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Intestinal strictures are an important complication of Crohn's disease (CD), with ~40% of patients developing symptomatic obstruction within 10 years of diagnosis. However, there is a paucity of research examining the mechanisms driving the development of fibrotic strictures in CD. The present study aimed to identify the mucosal markers associated with stricturing complications by examining the differences in the gene expression profiles of two patient cohorts: Patients diagnosed with inflammatory CD (n=12) and patients with stricturing CD (n=9). For each patient, a paired sample of inflamed and uninflamed mucosa was isolated and assessed by quantitative PCR using a large panel of genes associated with inflammatory bowel disease. The presents study revealed a significantly increased level of four genes in the mucosa of patients with strictures compared with the inflammatory pattern of the disease: Formyl-peptide receptor 1 [P=0.019; fold change (FC)=11.6], C-C chemokine receptor type 1 (P=0.035; FC=5.44), IFN-γ-inducible protein 10 (P=0.037; FC=3.8) and C-C chemokine ligand 25 (P=0.048; FC=3.56). The augmented expression of these four genes in the CD stricturing phenotype, if confirmed in larger cohorts of patients, could help elucidate the mechanisms leading to disease-associated complications. [ABSTRACT FROM AUTHOR]

Historic. A 59-year-old patient, a chronic ethanol user, without any medical history, presents with hematemesis and abdominal pain. Methods. The level of hemoglobin was 8.2 g/dL, without any other biological modification. The emergency upper digestive endoscopy revealed a large clot that almost completely occupied the esophageal and gastric lumen, up to the duodenal angle. Endoscopic re-evaluation at 24 hours: esophagus and stomach with free lumen, gastric body with extrinsic compression on the posterior face towards the greater curvature and intensely edematous mucosa at that level. Abdominal ultrasound revealed multiple calcifications at the level of the pancreatic head and body and at the level of the tail of the pancreas, a cystic formation of approximately 5 cm was visualized, with a pulsed Doppler signal. CEUS:hyperinhancement in the center of the lesion and lack of contrast in the periphery, an aspect that was maintained in the portal and parenchymal phases. The abdominal CT showed a corporeo-caudal pancreatic pseudoaneurysm of the splenic artery with dimensions of 65 mm, with parietal thrombosis with a stratified appearance, affecting about 40% of the lumen, with contrast extravasation, in direct contact with the posterior gastric wall. Results. The suspicion of upper digestive hemorrhage secondary to a fistula between the pseudo-aneurysm of the splenic artery and the stomach was raised, but also the possibility of a wirsungorrhagia, given the direct contact of the lesion with the pancreatic tail. Abdominal angiography with angioplasty was performed, secondary to the extravasation of the contrast substance at the level of the splenic artery with a 3/18 mm Bentley type stent graft, with an optimal result, without extravasation of contrast. Diagnosis. Upper gastrointestinal hemorrhage secondary to a splenic artery pseudoaneurysm. Chronic ethanolic pancreatitis. Conclusions. Bleeding from splenic artery pseudoaneurysm is a rare and often fatal cause of gastrointestinal bleeding The most common causes are pancreatitis and abdominal trauma. In pancreatitis, pancreatic enzymes can cause vascular necrosis and rupture of elastic tissue, leading to pseudoaneurysm formation. Another way can be through pseudocysts (41% of patients with pseudoaneurysms), In this patient's case, the pseudoaneurysm most likely occurred secondary to a pseudocyst that eroded the splenic artery, with intracystic hemorrhage, which led to a localized hemorrhage and not to a hemoperitoneum, and subsequently to the digestive tract, transgastric or through the main pancreatic duct. After stent placement by angiography, the patient had a favorable evolution at ultrasound reevaluation at 1 month, with remission of the lesion. [ABSTRACT FROM AUTHOR]

Aims. Among the non-invasive methods of evaluation in cirrhotic patients, the shear wave elastography (2D-SWE) method has been used to quantify the stiffness in chronic liver disease with good accuracy. Several studies have shown that each complication of cirrhosis is associated with a certain amount of liver stiffness. The objective of the study we performed was to quantify the use of elastography (liver and spleen) in predicting the risque and the grade of gastro-esophageal varices in patients diagnosed with hepatic cirrhosis. Methods. We used the GE Logiq E9/E10 ultrasound system for 34 pacients. We excluded the pacients with liver neoplasia, infiltrative liver disease, acute virale hepatitis and obstructive cholestasis. The value cutt-off used for liver stiffness was >11.88 kPa (>1.99 m/s), correspondent for F4 Metavir. The procedure was realized after 4 hours of fasting, intercostal at 1.5-2 cm below liver and spleen capsule avoiding vessels. Six measurements were obtained for each patient. The results were compared with upper digestive endoscopy. Results. We performed liver elastography for 34 patients known with liver cirrhosis, 94.2% due to ethanol consumption, of which 29.4% (n:10) were female and 70.5% (n:24) were male. We compared the degree of esophageal varices with the value of elastography. Elastography can differentiate patients without esophageal varices from patients with moderate (p value=0.072) or large esophageal varices (p value=0.013), but it cannot differentiate between patients without esophageal varices and those with small esophageal varice (p value=0.8249). However, there was a lack of correlation between the elastographic values of the spleen and the degree of esophageal varices (p value= 0.5860). Conclusions. The results obtained are indicating that 2D-SWE of the liver can be used for ruling-out varices needing treatment in patients with cACLD, knowing that the presence of varices and especially of varices needing treatment indicates distinct prognostic stages in patients with compensated ACLD (cACLD). [ABSTRACT FROM AUTHOR]

