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The support center for smokers is made up of tobacco specialists whose role is to inform patients who wish to quit smoking, help them prepare, and support them throughout the process.Make an appointmentTel: 02 555 3773Responsible physicianProf. Jean-Paul Van VoorenTobacco specialistJacques DumontNurse, Pulmonology DepartmentTel: 02 555 3420E-mail: jacques [dot] dumont [at] hubruxelles [dot] be

The Brussels University Hospital (H.U.B) is the first hospital in Belgium to have acquired technology dedicated to biportal endoscopic surgery. The Brussels University Hospital (H.U.B) is the first hospital in Belgium to have acquired technology dedicated to biportal endoscopic surgery. An acquisition that further strengthens the expertise built up over a number of years ​ by the Department of Neurology in the field of minimally invasive spinal surgery, establishing the H.U.B as a pioneering hospital in Belgium. ​Two access routes to regain the technical freedom of conventional surgeryEndoscopic surgery involves introducing a camera into the treatment zone for a precise visualisation of the anatomical structures while at the same time operating through a limited surgical opening. In the case of a monoportal approach the camera and surgical instruments enter through the same access route. While this method already permits certain interventions through a very small incision, it can limit the technical possibilities available to the surgeon. The biportal approach uses two small and distinct access ​ routes. One is for the camera and visualisation, the other is for the surgical instruments. ​ This configuration gives the surgeon greater freedom of movement and permits the use of instruments similar to those used in conventional spinal surgery, while retaining the advantages of the endoscopic approach. ​“For the surgeon, the approach is particularly intuitive. We can operate on precisely those structures that are sometimes very deep or with difficult access without having to make a big opening to reach the treatment zone,” explains Dr Alphone Lubansu, Neurosurgeon and Director of the Spine Clinic at the Erasmus HospitalA technique used across many indicationsThe development of biportal endoscopic surgery at the H.U.B covers a growing number of indications, notably: ​ ​ ​ discal hernias, lumbar spinal stenosis, stabilisation surgery and arthrodeses, the draining of certain infections and vertebral biopsies. ​ It will ultimately be possible to use the endoscopic approach ​ for more complex spinal fusion procedures as is already happening in some expert centres in Asia and the United States“Endoscopy is probably one of the most important developments we have seen in minimally invasive spinal surgery. The biportal approach today allows us to envisage increasingly complex interventions through very limited access routes. It is a technological development that will progressively enlarge our surgical arsenal as well as our care offer,” stresses Professor Olivier de Witte, Director of the H.U.B Department of Neurosurgery.More rapid recovery for patientsOne of the benefits sought with endoscopy is to reduce the muscle and tissue trauma associated with surgery. ​ Less severe post-operative effects, earlier mobilisation and a shorter period of hospitalisation (reduced from 3 days to 1.5 days) can result. In the future, day hospitalisation can be envisaged. This development is also important in terms of the care pathway logic: ​ the aim is to enable the patient to ​ ​ regain their autonomy more rapidly and return more quickly to their family, professional or sports environment and at no extra cost. Thanks to the acquisition of this new technology, the H.U.B intends to continue to develop its neurological expertise and contribute to the expansion of endoscopic spinal surgery in Belgium. Its ambition is to become a reference centre for treating patients using this innovative approach and the associated training and development. ​ Contact our Neurosurgery Department

Contact the H.U.B Endoscopy Clinic You would like to:Make an appointment for an endoscopy at Erasmus Hospital: rendez-vous [dot] Endoscopie [dot] erasme [at] hubruxelles [dot] beMake an appointment for an endoscopy at the Jules Bordet Institute: accueil [dot] endoscopie [at] bordet [dot] beObtain the results of your endoscopy or your patient’s endoscopy at Erasmus Hospital: SecMed [dot] endoscopie [dot] erasme [at] hubruxelles [dot] beObtain the results of your endoscopy or your patient’s endoscopy at the Jules Bordet Institute: micheline [dot] vion [at] hubruxelles [dot] beMake an appointment for a consultation at Erasmus Hospital: ConsGastroMed [dot] erasme [at] hubruxelles [dot] be Endoscopy A minimally invasive technique for your digestive health Endoscopy is a procedure used to make a diagnosis and, if necessary, provide treatment through a minimally invasive approach, using instruments that allow visualization of the inside of the body (an endoscope). It enables examination of the esophagus, stomach, duodenum, small intestine, and colon. Image Image Image The Multiple Uses of Endoscopy It is possible to take tissue samples (biopsies), remove polyps or superficial tumors, treat bleeding, dilate narrowings (strictures), insert stents, treat conditions such as achalasia or diverticula, eradicate precancerous lesions (e.g., Barrett’s esophagus), and treat or prevent complications of cirrhosis (treatment of varices). Some procedures are combined with radiology or ultrasound, making it possible to see beyond the digestive tract and to treat biliary and pancreatic diseases. To Detect or Treat the Problem The H.U.B Endoscopy Clinic brings together all disciplines related to gastroenterology, hepatology, pancreatology, and digestive oncology, and works in close collaboration with the digestive surgery department. Its mission is to offer each patient the best minimally invasive diagnostic and therapeutic option according to their individual condition. Our Healthcare Services The Endoscopy Clinic offers patients a wide range of examinations at Erasmus Hospital (main site and day hospital) as well as at the Jules Bordet Institute.Depending on the type of examination, sedation or even anesthesia may be offered. A consultation with one of the team’s physicians is always possible before scheduling these procedures.Below is a non-exhaustive list of the main procedures available:Gastroscopy (esophagogastroduodenoscopy): examination of the upper digestive tract.Colonoscopy: examination of the lower digestive tract.Endoscopic retrograde cholangiopancreatography (ERCP or CPRE or CWR ): procedure on the bile ducts or pancreas.Endoscopic ultrasound (EUS): abdominal and/or thoracic exploration using an ultrasound probe brought close to the organs by means of an endoscope.Small bowel video capsule: exploration of the small intestine using a swallowed mini-camera.Enteroscopy: exploration of the small intestine for therapeutic purposes.Functional investigations of the esophagus: esophageal manometry and pH-impedance monitoring.Liver biopsyProctology consultationTo schedule an appointment with our proctology specialists, please contact us by phone at +32 (0)2 555 32 92 or by email at rendez-vous [dot] Endoscopie [dot] erasme [at] hurbuxelles [dot] beA number of other procedures are available and will be discussed on a case-by-case basis after consultation with a member of the gastroenterology team:Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD): removal of superficial tumors (esophagus, stomach, duodenum, colon, and rectum).Cholangioscopy (retrograde or percutaneous): visualization of the inside of the bile ducts: biopsy of a stricture / destruction of stones.Percutaneous cholangiography (CTH): access to and treatment of biliary diseases through the skin when