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What is COPD? Chronic Obstructive Pulmonary Disease (COPD) is a common and potentially fatal respiratory disease that in most cases is linked to smoking.   It is characterised by a permanent and progressive obstruction of the airways that is the result of the combination of two mechanisms, present to varying degrees depending on the patient: Chronic bronchitis: the airways become increasingly narrow due to chronic inflammation Emphysema: the pulmonary alveoli (that part of the lung that enables oxygen to enter the blood) are destroyed progressively . The establishing of an obstructive breathing disorder by spirometry (breathing test) permits a COPD diagnosis.  What are the causes of COPD? Smoking  is the most frequent cause of COPD in developed countries. One in five smokers and a half of all those who smoke at the age of 65 suffer from COPD. Nevertheless, other factors  (environmental, immune and/or genetic) can play a role and render certain subjects  more susceptible to developing COPD. The best known, albeit rare, genetic cause is  alpha-1-antitrypsin deficiency. When to be screened? What are the symptoms? This disease often starts with a cough and bringing up phlegm in the morning. These symptoms are often ignored by the smoker who regards them as “normal” consequences of smoking. Progressively, the sufferer experiences shortness of breath on exertion that can pose a problem in everyday life, causing the patient to move around less and less. This in turn results in a loss of physical fitness that aggravates the shortness of breath.   Early screening for COPD (breathing capacity test) should be carried out for smokers with COPD-like symptoms, such as coughing, persistent bringing up of phlegm and/or shortness of breath and indeed for all smokers aged over 40. COPD care at the Erasmus Hospital Once a diagnosis has been established, the Erasmus Hospital proposes a number of supplementary checks: A thoracic scan to screen for emphysema and suspicious shadows (lung cancer is more common among COPD patients) A heart ultrasound to rule out the presence of a cardiac effect of the lung disease and/or an associated heart disease   An exercise assessment (bicycle ergospirometry and/or walking test) to assess capacity during exercise A blood test to evaluate the degree of inflammation in the blood and to screen for a potential genetic cause (alpha-1-antitrypsin insufficiency) An early and comprehensive blood test is necessary in order to:  Prevent the COPD from progressing Relieve symptoms Improve lung capacity during exercise and quality of life Prevent and treat exacerbations (episodes of aggravated respiratory problems, primarily due to infections) Reduce mortality First-line treatment includes: Stopping smoking.  This is the best way of preventing the disease from developing further. A smokers’ assistance centre (CAF) is available at the Erasmus Hospital    Flu and pneumococcal vaccination, designed to avoid infections that are more often fatal among COPD patients  A pharmacological treatment consisting essentially of bronchodilators Respiratory rehabilitation which consists of a set of care measures (bike/carpet retraining and muscular retraining; nutritional and psychosocial accompaniment; education) given by a multidisciplinary team (doctor, physiotherapist, occupational therapist and others) The administration of oxygen in the long term for severe cases in whom COPD is resulting in respiratory insufficiency   Leading edge treatment In patients with an advanced stage of COPD despite a maximum of care, second-line treatment is proposed at specialised centres such as the Erasmus Hospital:     Interventions to reduce lung volume  (endoscopic or surgical) for patients with severe emphysema: The placing of endobronchial valves  that are positioned in the most damaged  bronchi to prevent the air from entering there, consequently enabling the less damaged zones to benefit from more air Surgery to reduce lung volume that, according to the same principle, removes the least efficient and most diseased zones of the lung to enable the rest of the lung to function better A lung transplant can be envisaged for patients at a terminal stage of COPD aged no more than 65 and with no other major associated illnesses (comorbidities).     Our specialists Services

