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The objective of the study is to assess the immune status after vaccination of the Romanian troops that are participating in different missions abroad. Active immunization was performed according to the schedule privided in the Technical Provision MND Head of Medical Department, with imported vaccines. The aim was to determine the immunological protection of the military against infectious diseases of practical interest : hepatitis A and B , tetanus and yellow fever. For the analysis of immune status in military personnel participating in missions in theaters, were collected to Ambulatory Diagnostic and Treatment „Academician Stefan Milcu“ Medical Center Medical Center (with support of Preventive Medical Center) blood samples from 168 subjects. For immunological analyzes of interest antibodiest, determined by the Preventive Medical Center of the Ministry of Defence, we used ELISA kits for hepatitis A and B, for tetanus toxin and kit immunofl uorescence for yellow fever . Four types of tests carried out on the group of 168 subjects have made the determination of antibodies specifi c for immune research and highlighted residual review recorded at different periods of time ( years ) after vaccination . We followed the decrease dynamics of antibody to the minimum detectable, we compared it with a minimum protective level. The period under study was between 1991 and 2013. The results of immunological investigations, that we performed, to assess protection after vaccination in the military from TO, confi rming the effectiveness of prophylactic vaccination schedule as specifi ed in documentation. [ABSTRACT FROM AUTHOR]

Background & Aims: Colorectal cancer (CRC) is the third cause of cancer-related death worldwide. Screening programs can reduce CRC mortality rates by up to 60%. In line with the European Union recommendations, Romania started the first four regional pilot screening programs in 2020 (the ROCCAS II projects). This study reports the interim screening performance indicators. Methods: People aged 50 to 74 years were invited to the screening program. General practitioners (GPs) evaluated CRC risk based on a survey. High-risk or symptomatic individuals were referred directly to colonoscopy. The average risk participants received a fecal immunochemical test (FIT). Positive cases were invited to colonoscopy. Three regions were screened using the OC-SENSOR® (South-Muntenia, Bucharest-Ilfov, South-East) and one region (South-West) used the FOB GOLD®. The data was collected in the ROCCAS screening electronic registry. The following FIT parameters were evaluated: rates of return, invalidity, positivity, and colonoscopy acceptance rate according to age group, gender, region of provenience, and vulnerability status. Results: We included all cases screened between January 1, 2022 and September 30, 2023. In total, 168,958 people received the FIT test within the projects. The global FIT return rate was 90%. Factors associated with a higher return rate were female gender (90.77% vs 88.83%, p<0.0001), vulnerable status (91.23% vs 88.83%; p<0.00001), and rural residence (91.84% vs 88.42%, p<0.00001). The overall positivity rate was 5.75%. It was higher in males (7.64% vs 4.57% in females, p<0.00001) and progressively increased with the age group. The total invalid FIT rate was 5.87%, significantly lower for OC-SENSOR® (2.24%) than for the FOB GOLD® (13.6%). The overall acceptability rate for colonoscopy was 51.3%. Conclusions: According to our preliminary data, GP's participation in the pilot programs ensured adequate adherence to screening through FIT. The rate for FIT return and positivity were acceptable for both tests, while the invalid rate was much higher in FOB GOLD® compared to the OC-SENSOR®. Moreover, colonoscopy acceptance needs to be improved. Our preliminary analysis revealed the screening performance indicators meet the EU recommendations and fulfill the premises for national-level expansion of the program starting in 2024. [ABSTRACT FROM AUTHOR]

Background & Aims: Gastroesophageal reflux disease (GERD) is a common condition present in daily practice with a wide range of clinical phenotypes. In this line, respiratory conditions may be associated with GERD. The Romanian Societies of Gastroenterology and Neurogastroenterology, in association with the Romanian Society of Pneumology, aimed to create a guideline regarding the epidemiology, diagnosis and treatment of respiratory conditions associated with GERD. Methods: Delphi methodology was used and eleven common working groups of experts were created. The experts reviewed the literature according to GRADE criteria and formulated 34 statements and recommendations. Consensus (>80% agreement) was reached for some of the statements after all participants voted. Results: All the statements and the literature review are presented in the paper, together with their correspondent grade of evidence and the voting results. Based on >80% voting agreement, a number of 22 recommendations were postulated regarding the diagnosis and treatment of GERD-induced respiratory symptoms. The experts considered that GERD may cause bronchial asthma and chronic cough in an important number of patients through micro-aspiration and vagal-mediated tracheobronchial reflex. GERD should be suspected in patients with asthma with suboptimal controlled or after exclusion of other causes, also in nocturnal refractory cough which needs gastroenterological investigations to confirm the diagnosis. Therapeutic test with double dose proton pump inhibitors (PPI) for 3 months is also useful. GERD induced respiratory conditions are difficult to treat; however, proton pump inhibitors and laparoscopic Nissen fundoplication are endorsed for therapy. Conclusions: This guideline could be useful for the multidisciplinary management of GERD with respiratory symptoms in current practice. [ABSTRACT FROM AUTHOR]

Background & Aims: Bowel ultrasound (BU) is a non-invasive, inexpensive, widely available tool, valuable for inflammatory bowel disease (IBD) assessment. The aim of the present study was to investigate the clinical utility of BU to predict the need to intensify therapy in IBD patients. Methods: One hundred seventeen IBD patients (89 Crohn's disease, and 28 ulcerative colitis) diagnosis established at least 6 months before enrolment, undergoing maintenance therapy were prospectively included in the study. Bowel ultrasound investigated the following parameters: the bowel wall thickness (BWT), loss of wall stratification, the presence of the bowel wall Doppler signal, the visible lymph nodes, the mucosal hyperechoic spots, and the irregular external bowel wall. The patients were followed-up for 6 months, registering the need to escalate the treatment regimen. Subgroup analyses were conducted for patients requiring immediate treatment intensification (37 subjects), due to active disease at baseline and patients with subsequent treatment intensification, in the 6 months follow-up period (21 cases) in comparison to patients that required no therapeutic optimization (59 cases). Results: During the follow-up, 49.6% of patients needed treatment escalation. All the investigated BU variables were significantly associated with the main outcome. In the multivariate analysis, the mean BWT (p<0.0001), and the presence of the bowel wall Doppler signal (p=0.007) were independent predictors of the main outcome. For the subgroup analyses: mean BWT (p=0.0001) and the presence of the bowel wall Doppler signal (p=0.01) were independent predictors for immediate treatment intensification (active disease at baseline) and mean BWT (p=0.0003) and the lack of bowel wall stratification (p=0.05) were independent predictors for the need of subsequent therapeutic optimization. Logistic regression prediction models and prediction scores (BU score) had the best AUROC values (>0.91) when compared to traditional biomarkers of active inflammation, such as C reactive protein or fecal calprotectin. Conclusion: Bowel ultrasound could be used as a non-invasive, easy to use diagnostic tool to predict the need to intensify therapy in patients with IBD. [ABSTRACT FROM AUTHOR]

