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Primary rectal lymphoma is the rarest disorder of all primary gastrointestinal lymphomas. The association between Crohn’s disease and primary rectal lymphoma is also very rare and there are a few case reports in the literature describing the association between these two diseases.

Systemic sclerosis (SS) is an autoimmune disorder that may result in diverse esophageal motor disorders. Typical manometric disorders include decreased lower esophageal sphincter (LES) pressure, absent contractility and ineffective peristalsis.The aims of the study were to assess esophageal motor abnormalities in SS patients using high resolution manometry and to evaluate clinical and endoscopic features that are associated with manometric findings.Patients with SS who underwent esophageal high-resolution manometry (HRM) between December 2016 and August 2020 were enrolled in the study. Data regarding demographics and symptom frequency were obtained through a questionnaire. Chicago classification criteria (V3.0.) were used for defining esophageal dysmotility.A total of 49 patients were enrolled in the study. Median age was 56 ±13.4 years. High-resolution manometry showed that absent contractility (n= 24; 49%) and ineffective motility (n=14; 28.6%) were the most frequent motor abnormalities. One case of esophageal gastric junction (EGJ) outflow obstruction was observed in a female patient. A hypotensive LES was observed in 18 patients (36.7%). Absent contractility was associated with regurgitations (=0.013), and erosive esophagitis (p=0.003).Absent contractility and ineffective motility were the most common esophageal contractile patterns among our patients. Patients with absent contractility experienced more frequently regurgitations and had more often erosive esophagitis.

[Background & Aims]: Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent, yet largely underappreciated liver condition which is closely associated with obesity and metabolic disease. Despite affecting an estimated 1 in 4 adults globally, NAFLD is largely absent on national and global health agendas., [Methods]: We collected data from 102 countries, accounting for 86% of the world population, on NAFLD policies, guidelines, civil society engagement, clinical management, and epidemiologic data. A preparedness index was developed by coding questions into 6 domains (policies, guidelines, civil awareness, epidemiology and data, NAFLD detection, and NAFLD care management) and categorising the responses as high, medium, and low; a multiple correspondence analysis was then applied., [Results]: The highest scoring countries were India (42.7) and the United Kingdom (40.0), with 32 countries (31%) scoring zero out of 100. For 5 of the domains a minority of countries were categorised as high-level while the majority were categorised as low-level. No country had a national or sub-national strategy for NAFLD and, [Conclusions]: Although NAFLD is a pressing public health problem, no country was found to be well prepared to address it. There is a pressing need for strategies to address NAFLD at national and global levels., The data collection and analysis were funded by the EASL International Liver Foundation with support from, Intercept, Bristol-Myers-Squibb Company, Genfit, and MSD. Data collection for the original European data was funded by the EASL International Liver Foundation supported by Gilead Sciences Europe Ltd., Allergan Pharmaceutical International Ltd., Bristol-Myers-Squibb Company, Pfizer Inc., and Resoundant Inc.

Thiopurines have proven efficacy in inflammatory bowel disease. However, their use is limited by adverse effects in a subset of patients.The present study aimed to evaluate toxicity profile and identify clinical predictive factors of thiopurine adverse effects in inflammatory bowel disease patients.A retrospective longitudinal study was conducted among inflammatory bowel disease patients treated with thiopurines. Multiple logistic regression was used to identify risk factors for thiopurine adverse effects.A total of 210 patients were enrolled in the study. Mean age at disease onset was 29.8±11.4 years. One hundred sixty-nine (169) patients had Crohn's disease, 29 had ulcerative colitis and 12 had indeterminate colitis. During a median follow-up of 28.5 ± 20 months, 56 patients (26.6%) had thiopurine-related adverse effects including digestive intolerance (n=14; 6.6%), immunoallergic reactions (n=8; 3.8%), myelotoxicity (n=25; 11.9%) and hepatotoxicity (n=8; 3.8%). Treatment withdrawal was reported in 19 patients (9%). The only independent predictive factor for thiopurine adverse effects found in this study was steroid-dependence (OR= 3.96; 95% CI: 1.07- 14.53; p= 0.038).Almost a quarter of inflammatory bowel disease patients treated with thiopurines developed adverse effects. These adverse effects lead to drug withdrawal in almost 9% of patients either as monotherapy or as in combination with biologic therapies. Steroid-dependent patients were significantly at higher risk for thiopurine-related toxicity.