What is diabetes? Diabetes is characterised by an excessively high level of sugar in the blood (glycaemia). Eventually, without appropriate treatment, this chronic hyperglycaemia increases the risk of cardiovascular disease: coronary thrombosis, stroke, etc. Other complications of diabetes can affect the eyes, kidneys and nerves.  Image There are several kinds of diabetes and they require sometimes different medical treatment. The most frequent are: Type 1 diabetes, treated at the Convention du diabète [Diabetes Convention] centres;Type 2 diabetes, with first-line treatment by GPs (Trajet de Démarrage) [Start-Up Pathway] and/or in a hospital environment, in the framework of a Trajet de soins [Care Pathway) or a Convention du diabète ;Gestational diabetes, treated at Convention du diabète  centres;MODY type diabetes  and other rarer genetic diabetes can also be treated at   Convention du diabète centres Care A multidisciplinary teamThe H.U.B Diabetology Clinic consists of a multidisciplinary team of medical, paramedical and nursing staff who are dedicated to optimal care for all diabetes patients in line with their specific needs.  In addition to the acts and services foreseen by the Care Pathways and the Diabetes Convention (in particular therapeutic education on insulin treatment), the Diabetology Clinic proposes specialised consultations for diabetic foot, gestational diabetes and hypoglycaemias. Learning to manage your diabetesOptimal diabetes care means autonomy for the diabetes patient in regard to their treatment. In this respect the H.U.B’s Diabetology Clinic has been a pioneer in therapeutic education. We consider the person with diabetes  as a genuine partner in his or her care. Our team organises group sessions for treatment education, covering: the particularities of diabetes, diet management and, above all, how to (effectively) manage treatment with insulin.    Diabetic footWith its myriad of small blood vessels and nerves, the foot is a zone that is particularly vulnerable to diabetes complications. This can result in desensitization and wounds or sores that do not heal. The persons concerned can make an appointment at the diabetic foot consultation, recognised as a reference centre by the INAMI [National Institute for Sickness and Disability Insurance]. Depending on their needs, patients are seen by a diabetes specialist, a nurse specialising  in wound care, a chiropodist and, if necessary, a shoemaker. A vascular surgeon is also a member of the team.      Gestational diabetesWomen who develop diabetes during their pregnancy are at increased risk of certain complications during childbirth. They are also at a greater risk of developing type 2 diabetes later in life. These patients are treated jointly by the Diabetology Clinic and gynaecologists at the H.U.B’s Obstetrics Department both during and after their pregnancy.   (Non) diabetic hyperglycaemiasThe H.U.B’s Diabetology Clinic diagnoses and treats hypoglycaemias. These (sudden) falls in blood sugar levels can, in their severe form, lead to behavioural disorders or even a loss of consciousness. A badly managed diabetes, an insulimona (rare tumour of the pancreas) or obesity surgery (bypass, gastroplasty) can result in severe hypoglycaemias. Advice If you are diabetic, as your GP if you can benefit from  a Trajet de Démarrage,a ”Type 2 diabetes” Trajet de soinsor a Convention du diabète.These programmes entitle you to services, specialised consultations and additional reimbursements. Focus As a centre of excellence, the H.U.B Diabetology Clinic has signed a number of conventions with the INAMI so as to be able to offer persons treated with insulin access to the latest diabetes monitoring technologies. Most notably: different types of blood sugar sensors (for type 1 and type 2 diabetes), conventional insulin pumps and “patch” pumps without tubing (for type 1 diabetes). Some people with type 1 diabetes can also benefit from insulin treatment in a closed circuit. This automated “artificial pancreas” system consist of connecting a blood sugar sensor to an insulin pump. This system then effects the insulin injections semi- automatically. Research The H.U.B Diabetology Clinic participates in and/or initiates clinical trials on future medicines and new technologies for treating diabetes.  Our specialists Services

Rare diseases function Patients with a rare disease must receive proper and specific care: a rapid diagnosis followed by treatment in care units with staff trained in these rare diseases. The mission of the Rare Diseases Function (8 in Belgium) is to coordinate, with teams with the required expertise, the care pathways and scientific research and training projects of all the professionals involved  in providing an adapted and constantly evolving care.  