Background & Aims: Identifying the risk factors for extraintestinal manifestations (EIMs) in inflammatory bowel diseases (IBD) may optimize the therapeutic decision. We aimed to assess the prevalence of EIMs in IBD patients in Romania and to determine the risk factors. Methods: We analyzed 2,626 patients registered in the Romanian IBD Prospect National Registry. We performed a descriptive cross-sectional study to assess the point prevalence of EIMs, calculating global prevalence and analyzing the different types of EIMs and their respective frequencies were carried out. Demographic and clinical risk factors were researched as possible predictors for EIMs development, based on the results of the univariate and multivariate logistic regression analysis. Results: The overall point prevalence of EIMs was 16.3%. A significantly higher frequency of EIMs in Crohn's disease (CD) was noted in comparison to ulcerative colitis (UC) and IBD unclassified (IBDU) (23.2% vs 11.3% and 16.3%, respectively, p<0.001). The most frequent type of EIM was peripheral arthropathy (8.3%), significantly associated with CD (p<0.001). Univariate analysis highlighted the significant independent common predictive risk factors for EIMs, in both CD and UC patients: female gender, patient's urban area of origin, anemia, hypoalbuminemia, and high level of C-reactive protein (CRP), while significant independent IBD phenotype-related risk factors were ileocolonic location and concomitant involvement of upper gastrointestinal tract for CD, non-smoker status and both moderate and severe disease activity for UC (p<0.05). Multivariate analysis determined that female CD patients with moderate or severe disease activity, with other than isolated ileal disease, and female UC patients with moderate or severe extensive colitis are the most likely to develop EIMs. Conclusions: IBD patients are experiencing EIMs in a large proportion, with higher rates for CD. As EIMs negatively affect patient outcomes, foreseeing the risk by identifying independent and associated predictive factors could be a first step to optimal work-up and treatment [ABSTRACT FROM AUTHOR]

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]

Fecal microbiota transplantation involves the infusion of intestinal microorganisms via the transfer of a stool from a healthy individual into a diseased individual, with the intent of restoring normal intestinal flora. Fecal transplant is proposed for the treatment of refractory Clostridioides difficile infection. At present, recurrent Clostridioides difficile infection is the only indication supported by solid scientific evidence. Regulations by healthcare authorities vary among different countries. Considering that Romania does not have an available national guideline to offer standardization, this paper aimed to create a national fecal microbiota transplantation guideline concerning indications, techniques and donor screening, developed by international and local scientific working groups. [ABSTRACT FROM AUTHOR]

Background & Aims: Inflammatory bowel diseases (IBD) patients management has been challenging during the ongoing coronavirus disease 2019 (COVID-19) pandemic, due to lockdowns, limitation of access to medical facilities and new recommendations regarding patient management. The implications of the COVID-19 pandemic on IBD patients' management were assessed in our Tertiary Gastroenterology Center in Bucharest, Romania. Methods: Medical records of IBD patients admitted between 15th of March and 15th of August 2020 were retrospectively reviewed and compared to a control cohort of consecutive IBD patients admitted to our unit during the corresponding period of 2019. Results: There was a highly significant shift towards one-day hospitalization during the referral period in 2020 for IBD cases (91% in 2020 vs 82.2% in 2019, p=0.0001). There was no statistically significant difference between the distribution of patient's gender, IBD phenotype or newly diagnosed IBD cases. A significantly lower proportion of admitted patients received 5-aminosalicylic acid (29% vs 41.2%, p=0.0001), whereas a substantially higher number of patients were prescribed biological therapy in 2020 in comparison to the corresponding 2019-time frame (79.5% vs 57.9%, p<0.0001). The distribution of the biological agent used was significantly different in 2019 in comparison to the 2020 period mainly due to the increase in vedolizumab prescription in 2020 (p<0.0001). During the study period in 2020, seven IBD patients (1.7%) were diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infection, all of them with mild symptoms without impact on the IBD course. Conclusions: The COVID-19 pandemic led to reorganizing medical care, limiting the hospital admissions in favor of severe IBD cases, favoring telemedicine for mild disease and optimization of treatment for moderate to severe IBD with an increased use of biologicals aimed to maximize the risk/benefit ratio. Incidence of SARS-Cov2 infection during the first wave of COVID-19 infection in our study group was 1.7% and did not adversely impact the IBD disease course. [ABSTRACT FROM AUTHOR]

Background & Aims: Elimination of hepatitis C worldwide is more feasible if micro-elimination screening strategies are adopted. We aimed to screen hepatitis C virus (HCV) in specific high-risk populations in certain sub-regions of Romania and link them to antiviral treatment. Methods: A multicenter prospective study was conducted among the hospitalized or ambulatory adult patients from March 2019 to March 2020 in more than 20 medical institutions from 4 Romanian cities (Bucharest, Iasi, Timisoara, Cluj-Napoca). A rapid diagnostic test for HCV diagnosis was performed to all admitted patients and the positive ones were sent to gastroenterology departments for confirming the active infection, staging and treatment prescription. Results: In total, 25,141 subjects signed the informed consent and were consequently enrolled into the study. The prevalence of anti-HCV antibodies was 1.39% (95%CI: 1.25-1.54) and increased with the number of risk factors presented by one subject. There was a positive association between the presence of anti-HCV antibodies and female gender (p<0.001), rural area of residence (p<0.001), advanced age (p<0.001), as well as a negative association with the education level (p<0.001). Conclusions: In a hospital-based screening micro-elimination program in Romania, HCV prevalence was lower than previously reported. This is a first step towards a cost-effective screening in a well-defined group of persons at risk and provides sufficient capacity to deliver access to HCV treatment and linkage to care in Romania. [ABSTRACT FROM AUTHOR]

Introduction. Obesity, lack of physical activity and diet have been inconsistently associated with pancreatic cancer. Aim. To evaluate the prevalence of overweight, body weight change trends, diet and physical activity level in pancreatic cancer patients diagnosed between 01.2018-02.2023. Methods. Prospective observational study that included patients diagnosed with pancreatic adenocarcinoma who were interviewed about dietary habits and weight changes, and physical activity over time. Results. A total of 186 patients with pancreatic adenocarcinoma were included. Regarding weight changes, it was observed that 56% of patients were under or normal weight at diagnosis, while a BMI below 25 was observed at one year and 5 years before only in 19.35%, respectively 12.9%. Excluding the data 5 years before diagnosis, the overweight and obesity prevalence between 20-29 years old was 43.54% respectively 11%, at 30-39 years old 43.54% respectively 25.8%, at 40-49 years old 22% respectively 45,6%, and at 50-59 years old 34% respectively 52.3%. Over 50 % of patients led a sedentary life. Regarding diet more than 75% of patients consumed red meat, dairy products, bread and bakery products, fruits and vegetables regularly more than 5 times a week. The consumption of fish and nut products was generally much less frequent, maximum 2 times a week in over 80% of cases. Less than half of the patients (47%) confirmed alcohol consumption, mostly occasionally, only 17% reported drinking more than 5 times a week. The favorite alcoholic drink was liquor, followed by wine, generally homemade. Conclusions. Most of the patients in the study were obese throughout their lives, but there was a weight loss starting 5 years before diagnosis, more severe in the last year. This can be explained by the advanced degree of the disease at diagnosis associated with a possible paraneoplastic hyperanabolic syndrome, the majority not complaining of loss of appetite or early satiety in the last year. Diet studies have suggested a protective effect against pancreatic cancer of the Mediterranean diet and regular consumption of nuts, even if in small quantities. This can also be confirmed by the patients included in this study whose diet does not respect these principles. Alcohol consumption does not seem to increase the risk of pancreatic neoplasm. This has also been observed in numerous studies with inconsistent results, and can also be determined by a declarative reduced consumption, due to the stigma associated with high consumption. [ABSTRACT FROM AUTHOR]

