Najet Bel Hadj

University of Tunis El Manar, Tunis-Ville, Tūnis, Tunisia

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Publications (23)13.68 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction Le foie étant le site principal du métabolisme des antalgiques, en cas de cirrhose, leur biotransformation est modifiée, exposant au risques d’effets indésirables parfois sévères. La prise en charge de la douleur chez le cirrhotique est une situation fréquente et il n’existe pas de recommandations précises sur le sujet. Le but de cette mise au point est de préciser les connaissances actuelles relatives à la prescription d’antalgiques chez le cirrhotique afin de proposer une conduite pratique. Méthodes Recherche bibliographique en se référant aux bases de données bibliographiques MEDLINE en utilisant les mots clés suivants: antalgiques ou analgésiques, cirrhose ou insuffisance hépatique, paracétamol, anti-inflammatoires non stéroïdiens (AINS), opioïdes. Résultats Plusieurs mécanismes altèrent la clearance hépatique en cas de cirrhose: modification des flux vasculaires, shunt porto-systémique, insuffisance hépatocellulaire et hypoalbuminémie. Le paracétamol à une dose ne dépassant pas 2-3g/24h est bien toléré et recommandé en 1re intention. Les AINS sont contre-indiqués. Le tramadol est possible à condition d’espacer les prises et de réduire les doses. Le fentanyl, l’hydromorphone, la morphine sont les opioïdes forts dont la pharmococinétique est la moins altérée; ils peuvent être prescrits en veillant à diminuer les doses pour les premiers et espacer les prises pour la morphine. Parmi les co-analgésiques, les tricycliques à doses réduite, la gabapentine et la prégabaline sont le plus souvent bien tolérés. Conclusion La prise en charge de la douleur chez le cirrhotique est une situation de plus en plus fréquente qu’il est possible de contrôler à condition de choisir l’antalgique le mieux adapté, en respectant les doses et les paliers et en surveillant la survenue d’effets indésirables.
    Journal Africain d?Hépato-Gastroentérologie 06/2015; 9(2). DOI:10.1007/s12157-015-0588-6
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    ABSTRACT: Nodular lymphoid hyperplasia (NLH) of the gastrointestinal tract is a rare disease usually reported in patients with congenital or acquired immunodeficiency and chronic gastrointestinal infections. However, no case of NLH in a patient receiving immunosuppressive therapy has been reported to date. We describe the case of a woman who developed chronic diarrhea related to NLH 9 years after liver transplantation. Other causes of diarrhea and NLH were excluded. Her immunosuppressive regimen consisted on mycophenolate mofetil (MMF) and tacrolimus. Reduction of MMF dose improved symptoms but led to a rising aminotransferase level. Given the risk of graft rejection, MMF at full dose was resumed and she was started on symptomatic treatment for diarrhea. The role of immunosuppressive drugs in the pathogenesis of NLH may be related to the reduction of T- and B-lymphocyte proliferation and decreasing antibody production. NLH will further develop to compensate functionally inadequate lymphoid tissue, as reported in congenital immunodeficiency states. Copyright © 2015 Elsevier Inc. All rights reserved.
    Transplantation Proceedings 04/2015; 47(3):820-2. DOI:10.1016/j.transproceed.2015.02.009 · 0.95 Impact Factor
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    ABSTRACT: Behçet's disease (BD) is a multisystemic disorder that involves vessels of all sizes. Superior vena cava (SVC) thrombosis is a rare complication that can lead to the development of various collateral pathways. A 31-year-old man presented with SVC syndrome. He had a history of recurrent genital aphthosis. Computed tomography revealed extensive thrombosis of the right internal jugular, axillary, and subclavian veins with collateral circulation. The patient was diagnosed with BD, and he was started on anticoagulation and immunosuppressive therapy. One week later, he presented with haematemesis. Upper gastrointestinal endoscopy disclosed varices in the upper third of the oesophagus with stigmata of recent bleeding. Portal hypertension was ruled out. Anticoagulation therapy was discontinued. He was discharged on immunosuppressive therapy. Bleeding from downhill oesophageal varices should be suspected in any patient presenting with upper gastrointestinal bleeding and a history of SVC syndrome due to BD. Copyright © 2015 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved.
