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Introduction. There are an inverse association between Helicobacter Pylori (H. pylori) infection and prevalence of IBD [5, 10,11,12]. Also studies have reported an inverse association between H. pylori prevalence and disease severity of IBD [13]. H. pylori is one of the environmental infections causing changes in gut microbiota and immune system dysregulation, which may affect IBD activity. The current study aimed to compare the clinical, laboratory, and histological severity of the newly diagnosed IBD with the presence or absence of H. pylori infection. Methods. This was a retrospective study that included 50 newly diagnosed inflammatory bowel disease patients (30 ulcerative colitis patients and 20 Crohn's disease patients). Diagnosis of IBD was based on both endoscopy/colonoscopy and biopsy. Also, for assesing Disease activity was quatified by CDAI for Crohn disease and UCDAI dor ulcerative colitis. Also, fecal calprotectine was evaluated. The presence of H. pylori was evaluated by the H. pylori stool antigen test (HpSA). Results: The overall positivity of H. pylori infection in patients with IBD was 19.2%. Patients with HpSA had a significantly lower fecal calprotectine (145.57 ± 28.12 vs. 320.57 ± 67.54 (μg/mg); P= 0.02), Mayo score (4.12 ± 1.09 vs. 8.01 ± 1.23; P < 0.001) and CDAI score (112 ± 67 vs. 198 ± 89; P < 0.001) compared to those with negative HpSA. Conclusion. We reported a significantly lower H. pylori infection rate in IBD patients. H. pylori-positive IBD patients have a milder disease with less activity compared to H. pylori-negative IBD patients. [ABSTRACT FROM AUTHOR]

Background & Aims: The burnout syndrome (BOS) is commonly seen in healthcare professionals, particularly in physicians who are exposed to a high level of stress at work and has a negative impact on the medical activity. Physicians with BOS manifest a negative attitude, a reduction in compassion at work, and suboptimal patient care experiences. These all can lead to absenteeism, poor performance and more frequent medical errors. We aimed to assess the level of BOS in a tertiary gastroenterology university center in Romania. Methods: This observational study involved 40 physicians from a tertiary gastroenterology university center. An online questionnaire assessed the presence of BOS using the Maslach Burnout Inventory. Results: A total of 40 physicians responded to the questionnaire. The prevalence of overall BOS of 87.5%. In terms of high burnout, 15 doctors (37.5%) had emotional exhaustion, 10 doctors (25%) had depersonalization, and 30 doctors (80%) scored low for personal achievement. Men presented more frequently emotional exhaustion and women lower personal achievement scores, but there was no significant statistical difference. No significant relationship was found between marital status or the number of children and BOS. We identified multiple risk factors associated to BOS, the most important one being strict internal regulations. Conclusions: Physicians presented an increased risk for BOS. The high rate of BOS among physicians found in our study requires careful attention. Further studies aiming to identify other factors that contribute to BOS and to identify measures to combat this syndrome are necessary. [ABSTRACT FROM AUTHOR]

Background & Aims: Real-world assessments of efficacy and safety of advanced therapies used for inflammatory bowel disease (IBD) patients are limited. We aimed to report safety, efficacy and treatment persistence of new molecules (infliximab, adalimumab, vedolizumab, tofacitinib, ustekinumab) in a retrospective multicentric national Romanian analysis. Methods: We conducted a nationwide, retrospective observational multicentric study. Data were collected retrospectively from electronic and paper files. Patients who started on one of the five investigated molecules during December 2019-December 2021 were included. The main outcome measures were clinical remission, endoscopic healing, persistence on treatment and safety data. Results: A total of 678 adult patients from 24 Romanian IBD centers with a diagnosis of ulcerative colitis or Crohn's disease were included. Participants had previously failure to one (268, 39.5%), two (108, 15%) or more treatment lines and only 38% (259) were biologic naïve. In the 24 months study period, most patients were started on vedolizumab (192, 28%), followed by adalimumab, infliximab, ustekinumab and tofacitinib. In biologic-naïve patients, most physicians (72%) preferred anti-TNF treatment as first line biologic (93 patients started on infliximab, 92 on adalimumab), followed by vedolizumab, ustekinumab and tofacitinib. During follow-up, 71% (470, p=0.05) of patients achieved clinical remission and 36% (134, p=0.03) achieved mucosal healing. The 6 months milestone for persistence was reached in 78% (530) of cases. Almost half of patients (47%, 316 patients) persisted on their current treatment for over 12 months. Overall, an adverse reaction was reported for 67 (10.4%) patients, with no lethal events. Conclusions: Population of biologic-experienced IBD patients in Romania is increasing and is becoming more difficult to achieve long-term disease control. Discontinuation rates for advanced therapies are high. [ABSTRACT FROM AUTHOR]

