand J Gastroenterol 2020 Jul 7;55(7):777-779. Epub 2020 Jul 7.

Service de Gastroentérologie, Hôpital Nord, Aix-Marseille Université, AP-HM, Marseille, France.

Background: Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by fibrosis involving skin and multiple internal organs. Gastrointestinal manifestations occur with a prevalence of 75-90%, and severely impact the quality of life. Among them, gastric involvement may concern 50-80% of patients with gastroparesis. GPOEM has been recently proposed as effective treatment in refractory gastroparesis, reaching 80% of short-term efficacy with very low complication rate. This procedure has never been assessed in SSc patients; thus, we describe two cases of patient who benefited from GPOEM. There were 40 and 35 years old women suffering from SSc for 10 years, whom developed gastroparesis symptoms over the last year, with GCSI score of 3.4. The diagnosis was confirmed by gastric emptying scintigraphy showing increased half emptying time and residual percentages. After failure of medical therapy associating prokinetic agents and dietary measures, they were referred after multidisciplinary discussion for GPOEM procedure. The follow-up included GCSI score calculation, adverse events, and GES at 2 months.

Results: The procedures were uneventful, and the patients were discharged after 4 days and gradual refeeding. The post-operative GCSI 1 and 2.1, respectively, with both patients feeling significant clinical improvement, after a follow-up of 6 months. GES were also normalized in one patient. Despite improvement, one patient did not gain weight and had an additional jejunostomy.

Conclusions: GPOEM may be an interesting therapeutic option in patient with SSc and severe gastroparesis after failure of classical treatment. This procedure could be proposed to patients after multidisciplinary discussion.
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http://dx.doi.org/10.1080/00365521.2020.1761997DOI Listing
July 2020

Gastric Peroral Endoscopic Myotomy (GPOEM): a Helpful Tool for Post Laparoscopic Sleeve Gastrectomy Gastroparesis.

Obes Surg 2021 Jan 10;31(1):403-404. Epub 2020 Jun 10.

Department of Gastroenterology, AP-HM, Hôpital Nord, Aix-Marseille Université, Marseille, France.

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http://dx.doi.org/10.1007/s11695-020-04752-5DOI Listing
January 2021

Jackhammer esophagus: Clinical presentation, manometric diagnosis, and therapeutic results-Results from a multicenter French cohort.

Neurogastroenterol Motil 2020 11 8;32(11):e13918. Epub 2020 Jun 8.

Gastroenterology Unit, AP-HP Hôpital Louis Mourier, Université de Paris, Paris, France.

Background/aims: Jackhammer esophagus (JE) is a hypercontractile esophageal motor disorder defined by at least two swallows with a distal contractile integral (DCI) >8000 mm Hg.s.cm during high-resolution manometry (HRM). The relationship between symptoms and hypercontractility and the response to therapies have been poorly evaluated. The aim of this study was to determine the clinical presentation, manometric diagnosis, and therapeutic results in a large cohort of JE patients.

Methods: Patients with JE diagnosed among the HRM tests performed in nine academic French centers from 01/01/2010 to 08/31/2016 were included. Patient charts were reviewed to collect clinical and therapeutic data.

Results: Among the 16 264 HRM tests performed during this period, 227 patients (60.8 ± 13.8 years, 151 male) had JE (1.7%). Dysphagia was the most frequent symptom (74.6%), followed by regurgitation (37.1%) and chest pain (36.6%); 4.7% of the patients were asymptomatic. The diagnostic workup was heterogeneous, and only a minority of patients had esophageal biopsies. None of the individual symptoms were significantly associated with any of the manometric parameters defined, except for dysphagia, which was significantly associated with the mean of all DCIs >8000 mm Hg.s.cm (P = .04). Additionally, the number of symptoms was not associated with any manometric parameter. Medical treatment and endoscopic treatments had poor efficacy and a high relapse rate.

