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Objective: This study aims to determine the correlation between risk factors and erosive esophagitis development. Methods: We conducted a retrospective observational study on a consecutive series of 19.672 patients who underwent upper gastrointestinal endoscopy between 01.01.2011-31.12.2017. A total of 3005 patients, diagnosed with erosive esophagitis, were included in the present study and stratified according to Los Angeles classification. Results: During the studied period we found 3005 patients with erosive esophagitis, sex ratio male to female was 1.3/1, the most common forms of esophagitis being grade A and B: 74.54% patients with esophagitis grade A, 14.80% patients with grade B; 5.29% patients were with grade C and 5.35% patients with esophagitis grade D. In severe esophagitis the male predominance was more prevalent (249 males, 71 female), with a sex ratio 3.50/1. The correlation of male gender with severe esophagitis was highly statistically significant (p < 0.0001, OR 2.97; 95% CI 2.25-3.91). Hiatal hernia was diagnosed in 1171 patients, the presence of large hiatal hernias, being an important predictor, with statistical significance (p < 0.0001, OR 3.41; 95% CI 2.22-5.21), for severe esophagitis development. Incidence of Helicobacter pylori infection was 11.51%, in the entire study group, with no statistical significant difference between patients with mild or severe esophagitis (12.02% vs 7.18%). Conclusion: Erosive esophagitis is a frequent disease, the most common forms being grade A and B. Male gender and the presence of hiatal hernia are the most important risk factors for erosive esophagitis development, in our study group. [ABSTRACT FROM AUTHOR]

Background. Non-alcoholic fatty liver disease (NAFLD) is a pathology whose incidence and prevalence continues to increase, especially in countries where their inhabitans have adopted a Western type diet and a sedentary lifestyle and in our regional gastroenterology center the incidence of patients with NAFLD is 14, 46% from 1st January 2020 to 6th December 2022. There are several published studies in the last decade that have shown an essential role of mediterranean diet (MD) in the process of modulating the intestinal flora for the patients with NAFLD. Material and methods: We conducted a search of PubMed and Web of Science using multiple search terms including: NAFLD, MD, gut-liver axis. We included studies that contained pathways and mechanisms models of non-alcoholic fatty liver disease and the link with MD. Results: The results of the studies revealed that the percentage of patients with hepatic steatosis of grade 2 or even higher was reduced from 93% to 48% and a percentage of 20% of patients showed regression of steatosis and it seems also a greatly improvement in biochemical profile of the patients with the decrease of liver enzymes and even the normalization of ALT values; also MD positively influences the diversity of the intestinal flora that associates the increase of Bacteroides, decrease of Firmicutes and growth of Bifodbacteria which associates the decrease in serum cholesterol and the decrease in C-reactive protein (p < 0.05). Conclusions. A correct, Mediterranean-type diet, with promising results in many of the studies carried out so far can be one of the best treatment options for diagnosed patients with NAFLD. [ABSTRACT FROM AUTHOR]

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]

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.

Upper gastrointestinal bleeding (UGIB) is a potentially life-threatening emergency that remains a common cause of admission to hospital for cirrhotic patients. This retrospective study included 230 patients, over a period of two years, who presented with UGIB and underwent emergency gastroscopy at the County Emergency Clinical Hospital Târgu-Mureș. The patients were divided into two groups (patients with variceal bleeding versus non-variceal bleeding, and alcoholic cirrhosis versus viral cirrhosis). Comparisons were made to identify the sources of digestive bleeding, the risk factors and the clinical outcomes, such as mortality, need for transfusion and hemostasis. This study shows that esophageal varices are the main cause of UGIB in cirrhotic patients regardless the etiology, but almost a half experience bleeding from a non-variceal source, the most common being peptic ulcer. Bleeding from a non-variceal source is as severe as variceal rupture, requiring the same number of transfusions, with a similar rate of rebleeding and mortality. Male young patients with alcoholic cirrhosis have a higher risk of UGIB and need more transfusions than in patients with viral cirrhosis. The large number of patients requiring endoscopic hemostasis reveals the importance of upper digestive endoscopy to specify the etiology and establish the appropriate treatment. [ABSTRACT FROM AUTHOR]