ERCP is not possible.Cystogastrostomy: drainage of a fluid collection/abscess under endoscopic ultrasound.Hepatico-gastrostomy / cholecysto-bulbostomy: drainage of the bile ducts between the left liver and the stomach when ERCP is not possible / drainage of the gallbladder (cholecystitis) under endoscopic ultrasound.Gastrojejunostomy: creation of a connection between the stomach and the jejunum using a stent under endoscopic ultrasound when the duodenum is obstructed.Extracorporeal lithotripsy (ESWL): fragmentation of pancreatic stones by shock waves (treatment of chronic pancreatitis).Treatment of Zenker’s diverticulumPOEM (peroral endoscopic myotomy) for the treatment of achalasia.G-POEM: endoscopic myotomy for the treatment of gastroparesis.Radiofrequency ablation: thermal destruction of dysplasia (Barrett’s esophagus), or under endoscopic ultrasound for small pancreatic tumors.TIPS (Transjugular Intrahepatic Portosystemic Shunt): vascular stent placed to relieve problems related to portal hypertension.Treatment of digestive tract strictures by endoscopic dilation.Placement of prostheses or stents (esophageal, esophagogastric, duodenal, colonic) for the treatment of narrowings or fistulas.Obesity treatments: intragastric balloon, endoscopic gastroplasty.Treatment of surgical complications Image A major H.U.B contribution to the new European recommendations on the management of biliary strictures The new recommendations from the European Society of Gastrointestinal Endoscopy (ESGE) on the management of biliary strictures have just been published in the journal Endoscopy. The expertise of the H.U.B.’s Digestive Endoscopy Clinic is at the heart of this landmark publication. More info Our Team of Specialists Prof. Arnaud LEMMERS, Head of the Endoscopy ClinicHead of the Digestive Endoscopy Clinic at the Brussels University Hospital (H.U.B)Gastroenterologist, specialized in interventional endoscopyDepartment of Gastroenterology, Erasmus HospitalProf. Arnaud Lemmers specializes in interventional endoscopy (hepato-bilio-pancreatic endotherapy, endoscopic resection of tumors and polyps, treatment of dysplasia and Barrett’s esophagus, management of strictures, fistulas, achalasia, and Zenker’s diverticula).After clinical and endoscopic training with Prof. Jacques Devière’s team at Erasmus Hospital, he spent time in Tokyo in 2015 learning the technique of endoscopic submucosal dissection from Prof. Yahagi. His research, as well as that of his team, covers many aspects of endoscopy, with the aim of further developing minimally invasive patient care. He served as President of the Belgian Society of Digestive Endoscopy (BSGIE) from 2021 to 2024.View Prof. Lemmers’ publications Make an appointment Image Member of the medical team of the Endoscopy Clinic Department members:Prof. Arnaud LemmersProf. Sara Teles de CamposProf. Marianna ArvanitakisDr Michael FernandezConsultants:Prof. Jacques DevièreProf. Pierre EisendrathProf. Vincent HubertyDr Sohaib OuazzaniDr Mariana Figueiredo FerreiraAll these physicians specialize in diagnostic and therapeutic endoscopy. Members of the H.U.B Department of Gastroenterology Heads of DepartmentProf. Christophe MorenoProf. Jean-Luc Van LaethemClinic of Pancreatology and Nutritional SupportProf. Marianna ArvanitakisDr. Michael Fernandez Y ViescaDr. Alia HadefiClinic of Intestinal DiseasesProf. Denis FranchimontProf. Leila AmininejadProf. Anneline CremerProf. Claire LiefferinckxDr. Clémence VuckovicClinic of Functional Digestive DisordersProf. Hubert LouisDr. Cagla GulkilicClinic of Hepatology and Liver TransplantationProf. Christophe MorenoProf. Thierry GustotDr. Nathalie BoonProf. Delphine DegréDr. Laura Weichselbaum ConsultantsDr. Vincent BouillonDr. Mélanie BrognetProf. Myriam DelhayeProf. Pierre DeltenreProf. Jacques DevièreDr. Leo DuezProf. Pierre EisendrathDr. Mariana Figueiredo FerreiraProf. Philippe GolsteinDr. Sohaib OuazzaniDr. Thomas SerstéProf. Eric TrepoDr. Haydeh Vafa ZanjaniDepartment of Digestive OncologyProf. Jean-Luc Van LaethemProf. Anne DemolsProf. Francesco SclafaniDr. Ana Maria BucalauDr. France GayDr. Laura MansDr. Rita Saude CondeDr. Gontran VersetAll our physicians specialize in diagnostic endoscopy. The departments we collaborate with Digestive Oncology Lien vers Digestive Oncology Digestive surgery Lien vers Digestive surgery Radiology - Medical Imaging Lien vers Radiology - Medical Imaging Anatomopathology Lien vers Anatomopathology Interventional Radiology Lien vers Interventional Radiology Nuclear Medicine Lien vers Nuclear Medicine Intensive care Lien vers Intensive care Anaesthesiology Lien vers Anaesthesiology Emergencies Lien vers Emergencies Resources & useful links FICHE INFO - Préadmission - Informations de préparation à la colonoscopie - Hôp… FAQ about endoscopy 1. How is an endoscopy performed? Our explanatory sheets for the different procedures are available in the Resources and Useful Links section. 2. Do I need sedation or anesthesia for my endoscopy? Some procedures require sedation or anesthesia depending on the type of intervention, to ensure your comfort, avoid potential pain, or allow more complex procedures. It is best to discuss this with your doctor or schedule a consultation to determine the best option for you (tel: +32 (0)2 555.35.04). 3. How can I get the results of the examination? Please provide the secretariat with the contact details of your treating or referring physician so a copy of the report can be sent to them. A copy is also accessible via the health network. The physician performing your endoscopy will give you immediate information right after the procedure. If biopsies are taken, a follow-up consultation may be offered to review the results. 4. How can I make an appointment for an endoscopy? Your treating physician can write a request for the examination, which allows you to schedule an appointment directly through the secretariat (without anesthesia, Erasmus Hospital +32 (0)2 555.32.92; with anesthesia at the day hospital, Erasmus/Bordet +32 (0)2 555.85.85; without anesthesia at Bordet +32 (0)2 541.37.20). You can also discuss the procedure in consultation with a gastroenterologist beforehand (+32 (0)2 555.35.04). 5. How should I prepare for an endoscopy? For a colonoscopy, the inside of the colon must be clean. Details of colon preparation are available in the Resources and Useful Links section. 6. I take anticoagulants: should I stop them before the endoscopy? The rules for stopping anticoagulants depend on why you take them and the type of endoscopic procedure planned. Discuss this with your doctor. Some information is available in the Resources and Useful Links section. 7. Can I drive after my endoscopy? If sedation or anesthesia is used, you are not allowed to drive afterwards. Please arrange for someone to accompany you home. 8. For a procedure under anesthesia, do I need to see an anesthesiologist? If your endoscopy is scheduled under anesthesia, a prior anesthesia consultation will be proposed. If you have had anesthesia in the past 6 months without new medical issues, a new consultation is not required. Discuss this with your doctor and make sure your previous anesthesia record is available. 9. During the procedure, can I see the inside of my digestive tract? Photos are taken during the endoscopy. At your follow-up gastroenterology consultation, you can request to see these photos and receive explanations from the doctor. 10. How often should I repeat endoscopic exams? The recommended intervals depend on the health issue for which the examination was done. For example, there is usually no reason to repeat a gastroscopy for mild esophagitis for several years. For follow-up after removal of colonic polyps, intervals are also well standardized. Discuss your personal follow-up schedule with your gastroenterologist. Health Issues Managed by the Endoscopy Clinic Colorectal cancer Slow digestion Bile duct diseases (strictures, stones, and leaks) Esophageal dysplasia

