Papers by Lilia Zouiten-mekki
PubMed, Apr 1, 2015
Background: Nocturnal gastroesophageal reflux has been shown to be associated with the more sever... more Background: Nocturnal gastroesophageal reflux has been shown to be associated with the more severe forms of gastroesophageal reflux disease (GERD), particularly with extraesophageal manifestations as well as complications of mucosal damage. Aim: To determine the frequency of nocturnal gastro esophageal reflux disease on 24-hour esophageal pH monitoring in patients with digestives or extra-digestives symptoms and to evaluate the clinical and pHmetric characteristics of nocturnal reflux in these patients. Methods: We conducted a retrospective study based on results of 24- hour esophageal pH monitoring during a 11-year period in patients with or without digestive symptoms of gastroesophageal reflux disease. The nocturnal gastroesophgeal reflux was defined. Results: We studied 696 patients (299 men, 397 women; mean age: 34.05 years). Gastroesophageal reflux was found in 350 patients (50%). Nocturnal reflux was observed in 240 patients (34.3%), mostly in association with pathological reflux in the total period (223 cases). Compared to the diurnal period, the nocturnal period was characterized by fewer number of reflux episodes (21.9±27.4 vs 67.4±5.,1 ; p<0.0001), more longer duration of reflux episodes (24.4±37.9 minutes vs 13.9± 17.5 minutes ; p<0.001), and a lower symptomatic correlation (26% vs 45% ; p=0.0005). Conclusion: Nocturnal reflux is associated with overall reflux on the 24 hour examination. Nocturnal period is characterized by longer reflux episodes, less number of reflux episodes and less symptomatic correlation.
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La Revue de Médecine Interne
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La Tunisie medicale, 2021
BACKGROUND Systemic sclerosis (SS) is an autoimmune disorder that may result in diverse esophagea... more BACKGROUND Systemic sclerosis (SS) is an autoimmune disorder that may result in diverse esophageal motor disorders. Typical manometric disorders include decreased lower esophageal sphincter (LES) pressure, absent contractility and ineffective peristalsis. AIMS The aims of the study were to assess esophageal motor abnormalities in SS patients using high resolution manometry and to evaluate clinical and endoscopic features that are associated with manometric findings. METHODS Patients with SS who underwent esophageal high-resolution manometry (HRM) between December 2016 and August 2020 were enrolled in the study. Data regarding demographics and symptom frequency were obtained through a questionnaire. Chicago classification criteria (V3.0.) were used for defining esophageal dysmotility. RESULTS A total of 49 patients were enrolled in the study. Median age was 56 ±13.4 years. High-resolution manometry showed that absent contractility (n= 24; 49%) and ineffective motility (n=14; 28.6%) w...
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Journal of Crohns & Colitis, 2018
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La Tunisie medicale, 2019
BACKGROUND Assessment of health-related quality of life (HRQOL) in patients with cirrhosis has be... more BACKGROUND Assessment of health-related quality of life (HRQOL) in patients with cirrhosis has been increasingly reported in literature. Aims: To compare quality of life scores between cirrhotic patients and healthy controls and to assess factors associated with the impairment of quality of life in cirrhotic patients. METHODS HRQOL was measured in cirrhotic patients by the Tunisian version of MOS 36-item short-form health survey (SF-36) and the Arabic version of the Liver Disease Symptom index 2.0 (LDSI2.0). Age-and sex- matched controls were asked to complete only the SF36. The SF36 scores were compared between cirrhotic patients and controls and LDSI2.0 scores were compared across cirrhotic patients according to the characteristics of cirrhosis. Factors associated with poor perceived health status were identified by logistic regression. RESULTS Fifty cirrhotic patients and fifty controls were enrolled in the study. The cirrhotic group had significantly lower SF36 scores than heal...
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SUMMARY Background: Classical techniques like endoscopy and esophageal pH-metry are the gold stan... more SUMMARY Background: Classical techniques like endoscopy and esophageal pH-metry are the gold standard to study patients with symptoms related to gastroesophageal reflux disease. Although these techniques have been useful over the years both for diagnosis and therapeutic guidance, there are still many patients with typical or atypical gastroesophageal reflux disease symptoms with normal endoscopy and pH-metry that do not respond adequately to antisecretory therapy. Ambulatory esophageal impedance-pH monitoring is a new technique that can be used to evaluate all types of gastroesophageal reflux, achieving higher rates of sensitivity and specificity than standard techniques. Aim: To precise the technical aspects of the esophageal impedancepH monitoring, indications and results of this technique in clinical practice. Methods: Literature revue of the esophageal impedance - pH monitoring Results: Combined multichannel intraluminal impedance and pH monitoring is a new technique that can be...
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Journal of Crohn's and Colitis, 2018
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Cancer Genetics, 2019
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La Tunisie medicale, 2016
Background - Crohn's disease is a clinically heterogeneous condition. Our aim was to identify... more Background - Crohn's disease is a clinically heterogeneous condition. Our aim was to identify the phenotype evolution of Crohn's disease over time according to the Montreal Classification and to precise predictive factors of the need for immunosuppressant treatment or surgery. Methods - We included Crohn's disease patients who were followed up for at least 5 years. We excluded patients who were lost to follow up before five. Patients were classified according to the Montreal classification for phenotype at diagnosis and five years later. The evolution of phenotype over time and the need for surgery, immunosuppressive or immunomodulatory drugs were evaluated. Results - One hundred twenty consecutive patients were recruited: 70 males and 50 females. At diagnosis, 68% of patients belong to A2 as determined by the Montreal classification. Disease was most often localized in the colon. The disease location in Crohn's disease remains relatively stable over time, with 93.4%...
