Introduction: The advent of biotherapies has radically changed the management of IBD. However, the use of these drugs may in some cases result in to primary non-response or a loss of secondary response. Therapeutic Drug Monitoring (TDM) is a tool that was developed to manage biotherapy as accurately as possible in these situations. Material and methods: This is a retrospective descriptive study spread over 8 years of 53 patients followed for IBD put on anti-TNF(, in whom assays of residual levels of anti-TNF and anti-drug antibodies were carried out. Results: 48 suffer from Crohn’s disease and 5 from ulcerative colitis. Of these patients, 41 were on infliximab and 12 on adalimumab. The TDM performed in front of a primary non-response in 18 patients, and a loss of secondary response in 34 patients. We found immunization in 28% of patients, underdosage in 56%, and 15% had a normal dosage. Therapeutic optimization was adopted in 52% of patients, a switch in 19%, a swap in 25% of patients, and the addition of an immunosuppressant in 6.5%. The evolution was marked by the achievement of a prolonged remission in 69% of these patients. Conclusion: Pharmacological dosage of the residual rate of the anti-TNF and anti-drug antibodies currently constitutes an important element for managing the primary non-response or the loss of secondary response to anti-TNF in patients with IBD treated by biotherapy.

Objective: To report an uncommon presentation of a rare case of autoimmune polyglandular syndrome type IIIb in a patient presenting as well with Small Duct Primary Sclerosing Cholangitis. Clinical Presentation and Intervention: A 42-year-old man presented with jaundice and intermittent fever. Blood tests showed macrocytic anaemia due to vitamin B 12 deficiency compatible with Biermer’s disease. A thyroid function test was consistent with hyperthyroidism compatible with Basedow’s disease. And Liver biopsy revealed signs compatible with Small Duct Sclerosing Cholangitis. A final diagnosis of Small Duct Sclerosing Cholangitis with Biermer’s disease and Basedow’s disease, which constituted autoimmune polyglandular syndrome type IIIb, was made and the patient was treated with L-thyroxine, vitamin B 12 injection and Ursodeoxycholic acid with a impressive improvement during his follow up. Conclusion: This case showed a rare combination between APS type IIIb and Small Duct Sclerosing Cholangitis and that the presence of one autoimmune endocrine disease should prompt clinicians to look for other coexisting autoimmune diseases which may be asymptomatic.

To evaluate the effectiveness of endoscopic biliary sphincterotomy in patients with a large obstructive stone measuring more than 15mm and in patients with simple stones and to identify the factors influencing endoscopic drainage as well as its complications in the management of large choledochal stones. This is the evaluation of endoscopic retrograde cholangio-pancreatography by a descriptive and analytical retrospective study carried out in the Hepato-Gastro-Enterology II department of the Military Hospital of Rabat between April 2002 and September 2020. 1011 patients included in the study who were divided into two groups: Group I (n = 143): Patients with a large obstructive stone measuring more than 15mm. Group II (n = 868): Patients with one or two stones, or bile duct stones. The overall success rate was 88.7% in group I versus 92.5% in group II (p = 0.125). The overall rate of early complications was 10.5% in group I versus 5.1% in group II (p = 0.017). Only the presence of acute cholangitis and stenosis of the main bile duct were factors associated with decreased overall success of endoscopic treatment. Our study showed that there is no statistically significant difference in the effectiveness of endoscopic treatment in patients with a large stone and those with simple lithiasis. The presence of cholangitis and stenosis of the main bile duct appear to be factors associated with decreased overall success of endoscopic treatment.