Background & Aims: Prevalence of malnutrition in inflammatory bowel diseases (IBD) varies between 16% and 75%. Data on the nutritional status at initial diagnosis of ulcerative colitis (UC) or Crohn's Disease (CD) are scarce. It is believed that more than 50% of IBD patients suffer significant weight loss prior to diagnosis. The aims of our study were to assess malnutrition in patients recently diagnosed with IBD and to determine its predictive factors. Methods: We retrospectively included 625 IBD patients registered in the Romanian "IBD Prospect" database between January 2006 and July 2017. All patients were diagnosed within 6 months prior to registration. We defined malnutrition as weight loss of more than 5% of the initial weight during the 3 months prior to registration. Results: There were 361 new cases of UC, 241 CD and 23 cases of unclassified IBD. There was a slight male predominance (M/F=1.2). Prevalence of overall malnutrition was 36.3%. It was significantly more frequent in CD than in UC patients (41.1% vs. 32.4%, p=0.031). In multivariate analysis, malnutrition in UC patients was associated with male gender (p=0.001), more severe disease (p<0.0001) and more extensive disease (p=0.027), while in CD it was associated with younger age (p=0.013) and more severe disease (p<0.0001). Conclusions: About 1 in 3 newly diagnosed IBD patients presents with malnutrition at the time of diagnosis. [ABSTRACT FROM AUTHOR]

Introduction. In the last decade, bariatric surgery has proven to be the only effective method for weight loss (WL) in patients with morbid obesity. Objective. To determine the factors that influence optimal WL after sleeve gastrectomy in patients with morbid obesity. Material and method. 72 patients with BMI >40 kg/m2 or BMI 35-39.9 kg/m2 with severe comorbidities were included in the study. The patients were evaluated clinical, biochemical, immunological, imaging and histological preoperative and postoperative (on average 8.7 months after the surgical intervention). WL were assessed by calculated the percentage of excess body mass index loss (%EBMIL) using the following formulas %EBMIL=(BMI1-BMI2) / (BMI1-25) x100; Optimal treatment response was considered a decrease in %EBMIL >50 Results. The patient had a mean age of 44.78±10.5 years, an average BMI and preoperative waist of 47.05 kg/m2 (between 33.3 and 70.1), respectively 130 cm (between 90 and 180cm). The results of our study showed a mean decrease in %EBMIL of 69.9 ± 27.6 (14.6-144.47), the value that shows an optimal response of postoperative weight loss. Using the univariate analysis we noted a negative correlation between % EBMIL and both the age and initial BMI of the patients (r=-0.438, p<0.01, r2=0.19). Patients with optimal WL have statistically significantly lower preoperative values of FG (U= 95.5, z=-2.25, p<0.05), TNFα (U=53, z=-2.5, p<0.05) and IL-6 (U=79, z=-2.3, p<0.05) compared to patients without clinical response (%EBMIL<50%). A negative correlation between %EBMIL and the presence of NASH was also found. Patients with preoperative NASH had a significantly lower %EBMIL than those with simple steatosis (U=56, z=-2.2, p<0.05). Conclusions. Sleeve gastrectomy was an effective bariatric surgery to treat obesity. Preoperative BMI, excess weight, age, TNF α, IL-6 and the presence of diabetes and steatohepatitis were predictive factors for optimal weight loss in patients with morbid obesity after sleeve gastrectomy. [ABSTRACT FROM AUTHOR]

Background and aim. In spite of prolonged disease remission of IBD patients, induced by the new biological molecules, a significant number of them suffer from persistent debilitating symptoms with major impact on the quality of life. Frequently, these symptoms are due to post-inflammatory motility changes and misinterpreted as functional disorders. Our aim is to identify and characterize the anorectal motility dysfunction in IBD patients. Method. We are conducting an ongoing prospective study started in August 2019, which includes the IBD patients admitted in a Tertiary Gastroenterology Centre in Bucharest, with specific symptoms (anorectal pain, incontinence, difficult defecation). We perform high resolution anorectal manometry using Sandhill Scientific systems, the parameters being analysed using InSIGHT software. The manometric testing comprise measurements of anorectal pressure at rest, during squeeze, simulated evacuation, rectoanal inhibitory reflex (RAIR) and rectal sensory testing, in compliance with International Anorectal Physiology Working Group protocol. Results. We studied 21 patients (12 patients with Ulcerative Colitis and 9 patients with Crohn's Disease, 15 females and 6 males, mean age 40 (±11.43) years. Only 23.1% (5 patients) had rectal active involvement. Symptoms were reported by 81.0% (17) patients: pain (57.1%), anal incontinence (94.1%), difficult evacuation (29.4%), urgency (64.7%) and intolerance of rectal therapies (35.3%); rectal inflammation was not correlated with the presence of symptoms in our study group (p= 0.53). Modified manometric parameters were found in 81.0% patients and were associated with previous pelvic surgical interventions (p<0.05); although, the latter does not seem to increase the risk of incontinence (p= 0.33). In 61.9% cases the manometric measurements correlated with the symptoms. 85% of the patients with passive incontinence presented lower resting pressure and 57.1% of those with active incontinence were found with lower squeeze pressures. Changes compatible with dyssynergia were detected in 61.9% of the cases. Sensory testing revealed alterations in 46.2% of patients, and RAIR was negative in 33.3% of the cases. Conclusions. There was a considerable number of patients with anorectal motility changes. Therefore, pelvic floor investigation is an essential tool in the management of IBD patients with anorectal syptoms. [ABSTRACT FROM AUTHOR]