Assessment of health-related quality of life (HRQOL) in patients with cirrhosis has been increasingly reported in literature. Aims: To compare quality of life scores between cirrhotic patients and healthy controls and to assess factors associated with the impairment of quality of life in cirrhotic patients.HRQOL was measured in cirrhotic patients by the Tunisian version of MOS 36-item short-form health survey (SF-36) and the Arabic version of the Liver Disease Symptom index 2.0 (LDSI2.0). Age-and sex- matched controls were asked to complete only the SF36. The SF36 scores were compared between cirrhotic patients and controls and LDSI2.0 scores were compared across cirrhotic patients according to the characteristics of cirrhosis. Factors associated with poor perceived health status were identified by logistic regression.Fifty cirrhotic patients and fifty controls were enrolled in the study. The cirrhotic group had significantly lower SF36 scores than healthy controls in all 8 dimensions (p0.001). Most impaired LDSI items were severity of fear of complications (item 8), change in use of time (item 13), decreased sexual interest (item 14) and decreased sexual activity (item 15). Multiple logistic regression analysis showed that female sex (p=0.009), diabetes (p=0.046), treatment with diuretics (p=0.022), increased levels of serum bilirubin (p=0.045) and prolonged prothrombin time (p=0.041) were associated with poorer HRQOL.HRQOL was significantly more impaired in cirrhotic patients than controls. Female sex, diabetes, treatment with diuretics, increased levels of serum bilirubin and prolonged prothrombin time were important factors in reducing HRQOL.

Pathophysiology of the internal hemorrhoidal disease is poorly understood but seems to be multifactorial. Some types of food and lifestyle have been assumed to increase the risk of internal hemorrhoidal disease. Aims: To identify alimentary habits that are associated with internal hemorrhoidal disease.Fifty patients and 50 healthy controls matched for age and sex were enrolled in a case-control study. Food intake of patients and controls was assessed by a nutritionist using the 72-hour recall method and the food frequency questionnaire. Data regarding their eating behavior were also collected using an eating behavior questionnaire.Mean age of patients was 42 ± 11.8 years with a female to male ratio of 1.17. Prolapse and anal pain were the most common presenting symptoms. Constipation was found in almost all patients. High-fiber foods were less often consumed by patients than by controls with the difference being significant for vegetables, fruits and cereals. Regarding spicy aliments, consumption of pepper and chili powder was found to be significantly less frequent in patients than in controls. Multivariate analysis revealed daily fiber intake12 g (OR 7.08; 95%CI 1.24 - 40.30; p=0.027) and daily water intake2L (OR 8.68; 95%CI 3.07 - 24.51; p0.001) significantly increase the risk of internal hemorrhoidal disease.Internal hemorrhoidal disease was more frequently observed in patients with low-fiber diet and a reduced water intake. These dietary habits were described as precipitating factors of constipation which was found in almost all patients.

Introudction Crohn's disease (CD) is a lifelong condition. Multiple imaging investigations are often performed during follow-up. This could cause overexposure to radiation. The aim of our study was to determine mean radiation dose in patients with at least a 5-year course of CD and to determine possible risk factors associated with exposure to high doses of radiation. Methods We conducted a retrospective study including patients whose CD was diagnosed between 1998 and 2005. Epidemiologic features of patients, characteristics of the disease, types of imaging investigations that were performed during follow-up and cumulative radiation effective dose were determined. Risk factors associated with exposure to high doses of radiation were then determined. Results One hundred sixty seven patients were included. There were 92 males (55.1%) and 75 females (44.9%) with mean age at dianosis of 31.4±12.3years. Global radiation dose was 18.8±18.9 mSv. Twenty seven patients (16,2%) were exposed to more than 35 mSv and 4 patients (2.4%) had an exposure of more than 75 mSv. Use of Infliximab, age at disease onset ≤ 24 years old and number of flares ≥ 8 were independent risk factors of radiation exposure more than 35 mSv with adjusted Odds ratios (OR) : 2.5 [2.1- 5.3]; 1.6 [1.2- 4.7] and 3.2 [2.1- 7.8] respectively. Similarly, use of Infliximab and number of flares ≥ 8 were independent risk factors of radiation exposure more than 75 mSv with adjusted OR : 4.3 [2.8-9.5] and 7 [3.2-11.2] respectively. Conclusion Radiation risk seems to be increased with severe course of CD. Both referring physicians and radiologists have the responsibility to minimise radiation exposure. Entero-magnetic resonance imaging (Entero-MRI) may reduce this risk.

Crohn's disease is a chronic relapsing- remitting affection. It has a strong immunologic component which represent the target of standard therapies including immunosppressants and biological therapies. However, many patients remain refracory or intolerant to these therapies.The aim of this review is to determine the effects of stem cell transplantation in patients with refractory Crohn's disease.Systematic review of observational studies, clinical trials and case reports that focused on the effectiveness and safety of stem cell transplantation in patients with refractory Crohn's disease.Hematopoietic stem cell transplantation seems to be efficient in maintaining clinical and endoscopic remission in patients with Crohn's disease refractory or intolerant to current therapies. However, it has been associated to high morbidity and mortality due to chemotherapy. Mesenchymal stem cell transplantation could induce remission in patients with fistulising refractory Crohns disease with no severe side effects. Its impact on luminal Crohns disease is still controversial.Stem cell transplantation seems to hold promising in patients with refractory Crohn's disease. However, because of the high morbidity and mortality related to chemotherapy, hematopoietic stem cell transplantation should be used as last resort to control this disease. Effectiveness of mesenchymal stem cell transplantation in luminal Crohn's disease has yet to be proven.