Ulcerative Colitis: Nancey S

Nancey S, Moussata D, Flourié B. · Service d'Hépato-Gastroentérologie, Centre Hospitalier Lyon-Sud, 69495 Pierre-Bénite. · Gastroenterol Clin Biol. · Pubmed #17273136 No free full text.

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Vitton V, Damon H, Roman S, Nancey S, Flourié B, Mion F. · Hospices Civils de Lyon, Digestive Physiology, Hôpital Edouard Herriot, Lyon, France. · Inflamm Bowel Dis. · Pubmed #18972550 No free full text.

Abstract: BACKGROUND: Fecal incontinence associated with inflammatory bowel disease (IBD) may be particularly difficult to treat. Two recent studies showed that transcutaneous posterior tibial nerve stimulation may improve fecal continence. In this pilot study, we tested the usefulness of this noninvasive technique to treat fecal incontinence in IBD. METHODS: Twelve patients with IBD (7 Crohn's disease, 2 undetermined colitis, 3 ulcerative colitis) were treated by applying transcutaneous posterior tibial nerve electrical stimulation daily for 3 months. A clinical evaluation was performed at the end of treatment, with Wexner's score and Harvey-Bradshaw index and analog scales to assess symptoms and quality of life. RESULTS: At 3 months, 5 patients (41.6%) reported a significant symptomatic and quality of life improvement, although only 1 reported a significant modification in the Wexner score. CONCLUSION: These preliminary results are encouraging, although further studies are necessary. Posterior tibial nerve electrical stimulation may represent a new therapeutic option to treat the difficult problem of fecal incontinence in patients with IBD.

Chalumeau S, Moussata D, Nancey S, Claudel-Bonvoisin S, Saurin JC, Flourié B. · Service d'hépatogastroentérologie, Centre hospitalier Lyon-Sud, Pierre-Bénite. · Gastroenterol Clin Biol. · Pubmed #18176366 No free full text.

Abstract: A 72 year-old man with steroid-dependent ulcerative colitis was treated with methotrexate at 25 mg subcutaneous weekly. Three days after the second injection of methotrexate a pancytopenia occurred associated with a Klebsiella pneumoniae septicemia which evolution was favourable under treatment. Pancytopenia is a rare but severe adverse effect of low-dose methotrexate therapy. In our patient the risk factors were age upper than 65 years, renal insufficiency and hypoalbuminemia. This report emphasizes the need for a close monitoring of hematologic tests after onset of methotrexate particularly if some risk factors are present.

Moussata D, Nancey S, Flourié B, Bonvoisin SC, Cenni JC, Descos L. · Unité Inserm 407, Faculté de médecine Lyon Sud, Oullins. · Presse Med. · Pubmed #15226690 No free full text.

Abstract: OBJECTIVE: To know whether the therapeutic protocol applied in the case of severe acute ulcerative colitis (UC) associating ciclosporine and azathioprine was also effective in the case of moderate chronic active ulcerative colitis (UC). SUBJECTS AND METHODS: in this retrospective study 10 patients (31-65 years, 6 distal colitis, 1 left colitis, 3 pancolitis) moderately active and corticosteroid-resistant or dependent were included. Patients received ciclosporine intraveinously (4 mg/kg/d) and were evaluated 10 days later. If efficient, ciclosporine was given orally for 3 Months, azathioprine was introduced and steroids were progressively tapered. RESULTS: on inclusion the clinical score, based on the Mayo Clinic score, was of 5.7 +/- 0.5. On Day 10, the score decreased significantly (2.1 +/- 0.7, p<0.001) and the therapeutic effect was sustained at the third Month (1.8 +/- 0.7). With azathioprine, 4 patients were still in remission with a mean follow up of 23.3 +/- 15.5 Months. CONCLUSION: therapeutic scheme proposed in severe acute UC failing to respond to steroids may be helpful in some patients with a chronic active UC. Clinical improvement is rapid and long-term response is maintained in about 1 patient out of 2.

Morelec I, Nancey S, Roman S, Rocca P, Potier P, François Y, Pellet O, Vignal J, Bonmartin A, Descos L, Flourié B. · Service de Médecine Nucléaire, Centre Hospitalier Lyon-Sud, Pierre-Bénite. · Gastroenterol Clin Biol. · Pubmed #15094670 links to  free full text

Abstract: AIM: In comparison to endoscopy, clinical and biological criteria are less predictive of severity in attacks of ulcerative colitis (UC). Our aim was to assess the value of the double-track scintigraphic appearance in the assessment of the severity of acute UC by comparing it to endoscopic criteria. PATIENTS AND METHODS: We reviewed medical records of 52 patients hospitalized for an acute attack of UC, who had undergone within 48 hours of presentation both a technetium 99m hexamethyl propylene amine oxime (99mTc-HMPAO) granulocyte scintigraphy and endoscopic examination (colonoscopy: n=20; rectosigmoidoscopy: n=32). RESULTS: Taking into account the colonic segments examined together with both methods in the same patient or results obtained with colonoscopies, there was an excellent agreement between the double-track scintigraphic appearance and endoscopic criteria of severity. CONCLUSION: In patients with previously diagnosed UC, 99mTc-HMPAO granulocyte scintigraphy when available may replace endoscopic examination to assess the severity of attacks.

Roblin X, Peyrin-Biroulet L, Biroulet LP, Phelip JM, Nancey S, Flourie B. · Department of Gastroenterology, CHU Grenoble, Grenoble, France. · Am J Gastroenterol. · Pubmed #19086961 No free full text.

Abstract: BACKGROUND AND AIMS: A therapeutic level of 6-thioguanine nucleotides (6-TGN) has been reported in inflammatory bowel disease (IBD) patients under azathioprine (AZA). We investigated the threshold value of 6-TGN that may be predictive of AZA refractoriness and its impact on safety profile. METHODS: Patients with normal thiopurine methyltransferase (TPMT) activity (7.5-14 U/mL erythrocytes), suffering from steroid-dependent or active IBD despite AZA use for at least 6 months, were prospectively included. Clinical efficacy, adverse events, and thiopurine metabolite levels were recorded at baseline, 1 month after each dose escalation, and thereafter every 3 months. RESULTS: Fifty-five patients were included (43 with Crohn's disease, 12 with ulcerative colitis). After a mean follow-up of 12 months, 31 patients (56.3%) did not reach clinical remission despite a gradual increase in AZA dose and 6-TGN level of >400 pmol/8 x 10(8) erythrocytes, and were considered refractory to AZA (sensitivity 45%, specificity 100%). Adverse events occurred more frequently in these patients than in responders (42%vs 25%, respectively, P= 0.02). Among 55 patients, 15 cases of myelotoxicity associated with elevated levels of total methylated metabolites (14,500 pmol/8 x 10(8) erythrocytes vs 5,230 pmol/8 x 10(8) erythrocytes in patients without myelotoxicity, P= 0.03) were observed. Patients with total methylated metabolites of >11,100 pmol/8 x 10(8) erythrocytes had an increased risk of developing myelotoxicity (odds ratio [OR] 11.0, 95% confidence interval [CI] 1.1-250, P= 0.05). CONCLUSION: A 6-TGN level of >400 pmol/8 x 10(8) erythrocytes in IBD patients with normal TPMT activity and steroid-dependent or active disease despite an optimal AZA regimen may predict refractoriness to this drug. Furthermore, high levels of methylated derivatives are associated with an increased risk of myelotoxicity.