Conclusion: Jackhammer esophagus is a rare motility disorder. Diagnostic workup is heterogeneous and should be standardized. Symptoms are poorly associated with manometric parameters. The medical treatments and endoscopic therapies currently used are inefficient.
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http://dx.doi.org/10.1111/nmo.13918DOI Listing
November 2020

DUAL-POEM for associated esophageal and gastric motility disorders: case series of endoscopic cardiomyotomy and endoscopic pyloromyotomy.

Scand J Gastroenterol 2020 May 18;55(5):634-637. Epub 2020 May 18.

Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France.

Per-oral esophageal myotomy endoscopic (E-POEM) has clearly proved safety and efficiency in the treatment of esophageal spastic disorders. Recent studies on endoscopic pyloromyotomy (G-POEM) suggest good efficiency and safety in the treatment of gastroparesis. In recent literature, some reports showed both esophageal motility disorders and gastroparesis. We report the case of four patients with esophageal and gastric motility disorders who were successfully treated with DUAL POEM (E-POEM and G-POEM) in two separate procedures. Clinical improvement was reported in all patients with a decrease of the Eckardt score for esophageal motility disorders and a decrease of the GCSI score for gastroparesis. No adverse events occurred after any procedure. These reported cases suggest that is possible to perform an E-POEM and a G-POEM in the same patient in two distinct procedures. DUAL POEM seems to be faisable in patient with esophageal motility disorders associated with gastroparesis. The possibility of the concomitant occurrence of esophageal and gastric motility disorders could lead to change in practices with an overall assessment including gastric empting scintigraphy, high resolution manometry and pH-impedancemetry for patients with digestive motility disorders.
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http://dx.doi.org/10.1080/00365521.2020.1766103DOI Listing
May 2020

Peroral endoscopic myotomy (POEM) for dysphagia and esophageal motor disorder after antireflux fundoplication.

Endoscopy 2020 07 23;52(7):583-588. Epub 2020 Apr 23.

Service de gastroentérologie, Aix-Marseille Université, AP-HM, Hôpital Nord, Marseille, France.

Introduction: Laparoscopic fundoplication is the treatment of severe and refractory gastroesophageal reflux disease (GERD). It induces dysphagia in 5 % - 10 % owing to a tight valve ± esophageal motility disorders (EMD), with challenging management. We assessed the first case series assessing peroral endoscopic myotomy (POEM) in such a situation.

Methods: A retrospective case series including eight patients with severe dysphagia after laparoscopic fundoplication who were treated by POEM. They were assessed clinically by Eckardt and Mellow - Pinkas dysphagia scores, and by high resolution manometry (HRM). The procedure was a regular esophageal POEM, mainly posterior, including a myotomy of the wrap. The objectives were to evaluate the clinical efficacy, technical difficulties, and complications of this approach.

Results: HRM showed aperistalsis in 6 /8 patients and raised lower esophageal sphincter (LES) pressure in 5 /8. The median preoperative Eckardt and dysphagia scores were 5 and 3.5, respectively. The procedure was completed in 7 /8 patients, with a clinical efficacy rate (normalization of both scores) of 75 % (6 /8). Although the submucosa seemed more fibrotic and vascularized, no severe complications occurred.

Conclusion: POEM is a newly described therapeutic option to consider for managing dysphagia due to EMD after laparoscopic fundoplication.
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http://dx.doi.org/10.1055/a-1147-1348DOI Listing
July 2020

Antireflux mucosectomy band in treatment of refractory gastroesophageal reflux disease: a pilot study for safety, feasibility and symptom control.

Endosc Int Open 2020 Feb 22;8(2):E147-E154. Epub 2020 Jan 22.

Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France.

