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The progressive potential of liver damage in type 2 diabetes mellitus (T2DM) towards advanced fibrosis, end-stage liver disease, and hepatocarcinoma has led to increased concern for quantifying liver injury and individual risk assessment. The combination of blood-based markers and imaging techniques is recommended for the initial evaluation in NAFLD and for regular monitoring to evaluate disease progression. Continued development of ultrasonographic and magnetic resonance imaging methods for accurate quantification of liver steatosis and fibrosis, as well as promising tools for the detection of high-risk NASH, have been noted. In this review, we aim to summarize available evidence regarding the usefulness of non-invasive methods for the assessment of NAFLD in T2DM. We focus on the power and limitations of various methods for diagnosis, risk stratification, and patient monitoring that support their implementation in clinical setting or in research field. [ABSTRACT FROM AUTHOR]

Introduction: Hyperechoic liver lesions identified by conventional ultrasonography are diverse in underlying pathology and most of the time require further investigations. Gastrointestinal stromal tumors (GIST) are rare neoplasms of the gastrointestinal tract which are uncommonly found in metastatic stages at first presentation. Case report: We present the case of a 51 years old woman with nonspecific symptoms in which conventional ultrasonography showed hyperechoic lesions in the right lobe of the liver with a diameter up to 40 mm. Esophagogastroduodenoscopy revealed a submucosal tumor on the small curvature of the stomach, on the anterior wall, with central ulceration, with normal narrow band imaging (NBI) mucosal pattern and negative gastric biopsy. Contrast enhanced ultrasonography was performed, describing multiple lesions with inhomogeneous enhancement in the arterial phase and rapid washout at the end of arterial phase. Endoscopic ultrasound with fine needle aspiration (EUS-FNA) biopsy examination was definitive for the final diagnosis of epithelioid gastric gastrointestinal stromal tumor. The patient was diagnosed with T2N0M1 epithelioid gastric GIST, stage IV, and is currently under treatment with tyrosine kinase inhibitors. Conclusions: GIST represent a diagnostic challenge in medical practice because of its size, unusual location in the submucosal layer and lack of symptoms. The role of EUS-FNA is of paramount importance in increasing the accuracy of diagnosis in the case of GIST. The particularity in our case consists of the unusual presentation with the lack of specific symptoms and signs associated with the presence of metastatic lesions at the moment of the diagnosis of GIST. [ABSTRACT FROM AUTHOR]

Duodenal neuroendocrine tumors (NETs) are rare tumors, consisting of five different types of tumors. In many cases, they may be asymptomatic, leading to delay in diagnosis. Clinical symptoms are related to local tumor growth and mucosal ulceration. We report a 38-year old man with duodenal gangliocytic paraganglioma causing overt upper gastrointestinal bleeding and anemia. We describe specific clinical and histopathological features of the tumor, and review the diagnostic and therapeutic strategy. Gangliocytic paragangliomas are regarded as benign tumors. However, the disease recurrence and the malignant potential of the tumor have also been reported. [ABSTRACT FROM AUTHOR]

Neuroendocrine tumors (carcinoids) are tumors originating from neuroendocrine cells. The distinction between different types of gastric carcinoids is important for their management. We present the case of a 38-year old woman with type 1 gastric neuroendocrine tumors (NETs) associated with autoimmune atrophic gastritis. The management of these tumors has not been yet codified and different therapeutic strategies have been suggested. A proper evaluation before therapy is indicated in order to rule out both the malignant transformation as well as the presence of synchronous lesions, such as dysplasia or gastric adenocarcinoma. We describe our diagnostic and therapeutic strategies with references to previously published reports. [ABSTRACT FROM AUTHOR]