Introduction. Celiac disease (CD) malabsorption may provoke various extraintestinal features like neurological disorders with a powerful impact on the patient's life. Gluten enteropathy diagnosis may be delayed and therewith the cancer risk may increase. Case presentation. A 35-year old epileptic male patient was admitted with newly onset abdominal pain, vomiting, jaundice and weight loss. The abdominal ultrasonography (US) showed ductal criteria for chronic pancreatitis (CP): irregular duct contour, visible side branches, hyperechoic duct margins and dilated main duct. Besides hepatic cholestasis and cytolysis, the blood tests showed significant lipase elevation, suggesting acute pancreatitis (AP). The upper digestive endoscopy using the side-viewing endoscope revealed the loss of duodenal folds with scalloping appearance. Advancing towards the second part of the duodenum this aspect became more irregular with an infiltrative and stenosing appearance. The biopsies showed poorly differentiated duodenal adenocarcinoma with diffuse areas of signet ring cells, respectively marked villous atrophy: Corazza-Villanacci grade B2. The tTGA were positive at high titer, same as HLA DQ2. Cephalic pancreaticoduodenectomy was performed, with clear resection margins - G3, pT3N0M0. Following surgery, besides the jaundice remission, the patient's neurological status considerably improved under optimized treatment and gluten free diet (GFD). At 6 months follow-up there were no signs of tumor residue, the patient gained weight, US revealed no signs of pancreatitis and the seizures bouts were less frequent. Discussions. There is a 60-to 80-fold increased risk of small bowel carcinoma in patients with celiac disease (CD), a long-standing or refractory disease increasing even more the risk of malignancy. In this case the morbidity was higher due to development of acute pancreatitis episodes on CP, caused by the ampular obstruction. Patients with CD have an increased risk of CP and AP, but the strength of these associations as well as the implied mechanisms are not very well clarified. A Swedish retrospective study found that patients with CD had a 3-fold increased risk of developing pancreatitis, with a lower hazard ratio for gallstone related AP comparative with nongallstone related AP. We consider that the association with the neurological disorder might be only incidental since the imaging found no occipital calcifications specific to a seizure syndrome associated with CD. Conclusions. Gluten enteropathy is a complex disease associating multiple extraintestinal symptoms. An early diagnosis with early GFD reduce the risk of small bowel carcinoma and definitely can prevent other extraintestinal manifestations. [ABSTRACT FROM AUTHOR]

Introduction. Patients with end-stage liver diseases, included on the waiting list (WL) for liver transplant (LT) can develop complications that increase the morbidity and mortality, due to different risk factors. The aim was to evaluate different prognostic factors for mortality in patients included on the WL for LT. Materials and Methods. We performed a singlecenter retrospective cohort study from 1 January, 2018 to 31 December, 2022, in 120 patients included on the WL for LT. We analyzed the following prognostic factors: MELD, MELD Na, MELD 3.0, ALBI, occurrence of acute-on-chronic liver failure (ACLF) from grade 1 to 3, occurrence of liver cirrhosis complications, infections, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio, plateletto-lymphocyte ratio, using univariable and multivariable Cox proportional hazards models. Results. From 120 patients included, 63.3% were males, with a median age of 55 ± 11.55 years. The most frequent etiology of the liver disease was B + delta hepatitis viral infection in 35.8%, followed by alcoholic etiology in 35% of cases. 30.8% of patients had hepatocellular carcinoma. The median MELD Na score at the inclusion on the waiting list was 17 ±7.3. During the follow-up on the waiting list, 39.2% of patients had infectious complications, such as spontaneous bacterial peritonitis (SBP), pneumonia, urinary tract infections and cellulitis. The median waiting time for all patients was 300 ± 686 days. Liver transplant was performed in 66.7% of cases, and 22.5% patients died during follow-up. Univariate analysis demonstrated that the following factors were associated with higher death rates: presence of ACLF (p<0.0001), refractory ascites (p=0.012), acute kidney injury (p=0.0007), hepatic encephalopathy (p=0.0064), infectious complications (p=0.0077), higher MELD score (p=0.043), MELD Na score (p=0.0048) and MELD 3.0 (p=0.0053), higher NLR (p=0.0011). Multivariate analysis was performed and the presence of ACLF (p=0.0051) and a higher NLR (p=0.042) were found to be independent predictors for mortality. Conclusions. In patients included on the waiting list for liver transplant, occurrence of acute-on-chronic liver failure and neutrophil-to-lymphocyte ratio can be used as predictive factors for mortality. [ABSTRACT FROM AUTHOR]

Introduction. Even if for a long time patients with IBD were considered malnourished and underweight, there is an important subgroup suffering from obesity and overweight. Aim. The aim of this study was to assess how obesity influences the response to treatment and the evolution of IBD. Materials and Methods. We perform a retrospective observational study including102 patients divided into 23 patients with obesity (BMI>30kg/m2)-22.5%, 41 overweight patients (BMI> 25kg/m2)-40.1%, 33 normal weight patients (BMI 18.5-25 kg/m2)- 32% and 5 underweight pacients (BMI <18.5)- 4.9% out of 177 patients with IBD admitted in our center during 1st Jan 2022-31 Dec 2022. Because of lack of data 75 patients were excluded from this study. We decided to organise the patients in 2 groups: G1- obese and overweight and G2- normal weight patients. Results: There were 64.7% CD patients (24.2% obese, 39.4% overweight) and 35.3% UC patients(a lower percentage of obese patients 19.4% but similar for overweight patients 41.7%). Also, obesity and overweight was more frequently identified at male patients than female patients(70.8%vs 48.6%) and it seems to be more common for people over 40 years old(67.1% of our patients). CD patients from G1 had a lower prevalence of penetrating disease 4.7% vs 21.2% from G2 patients, but higher rates of perianal disease(26.2% vs 12.1%). Obesity seems not affect the extension of UC disease as G1 and G2 patients present the most common form- pancolitis 45.5% and 61.5%. Anti-TNF medication was preferred for both categories(48.4% Infliximab and 26.5% Adalimumab for G1vs 42.4% and 24.2% for G2), with the mention that 46.9% of G1 patients vs 21.2% of G2 patients required the optimization of the dose of biological treatment, but with similar rates of switch with another biosimilar. The prior surgery was comparable for both groups(28.1% G1 vs 21.2% G2), with a preference for laparoscopic surgery 54.1% vs 35% for the last category(G2) and also a lower risk of postoperative complications (3% vs 20%). Conclusion: Patients with IBD present rates similar to the general population of obesity prevalence. Also, obesity seems to be involved in maintaining a chronic proinflammatory status of these patients, with a poor response to therapies that are not weight-based and intravenously administered, frequently requiring to escalate the treatment dose and a more difficult laparoscopic access for surgery with a higher risk of developing postoperative complications. [ABSTRACT FROM AUTHOR]

