Health issues
Anal fistula and anal abscess
Nos spécialistes Services associés
Anal fistula and anal abscess
Health issues
Hereditary nonpolyposis colorectal cancer
Nos spécialistes Service associé
Hereditary nonpolyposis colorectal cancer
Health issues
Intestinal polyposis syndrome
Nos spécialistes Service associé
Intestinal polyposis syndrome
Health issues
Rare pancreatic diseases
Le pancréas : Qu'est-ce que c'est ? Le pancréas est une glande située derrière l'estomac qui remplit deux rôles essentiels : la digestion des nutriments, grâce à la sécrétion d'enzymes digestives, et la régulation du taux de sucre dans le sang, grâce à la sécrétion d'insuline. La pancréatite chronique est une inflammation prolongée du pancréas. Au fil du temps, le pancréas se transforme et peut développer des calculs (« pierres ») ou des rétrécissements de son canal principal (sténoses). Ces modifications entraînent des douleurs, une difficulté à digérer les aliments et des troubles de la régulation du sucre dans le sang. La consommation excessive d'alcool est la cause la plus fréquente de pancréatite chronique. Parfois, il y a des altérations génétiques qui explique la pancréatite chronique. Cependant, dans certains cas, aucune cause n'est identifiable : on parle alors de pancréatite chronique idiopathique. Parfois, la maladie est d'origine auto-immune — c'est-à-dire liée à une réaction anormale du système immunitaire contre le pancréas — avec ou sans présence d'anticorps spécifiques dans le sang : on parle dans ce cas de pancréatite auto-immune. Les symptômes Des douleurs abdominales, soit sous forme d'épisodes aigus (accès de pancréatite aiguë), soit de façon continue.Des selles graisseuses (stéatorrhée), liées à une mauvaise digestion des graissesUne perte de poids et une dénutrition, dues à une absorption insuffisante des nutriments.Des anomalies biologiques : manque de certains minéraux (sodium, potassium), de vitamines et d'oligo-élémentsUn diabète, lié à l'atteinte des cellules productrices d'insuline Comment le diagnostic est posé Vous rencontrerez d'abord un(e) spécialiste du pancréas (gastroentérologue), qui fera le point sur vos symptômes et votre histoire médicale et chirurgicale. Des examens complémentaires seront ensuite réalisés :Une prise de sang complète pour évaluer votre état général, la fonction renale, le taux du sucre, le taux des vitamines et des minéraux et l'état de votre foieLe dosage des anticorps dans le sang, si une origine auto-immune est suspectéeUne analyse génetique, selon votre situationUn examen des selles si nécessaireUn scanner et une resonance magnetique pour evaluer votre pancréasUne densitométrie osseuse (pour vérifier la solidité de vos os) Comment peut-on vous soigner La prise en charge fait appel à plusieurs spécialistes travaillant ensemble sous la coordination de votre gastroentérologue:Un(e) diététicien(ne) vous aidera à adapter votre alimentationDes médicaments et des supplements vitaminiques seront prescrits pour controler la douleur et corriger les carencesDes enzymes pancréatique de subtitution si nécessaireDes medicament pour le diabète si nécessaire et un suivi par un(e) endocrinologueDes médicaments specifiques (ex corticoides ou immunosupresseurs) peuvent être indiqués si vous avez une pancréatiqte auto-immuneUne consultation avec un(e) geneticien(ne) sera proposé si nécessaireDans certains cas, une intervention peut être proposée: La lithotritie extracorporelle permet de fragmenter les calculs (pierres) présents dans le canal pancréatique grâce à des ondes de choc (lien lithotripsie endoscopie-nouveau)L'endoscopie peut permettre de déboucher davantage le canal pancréatique, en retirant les calculs et en plaçant de petits tubes en plastique (prothèses) pour maintenir le canal ouvert (https://www.erasme.be/fr/cholangio-pancreatographie-endoscopique)La chirurgie peut être nécessaire si une partie du pancréas doit être retirée  Comment se passe le suivi ? Un suivi regulièr est primordial pour le bon deroulement de vos soins:Au moins 1 consultation par an avec votre gastroentérologueDes prises de sang à chaque visiteUn scanner abdominal ou une resonance magnetique chaque annéeUne densitométrie osseuse tous les 2 ans (ou plus souvent si nécessaire) Nos spécialistes Service associé
Rare pancreatic diseases
Health issues
Rare genetic and immune-mediated glomerular diseases
Qu'est-ce qu'une maladie glomérulaire rare ? Les maladies glomérulaires sont des affections qui touchent les glomérules, les filtres microscopiques du rein chargés d'éliminer les déchets et l'excès d'eau de l'organisme. Lorsqu'ils sont endommagés, ils peuvent entraîner une perte de protéines dans les urines, la présence de sang dans les urines et une diminution progressive de la fonction rénale.Certaines de ces maladies sont rares et résultent d'anomalies génétiques, tandis que d'autres sont liées à un dérèglement du système immunitaire (maladies immunomédiées). Ces affections nécessitent une expertise spécialisée afin d'établir un diagnostic précis et de proposer un traitement adapté. Quels sont les symptômes ? Les manifestations varient selon la maladie et son stade d'évolution.Les signes les plus fréquents sont :Une protéinurie (présence excessive de protéines dans les urines) ;Une hématurie (présence de sang dans les urines) ;Des œdèmes, notamment au niveau des jambes ou du visage ;Une hypertension artérielle ;Une altération de la fonction rénale ;Une fatigue importante ;Dans certaines formes génétiques, des atteintes d'autres organes peuvent être associées.Certaines maladies peuvent évoluer silencieusement pendant plusieurs années avant d'être diagnostiquées. Comment établit-on le diagnostic ? Le diagnostic repose sur une évaluation approfondie réalisée par une équipe spécialisée.Les examens peuvent comprendre :Des analyses sanguines et urinaires ;Une évaluation complète de la fonction rénale ;Une biopsie rénale lorsque celle-ci est indiquée ;Des analyses immunologiques spécialisées ;Des examens génétiques visant à identifier une cause héréditaire ;Une évaluation des autres organes potentiellement concernés.L'identification précise de la maladie est essentielle pour adapter le traitement et déterminer le pronostic. Notre prise en charge au HUB Le HUB dispose d'une expertise reconnue dans le diagnostic et le suivi des maladies glomérulaires rares, qu'elles soient génétiques ou immunomédiées.Les patients bénéficient d'une prise en charge personnalisée intégrant les avancées diagnostiques et thérapeutiques les plus récentes.Expertise en maladies glomérulaires raresL'équipe de Néphrologie prend en charge l'ensemble des maladies glomérulaires rares, notamment :Les syndromes d'Alport et autres néphropathies héréditaires ;Les podocytopathies génétiques ;Les glomérulopathies liées aux anomalies du complément ;Les glomérulonéphrites à dépôts d'IgA ;Les glomérulonéphrites membranaires ;Les vascularites associées aux ANCA ;Le lupus érythémateux systémique avec atteinte rénale ;Les maladies glomérulaires associées à des maladies systémiques rares.Chaque dossier est discuté au sein d'une équipe spécialisée afin de définir la stratégie diagnostique et thérapeutique la plus appropriée. Une