    Arab Journal of Gastroenterology 03/2015; 16(1). DOI:10.1016/j.ajg.2015.02.003
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    ABSTRACT: Solitary rectal ulcer syndrome is an uncommon and benign defecation disorder. Occidental series are scarce and to our knowledge, Tunisian data are not available. The aim of this study was to evaluate the clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome. All the patients diagnosed with solitary rectal ulcer syndrome from January 2001 to 2012 were included in the study. The medical records were reviewed retrospectively to evaluate the clinical spectrum of the patients along with the endoscopic, histological and therapeutic findings. A total of 15 patients were evaluated: 7 males; mean age 42.6 years. Bleeding per rectum was present in 66% and dyschezia in 73%. Endoscopically, solitary lesion was present in 66% patients. The most frequent dynamic abnormalities shown by defecography were of rectal intussusception (53%). Anorectal manometry was performed in seven cases disclosing dyssynergia in 2 cases. Thirty patients underwent surgery, always after failure of medical treatment and one patient was treated with biofeedback. Rectopexy was the most utilized technic. After a mean follow-up of 29 months, total regression of symptoms was noted in 50% of patients who underwent surgery. In this cohort, diagnostic and therapeutic spectrum of solitary rectal ulcer syndrome was comparable to occidental features. Nevertheless, accesses to manometry and defecography as well as biofeedback were limited.
    La Tunisie médicale 01/2015; 93(1):6-10.
  • Pan African Medical Journal 01/2015; 21. DOI:10.11604/pamj.2015.21.2.6789
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    ABSTRACT: Prérequis Les patients cirrhotiques sont à risque de développer une insuffisance rénale aigüe du fait des anomalies circulatoires inhérentes à leur maladie. Il s’agit ďune complication fréquente de la cirrhose sans que toutefois son incidence exacte soit connue. Elle induit une morbidité et une mortalité significative, justifiant que ľon s’y intéresse. But Le but de cette étude est de préciser les connaissances actuelles relatives aux particularités diagnostiques et thérapeutiques de ľIRA au cours de la cirrhose, ainsi que sa prévalence et ses mécanismes. Méthode Recherche bibliographique et revue de la littérature en se référant aux bases de données médicales informatisées. Les mots clés utilisés étaient: insuffisance rénale aigüe, cirrhose, syndrome hépatorénal, diagnostic, traitement. Résultats Nous avons identifié une définition spécifique à ľinsuffisance rénale chez le cirrhotique, déterminé sa fréquence et ses principaux mécanismes. Nous avons proposé une stratégie diagnostique et thérapeutique devant la constatation ďune insuffisance rénale aigüe chez le cirrhotique. Conclusion Ľinsuffisance rénale aigüe survient chez 20% des patients cirrhotiques, ses mécanismes sont principalement ďorigine pré-rénale ou secondaire à une nécrose tubulaire aigüe. En dehors du syndrome hépatorénal, peu ďétudes se sont intéressé au diagnostic et à la prise en charge de ľinsuffisance rénale aigüe chez le cirrhotique. Le traitement préventif et la prise en charge précoce adaptée au mécanisme permettent ďaméliorer le pronostic.