Presentation The Palliative Care – Continuous Care Unit is a mobile, multidisciplinary team made up of healthcare professionals from different disciplines. Its aim is to ensure continuity of care for patients approaching the end of life. Image Care pathway This multidisciplinary team, made up of healthcare professionals from different professions, aims to ensure continuity of care at Erasme Hospital and outside it when patients are approaching the end of life or require symptomatic treatment, particularly for pain management.The team consists of psychiatrists or internists, nurses, psychologists, physiotherapists, dietitians, pharmacists and social workers. Their role is to provide occasional and/or repeated medical advice without directly managing the patient’s care, offer support to relatives and care teams, and prepare discharge, a return home, or a transfer to another institution or nursing home, in close collaboration with the family doctor and the required outpatient care and support services. Each team member will ensure that they provide a listening ear, any necessary advice, and raise awareness among each of their contacts, while respecting their individual philosophical and religious beliefs.The shared approach to patients with a serious, progressive, incurable condition must focus on respecting their autonomy, with the aim of ensuring the best possible quality of their remaining life and their comfort. Useful links Brussels Federation for Palliative Care (FBSP)Website: www.fbsp-bfpz.orgPluralist Association for Palliative Care in the Brussels Region (Palliabru)Website: www.palliabru.be Our specialists Associated Services

Our role The Royal Decree defining the Care Programme for the geriatric patient stipulates that frail patients aged 75 and over must be assessed by a multidisciplinary mobile geriatric team, or internal liaison team. The care units screen their patients for frailty upon admission and then contact the internal liaison team if necessary. The latter assesses the patient and provides recommendations so that care can be adapted to each patient’s medical and psychosocial situation. Throughout the hospitalisation of the older person, the liaison team also provides geriatric expertise to the hospital’s medical and surgical departments. A report is also sent to the attending physician. Image Our specialties The care pathway followed by the geriatric older patient begins at home. The hospital is only one stage, and coordination of care, whether at home or in an institution, is essential. The geriatric team maintains strong contacts with general practitioners, home care services, rehabilitation centres, day centres, and nursing and care homes to coordinate the care provided as effectively as possible. It also arranges transport and provides continuing education for nursing and care home staff. Good communication is essential. The purpose of inpatient care is to assess the potential and resources of frail older patients who cannot be assessed in the Day Hospital, with a view to proposing a care and discharge plan aimed at maintaining the older patient’s independence. The department offers the expertise of a multidisciplinary team that assesses the patient’s functional, cognitive, nutritional and social potential, among other aspects, while treating diseases in accordance with current recommendations. The main geriatric syndromes treated by the team include falls, memory disorders, confusion, loss of independence, malnutrition and dysphagia, urinary incontinence, etc. Acute inpatient ward The purpose of inpatient care is to assess the potential and resources of frail older patients who cannot be assessed in the Day Hospital, with a view to proposing a care and discharge plan aimed at maintaining the older patient’s independence. The department offers the expertise of a multidisciplinary team that assesses the patient’s functional, cognitive, nutritional and social potential, among other aspects, while treating diseases in accordance with current recommendations. “Liaison” geriatric care The Royal Decree defining the Care Programme for the geriatric patient stipulates that frail patients aged 75 and over must be assessed by a multidisciplinary mobile geriatric team. The care units screen their patients for frailty upon admission and then contact the liaison team, which provides care recommendations tailored to each patient’s medical and psychosocial situation. The liaison team provides geriatric expertise to the hospital’s medical and surgical departments. Geriatric syndromes The geriatrician therefore has multiple conditions to treat, including geriatric syndromes such as: Polypharmacy and inappropriate prescribing sensory deficits, such as hearing loss or visual impairment falls and trauma, which may have more serious consequences at an advanced age (for example, a fracture of the neck of the femur) osteoporosis and osteoarthritis neurological diseases, such as dementia depressive disorders cardiovascular and respiratory diseases nutritional disorders sleep disorders complex social issues. The involvement of a geriatrician in a care pathway The health problems frequently encountered by older people may sometimes require planned surgery, chemotherapy or radiotherapy in the event of cancer, minimally invasive interventional techniques such as TAVI (treatment of aortic valve stenosis), or dialysis in cases of severe kidney failure. The decision to intervene may depend on numerous factors, relating both to the disease itself and to other conditions the person may have, or to the combination of specific issues affecting older people, such as malnutrition, memory or mood disorders, loss of mobility, and so on. The specialist physician, surgeon or other healthcare professional therefore seeks the opinion of the geriatrician and their team in order to prepare the patient as effectively as possible before the procedure or treatment, by addressing the geriatric issues. This assessment takes place either during an inpatient stay or in a geriatric day hospital. Focus Inappropriate prescribing of medicines in older people   The number of conditions affecting older people can lead to an accumulation of medicines that cause side effects, interact negatively with one another and sometimes result in hospital admissions that could have been avoided. The geriatrician and clinical pharmacist can make treatment recommendations to prevent complications associated with inappropriate prescribing. Our specialists Associated services