The new recommendations from the European Society of Gastrointestinal Endoscopy (ESGE) on the management of biliary strictures have recently been published in the journal Endoscopy. This publication represents an important step forward for digestive endoscopy practice in Europe. It provides evidence-based recommendations to guide the management of benign and malignant biliary strictures, including through endoscopic retrograde cholangiopancreatography (ERCP) and therapeutic endoscopic ultrasound (EUS).H.U.B expertise at the heart of these recommendationsThe H.U.B. is strongly represented in this work: Prof. Arnaud Lemmers, Director of the  Digestive Endoscopy Clinic is the first author and personally coordinated the development of these guidelines together with a panel of international experts. Prof. Sara Teles de Campos, Gastroenterology, specialising in therapeutic endoscopy, and Prof. Marianna Arvanitakis, also specialising in therapeutic endoscopy and Director of the Pancreatology and Nutritional Support Clinic, are also among the co-authors.The development of these recommendations, commissioned by the ESGE in 2025, brought together several groups of experts and included a systematic review of the scientific literature following the GRADE methodology. The document notably updates previous recommendations on biliary stenting and incorporates recent developments in endoscopic techniques and therapeutic endoscopic ultrasound.Recommendations set to become a reference for the years to comeAmong the key developments, the guidelines clarify the role of different types of stents in benign and malignant strictures, drainage strategies according to the location of the stricture and the patient’s anatomy, and the role of endoscopic ultrasound when ERCP is unsuccessful or cannot be performed.These recommendations now constitute a European reference for specialists involved in the endoscopic management of biliary diseases and will contribute to harmonising clinical practice through an evidence-based approach tailored to each clinical situation.Congratulations to Prof. Arnaud Lemmers, Prof. Sara Teles de Campos and Prof. Marianna Arvanitakis, as well as to all the international experts, on this important work, which contributes to the scientific reputation of the H.U.B and to the continued development of digestive endoscopy! Consult the new ESGE guidelines

What are interstitial pneumonias? Diffuse interstitial pneumonias are a group of relatively rare lung diseases. They are disorders of the lung parenchyma (that is, of the lung itself) with a varying degree of inflammation and fibrosis resulting in a sometimes severe respiratory insufficiency.  The principal pathologies covered by this term are •    Idiopathic pulmonary fibrosis •    Sarcoidosis •    Non-specific interstitial pneumonia •    Cryptogenic organising pneumonia •    Lung disorders secondary to autoimmune diseases (connective tissue disease and vasculitis)  •    Hypersensitivity pneumonitis (farmer‘s lung, bird fancier’s lung •    Some pneumonias of occupational origin (exposure to asbestos or to mineral or metal dust) or drug induced Idiopathic pulmonary fibrosis (IPF) Idiopathic pulmonary fibrosis (IPF) is the most common disease of this group, together with sarcoidosis. The annual incidence is estimated at 10 new cases for 100,000 persons per year and this figure seems to be rising. In IPF the lung is progressively destroyed and replaced by scar tissue. This results in an irreversible and progressive respiratory insufficiency.  Causes and risk factors Its etiology is unknown but smoking, pollution, exposure to certain viruses and the presence of gastroesophageal reflux are risk factors. There are also family forms in which gene mutations have been clearly identified.  IPF affects more men than women and is generally diagnosed at around the age of 60.  Diagnosis and treatment These diseases are rare and therefore demand particular expertise. The diagnosis is complex and requires a multidisciplinary discussion.  In the case of idiopathic pulmonary fibrosis there are two possible treatments: with Esbriet or Ofev. These do not cure the diseases but do make it possible to slow its progress.  If the patient shows no contraindications a lung transplant must be envisaged. In this particular case we work closely together with the lung transplant team. Multidisciplinary meetings are held regularly to discuss complex cases and we have a clinical research unit that permits access to an advanced research programme in this field and patients are invited to participate in international trials to test new treatments.  The Erasmus Hospital is a member of the European experts network in the field of diffuse interstitial pneumonia (ERN lung). We are active in the field of clinical research by providing the opportunity to participate in research protocols and clinical trials.  Finally, we support and participate actively in activities organised by patients’ associations, in particular the   Association Belge Francophone contre la Fibrose Pulmonaire (ABFFP). Useful documents Informations destinées aux patient(e)s Brochure : thérapie par Esbriet (pirfénidone) Brochure : Fibrose Pulmonaire Idiopathique (FPI) Brochure : traitement de votre Fibrose Pulmonaire Idiopathique (FPI) avec OFEV® File information_patient_pid_hub_v3.pdf File 1.2.d_interventions.pdf Requests for opinion Téléchargez le document de demande d'avis de la part du médecin traitant ou spécialiste à destination de la Clinique des pneumopathies interstitielles diffuses. Demande d'avis Multidisciplinary team Découvrez l'équipe multidisciplinaire de la Clinique de Pneumopathies interstitielles et diffuses. Organisation chart Our specialists

Qu’est-ce que c'est ? Les immunodéficiences primaires sont des maladies rares, le plus souvent d'origine génétique, dans lesquelles une partie du système immunitaire ne fonctionne pas correctement dès la naissance. Elles touchent aussi bien l'enfant que l'adulte, parfois révélées tardivement. Le plus souvent, elles se traduisent par des infections qui reviennent souvent, durent longtemps ou guérissent mal ; certaines s'accompagnent de manifestations auto-immunes ou inflammatoires. Reconnaître ces signes permet un diagnostic et une prise en charge adaptés. Un avis spécialisé, sur orientation de votre médecin traitant, est recommandé en cas d'infections inhabituelles et répétées. Bilan et diagnostic Notre Unité de traitement des immunodéficiences réunit, autour du patient, internistes-immunologues, pédiatres, biologistes, pneumologues, gastro-entérologues et infectiologues. La démarche commence par un bilan immunologique : dosage des anticorps (immunoglobulines IgG, IgA, IgM), évaluation de la réponse aux vaccins, analyse des cellules immunitaires et, lorsque c'est utile, un test génétique. Ce bilan permet de poser un diagnostic précis et d'identifier le type de déficit. La prise en charge est personnalisée : prévention et traitement rapide des infections, vaccinations adaptées, et, pour de nombreux déficits en anticorps, un traitement substitutif par immunoglobulines administré à l'hôpital (voie intraveineuse) ou à domicile (voie sous-cutanée). Le suivi régulier vise à dépister et traiter les complications éventuelles (auto-immunes, pulmonaires ou digestives) et à adapter le traitement dans le temps. Cette approche multidisciplinaire et coordonnée, de l'enfance à l'âge adulte, améliore la qualité de vie et réduit le risque de complications. Conseils Au quotidien, des gestes simples aident à limiter les infections : vaccinations à jour, bonne hygiène des mains, soins dentaires réguliers et traitement rapide des infections. La plupart des épisodes se gèrent en ambulatoire. Il