BackgroundProton pump inhibitors (PPI) are widespread nowadays. Recent concerns have emerged about possible bone complications of long-term use of PPIs, such as low bone mineral density (BMD) and an increased risk of fractures.ObjectivesThe aim of our study was to evaluate the effect of long-term use of PPIs on bone by measuring the BMD in order to estimate the frequency of osteopenia and osteoporosis, and to determine the risk factors associated to this complication.MethodsIt was a prospective study including consecutive patients who where taking proton pump inhibitors for at least one year. In all patients we realized a bone densitometry in order to evaluate the bone strength and we calculated the FRAX score to estimate the risk of osteoporotic fracture at ten years.ResultsWe included 52 patients. The mean age was 49,5 years old. The male-female ratio M/F was 0,48. At least three risk factors were found in more than 50% of the population. The calculated daily calcium intake was insufficient in 94% of the patients. The mean duration of PPIs intake was 45 months. The most frequent indication was gastro esophageal reflux disease (75%). The PPI prescription was appropriate in 94% of the cases. The prevalence of osteopenia and osteoporosis was respectively 52% and 19%. The predictive factors of low BMD were an age ≥50 years old (p=0,03), the menopause (p<0,0001), a calcium intake ≤550 mg/day (p<0,038), and a PPI use duration ≥30 months (p<0,006). The multivariate study could not be undertaken because of co linearity of the factors.ConclusionsThe long term PPI use is associated to the risk of bone complications, especially among patients at risk for osteoporosis. It seems reasonable to be more vigilant in prescribing PPIs and use lowest effective dose for patients with appropriate indications, and to screen these complications if necessary.Disclosure of InterestNone declared

Sarcoidosis is a systemic non caseous granulomas disease. Liver is a common location but usually asymptomatic. Evidence based guidelines for this location treatment is lacking and the effect of corticosteroids may be inadequate. The aim of our study was to describe the clinical, biochemical, radiological and therapeutic features of seven patients with systemic sarcoidosis and liver involvement. A retrospective and descriptive monocentric study, over 3 years, including seven patients with systemic sarcoidosis and liver involvement. We included 5 women and 2 men with an average age of 43 years. Hepatic localization revealed sarcoidosis in 5 cases. Hepatomegaly was observed in all patients as well as abnormal serum liver function test reflected by anicteric cholestasis. Liver biopsy, showed in all granulomatous lesions consistent with sarcoidosis and severe fibrosis in 2 cases. Extra-hepatic manifestations were present in all patients represented mainly by pulmonary location. All patients were treated, five by corticosteroid and two with ursodeoxycholic acid (UDCA). Complete response was observed in one case, partial response in another case and corticosteroid refractoriness in one case. In two cases, corticosteroid therapy was introduced for less than 1 month, not allowing assessment of response. Antimalarials in combination with UDCA were used successfully in a patient with steroid-resistant liver disease. Liver involvement can reveal systemic sarcoidois. Given the risk of progression to severe liver disease, it must be screened in all patients with systemic sarcoidosis. Treatment is not systematic, and still based on corticosteroid therapy. In the absence of prospective randomized controlled trials, the efficacy of UDCA need to be proven.

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