What is pancreatic cancer? Pancreatic cancer is the 4th cause of cancer deaths. In recent years the incidence of pancreatic cancer has continued to increase and today it accounts for 10-12 cases/100,000 persons. Pancreatic cancer develops from pre-cancerous lesions some of which are in the form of pancreatic cysts. Together with certain family factors, risk factors for this cancer are smoking, diabetes, alcohol consumption and obesity.   Care At our institutions we have developed a Fast Track care pathway for screening/diagnosing pancreatic cancer in all persons presenting a clinical (unexplained weight loss, jaundice, abdominal pain, decompensated diabetes) or radiological suspicion of cancer as well as for persons screened who are  at increased risk of pancreatic cancer (family history, chronic hereditary pancreatitis).  Following a pancreatic cancer diagnosis a complete medical check-up is carried out and the results discussed at a multidisciplinary meeting so as to decide on the line of treatment. If the pancreatic cancer is considered to be localised and resectable, pancreatic surgery can be envisaged, possibly  following  induction treatment (chemotherapy +/- radiotherapy). If it is non-resectable or metastatic, chemotherapy is proposed, possibly in the framework of study protocols. In Belgium, pancreatic surgery has been centralised since July 2019 at 15 experienced hospitals (including 6 French-speaking hospitals) with a high volume of pancreatic interventions so as to improve the care quality. The Erasmus Hospital is the leading French-speaking hospital in terms of the annual number of pancreatic surgery operations.     Research The HUB is active in developing new treatment approaches and initiated a multicentric study ((STEREOPAC) to assess the impact of stereotaxic radiotherapy (radiotherapy targeted at the tumour) following neoadjuvant chemotherapy in the case of localised pancreatic cancer .The Digestive Oncology Department is linked to the Laboratory of Experimental Gastroenterology (LGE) of the ULB’s Faculty of Medicine and to the Jules Bordet Institute’s GI Lab where a number of research projects are carried out, in particular on the immune-molecular impact of pancreatic cancer treatment.   A number of our doctors are members of various national and international groups of experts, namely :  the Belgian Group of Digestive Oncology, the Belgian Pancreatic Group, the Belgian Pancreatic Cancer Group, the European Society of Digestive Oncology and the European Society of Gastrointestinal Endoscopy. Our specialists Image Multidisciplinary bilio-pancreatic pathology group Associated services Publications Preoperative treatment with mFFX or GemNab and iHDSBRT (STEREOPAC trial) Authors : Bouchart et al Journal : BMC Cancer NAC associated with iHD-SBRT does not increase complications after PD Authors : Navez J et al Journal : J Surg Oncol Stratification of Pancreatic Ductal Adenocarcinomas Based on Tumor and Microenvironment Features Authors : Puleo et al Journal : Gastroenterology Assessment of response to chemotherapy in pancreatic ductal adenocarcinoma: Comparison between diffusion-weighted MR quantitative parameters and RECIST Authors : Bali et al Journal : Eur J Radiol

What is systemic amyotrophy? under construction A service recognised as an expert centre ERN-RND ERN-RND – Expert Centres