    Journal Africain d?Hépato-Gastroentérologie 12/2014; 8(4):189-194. DOI:10.1007/s12157-014-0552-x
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    ABSTRACT: Background and aims Minimal hepatic encephalopathy (MHE) is the mildest form of the spectrum of hepatic encephalopathy that impairs health-related quality of life. The aim of this study is to evaluate the prevalence of MHE in patients with liver cirrhosis and analyze risk factors. Methods Between September 2011 and December 2012, consecutive cirrhotic patients seen in our department were evaluated. Patients included were screened by the psychometric hepatic encephalopathy score (PHES) battery comprising 5 tests: number connection test A and B, line tracing test, serial dotting test and digit symbol test. Patients included were regularly followed-up for the development of overt hepatic encephalopathy, driving accidents, falls and death. Results We included 45 cirrhotic patients. Etiology of cirrhosis was viral in half of cases. Child-Pugh score was A in 55.6 %, B in 26.7 % and C in 17.8 %. Median Meld score was 14. According to the PHES score, MHE was detected in 44.4 % of patients. Univariate analysis identified 4 variables significantly associated with the presence of MHE: age ≥ 55 years (P = 0.031), poor educational status with years of study < 9 years (P = 0.007), MELD score ≥ 15 (P = 0.002) and Child-Pugh ≥ 7 (P = 0.001). At multivariate analysis, the only independent risk factor of MHE was a MELD score ≥ 15 (OR = 15.4; P < 0.001). During the follow-up, patients with MHE developed more often overt encephalopathy, falls and driving accidents, and had a lower survival, although the difference was not statically significant. Conclusion In this preliminary small series, prevalence of MHE in Tunisian cirrhotic patient was 44.4 %. A MELD score ≥ 15 was the only independent risk factor. MHE had a negative impact on the outcome, justifying an early diagnostic. Adequate therapy may improve cognitive function. Ce qui était connu•L’encéphalopathie hépatique minime (EHM) représente le stade le moins sévère des anomalies neuro-cognitives compliquant la cirrhose.•Elle n’est pas détectable par un examen neurologique conventionnel.•Sa prévalence et son impact pronostique sont sous-estimés du fait de son caractère latent.Ce qu’apporte l’article•Le « psychometric hepatic encephalopathy score » (PHES) est un test simple et validé qui permet de diagnostiquer une EHM en pratique courante.•L’EHM est fréquente et liée à la sévérité de la cirrhose.•Son retentissement sur le pronostic n’est pas négligeable, justifiant un diagnostic et une prise en charge précoce.
    La Presse Médicale 05/2014; 43(5). DOI:10.1016/j.lpm.2013.09.016 · 1.17 Impact Factor
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    ABSTRACT: Background: Ischemic colitis is the most common form of intestinal ischemia. The presence of diarrhea and mild lower gastrointestinal bleeding should guide the diagnosis. Although many laboratory tests and radiographic images may suggest the diagnosis, colonic endoscopic with histological analysis of biopsies is the gold standard for identification of colonic ischemia. aim : The aim of this study was to resume in 5 points: the epidemiology, the clinical features, the diagnostic approach and the management of ischemic colitis in five points. methods: Review of literature. results: Incidence of ischemic colitis was between 3 and 10%. The clinical presentation is predominated by the non gangrenous form associating abdominal pain, tenderness, diarrhea and lower gastrointestinal bleeding. The most frequent causes are represented by systemic hypoperfusion. Laboratory tests can orientate the diagnosis but are unspecific. Radiographic images based on computed tomography or more recently magnetic resonance imaging may suggest the diagnosis, but the confirmation will be given by endoscopic visualization of colonic mucosa with histological analysis of biopsies. Conservative treatment is the most often sufficient to improve colonic lesions. Surgical treatment is reserved for perforations and strictures. Conclusion: The incidence of colonic ischemia is difficult to ascertain. The diagnosis is usually made by medical history, examination, and endoscopy which have become the diagnostic procedure of choice. A high index of suspicion and prompt management are essential for optimum outcomes in patients with colonic ischemia.
    La Tunisie médicale 05/2014; 92(5):299-303.