Introduction. Hereditary colorectal cancer (HCRC) syndromes represent a relatively diverse group of disorders that exhibit different patterns of inheritance. We aim to create the first registry of this type for this category of patients in order for them to have access to better healthcare and to give them a new perspective Keyword: colorectal cancer, hereditary syndromes, cancer registry Materials and Methods. We started collecting data since August 2021. We made an extensive examination consisting of personal infromation and important clinical data. All patients introduced in the study had lower and upper GI examinations performed, and also CT exams when indicated by guidelines. For Lynch Syndrome we used the Amsterdam and Bethesda criteria, while for familial adenomatous polyposis syndrome we combined the colonoscopy results with family history. We also collected family information in order to be able to perform screening testing for them depending on their respective syndrome. Results. We managed to introduce 26 patients that have either a genetic, histological or clinical diagnosis. Out of these, some are only family members that haven't been genetically tested and aren't diagnosed yet, but still have to be followed. We have 22 index patients, and are currently actively following other family members at high risk. We have 6 Lynch Syndrome families, 2 Peutz-Jeghers families, 3 Attenuated FAP Syndrome families, 2 MAP families, 7 FAP families and one Juvenile polyposis syndrome family with a sex distribution male to female of 9:17, (34.61% male, 65.39% female). Both patients with MAP have had genetic testing done, and also the Juvenile polyposis patient. Currently, family members are being introduced into the study in order to perform screening examinations according to guidelines and create an efficient timetable that can help prevent complications and diagnosis of advanced tumours. Conclusion. While challenging, it is clear that there is an urgent need for an electronic registry in order to offer this category of pacients a better life expectancy and a better quality of life. [ABSTRACT FROM AUTHOR]

Background & aims. In our country prospective studies to establish the prevalence of obesity and non-alcoholic fatty liver disease (NAFLD) are lacking. We prospectively assessed the prevalence and severity of NAFLD in a cohort of asymptomatic patients attending the national screening programme for colorectal cancer. Methods. Screening for NAFLD was performed using abdominal ultrasound and Fibroscan with CAP module. Also antropometric parameters, comorbidities like diabetes and arterial hypertension, and risk behaviours like smoking and alcohol consumption were evaluated Results. We screened 70 patients with FIT positive tests, attending for colonoscopy. The mean age was 60 ± 7.0 years, 48.5% were male, the mean BMI was 28.46 ± 4.54 kg/m2, and 37,1% were obese. The prevalence of NAFLD as evaluated as any degree of steatosis on Fibroscan with CAP module was 79.7% and the prevalence of severe steatosis was 26.6%. Significant fibrosis (F =2) was present in 13.8%. In a multivariable logistic analysis, the only factor associated with the presence of NAFLD was waist cirumference at high risk (>102 cm in men and >88 cm in women) Conclusion. The obesity and NAFLD incidence rate in asymptomatic general population is high and worrying. Abdominal obesity seems to be more predictable than BMI for the diagnosis of fatty liver. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Tuberculin skin test and quantiferon in BCG vaccinated, immunosuppressed patients with moderate-tosevere inflammatory bowel disease," Z. Kurti and colleagues in the 2015 issue.

Management of patients undergoing endoscopy and under treatment with the newer direct oral anticoagulants (DOACs) is a common and a complex clinical issue that gastroenterologists have to face more and more often these days. The increasing use of DOACs in patients requiring both short- and long-term anticoagulation is mostly due to the advantages these agents offer, among which the lack of monitoring requirements and the reduced need of dose adjustments are perhaps the most important ones. Managing these patients in the peri-endoscopic period implies balancing the risk for thrombosis that a certain patient carries and the bleeding risk associated with the endoscopic procedure itself. The Romanian Society of Gastroenterology and Hepatology decided to create a consensus paper to serve to practitioners and teachers. After reviewing the available published data and existing recommendations, a Delphi consensus process was carried out involving the leaders of opinion in this field. After reaching expert consensus, we provide herein guidance for a practical approach of DOACs therapy management in patients with endoscopic interventions.Management of patients undergoing endoscopy and under treatment with the newer direct oral anticoagulants (DOACs) is a common and a complex clinical issue that gastroenterologists have to face more and more often these days. The increasing use of DOACs in patients requiring both short- and long-term anticoagulation is mostly due to the advantages these agents offer, among which the lack of monitoring requirements and the reduced need of dose adjustments are perhaps the most important ones. Managing these patients in the peri-endoscopic period implies balancing the risk for thrombosis that a certain patient carries and the bleeding risk associated with the endoscopic procedure itself. The Romanian Society of Gastroenterology and Hepatology decided to create a consensus paper to serve to practitioners and teachers. After reviewing the available published data and existing recommendations, a Delphi consensus process was carried out involving the leaders of opinion in this field. After reaching expert consensus, we provide herein guidance for a practical approach of DOACs therapy management in patients with endoscopic interventions.Management of patients undergoing endoscopy and under treatment with the newer direct oral anticoagulants (DOACs) is a common and a complex clinical issue that gastroenterologists have to face more and more often these days. The increasing use of DOACs in patients requiring both short- and long-term anticoagulation is mostly due to the advantages these agents offer, among which the lack of monitoring requirements and the reduced need of dose adjustments are perhaps the most important ones. Managing these patients in the peri-endoscopic period implies balancing the risk for thrombosis that a certain patient carries and the bleeding risk associated with the endoscopic procedure itself. The Romanian Society of Gastroenterology and Hepatology decided to create a consensus paper to serve to practitioners and teachers. After reviewing the available published data and existing recommendations, a Delphi consensus process was carried out involving the leaders of opinion in this field. After reaching expert consensus, we provide herein guidance for a practical approach of DOACs therapy management in patients with endoscopic interventions.Management of patients undergoing endoscopy and under treatment with the newer direct oral anticoagulants (DOACs) is a common and a complex clinical issue that gastroenterologists have to face more and more often these days. The increasing use of DOACs in patients requiring both short- and long-term anticoagulation is mostly due to the advantages these agents offer, among which the lack of monitoring requirements and the reduced need of dose adjustments are perhaps the most important ones. Managing these patients in the peri-endoscopic period implies balancing the risk for thrombosis that a certain patient carries and the bleeding risk associated with the endoscopic procedure itself. The Romanian Society of Gastroenterology and Hepatology decided to create a consensus paper to serve to practitioners and teachers. After reviewing the available published data and existing recommendations, a Delphi consensus process was carried out involving the leaders of opinion in this field. After reaching expert consensus, we provide herein guidance for a practical approach of DOACs therapy management in patients with endoscopic interventions. [ABSTRACT FROM AUTHOR]

Background & Aims: Hepatitis C virus (HCV) infection is a common condition with endemic prevalence in some areas of the world. In Romania, the mean prevalence is about 3%. New treatments have become available on the market in recent years and new drugs are in the pipeline. A re-evaluation of HCV therapy was considered mandatory. The Romanian Society of Gastroenterology and Hepatology undertook this task for the practitioners of this country. Methodology: A group of recognized experts was created who screened the available literature and the major available guidelines. A list of items requiring attention was created and these were discussed and rated. Decisions were taken by consensus. Recommendations: We present here the second part of the Society's recommendations for chronic HCV infection treatment. An agreement between experts was reached regarding the therapy of the special categories of patients infected with HCV, complications and monitoring of the therapy, follow-up of the patients who reached sustained virologic response and re-treatment of the patients with therapy failure. Conclusions: This Position Paper represents a guide for the assessment and the therapy of HCV infection. The recommendations are in concordance with other guidelines but are applied to real-life conditions in Romania. [ABSTRACT FROM AUTHOR]