Background & Aims: The burnout syndrome (BOS) is commonly seen in healthcare professionals, particularly in physicians who are exposed to a high level of stress at work and has a negative impact on the medical activity. Physicians with BOS manifest a negative attitude, a reduction in compassion at work, and suboptimal patient care experiences. These all can lead to absenteeism, poor performance and more frequent medical errors. We aimed to assess the level of BOS in a tertiary gastroenterology university center in Romania. Methods: This observational study involved 40 physicians from a tertiary gastroenterology university center. An online questionnaire assessed the presence of BOS using the Maslach Burnout Inventory. Results: A total of 40 physicians responded to the questionnaire. The prevalence of overall BOS of 87.5%. In terms of high burnout, 15 doctors (37.5%) had emotional exhaustion, 10 doctors (25%) had depersonalization, and 30 doctors (80%) scored low for personal achievement. Men presented more frequently emotional exhaustion and women lower personal achievement scores, but there was no significant statistical difference. No significant relationship was found between marital status or the number of children and BOS. We identified multiple risk factors associated to BOS, the most important one being strict internal regulations. Conclusions: Physicians presented an increased risk for BOS. The high rate of BOS among physicians found in our study requires careful attention. Further studies aiming to identify other factors that contribute to BOS and to identify measures to combat this syndrome are necessary. [ABSTRACT FROM AUTHOR]

The article focuses on the need for an excellence centers in Romania to provide quality of care to patients with inflammatory bowel diseases (IBDs). Topics include the adherence for expert physicians and guidelines to treat IBD patients, the implementation of certain measures and required criteria to address the widespread variations in the care of IBD patients, and the applicability of the measures into clinical practice in the country.

Background & Aims: The nonpharmacological therapy in irritable bowel syndrome (IBS) is expanding rapidly. Practitioners and medical educators need to be aware of progress and changes in knowledge of this topic. The Romanian Society of Neurogastroenterology aimed to create guidelines based on best evidence on the use of nonpharmacological therapy in IBS. Methods: A group of experts was constituted. This was divided in eleven subgroups dedicated to eleven categories of nonpharmacological therapy. The subgroups searched the literature and formulated statements and recommendations. These were submitted to vote in order to obtain consensus. Results: The outcome of this activity is represented by the guidelines of the Romanian Society of Neurogastroenterology, presented in this paper. The recommendations are seen as complementary to the pharmacological therapy and are not intended to recommend avoiding pharmacological drugs. Conclusions: These guidelines were elaborated by a Delphi process and represent a useful tool for physicians managing patients with IBS. [ABSTRACT FROM AUTHOR]

Background & Aims: Both inflammatory bowel diseases (IBD) and ankylosing spondylitis (AS) can be considered chronic immune disorders sharing common etiopathogenetic mechanisms. Changes in the composition of the intestinal microbiota, which can lead to an abnormal mucosal response, could be the missing link between these two diseases. Our study evaluate the composition of intestinal microbiota and to characterize gut dysbiosis in patients with IBD and AS. Methods: We conducted a prospective case-control study that enrolled 124 patients [20 Crohn's disease (CD), 27 ulcerative colitis (UC), 28 AS, 17 IBD + AS and 32 controls). Intestinal microbiota analysis was performed by real-time polymerase chain reaction in stool samples. Results: The total quantity of bacteria was decreased in all investigated groups compared to the control group. In studied groups, we noticed an increased percentage of Bacteroides and Escherichia coli (E.coli) and a decreased percentage of Clostridium coccoides, Clostridium leptum, and Faecalibacterium prausnitzii compared to the control group. The percentages of Bifidobacterium (p=0.010) as well as Lactobacillus group (p=0.023) were higher in the L3 form of CD patients. In the E2 form of UC, the quantity of Bacteroides was much higher compared to the E3 form (p=0.004). In AS patients, significant correlations were observed only for the Bifidobacterium species, significantly increased in the axial form compared to peripheral disease (p=0.035). Statistically significant correlations were demonstrated between the Crohn Disease Activity Index score and the total bacterial group (p=0.023, r=-0.507), respectively Bacteroides (p=0.021, r=-0.511) and between the Mayo score and Lactobacillus (p=0.001), respectively E. coli (p=0.001). In IBD + AS group, the Crohn Disease Activity Index score was inversely correlated with the total bacterial group (p=0.010) and directly correlated with Lactobacillus (p=0.047). Conclusions: Intestinal dysbiosis is associated with both IBD and AS. In the association of IBD with AS, dysbiosis is intermediate, but it is associated with the more severe articular disease. Bifidobacterium and Lactobacillus (commonly used as probiotics!) were found to be increased in the association between active IBD and active AS. Further studies are needed to understand how dysbiosis regulates the gut immune system and contributes to intestinal and articular inflammation. [ABSTRACT FROM AUTHOR]