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    ABSTRACT: Minimal hepatic encephalopathy (MHE) is the mildest form of the spectrum of hepatic encephalopathy that impairs health-related quality of life. The aim of this study is to evaluate the prevalence of MHE in patients with liver cirrhosis and analyze risk factors. Between September 2011 and December 2012, consecutive cirrhotic patients seen in our department were evaluated. Patients included were screened by the psychometric hepatic encephalopathy score (PHES) battery comprising 5 tests: number connection test A and B, line tracing test, serial dotting test and digit symbol test. Patients included were regularly followed-up for the development of overt hepatic encephalopathy, driving accidents, falls and death. We included 45 cirrhotic patients. Etiology of cirrhosis was viral in half of cases. Child-Pugh score was A in 55.6 %, B in 26.7 % and C in 17.8 %. Median Meld score was 14. According to the PHES score, MHE was detected in 44.4 % of patients. Univariate analysis identified 4 variables significantly associated with the presence of MHE: age≥55years (P=0.031), poor educational status with years of study<9years (P=0.007), MELD score≥15 (P=0.002) and Child-Pugh≥7 (P=0.001). At multivariate analysis, the only independent risk factor of MHE was a MELD score≥15 (OR=15.4; P<0.001). During the follow-up, patients with MHE developed more often overt encephalopathy, falls and driving accidents, and had a lower survival, although the difference was not statically significant. In this preliminary small series, prevalence of MHE in Tunisian cirrhotic patient was 44.4 %. A MELD score≥15 was the only independent risk factor. MHE had a negative impact on the outcome, justifying an early diagnostic. Adequate therapy may improve cognitive function.
    La Presse Médicale 04/2014; · 1.17 Impact Factor
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    ABSTRACT: Background Loss of bone mass is frequently identified in cirrhosis, leading to fragility fractures and significant morbidity. The pathogenesis is not completely elucidated. Objectives The aim of this study is to assess the prevalence of bone loss in cirrhotic patients and identify risk factors. Methods Bone mineral density (BMD) was performed in patients with cirrhosis seen in our department in 2011, by X-ray absorptiometry (DEXA) at both lumbar spine and femoral neck sites. Other diseases disturbing the bone density were excluded. Osteopenia was considered if T score < -1.5 DS and osteoporosis if T-score <-2.5 DS. We collected clinical data including risk factors for bone mass loss and nutritional status. Results Fifty patients with cirrhosis were included. They were 28 males and 22 females with a mean age of 54 years (17-84). Aetiology of cirrhosis was viral in 48% and auto-immune in 20%. Child-Pugh score was C in 32% and mean Meld score was 14 (5-32). BMD disclosed osteopenia in 32% and osteoporosis in 32%. Mean bone mass and T score were 0.94 kg/m2 and -0.67 DS in femoral neck; 0.98 kg/m2 and -1.2 DS in lumbar spine. History of fracture was present in 10% of cases. Low bone mass was correlated with female sex (p=0.01), age (p=0.04), sedentary (p=0.01) and Child Pugh C (p=0.03) but not with nutritional status. Conclusions In our study, prevalence of osteoporosis was 32%, as reported in Occident. Advanced liver disease in association with classical risk factors of osteoporosis was correlated with BMD. This high prevalence suggests that bone status should be evaluated routinely in patients with cirrhosis. Disclosure of Interest None Declared
    Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):697-697. DOI:10.1136/annrheumdis-2012-eular.1040 · 10.38 Impact Factor
  • Open Journal of Gastroenterology 01/2014; 04(08):289-294. DOI:10.4236/ojgas.2014.48042
  • La Tunisie médicale 01/2014; 92(1):42-43.
  • Source
    R. Ennaifer · M. Sabbah · R. Hefaiedh · H. Romdhane · N. Bel Hadj
    12/2013; 1(1):4-7. DOI:10.1016/j.jcco.2012.11.001
  • La Tunisie médicale 12/2013; 91(12):748-50.
