Ulcerative Colitis: Tiret E

Flourié B, Abitbol V, Lavergne-Slove A, Tennenbaum R, Tiret E. · Service d'hépato-gastroentérologie, CH Lyon SUD, 69495 Pierre Bénite. · Gastroenterol Clin Biol. · Pubmed #15672573 No free full text.

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Svrcek M, Tiret E, Bennis M, Guyot P, Fléjou JF. · Service d'Anatomie et Cytologie Pathologiques, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France. · Dis Colon Rectum. · Pubmed #19273971 No free full text.

Abstract: Kaposi sarcoma-associated herpesvirus (KSHV), also known as human herpesvirus 8 (HHV8), has been identified in all four forms of Kaposi's sarcoma (classic, endemic, HIV-associated and iatrogenic). We report the rare case of an intestinal (small intestine and rectosigmoid) Kaposi's sarcoma in a 62-year-old HIV-negative man with ulcerative colitis. This patient was receiving immunosuppressive therapy with steroids and azathioprine. To date, the causative role of KSHV/HHV8 in the pathophysiology of Kaposi's sarcoma associated with ulcerative colitis has only been proven for cutaneous lesions but not for intestinal lesions of Kaposi's sarcoma. We report for the first time, the expression of HHV8 (by using immunohistochemistry) in colonic Kaposi's sarcoma in a patient with an ulcerative colitis-related tumor. The patient underwent a total proctocolectomy. At laparotomy, numerous Kaposi's sarcoma lesions were found in the small intestine, which were left in situ. Forty months after surgery and following withdrawal of immunosuppressive therapy, the patient had no evidence of any disease and a normal abdominal and thoracic CT scan. Cases of colorectal Kaposi's sarcoma complicating inflammatory bowel disease should be managed with a conservative approach and discontinuation of the immunosuppressive treatment. However, discontinuation of the immunosuppression is not always possible and in those cases chemotherapy may be indicated.

Svrcek M, Cosnes J, Beaugerie L, Parc R, Bennis M, Tiret E, Fléjou JF. · AP-HP Hôpital Saint-Antoine, Service d'Anatomie et Cytologie Pathlogiques, Université Paris, Faculté de Médecine Pierre et Marie Curie, Paris, France. · Histopathology. · Pubmed #17394493 No free full text.

Abstract: AIMS: To determine the clinicopathological features of colorectal cancer (CRC) in Crohn's disease (CD). METHODS AND RESULTS: All histological slides from surgical specimens with inflammatory bowel disease-related colorectal neoplasia examined in our hospital between 1990 and 2005 were reviewed. We identified 18 CRCs in 16 patients with CD and compared them with 57 CRCs in 41 patients with ulcerative colitis (UC). We also studied 25 patients with dysplasia without cancer (CD 2, UC 23). When CD and UC were compared, the median age at diagnosis of cancer (CD 52 years, UC 51 years), the frequency of mucinous adenocarcinoma (CD 16.7%, UC 17.5%) and the frequency of dysplasia adjacent to and distal from cancer (CD 56.3 and 37.5%, UC 65.8 and 39%, respectively) were similar. All neoplastic lesions occurred in areas affected by inflammatory bowel disease. CONCLUSIONS: CRC complicating CD and UC shares many clinicopathological features, in particular similar frequencies of dysplasia, both adjacent and distal, with cancer. Thus, surveillance for patients with Crohn's colitis should be similar to that for patients with UC. Consideration should be given to a more extensive UC-like surgical approach instead of segmental resection of the involved area.

Prudhomme M, Dehni N, Dozois RR, Tiret E, Parc R. · Department of Digestive Surgery, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France. · Br J Surg. · Pubmed #16288450 No free full text.