Antireflux mucosectomy band ligation (ARM-b) is an endoscopic procedure that mimics a fundoplication for managing gastroesophoageal reflux disease (GERD). The aim of this study was to assess safety and feasibility of ARM-b.  This was a single-center study on consecutive patients operated between June 2017 and January 2019 with refractory GERD, confirmed with pH-metry and without motility disorder at high-resolution manometry. A piecemeal mucosectomy of three quarters of circumference of esophagogastric junction was performed using a band ligation system and a hexagonal snare. The primary objective was to assess procedural safety and feasibility. The secondary objective was to document the clinical improvement at 3 and 6 months based on patient satisfaction, proton pump inhibitor (PPI) intake, symptoms, and quality of life scores.  Twenty-onepatients (11 men) with mean age 56.9 ± 14.4 years were analyzed. The technical success rate was 100 % (mean duration 35 ± 11 min). Four patients (19 %) had mild adverse events: one delayed bleeding at Day 1 managed conservatively, and three dysphagia endoscopically managed. Mean follow-up was 10 ± 5 months. Decrease/discontinuation of PPI intake was 76 % at 3 months and 72 % at 6 months. Improvement in mean symptoms and quality of life scores (GERD-Q and GERD-HQL) were statistically significant. One patient required laparoscopic fundoplication after ARM-b failure without complication.  ARM-b is safe, feasible, and symptom-effective for treating refractory GERD, and it can be performed in the ambulatory setting. Further prospective studies are required to confirm these promising outcomes.
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http://dx.doi.org/10.1055/a-1038-4012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6976317PMC
February 2020

Efficacy of per-oral endoscopic myotomy for the treatment of non-achalasia esophageal motor disorders.

Surg Endosc 2020 12 13;34(12):5508-5515. Epub 2020 Jan 13.

CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux; INSERM CIC 1401, Bordeaux, France.

Introduction: Per-oral endoscopic myotomy (POEM) is effective in achalasia. The objective of this study was to evaluate the short-term clinical efficacy of POEM in non-achalasia esophageal motility disorders (NAEMD).

Patients And Methods: Patients with NAEMD diagnosed by high-resolution manometry were included in a retrospective multicentric study. For each individual case, two controls paired on gender and age were matched: one with type I/II achalasia and one with type III achalasia. The clinical response, defined by an Eckardt score ≤ 3, was assessed at 3 and 6 months.

Results: Ninety patients (mean age 66 years, 57 men) were included, 30 patients with NAEMD (13 jackhammer esophagus, 6 spastic esophageal disorders, 4 nutcracker esophagus, and 7 esophagogastric junction obstruction), 30 patients with type I-II achalasia, and 30 patients with type III achalasia. The 3-month response rates were 80% (24/30), 90% (27/30), and 100% (30/30) in NAEMD, type I-II achalasia and type III achalasia, respectively (p < 0.01). Eckardt scores improved from preoperative baseline in all groups (median scores 2.0 after POEM vs. 6.5 before POEM, 1.3 vs. 7.2, and 0.5 vs. 6.1 in NAEMD, type I//I and Type III, respectively). No predictive factor of response was identified. In NAEMD patients, there was a significant improvement of dysphagia, regurgitation, and chest pain scores. The 6-month response rates were 63.2% (12/19), 95.5% (21/22), and 87.0% (20/23) in NAEMD, type I-II achalasia and type III achalasia, respectively (p = 0.03).

Conclusion: Although less effective than in achalasia, POEM is an effective treatment for NAEMD. Long-term follow-up data are needed to further confirm that POEM may be a valid treatment of NAEMD.
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http://dx.doi.org/10.1007/s00464-019-07348-yDOI Listing
December 2020

The international anorectal physiology working group (IAPWG) recommendations: Standardized testing protocol and the London classification for disorders of anorectal function.

Neurogastroenterol Motil 2020 01 12;32(1):e13679. Epub 2019 Aug 12.

Queen Mary, University of London, London, UK.

Background: This manuscript summarizes consensus reached by the International Anorectal Physiology Working Group (IAPWG) for the performance, terminology used, and interpretation of anorectal function testing including anorectal manometry (focused on high-resolution manometry), the rectal sensory test, and the balloon expulsion test. Based on these measurements, a classification system for disorders of anorectal function is proposed.

Methods: Twenty-nine working group members (clinicians/academics in the field of gastroenterology, coloproctology, and gastrointestinal physiology) were invited to six face-to-face and three remote meetings to derive consensus between 2014 and 2018.