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    ABSTRACT: Toxic megacolon is a rare and serious complication of Crohn’s disease. Because of the associated high morbidity and mortality, early recognition and management of toxic megacolon is important. Through two cases of toxic megacolon complicating Crohn’s disease, we assessed the clinical, radiologic and therapeutic characteristics of this complication. A 35-year-old man presented a first course of Crohn’s disease treated with corticosteroid. He exhibited sudden severe abdominal pain and distension with shock. A plain abdominal radiography revealed toxic megacolon. He underwent medical therapy, but symptoms not relieved. The patient underwent subtotal colectomy with ileostomy. The resected specimen confirmed the diagnosis. Recovery of digestive continuity was performed. Endoscopic evaluation six months later did not shown recurrence. A 57-year-old man presented with severe acute colitis inaugurating Crohn’s disease, was treated with corticosteroid and antibiotics. He exhibited signs of general peritonitis. Computed tomographic examination revealed toxic megacolon with free perforation, showing prominent dilation of the transverse colon and linear pneumatosis. The patient underwent emergent subtotal colectomy and ileostomy. The final histological patterns were consisting with diagnosis of Crohn’s disease associated with cytomegalovirus infection. The patient underwent antiviral therapy during 15 days. Because of the high risk of postoperative recurrence, he underwent immunosuppressive therapy. Recovery of digestive continuity was performed successfully. Toxic megacolon in Crohn’s disease is a serious turning of this disease. We underscore the importance of early diagnosis of toxic megacolon and rapid surgical intervention if improvement is not observed on medical therapy.
    08/2013; 3(2):e24. DOI:10.4081/cp.2013.e24
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    ABSTRACT: Background: The Budd-Chiari syndrome is a rare disease, often fatal if not treated optimally. It is characterized by a blocked hepatic venous outflow tract. aim: This review attempted to present pathophysiology, aetiologies,diagnosis and therapeutic modalities of the Budd-Chiari syndrome. methods: Review of literature. results: Budd-Chiari syndrome is a complex disease with a wide spectrum of aetiologies and presentations. Hematologic abnormalities, particularly myeloproliferative disorders, are the most common causes of the Budd-Chiari syndrome. The clinical presentation is governed by the extent and rapidity of the hepatic vein occlusion. Doppler-ultrasound, computed tomography or magnetic resonance imaging of hepatic veins and inferior vena cava are usually successful in demonstrating non-invasively the obstacle or its consequences. A therapeutic strategy has been proposed where anticoagulation, correction of risk factors, diuretics and prophylaxis for portal hypertension are used first; then angioplasty for shortlength venous stenosis; then Transjugular Intrahepatic Portosystemic Shunt (TIPS); and ultimately liver transplantation. Treatment progression is dictated by the response to previous therapy. This strategy has achieved 5-year survival rates approaching 70%.Medium-term prognosis depends on the severity of liver disease. Conclusion: The diagnosis of the Budd-Chiari syndrome must be considered in any patients with acute or chronic liver disease. Management of this syndrome should follow a step by step strategy.
    La Tunisie médicale 06/2013; 91(6):376-81.
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    ABSTRACT: Hepatic encephalopathy (HE) is a common long term complication of porto-systemic shunt. We report herein the case of a 59-year-old man with Child-Pugh A cirrhosis treated successfully 9 years earlier with distal splenorenal shunt for uncontrolled variceal bleeding. In the last year, he developed a severe and persistent hepatic encephalopathy secondary to the shunt, which was resistant to medical therapy. As liver transplantation was not available and obliteration of the shunt was hazardous, we performed subtotal colectomy in order to reduce ammonia production. This therapeutic option proved successful, as the grade of encephalopathy decreased and the patient improved. Our experience indicates that colonic exclusion should be considered as an option in the management of HE refractory to medical treatment in highly selected patients when liver transplantation is not available or even as a bridge given the long waiting time on lists.