What is tooth decay? Tooth Decay is a common problem that occurs when the bacteria in the mouth cause the sugars to turn into acids.  This process leads to progressive demineralisation and the formation of dental cavities. If ignored, a cavity can worsen, causing pain, infection and sometimes the loss of the tooth. A rapid identification of the symptoms, such as an unusual sensitivity or discolouring, is essential for effective treatment.   Care Our clinic proposes a comprehensive care that combines prevention, early diagnosis and a variety of treatment, ranging from a simple filling to more complex procedures such as root canal treatment. Our collaborative approach that has recourse to specialists from various disciplines (speech therapist, ENT, stomatologist, hygienist, etc.) aims to provide individualised care and prevent further issues by educating patients in oral hygiene.  Advice to parents Preventing tooth decay in children starts with adopting healthy habits: brushing twice daily, limiting consumption of sweets and regular visits to the dentist.  Instilling good hygiene practices at a very young age is the foundation of long-term dental health.  Image Research Our commitment to research and innovation enables our patients to benefit from the latest developments in dental restoration materials and less invasive techniques for an improved management of tooth decay.  Our specialists Associated service

What is MIH? Molar Incisive Hypomineralisation is an anomaly of the enamel that gives rise to cream, yellow or brown stains on the teeth.  These stains are the result of insufficient mineralisation of the enamel during its development, making the teeth more vulnerable to decay and hypersensitivity. MIH affects approximately 15%  of children worldwide with variations depending on the geographical region. The exact causes of MIH remain to some extent unknown. Research nevertheless suggests that a role is played by a complex set of potential factors, including genetic and environmental elements and health issues during the first years of life.  Severe childhood illnesses between the ages of 0 and 4, the use of medicines and of anti-inflammatory drugs in particular, as well as certain prenatal and postnatal conditions, are all seen as factors contributing to the development of MIH. The signs of MIH include discoloured and stained molars and incisives. The affected teeth can become more sensitive, especially in response to cold, heat or sugar. In severe cases the enamel can erode, leading to cavities and pain that can potentially affect chewing and speech.   Treatment MIH is diagnosed during a thorough dental examination. A dentist is able to identify characteristic lesions of the tooth enamel and evaluate the extent of the problem. Treatment depends on the severity of the symptoms and can range from the application of fluoride varnish or dental cement to strengthen the enamel to more invasive treatment, especially if the tooth structure is seriously compromised.  Advice for parents Prevention and Early Detection: Make regular visits to the dentist as soon as the first permanent teeth appear for early detection. Oral hygiene: Encourage a strict brushing routine using fluoride toothpaste and also dental floss.Diet : Limit sugars and acids that can aggravate already vulnerable teeth. Professional treatment : Follow the dentist’s recommendations for protective or restorative treatment. MIH is a challenge for dentists as well as for the families who are affected by it. Nevertheless, with a clear and thorough understanding, early detection and proactive management it is possible to minimise its impact on the oral health of children. Parents have a key role to play in monitoring and caring for the dental health of their children and are encouraged to act in close cooperation with their dentist to ensure the best possible follow up. 

Our role The role of the vascular surgeon is to treat pathologies of the veins and arteries, with the exception of the heart, the proximal segment of the aorta and the brain. We devote much of our time in consultations to screening and considering cardiovascular risk factors. Our very close collaboration with Interventional Radiology and Medical Imaging provides us with rapid access to the diagnostic examinations that are essential in deciding on the best course of action for our patients, whether medical, surgical, endovascular or mixed.    Image Our specialities The Erasmus Hospital Vascular Surgery Department treats the following pathologies:     Arterial disease : Carotid surgery – Endovascular or surgical treatment of the abdominal aorta  – Arteriopathy of the lower limbs, etc. Venous diseases (phlebology), in particular symptoms of chronic venous insufficiency of the lower limbs: varicose veins, varicose ulcers, etc. Vascular acrosyndrome. Examples: Raynaud’s syndrome, chilblains, etc. Pathologies relating to coagulation disorders. Examples : thrombophilia, anticoagulation, venous thromboses (clot, pulmonary embolism). Vascular surgeons cooperate closely with their colleagues from the Diabetic Foot Clinic, the Stroke Center (Neurology) and Nephrology, principally in relation to vascular access for dialysis and kidney transplants. 