Key Recommendations: The IAPWG protocol for the performance of anorectal function testing recommends a standardized sequence of maneuvers to test rectoanal reflexes, anal tone and contractility, rectoanal coordination, and rectal sensation. Major findings not seen in healthy controls defined by the classification are as follows: rectoanal areflexia, anal hypotension and hypocontractility, rectal hyposensitivity, and hypersensitivity. Minor and inconclusive findings that can be present in health and require additional information prior to diagnosis include anal hypertension and dyssynergia.

Conclusions And Inferences: This framework introduces the IAPWG protocol and the London classification for disorders of anorectal function based on objective physiological measurement. The use of a common language to describe results of diagnostic tests, standard operating procedures, and a consensus classification system is designed to bring much-needed standardization to these techniques.
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http://dx.doi.org/10.1111/nmo.13679DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6923590PMC
January 2020

Three-dimensional high-resolution anorectal manometry can predict response to biofeedback therapy in defecation disorders.

Int J Colorectal Dis 2019 Jun 1;34(6):1131-1140. Epub 2019 May 1.

Service de Gastroenterologie, Hôpital NORD, Assistance Publique Hôpitaux de Marseille, Marseille, France.

Purpose: Biofeedback therapy (BT) is a simple and effective technique for managing outlet constipation and fecal incontinence. Several clinical factors are known to predict BT response, but a 50% failure rate persists. Better selection of BT responsive patients is required. We aimed to determine whether the defecation disorder type per high-resolution manometry (HRM) was predictive of BT response.

Methods: We analyzed clinical, manometric, and ultrasound endoscopic data from patients who underwent BT in our department between January 2015 and January 2016. Patients were classified into four groups per the following defecation disorder classification criteria: rectal pressure > 40 mmHg and anal paradoxical contraction (type I); rectal pressure < 40 mmHg and anal paradoxical contraction (type II); rectal pressure > 40 mmHg and incomplete anal relaxation (type III); and rectal pressure < 40 mmHg and incomplete anal relaxation (type IV). An experienced single operator conducted ten weekly 20-min sessions. Efficacy was evaluated with the visual analog scale.

Results: Of 92 patients, 47 (50.5%) responded to BT. Type IV and type II defecation disorders were predictive of success (p = 0.03) (OR = 5.03 [1.02; 24.92]) and failure (p = 0.05) (OR = 0.41 [0.17; 0.99]), respectively. The KESS score severity before BT (p = 0.03) (OR = 0.9 [0.81; 0.99]) was also predictive of failure.

Conclusion: The manometry types identified according to the defecation disorder classification criteria were predictive of BT response. Our data confirm the role of three-dimensional HRM in the therapeutic management of anorectal functional disorders.
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http://dx.doi.org/10.1007/s00384-019-03297-zDOI Listing
June 2019

Anti-reflux mucosectomy with band ligation in the treatment of refractory gastroesophageal reflux disease.

Endoscopy 2019 08 30;51(8):E215-E216. Epub 2019 Apr 30.

Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France.

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http://dx.doi.org/10.1055/a-0875-3479DOI Listing
August 2019

Can wearing high heels influence anal canal pressure and the severity of fecal incontinence?

Int Urogynecol J 2019 12 22;30(12):2049-2054. Epub 2019 Feb 22.

Service de Gastroentérologie, CHU Nord, Aix-Marseille Université, Marseille, France.

Introduction And Hypothesis: Wearing high heels may not only produce deleterious effects on the musculoskeletal system and on the general posture, but also on the activity of pelvic floor muscles. However, no data are currently available concerning the link between fecal incontinence and wearing high heels. Our aim was to determine whether wearing high-heeled shoes could influence anal canal pressure values in patients suffering from fecal incontinence.

Methods: In this retrospective monocentric study, 338 female patients were included. Clinical data, including the Wexner score, and manometric data were recorded (using 3D high-resolution anorectal manometry). Wearing high heels was defined by the use of high-heeled shoes at least four times a week for 4 consecutive hours with at least 1 year of usage time and heels ≥3 cm. Two sub-groups were defined: "high heels" vs "no high heels."