faut toutefois consulter sans tarder, voire se rendre aux Urgences selon l’avis de nos médecins spécialistes disponibles, en cas de fièvre élevée et persistante, de difficultés à respirer, d'altération brutale de l'état général, de raideur de la nuque ou de signe infectieux sévère. En cas de doute, contactez votre équipe soignante : mieux vaut un appel de trop. Trajet de soins spécifiques 1. Premiers signes et orientation — Des infections ORL, bronchiques ou pulmonaires qui reviennent souvent, traînent ou répondent mal aux traitements habituels peuvent faire évoquer un déficit immunitaire. Le médecin traitant ou le pédiatre oriente alors vers la consultation spécialisée.2. Bilan et diagnostic — Une prise de sang mesure les anticorps (IgG, IgA, IgM) et la réponse aux vaccins ; l'analyse des cellules immunitaires et, parfois, un test génétique complètent le bilan. Ces examens permettent de confirmer le diagnostic et d'en préciser le type, comme le déficit immunitaire commun variable (DICV), le plus fréquent chez l'adulte.3. Mise en route du traitement — Lorsque le déficit en anticorps est confirmé, un traitement substitutif par immunoglobulines est généralement proposé, par perfusion intraveineuse à l'hôpital ou par voie sous-cutanée à domicile. Il s'accompagne d'un traitement rapide des infections et de vaccinations adaptées.4. Suivi au long cours — Des consultations régulières permettent de surveiller l'efficacité du traitement, d'ajuster les doses et de dépister d'éventuelles complications auto-immunes, pulmonaires ou digestives. Le suivi est coordonné entre les différents spécialistes.5. Vie quotidienne et accompagnement — L'éducation thérapeutique, le soutien des associations de patients et, pour les enfants, l'organisation de la transition vers l'équipe adulte aident à vivre au mieux avec la maladie. Image Transition vers l’âge adulte De nombreuses immunodéficiences primaires diagnostiquées dans l'enfance nécessitent un suivi tout au long de la vie. Pour assurer une continuité sans rupture, le passage de la pédiatrie vers la médecine adulte est préparé à l'avance, de façon progressive et accompagnée. Le jeune patient rencontre l'équipe adulte, apprend à mieux connaître sa maladie et son traitement, et gagne en autonomie. Pédiatres et médecins d'adultes échangent les informations médicales afin que le relais se fasse en confiance, sans perte d'information ni interruption de la prise en charge. Focus / Recherche Notre équipe participe à la recherche internationale sur les erreurs innées de l'immunité. Les travaux de Jean-Christophe Goffard, menés en collaboration avec de grands réseaux académiques, ont notamment contribué à comprendre pourquoi certaines personnes développent des formes graves d'infections virales : ils ont montré le rôle d'auto-anticorps dirigés contre les interférons de type I — des molécules clés de la défense antivirale — et de déficits immunitaires sous-jacents, par exemple dans la COVID-19 sévère. Cette recherche améliore le diagnostic des immunodéficiences et ouvre la voie à des prises en charge plus personnalisées. Nos Spécialistes Service associé

What is dysphagia? Eating, drinking, swallowing saliva… actions we perform every day without thinking about them. Yet, for some people, swallowing becomes difficult, painful or even dangerous. Dysphagia refers to swallowing disorders, that is, difficulties in properly passing food, drinks or saliva from the mouth to the stomach. It can occur at any age and have many causes. It may be due to a neurological cause (neurodegenerative disease, neuromuscular disease, cerebrovascular accident), a surgical cause (ENT, respiratory or cardiac surgery), prolonged intubation, ageing, certain medications, etc.  Dysphagia should not be trivialised: it can lead to weight loss, dehydration, or food or liquids entering the airways. Appropriate care can reduce these risks and preserve, as much as possible, the pleasure of eating and drinking.  When the problem is located in the mouth or throat This is referred to as oropharyngeal dysphagia. For example, the person may have difficulty preparing food in their mouth, initiating swallowing, or moving food and drinks towards the oesophagus. When the problem is located lower down This is referred to as oesophageal dysphagia. The person may feel that food is stuck or moves down with difficulty between the throat and the stomach. Dysphagia may be temporary or long-lasting. Key point: dysphagia is not a single disease. It is a symptom or disorder that can have various causes.  What are the symptoms? The signs are not always the same from one person to another. They may include: Coughing or choking during or after eating or drinking;Regularly needing to clear one’s throat during meals;Having a “wet” or hoarse voice after swallowing;Feeling as though food is stuck in the throat or chest;Having difficulty chewing;Keeping food in the mouth for a long time before swallowing it;Needing much more time to finish a meal;Food or drinks escaping through the mouth or sometimes the nose;Experiencing pain when swallowing;Avoiding certain foods or drinks because they are difficult to swallow;Drinking or eating less than before;Losing weight unintentionally;Having repeated episodes of respiratory infection or pneumonia.  Warning: it is sometimes possible to “aspirate” WITHOUT coughing Aspiration occurs when food, a drink or saliva enters the airways instead of passing into the oesophagus. This can sometimes happen without coughing or any obvious sign. This is known as silent aspiration. This is one of the reasons why a medical assessment may be necessary when several signs suggest dysphagia. How common is dysphagia in Belgium? To date, there is no sufficiently robust national Belgian figure to determine precisely how many people have dysphagia in Belgium. This difficulty is not specific to Belgium: international studies produce very different results depending on the age of the people studied, their state of health and, above all, how dysphagia is screened for or diagnosed. European recommendations generally estimate its prevalence at 10 to 20%, while emphasising that the level of evidence is low and that estimates vary according to the populations and definitions used.  Nevertheless, the available data show that dysphagia is particularly common in certain populations: Among older people living at home, studies report highly variable estimates; a recent meta-analysis estimates the pooled prevalence at approximately 18%.Among older people living in a care home, the pooled prevalence is approximately 47% in a meta-analysis.Among hospitalised older people, it may reach approximately 38%, depending on the method used to detect it.After a cerebrovascular accident, studies report particularly high rates, with estimates varying considerably according to the populations and assessment methods. One meta-analysis reports a prevalence of 55.4% among people who have had a cerebrovascular accident.  These figures cannot be directly extrapolated to the Belgian population as a whole. They mainly help explain why dysphagia is an important problem, particularly among older people or those with certain diseases.  Main sources for the figures UEG/ESNM, 2025 clinical guidelines: general prevalence estimated at 10–20%, with substantial variability according to the definitions and populations. Zhao et al., Prevalence and Methods for Assessment of Oropharyngeal Dysphagia in Older Adults, meta-analysis: 18.39% among older people living in the community, 46.98% in institutions and 37.98% in hospital. Dziewas et al./systematic review of care settings: 36.5% in hospital, 42.5% in rehabilitation and 50.2% in care homes. Wang et al., global meta-analysis: substantial variability according to the populations; 55.4% among patients who had suffered a cerebrovascular accident in the included studies.  