(1) Background: Clostridioides difficile (C. difficile) and SARS-CoV-2 coronavirus represent significant health threats. Our study focused on the impact of concurrent infections on patient outcomes against the backdrop of changes imposed by the pandemic. (2) Materials and methods. We performed a retrospective analysis and included patients diagnosed with CDI who were admitted in our hospital before and during the pandemic. We compared patient exposure to risk factors for CDI in both groups and patient negative outcomes: need for ICU care, prolonged hospitalization, organ failure, toxic megacolon, and death. (3) Results. Overall, 188 patients were included, of which 100 had CDI (the pre-pandemic group), and 88 patients presented both CDI and COVID-19 (the pandemic group). Patients in the pandemic group were significantly older, with a higher Charlson Comorbidity Index (CCI) and a greater exposure to antibiotics and corticosteroids, and were more likely to develop organ dysfunction, to require ICU care and have prolonged hospitalization. The severity of COVID-19, leukocytosis and increased D-dimer levels were indicators of poor prognosis in the pandemic group. Higher CCI scores and leukocytosis increased the risk for negative outcomes in CDI alone patients. (4) Conclusions. The study highlights the negative impact of associated infections on patient outcome. The severity of COVID-19 directly influences the prognosis of patients with concurrent infections [ABSTRACT FROM AUTHOR]

Introduction: Early diagnosis of gastric neoplasia involves both the detection and surveillance of patients with premalignant gastric lesions. Magnifying endoscopy allows the analysis of the fine mucosal structure and microvascular architecture. Material and methods: The aim of our study is to identify specific patterns associated with premalignant gastric lesions by magnifying endoscopy in conjunction with chromoscopy. We performed conventional upper endoscopies and we selected a number of patients for chromodiagnostic and magnification. We classified the endoscopic patterns in normal and abnormal (modified) patterns. Target biopsies were obtained from magnified areas and we analyzed the correspondence with the histological findings. Results: We identified specific pit patterns for normal gastric mucosa and for inflamed mucosa. A tubular pattern was associated with the detection of intestinal metaplasia. An irregular pattern and abnormal microvessels were endoscopic findings associated with the detection of high-grade dysplasia. An irregular form of collecting venules was detected in areas with atrophic gastritis. Conclusions: An initial selection of patients based on conventional endoscopic findings is mandatory. Gastric mucosal changes identified by magnifying endoscopy raise the number of detected premalignant lesions by targeted biopsies. Our work emphasizes the current challenges related to the use of these endoscopic methods. [ABSTRACT FROM AUTHOR]

Summary: Background: The advent of new therapeutic agents and the improvement of supporting care might change the management of acute severe ulcerative colitis (ASUC) and avoid colectomy. Aims: To evaluate the colectomy‐free survival and safety of a third‐line treatment in patients with ASUC refractory to intravenous steroids and who failed either infliximab or ciclosporin. Methods: Multicentre retrospective cohort study of patients with ASUC refractory to intravenous steroids who had failed infliximab or ciclosporin and received a third‐line treatment during the same hospitalisation. Patients who stopped second‐line treatment due to disease activity or adverse events (AEs) were eligible. We assessed short‐term colectomy‐free survival by logistic regression analysis. Kaplan–Meier curves and Cox regression models were used for long‐term assessment. Results: Among 78 patients, 32 received infliximab and 46 ciclosporin as second‐line rescue treatment. Third‐line treatment was infliximab in 45 (58%), ciclosporin in 17 (22%), tofacitinib in 13 (17%) and ustekinumab in 3 (3.8%). Colectomy was performed in 29 patients (37%) during follow‐up (median 21 weeks). Of the 78 patients, 32 and 18 were in clinical remission at, respectively, 12 and 52 weeks. At the last visit, 25 patients were still on third‐line rescue treatment, while 12 had stopped it due to clinical remission. AEs were reported in 26 (33%) patients. Two patients died (2.6%), including one following colectomy. Conclusion: Third‐line rescue treatment avoided colectomy in over half of the patients with ASUC and may be considered a therapeutic strategy. [ABSTRACT FROM AUTHOR]