Background & Aims: Ombitasvir/Paritaprevir/ritonavir/Dasabuvir (OBV/PTV/r+DSV) is one of the elective direct-acting antivirals (DAAs) recommended by international guidelines and the only one covered by the National Insurance System in Romania until November 2016. Our aim was to present the first prospective Romanian cohort evaluating the effectiveness and safety in clinical practice of this 3DAA combination in patients with HCV genotype-1b Child A liver cirrhosis. Methods: 681 patients received OBV/PTV/r+DSV+RBV for 12 weeks and were assessed clinically and biologically at baseline, week 4, 8, 12 (end of treatment, EOT), and 12 weeks after therapy (sustained viral response, SVR). Results: Per protocol, EOT virological response was 99.8% and SVR12 rate was 99.4%. Adverse events were present in 36.4% of patients. Permanent discontinuation of 3DAA regimen due to side effects was reported in 11 patients (1.6%). In 47.6% (185/389) of patients, Transient Elastography values were >20kPa (defined as clinically significant portal hypertension, CSPH) at baseline. Independent variables associated with CSPH were: baseline cholesterol level (p=0.003), platelet count <120,000/mm? (p=0.02), MELD score (p=0.01). Liver stiffness measurement has significantly improved between baseline (26.6±12.7kPa) and SVR12 (21.6±11.8kPa) (p<0.0001). The same was true for APRI score (2.66±0.15 at baseline vs 0.85±0.02 at SVR12, p<0.0001) and FIB4 score (5.53±0.28 vs 3.24±0.08, p<0.0001), but not for Lok score (0.57±0.01 vs 0.63±0.01, p<0.0001). Conclusions: We report a high efficacy of the 3DAA regimen in a homogeneous compensated HCV genotype- 1b liver cirrhosis population, in a real-life setting. Noninvasive fibrosis scores significantly improved at SVR12. [ABSTRACT FROM AUTHOR]

Background & Aims: Hepatitis C Virus (HCV) infection is a common condition with endemic prevalence in some areas of the world. In Romania, the mean prevalence is about 3%. New treatments became available on the market in recent years and new drugs are in the pipeline. A re-evaluation of HCV therapy was considered mandatory. The Romanian Society of Gastroenterology and Hepatology undertook this task for the practitioners of this country. Methodology: A group of recognized experts was created who screened the available literature and the major available guidelines. A list of items requiring attention has been created. These items were discussed and rated. Decisions were taken by consensus. Recommendations: We present here the first of the two parts of our Society's recommendations for chronic HCV infection treatment. An agreement was reached regarding the diagnostic tools, the assessment of severity and the up-dated therapy schedules. Conclusions: This Position Paper represents a guide for the assessment and the therapy of HCV infection. The recommendations are in concordance with other guidelines but are applied to the real-life conditions in this country. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article on the diagnosis of clostridium difficile infection in gastroenterology in the previous issue.

The article discusses the prevalence and mildness of inflammatory bowel diseases (IBD) in South Eastern Europe. The authors had reported the low incidence and low prevalence of IBD in Romania. They compare the characteristic of IBD in Romania and Turkey and noted that most patients had ulcerative colitis and some had Crohn's disease.

We present the case of a 63-year-old man that was admitted for melena and severe anemia. Upper GI endoscopy and colonoscopy failed to identify the lesion responsible for bleeding, and enteroCT scan was also non-contributive to the diagnosis. Capsule endoscopy indicated possible jejunal bleeding but could not indicate the source of bleeding, recommending anterograde enteroscopy. Single balloon enteroscopy identified a 2 cm submucosal tumour in the distal part of the jejunum, with a macroscopic appearance suggesting a gastrointestinal stromal tumour (GIST). The tumor location was marked using SPOT tattoo and subsequently easily identified by the surgeon and resected via minimally invasive laparoscopic-assisted approach. Histological and immunohistochemical analysis indicated a low risk GIST. The unusual small size of the GIST as a modality of presentation, with digestive bleeding and anemia and the ability to use VCE/enteroscopy to identify and mark the lesion prior to minimally invasive surgery, represent the particularities of the presented case. [ABSTRACT FROM AUTHOR]

Background: Hepatitis delta virus (HDV) infection is associated with accelerated progression of fibrosis, early occurrence of hepatic decompensation and an increased risk for hepatocellular carcinoma. Epidemiological data on hepatitis delta virus (HDV) in Romania are still lacking. Aim: To assess the prevalence, virological, clinical and epidemiological features of HDV infection in Romanian patients. Methods: We conducted a multicenter study in 10 centers. Data on sociodemographic characteristics and potential risk factors were collected through a questionnaire. Virological markers of HBV and HDV infection, biochemical and clinical features of liver disease were evaluated. Results: The study population comprised 2,761 HBsAg(+) patients with a mean age of43.8±13.8years, out of whom 5.2% were HBeAg(+) and 55.7% were males. Liver cirrhosis was detected in 17.9% of patients, while 80.4% had chronic hepatitis. The prevalence of IgG anti-HDV(+) patients was 23.1%, out of whom 16.4% were HDV RNA positive. The highest prevalence of HDV infection was encountered in patients aged 50-59 years (28.9%) and patients aged >60 (24.8%) (p=0.0001). Seroprevalence of HDV was significantly higher in AgHBs(+) cirrhotics vs. noncirrhotics (43.4% vs 19.0%, p=0.0001). Risk factors for HDV infection were: occupational hazard, no HCV chronic infection, lack of anti-HBV vaccination, presence of blood transfusions, any previous surgery, frequent hospitalization or endoscopies, tattoos, body piercing, use of glass syringes, number of female sexual partners. Conclusions: HBsAg(+) population in Romania is characterized by a high prevalence of HBeAg(-) HBV infection as well as HDV co-infection. A cohort phenomenon for HDV prevalence is also observed similar to that of HCV/HBV monoinfections. [ABSTRACT FROM AUTHOR]

The article describes the case of a 56-year old woman who was diagnosed with alpha fetoprotein (AFP)-producing colon cancer. The patient underwent blood tests, upper endoscopy, colonoscopy, computed tomography scan of the thorax, abdomen and pelvis, liver and colon biopsy. Blood test results revealed increased liver enzymes, mild cholestasis and inflammatory syndrome, while immunohistochemistry results included tubulo-papillary pattern, liver metastasis and synaptophysin positive cells.