What are the causes of dysphagia? Dysphagia can have many causes. It may notably be associated with: A cerebrovascular accident;Parkinson’s disease or other neurological diseases;Multiple sclerosis;Certain neuromuscular diseases;Dementia;Cancer of the mouth, throat or oesophagus;Surgery or radiotherapy in the head and neck region;Certain abnormalities of the oesophagus;Significant frailty or loss of muscle strength related to ageing.  The cause must therefore be investigated on a case-by-case basis.  How is dysphagia diagnosed? The first step generally consists of listening to the difficulties experienced by the person and taking a complete medical history: which foods cause problems? When does the coughing occur? Are liquids more difficult to swallow than solid foods? Has there been any weight loss or respiratory infections? Has there been a loss of appetite? Etc.  A healthcare professional can then carry out a thorough motor examination of the orofacial sphere, observe the person while they are eating and perform various swallowing tests. Depending on the symptoms and the suspected cause, additional examinations may be necessary. A specialist assessment A speech therapist specialising in swallowing disorders can assess how the person chews and swallows and identify the difficulties they are experiencing. Other specialists may be involved depending on the cause: general practitioner, ENT specialist, gastroenterologist, neurologist, dietitian, physiotherapist, nurse or other healthcare professionals. More in-depth examinations In certain situations, it is necessary to directly observe what happens during swallowing. Two examinations may in particular be used: Videofluoroscopy: an X-ray examination performed while the person swallows different consistencies;Fiberoptic Endoscopic Evaluation of Swallowing (FEES): a small flexible camera is used to observe the throat during swallowing.  These examinations provide a better understanding of where and why swallowing is problematic and help tailor the care provided.   How is dysphagia treated? There is no single treatment. Management depends on the cause, the type of dysphagia and each person’s abilities. The aim is twofold: to make swallowing as safe and effective as possible and to enable the person to continue eating and drinking in the best possible conditions. Swallowing rehabilitation The speech and language therapist may suggest exercises and techniques designed to improve certain movements or stages of swallowing. They may also teach different strategies: modifying the position of the head, adapting how a bite or sip is taken, slowing the pace of the meal, implementing safe postures, adapting the patient’s food textures, … Adapting food and drinks In some cases, it is necessary to temporarily or permanently modify the texture of food or the consistency of drinks. For example, certain foods can be chopped, blended or made easier to chew. Drinks can also be thickened when indicated. These adaptations must be personalised: a texture suitable for one person may not necessarily be suitable for another. The IDDSI (International Dysphagia Diet Standardisation Initiative) system enables the use of a common international classification to describe food textures and drink consistencies.  Treating the cause Whenever possible, treating the disease or problem causing the dysphagia is also essential. Preventing malnutrition and dehydration If the person is no longer able to eat or drink enough, a dietitian can adapt their food intake and suggest solutions to maintain a sufficient intake of energy and fluids. In some situations, tube feeding may be considered. This decision is made on a case-by-case basis with the person and the medical team. Management is therefore often multidisciplinary, involving several professionals working together.   Why should dysphagia be taken seriously? Unidentified or poorly managed dysphagia can have several consequences: Aspiration → respiratory infection Food or liquids may enter the airways and cause, in particular, aspiration pneumonia. Difficulty eating → malnutrition The person may gradually reduce the amount they eat or avoid certain foods. Difficulty drinking → dehydration Drinking may become difficult or tiring, which can lead to insufficient fluid intake. Difficult meals → loss of enjoyment Eating may become a source of worry, fatigue or social isolation.   When should you seek medical attention? Difficulty swallowing that recurs or persists should be discussed with a healthcare professional. It is particularly important to seek medical advice in the event of: Frequent coughing or choking during meals;A repeated sensation of food becoming stuck;Unexplained weight loss;A significant reduction in the amount of food or drink consumed;Repeated respiratory infections;A change in voice after swallowing;Difficulty that appears suddenly.  Sudden difficulty swallowing, particularly when accompanied by weakness on one side of the body, speech impairment or facial drooping, may be a sign of a cerebrovascular accident and constitutes a medical emergency.  Our specialists ENT Department: 02/555.37.75 ENT specialists in swallowing disorders:  Dr Nicolas ROPERDr Céline LAURENT  Speech therapists in the ENT Department:  Loriana SNELAlix LE JEMTEL   Discover our ENT department FAQ on dysphagia 1. Does dysphagia mean that I will inevitably choke? No. Dysphagia can take different forms, and its severity varies from one person to another. It may simply cause a sensation of blockage, make certain foods difficult to swallow, or lead to aspiration. 2. Is it normal to have more difficulty swallowing as you get older? Ageing can alter certain functions involved in swallowing. However, regular difficulty swallowing should not be considered a normal consequence of ageing. An assessment can help identify a cause and suggest solutions. 3. Why do I cough when I drink water? Coughing during or immediately after drinking may be a sign that the liquid is not passing properly into the oesophagus. This does not necessarily mean that you have dysphagia, but if it happens frequently, it is best to discuss it with a healthcare professional.   4. Is it possible to have dysphagia without coughing? Yes. Some aspiration episodes can be silent, without coughing or any obvious signs. 5. Can dysphagia go away? Yes, in certain situations. It may be temporary, particularly when it is related to an acute condition or certain treatments. In other cases, it may last longer and require rehabilitation or adaptations.  6. Can you still eat normally with dysphagia? It depends on the situation. Where possible, the aim of care is to enable the person to continue eating and drinking by mouth under appropriate safety conditions. 7. Why do drinks sometimes need to be thickened when you have dysphagia? Some people have greater difficulty controlling very thin liquids. In these situations, an adapted consistency can facilitate control of the drink during swallowing. This adaptation should be recommended following an appropriate assessment.  8. Who should you consult for dysphagia? Several professionals may be involved: a doctor, speech therapist, dietitian, nurse, physiotherapist, ENT specialist, gastroenterologist, neurologist, and so on. The professional involved depends in particular on the cause and the difficulties encountered. 9. Can dysphagia lead to weight loss? Yes. Difficulties swallowing can lead to eating less, avoiding certain foods or considerably prolonging mealtimes. This can contribute to malnutrition.   10. What should I do if I think I have dysphagia? Talk to your doctor or another healthcare professional. Do not wait until the difficulties become significant, especially if you regularly cough while eating or drinking, lose weight, or experience recurrent respiratory infections.