prise en charge multidisciplinaire La prise en charge des maladies glomérulaires rares nécessite souvent l'intervention de plusieurs spécialistes.Selon les besoins du patient, les équipes suivantes peuvent être impliquées :Néphrologie ;Génétique médicale ;Immunologie clinique ;Rhumatologie ;Médecine interne ;Anatomopathologie ;Ophtalmologie ;ORL ;Cardiologie ;Pédiatrie spécialisée.Cette collaboration permet une prise en charge globale tenant compte de toutes les dimensions de la maladie. Collaboration avec l'HUDERF De nombreuses maladies glomérulaires rares d'origine génétique se manifestent dès l'enfance ou l'adolescence. Le HUB collabore étroitement avec l'Hôpital Universitaire des Enfants Reine Fabiola (HUDERF) afin d'assurer un parcours de soins coordonné pour les jeunes patients atteints de maladies rénales rares.Un programme de transition pédiatrique-adulte est organisé afin d'accompagner progressivement les adolescents vers les soins adultes. Cette transition structurée permet d'assurer la continuité du suivi médical, le transfert des données cliniques et génétiques ainsi que l'acquisition de l'autonomie nécessaire à la gestion de leur maladie.Les équipes pédiatriques et adultes travaillent conjointement afin d'offrir une prise en charge cohérente et sécurisée tout au long de la vie du patient. Quels traitements sont disponibles ? Les traitements dépendent du type de maladie identifié.Ils peuvent comprendre :Des traitements visant à protéger la fonction rénale ;Des médicaments réduisant la protéinurie ;Des traitements immunosuppresseurs ;Des biothérapies ciblées ;Des traitements spécifiques de certaines maladies génétiques ;Une prise en charge des complications cardiovasculaires et métaboliques ;Une préparation à la transplantation rénale lorsque celle-ci devient nécessaire.L'objectif est de ralentir l'évolution de la maladie, préserver la fonction rénale et améliorer la qualité de vie. Recherche et innovation Le HUB participe activement à la recherche dans le domaine des maladies glomérulaires rares.Les équipes sont impliquées dans :Des registres nationaux et internationaux ;Des programmes de recherche translationnelle ;Le développement de nouveaux biomarqueurs diagnostiques ;Des études génétiques ;Des essais cliniques évaluant de nouveaux traitements ciblés.Cette activité permet aux patients d'accéder à une expertise de pointe et aux innovations thérapeutiques les plus récentes. Notre expertise Le HUB est un centre de référence pour les maladies rénales complexes et rares.Nos points forts :Expertise reconnue dans les maladies glomérulaires rares ;Accès à des analyses génétiques spécialisées ;Réunions multidisciplinaires dédiées ;Collaboration étroite avec les spécialistes des maladies systémiques et génétiques ;Parcours structuré de transition pédiatrique-adulte ;Participation active à la recherche clinique et translationnelle ;Approche personnalisée centrée sur le patient. Nos spécialistes Service associé
Rare genetic and immune-mediated glomerular diseases
Health issues
Thrombotic microangiopathies
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
Thrombotic microangiopathies
Health issues
Inflammatory Bowel Disease (IBD) Clinic
Image Contact the Clinic for Chronic Inflammatory Bowel Diseases (IBD) Would you like to make an appointment with a specialist from the IBD clinic for yourself or one of your relatives?Contact us by telephone on +32 (0)2 555 35 04 or by email at: ibd [dot] erasme [at] hubruxelles [dot] be (ibd[dot]erasme[at]hubruxelles[dot]be)Would you like to make an appointment for an endoscopy with a specialist from the IBD clinic for yourself or one of your relatives?Contact us by telephone on +32 (0)2 555 3292 or by email at: ibd [dot] erasme [at] hubruxelles [dot] be (ibd[dot]erasme[at]hubruxelles[dot]be)Are you a patient with an administrative request (prescriptions, reimbursements, certificates, documents for insurance purposes or copies of medical records)?Contact our medical administration by telephone on +32 (0)2 555 5422 or by email at: ibd [dot] erasme [at] hubruxelles [dot] be (ibd[dot]erasme[at]hubruxelles[dot]be)Are you a doctor and would you like to obtain your patients’ medical results, refer a patient or request a (second) opinion?Contact our clinic by telephone on +32 (0)2 555 54 22 or by email at: ibd [dot] erasme [at] hubruxelles [dot] be (ibd[dot]erasme[at]hubruxelles[dot]be) Do you suffer from Inflammatory Bowel Disease (IBD)? The Clinic for Chronic Inflammatory Bowel Diseases (MICI) or Inflammatory Bowel Diseases (IBD) provides care for all patients suffering from Crohn’s disease, ulcerative colitis, unclassified colitis, lymphocytic/collagenous colitis, as well as coeliac disease, autoimmune diseases or intestinal vasculitis. Image Image Image Comprehensive care Several specialist consultations are being developed for the care of adolescents and pregnant or breastfeeding women, the screening of primary immunodeficiency syndromes in adults, and patients with coeliac disease or autoimmune enteritis. A multidisciplinary approach There is a high level of multidisciplinary collaboration in the care of patients with chronic inflammatory bowel disease, particularly during a weekly meeting involving colorectal surgeons, radiologists, pathologists, rheumatologists and dermatologists (or ophthalmologists or specialists responsible for immunodeficiency syndromes). Discover the IBD Clinic at Erasme Hospital, H.U.B. Image Prof. Denis Franchimont, Director of the Clinic for Chronic Inflammatory Bowel Diseases SpecialitiesChronic inflammatory bowel diseases.Screening for colon cancer and genetic screening for hereditary colon cancer syndromes.Diagnostic and therapeutic gastroscopy and colonoscopy.Upper gastrointestinal and anorectal endoscopic ultrasound.Resection of superficial colorectal tumours. Make an appointment with Prof. Franchimont A team of specialists by your side PhysiciansProf. Claire LiefferinckxProf. Anneline CremerProf. Leila AmininejadDr. Cagla Gulkilik Dr. Clémence VukovicProf. Denis Franchimont Coordination of studies and clinical trialsCharlotte Minsart, Doctor of Biomedical Sciences, PhD. Emma DescampsChloé HelmanClinic coordination nurseValérie WambacqDietitianPauline Van OuytselConsultantsDr. Vincent BouillonDr. Haydeh Vafa ZanjaniMedical secretaryGeorgiana Vilcinschi Make an appointment with Prof. Franchimont A clinic committed to research The clinic is involved in pharmaceutical clinical research (we have access to new molecules as part of international clinical trials), as well as translational and genetic research, particularly in collaboration with the BIRD (Belgium IBD Research Disease Group), the ECCO (European Crohn and Colitis Organisation) and the IIBDGC (International IBD Genetics Consortium).  