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La Revue de Médecine Interne, 2016
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La Revue de Médecine Interne, 2016
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La Revue de Médecine Interne, 2016
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La Revue de Médecine Interne, 2016
Introduction La cavitation ganglionnaire mesenterique (CGM) est une complication rare de la malad... more Introduction La cavitation ganglionnaire mesenterique (CGM) est une complication rare de la maladie cœliaque, pres de 36 cas ont ete recenses dans la litterature La physiopathologie de ce syndrome demeure incertaine : une depression lymphocytaire regionale pourrait etre a l’origine de l’hypertrophie et de l’excavation ganglionnaire mesenterique. Sur les coupes histologiques, les ganglions sont deshabites, leur capsule est simplement recouverte d’un tapis interne de polynucleaires. Ils contiennent un liquide blanchâtre riche en eosinophiles. Le diagnostic de la CGM n’est pas aise surtout en cas de MC meconnue. Observation Il s’agit d’une patiente âgee de 47 ans sans antecedents medicaux notables qui consulte pour une diarrhee graisseuse et des douleurs abdominales diffuses evoluant depuis 2 mois associees a une augmentation progressive du volume abdominal et des œdemes des membres inferieurs le tout evoluant dans un contexte l’alteration de l’etat general. A l’examen, on a note un etat general altere, un BMI a 23 kg/m2, une pâleur cutaneo-muqueuse avec des signes de sideropenie, une ascite de moyenne abondance sans masses palpables ni adenopathies peripheriques. Le bilan biologique a mis en evidence un syndrome carentiel, une cytolyse a 2 fois la normale, une cholestase anicterique a 1,5 fois la normale, un taux de prothrombine bas a 39 % ainsi qu’une thrombopenie a 102 000/mm3, des LDH eleves a 634 U/L. L’analyse du liquide d’ascite a montre un liquide trans-sudatif pauvre en cellules, la serologie de la maladie cœliaque etait positive. La fibroscopie digestive haute a montre un aspect lisse en fond d’œil avec par endroit un aspect crenele des sommets et en mosaique de la muqueuse duodenale en faveur d’une MC, l’examen histologique des biopsies duodenales a conclu a un atrophie villositaire totale stade 3 de Marsh. Un scanner abdominal a ete realise devant la suspicion de degenerescence de la MC concluant a la presence d’adenopathies cœlio-mesenteriques et lombo-aortiques excavees avec une prise de contraste arterielle peripherique. Devant le doute sur une tuberculose associee, on a procedee a une cœlioscopie diagnostique : l’aspect macroscopique du foie etait celui d’une cirrhose. Les biopsies hepatiques concluent a une cirrhose micronodulaire sur les lesions de steatohepatite chronique et etendue, les biopsies ganglionnaires ont conclu a un aspect de cavitation ganglionnaire. Le diagnostic de MC compliquee d’un CGM associee a une cirrhose post-NASH decompensee a ete retenu. La patiente a ete mise sous regime sans gluten associe a une corticotherapie orale a pleine dose (1 mg/kg/j). L’evolution etait marquee par la degradation rapide de l’etat general et le deces apres quelques jours. Conclusion La CGM est une entite rare dont le diagnostic peut etre concomitant a celui de la maladie cœliaque. Elle est associee a un mauvais pronostic. La place de l’imagerie dans le diagnostic reste capitale, la tuberculose reste un diagnostic a eliminer sous nos cieux d’ou la necessite d’une confirmation histologique.
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La Tunisie médicale, 2010
Sleep disorders are frequent in patients with GERD. Severity of sleep disorders could be related ... more Sleep disorders are frequent in patients with GERD. Severity of sleep disorders could be related to occurrence of nighttime symptoms, but the relationship between severity of GERD and the severity of sleep disorders is not well established. To identify the frequency of sleep disorders in patients with suspected GERD and the correlation between the severity of sleep disorders and pHmetric parameters in these patients. We studied prospectively 50 patients with esophageal and supra-esophageal symptoms of GERD. 24-hour esophageal pH monitoring examination was performed in all patients. Standard survey was applied to determine the frequency and the severity of sleep disorders in these patients. We included 50 patients (10 men, 40 women), mean age 43.7 years (18-70). Nighttime symptoms were present in 26 patients (52%). Pathological acid gastro-esophageal reflux was diagnosed by 24-hour esophageal pH recording in 18 patients (36%), with nocturnal acid reflux in 19 patients (38%). Sleep di...
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Journal of Crohn's and Colitis, 2014
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Gastroentérologie Clinique et Biologique, 2009
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Diseases of the Esophagus, 2009
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Diseases of the Esophagus, 2010
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Background: The immune responses to bacterial products through the pattern recognition receptor (... more Background: The immune responses to bacterial products through the pattern recognition receptor (PRR) play a pivotal role in pathogenesis of Crohn's disease. A recent study described an association between CD and some gene coding for bacterial receptor like NOD2/CARD15 gene and TLR4. In this study, we sought to determine whether TLR4 gene was associated with Crohn's disease (CD) among the Tunisian population and its correlation with clinical manifestation of the disease. Methods: 90 patients with CD and 80 healthy individuals are genotyped for the Asp299Gly and Thr399Ile polymorphisms by restriction fragment length polymorphism analysis. Results: The allele and genotype frequency of the TLR4 polymorphisms did not differ between patients and controls. The genotype-phenotype correlation permitted to show that the Thr399Ile polymorphism was associated with early onset disease. Conclusion: this study reported the absence of association between CD and TLR4 gene in the Tunisian ...
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Papers by Lilia Zouiten-mekki