What is thrombotic microangiopathy? Thrombotic microangiopathies (TMAs) are a group of rare diseases characterised by the formation of small clots in very small blood vessels. These clots can lead to a reduced platelet count, destruction of red blood cells (haemolytic anaemia), and damage to various organs, particularly the kidneys, brain and heart. The main forms of TMA are thrombotic thrombocytopenic purpura (TTP) and atypical haemolytic uraemic syndrome (aHUS).TMAs constitute a diagnostic and therapeutic emergency. Rapid management can now considerably improve patients’ prognosis. When should TMA be suspected? Symptoms may appear suddenly and vary from person to person:Severe fatigue related to anaemia;Bruising or bleeding related to a drop in platelet count;Decreased kidney function;High blood pressure;Neurological disorders (headaches, confusion, visual disturbances, seizures);Abdominal pain or involvement of other organs. How is the diagnosis established? Diagnosis is based on a rapid assessment carried out by specialised teams.Tests generally include:A complete blood count;Tests for signs of haemolysis;Examination of a blood smear to look for schistocytes;Assessment of kidney function;Measurement of ADAMTS13 activity to identify TTP;Specialised analyses of the complement system when atypical haemolytic uraemic syndrome (aHUS) is suspected;Additional tests to identify an underlying cause. Our care at HUB The management of thrombotic microangiopathies at HUB is based on close collaboration between several specialties to ensure rapid diagnosis and treatment tailored to each patient.Nephrology expertiseAs the kidneys are frequently affected in thrombotic microangiopathies, patients receive a specialist assessment within the HUB Nephrology Department. Nephrologists provide diagnosis, monitor kidney function and, when necessary, implement specialised treatments such as dialysis or targeted treatments for complement-mediated forms.Multidisciplinary careDepending on the clinical situation, various specialists work together to care for the patient:Nephrology;Haematology;Internal medicine;Intensive care;Neurology;Cardiology;Medical genetics;Specialised laboratories.This multidisciplinary approach ensures comprehensive, personalised care. What treatments are available? Treatment depends on the type of thrombotic microangiopathy (TMA) identified.Depending on the situation, it may include:Plasma exchange;Immunomodulatory treatments;Treatments targeting the complement system;Management of an underlying cause (infection, autoimmune disease, medication, pregnancy, transplantation, etc.);Specialised renal care, including dialysis if necessary. Research and innovation at HUB HUB actively contributes to the advancement of knowledge in the field of rare kidney diseases and thrombotic microangiopathies.Where relevant, patients may benefit from access to clinical research protocols, specialised diagnostic analyses, and the expertise of national and international reference centres.This research activity helps improve diagnosis, understanding of disease mechanisms, and the development of new treatments. Why choose HUB? Recognised expertise in nephrology and complex kidney diseases;Specialised multidisciplinary collaboration;Access to specialised diagnostic tests;Management of emergency situations;Participation in expert networks and research projects;Personalised support for patients and their families. Collaboration with HUDERF Some thrombotic microangiopathies, particularly forms associated with genetic abnormalities of the complement system, may manifest during childhood. HUB works closely with the Queen Fabiola Children’s University Hospital (HUDERF) to ensure coordinated care for children and adolescents affected by these rare diseases.For patients receiving paediatric care, a transition programme is organised between the paediatric and adult teams. This gradual transition ensures continuity of care, the transfer of essential medical information and support for the young patient towards autonomous care in adulthood.Nephrologists, paediatricians, geneticists and other relevant specialists work closely together to ensure optimal follow-up throughout the care pathway, from childhood to adulthood. Our specialists Associated department

Our specialists

Department overview The Adult Endocrinology Clinic provides diagnosis and follow-up for adult patients with an endocrine problem, i.e. a condition affecting the secretion of a hormone (excessive or insufficient secretion) and/or the gland that secretes it. The department manages conditions affecting the thyroid, parathyroid glands, adrenal glands, gonads (ovaries and testicles), and pituitary gland.Since 2016, the Erasme Hospital Endocrinology Department, together with the Queen Fabiola Children’s University Hospital (HUDERF) for paediatric care, has been part of the ENDO-ERN network (European Reference Network for Rare Endocrine Conditions), the European Reference Network for rare endocrine diseases.The mission of this network is to improve access to high-quality care for patients with rare endocrine disorders. It supports clinical research and contributes to the creation of registries listing patients receiving follow-up for rare conditions, in order to promote knowledge sharing and improve clinical practice.The management of rare endocrine diseases is multidisciplinary. Regular consultations are organised to discuss complex cases with numerous specialists within our institution, as well as through virtual consultations with recognised European experts via the ENDO-ERN network or during international multidisciplinary consultation meetings (France).Some endocrine diseases begin at birth or during childhood and require lifelong treatment and follow-up. Transition consultations have been provided for many years with our paediatric colleagues at HUDERF to ensure the smoothest possible transition from paediatric to adult care. What is pituitary insufficiency? The pituitary gland is a pea-sized gland located at the base of the brain, behind the nose. It acts as the conductor of most of the body’s other glands. It produces several hormones that regulate the secretion of hormones by other glands (the thyroid, ovaries or testes, and adrenal glands). It also produces growth hormone and releases prolactin, which plays an important role during pregnancy and breastfeeding, as well as vasopressin, a hormone involved in maintaining the body’s water balance.Some people have a pituitary gland that does not function, either partially or completely, and consequently have deficiencies in hormone secretion. Depending on which hormones are affected, their functions, and the age at which the insufficiency develops, the symptoms experienced by patients may vary: growth retardation and/or delayed puberty in children and adolescents, fatigue, hypoglycaemia, dizziness, a drop in blood pressure, abdominal pain, nausea, unexplained weight loss or gain, libido disorders, cessation of menstruation, etc. Vasopressin deficiency causes the kidneys to eliminate large amounts of water; patients urinate excessively both during the day and at night. As a result, they are very thirsty and drink a great deal to compensate.Pituitary diseases may be caused by congenital conditions (abnormal development of the gland) that are present from birth, but are most often related to conditions acquired later in life. These conditions may be tumours (most often benign), inflammatory, haemorrhagic or, more rarely, infectious. Pituitary hormone deficiencies may also occur following treatment of tumours located in this region, through surgery and/or radiotherapy.  Diagnosis and management Pituitary disease is often investigated based on the patient’s symptoms (headaches, vomiting, hypoglycaemic episodes, abnormal weight gain or loss, menstrual disorders, reduced libido, etc.) or as part of an assessment of delayed growth or puberty in children. Hormonal deficiencies are systematically investigated after surgery or radiotherapy to the pituitary region. A simple blood test is usually sufficient to diagnose pituitary insufficiency. However, other tests, known as “dynamic” tests, may sometimes be required to confirm the diagnosis: a substance is administered by infusion to stimulate hormone secretion; in cases of insufficiency, the level of the hormone in question will not rise appropriately.These tests are performed on an outpatient basis, usually during one morning, with a specialist nurse, in a dedicated room in the Endocrinology consultation building.  