Background & Aims: Anemia is the most frequent systemic complication in inflammatory bowel diseases. It affects the quality of life and can interact with working capacity. Our objectives were to identify the prevalence of anemia, its main causes and its management in patients with inflammatory bowel disease from Romania. Methods: We conducted a multicenter prospective study from March 2013 to August 2014. We enrolled 291 patients from three referral centers: 115 (39.52%) with Crohns disease (CD) and 176 (60.48%) with ulcerative colitis (UC). We defined anemia according to the WHO criteria. Results: Median age of the patients was 41 years and the median time period since diagnosis was 3 years (0.75-7). The median activity index for UC (UCAI) was 4 and the median CD activity index (CDAI) was 96. More patients with CD were on antiTNFa therapy (p < 0.01), corticosteroids (p =0.18) or azathioprine (p=0.05) and required surgery for their underlying disease at study enrollment (p < 0.01). Anemia was present in 31.27% of the patients, more often in those with CD (35.65%) than with UC (28.41%) (not statistically significant); 53.26% of the patients had iron deficiency while 4.12% had folic acid and 8.59% vitamin B12 deficiency; 9.62% of the patients had received anti-anemic therapy at inclusion in the study or in the last three months prior to study enrollment. Conclusions: About one in three Romanian patients with inflammatory bowel disease has anemia, which is frequently associated with iron deficiency. About 30% of the patients with anemia are under therapy and the most frequent route for iron supplementation is the oral one. This might contribute to the high prevalence of iron deficiency and the low level of compliance. [ABSTRACT FROM AUTHOR]

The article presents a study which discusses the use of mebeverine, an antispasmodic drug, in the treatment of irritable bowel syndrome (IBS). The methodology used include selection of working group, development of draft statements, and a systematic literature review on the evidence to support the statement. Topics discussed include the use of antispasmodics in IBS treatment, impact of mebeverine on quality of life (QOL) of IBS patients, and prescription of mebeverine in Romania.

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.

The article presents a response to a 2021 article by Pioppo et al. on patients with admissions for gastric antral vascular ectasia (GAVE) and the factors of portal hypertension and chronic kidney disease for their readmission. Topics discussed include the effectivity of endoscopic treatment for GAVE in reducing acute rebleeding and chronic blood loss, and the still undetermined timing of endoscopic treatment due to minimal GAVE cases. Also noted is the need for multicentric studies on timing.

Although controlled by vaccination long ago, diphtheria may become a re-emergent disease as a result of at least two factors: the circulation of toxigenic strains in endemic areas (countries of former CSI, some of them neighbouring countries of Romania) and the lack of interest of the local health institutions for surveillance of this very low incidence disease. The aim of this study was to evaluate the carriage of potentially toxigenic Corynebacterium strains in healthy people in Romania. In this study, 1120 biological samples were analysed consisting of swabs, nasal exudates and conjunctival secretions collected from 730 healthy individuals from eight different geographic regions of the country, in order to establish carriage of potentially toxigenic strains belonging to the Corynebacterium genus. 129 strains of the Corynebacterium species were isolated and identified by phenotypic and molecular methods: Corynebacterium pseudodiphtheriticum (n = 76), C. propinquum (n = 34), C. striatum (n = 9), C. macginleyi (n = 2), C. glucuronolyticum/seminale (n = 2), C. group F1(n = 6). These species are saprophytic species for the upper respiratory tract, some of them being an opportunistic pathogen especially in immunocompromised hosts. The present data require the attention of clinicians, epidemiologists and microbiologists since diphtheria is an infectious disease that could re-emerge. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to characterize the dynamics of the Romanian waiting list (WL) for liver transplantation (LT) over two periods: 2004-2007 vs. 2008-2011. Methods: 1,085 patients listed for LT during the time period 2004-2011 were included in our analysis. Results: Death on the WL was significantly higher before 2008 (37% vs. 26.4%, p=0.0001) and risk of dying while on WL was 60% higher. Waiting time on the WL was 75% longer and time until LT was 102% longer before 2008 compared to the second time period (p=0.0001). After 2008, 62.3% of patients were listed for LT with Child Pugh class C compared to 22.1% before 2008 (p<0.0001). Conclusion: A significant reduction of mortality has been registered on the Romanian WL for LT after 2008, despite the increased severity of liver disease in patients listed for LT. [ABSTRACT FROM AUTHOR]

We present the case of a previously healthy 62 year old man who developed primary non-Hodgkin lymphoma of the liver. Biopsy confirmed that it was a diffuse large anaplastic T-cell lymphoma of an extremely rare type. The diagnosis of this type of lesions is suggested by the presence of a hepatic mass without lymphadenopathy, splenomegaly or bone marrow involvement associated with normal tumor markers (carcinoembryonic antigen, alpha-fetoprotein and CA 19-9 levels). Histological examination of tissue is essential to confirm the diagnosis. Treatment options are surgical resection and/or chemotherapy but the rate of response to treatment varies widely. Some patients can achieve prolonged remission. [ABSTRACT FROM AUTHOR]

Background & Aim. Wilson's disease (WD) is a rare autosomal recessive disease. More than 500 mutations have been described so far, out of which 29 in exon 14. H1069Q mutation in the exon 14 of ATP7B gene is the most frequently encountered in Europe. The aim of the present study was to evaluate the incidence of mutations occurring in exon 14 of ATP7B gene in Romanian patients referred to a tertiary gastroenterology center, with known or suspected WD and in asymptomatic first degree relatives of index cases. methods: 93 patients were included in the study. Exon 14 of ATP7B gene has been amplified by PCR from genomic DNA and mutations identified by sequencing. Results: Only H1069Q missense mutation was detected in our study group. In patients with an established diagnosis of WD (38 cases), 34.2% were heterozygous for H1069Q and 21.1% were homozygous, with an allelic frequency of 38.1%. In paediatric WD patients (12 cases) 25% were heterozygous and 16.7% were homozygous (not significant versus adult population). Among asymptomatic first degree relatives of patients with WD (12 siblings, 25 parents) there were 40.5% cases heterozygous for H1069Q. In patients with suspected WD (17 cases), only 5.9% were heterozygous and no homozygous patient was identified. In our study group, H1069Q screening alone could not raise the Leipzig score to confirm diagnosis in patients with suspected WD or in asymptomatic first degree relatives. Conclusion: H1069Q mutation is highly prevalent in Romanian WD patients and first degree relatives, similar to other central and continental western European populations. [ABSTRACT FROM AUTHOR]

