The cobalamin status of 27 patients suffering from alcoholic cirrhosisand 20 control subjects was analyzed. Plasma cobalamin (p < 0.005), total corrinoids (p < 0.005) and their analogs (p < 0.05) were all significantly elevated in the cirrhosis patients. These differences were due to increased haptocorrin (HC)-bound corrinoid (p < 0.02), which could be explained by a deficient hepatic clearance of cobalamin bound to HC. The increase in the concentration of true cobalamin was greater than that of its analogs. There were positive correlations between cholestasis (serum alkaline phosphatase) and plasma analog concentrations (p < 0.05), HC-bound cobalamin (p < 0.005) and total corrinoids bound to HC (p < 0.005). The plasma concentrations of the indicators of cobalamin deficiency, homocysteine (p < 0.05) and methylmalonic acid (p < 0.001), were increased, which could indicate poor cellular penetration of vitamin B₁₂ or a defect in the activation of the two vitamin-B₁₂-dependent enzymes.

In an analysis of data from the CESAME cohort in France, patients with anal and/or perianal Crohn's disease have a high risk of anal cancer, including perianal fistula-related cancer, and a high risk of rectal cancer.

Objective: Narrow-Band Imaging (NBI) is as sensitive as Lugol chromoendoscopy to detect oesophageal squamous cell carcinoma (SCC) but its specificity, which appears higher than than that of Lugol chromoendoscopy in expert centres, remains to be established in current practice. This study aimed to prove the superiority of NBI specificity over Lugol chromoendoscopy in the detection of oesophageal SCC and high-grade dysplasia (HGD) in current practice (including tertiary care centres, local hospitals, and private clinics). Trial Design: Prospective randomised multicentre trial including consecutive patients with previous or current SCC of the upper aerodigestive tract addressed for gastroscopy. Patients included were randomly allocated to either the Lugol or NBI group. In the Lugol group, examination with white light and Lugol chromoendoscopy were successively performed. In the NBI group, NBI exam was performed after white light endoscopy. We compared the diagnostic characteristics of NBI and Lugol chromoendoscopy in a per-patient analysis. Results: 334 patients with previous history of SCC were included and analysed in intention-to-tret from 15 French institutions between March 2011 and December 2015. In a per-patient analysis, sensitivity, specificity, positive and negative likelihood values were respectively 100%, 66.0%, 21.2%, and 100% for Lugol chromoendoscopy vs. 100%, 79.9%, 37.5%, and 100% for NBI. NBI specificity was greater than Lugol chromoendoscopy (p=0.0023). Conclusions: As previously demonstrated in expert centres, NBI is more specific than Lugol in current gastroenterology practice for the detection of early SCC but combined approaches with both NBI and lugol could improve the detection of squamous neoplasia.

The concentrations of vitamin B12, its analogs, and the haptocorrin and transcobalamin carriers in 21 patients suffering from Crohn's disease and a group of controls (20 adults) were measured. There were no significant differences in the mean values for vitamin B12, total corrinoids (vitamin B12 + analogs), or vitamin B12 or total corrinoids bound to haptocorrin or transcobalamin of the Crohn's and control patients. There was a significant increase in the binding capacity of transcobalamin in the Crohn's patients compared to the controls (P < 0.001), but there was no difference in the binding capacities of haptocorrin. The serum concentrations of the markers of vitamin B12 status, homocysteine and methylmalonic acid, showed an increase (P < 0.01) in homocysteine in the Crohn's disease patients, but no change in methylmalonic acid. As the hyperhomocysteinemia was associated with normal folate concentrations, there may have been a defect in the activation of the enzyme due to altered intracellular vitamin B12 status.