No reflux pattern demonstrated by 24 h pH-impedance monitoring is associated with response to PPIs in patients with GORD symptoms. In contrast, absence of oesophagitis, presence of functional digestive disorders and BMI ≤25 kg/m(2) are strongly associated with PPI failure.

Background: Few data exist to help select a second biologic agent in patients with refractory ulcerative colitis (UC). Aim:To compare the efficacy of infliximab (IFX) and vedolizumab (VDZ) in UC patients who failed a first subcutaneous anti-tumor necrosing factor (TNF) agent.Methods: Consecutive UC patients from 12 French centres starting IFX or VDZ after at least one injection of adalimumab or golimumab have been included in a retrospective study. Outcomes were clinical remission at week 14, survival without treatment discontinuation and survival without UC-related event.Results: Among the 225 patients included, clinical remission at week 14 was achieved in 40/154 (26%) patients treated with IFX and in 35/71 (49%) treated with VDZ (P = 0.001). After a propensity score matching analysis, this difference remained significant (odds ratio: 1.67; 95% confidence interval: 1.08-2.56; P = 0.02). With a median follow-up of 117 weeks, survival rates without treatment discontinuation at years 1 and 3 were 50% and 29% with IFX, and 80% and 55% with VDZ, respectively (P < 0.001). Regarding survival without UC-related event, they were 49% and 27% with IFX, and 74% and 52% with VDZ (P < 0.01). Conclusion:After failure of a first subcutaneous anti-TNF agent, UC patients were more likely to achieve clinical remission with VDZ than those treated with IFX.Although due to prescription habits patients in the IFX group had a significantly more severe disease, these differences remained after adjustments and subgroup analyses. Such results have to be confirmed prospectively and warrant dedicated head-to-head trials. | 853HUPÉ et al.

Pancreatic acinar cell carcinoma (PACC) is a rare tumor with a poor prognosis in the absence of surgery. Moreover, there is currently no standard chemotherapy for metastatic PACC.We report the case of a patient treated by the FOlFOX 4 regimen with an objective response and a prolonged tumor control and we provide a review of chemotherapy regimens reported for PACC in the literature. Case reportA 79-year-old man, whose main medical history was a prostatic cancer (2004) treated by hormone therapy and radiotherapy with complete remission, was admitted in March 2009 following three months of painful erythematous subcutaneous nodules mainly located on both lower limbs. Performance Status was good (ECOg 1) with, however, a 4 kg weight loss within the past three months. The patient described also for several months slight transitory pain in the left side of the abdomen. The skin lesions evolved typically from erythematous and painful infiltrated plaques, secondly ulcerated with emission of subcutaneous fat, resolving into hyperpigmented scars. Skin biopsy showed focal subcutaneous fat necrosis, pathognomonic of pancreatic panniculitis, suggesting an underlying pancreatic disease. The serum lipase level was markedly elevated (5000 Ui/l). As for tumor markers, levels of CEA and CA 19-9 were low. A computed tomography (CT)-scan showed an infiltrating mass in the tail of the pancreas with spleen invasion and four suspect lesions in the liver (Figure 1). The biopsy of liver metastasis revealed a secondary localization of a pancreatic acinar cell carcinoma.A weekly chemotherapy with gemcitabine (1000 mg/m² weekly) was introduced. in addition, considering the disabling skin lesions, a systemic corticotherapy was initiated in the same time (prednisone 1 mg/kg/day for three days and then 30 mg per day).After two months of treatment, the patient presented a marked weakness with a 7 kg weight loss and a worsening of the skin eruption, without any improvement after corticosteroids were increased. On imaging, liver metastases had increased in size and number (unequivocal progression  50% by rECiST), although the pancreatic mass was stable in size (Figure 1).Then second-line chemotherapy was begun with the FOlFOX4 regimen. A clinical benefit was quickly observed as after only two courses skin lesions gradually improved and after four courses all lesions were almost healed, and the patient had recovered 5 kg and a good Performance Status. The clinical impression was reinforced by morphological assessment: the CT-scan showed a dramatic decrease of the pancreatic mass and of the liver metastases ( 50% by rECiST). After eight courses, the clinical good evolution was confirmed by an additional decrease of the pancreatic lesion and of the liver metastases (25% by rECiST), and serum lipase level was 130 Ui/l. The treatment had to be stopped after 12 courses in December 2009 because of a grade 3 neurotoxicity related to oxaliplatin. The patient was under medical surveillance for the following seven months without any clinical or morphologi...