In 2022, the clinic opened its translational research laboratory on the microbiota — The H.U.B Center for the Study of Inflammatory Bowel Disease (IBD) and Microbiota — where three doctors, one technician, two PhD students and one artificial intelligence engineer work. Our scientific publications In-depth study of monogenic primary immunodeficiency genes identifies rare XIAP variants in Crohn’s disease patients. Amininejad L, Charloteaux B, Theatre E, Dmitrieva J, Hayard P, Muls V, Maisin J-M, Schapira M, Ghislain J-M, Closset P, Talib M, Abramowicz M, Momozawa Y, Deffontaine V, Crins F, Mni M, Karim L, Cambisano N, Deviere J, Hugot J-P, De vos M, Louis E, Vermeire S, Van Gossum A, Coppieters W, Twizere J-C, Georges M, Franchimont D. Gastroenterology 2018 Jun;154(8):2165-2177 (I.F. 33) 01 June 2018 Risk of Development of More-advanced Lesions in Patients With Inflammatory Bowel Diseases and Dysplasia Cremer A, Demetter P, De Vos M, Rahier JF, Baert F, Moreels T, Macken E, Louis E, Ferdinande L, Fervaille C, Dedeurwaerdere F, Bletard N, Driessen A, De Hertogh G, Vermeire S, Franchimont D. Clinical Gastroenterology and Hepatology. 13 June 2019. pii: S1542-3565(19)30645-7 13 June 2019 Collecting New Peak and Intermediate Infliximab Levels to Predict Remission in Inflammatory Bowel Diseases Liefferinckx C, Bottieau J, Toubeau JF, Thomas D, Rahier JF, Louis E, Baert F, Dewint P, Pouillon L, Lambrecht G, Vallée F, Vermeire S, Bossuyt P, Franchimont D.  Inflamm Bowel Dis. 2022 Feb 1;28(2):208-217.  01 February 2022 Large-scale sequencing identifies multiple genes and rare variants associated with Crohn’s disease susceptibility . Sazonovs A, Stevens CR, Venkataraman GR, Yuan K, Avila B, Abreu MT, Ahmad T, Allez M, Ananthakrishnan AN, Atzmon G, Baras A, Barrett JC, Barzilai N, Beaugerie L, Beecham A, Bernstein CN, Bitton A, Bokemeyer B, Chan A, Chung D, Cleynen I, Cosnes J, Cutler DJ, Daly A, Damas OM, Datta LW, Dawany N, Devoto M, Dodge S, Ellinghaus E, Fachal L, Farkkila M, Faubion W, Ferreira M, Franchimont D, Gabriel SB, Ge T, Georges M, Gettler K, Giri M, Glaser B, Goerg S, Goyette P, Graham D, Hämäläinen E, Haritunians T, Heap GA, Hiltunen M, Hoeppner M, Horowitz JE, Irving P, Iyer V, Jalas C, Kelsen J, Khalili H, Kirschner BS, Kontula K, Koskela JT, Kugathasan S, Kupcinskas J, Lamb CA, Laudes M, Lévesque C, Levine AP, Lewis JD, Liefferinckx C, Loescher BS, Louis E, Mansfield J, May S, McCauley JL, Mengesha E, Mni M, Moayyedi P, Moran CJ, Newberry RD, O'Charoen S, Okou DT, Oldenburg B, Ostrer H, Palotie A, Paquette J, Pekow J, Peter I, Pierik MJ, Ponsioen CY, Pontikos N, Prescott N, Pulver AE, Rahmouni S, Rice DL, Saavalainen P, Sands B, Sartor RB, Schiff ER, Schreiber S, Schumm LP, Segal AW, Seksik P, Shawky R, Sheikh SZ, Silverberg MS, Simmons A, Skeiceviciene J, Sokol H, Solomonson M, Somineni H, Sun D, Targan S, Turner D, Uhlig HH, van der Meulen AE, Vermeire S, Verstockt S, Voskuil MD, Winter HS, Young J; Belgium IBD Consortium; Cedars- Sinai IBD; International IBD Genetics Consortium; NIDDK IBD Genetics Consortium; NIHR IBD BioResource; Regeneron Genetics Center; SHARE Consortium; SPARC IBD Network; UK IBD Genetics Consortium; Duerr RH, Franke A, Brant SR, Cho J, Weersma RK, Parkes M, Xavier RJ, Rivas MA, Rioux JD, McGovern DPB, Huang H, Anderson CA, Daly MJ. Nat Genet. 2022 Sep;54(9):1275-1283. 29 August 2022 Useful Resources and Links for Patients with Crohn’s Disease, Colitis and IBD Whether you have already been diagnosed or suspect that you may have IBD, we are here to support and inform you every step of the way. That is why we offer a series of resources (produced by doctors, researchers, patient associations and public health stakeholders) to help you better understand and manage your condition and identify support groups with which you can connect. ASSOCIATION – The Crohn-RCUH non-profit association seeks to meet the social an… ASSOCIATION – Belgian Coeliac Society PODCAST – IBD Today: The podcast dedicated to inflammatory bowel diseases FOUNDATION - BRIDGE - Brussels IBD Effort, a Network of ULB Hospitals FAQ on Crohn’s Disease and Colitis 1. What is Crohn’s disease? Crohn’s disease is a chronic inflammatory bowel disease (IBD) that can affect any part of the digestive tract, from the mouth to the anus. It is characterised by segmental inflammation and may lead to complications such as strictures or fistulas. 2. What are the differences between Crohn’s disease and other forms of colitis? Crohn’s disease affects the entire digestive tract, with discontinuous lesions.Ulcerative colitis (UC) affects only the colon and rectum, with continuous lesions.Infectious colitis is caused by bacteria, viruses or parasites and is generally temporary.Ischaemic colitis results from reduced blood flow to the colon.Microscopic colitis (lymphocytic and collagenous) is visible only under a microscope and causes chronic diarrhoea. 3. What are the main symptoms of Crohn’s disease? Symptoms include abdominal pain, diarrhoea (sometimes bloody), weight loss, fatigue, and sometimes fever. Extraintestinal manifestations, such as joint pain, skin rashes or eye problems, may also occur. 4. Is Crohn’s disease hereditary? There is a genetic predisposition: approximately 10 to 20% of people with inflammatory bowel disease have a close relative with IBD. However, other environmental and immune factors are necessary to trigger the disease. 5. How can Crohn’s disease be differentiated from infectious colitis? Infectious colitis is generally acute and caused by an identifiable infection (bacteria, viruses or parasites). Stool tests can confirm the infectious cause. Crohn’s disease, on the other hand, is chronic, with recurrent flare-ups and periods of remission. 6. What are the treatments for Crohn’s disease? Treatments include:Anti-inflammatory drugs (such as mesalazine or corticosteroids).Immunosuppressants (azathioprine, methotrexate).Biological therapies targeting specific molecules (anti-TNF, anti-IL-12/23, etc.).In the event of complications, surgery may be necessary to remove affected sections of the intestine. 7. Can Crohn’s disease cause serious complications? Yes, it can lead to:Strictures (narrowing of the intestines that can cause obstructions).Fistulas (abnormal connections between organs or the skin).Abscesses.Increased risk of colorectal cancer (in cases of prolonged inflammation). 8. What factors worsen colitis and Crohn’s disease? Stress and anxiety can exacerbate symptoms.Smoking particularly worsens Crohn’s disease.An unbalanced or irritating diet can intensify flare-ups. 9. Can diet prevent or cure colitis and Crohn’s disease? There is no diet capable of curing the disease, but certain dietary choices may alleviate symptoms. Low-residue or low-FODMAP diets are often used during flare-ups. A balanced diet is essential to prevent deficiencies. 10. How does one live with a chronic disease such as Crohn’s disease or colitis? With appropriate treatment, many patients can achieve remission and lead a normal life.It is important to maintain regular follow-up with a gastroenterologist.Taking part in support groups or associations can help manage the psychological impact of the disease. They support us
Inflammatory Bowel Disease (IBD) Clinic
Health issues
Hyperparathyroidism