A magnetic resonance scan of the pituitary gland completes the assessment to determine the cause of the insufficiency. In some cases, genetic testing is also offered, as well as other laboratory or radiological examinations depending on the suspected cause.Regardless of the cause of pituitary insufficiency, hormone replacement therapy is offered. The missing hormone is replaced by daily capsules and/or tablets, with a dose adjusted to each patient’s needs (thyroid hormone, adrenal hormone = cortisol, sex hormones). Some hormones are administered by injection, such as growth hormone or testosterone. Vasopressin can be taken orally or administered as a nasal spray. If the cause is a tumour, surgery is usually offered, particularly if the tumour is large and may cause other complications.  Advice for patients It is very important to take the thyroid hormone and adrenal hormone (cortisone) correctly every day. Cortisone is an essential hormone for feeling well and energetic, maintaining good blood pressure and having energy, but also for responding to situations that put the body under stress (infection, fever, gastroenteritis, surgery, anaesthesia, trauma). The doses are adjusted according to the blood test results, but also according to the patient’s own feelings and experience and the clinical examination, particularly in the case of cortisone (level of fatigue, weight, blood pressure, etc.). The cortisone dose must be increased in situations that put the body under stress. In the event of repeated vomiting preventing proper oral administration, cortisone may be administered intramuscularly by a family member or an on-call doctor.  In situations of major stress, such as surgery, anaesthesia or a serious infection, cortisone must be administered at a higher dose intravenously.  Patients with cortisol deficiency and their families are informed about situations requiring an increase in the doses. A nurse shows them how to inject cortisone intramuscularly when necessary. They all carry a card in their wallet indicating their cortisol deficiency and the need to increase the doses in the event of stress. They are encouraged to show this card to the doctors caring for them, particularly in the event of surgery or a visit to the Emergency Department. Growth hormone is administered every evening by daily subcutaneous injection, most often in the abdomen, using a pen that must be kept in the refrigerator. The dose is adjusted according to the blood test results and the child’s growth progression. In adults, it no longer plays a role in growth but may improve quality of life and have a beneficial effect on body composition (the ratio of fat to muscle).   Transition to adulthood During adolescence, a gradual preparation for the transition to adult care is organised. This step helps strengthen the young patient’s autonomy, ensure continuity of medical follow-up and transfer all the necessary information to the specialised adult service. The transition is planned in collaboration with the patient, their family, and the paediatric and adult teams. Focus: Expertise Patients are treated by a licensed adult endocrinologist. Hormone assays and genetic tests are performed in a specialised laboratory. We work closely with the radiology and neurosurgery departments. Magnetic resonance imaging is of high quality and can be supplemented by functional imaging (methionine PET, choline PET). The neurosurgeons are experts in pituitary surgery. Patients requiring additional treatment after surgery may benefit from a targeted radiotherapy technique, the gamma knife, which is available in only a few hospitals in Belgium.Complex pituitary cases are discussed during monthly multidisciplinary meetings with expert neurosurgeons and neuroradiologists. An on-call service is available 24 hours a day. Our centre is actively committed to improving knowledge and care for patients with rare endocrine diseases. A local registry has been established and feeds into a European ERN database dedicated to the pituitary gland. The aim is to optimise follow-up practices and compare the management of patients between different specialised centres.Particularly rare and/or complex cases are also discussed with international experts. The team receives ongoing training, participates in conferences and seminars, initiates and collaborates on studies, and publishes in the field of pituitary medicine. It also provides training and teaching for students and doctors in training.  Our specialists

Are you a doctor wanting to obtain your patients’ medical results? Siege [dot] Clini-obs [dot] erasme [at] hubruxelles [dot] be (Contact the Breech Clinic directly ) Is your baby in the breech position? Let’s talk about your delivery options The Erasmus Hospital Breech Clinic supports patients and couples whose baby is in the breech position after 36-37 weeks of pregnancy. Image Image Image In 2023, approximately 4% of pregnancies in Brussels and 5% in Wallonia were in the breech position at term. Up to 92% of Caesarean deliveries were carried out for this reason alone, not all of which were justified. Given the right conditions, there is no reason why a vaginal delivery cannot be considered as an option for these babies   (Ref. : Van Leeuw V, Leroy Ch. Santé périnatale en Région bruxelloise – Année 2023. Centre d’Épidémiologie Périnatale, 2024).In 2016 the Erasmus Hospital put into place a care pathway to accompany future mothers and  parents in making their decisions, providing them with clear and detailed information on the available care options, including that of performing a version to turn the baby.  In 2016 the Erasmus Hospital put into place a care pathway to accompany future mothers and  parents in making their decisions, providing them with clear and detailed information on the available care options.    The breech delivery options After 36 weeks of pregnancy, we have a meeting at which we discuss the  possibility of carrying out an External Cephalic Version (ECV), This procedure  involves an obstetrician, assisted by ultrasound parameters, applying  manual external pressure that causes your baby to flip to a head-down position. If the ECV is unsuccessful or if you decide not try it, a pelvimetry (a scan to measure the size of your pelvis) is proposed to explore the possibilities of a vaginal delivery.   We also discuss the various  delivery options: vaginal, a possibility given the right conditions, or a Caesarean.Finally, if you opt for a vaginal delivery,  specific preparations are proposed for a breech birth. We also propose appointments to look at the various delivery options for your breech baby.A physiological approach will be favoured for the delivery of your foetus in a breech position.   The gentle C-section at the H.U.B Erasmus Hospital Dr. Sara Derisbourg Gynaecologist obstetricianSpecialities: monitoring high risk pregnancies, prenatal monitoring (clear information, ECV, etc.) and delivery of breech foetuses, follow-up of breastfeeding complications (committee member of the Baby-Friendly Hospital Initiative, Erasmus Hospital).   Doctor Sara Derisbourg is working on a thesis on caring for breech babies at term. She was actively involved in opening the Breech Clinic, helping to develop the care pathway, brochures and other resources. A specialised team dedicated to the well-being of you and your baby DoctorsDr De ConinckDr DerisbourgDr Di GiovanniDr GarofaloDr LamyDr MinckeDr RomnéeDr ValcarenghiDr VercoutereDr ZaytouniMidwivesPauline Eon, head midwife of the delivery room, Maternal Intensive Care (MIC) and the CoconMartine PierreuxMarie TrullemansDelivery room midwifery team  The departments we work with Anaesthesiology Lien vers Anaesthesiology Paediatrics Lien vers Paediatrics Ressources BROCHURE - Mon bébé est en siège FICHE - Accouchement d'un bébé en siège ARTICLE - La naissance en siège VIDEO - My baby is in a “breech position”: What should I do? La Maison des Mate… VIDEO - The VME to Help Babies Roll Over - La Maison des maternelles VIDEO - Gentle Cesarean: A Gentle Cesarean at Erasme Hospital 1. Why is my baby in the breech position ? In most cases, there is no identified cause for the baby being in the breech position.However, it could be linked to: Uterine malformations, the presence of fibromas.A reduction in amniotic liquid.The insertion of the placenta praevia or low placenta 2. Is the external cephalic version (ECV) a painful procedure? In most cases, the procedure is not painful. It is generally described as uncomfortable or unpleasant. About 5 to 7% of patients report pain following the procedure. However, during the procedure, we encourage you to communicate with the practitioner and report any pain you may experience. The procedure will be stopped if the pain becomes intolerable. 3. Is the ECV painful for my baby? We have no evidence to suggest that an external version would be painful for the baby.  In general, pain in utero is indicated by an increase in heart rate. The fetal heart rate will be monitored before, during, and after the external version. If there are any concerns or doubts, the procedure will be stopped. 