Results: The two subgroups were comparable for clinical data, including Wexner score, except for a higher age, menopause and hormone replacement therapy, and urinary incontinence in the group with "high heels." No statistical difference was observed concerning the anal canal pressure. Using analysis by logistic regression, only age was related to a significantly lower resting pressure.

Conclusions: In this retrospective cohort of women with fecal incontinence, no clinical or manometric differences were observed between women who wore high heels versus those who did not. Because there is limited knowledge on this potential link and because the pelvic tilt may vary according to age and the habit of walking with high heels, further studies are necessary.
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http://dx.doi.org/10.1007/s00192-019-03902-3DOI Listing
December 2019

Three-dimensional high-resolution anorectal manometry in functional anorectal disorders: results from a large observational cohort study.

Int J Colorectal Dis 2019 Apr 31;34(4):719-729. Epub 2019 Jan 31.

Gastroenterology Department, North Hospital, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France.

Background: The aim of the study was to describe the results of 3D high-resolution anorectal manometry (3DHRAM) in a large cohort of patients with functional anorectal disorders.

Methods: In this single-center retrospective study, all consecutive patients referred for investigation of fecal incontinence (FI) or dyssynergic defecation (DD) underwent 3DHRAM. The parameters analyzed were usual manometric data, repartition of dyssynergic patterns, and the prevalence of a new "muscular subtype classification" underlying dyssynergia, anal sphincter defects, and pelvic floor disorders.

Results: Final analyses were performed in 1477 patients with a mean age 54 ± 16 years; 825 patients suffered from DD, and 652 patients suffered from FI. Among these patients, 86% met the diagnostic criteria for dyssynergia. Type II dyssynergia was the most frequently observed (56%) in women and men suffering from FI and in women with DD. Type I was the most frequently observed in men with DD (49%). Regarding the muscle type subgroups, combined puborectalis muscle involvement with an external anal sphincter profile was the most frequently observed. The global prevalence of rectal intussusception and excessive perineal descent were 12% and 21%, respectively. Type III dyssynergia was more frequently associated with pelvic floor disorders than were other types of dyssynergia (p < 0.001).

Conclusion: This large cohort study provides reference values for 3DHRAM in patients with functional anorectal disorders. Further studies are necessary to assess the prevalence of pelvic floor disorders in healthy volunteers and to develop new scores and classifications including all of these new parameters.
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http://dx.doi.org/10.1007/s00384-019-03235-zDOI Listing
April 2019

Correlation Between Clinical Signs and High-resolution Manometry Data in Children.

J Pediatr Gastroenterol Nutr 2019 05;68(5):642-647

Department of Gastroenterology, North Hospital, Assistance Publique - Hôpitaux de Marseille.

Objectives: High-resolution manometry (HRM) is the gold standard for diagnosis of esophageal motility disorders. However, clinical signs associated with these disorders are nonspecific, and it is difficult to correlate clinical signs with HRM data. The main objective of our study was to assess the positive predictive value (PPV) and negative predictive value (NPV) of each clinical sign, as well as their sensitivity and specificity in the diagnosis of esophageal motility disorders.

Methods: This is a bicentric retrospective cohort study based on HRM data collected between May 2012 and May 2016. The studied symptoms were weight loss, feeding difficulties, swallowing disorders, dysphagia, food blockages, vomiting, gastroesophageal reflux disease (GERD), belching, and respiratory symptoms. HRM data were analyzed according to the Chicago Classification (3.0).

Results: In total, 271 HRM data were analyzed, of which 90.4% showed abnormal results. HRM was well tolerated in 91% of the cases. The most common esophageal motility disorder was ineffective esophageal motility (38%). Weight loss was significantly associated (P = 0.003) with an abnormal HRM with a 96% PPV.

Conclusions: With nonspecific clinical signs suggesting an esophageal motility disorder, weight loss was a predictive sign of abnormal HRM results. HRM was well tolerated in pediatric patients, and ineffective esophageal motility appears to be the most frequent motility disorder in our cohort, as already observed in adult patient studies.
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http://dx.doi.org/10.1097/MPG.0000000000002232DOI Listing
May 2019

Repertoire of the gut microbiota from stomach to colon using culturomics and next-generation sequencing.