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 therefore 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 ENDO-ERN (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 monitored for rare conditions, in order to promote knowledge-sharing and improve clinical practices. The management of rare endocrine diseases is multidisciplinary. Regular case discussions are organised for 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 case conferences (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 primary hyperparathyroidism? Primary hyperparathyroidism results from overactivity (hyperfunction) of the parathyroid glands, located behind the thyroid gland in the neck. These glands secrete parathyroid hormone (PTH), a hormone that is essential for regulating calcium levels in the blood. Primary hyperparathyroidism is the third most common endocrine disorder.In the vast majority of cases, this overactivity is caused by a parathyroid adenoma, that is, a small benign tumour that develops in one of the four parathyroid glands. More rarely, several glands are affected (referred to as hyperplasia or multiglandular disease), particularly in certain genetic disorders (for example, multiple endocrine neoplasia type 1 [MEN1]) or in patients with severe chronic kidney disease.Excess parathyroid hormone causes an increase in the level of calcium in the blood (hypercalcaemia). This increase may cause various symptoms, such as excessive thirst, nausea, vomiting, constipation or kidney stones.In the longer term, excess parathyroid hormone may affect the bones (osteopenia, osteoporosis and an increased risk of fractures) and the kidneys (nephrocalcinosis and kidney failure).Today, primary hyperparathyroidism is increasingly detected at an early stage, during a simple blood test performed for another reason. Even in the absence of symptoms, a complete assessment is necessary to evaluate the effects of the disease on the bones and kidneys. Appropriate management can prevent complications and sustainably improve patients’ quality of life. Care management Surgery of the parathyroid gland or glands responsible for the hypersecretion is the standard treatment for primary hyperparathyroidism and leads to a cure in the majority of cases.The indication for surgery and the optimal timing of the procedure are determined after a comprehensive assessment of any potential complications, taking the patient’s age and various clinical and biological criteria into account.Management must be multidisciplinary and involves endocrinologists, surgeons specialising in parathyroid surgery, radiologists and nuclear medicine physicians, in order to precisely locate the abnormal glands before surgery. Depending on the situation, geneticists, nephrologists and rheumatologists may also be involved in the patient’s care.At our centre, a multidisciplinary meeting dedicated to parathyroid disorders is held every month to discuss complex cases and define the most appropriate treatment strategy.The aim is to support each patient in understanding their condition, provide personalised care and sustainably improve their quality of life.Multidisciplinary teamAdult endocrinology: see the doctors responsible for the conditionNuclear medicine: Dr Magdalena MilevaParathyroid surgery: Dr Maria RuizNephrology: Dr Caroline La, Dr Delphine KemlinRadiology: Dr Isabelle Delpierre, Dr Yolène LefebvreRheumatology: Prof. Muhammad Soyfoo, Dr Joëlle MargauxGenetics: Dr Isabelle Vandernoot Patient advice A balanced diet, adequate hydration (at least 2 litres of water per day), moderate salt consumption, correction of any vitamin D deficiency, and regular physical activity all contribute to maintaining good mineral balance. In the event of unusual acute symptoms (feeling unwell, palpitations, severe pain, haematuria), it is recommended that you promptly consult an Emergency Department. If you have any doubts or questions, the medical team remains your preferred point of contact to adapt your care. Focus / Search Patients are cared for by a specialist endocrinologist. Hormone assays and genetic analyses are performed in a reference laboratory. Specialist on-call cover is provided 24 hours a day.Our centre is actively involved in improving the diagnosis and management of primary hyperparathyroidism, notably through the creation of a dedicated diagnostic unit for thyroid nodules and parathyroid disorders.This “fast-track” outpatient unit, located within the Nuclear Medicine Department of the Jules Bordet Institute, makes it possible to perform the main examinations required for the assessment on the same day: cervical ultrasound targeting the parathyroid glands, renal ultrasound, fluorocholine PET (a tracer offering excellent sensitivity for detecting parathyroid adenomas) and bone densitometry. The results are then discussed during the consultation with the endocrinologist in order to establish an accurate diagnosis and propose the most appropriate treatment strategy. Our specialists Associated services
Hyperparathyroidism
Health issues
Hypoparathyroidism
Department overview The Adult Endocrinology Clinic provides diagnosis and follow-up for adult patients with an endocrine problem, that is, 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 the paediatric component, has been part of ENDO-ERN (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 monitored for rare conditions, in order to promote knowledge sharing and improve clinical practices. The management of rare endocrine diseases is multidisciplinary. Regular consultations are organised to discuss complex cases, involving numerous specialists within our institution, as well as through virtual consultations with recognised European experts via the ENDO-ERN network or during international multidisciplinary case-review 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 is hypoparathyroidism? Hypoparathyroidism and pseudohypoparathyroidism (recently referred to as IPPSD type 2, or “Inactivating PTH/PTHrP Signaling Disorder”) are rare diseases of the parathyroid glands. The parathyroid glands are four small glands located next to the thyroid gland that secrete parathyroid hormone (PTH), a hormone essential for regulating calcium and phosphorus levels in the body. These diseases cause a decrease in the level of calcium in the blood. This hypocalcaemia can cause a range of symptoms, depending on its severity and how quickly it develops: cramps, muscle stiffness, tingling in the extremities, unusual fatigue, irritability, attention and concentration problems, and seizures.The disease may be present from birth or childhood, as part of a genetic syndrome, or may be acquired later in life, most often as a complication of thyroid surgery (thyroidectomy). Pseudohypoparathyroidism is a particular and very rare form of hypoparathyroidism, linked to a genetic mutation that makes the body resistant to the action of parathyroid hormone. There is no defect in PTH secretion, but the mutation impairs its action. The disease generally appears during childhood and is associated with resistance to other hormones, most often thyroid hormones, but sometimes also growth hormone or the hormones involved in puberty. Care/management In most cases, the diagnosis is suspected on the basis of symptoms suggestive of hypocalcaemia (cramps, tingling, etc.) and confirmed by a blood test (calcium, phosphate, PTH levels, etc.). In the majority of cases, hypoparathyroidism in adults occurs after a thyroidectomy. In