Steatotic liver disease (SLD) refers to conditions characterized by an abnormal accumulation of lipids in the liver (hepatic steatosis). They include alcohol-related liver disease (ALD), metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), mixed disease linked to alcohol and the metabolic context (MetALD), and rarer etiologies of hepatic steatosis. They affect more than 30% of the population and are the leading cause of cirrhosis. However, only a small proportion of people with steatosis progress to cirrhosis. This is linked to the presence of inflammation and hepatocyte damage, in addition to steatosis. Thanks to joint efforts of various health professionals (general practitioners, hepatologists, endocrinologists) and simple management algorithms, screening for disease severity is possible in at-risk individuals and is recommended by scientific societies.
This article sets out some advice on how to approach a patient with an alcohol use disorder. From the general approach to the initial assessment, diagnosis, and therapeutic plan, there are a number of aspects to be taken into account in order to build a trust relationship with the patient and provide appropriate care.
Post-polypectomy monitoring is essential to prevent lesion recurrence and reduce the risk of colorectal cancer. The quality of the initial colonoscopy is crucial. A complete colonoscopy (with visualized cecum), after adequate preparation, performed by an experienced endoscopist (with an adenoma detection rate of at least 25%) who has performed a complete resection of the identified polyps and provided clear recommendations for subsequent follow-up enables optimal and high-quality management after colorectal polypectomy. Current follow-up recommendations vary based on the type, number, and size of resected polyps, as well as the individual characteristics of the patient. Usually, for patients with non-advanced polyps (<10mm, 1-2 tubular adenomas), monitoring via colonoscopy is recommended at intervals of 7 to 10 years. In contrast, patients with advanced adenomas (size ≥10mm, presence of villous components or high-grade dysplasia), or multiple adenomas (≥3), require closer monitoring, often within 3 to 5 years. This text details the current surveillance recommendations, risk factors, and the importance of personalizing follow-up strategies.
IBS symptoms include abdominal pain associated with defecation and changes in bowel habits. The pathophysiology of this disorder is complex and combines various organic and psychosocial factors. The impact on quality of life is significant, affecting morbidity, work productivity, and social integration. We emphasize the importance of a positive diagnosis based on clinical history, physical examination, and, in some cases, limited diagnostic tests. Initial management includes providing patients with a clear diagnosis and explaining the pathophysiology of their condition. Lifestyle modifications, fiber supplementation, and pharmacological treatments such as antispasmodics are discussed. We also cover pain, diarrhea, and constipation management, the role of diet, microbiome modulation, and non-pharmacological interventions like cognitive-behavioral therapy and hypnotherapy. In conclusion, the paper provides a detailed guide for clinicians on the recognition, diagnosis, and treatment of IBS, with a focus on the Belgian healthcare system.
Proton pump inhibitors (PPIs) are the first line of treatment for peptic ulcer and gastroesophageal reflux disease (GERD). Current national guidelines state that chronic PPI therapy is indicated for esophagitis grade C and D, for Barrett’s esophagus, Zollinger-Ellison syndrome, or to prevent bleeding ulcers with chronic NSAID intake in at-risk patients. In primary care, guidelines propose empiric short-term PPI therapy during a maximum of 8 weeks to control symptoms, confirming a putative GERD diagnosis, followed by PPI therapy interruption. Yet, the available data suggest insufficient occurrence of down-titration and/or cessation. Moreover, PPIs are also used for treatment of dyspeptic symptoms and a number of other non-gastrointestinal indications, such as ear-nose-throat and pulmonary symptoms, or to protect the stomach in case of polypharmacy intake. As such, concerns have emerged about the considerable impact of PPIs on the healthcare budget, and an increasing number of risks and side effects associated with chronic use. An ongoing national study, the PEPPER trial, aims to provide quality evidence to determine the most effective strategy for stopping chronic PPI intake in patients for whom there is no firm medical indication for their continued use
Treatments for chronic inflammatory bowel diseases (IBDs) have considerably evolved over the last two decades. Advances in treatment have led to greater in-depth control of the diseases, in particular by achieving healing of lesions. Therapeutic objectives now include mucosal healing, essential for preventing complications and surgery. Early and intensive strategies, such as “Top-Down”, are showing increased efficacy in Crohn's disease. In 2024, new drugs such as mirikizumab and etrasimod offer new treatment options for ulcerative colitis. Particular attention is paid to fecal calprotectin, which plays a key role in IBD monitoring. It has become an indispensable tool for assessing inflammation and response to treatment, as well as predicting relapse. Our primary goal remains to improve the quality of life of IBD patients, but also to attempt to modify the natural history of these diseases through optimized monitoring and management.