    01/2013; 3(1):e4. DOI:10.4081/cp.2013.e4
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    ABSTRACT: To determinate factors that contribute to the steatosis's formation in chronic hepatitis B, to evaluate its influence on the development of hepatic fibrosis and to research an eventual relation to virologic factors in a Tunisian cohort of patients. All patients with chronic hepatitis B confirmed by data of liver biopsy were included in this study, which was enrolled from 1990 to 2006. The studied parameters were: age, gender, body mass index, transaminases, cholesterol, triglycerides, glycaemia and DNA rate, status HBe antigen and the degree of activity and histological fibrosis was estimated according to the score of METAVIR. Fifteen patients (34.1%) among the 44 patients includes in this study had hepatic steatosis; that was mild in 10 patients (66.6%), moderate in 3 cases (20%) and severe in 2 patients (13.4%). The antigen HBe was negative in 27 patients (62.22%). The mean age of the patients having a steatosis was of 32.33 years versus 27.75 years for those who had no it (p=0.185). The transaminases rate was superior in patients with steatosis than those without, the difference was not significant. Univariate correlation between predictor variables was studied. Significant predictors to steatosis included body mass index (p=0.011) and cholesterol (p=0.037). HBe Ag status was not associated with steatosis. Neither activity nor fibrosis was correlated with steatosis. In Tunisian patients, factors contributing to the formation of steatosis during the chronic hepatitis B were the body mass index and the rate of cholesterol. The steatosis did not seem to have an influence on the development of the hepatic fibrosis and seems to be independent on the viral effect.
    La Tunisie médicale 12/2008; 86(11):1000-3. DOI:10.1016/j.ajg.2009.07.089
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    ABSTRACT: Digestive epilepsy is a vegetative comitial at the origin of abdominal pain that can dress a variety of clinical pictures returning its diagnosis difficult. Gastroenterologists and abdominal surgeons poorly recognize this entity. To determine clinical characteristics of digestive epilepsy and its therapeutic modalities. Patient and We report the particular case of an epileptic 36-year-old patient who came in emergency twice in a pseudo-surgical abdominal picture having brought to a laparotomy. The diagnosis of digestive epilepsy was carried in front of a beam of clinical arguments and the negativity of explorations. An anti-convulsive treatment allowed the decline of the symptomatology. Digestive epilepsy can be presented as a pseudo-surgical abdominal picture, so it is important to think about before surgery when there is a stereotyped symptomatology and whether the diagnosis of epilepsy is known or not.
    La Tunisie médicale 09/2008; 86(8):758-60.
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    ABSTRACT: The aim determine the clinical, morphological, endoscopical and progressive profile of patients with ampullary carcinoma. Thirty-two patients with a carcinoma of the ampulla of Vater, hospitalised in the Gastro-enterology service of Habib Thameur Hospital (Tunis) (1992-2002) have been analysed retrospectively. Twelve men and 20 women of an average age of 66 years have been included. Twelve patients (37%) had had a cholecystectomy into the 3 years preceding the diagnosis of the ampullary carcinoma. A duodenal tumour had been found at 29 patients (91%). After endoscopical sphincterectomy, an intra-ampullar exophytic tumour had been found in I case and an infiltrated aspect of the ampulla of Vater in 2 cases. The jaundice was frequent. The use of lateral duodenoscopy allowed carrying the positive diagnosis in all cases. Five patients had metastasis at the moment of diagnosis. A DPC has been practiced at 15 patients. A palliative biliary diversion has been realized at 9 patients. Six patients had an endoscopical palliative drainage with installation of a plastic prosthesis. The rate of post- operative mortality was 20%. The rate of morbidity linked to the surgery was 21.8%. The ampullary carcinoma is a rare tumour diagnosed belated. The postoperative mortality is raised. The identification of factors forecast and the utilization of adjuvant processing will be able to allow the improvement of the prognosis.
    La Tunisie médicale 12/2006; 84(11):701-4.

Publication Stats

4 Citations
13.68 Total Impact Points

Institutions

  • 2015
    • University of Tunis El Manar
      Tunis-Ville, Tūnis, Tunisia
  • 2014
    • Faculty of Medecine of Tunis
      Tunis-Ville, Tūnis, Tunisia
  • 2005–2008
    • Hopital Habib Thameur
      Tunis-Ville, Tūnis, Tunisia