{"id":2296,"date":"2019-12-31T19:32:06","date_gmt":"2019-12-31T18:32:06","guid":{"rendered":"https:\/\/angh.net\/abstracts\/sanghria-a-perpignan-des-specificites-locales-a-expliquer\/"},"modified":"2019-12-31T19:32:06","modified_gmt":"2019-12-31T18:32:06","slug":"sanghria-a-perpignan-des-specificites-locales-a-expliquer","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/sanghria-a-perpignan-des-specificites-locales-a-expliquer\/","title":{"rendered":"SANGHRIA \u00e0 Perpignan : des sp\u00e9cificit\u00e9s locales \u00e0 expliquer ?"},"content":{"rendered":"

2019<\/strong><\/p>\n

AJ REMY, L LE CLOAREC, MC ORTIZ, A SAEZ, C AMOUROUX, M KOUAOUCI, F KHEMISSA. Service d\u2019H\u00e9pato-Gastroent\u00e9rologie et de Canc\u00e9rologie Digestive, Centre Hospitalier de Perpignan<\/em><\/p>\n

Endoscopie <\/strong>– \u00a02019-05-14 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Introduction\u00a0: Dans l\u2019observatoire SANGHRIA sur les h\u00e9morragies digestives hautes initi\u00e9 par l\u2019ANGH en novembre 2017, l\u2019\u00e9quipe du Centre Hospitalier de Perpignan arrive en t\u00eate du nombre d\u2019inclusions\u00a0: 430 inclusions \u00e0 Perpignan sur un total de 2498 soit plus de 17% du total des inclusions. La moyenne d\u2019inclusions dans notre centre est proche de 1,5 par jour avec un pic maximal \u00e0 6 inclusions en 24h. Les h\u00e9morragies digestives re\u00e7ues dans notre centre comprenaient tous types d\u2019\u00e9tiologies : hypertension portale, ulc\u00e8res gastroduod\u00e9naux, oesophagites, cancers, etc\u2026 Objectif\u00a0: expliquer pourquoi il y a eu autant d\u2019inclusions dans SANGHRIA \u00e0 Perpignan. R\u00e9sultats\u00a0: les explications possibles peuvent \u00eatre li\u00e9es 1\/ \u00e0 l\u2019organisation m\u00e9dicale 2\/ \u00e0 une diff\u00e9rence sur le circuit d\u2019inclusion 3\/ aux caract\u00e9ristiques de la population du bassin de sant\u00e9 4\/ aux habitudes locales de prescription\u00a05\/ \u00e0 des caract\u00e9ristiques diff\u00e9rentes des patients ayant une h\u00e9morragie digestive.
\n1\/ Pour l\u2019organisation m\u00e9dicale, notre \u00e9tablissement est le seul \u00e9tablissement public somatique du d\u00e9partement des Pyr\u00e9n\u00e9es-Orientales avec plus de 1000 hospitalisations par jour et plus 1200 consultants par jour. Il y a absence et\/ou abandon du secteur lib\u00e9ral dans la prise en charge des h\u00e9morragies digestives\u00a0: 16% des malades inclus sont pass\u00e9s auparavant par un service priv\u00e9 d\u2019urgences sans voir de gastroent\u00e9rologue. Le Centre Hospitalier de Perpignan est de fait le seul centre d\u2019accueil des h\u00e9morragies digestives GHT Aude Pyr\u00e9n\u00e9es. La comparaison 2005-2017 demand\u00e9e au DIM montrait une augmentation des passages au SAU de 31% mais une augmentation des s\u00e9jours pour h\u00e9morragies digestives hautes de 141%, qui correspond en valeur brute \u00e0 une augmentation de nombre de s\u00e9jours de 296 \u00e0 713. Par ailleurs, l\u2019\u00e9quipe m\u00e9dicale du service d\u2019h\u00e9pato-gastroent\u00e9rologie assurant l\u2019astreinte op\u00e9rationnelle comprenait 6 praticiens hospitaliers et une assistante sp\u00e9cialiste. 