other cases, genetic testing may be necessary to rule out hereditary conditions and to guide the diagnosis and management. The aim of treatment is to maintain calcium and phosphate levels as close to normal and as stable as possible, in order to alleviate symptoms and prevent complications. Treatment generally combines calcium and active vitamin D supplementation, with individualised adjustment. New molecules that are very similar in structure to parathyroid hormone (= “PTH analogues”) are currently being evaluated in clinical studies and are already being used in some European countries for adult patients.Management is multidisciplinary, involving endocrinologists, dietitians (advice on dietary calcium intake) and, depending on the situation, geneticists, nephrologists and psychologists. The aim is to provide patients with the best possible support in understanding their condition and treatment, and to sustainably improve their quality of life. Patient advice Adherence to treatment and regular medical follow-up are essential. It is important to respect the number of doses and the prescribed doses of the supplements, and to report any change in general condition to the healthcare team, such as unusual fatigue or persistent or recurrent symptoms of hypocalcaemia. A balanced diet also contributes to maintaining good mineral balance. In the event of unusual acute symptoms (discomfort, severe spasms, altered consciousness), it is recommended to go to the Emergency Department without delay. If in doubt, the medical team remains the best point of contact for adapting the care plan. Care pathway File trajet-de-soins.pdf Transition to adulthood During adolescence, a gradual preparation for the transition to adult care is organised. This stage 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 / Research Patients are treated by a licensed adult endocrinologist. Hormone assays and genetic tests are performed in a specialised laboratory. An on-call service is available 24 hours a day. Our centre is actively involved in improving knowledge and care for patients with rare endocrine diseases. A local registry has been established. A dedicated European ERN database for hypoparathyroidism will be set up shortly. The aim is to better understand the course of the disease, optimise follow-up practices, and compare management approaches between different specialised centres. The team undertakes continuous professional development, participates in congresses and seminars, initiates and collaborates on studies, and publishes in the field of parathyroid disorders. It also provides training and teaching for students and doctors in training. Our specialists
Hypoparathyroidism
Article
Nutrition: a valuable asset in stroke prevention
As part of Stroke Tuesdays, organised by the H.U.B Neurovascular Clinic, Prof. Philippe Van De Borne, Director of the Cardiovascular Prevention Clinic, and Ms Marie-Eve Velghe, a dietitian specialising in the management of cardiovascular risk factors, explain how diet fundamentally influences patients’ cardiovascular health before and after a stroke. Could you explain the various cardiovascular risk factors? How can they affect cardiovascular health and the occurrence of a stroke?Cardiovascular risk factors are important because they are factors that increase the likelihood of developing heart disease or having a stroke. There are two categories of cardiovascular risk factors.“Non-modifiable” risk factors include:Age, because the older we get, the more the risk increases; Sex: men are at greater risk than women before menopause. After menopause, hormonal changes make women more vulnerable. Many cardiovascular events are observed in women aged 80. Family history, as cardiovascular diseases and strokes are among the leading causes of death. Statistically, there is always someone in the family who has had a cardiovascular event or a stroke. It must have occurred early, in a first-degree relative (for example, a parent), and before the age of 55 in men and 65 in women. This type of family history considerably increases one’s own risk of having a stroke.“Modifiable” risk factors can, through a healthy lifestyle and appropriate follow-up, help patients gain years of healthy life. In the context of a stroke, diet has a real influence on the patient’s health.High blood pressure: This is the number-one risk factor for strokes. Excessively high blood pressure weakens the arteries and can cause them to rupture or become blocked. Reducing salt intake, eating more potassium (particularly by consuming enough fruit and vegetables), and engaging in regular physical activity are essential for controlling it more effectively. Smoking is another major risk factor for developing cardiovascular diseases (CVDs), which mainly affect the heart, the arteries of the brain and the peripheral arteries. Recent studies show that active female smokers are 2.5 times more likely to die from cardiovascular disease than women who have never smoked. This is enormous! Tobacco is a genuine poison, and many smokers find it very difficult to quit, but they should be made as aware as possible of the benefits of taking action, because quitting smoking greatly reduces cardiovascular risks, at any age. Excess cholesterol is harmful to the arteries because it promotes atherosclerosis, that is, the deposition of cholesterol in the arterial wall. This gradually impedes blood flow by narrowing the diameter of the blood vessels, particularly those supplying the brain and heart. It is essential to keep the level of “bad” cholesterol as low as possible in order to prevent a stroke. Diabetes and excess glucose can also cause strokes. A sedentary lifestyle and lack of physical activity are also important factors. At least 30 minutes of moderate physical activity per day is recommended. It is always possible to fit this activity into a busy schedule, even if it means parking your car a little farther away than usual or taking the stairs instead of the lift—there are solutions! Being overweight and obesity, particularly abdominal obesity, are very harmful to the cardiovascular system. A balanced diet and regular physical activity can address this risk factor. Stress, mental health problems and air pollution also contribute, although to a lesser extent, to an increased cardiovascular risk. There are solutions for learning to manage stress. Mental health problems may contribute more indirectly to the development of cardiovascular risk factors because, when combined with an unfavourable socioeconomic context, they can lead to poor treatment adherence. Air pollution is toxic to the small blood vessels. You should avoid being outdoors or exercising outside during pollution peaks, because the particles present in the air increase cardiovascular risk.Why does diet play a key role in preventing recurrent strokes?Diet plays a key role in preventing recurrent strokes because it directly affects the main modifiable cardiovascular risk factors mentioned above. For example, a balanced diet helps control high blood pressure, which is the leading cause of stroke, notably through limited salt intake and a higher potassium intake. Similarly, consuming enough fibre-rich foods, such as fruit, vegetables, pulses, wholegrain cereals and nuts, improves cholesterol levels and arterial health. Reducing “fast” sugars and fats, particularly saturated fats and industrial trans fats, also helps regulate blood lipids, blood glucose and weight more effectively, thereby controlling two other important risk factors: diabetes and excess weight.