Helicobacter pylori is a Gram-negative bacterium responsible for chronic gastritis, peptic ulcers, and gastric adenocarcinoma, recognized as a class I carcinogen by the WHO. Worldwide prevalence is approximately 50%, with significant geographical variations. In Belgium, migrant populations present higher infection rates. Rising antibiotic resistance, particularly to clarithromycin (21%) and levofloxacin (24%), causes challenges for eradication protocols.
First-line therapies feature quadruple regimens with or without bismuth, personalized according to local resistance rates and antimicrobial susceptibility testing (AST) results, if possible. Specific management is recommended for refractory cases, children, and HIV patients. Esomeprazole 2 x 40mg and rabeprazole 2 x 20mg are more powerful than other proton pomp inhibitors (PPIs).
Diagnosis involves non-invasive methods (urea breath test, fecal antigen test) and invasive techniques (biopsies for histology and AST). Endoscopic diagnosis is based on the regular disposition of gastric collecting venules (RAC), determining the need for targeted biopsies for AST. Post-treatment eradication confirmation is critical, typically through a breath test conducted at least four weeks after antibiotic cessation and two weeks after PPI discontinuation
Palliative care is recognized as a way to improve the quality of life and satisfaction of patients and their families, and even to optimize the use of health care services. However, it is implemented too little and too late for people with advanced chronic illnesses – and even more so for those suffering from non-cancer diseases. One of the main reasons for this is the “prognostic paralysis” that physicians face. Progressive chronic illnesses actually tend to have unpredictable trajectories, making it uncertain when the time is right to initiate end-of-life discussions. Various tools are available to help general practitioners identify patients who would benefit from a palliative approach, initiate such discussions, and assess potential unmet needs. Other tools exist to guide highly emotional conversations, to which physicians should add communication training to acquire the skills necessary to lead these complex discussions.
Pascale Jadoul (1,3), Fréderique Dessy (2), Jean Squifflet (1,3), Mathieu Luyckx (1,3), Amandine Gerday (1,3), Charlotte Maillard (1,3)Published in the journal : December 2024Category : Gynécologie
Physicians have an important role to play in the choice of a contraceptive method and in advising of their patients, who are strongly influenced by social media. They need to keep up to date with the latest developments in this area.
This article reviews the novelties in female and male contraceptives that have been commercialized these last five years and, to a limited extent, those expected in the future.
The progestogen-only pill containing drospirenone and the estro-progestogen pill containing estetrol are the main innovations in female contraception.
There has been a lot of research on male contraceptives for many years, which has not yet resulted in new products on the market. Thermal male contraception is not recognized, but is increasingly used by our patients.
Marine Wanlin (1), Jean-Louis Mariage (2), Pierre-Arnaud Rogghe (3), Marie-Odile Bleuzé (4), Stéphane Dechambre (5), Laurent Truffaut (6)Published in the journal : December 2024Category : Emergency
In developed countries, meningeal tuberculosis, with its non-specific clinical presentation, has a low incidence, and early diagnosis is challenging. Based on the clinical suspicion, which must be rapid, the work-up includes cerebrospinal fluid analysis showing hypoglycorrhachia and lymphocytosis features, and should be complemented by imaging studies (preferably magnetic resonance). The diagnostic gold standard remains direct microscopic examination, which requires specifically trained personnel, supplemented by mycobacterial culture, which implies long processing time. Nucleic acid amplification techniques (PCR), which are fast and specific, are not widely available in general practice settings and have poor sensitivity in non-respiratory samples. Skin test and IGRA test may be negative in cases of active and/or severe tuberculosis. To highlight the current challenges in managing extrapulmonary tuberculosis, we report a case of severe meningeal tuberculosis and delayed and difficult diagnosis despite the availability of modern molecular biology diagnostic tools.