Background & Aims. Serological markers have been widely used for diagnostic purposes and disease stratification in inflammatory bowel diseases (IBD). The aim of this study was to investigate the seroprevalence and the correlations of anti-Saccharomyces cerevisiae antibodies (ASCA) titers with different clinical phenotypes in Romanian patients with Crohn's disease (CD). Methods. The study included 107 CD and 86 ulcerative colitis (UC) patients from the Gastroenterology Departments of three University Hospitals, and 60 healthy subjects. ASCA IgA and IgG titers were determined using ELISA test. For CD patients the phenotype was established according to the Montreal classification. The differences in ASCA titers for different CD phenotypes were assessed using the Mann-Whitney U test. Results. ASCA prevalence was 33.6% in CD group, 12.8% in UC group and 6.6% in the control group. Significantly higher IgA (p=0.05) and IgG (p=0.03) titers were found in patients from the Montreal A1+A2 groups (age at onset below 40) compared with the older patients (A3). Higher titers were found in patients with extensive ileo-colonic lesions (L3) and upper gastrointestinal tract involvement (L4) than in patients having only colonic disease (L2). Significantly higher IgA (p=0.03) and IgG (p=0.03) titers were observed in patients with stenosing (B2) and penetrating (B3) disease compared with the nonstricturing, nonpenetrating (B1) phenotype. No correlation between ASCA titers and disease duration was found. Conclusion. ASCA seropositivity in Romanian CD patients is lower than in Western Europe. Higher ASCA IgA and IgG titers are associated with a younger age at diagnosis and more aggressive phenotypes. [ABSTRACT FROM AUTHOR]

Background: Clinical presentation in microscopic colitis (MC) is similar in many cases to that of diarrhea-predominent irritable bowel syndrome (IBS-D). The proper differential diagnosis requires total colonoscopy with multiple biopsies from normal-appearing mucosa and a detailed histopathological exam. Specific treatment may improve symptomatology. Aim: To evaluate the prevalence of MC in patients with an initial diagnosis of IBS-D, to analyse demographic and clinical features of MC patients and to assess the efficacy of specific treatment. Material and methods: Our retrospective study analyzed patients diagnosed with microscopic colitis in clinic during a three-year period. Diagnosis was established on histological exams of the samples obtained during colonoscopy in patients previously thought to have IBS-D. We evaluated clinical manifestations, time lapsed from their onset to definitive diagnosis, the association of MC with autoimmune diseases or with prior medication and the efficacy of treatment with budesonide or mesalazine. Results: From 247 patients considered to have IBS-D, 15 patients (6.07%) had actually MC (13 lymphocytic colitis and 2 collagenous colitis). MC was associated with nonsteroidal antiinflammatory drugs (3 patients), Lansoprazole (2 patients) and autoimmune diseases (6 patients). Watery, non-bloody diarrhea was present in all patients with MC. Other frequent complaints were nocturnal diarrhea (11 patients), abdominal pain (8 patients), abdominal bloating and flatulence (8 patients) and slight weight loss (6 patients). The diagnostic samples were obtained from the right colon in 6 cases and from rectosigmoid or transverse colon in 9 patients. Treatment was initial symptomatic in all patients, but there were 5 patients that required mesalazine and/or Budesonide, with favourable outcome. Conclusions: All the patients thought to have diarrhea-irritable bowel syndrome should be evaluated for microscopic colitis. Symptomatology is almost superimposable, but a few distinct features can be noticed. The proper and early diagnosis and the specific treatment may lead to significant clinical improvement in some difficult cases of the so-called "irritable bowel syndrome". [ABSTRACT FROM AUTHOR]

Aims: This study was aimed at determining the seroprevalence of hepatitis C virus (HCV) infection in Romania and the possible risk factors and modality of HCV transmission. Methods: A nationwide cross-sectional survey among the adult population was conducted between 2006-2008 in Romania through a population multicenter stratified random cluster sampling. Serum samples from 13,460 subjects were tested with a 3rd generation ELISA and a standardized questionnaire concerning the socio-demographic characteristics and potential risk factors was used. Results: The prevalence rate of HCV infection in Romanian adult population was 3.23% with significant differences between the main geographical regions (Moldavia 4.25%, Wallachia & Dobrogea 3.35% and Transylvania & Banat 2.63%), as well as between different counties (maximum 7.19%, minimum 0.56%). Overall participation rate to the survey of the selected subjects was 74.69%. Risk factors for HCV infection were: blood/blood products transfusions (p=0.0001), previous surgery (elective and emergency, p=0.0001 and p=0.043, respectively), frequent hospitalizations (p=0.0001), injections at home (p=0.0001), accidents/trauma (p=0.0001), occupational hazard related to blood exposure (p=0.025), intravenous drug administration (p=0.002), a partner chronically infected with HCV/hepatitis B virus (HBV) (p=0.046), first sexual intercourse <18 years (p=0.019), familial exposure to HCV/HBV infection (p=0.001) or to chronic HBV/HCV liver disease (p=0.001), personal history of chronic HBV infection (p=0.001). HCV RNA positivity was detected in 91% of the anti HCV positive subjects. Conclusions: Overall HCV prevalence in Romania is 3.23%. Both nosocomial and non-nosocomial routes are implicated as risk factors for HCV infection. [ABSTRACT FROM AUTHOR]

Background: Small nodules (<3 cm) detected on ultrasound (US) in cirrhotics represent the most challenging category for noninvasive diagnosis of hepatocellular carcinoma (HCC). Aim: To evaluate real-time sonoelastography as a noninvasive tool for the diagnosis of small HCC nodules in cirrhotic patients. Methods: 42 cirrhotic patients with 58 nodules (1-3 cm) were evaluated with real-time elastography (Hitachi EUB-6500); the mean intensity of colors red, blue, green were measured using a semi-quantitative method. Analysis of histograms for each color of the sonoelastography images was performed for quantifying the elasticity of nodule tissue in comparison with the cirrhotic liver tissue. AUROC curves were constructed to define the best cut-off points to distinguish malignant features of the nodules. Univariate and multivariate logistic regression analysis was performed. Results: 595 sonoelastography images from 42 patients (25 men; 17 women) were analyzed. The mean age was 56.4±10.7 years and 69% patients were in Child-Pugh class A, 19% class B, 11% class C. For the mean intensity of green color AUROC=0.81, a cut-off value of <108.7 being diagnostic for HCC with a Sp=91.1%, Se=50%, PPV=92.1%, NPV=47.1%. Mean intensity of blue color proved to be an excellent diagnostic tool for HCC (AUROC=0.94); for a cut-off value>128.9, Sp=92.2%, Se=78.9%, PPV=95.4%, NPV=68%. Independent predictive factors of HCC for a small nodule in cirrhotic patients were: blue color>128.9 at sonoelastography and hypervascular appearance at Doppler US. Conclusions: US elastography is a promising method for the non-invasive diagnosis of early HCC. Blue color at elastography and hypervascular aspects are independent predictors of HCC. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 35-year-old epileptic male with abdominal pain, vomiting, jaundice, and weight loss. Examinations showed ductal criteria for chronic pancreatitis, cholestasis, loss of duodenal folds, and poorly differentiated duodenal adenocarcinoma. The patient had celiac disease (CD) with high risk of morbidity due to acute pancreatitis (AP), but after surgery, his neurological status improved with no tumor residue at 6 months follow-up.

A quiz concerning gastroentrology is presented.

The article presents a case study of 59-year-old female with dysphagia and significant weight loss. It mentions diagnosis of lymphocytic esophagitis (LE), a rare condition of the esophagus; and also mentions use of Proton-pump inhibitors and topical corticosteroids to induce histological remission for LE management.