4. Is a Caesarean always indicated for a baby in the breech position? No. In fact, if the obstetric and medical conditions of both the patient and the baby are favorable, a vaginal delivery of a breech baby is entirely possible. 5. Is a vaginal delivery more painful for a breech baby than for a baby in a head-down position? There is no scientific evidence to suggest that giving birth to a baby in a breech position is more painful than giving birth to a baby in a head-first position. Childbirth without an epidural is painful in the vast majority of cases, whether the baby is in a breech position or head-first. The decision to have an epidural is entirely up to you. 6. Is an ECV possible if the umbilical cord is wrapped around the neck? First of all, it is not always easy to detect the umbilical cord around the neck. In any case, this is not a contraindication to considering an external version. Conference on breech births in Belgium The H.U.B. Breech Clinic invites you on the 25 and 26 September 2026 to a conference on breech births at term with a discussion of the latest recommendations and clinical practices plus simulations. This conference is accredited and will be held in French. It will be of interest to doctors, midwives and perinatal professionals.  Programme & Registration

Department presentation The Adult Endocrinology Clinic provides diagnosis and follow-up for adult patients with an endocrine disorder, meaning a condition affecting the secretion of a hormone (excessive or insufficient secretion) and/or the gland that secretes it. The department therefore manages conditions affecting the thyroid, parathyroid glands, adrenal glands, gonads (ovaries and testicles), and pituitary gland.Since 2016, the Endocrinology Department of Erasme Hospital, together with the Queen Fabiola Children’s University Hospital (HUDERF) for paediatric care, has been part of the ENDO-ERN network (European Reference Network for Rare Endocrine Conditions), the European Reference Network for rare endocrine diseases.This network aims to improve access to high-quality care for patients with rare endocrine disorders. It supports clinical research and contributes to the creation of registries that list patients receiving follow-up for rare conditions, in order to promote knowledge-sharing and improve clinical practices.The management of rare endocrine diseases is multidisciplinary. Regular discussions are organised for complex cases with numerous specialists within our institution, as well as during virtual consultations with recognised European experts through the ENDO-ERN network or during international multidisciplinary consultation meetings (France).Some endocrine diseases begin at birth or during childhood and require lifelong treatment and follow-up. Transition consultations have been provided for many years in collaboration with our paediatric colleagues at HUDERF, to ensure the smoothest possible transition from paediatric to adult care.  What are rare congenital thyroid diseases? Rare congenital thyroid diseases are conditions that are most often present from birth and affect the functioning of the thyroid gland. In the majority of cases, they involve congenital hypothyroidism, i.e. insufficient production of thyroid hormones. Thyroid hormones are essential for growth, but also—and above all—for the normal development of the brain during fetal life and childhood. In adulthood, they are primarily involved in regulating body temperature (thermoregulation), controlling metabolism (energy expenditure), fertility, intestinal transit, heart rate and mood. Hypothyroidism occurring in adulthood is most often acquired and has various causes (autoimmunity, thyroid surgery, medication, etc.). It does not fall into the category of rare endocrine diseases, unlike congenital hypothyroidism.The latter may be caused by an absent thyroid (agenesis), an abnormally formed thyroid (dysgenesis), or a defect in the synthesis of thyroid hormones linked to a mutation in one of the key enzymes (proteins) involved in hormone production. They are most often detected very early, during the first days of life, through newborn screening. This enables rapid and effective management, helping to prevent the harmful effects of thyroid hormone deficiency on the child’s brain and musculoskeletal development. During pregnancy, the mother provides the fetus with thyroid hormones and thus compensates for the defect in hormone synthesis by the fetal thyroid. However, once born, the affected baby no longer benefits from its mother’s thyroid hormones and must therefore receive prompt oral hormone replacement therapy.Another category of rare congenital thyroid diseases comprises disorders of the metabolism, transport and action of thyroid hormones, including thyroid hormone resistance syndromes. These very rare conditions (1/19,000–1/40,000 births) are caused by genetic abnormalities affecting one of the thyroid hormone receptors (there are two types). Thyroid hormones are produced in sufficient quantities, but cannot act optimally in tissues containing the mutated receptor (brain, liver, heart, muscle and bones). The severity and type of symptoms vary considerably depending on the mutation. In the most common forms of these rare conditions, which are also the least severe, the diagnosis is most often made following so-called “discordant” thyroid function tests (with an unusual profile) performed during routine blood tests or as part of family screening in the context of a known familial mutation.   Diagnosis and management Congenital hypothyroidism is screened for in newborns. A drop of blood is taken from the newborn’s heel between the 2nd and 5th day of life and placed on filter paper before being analysed. The parents are recalled for an endocrinology consultation if the screening test result is abnormal. Additional tests are performed to confirm the diagnosis (a follow-up blood test) and determine its cause (thyroid ultrasound and scintigraphy). Management is based on early treatment with thyroid hormone replacement therapy, started during the first days of life. This treatment is simple, well tolerated and enables the child to develop normally. As with acquired hypothyroidism, the challenges when continuing follow-up into adulthood are to ensure proper metabolic function, fertility and optimal quality of life in all areas (physical, psychosocial and professional).Regular clinical and laboratory follow-up is essential in order to adjust the doses as the child grows, as well as according to changing needs in certain situations (weight fluctuations, interactions with other medicines, digestive absorption problems, fertility, pregnancy, etc.).Medical follow-up must continue lifelong. Providing patients and families with information and support is essential to ensure treatment adherence and long-term quality of life.In the most common cases of resistance to thyroid hormones, symptoms are mild and patients generally do not require specific treatment. However, this is a difficult diagnosis to make and requires the exclusion of other conditions through specific tests (including genetic analysis for confirmation), with a risk of misdiagnosis that could lead to unnecessary thyroid surgery or drug treatment. Follow-up is also essential, as symptoms may evolve and require drug treatment.  Care pathway File trajetdesoin.pdf Transition to adulthood During adolescence, a gradual preparation for the transition to adult care is organised. This step helps strengthen the young patient’s autonomy, ensure continuity of medical follow-up, and transfer all the necessary information to the specialised adult service. The transition is planned in collaboration with the patient, their family, and the paediatric and adult care teams. Focus: expertise Patients are treated by an accredited adult endocrinologist. Hormone assays and genetic tests are performed in a specialised laboratory. Genetic counselling is offered. An on-call service is available 24 hours a day. Our centre is actively committed to improving knowledge and care for patients with rare endocrine diseases.A local registry of cases of congenital hypothyroidism and thyroid hormone resistance has been established, and the number of new cases managed is continuously reported to the European ENDO-ERN registry. The aim is to optimise follow-up practices and compare patient management between different specialised centres. The team undertakes continuing education, participates in congresses and seminars, initiates and collaborates on single-centre and multicentre studies, and publishes work in the field of thyroid disease. It also provides training and teaching for students and doctors in training. Our specialists Associated department