“Adopting a protective diet—one that is rich in fibre, antioxidants and unsaturated fats (particularly omega-3), while limiting unhealthy fats, salt and sugars—therefore means acting on several fronts at once to protect the body’s arteries, including those in the brain, and reduce the risk of recurrent stroke and other CVDs.”Are there one or more dietary patterns that are particularly recommended for stroke prevention? Image Yes, the best-known is the Mediterranean diet, based on the traditional eating habits of people living in Mediterranean countries such as Greece, Italy and Spain in the 1960s. It is based on a high intake of fruit, vegetables, pulses (such as lentils, chickpeas, dried beans and split peas), whole grains, extra-virgin olive oil (the main source of fat), nuts and seeds, regular consumption of fish and seafood, poultry and low-fat dairy products (cheese and yoghurt). These foods are rich in fibre and healthy fats and are packed with antioxidants that protect the arteries, reduce inflammation and help regulate blood pressure and cholesterol. The World Health Organization (WHO) has described the Mediterranean diet as an effective dietary strategy for the prevention and management of non-communicable diseases such as cardiovascular diseases, diabetes, certain cancers and neurodegenerative diseases (Parkinson’s disease and Alzheimer’s disease). The European Society of Cardiology (ESC) also stated in its latest 2021 recommendations on cardiovascular disease prevention that “Adopting a Mediterranean-type diet may contribute to reducing cardiovascular risk in all individuals, including people at high cardiovascular risk and patients with cardiovascular disease”.Another diet that is also highly beneficial for combating hypertension, and therefore reducing the risk of cerebrovascular accident, is the “DASH” diet (Dietary Approaches to Stop Hypertension). This diet focuses on reducing salt intake while increasing the intake of potassium, magnesium and calcium, essential minerals for lowering blood pressure.These two diets share common principles: little or no ultra-processed food, less saturated fat and added sugar, and a central role for unprocessed foods rich in protective nutrients. They are affordable and easy to implement in daily life, helping people adopt healthy eating habits that can make a significant difference to long-term cardiovascular health.What are the main principles of a suitable diet after a cerebrovascular accident? In other words, what are the main dietary recommendations you give to the patient and/or, where appropriate, their close caregiver, to optimise their cardiovascular health?After a cerebrovascular accident, it is essential to adopt a balanced diet in order to minimise the risk of recurrence associated with cardiovascular risk. Here are the six main recommendations we give patients:1. Limit salt intakeWe recommend that patients limit or even completely eliminate added salt, remove the salt shaker from the table, and use alternatives to season their meals, such as aromatic herbs, spices and unsalted condiments including garlic, ginger and lemon juice. We also raise awareness of “hidden” salt, which accounts for almost 80% of our daily salt intake. This hidden salt can be reduced by avoiding or severely limiting the consumption of industrially prepared meals, processed meats, very salty cheeses and savoury snacks such as crisps, salted peanuts and savoury biscuits.2. Choose healthy fatsWe inform patients about so-called “visible” fats and “hidden” fats. Image “Visible” fats are those added to bread, used for cooking or dressing a salad.For cooking, it is recommended to use fats rich in monounsaturated fatty acids, which are more heat-resistant and better for your health, such as olive oil, peanut oil or high-oleic sunflower oil (“oleisol”). For cold use, it is preferable to consume oils rich in omega-3, such as rapeseed, camelina or walnut oil. Warning! These oils should not be used as cooking fats, as omega-3 fatty acids are highly sensitive to heat and may become harmful when heated. For bread, it is preferable to use a vegetable-based spread, reduced in fat and enriched with omega-3, or possibly to use a small amount of unsalted butter, spread very thinly on the slice of bread. Nut butters and pastes (peanut butter, almond or hazelnut paste) are also very interesting options! Our omega-3 intake is often insufficient in proportion to our intake of omega-6, which is generally high. One of the aims of a healthy diet is therefore to rebalance the ratio between omega-6 and omega-3 by increasing omega-3 consumption. For example, we recommend using rapeseed or camelina oil (rich in omega-3) to prepare a vinaigrette or mayonnaise, rather than sunflower or corn oil (rich in omega-6)!“Hidden” fats are, by definition, those naturally present in foods.Sources of healthy fats include oily fish, which should preferably be chosen small in size (as they contain fewer heavy metals), such as sardines, mackerel, herring, trout or wild salmon. Nuts and seeds, poultry (without the skin), rabbit and avocado (the only fruit containing fat) are also good sources. It is also strongly recommended to avoid cooking with coconut oil, palm oil or coconut oil because these tropical oils are very rich in so-called “atherogenic” saturated fats, i.e. fats that increase bad cholesterol levels and clog the body’s arteries!  Foods containing these types of hidden fats should therefore also be avoided.3. Eat sufficient fibre and antioxidantsThey help regulate cholesterol and blood sugar levels, control weight and combat inflammation of the arteries. The main sources are vegetables, fruit, pulses, wholegrain products, nuts and seeds. In practical terms, we recommend consuming the following amounts and frequencies:At least 300 g of vegetables per day (cooked, raw, in soup, etc.). Vary them and give preference to seasonal, locally grown vegetables. At the main meal, they should ideally fill 50% of the plate. 2 portions of fresh fruit per day (1 portion = the volume of a fist = approximately 125 g/day). Here too, preference should be given to seasonal, locally grown fruit.80 g of pulses twice a week as part of meals (for example, hummus on bread, falafel balls as a main course or lentils in a salad).A wholegrain product at least once a day (such as wholemeal bread, porridge oats, muesli, bulgur, quinoa, whole-wheat pasta, brown rice, etc.).4. Consume high-quality plant and animal proteinsThese include pulses, soya and tofu, poultry (without the skin), fish and eggs, especially omega-3-enriched eggs.