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Master Thesis

La pseudo-obstruction intestinale chronique chez l'adulte en France en 2018

Abstract : Introduction: chronic intestinal pseudo-obstruction (CIPO) is a rare and little-known disease. The clinical picture is represented by signs of intestinal obstruction, without any mechanical cause documented, with neuro-muscular digestive impairment associated. The aim of this study was to assess the different demographics, clinicals, diagnostics characteristics, and the different medicals, nutritional and surgical cares in the patient population in France in 2018. Methods: patient’s chart, alive or deceased after January 2017, aged of 18 years or more and followed for a CIPO disease in nutritional facilities (Beaujon, Bordeaux, Lyon Sud, Rouen, and Poitiers) were retrospectively studied. The following data were collected: demographic characteristics, clinical picture, aetiologies, diagnostic criteria, medical treatment, nutritional care, surgical care. Results: 116 patients were included (46 men, 70 women). Main symptoms were abdominal distension (81.7%) and chronic abdominal pain (81.8%). Median time between first symptoms and diagnosis were 3.8 years. Median age at diagnosis was 35 years. Six patients died during the follow-up (5.2% of the population studied). The CIPO type, primitive or secondary, was established in 109 patients: 66.9% were primitive. Among the secondary forms, systemic scleroderma was the most frequent with 25.5% of cases. Anatomopathological diagnosis was obtained in 36,2% of cases. Antro-duodenal manometry was positive in 16.4% of cases. It was not realised in 72.4% of cases. Sequential antibiotic treatment was prescribed in 62.7% of cases. Oral feeding was still possible in 80% of patients and 69.8% of the population was dependant on parenteral nutrition at the last news date. Median survival time from symptoms appearance to parenteral nutrition introduction was 6.6 years (IC 95% [54.9-101.8]). Patients proportion with a surgical digestive resection history was 63.16% and 44.8% was considered with a short bowel syndrome. Median survival without digestive surgical resection (all causes included) was 9 years (IC 95% [84.3 – 165.7)]. Terminal stoma percentage at inclusion was 30.7%. Three patients had an history of intestinal transplantation: one of them died, the other two had the surgery reversed. Conclusion: CIPO in adults in France in 2018 is a heterogenous disease. Nutritional care is crucial. Surgery background remains prevalent. A prospective follow-up would allow a more accurate survey of patients, knowledge and experiences aggregation, standardisation of global care.
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Margot Biscay. La pseudo-obstruction intestinale chronique chez l'adulte en France en 2018. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02447190⟩

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