Introduction: the detection of gastric preneoplastic lesions (atrophic gastritis, intestinal metaplasia, dysplasia) is important regarding the patient's risk evaluation for gastric cancer. The purpose of this study consists in the pit pattern evaluation, specific to the 3 premalignant lesions by magnifying endoscopy and chromeondoscopy. Material and methods: The study has started in January 2010 and it is still in progress. The patients have been examined by conventional endoscopy, respectively selected for magnifying endoscopy and chromoendoscopy. Partial results: I have obtained pit patterns specific to gastric mucosa in precancerous lesions. Partial conclusions: 1. Several pit patterns can be identified in the same patient. 2. The stomach can be mapped more exactly, this way being identified the area of modified mucosa; thus target biopsies can be done raising the chances for an accurate diagnosis. 3. It is a resource and time-consuming method. [ABSTRACT FROM AUTHOR]

The author reflects on the development of ultrasound contrast agents (UCAs) microbubbles, which perform as blood pool tracers, used for ultrasound. She mentions that the UCAs need to be avoided in patients having severe cardiopulmonary disease. She states that rare anaphylactoid reactions have been revealed, manifesting as acute hypotension happening within a few seconds of injection.

Background: Non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome (MetS) are two closely related diseases, that consist mainly in excess fat accumulation in the liver. They share many risk factors and pathophysiological mechanisms. Metabolic risk factors include obesity, altered glucose metabolism, hypertension and dyslipidemia. Objective: The aim of the study was to compare risk factors of metabolic syndrome and non- alcoholic fatty liver disease in our clinic. Material and methods: A retrospective observational study was performed, including 60 patients diagnosed with NAFLD. The patients were admitted to the gastroenterology department of the "Mures County Clinical Hospital" in Targu Mures, Romania, from January 2023 to December 2023. Included were patients with a secured NAFLD diagnosis above the age of eighteen. The patients were grouped into two study groups: positive for NAFLD and positive for NAFLD and MetS. Excel and Jamovi were used for the statistical analysis. Results: No statistically significant differences were found in the demographic comparison of the study groups (age, gender, environment). The presence of metabolic risk factors was significantly higher in the group including MetS diagnosis, compared to the NAFLD only group: overweight/obesity (92,9% vs 58,7%, p=0.01), diabetes mellitus (78,6% vs 4,3%) or impaired fasting glucose (21,4% vs 4,3%) with p<0.001 and hypertension (100% vs 58,7%, p<0.01). Patients with NAFLD and metabolic syndrome either had three (57,1%) or all four (42,9%) of the risk variables listed (p=<0.001). 8,7% of the NAFLD group showed three risk factors, 45,7% showed two, 34,8% showed one, and 10,9% showed no metabolic risk factor (p<0.001). No significant differences were found in the analysis of various laboratory values and when comparing pulmonary, renal, neurological, oncological comorbidities. Conclusions: In addition to having an impact on the diagnosis of MetS, metabolic risk factors also typically influence, albeit to a lower degree, the development of NAFLD. [ABSTRACT FROM AUTHOR]