Fiber-reinforced composites are used as restorative materials for prosthetic oral rehabilitation. Gastroesophageal reflux disease (GERD) is an accustomed affection with various oral manifestations. This study aimed to evaluate the behavior of two high-performance CAD/CAM milled reinforced composites (Trinia™, TriLor) in artificial saliva at different pH levels through immersion tests, and to determine if changes in mass or surface morphology at variable pH, specific for patients affected by GERD, appear. After investigating the elemental composition and surface morphology, the specimens were immersed in Carter Brugirard artificial saliva for 21 days at different pH values (5.7, 7.6, and varying the pH from 5.7 to 3). The values of the weighed masses during the immersion tests were statistically processed in terms of mean and standard deviation. Results suggested that irrespective of the medium pH, the two composites presented a similar mass variation in the range of −0.18 (±0.01)–1.82 (±0.02) mg after immersion, suggesting their stability when in contact with artificial saliva, an aspect which was also highlighted by scanning electron microscope (SEM) analysis performed on the immersed surfaces. Novel composite biomaterials can be a proper alternative for metal alloys used for prosthetic frameworks in patients suffering from GERD. [ABSTRACT FROM AUTHOR]

Cobalt-chromium (Co-Cr) alloys are widely utilized in dentistry. The salivary pH is a significant factor, which affects the characteristics and the behavior of dental alloys through corrosion. This study aimed to evaluate the corrosion behavior in artificial saliva with different pH values (3, 5.7, and 7.6) of two commercial Co-Cr dental alloys manufactured by casting and by milling. Corrosion resistance was determined by the polarization resistance technique, and the tests were carried out at 37 ± 1 °C, in Carter Brugirard artificial saliva. After the electrochemical parameters, it can be stated that the cast Co-Cr alloy has the lowest corrosion current density, the highest polarization resistance, and the lowest speed of corrosion in artificial saliva with pH = 7.6. In the case of milled Co-Cr alloy, the same behavior was observed, but in artificial saliva with pH = 5.7, it recorded the most electropositive values of open circuit potential and corrosion potential. Although both cast and milled Co-Cr alloys presented a poorer corrosion resistance in artificial saliva with a more acidic pH value, the milled Co-Cr alloy had better corrosion behavior, making this alloy a better option for the prosthetic treatment of patients suffering from GERD. [ABSTRACT FROM AUTHOR]

Levodopa–entacapone–carbidopa intestinal gel infusion is a relatively new treatment option for advanced Parkinson's disease. We aimed to describe and analyze the characteristics of de novo levodopa–entacapone–carbidopa intestinal gel therapy in 20 consecutive patients with advanced Parkinson's disease. We assessed the profile of motor complications by evaluating the following: motor fluctuations, dyskinesias, and the freezing phenomenon at baseline (before the testing period) and before discharge. The treatment significantly reduced the duration of daily hours spent in off time compared with baseline pre-treatment values from a mean of 4.8 ± 0.9 h/day to a mean of 1.4 ± 0.5 h per day (p < 0.001). The duration and severity of peak-dose dyskinesia were also significantly reduced compared with baseline values. Out of the 10 patients who reported freezing, 8 did not present this complication at the pre-discharge assessment. Significant improvements were observed in Hoehn and Yahr scale scores in both the on and off states. The levodopa–entacapone–carbidopa intestinal gel therapy was well tolerated during the follow-up period immediately after initiation. Despite a relatively severe stage of the disease, all patients experienced a significant improvement in motor fluctuations, dyskinesias, and the freezing phenomenon. [ABSTRACT FROM AUTHOR]