BMC Microbiol 2018 10 24;18(1):157. Epub 2018 Oct 24.

Aix Marseille Univ, IRD, MEPHI, IHU - Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France.

Background: Most studies on the human microbiota have analyzed stool samples, although a large proportion of the absorption of nutrients takes place in upper gut tract. We collected samples from different locations along the entire gastrointestinal tract from six patients who had simultaneously undergone upper endoscopy and colonoscopy, to perform a comprehensive analysis using culturomics with matrix assisted laser desorption ionisation - time of flight (MALDI-TOF) identification and by metagenomics targeting the 16S ribosomal ribonucleic acid (rRNA) gene.

Results: Using culturomics, we isolated 368 different bacterial species, including 37 new species. Fewer species were isolated in the upper gut: 110 in the stomach and 106 in the duodenum, while 235 were isolated from the left colon (p < 0.02). We isolated fewer aero-intolerant species in the upper gut: 37 from the stomach and 150 from the left colon (p < 0.004). Using metagenomics, 1,021 species were identified. The upper gut microbiota was revealed to be less rich than the lower gut microbiota, with 37,622 reads from the stomach, 28,390 from the duodenum, and 79,047 from the left colon (p < 0.009). There were fewer reads for aero-intolerant species in the upper gut (8,656 in the stomach, 5,188 in the duodenum and 72,262 in the left colon, p < 0.02). Patients taking proton pump inhibitors (PPI) were then revealed to have a higher stomach pH and a greater diversity of species in the upper digestive tract than patients not receiving treatment (p < 0.001).

Conclusion: Significant modifications in bacterial composition and diversity exist throughout the gastrointestinal tract. We suggest that the upper gut may be key to understanding the relationship between the gut microbiota and health.
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http://dx.doi.org/10.1186/s12866-018-1304-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6201554PMC
October 2018

Esophageal Motor Disorders Are a Strong and Independant Associated Factor of Barrett's Esophagus.

J Neurogastroenterol Motil 2018 Apr;24(2):216-225

Service de Gastroentérologie, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France.

Background/aims: Esophageal motor disorder (EMD) has been shown to be associated with gastroesophageal reflux disease (GERD). However, the association of EMD with a Barrett's esophagus (BE) is controversial. Our objective was to evaluate whether the presence of EMD was an independent factor associated with BE.

Methods: A retrospective case-control study was conducted in GERD patients who all had oeso-gastroduodenal endoscopy and high-resolution esophageal manometry. The clinical data collected was known or potential risk factors for BE: male gender, smoking and alcohol consumption, age, body mass index, presence of hiatal hernia, frequency, and age of GERD. EMD were classified according to the Chicago classification into: ineffective motor syndrome, fragmented peristalsis and absence of peristalsis, lower esophageal sphincter hypotonia.

Results: Two hundred and one patients (101 in the GERD + BE group and 100 in the GERD without BE) were included. In univariate analysis, male gender, alcohol consumption, presence of hiatal hernia, and EMD appeared to be associated with the presence of BE. In a multivariate analysis, 3 independent factors were identified: the presence of EMD (odds ratio [OR], 3.99; 95% confidence interval [CI], 1.71-9.28; = 0.001), the presence of hiatal hernia (OR, 5.60; 95% CI, 2.45-12.76; < 0.001), infection (OR, 0.08; 95% CI, 0.01-0.84; = 0.035).

Conclusions: The presence of EMD (particularly ineffective motor syndrome and lower esophageal sphincter hypotonia) is a strong independent associated factor of BE. Searching systematically for an EMD in patients suffering from GERD could be a new strategy to organize the endoscopic follow-up.
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http://dx.doi.org/10.5056/jnm17090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885720PMC
April 2018

Clinical practice guidelines from the French National Society of Coloproctology in treating chronic constipation.

Eur J Gastroenterol Hepatol 2018 04;30(4):357-363

Gastroenterology Unit, Pontchaillou Hospital, Rennes 1 University.