What is malnutrition? Malnutrition is a condition in which the body does not function properly because it lacks essential nutrients. These nutrients are carbohydrates, fats and proteins, also known as macronutrients. Image There are several reasons why someone might be deficient in these nutrients:They do not eat enough.Their body cannot digest or absorb the food they have eaten.They have a serious illness that changes their nutritional needs. In this case, we refer to disease-associated malnutrition.In addition to macronutrients, our body needs micronutrients such as vitamins, trace elements and minerals. The reasons for a micronutrient deficiency may differ from those for a macronutrient deficiency. Care management Managing malnutrition requires several steps:Early screening of patients at risk: It is important to identify patients at risk of malnutrition as soon as possible, during the first contact with the patient, in consultation or on admission to hospital.Diagnosis of malnutrition: This is made when a combination of a cause and a visible consequence is present (unintentional weight loss, a body mass index (BMI) below normal, or a decrease in muscle mass or strength).Setting nutritional goals: Healthcare professionals set energy and protein intake goals to enrich the patient’s diet.Checking food intake: We check whether the patient is meeting these goals. If not, oral nutritional supplements may be offered to be taken between meals.Enteral nutrition: If nutritional supplements are not sufficient, enteral nutrition may be considered. This means that the patient receives food through a tube that reaches the stomach.Parenteral nutrition: As a last resort, if enteral nutrition is insufficient, parenteral nutrition may be considered. This means that the patient receives nutrition directly into the veins.Managing malnutrition requires close collaboration between different healthcare professionals, such as doctors, dietitians, nurses, speech therapists and pharmacists. Concrete cases There are several situations in which people can become malnourished and need special assistance with eating. For example:People with upper gastrointestinal cancer may have difficulty eating enough. They may need a tube inserted into their stomach or small intestine to help them eat.People with an eating disorder such as anorexia may also become malnourished. They may temporarily require enteral nutrition, meaning special food adapted to what their body can use.After bariatric surgery, patients may absorb insufficient amounts of certain nutrients. They need nutritional supplements to help prevent this.After a cerebrovascular accident, patients may have difficulty swallowing. They may need food with a modified texture or, sometimes, enteral tube feeding if their level of consciousness is reduced. Focus Home enteral or parenteral nutrition is managed by an experienced multidisciplinary team (doctors, dietitians and nurses). They assist with the placement of feeding tubes, educate patients and their relatives, and organise consultations for close follow-up. Several hundred patients at Erasme benefit from this type of follow-up. We have all the necessary facilities to identify, manage and monitor patients through a multidisciplinary team with extensive expertise and genuine know-how.  We have developed particular expertise in monitoring the nutritional problems of patients with pancreatic disease and oesophageal disease, for whom Erasme Hospital is an expert centre, thanks to our dedicated team and cutting-edge technologies.  The approved centre for parenteral nutrition has a multidisciplinary team that works closely together to ensure optimal care for patients requiring long-term parenteral nutrition following benign or malignant intestinal diseases. Erasme Hospital is an excellent choice for patients seeking high-quality care and long-term follow-up for diseases requiring specialised nutritional management.  Our specialists Associated services Publications Practical ESPEN guideline on clinical nutrition in acute and chronic pancreatitis. Arvanitakis M, Ockenga J, Bezmarevic M, Gianotti L, Krznarić Ž, Lobo DN, Löser C, Madl C, Meier R, Phillips M, Rasmussen HH, Van Hooft JE, Bischoff SC.Clin Nutr. February 2024;43(2):395–412.  Dietary strategies in patients with non-alcoholic fatty liver disease: from evidence to daily clinical practice—a systematic review. Hadefi A, Arvanitakis M, Trépo E, Zelber-Sagi S.United European Gastroenterol J. 2023 Sep;11(7):663-689. Percutaneous endoscopic jejunostomy: when, how, and when to avoid it. Gkolfakis P, Arvanitakis M.Curr Opin Gastroenterol. 2022 May 1;38(3):285-291.  Lien vers https://www.amub-ulb.be/revue-medicale-bruxelles/article/risque-de-denutrition-… Risk of malnutrition and confirmed malnutrition: updated diagnostic criteria. Preiser JC, Farine S.Rev Med Brux 2022;43(1):7-11. 

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