Background: Irritable bowel syndrome's (IBS) incidence is increasing worldwide. Among medical students, this diagnosis could be even more frequent, given the high level of work and requirements at medical universities. IBS can seriously affect the quality of life and academic performance of pupils. Objective: The present study focuses on identifying the prevalence and severity of IBS, including students from medical universities in Ro-Material and methods: A cross-sectional study was conducted using a questionnaire consisted in simple and multiple-choice answers. Diagnosis of IBS was established using ROMA IV criteria. Results: The study is still ongoing, until the present moment there are 75 participants, 83,27% aged between 23-27 years old, with a majority of female respondents (66,7%). Results showed a significant percentage of students experiencing abdominal pain (44%), most of them in the upper abdominal quadrant as well as changes in bowel movements (47,6%), distension and gas (80%), abdominal cramps (60,3%), constipation (38,2%), diarrhea (30,9%). Conclusions: Stress, burnout and high academic requirements can be strongly correlated with the presence of IBS. Our study shows that medical students experience a high prevalence of IBS. The study will continue to explore how this altered bowel habbits affect the quality of the students lives. It is important for physicians to keep in mind IBS diagnosis when medical students present with digestive symptoms such as abdominal pain, cramps, bloating, constipation and diarrhea, and have an appropirate therapeutic approach. [ABSTRACT FROM AUTHOR]

Continuous intra-jejunal infusion of levodopa-carbidopa intestinal gel (LCIG) is a long-term proven and effective treatment in advanced Parkinson's Disease (APD). Efficacy and safety of 16-h administration of LCIG has already been established. Additional benefits of 24-h LCIG administration have been reported in several case series and small clinical studies. The aim of this retrospective study was to compare the characteristics of patients who needed 24-h LCIG from the beginning of the DAT (device-aided treatment) with those who remained with the standard 16-h LCIG treatment and to identify particular motives if any. We initiated LCIG in 150 patients out of which in case of 62 patients (41,3%) due to unsatisfactory initial clinical benefits continuous 24-h LCIG was deemed necessary. Despite the subjective complaints and more severe clinical condition, at baseline evaluation we found statistically significant differences between 16-h LCIG cohort and 24-h LCIG cohort only in case of incidence of freezing (47% vs 65%, p = 0.03) and sudden off (32% vs 48%, p = 0.04). Wake hours/daytime LCIG does not always sufficiently improve the patient's quality of life in some patients due to persistent nighttime troublesome symptoms. Instead of labeling the patient as a non-responder, it is worth trying the 24-h LCIG dosage in a carefully selected group of patients, as there is currently no consensus on reliable criteria that serve the decision in these patients. [ABSTRACT FROM AUTHOR]

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

Background. Acute variceal bleeding (AVB) is a potentially life-threatening condition associated with high mortality among cirrhotic patients. Various risk scores are used in risk stratification for non-variceal bleed, but their utility in AVB remains unclear. OBJECTIVE: The aim of the study is to compare systems in predicting in-hospital mortality in cirrhotic patients with acute variceal bleeding - Model for End-Stage Liver Diseases (MELD), Child-Pugh, Glasgow-Blatchford Bleeding (GBS) and Rockall scores. Methods. We retrospectively included all cirrhotic patients admitted to the emergency room with acute variceal hemorrhage between 2017 to 2021, that underwent upper gastrointestinal endoscopy with endoscopic hemostasis (band ligation) in the emergency department of SCJU Targu-Mures. Results. A total of 210 patients were included (male/female: 165/45; mean age: 59.12±11.76 years; Child-Pugh class A/B/C: 47/91/72). The main endpoint of the study was the in-hospital outcome, 83% of patients (n = 175) survived while 17% (n = 35) died. The mean Glasgow-Blatchford score was 12.68 ± 3.25 vs 15.31 ± 2.91 (p<0.0001), Rockall score 6.98 ± 0.86 vs. 7.68 ±1.02 (p<0.0001) and MELD score 12.78±4.73 vs. 15.31±2.91 (p<0.0001). Areas under receiving-operator characteristics curve (AUROC) for predicting the in-hospital mortality were compared. AUROCs for predicting the in-hospital mortality for Child-Pugh score was 0.714 (95% confidence interval [CI]: 0.648-0.774), GBS 0.731 (95% CI: 0.666-0.790), MELD score 0.767 (95% confidence interval [CI]: 0.704-0.823), respectively for Rockall score was 0.699 (95% confidence interval [CI]: 0.632-0.760). Conclusions. The present study shows that MELD score is an excellent indicator in in-hospital mortality of acute UGIB in cirrhotic patients. [ABSTRACT FROM AUTHOR]