Pancreatic pseudocysts are frequent complications of both acute and chronic pancreatitis. By contrast, pancreatico-pleural fistula is rare. Here we report a case of massive pleural effusion secondary to a fistula in the left hemi-diaphragm, between a pancreatic pseudocyst and the left pleura, in a patient with a right kidney tumor and bilateral massive pulmonary thromboembolism. This fistula developed after several episodes of un-investigated acute pancreatitis. The pleural effusion was treated by three thoracocenteses, without recurrence. [ABSTRACT FROM AUTHOR]

Background. Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are perceived different pathologies, one organic and the other functional, which influence the quality of life (QOL). We aimed to compare the relative impact of the disease on QOL in two groups of outpatients suffering from IBS and IBD attending our outpatient clinic at a university hospital in Romania and to compare them with a healthy group of students. Methods. The studied groups completed an SF-36 quality of life form, the associations between gastrointestinal (GI) symptoms, psychosocial score (PS) and mental status (MS) were analyzed by multiple linear regressions. Results. QOL appears to be similarly reduced in both disease groups (global mean SF-36 value: 57.2 +/- 14.2 in IBS patients versus 55.4 +/- 17.3 in IBS patients IBD: P > 0.05) compared with the control group. GI symptoms were associated with changes in the PS, but not with the MS in both groups, significantly lower than in the control group (p<0.01). The most important predictor of the change in the mental score was depression (p<0.01). Anxiety significantly contributed to the decrease of the three scores (GI, PS, MS) in all studied groups. Conclusions. Patients with IBS present healthrelated quality of life, mental distress and psychosocial status similar to those with IBD. Anxiety and depression change the psychosocial and mental status even in healthy patients. [ABSTRACT FROM AUTHOR]

Background. Burnout syndrome is a commonly seen in healthcare professionals, particularly in physicians who are exposed to a high level of stress at work and has a negative impact on the medical activity. The physicians who had have high burnout levels have been shown to commit more medical errors. Aim: To assess the level of the burnout syndrome in a tertiary university centre of gastroenterology in Romania. Methods. This observational study involved physicians from a tertiary gastroenterology university centre. An online questionnaire assessed the presence of burnout using the Maslach Burnout Inventory (MBI). Results. A total of 64 physicians responded to the questionnaire. In terms of high burnout, 11 doctors (17.18%) had emotional exhaustion, 13 doctors (20.3%) had depersonalization, and 58 doctors (90.62%) scored low for personal achievement. There were statistically significant correlations between the personal accomplishment and exhausting scores and between the personal accomplishment and depersonalization scores, respectively (P=0.007, and P<0.001, respectively). Conclusion. Physicians present an increased risk for burnout relative to workers in other fields. The high rate of burnout among physicians found by our study requires careful attention. Further studies aiming to identify other factors that contribute to burnout and as well as measures to combat burnout are necessary. Professional societies should get involved in studying the factors that generate burnout among physicians as well as to find solutions to reduce them. [ABSTRACT FROM AUTHOR]

Infection with Strongyloides stercoralis (S. stercoralis) is rarely reported in temperate countries. In addition, there are few reported cases of patients with ascites with S. stercoralis worldwide, usually in immunocompromised subjects. We present the case of a young patient with alcoholic liver disease and acute pancreatitis, who developed ascites with S. stercoralis. The patient had no evident immunosupression (HIV negative and absence of immunosupressive therapy). This is the first reported case where acute pancreatitis could have precipitated infection of ascitic fluid with S. stercoralis. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the diagnostic and therapeutic challenges of gastric bezoars in the Institute of Gastroenterology and Hepatology in Iasi, Romania.