2\/ L\u2019investigateur principal du centre a \u00e9t\u00e9 tr\u00e8s investi dans SANGHRIA ainsi que le personnel d\u2019endoscopie mais ceci n\u2019est pas exclusif de Perpignan. Par contre le circuit d\u2019inclusion a \u00e9t\u00e9 optimis\u00e9. Les infirmi\u00e8res d\u2019endoscopie informaient syst\u00e9matiquement tous les patients\u00a0; il n\u2019y avait qu\u2019un seul m\u00e9decin inclueur qui passait au crible tous les plannings d\u2019endoscopies r\u00e9alis\u00e9es, weekends et jours f\u00e9ri\u00e9s inclus, sans temps sp\u00e9cifique d\u00e9gag\u00e9, ni soutien URC ou ARC. 2\/ dans les caract\u00e9ristiques de la population, le Centre Hospitalier de Perpignan dessert un bassin d\u00e9partemental de 482 131 habitants (donn\u00e9es INSEE au 1er janvier 2018) concentr\u00e9s sur la ville de Perpignan\u00a0(120\u00a0605 habitants) et son agglom\u00e9ration\u00a0(264\u00a0105 habitants). Ceci repr\u00e9sente 18,3% de l\u2019ancienne r\u00e9gion Languedoc-Roussillon, devenue l\u2019est de l\u2019Occitanie. La population est plus \u00e2g\u00e9e de 3% par rapport \u00e0 la moyenne nationale et r\u00e9gionale. Le % des plus de 60 ans est de 32% dans les Pyr\u00e9n\u00e9es-Orientales contre 28,5% en Occitanie et 25,6% en France tandis que le % des plus de 75 ans est de 12% dans le d\u00e9partement, de 10,5 en Occitanie et de 9,15% en France. La pr\u00e9carit\u00e9 est importante avec un revenu moyen par foyer de 21392 \u20ac (r\u00e9gional 23560 \u20ac, national 26163 \u20ac). La consommation d\u2019alcool et de tabac est sup\u00e9rieure dans le Languedoc-Roussillon. Il y a 16,6% de buveurs r\u00e9guliers, soit +5,6%\u00a0par rapport \u00e0 la moyenne nationale et 35% de fumeurs r\u00e9guliers soit +6% par rapport \u00e0 moyenne nationale.
\n3\/ les habitudes de prescription locales, obtenues par convention avec la CPAM des Pyr\u00e9n\u00e9es-Orientales montrent une consommation d\u2019antiagr\u00e9gants plaquettaires, de NACO et d\u2019AVK sup\u00e9rieure de 2 \u00e0 3% par rapport au reste de la r\u00e9gion mais avec une consommation globale d\u2019IPP \u00e9galement sup\u00e9rieure de 3%\u00a0; la fr\u00e9quence de la co-prescription est similaire \u00e0 la moyenne r\u00e9gionale, ente 45 et 51% selon les classes. La consommation d\u2019AINS \u00e9tait identique, y compris en co-prescription avec IPP. 5\/ Les malades inclus au Centre Hospitalier de Perpignan pr\u00e9sentaient des diff\u00e9rences uniquement sur les items suivants\u00a0: moins d\u2019h\u00e9morragies intra-hospitali\u00e8res (15.6% v 25.3%), h\u00e9morragie plus souvent li\u00e9e \u00e0 une oesophagite (19% v 11,5%) ou \u00e0 une hypertension portale (30% v 19%), malgr\u00e9 un pourcentage de malades cirrhotiques et un score moyen de CHILD identiques, score de Charlson plus \u00e9lev\u00e9 (3.4 v 2), endoscopies r\u00e9alis\u00e9es moins souvent sous anesth\u00e9sie g\u00e9n\u00e9rale (13% v 31%), nombre de culots transfus\u00e9s moins important (1,7 v 3.3), r\u00e9cidive intra-hospitali\u00e8re moins fr\u00e9quente (4.3% v 10.5%), dur\u00e9e d\u2019hospitalisation moins longue (8.2 jours v 10.2 jours)\u00a0; 22 patients cirrhotiques seulement sur 88 (25%) \u00e9taient sous propranolol. La mortalit\u00e9 intra-hospitali\u00e8re et \u00e0 6 semaines \u00e9taient similaires.