Chronic constipation is a common symptom that regularly affects the quality of life of adult patients. Its treatment is mainly based on dietary rules, laxative drugs, perineal rehabilitation and surgical treatment. The French National Society of Coloproctology offers clinical practice recommendations on the basis of the data in the current literature, including those on recently developed treatments. Most are noninvasive, and the main concepts include the following: stimulant laxatives are now considered safe drugs and can be more easily prescribed as a second-line treatment; biofeedback therapy remains the gold standard for the treatment of anorectal dyssynergia that is resistant to medical treatment; transanal irrigation is the second-line treatment of choice in patients with neurological diseases, but it may also be proposed for patients without neurological diseases; and although interferential therapy may be a new promising treatment, it needs further evaluation.
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http://dx.doi.org/10.1097/MEG.0000000000001080DOI Listing
April 2018

Prevalence of Fecal Incontinence in Adults with Cystic Fibrosis.

Dig Dis Sci 2018 Apr 30;63(4):982-988. Epub 2017 Oct 30.

Plateforme d'Interface Clinique, Aix Marseille Université, CNRS, CRN2M-UMR7286, 13344, Marseille Cedex 20, France.

Background: Patients with cystic fibrosis (CF) are deemed at risk of developing urinary incontinence (UI) due to repeated coughing and other factors causing increased pressure on the pelvic floor. Fecal incontinence (FI) is probably derived from the same mechanism, but only very few data are available on its frequency.

Aims: The aim of this study was to determine the prevalence of FI in an adult population with CF.

Methods: This retrospective study was conducted from January 2012 to June 2014. Patients were recruited from Marseille referral center for adult CF. They were asked to fill in a self-completed anonymous questionnaire for symptom assessment of UI and FI. Clinical data and a detailed history of CF were also recorded.

Results: A total of 155 out of 190 patients (92 females) of mean age 30.5 ± 11 years completed the survey. Seventy-three patients (47%) were lung transplanted. Forty patients (25.8%) reported FI with a mean St Mark's score of 4.9 ± 2. Thirty-five patients (22.6%) reported UI. Eighteen patients (11.6%) reported both FI and UI. FI was significantly more frequent in older patients (34.27 vs. 29.54 years, p = 0.03) and in patients with associated UI (p = 0.001). No relationship was found between respiratory, bacterial, nutritional status, transplantation, pancreatic status, practice of physiotherapy, delivery history, and FI.

Conclusions: The high prevalence of FI in CF and its negative impacts need to integrate this symptom in the overall treatment of this pathology. The systematic early detection of FI may allow its rapid management and limit their consequences.
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http://dx.doi.org/10.1007/s10620-017-4825-2DOI Listing
April 2018

An Involuntary and Unexpected Treatment of Nutcracker Esophagus.

Ann Thorac Surg 2017 Jun;103(6):e545-e547

Department of Thoracic Surgery, North Hospital, Aix-Marseille University and Assistance Publique-Hôpitaux de Marseille, Marseille, France. Electronic address:

A 76-year-old woman complained of painful dysphagia and loss of weight. Esophagoscopy results were negative, whereas computed tomography (CT) disclosed a 25-mm mediastinal tumor without a connection to the esophagus. A diagnosis of nutcracker esophagus was made on high-resolution esophageal manometry. Peroral endoscopic esophageal myotomy failed to improve the symptoms. Right video thoracoscopy allowed resection of the tumor, which looked like a neurogenic tumor of the posterior mediastinum that developed from the right vagus nerve. The patient's dysphagia dramatically improved postoperatively. Because the pathologic examination disclosed a benign solitary fibrous tumor of the pleura, we hypothesize that the motility disorder would have been resolved by the unilateral vagotomy.
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http://dx.doi.org/10.1016/j.athoracsur.2016.12.053DOI Listing
June 2017

Draft Genome Sequence of Blautia faecis Strain Marseille-P328, Isolated from the Human Ascending Colon.

Genome Announc 2016 Dec 15;4(6). Epub 2016 Dec 15.

Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, CNRS (UMR 7278), IRD (198), INSERM (U1095), AMU, UM63), Institut Hospitalo-Universitaire Méditerranée-Infection, Faculté de Médecine, Aix-Marseille Université, Marseille, France

Blautia faecis strain Marseille P328 was isolated from the ascending colon of a French patient. We sequenced the 4.45-Mb genome of the strain and compared it with that of other species of the Blautia genus.
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http://dx.doi.org/10.1128/genomeA.01383-16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5159572PMC
December 2016

Culture of previously uncultured members of the human gut microbiota by culturomics.

Nat Microbiol 2016 Nov 7;1:16203. Epub 2016 Nov 7.

Institut Louis Malardé, Papeete, Tahiti, Polynésie Française.

Metagenomics revolutionized the understanding of the relations among the human microbiome, health and diseases, but generated a countless number of sequences that have not been assigned to a known microorganism. The pure culture of prokaryotes, neglected in recent decades, remains essential to elucidating the role of these organisms. We recently introduced microbial culturomics, a culturing approach that uses multiple culture conditions and matrix-assisted laser desorption/ionization-time of flight and 16S rRNA for identification. Here, we have selected the best culture conditions to increase the number of studied samples and have applied new protocols (fresh-sample inoculation; detection of microcolonies and specific cultures of Proteobacteria and microaerophilic and halophilic prokaryotes) to address the weaknesses of the previous studies. We identified 1,057 prokaryotic species, thereby adding 531 species to the human gut repertoire: 146 bacteria known in humans but not in the gut, 187 bacteria and 1 archaea not previously isolated in humans, and 197 potentially new species. Genome sequencing was performed on the new species. By comparing the results of the metagenomic and culturomic analyses, we show that the use of culturomics allows the culture of organisms corresponding to sequences previously not assigned. Altogether, culturomics doubles the number of species isolated at least once from the human gut.
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http://dx.doi.org/10.1038/nmicrobiol.2016.203DOI Listing
November 2016

Esophageal and anorectal involvement in systemic sclerosis: a systematic assessment with high resolution manometry.

Clin Exp Rheumatol 2016 Sep-Oct;34 Suppl 100(5):63-69. Epub 2016 May 24.

Department of Gastroenterology, CHU Nord Aix-Marseille University, Plateforme d'Interface Clinique CRN2M UMR 7286, Aix-Marseille University, Marseille, France.

Objectives: In systemic sclerosis (SSc), esophageal and anorectal involvements are frequent and often associated with each other. In clinical practice, esophageal explorations are often prescribed, while anorectal explorations are rarely proposed and therefore, under-recognised. However, it is well documented in the literature that early detection of anorectal dysfunction could delay and/or prevent the onset of symptoms such as fecal incontinence (FI). The main objective was the systematic evaluation and detection of esophageal and anorectal involvements in SSc patients.

Methods: In this monocentric retrospective study, all patients with SSc addressed in the Department of Functional Digestive Explorations, North Hospital, Marseille for esophageal and anorectal explorations were included. Self-Questionnaires, evaluating the symptoms and quality of life, were filled by patients during their visit. Explorations were performed on the same day: high resolution esophageal manometry (EHRM), 3 Dimensional high resolution anorectal manometry (3DHRARM) and endo anal sonography (EUS).

Results: 44 patients (41 women), mean age 59.8±12 years, were included. With regard to the symptoms, 45.5% of patients had gastro-esophageal reflux disease (GERD), 66.9% dysphagia, 65.9% constipation and 77.3% FI. The incidence of esophageal dismotility was 65.9%, anorectal and both upper and lower dysfunction were 43.2%. More than 89% patients with abnormal explorations (EHRM, 3DHRARM or both) were symptomatic. Duration of SSc and altered quality of life was correlated with the severity of digestive involvement.

Conclusions: Anorectal dysfunction appears to be closely linked to esophageal involvement in SSc. Their routine screening is undoubtedly essential to limit the occurrence of severe symptoms such as FI.
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January 2017
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