Advanced Parkinson's disease (APD) cannot be treated efficiently using the classical medications however, in recent decades invasive therapeutical methods were implemented and confirmed as effective. One of these methods makes it possible to continue the levodopa (LD) supplementation as a gel administered directly into the upper intestine. However, there are a number of unanswered questions regarding this method. Therefore, we retrospectively analyzed a 10-year period of selected patients that were treated with levodopa/carbidopa intestinal gel (LCIG). We included all APD patients with motor fluctuations and dyskinesia at presentation. LCIG treatment was started in 150 patients: on average these patients received LD for 10.6 ± 4.4 years with a frequency of 5.2 ± 1.0/day until the introduction of LCIG. The estimated and the real LCIG dose differed significantly (mean: 1309 ± 321 mg vs. 1877 ± 769 mg). The mean duration of LCIG administration was 19.8 ± 3.6 h, but in a number of 62 patients we had to administer it for 24 h, to maximize the therapeutic benefit. A carefully and individually adjusted LCIG treatment improves the quality of life of APD patients, but questions remain unresolved even after treating a large number of patients. It is important to share the ideas and observations based on the real-life experience related to the optimal timing, the appropriate dose and duration of administration of the LCIG. [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.

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]

Introduction. Stauffer syndrome is a rare type of paraneoplastic syndrome that presents as cholestasis with absence of underlying disease. Classically Stauffer syndrome has been described in patients with renal cell carcinoma. Cholangitis is inflammation of the bile ducts. The bile duct system carries bile from the liver and gallbladder to the first part of your small intestine (the duodenum). Usually, cholangitis is caused by a bacterial infection. Case report. A 78 year-old male patient is brought to the Emergency department for epigastric pain, nausea and vomiting, chills and dark colored urine. Initial bloodwork revealed cholestasis and a slightly elevated CRP. An abdominal CT scan was performed that revealed a 7x6 cm mass on the left kidney, CBD diameter-8mm, hepatic steatosis and aortic, renal and iliac atherosclerosis. After 12 hours, the bloodwork was repeated. This time it revealed high leukocytosis with neutrophilia, high C-reactive protein level accompanied by a high procalcitonin level, modified creatinine level and cholestasis with bilirubin levels higher than the previous result. The patient was admitted and was started on broad spectrum antibiotics after blood cultures were taken. After the blood cultures result, the patient was switched to a lower tier antibiotic. A second CT scan was ordered, this time contrast enhanced. It described central intrahepatic bile duct dilatation, CBD with a diameter of 11 mm that narrowed near the ampulla of Vater, a 7x6 cm mass on the left kidney with central necrosis without malignancy criteria at that time. An EGD was performed in order to exclude a tumoral process of the ampulla. After 10 days the patient status improved, however the bloodwork results still revealed cholestasis. The patient was redirected to a urology clinic for an elective nephrectomy. Conclusions. We interpret the case as an overlap between Stauffer syndrome and acute cholangitis, and we want to emphasize the importance of abdominal imaging in cases with unexplained cholestasis. [ABSTRACT FROM AUTHOR]