\nDiscussion\u00a0: Nous pourrons essayer d\u2019expliquer comme suit l\u2019augmentation de 141%\u00a0: 1\/ augmentation d\u2019activit\u00e9 du Centre Hospitalier pour 31%, augmentation de prescription des NACO, autres anticoagulants et antiagr\u00e9gants 3%, diminution de prescription des IPP non constat\u00e9e, diminution de l\u2019activit\u00e9 lib\u00e9rale d\u2019urgence 21%. Une plus grande pr\u00e9carit\u00e9 et des consommations sup\u00e9rieures de tabac et d\u2019 alcool pourraient \u00eatre \u00e9galement impliqu\u00e9s. L\u2019hypertension portale plus fr\u00e9quemment en cause et des patients moins souvent sous propranolol sont des facteurs qui doivent nous faire r\u00e9fl\u00e9chir sur nos pratiques de pr\u00e9vention h\u00e9morragique. Conclusion : Le Centre Hospitalier de Perpignan est-il un cas \u00e0 part ou des sp\u00e9cificit\u00e9s locales peuvent-elles tout expliquer\u00a0? L\u2019analyse comparative de nos malades par rapport \u00e0 l\u2019ensemble des malades inclus dans SANGHRIA n\u2019a montr\u00e9 que des diff\u00e9rences mineures. L\u2019optimisation du circuit d\u2019inclusion a permis la collecte exhaustive de donn\u00e9es sur les h\u00e9morragies digestives hautes d\u2019un GHT.<\/p>\n","protected":false},"excerpt":{"rendered":"

2019 AJ REMY, L LE CLOAREC, MC ORTIZ, A SAEZ, C AMOUROUX, M KOUAOUCI, F KHEMISSA. Service d\u2019H\u00e9pato-Gastroent\u00e9rologie et de Canc\u00e9rologie Digestive, Centre Hospitalier de Perpignan Endoscopie – \u00a02019-05-14 –\u00a0CO – ________________________________ Introduction\u00a0: Dans l\u2019observatoire SANGHRIA sur les h\u00e9morragies digestives hautes initi\u00e9 par l\u2019ANGH en novembre 2017, l\u2019\u00e9quipe du Centre Hospitalier de Perpignan arrive en […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[6],"tags":[30],"class_list":["post-2296","post","type-post","status-publish","format-standard","hentry","category-endoscopie","tag-30"],"yoast_head":"\nSANGHRIA \u00e0 Perpignan : des sp\u00e9cificit\u00e9s locales \u00e0 expliquer ? - Abstracts des congr\u00e8s de l'ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/sanghria-a-perpignan-des-specificites-locales-a-expliquer\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"SANGHRIA \u00e0 Perpignan : des sp\u00e9cificit\u00e9s locales \u00e0 expliquer ? - Abstracts des congr\u00e8s de l'ANGH\" \/>\n<meta property=\"og:description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta property=\"og:url\" content=\"https:\/\/angh.net\/abstracts\/sanghria-a-perpignan-des-specificites-locales-a-expliquer\/\" \/>\n<meta property=\"og:site_name\" content=\"Abstracts des congr\u00e8s de l'ANGH\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/ANGH-2136322560030484\/\" \/>\n<meta property=\"article:published_time\" content=\"2019-12-31T18:32:06+00:00\" \/>\n<meta name=\"author\" content=\"Bruno Lesgourgues\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"\u00c9crit par\" \/>\n\t<meta name=\"twitter:data1\" content=\"Bruno Lesgourgues\" \/>\n\t<meta name=\"twitter:label2\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/angh.net\/abstracts\/sanghria-a-perpignan-des-specificites-locales-a-expliquer\/#article\",\"isPartOf\":{\"@id\":\"https:\/\/angh.net\/abstracts\/sanghria-a-perpignan-des-specificites-locales-a-expliquer\/\"},\"author\":{\"name\":\"Bruno Lesgourgues\",\"@id\":\"https:\/\/angh.net\/abstracts\/#\/schema\/person\/d70d83701c6dda5f93e12e8bafca7d7d\"},\"headline\":\"SANGHRIA \u00e0 Perpignan : des sp\u00e9cificit\u00e9s locales \u00e0 expliquer ?\",\"datePublished\":\"2019-12-31T18:32:06+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/angh.net\/abstracts\/sanghria-a-perpignan-des-specificites-locales-a-expliquer\/\"},\"wordCount\":942,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\/\/angh.net\/abstracts\/#organization\"},\"keywords\":[\"2019\"],\"articleSection\":[\"Endoscopie\"],\"inLanguage\":\"fr-FR\"},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/angh.net\/abstracts\/sanghria-a-perpignan-des-specificites-locales-a-expliquer\/\",\"url\":\"https:\/\/angh.net\/abstracts\/sanghria-a-perpignan-des-specificites-locales-a-expliquer\/\",\"name\":\"SANGHRIA \u00e0 Perpignan : des sp\u00e9cificit\u00e9s locales \u00e0 expliquer ? 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