“For a long time, people were advised against eating eggs because the yolk is rich in cholesterol. However, studies have shown that what really matters is not controlling dietary cholesterol, but limiting the consumption of saturated fatty acids and industrial trans fats as much as possible, as these have a greater influence on blood cholesterol levels. Today, recommendations allow patients to eat up to 7 eggs per week. Plant proteins contain no cholesterol at all.”Among animal proteins, certain meats should be limited. This applies to red meat (in short, all meat except poultry and rabbit), which should be limited to a maximum of 300 g per week. As for processed meats, i.e. minced meat and cold cuts, the less you eat, the better! They are often high in salt, as well as preservatives (nitrites and nitrates), which are compounds that are harmful to health!5. Reduce added sugar intake as much as possible.This means limiting the consumption of pastries, biscuits, viennoiseries, sweets, avoiding adding white or cane sugar, honey or various syrups (agave, maple, Liège, etc.) to drinks or food, and above all avoiding soft drinks and fruit juices. All these foods, which are highly concentrated in sugar, promote blood sugar spikes and the accumulation of fat in the brain and heart. It is important to know that even fruit juices labelled “no added sugar” contain a great deal of sugar—as much as soft drinks.6. Limit or avoid alcoholic beverages.“In the past, the protective effect of red wine was promoted, and people were advised to drink one or two glasses a day to stay healthy. Today, this recommendation is no longer valid at all. It has been proven that, to prevent cardiovascular diseases and other diseases such as cancer, it is advisable to drink little or no alcohol at all.”Ideally, to prevent cardiovascular diseases and help combat high blood pressure, no alcohol should be consumed at all. If alcohol is consumed, it should not exceed 10 units per week, equivalent to 10 small glasses of wine (120 ml) or pilsner beer (250 ml), spread well over the week and including 2 alcohol-free days. Image Water remains the best drink. Good hydration is vital, and it is recommended to drink at least 1.5 L per day, or approximately 8 glasses of water, in addition to the soup, coffee, tea or herbal teas that may be consumed during the day.“Of course, all these recommendations must take the patient’s overall health into account and ensure that any dietary contraindications that could contribute to deterioration related to another condition are avoided (for example, the use of potassium salt as a substitute for table salt in patients with kidney failure). Fluid intake must also be adjusted and reduced in certain situations, particularly in cases of fluid and sodium retention associated with heart failure.”Finally, for patients who have already experienced one or more cerebrovascular accidents, the challenge is to adapt meals to their abilities. Some patients do, in fact, suffer from swallowing disorders or severe fatigue that prevent them from eating “as before”. They should therefore be offered tasty dishes every day, with textures and portions adapted to their needs, so as to preserve the pleasure of eating without taking risks. We also ensure that the diet takes household arrangements, culture and religion into account. We encourage the family, close carers and those around the patient in general to become involved in preparing meals. This creates a convivial atmosphere around mealtimes and makes the patient’s life considerably easier, while helping to ensure that their healthy eating habits are sustainable.What medical care is currently available at Erasme Hospital - HUB to control cardiovascular risk factors in patients who have experienced one or more cerebrovascular accidents?In acute cases, patients receive highly specialised care at the Neurovascular Clinic (also known as the “Stroke Unit”).“When treating a cerebrovascular accident, every minute counts, for the brain as well as the heart, which is why the team is available 24/7.”The care provided includes monitoring and management of high blood pressure and metabolic disorders. Anticoagulant treatments may be administered. The team also has cutting-edge expertise and a flawless organisation enabling it to perform surgery and unblock the occluded arteries responsible for the cerebrovascular accident.Brussels University Hospital is an academic hospital that provides integrated and multidisciplinary care. The Cardiovascular Prevention Clinic provides preventive support for cardiovascular diseases, cardiovascular risk-factor assessments, dietary assessments, educational programmes, prevention workshops and a rehabilitation service. Care also includes smoking cessation support, which, as mentioned previously, is one of—if not the most important cardiovascular risk factor.“Our care approach is centred on the patient and their needs and, whenever possible, involves implementing a systemic care approach that includes the family, to help the patient adopt—and maintain—certain habits that can be difficult to sustain without family support.”Medical and paramedical follow-up is organised in such a way as to:Ensure that patients survive the cerebrovascular accident with as few sequelae as possible.Work together to prevent cardiovascular diseases, particularly when a lesion of the cerebral or coronary arteries occurs.Today, many effective therapeutic options are available, making it possible to increase life expectancy and, above all, reduce cardiovascular events, despite the ageing population.“In Belgium, in 1986, 33% of deaths were due to cardiovascular causes. Today, that figure is 22%. This trend is encouraging and continues to move in the right direction in preventing and combating cerebrovascular accidents and cardiovascular diseases.” Prof. Philippe VAN DE BORNEDirector of the Cardiovascular Prevention ClinicErasme Hospital, H.U.BMarie-Eve VELGHEDietitian accredited by the FPS Public HealthCardiology and cardiac rehabilitation departmentsErasme Hospital, H.U.B
Article
Obesity: a key factor in stroke prevention
As part of the Stroke Tuesdays series, we spoke with Dr Pascale Chasseur, endocrinologist at Erasme Hospital – H.U.B., about controlling stroke risk factors, particularly obesity. Discover the interview Pierre, 58, a father of two and a lover of good food, suffered a cerebrovascular accident eight months ago. Since then, his life has changed radically.“I had never been particularly athletic,” he says with a slightly guilty smile. “But I never thought that my excess weight would one day put my life at risk.”Following his hospitalisation at Erasme Hospital, Pierre was referred to Dr Pascale Chasseur, an endocrinologist specialising in cardiovascular risk factors related to metabolism. She treats many patients like him, with a clear objective: preventing recurrence. Image What factors should be monitored after a cerebrovascular accident? High blood pressure, diabetes, hypercholesterolaemia, smoking, physical inactivity, sleep apnea and, of course… obesity. This last factor is central. The risk of cerebrovascular accident increases linearly with excess weight.