Aim. We aimed to establish the independent predictive factors (from Helicobacter pylori infection, biliary reflux, histologic features of the gastric mucosa, drugs, comorbidities, and social habits) for gastric stump ulcer occurrence more than 15 years after surgery. Methods. 76 patients with previous gastric surgery were included: 21 patients with gastric ulcer (marginal ulcer or ulcer of the rest of the gastric remnant—study group) and 55 controls (nonulcer group). Results. Helicobacter pylori infection tended to be higher in the control group than in the ulcer group (14.5% vs. 4.8%, p=0.43), without statistical significance. Alcohol consumption had a significant positive association with ulcer (p=0.008), while smoking (p=0.064), low-dose aspirin (p=0.063), and biliary reflux (p=0.106) had a tendency toward statistical signification for positive association. On univariate analysis, smoking (p=0.048, OR = 3.15, 95% CI: 1.01–9.93) and low-dose aspirin consumption (p=0.067, OR = 2.63, 95% CI: 0.95–7.68) were significantly associated with ulcer. According to the multivariable regression model, alcohol consumption (OR = 6.68, 95% CI: 1.29–41.14) and biliary reflux (OR = 6.12, 95% CI: 1.36–38.26) remained significantly associated with increased odds of stump ulcer. Conclusion. Biliary reflux and alcohol consumption, but not Helicobacter pylori infection or gastrotoxic drug, seem to be the most important predictors for ulcer recurrence in patients with gastric surgery for peptic ulcer after more than 15 years. [ABSTRACT FROM AUTHOR]

Background. Between colorectal cancer (CRC) and systemic inflammation seems to be a powerful relationship. Inflammatory status can be quantified with analytical markers like neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), mean platelet volume (MPV) and platelet/hemoglobin ratio (PHR). The combined diagnostic efficacy of these four biomarkers in CRC remains unknown and need more complex researches. Aims: In this study we want to investigate the efficiency of NLR, PLR, MVP and PHR as a diagnostic tool in newly diagnosed patients with CRC. Methods. We performed a retrospective case control study in which we included patients who were diagnosticated with colorectal cancer on histopathological examination and a control group with patients without colorectal cancer on biopsy but who had different types of polyps. Patients with acute infection, acute gastrointestinal disease, cirrhosis, other inflammatory diseases and incomplete data were excluded from the study. The final study group included 38 patients with colorectal cancer and the control group was formed by 61 patients with polyps (tubular adenoma, tubule villous adenoma or sessile serrated) at colonoscopy. Results. The mean value of the neutrophil/lymphocyte ratio is statistically higher in patients with colorectal cancer compared with those without colorectal cancer (p <0.006), also the mean value of the hemoglobin was significantly lower in patients with colorectal cancer (p<0.001), but the mean value of the mean platelet volume was not statistically different between the groups (p=0.278). The mean value of platelet/lymphocyte ratio was significantly higher in patients with colorectal cancer (p = 0.012). Platelet to hemoglobin ratio, was statistically higher in patients with colorectal adenocarcinoma in comparison with patients with benign lesions (p = 0.001). Conclusions. In conclusion, parameters derived from complete blood count could be used to identify patients with high risk of colorectal cancer before colonoscopy is performed. [ABSTRACT FROM AUTHOR]

Background Preventive strategies developed to avoid the complications of antiplatelet therapies recommend the evaluation of risk factors for gastrointestinal events and indicated gastroprotective strategies. Aim We aimed to assess the impact of predisposing factors - histological findings, concomitant drug consumption, comorbidities, symptoms, social habits, Helicobacter pylori infection - on severe gastro-duodenal lesions in patients with low-dose aspirin and concomitant protective therapy with proton pump inhibitors (PPI). Method We enrolled 237 patients with LDA and PPI therapy, referred for upper digestive endoscopy, divided into two groups according to the severity of their endoscopic lesions (172 patients with no or mild endoscopic lesions and 65 patients with severe endoscopic lesions). Results In the univariate logistic regression model, the factors associated with severe gastro-duodenal lesions were gender (OR = 1.87, 95% CI: 1.04–3.41), anticoagulants (OR = 2.40, 95% CI: 1.26–4.53), gastric atrophy and/or intestinal metaplasia (OR = 1.85, 95% CI: 1.04–3.32), congestive heart failure (OR = 2.59, 95% CI: 1.16–6.62), anaemia (OR = 3.01, 95% CI: 1.67–5.47) and smoking (OR = 4.29, 95% CI: 1.57–12.32). In the final model, anticoagulants (p = 0.041 < 0.05) and anaemia (p = 0.019 < 0.05) were risk factors for severe lesions via multivariate regression analysis, while for active/inactive chronic gastritis and smoking a positive dependency with a tendency towards statistical significance (p < 0.10) was noticed for severe gastric lesions. Conclusions In patients treated with low-dose aspirin and gastroprotective therapy with proton pump inhibitors we have enough evidence to consider co-treatment with anticoagulants and anaemia important predictors for severe endoscopic lesions, while other factors such as inflammation in gastric biopsies, congestive heart failure, co-treatment with clopidogrel and smoking tended to have a positive influence on risk for severe gastro-duodenal lesions. [ABSTRACT FROM AUTHOR]