Background and aims. For the 8-week OPrD regimen, real world data are insufficient. This study aims to compare the efficacy of the two types of regimens (12-week versus 8-week) in a real world cohort of patients with genotype 1b. Material and methods. We analysed a multicentric retrospective cohort enrolling 1436 patients who started HCV therapy in 2018-2019. Liver fibrosis was staged in all subjects by Fibromax. Efficacy was assessed by the percentage of patients achieving SVR 12 weeks post-treatment (SVR12). Results. Out of the 1436 analysed patients, 112 received 8 weeks therapy and 1324 received 12 weeks. In this cohort the proportion of male patients was 25.2%, the median age 61 years, 28.2% were interferon pre-treated, and the rate of co-morbidities was 47%. 42% of the subjects had F2 fibrosis, 29% F1 fibrosis, 16% F3 and 12% F4. The SVR rate was comparable in both groups of patients (97% in those treated with OPrD 12 weeks vs 96.4% in those that received OPrD 8 weeks) (by intention-to-treat). In the 12 weeks arm, the drop-out rate was 0.8% and the rate of severe adverse events was 1%, while in the arm of 8 weeks therapy there were no severe adverse events reported and no drop-out (p = 0.25). The only predictive factor for non-response in both treatment arms was the male sex. Conclusions. OPrD 8 weeks proved to be highly efficient in our patients with a 96.4% SVR. No serious adverse events and no drop out were reported. [ABSTRACT FROM AUTHOR]

Aims. An 84-year-old patient with a history of high blood pressure presented to the emergency room with lower abdominal pain and haematochezia. Methods. Clinical:hemodynamically stable. Biological: WBC 32700/microL, Hb=8.1 g/dL, PLT = 321 000/microL, INR=1.23, CRP = 292 mg/L. CTscan: no contrast extravasation in the digestive tract, infrarenal aortic aneurysm (130 mm cranio-caudal), with parietal thrombus plus a retroaortic abscess with stenosis of the inferior vena cava. Vascular surgery consultation: no surgical indication ->admission to the gastroenterology department. Emergency upper GI endoscopy: adherent clot in the fornix, stasis fluid. 60 cm rectosigmoidoscopy: mucosal lesions suggestive of ischemic colitis. Reevaluation after 12 h: WBC = 26 000/microL, hemoglobin = 7.1 g/dL Results. Re-evaluation of the CT-scan: suspicion of an aorto-duodenal fistula. Second upper GI endoscopy: gastric mucosa, bulb and D2 lined with fresh blood. On withdrawal, an infrapapillary lesion suggestive for an aortoenteric fistula. Duodenoscopesecond look:an erosion with a diameter of 10 mm with a deep punctate hole: most likely aortoenteric fistula. The patient was transferred to cardio-vascular surgery: double-layer duodenorrhaphy and aorto-aortic interposition of a silver Dacron prosthesis were done. Conclusion. The particularity of the case was represented by the rare cause of haemorrhage with difficult diagnosis. The approach and treatment required a multidisciplinary team and a good collaboration. The patient was discharged after 17 days with a good general condition. [ABSTRACT FROM AUTHOR]

Aims. Variceal bleeding is a common and severe cause of hospitalization in cirrhotic patients. We analyzed how the COVID-19 waves modified the outcome of the patients compared to COVID-19 extra-wave intervals. Methods. We retrospectively included all patients hospitalized between March 2020 and December 2021 for variceal bleeding. They were separated in 2 categories: hospitalizations during COVID-19 extrawaves period and the COVID-19 waves. Variables like sex, age, hemoglobin at presentation, endoscopic timing, hemostatic methods, transfusion necessity, duration of hospitalization and mortality were analyzed. Results. Out of 76 patients (2020-2021), 20patients were hospitalized during the COVID-19 waves. The median age did not differ significantly across groups (61 years [IQR: 52-65] vs 58years [IQR: 44-64]), 59 patients being male and 17 being female. The number of admissions for variceal bleeding and gastroscopy requirement and timing were similar regardless of the studied period (p > 0.05). Median hemoglobin admission values were significantly lower in the following subgroups: patients in whom gastroscopy was performed in less than 6 hours or more than 12 hours (p = 0.045) and patients requiring PRBC transfusion (p = 0.018). There were also no differences in duration of hospitalization and mortality between the two studied periods (p>0.05). Conclusions. The number of patients remained relatively constant in both periods. We found no differences in the management and outcomes of patients with variceal bleeding throughout the COVID pandemic. Our results might be influenced by the low number of patients and need confirmation on larger cohorts. [ABSTRACT FROM AUTHOR]