“For each additional BMI unit (editor’s note: Body Mass Index – BMI), starting from a BMI of 20 kg/m2, the risk of cerebrovascular accident increases by 5%. Obesity is closely linked to the other risk factors: excess adipose tissue, mainly in the abdominal area, promotes insulin resistance, high blood pressure, diabetes, hypercholesterolaemia… leading to atherosclerosis and therefore… cerebrovascular accident. A 5–10% weight loss can significantly reduce the impact of these risk factors,” explains Dr Chasseur. Image And concretely, what can a patient do? For Pierre, the shock of the cerebrovascular accident was the wake-up call. « At first, I was lost. I knew I had to change, but I didn’t know where to start. » This is where the hospital team comes in.Dr Chasseur: « We first assess obesity and its comorbidities with the patient, provide information, then advise and support them. The aim is not to make them feel guilty, but to build a realistic plan together. This involves a multidisciplinary approach. »At Erasme Hospital, this includes:Personalised dietary follow-up, with advice tailored to the patient’s lifestyle (e.g. Mediterranean diet).Support with physical activity to help patients gradually resume exercise.Medication support, including GLP-1 treatments (an average weight loss of 13%-20% of body weight2 over 72 weeks, according to studies).An assessment for bariatric surgery if the patient has severe obesity (BMI > 35-40) with comorbidities.  Image Is losing weight really effective in preventing strokes? Dr Chasseur: “Yes, even a modest weight loss of 5 to 10% can improve blood glucose levels, blood pressure, cholesterol, and sleep apnea, thereby greatly reducing the risk of another cerebrovascular accident. We now know that even within 48 hours of a cerebrovascular accident, good blood glucose control has a positive impact.”A guided, patient-centred care pathway“It’s not just ‘eating less and exercising more’. It is a comprehensive challenge that requires time, compassion, and psychological support,” Dr Chasseur points out.Pierre confirms: “I had to accept that I needed help. It’s hard to look at yourself in the mirror. But I was supported. And above all, I’m not alone.”  And at home, what can be done to control weight? Pierre involved his partner in his efforts. “We changed our habits together. We cook more healthily, we walk every day. And above all, we motivate each other.”Close caregivers play a crucial role. They can:Encourage physical activity togetherAdapt the family’s dietHelp keep track of biological assessments (monitoring blood glucose, blood pressure and cholesterol)Be a non-judgemental source of support and listeningDr Chasseur: “Caregivers play a crucial role. They can help motivate loved ones to monitor health indicators (weight, blood pressure and blood glucose), encourage regular follow-up and attend appointments together. Self-image is also an important issue. People need help to overcome feelings of guilt and restore their motivation, with the support of a psychologist.”Key points:After a Cerebrovascular accident, prevention involves managing cardiovascular risk factors, of which obesity is a central factor.Even modest weight loss can have a major impact on cardiovascular health.Hôpital Erasme H.U.B offers multidisciplinary support to help patients take control of their health.Family members and loved ones can play a driving role in the process. “There are no small steps. There are only steps in the right direction.”  Sources:Kernan W.N. et al., Obesity, a stubbornly obvious target for stroke prevention, Stroke, 2013; 44: 278–286Aronne L.J. et al., Tirzepatide as compared with semaglutide for the treatment of obesity, NEJM, May 2025, SURMOUNT-5 trial
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Centre pluridisciplinaire ambulatoire spécialisé TCA
Image Un centre spécialisé dans les Troubles du Comportement Alimentaire (TCA)Notre centre se distingue par une approche pluridisciplinaire et individualisée, alliant détection précoce, orientation ciblée et soins spécialisés.Nous adoptons une approche globale qui combine des thérapies individuelles, familiales et de groupe. Nous intégrons des méthodes reconnues telles que la Family Based Therapy (FBT) et, prochainement, la Multi Familial Therapy (MFT), tout en offrant des soins diététiques et corporels adaptés.En cas de besoin, une prise en charge intensive peut être proposée.Notre objectif : accompagner patients et familles vers un rétablissement durable grâce à un parcours de soins structuré et coordonné.Fiche santé TCA A Erasme, la prise en charge des TCA s’adresse aux jeunes de 12 à 23 ans présentant des troubles tels que l’anorexie, la boulimie ou l’hyperphagie boulimique.A l’Hôpital des Enfants (HUDERF), la prise en charge des TCA s’adresse aux enfants et adolescents jusque 15 ans, présentant des troubles tels que l’ARFID/trouble alimentaire pédiatrique, l’anorexie, la boulimie ou l’hyperphagie boulimique.%20cpij [dot] psychiatrie [dot] erasme [at] hubruxelles [dot] be (Envoyer un mail)  De manière générale nos consultations s'adressent aux :familles souhaitant un accompagnement global, intégrant les proches comme acteurs clés de la guérison.patients nécessitant une prise en charge personnalisée, adaptée à leurs besoins psychiques et physiques. Nos expertes Pr. Veronique Delvenne, Directrice du service de psychiatrie du bébé, de l’enfant, de l’adolescent et du jeune adulte (H.U.B)Véronique Delvenne, professeure de psychiatrie de l’enfant et de l’adolescent à l’Université libre de Bruxelles (ULB), est une spécialiste reconnue en pédopsychiatrie en Belgique.Membre de l’Académie royale de Médecine de Belgique, elle a concentré ses travaux sur les troubles des conduites alimentaires et sur les enjeux spécifiques de la psychiatrie en âge de transition. Par son expertise et ses recherches, elle contribue à faire évoluer les connaissances et les pratiques dans ces domaines essentiels de la santé mentale. Dr Judith Dereau,  Pédopsychiatre référente de la prise en charge des TCA à l'H.U.BLe Dr Judith Dereau, responsable médicale du Centre ambulatoire TCA de l’H.U.B., s’impose comme une figure incontournable dans le paysage belge francophone des professionnels spécialisés dans les TCA. Experte reconnue, elle partage son expérience et ses connaissances à travers l’animation de séminaires et des interventions régulières lors de congrès.Forte d’une pratique clinique hospitalière et ambulatoire développée depuis 2003, le Dr Dereau met son expérience au service de la formation et de l’innovation des prises en charge. Notre équipe Pédopsychiatres Dr Mouna Al-Husni (HUDERF-Erasme)Pr Véronique Delvenne (HUDERF)Dr Judith Dereau (Erasme)Dr Maria Talib (HUDERF-Erasme) Au niveau somatiqueDr Jean-Charles Preiser (Erasme)Dr Celine Roman PsychologuesMme Christella di FioreMme Silvana Fuso (HUDERF-Erasme)Mme Nadia Ramsis KinésithérapeutesMme Nora El Meziani DiététiciensMme Charlotte Dupont Erasme Medical Center (EMC) Route de Lennik 900 − 1070 Bruxelles Standard EMC +32 (0)2 555 31 11 Secrétariat Pédopsychiatrie +32 (0)2 555 32 96Prendre rendez-vous  Hôpital des Enfants (Huderf) Avenue Jean Joseph Crocq 15 - 1020 BruxellesSecrétariat Pédopsychiatrie: +32 2 477 31 80Prendre Rendez-vous  Service de Psychiatrie du bébé, de l'enfant, de l'adolescent et du jeune adulte