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Background and Objectives: Biologic therapy has fundamentally changed the opportunity of medical treatment to induce and maintain remission in inflammatory bowel disease (IBD). Nevertheless, the rate of surgery is still at a very high rate, profoundly affecting the quality of life. We aimed to analyze surgical cases at three major IBD units in order to identify the main risk factors and the impact of biologic therapy on pre- and postsurgical outcomes. Material and Methods: This was a multicenter retrospective cohort study that included 56 patients with IBD-related surgical interventions from 3 tertiary care hospitals in Bucharest, Romania. The study was conducted between January 2017 and June 2021. All data were retrospectively collected from the medical records of the patients and included the age at diagnosis, age at the time of surgery, IBD type and phenotype, biologic therapy before or/and after surgery, timing of biologic therapy initiation, extraintestinal manifestations, type of surgery (elective/emergency), early and long-term postoperative complications and a history of smoking. Results: A low rate of surgical interventions was noted in our cohort (10.3%), but half of these occurred in the first year after the IBD diagnosis. A total of 48% of the surgical interventions had been performed in an emergency setting, which seemed to be associated with a high rate of long-term postoperative complications. We found no statistically significant differences between IBD patients undergoing treatments with biologics before surgery and patients who did not receive biologics before the surgical intervention in terms of the IBD phenotype, type of surgery and postoperative complications. Conclusion: Our study showed that biologics initiated before the surgical intervention did not influence the postoperative complications. Moreover, we demonstrated that patients with Crohn's disease and no biologics were the most susceptible to having to undergo surgery. Conclusion: In conclusion, the management of patients with IBD requires a multidisciplinary approach that considers an unpredictable evolution. [ABSTRACT FROM AUTHOR]

Background & Aims: The sofosbuvir (SOF) / velpatasvir (VEL) / voxilaprevir (VOX) combination has been evaluated in more than 800 patients enrolled in phase II and phase III studies, where it demonstrated excellent safety and efficacy, achieving overall sustained viral response (SVR) rates of more than 95%. We aimed to assess the efficacy and safety of SOF/VEL/VOX in a real-world study, including patients previously treated for genotype 1b hepatitis C virus (HCV) infection that did not obtain a sustained viral response with previous direct-acting antivirals (DAAs) therapy. Methods: In Romania, through a nationwide government-funded program in 2019-2020, 213 patients with chronic hepatitis C non-responders to previous DAAs therapy, received treatment with SOF/VEL/VOX 400/100/100 mg/day for 12 weeks. We performed a retrospective longitudinal study that included 143 individuals who were treated in Bucharest, Iași, Craiova and Constanța clinics, all with genotype 1b HCV infection. Efficacy was assessed by the percentage of patients achieving SVR 12 weeks post-treatment (SVR12). Serious adverse events (SAE) were registered. Results: Our cohort comprised 53% males with a median age of 60 years (27÷77); 47% were pre-treated with ombitasvir/paritaprevir/ritonavir+dasabuvir ± ribavirin, 40% with ledipasvir/SOF, 13% with elbasvir/grazoprevir. 42% of patients associated co-morbidities, 45% had compensated liver cirrhosis, 2% had treated hepatocellular carcinoma (HCC) and 1% had hepatitis B virus co-infection. SVR by intention to treat was reported in 139/143 (97.2%) and per protocol in 141/143 (98.6%). No predictive factors for SVR were identified. Rate of liver decompensation in patients with cirrhosis was 6% and was statistically associated in multivariate analysis with Child-Pugh score (p<0.01) and with severe steatosis (p=0.004). Occurrence of new HCC was reported in 3.6% of all patients with cirrhosis and was associated with poor liver function [higher Child-Pugh score (p=0.001) and low albumin levels (p=0.02)]. Serious adverse events related to therapy were reported in 1/143(0.7%). Conclusions: SOF/VEL/VOX was highly efficient in our population of patients with a 97.2% SVR. Liver decompensation occurred in 6% of cirrhotic patients at SVR, related to hepatic dysfunction. [ABSTRACT FROM AUTHOR]

Study's objectives. Helicobacter pylori (H.P) is the most common chronic bacterial infection in humans. Conservative estimates suggest that 50% of the world's population is affected. Infection is more frequent and acquired at an earlier age in resourcelimited countries compared with industrialized nations. Once acquired, infection persists and may or may not produce gastroduodenal diseases: antral gastritis, peptic ulcer disease and various gastrointestinal neoplasms. The latest studies highlight the benefit of eradicating H.P infection, but also the intestinal dysbiosis following therapy. Material and method. We present a prospective study, carried out within IC Fundeni, Bucharest for a period of 4 weeks after Helicobacter pylori (H.P) eradication therapy (proton pump inhibitor 40mg x2/day+ amoxicillin 1000mg x 2/day+ levofloxacin 500mg/day + bismuth 120mg x 4/day, 14 days), which included a number of 66 patients divided into 2 groups: 33 in the control group and 33 patients in the probiotic group: Streptococcus faecalis, Clostridium butyricum, Bacillus mesentericus, Lactobacillus sporogenes: 1 capsule x 2/day, during 4 weeks, after HP eradication therapy (BIOSUN), in order to assess the effects of Helicobacter pylori eradication therapy on intestinal dysbiosis, regarding the general state of health and the impact of probiotic therapy on improving the functional capacity. Patients were evaluated at the end of H.P eradication therapy - visit 1 and after 4 weeks from HP eradication therapy - visit 2, concerning the following aspects: self-assessment of general health state, the ability to perform physical/workplace-related activities, presence of pain (of any kind) with impact on daily/other activities, energy level, presence of melancholy or discouragement feeling, social activities impairment due to emotional or physical issues. Results. At visit 1, among the 66 patients included in our study, 36% patients (15 patients included in the probiotic group and 9 patients included in the control group) confirmed a good/very good/excellent general condition. A good general status proved to be consistent with the absence of: painful symptoms/abdominal discomfort, depressive/anxiety states and with an adequate energy level. 39% patients (12 patients included in the probiotic group and 14 patients in the control group) reported a moderately altered general status and 24% patients (6 patients included in the probiotic group and 10 patients in the control group) a severely altered general status. The altered general condition index was directly correlated with: limitation of physical/work-related activities, presence of pain/abdominal discomfort, frequency of depressive episodes and reduced energy levels. The evaluation carried out 4 weeks from HP infection eradication therapy confirms the improvement of the general condition in 10% of the 33 patients included in the probiotic group. The improvement of the general condition was associated with an increase in functional capacity and energy level, without changing the frequency of depressive episodes. Among the 33 patients included in the control group, 9% confirmed the improvement of general condition, with a directly proportional increase in functional capacity and energy level, also without changing the frequency of depressive episodes. Conclusions. The primary results, assessed shortly after the second visit, demonstrate insignificant differences between the two groups regarding the improvement of the general state, ability to perform physical / workplace-related activities and energy level. No changes were documented regarding the frequency of depressive episodes, possibly associated with the functional nature of the reported symptomatology. No adverse effects were reported during probiotic therapy based on Streptococcus faecalis, Clostridium butyricum, Bacillus mesentericus, Lactobacillus sporogenes. The obtained results will also be analyzed according to individual characteristics (age, sex, duration of symptoms, stress level at work); The long-term effects of probiotic therapy after HP eradication therapy remain to be assessed (possible using intestinal microbiota analysis before and after probiotic therapy). [ABSTRACT FROM AUTHOR]