Objectives: The current study aimed at evaluating the association between metabolic syndrome (MeS) in patients with hepatitis C virus (HCV) liver cirrhosis (compensated, genotype, 1b) and changes after sustained viral response (SVR) following a 12-week therapy with paritaprevir, ritonavir, ombitasvir, dasabuvir, and ribavirin (PrOD+R). Methods: The current multicenter retrospective study included 809 patients diagnosed with compensated HCV cirrhosis (child class A), all 1b genotype treated for 12 weeks with direct acting antiviral agents - PrOD+R - regimen (according to the protocol practiced in Romania) and achieved SVR. The parameters of MeS (according to the definition of the International Diabetes Federation) were collected from medical records before and 12 weeks after the treatment. The results were collected in a central database and analyzed with SPSS 18.0. Statistical analysis used both descriptive and analytical methods with a significance level of 95% (CI 95%). Results: Out of the 809 patients, 105 (13%) demonstrated 3 out of the 5 criteria for MeS. Based on the MeS criteria, the commonest parameters were abnormal glycaemia (54.1%), followed by visceral obesity (38.6%), raised triglycerides (26.1%), high blood pressure (12.1%), and a low high-density lipoprotein (HDL)-cholesterol (4.6%). The re-assessment of MeS parameters after SVR showed favourable changes, which were statistically significant: a siginficanttly lower serum triglyeride level (182.32 vs. 153.50 mg/dL, P = 0.001), lower systolic arterial blood pressure (130.57 vs. 124.85 mmHg; P = 0.001), lower diastolic arterial blood pressure (80.26 vs. 78.42 mmHg; P = 0.001) and lower glyceamic levels (130.06 vs. 120.71 mg/dL; P = 0.001), as well as a significant rise in HDL-cholesterol levels (48.61 vs. 50.50 mg/dL; P = 0.003). Abdominal circumference was the only parameter, which did not change after SVR. Following the changes sustained after SVR, 26.7% of the patients no longer fulfilled the minimum 3 criteria for MeS. No correlation was observed between the presence of MeS and the risk of severe adverse events, but it was noted that 37.5% of the patients who decompensated, 66.7% of the ones who developed hepatocarcinoma and 100% of the ones that died of abnormal glycaemic levels. Conclusions: Hyperglycemia, and not MeS, is associated with HCV compensated liver cirrhosis genotype 1b, and is a risk factor for severe adverse events. The attainment of SVR through PrOD+R regimen results in short-term improvements in MeS parameters. [ABSTRACT FROM AUTHOR]

Background. Aspirin use for cardiovascular or cancer prevention is limited due to its gastrointestinal side effects. Objective. Our prospective, observational case-control study aims to identify the predictive factors for ulcers in low-dose aspirin consumers (75–325 mg/day). Methods. The study included patients who underwent an upper digestive endoscopy and took low-dose aspirin treatment. Results. We recruited 51 patients with ulcer (ulcer group) and 108 patients with no mucosal lesions (control group). In univariate analysis, factors significantly associated with ulcers were male gender (p=0.001), anticoagulants (p=0.029), nonsteroidal anti-inflammatory drugs (p=0.013), heart failure (p=0.007), liver (p=0.011) or cerebrovascular disease (p=0.004), diabetes mellitus (p=0.043), ulcer history (p=0.044), and alcohol consumption (p=0.018), but not Helicobacter pylori infection (p=0.2). According to our multivariate regression analysis results, history of peptic ulcer (OR 3.07, 95% CI 1.06–8.86), cotreatment with NSAIDs (OR 8, 95% CI 2.09–30.58) or anticoagulants (OR 4.85, 95% CI 1.33–17.68), male gender (OR 5.2, 95% CI 1.77–15.34), and stroke (OR 7.27, 95% CI 1.40–37.74) remained predictors for ulcer on endoscopy. Conclusions. Concomitant use of NSAIDs or anticoagulants, comorbidities (cerebrovascular disease), and male gender are the most important independent risk factors for ulcer on endoscopy in low-dose aspirin consumers, in a population with a high prevalence of H. pylori infection. [ABSTRACT FROM AUTHOR]