Abstract: BACKGROUND: Pouch failure occurs in up to 10 per cent of patients after ileal pouch-anal anastomosis (IPAA). The aims of this study were to determine the reasons for pouch excision and to evaluate the outcome of the perineal wound after pouch excision. METHODS: Between 1984 and 2002, 91 patients with severe ileal pouch dysfunction were treated. This was a retrospective analysis of data collected prospectively from 24 patients who underwent pouch excision. RESULTS: Patients were grouped according to the final histological diagnosis. Fourteen patients with Crohn's disease developed extensive fistulous disease and/or recurrent abscesses, of whom six had a persistent perineal sinus after pouch excision. Five patients had familial adenomatous polyposis, in three of whom desmoid tumours were the cause of failure. Three patients had chronic ulcerative colitis and developed recurrent pelvic sepsis. Finally, two patients with multiple colorectal adenocarcinoma developed recurrent cancer (one) or sepsis (one). CONCLUSION: Sepsis was the principal reason for pouch excision and was usually associated with recrudescent Crohn's disease in the pouch. Perineal wound healing was problematic after pouch excision for Crohn's disease.

Gignoux BM, Dehni N, Parc R, Tiret E. · Centre de Chirurgie Digestive, Hôpital Saint-Antoine, Paris, France. · Gastroenterol Clin Biol. · Pubmed #12434066 links to  free full text

Abstract: AIM: Ileo-anal anastomosis (IAA) for ulcerative colitis (UC) or familial adenomatous polyposis (FAP) is usually associated with a defunctioning ileostomy, which may in itself cause morbidity. We report the results of a series of patients undergoing IAA without ileostomy. METHODS: Between 1993 and 1998, 84 patients underwent IAA without ileostomy: 51 for FAP, 30 for UC, 2 for non familial colonic polyposis and 1 for indeterminate colitis. Patients taking > 30 mg steroids daily were excluded. The decision not to fashion an ileostomy was taken if there were no perioperative difficulties. RESULTS: One patient died from a pulmonary embolus. Early and late complications were seen in 25 (30%) and 23 patients (27%) respectively, necessitating reoperation in 13, including three temporary ileostomies and one pouch excision for Crohn's disease. Functional results were analysed in 81 patients. Median follow-up was 22 months, the mean number of stools per day was 3.8 +/- 1. Daytime and night time continence was normal in 77 (95%) and 73 patients (90%) respectively. In 66 patients (94%) there was no urgency and in 61 (75%) no need for constipating agents. CONCLUSIONS: For a selected group of patients undergoing an IAA, a defunctioning ileostomy may be avoided. Morbidity and functional results are equivalent to those obtained with a defunctioning ileostomy

Brunel M, Penna C, Tiret E, Balladur P, Parc R. · Department of Alimentary Tract Surgery, Hôpital Saint-Antoine, 75012 Paris, France. · Gut. · Pubmed #10486362 links to  free full text

Abstract: BACKGROUND: Chronic distal colitis may cause troublesome symptoms and alter quality of life. When medical treatment fails to control symptoms, patients and doctors are often reluctant to consider surgical resection because of the relatively small portion of the large bowel affected by the disease. AIM: To assess the outcome of restorative proctocolectomy (RP) in patients with distal colitis who required surgery for chronic debilitating symptoms and failed medical management. PATIENTS/METHODS: From 1986 to 1996, of 263 patients receiving RP for ulcerative colitis, 27 (16 men) were operated on for distal ulcerative colitis limited to the rectum and sigmoid colon. Bowel function and quality of life were compared before and one year after RP. RESULTS: The mean (SD) duration of ulcerative colitis was 11 (6) years. RP was performed at a mean age of 46 (10) years. All the pouches were J-shaped, and a diverting loop ileostomy was always performed. Mean (SD) hospital stay was 25 (10) days. Seven complications occurred in six patients. Previously unknown severe dysplasia was discovered on the colectomy specimen in two patients. After RP there was a significant decrease in mean (SD) daytime stool frequency (8.2 (4) v 4.7 (2), p<0.05), night-time stool frequency (2 (2) v 1 (1), p = 0.05), and the number of patients with urgency to defecate (26/27 v 1/27, p<0.001). Sex life was improved in eight patients, social life in 26, and professional life in eight. Twenty six patients were satisfied with the results, and 25 wished that they had received surgery earlier in the course of their disease. CONCLUSION: RP can improve bowel function and quality of life in patients with disabling chronic symptoms of distal ulcerative colitis.