Introduction: D'après OMS l'infection virale C touche sur l'échelle mondiale environ 3% de la population ce qui représente environ 170 millions de sujets, et détermine une mortalité de plus de 350 000 décès par an. Sans traitement antiviral, l'histoire naturelle de l'infection chronique avec le virus de l'hépatite C est vers la cirrhose hépatique et vers le décès déterminé par les complications. L'arrivée des inhibiteurs de protéases spécifiques du VHC, le Télaprévir et Bocéprévir modifie profondément la prise en charge des malades atteints d'hépatite C de génotype 1. Matériel et méthode: On a étudié l'évolution d'une malade diagnostiquée avec une hépatite chronique à virus C génotype 1a ( score Métavir A2F3 à la biopsie hépatique effectuée en octobre 2002 ) vers la cirrhose (fibrose F4 selon Métavir au FibroScan du juin 2007) et jusqu'à présent avec les problèmes thérapeutiques concernant l'éradication virale et les complications survenues et on a rapporté aux données de la littérature. Résultats et discutions: La biopsie hépatique a été utilisée comme méthode directe d'évaluation de l'état initial de la maladie hépatique chronique chez notre malade, qui a été suivi après pendant plusieurs années, pour l'évaluation de la progression de la fibrose avec le FibroScan. Le FibroScan peut être utiliser pour mesurer la fibrose hépatique chez les patients avec l'hépatite chronique à virus C d'après les recommandations du 2011 de l'European Association of the Study of the Liver (EASL). Deux bithérapies, une de 17 semaines (Peginterferon alfa-2b et Ribavirine) de janvier à mai 2003 et une deuxième sur la demande de la patiente de 11 semaines. (Peginterferon alfa-2a et Ribavirine) de mai à juillet 2003, ont ététentées sans réponse virale. Un traitement suspensif par Peginterferon alfa-2b à été instauré de juillet 2004 jusqu'a en avril 2006 et de juin 2006 a octobre 2008. Le traitement a été interrompu en raison d'effets indésirables majeurs (asthénie, pertes de mémoire, syndrome dépressif, prurit). La trithérapie (PEG-Interferon, Ribavirine et Télaprévir) à été débutée en janvier 2012. A l'issue de 4 semaines de traitement, l'ARN du virus C était <100 UI/ml et à l'issue de 8 semaines de traitement le virus C était détectable mais non quantifiable. Les études de phase II et III chez les malades en échec thérapeutique ont montré que la trithérapie était significativement plus efficace que la bitherapie avec des taux de réponse virologique soutenue (RVS) jusqu'a 64-66 % chez les malades avec la trithérapie par rapport à 17-21 % pour la bithérapie .Conclusions: La biopsie hépatique reste comme ⪡gold standard⪢ pour l'évaluation directe de la fibrose hépatique et le FibroScan etant une méthode non-invasive, simple, de diagnostic et surveillance de la progression de la fibrose. La trithérapie est le traitement référence de l'hépatite C chronique de génotype 1,en cas de maladie hépatique compensée et de cirrhose documentée (F4) chez les patients adultes rechuteurs ou non-répondeurs à une bithérapie préalable. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the influence of MDR1, C3435T, and CYP2C19 gene polymorphisms with the severity of gastro-duodenal endoscopic lesions.