Background: Liver cirrhosis is a result of chronic damage to the liver which will cause scaring and fibrosis, ultimately leading to irreversible damage if it is not resolved or treated in the early stages, where it is still reversible if the harming agent factor is eliminated. Due to the ability of the liver to compensate even when damaged, the diagnosis of the disease is often late, leading to difficulty in treating. Therefore, the treatment consists in preventing cirrhosis and death. The only curable treatment option for patients remains with liver transplant. Material and methods: This study tries to focus on different aetiologies of liver cirrhosis and the associated complications they carry with them and whether there is any exclusivity to an aetiology when it comes to complications.This retrospective study includes 60 patients admitted to the Gastroenterology department of Mures county clinical hospital of Targu Mures, Romania, between the 01.01.2023 and 01.01.2024. The inclusion criteria consist in patients being above 18 years and diagnosed with liver cirrhosis, including all aetiologies presented to the clinic. Results: Most of the patient's diagnosis are caused solely by chronic alcoholic intoxication (44/60), whereas some patients suffer from viral Hepatitis B and C, also combinations of the mentioned aetiologies are present, which present with a significant increase in abnormal blood values.From the included patients, 3 patients died during their stay, where toxic liver cirrhosis caused by alcohol seemed to be the causing factor among other comorbidities. Worth mentioning is that 2/3 of the deceased patients were males and 2/3 below 60 years of age.Most of the patients are male (49/60) and above 60 years of age (35/60). Conclusions: Most of the patient diagnosed with liver cirrhosis in our clinic where due to chronic alcohol consumption, with comorbidities such as chronic cardiac and pulmonary diseases as well as diabetes and obesity. Patients' death was associated with chronic alcohol consumption. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 34-year-old housewife who is 15th week pregnant for her first baby, whihc has been reffered to the Romanian Hereditary Angioedema Centre in January, 2015 due to health complications. She had experienced recurrent swelling of her limbs when she was 14-year-old. It also mentions that she had been diagnosed to have idiopathic ascites, functional diarrhoea, irritable bowel syndrome, and dyspepsia.

The article presents a case study of a patient with acute liver failure during treatment with Ritonavir-boosted Paritaprevir, Ombitasvir and Dasabuvir drugs. It states that the patient has hepatitis C virus (HCV) genotype 1b cirrhosis. The patient was discharged after two weeks on therapy with hepatoprotective and diuretics drugs, without clinical signs of encephalopathy and with remission of ascites.

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 & Aims: Gastroesophageal reflux disease (GERD) therapy is challenging and suppression of acid secretion or prokinetics do not cure all cases. Some drugs with protective action on the esophageal mucosa have been used alternatively or in association with proton pump inhibitors (PPIs) and/or prokinetics. The Romanian Society of Neurogastroenterology undertook an Evidence-Based analysis, from which this position paper evolved. Methods: We performed a systematic literature search in PubMed until October 2015, using the terms: sucralfate, guaiazulene, gaiazulene, dimethicone, alginate, antacids and gastroesophageal reflux. Forty-seven papers were included and analyzed. Several statements were elaborated regarding the use of these drugs in GERD. The evidence and recommendations were discussed between the authors. Results: There is evidence in the medical literature suggesting the benefit of these drugs in GERD. In patients with persistent or mild reflux symptoms antacids rapidly relieve heartburn. Alginate-antacid combination is superior both over placebo and antacids to treat mild reflux symptoms, and can be used to treat persistent reflux symptoms despite acid suppressant therapy. Sucralfate is superior over placebo in alleviating GERD symptoms and can be used as maintenance therapy. Guaiazulene-dimethicone improves the quality of life in patients with GERD. Conclusions: Drugs used to protect the esophageal mucosa against acid are useful in alleviating chronic heartburn, especially in patients with mild reflux symptoms. [ABSTRACT FROM AUTHOR]

Background and aims. SARS-CoV-2 infection has raised the interest in clinical and paraclinical research worldwide, representing a public health issue since the beginning of 2020. Studies have established the variable, unpredictable character of COVID-19. Our main objective was to assess the liver function of patients without pre-existing liver disease, diagnosed with SARS-CoV-2 associated liver injury in a 6-month follow-up study after discharge from hospital. Methods. We conducted a prospective paraclinical and imagingstic follow-up study between 1st September 2020 and 30th April 2021 on patients without preexisting liver disease previously diagnosed with SARS-CoV-2 associated liver injury who had been admitted in Mures County Clinical Hospital, Targu Mures, Romania. We followed up the patients 'clinical and paraclinical datacharacteristics at index COVID-19 hospitalization and at T1 (6-month follow-up visit). Results. We performed abdominal ultrasonography and laboratory examinations in 78 patients (mean age 45±10 years) hospitalized 6 months earlier for symptomatic COVID-19, with a male:female ratio of 1.3:1. Thirty patients (38.46%) were discharged at index COVID-19 hospitalization with abnormal liver function tests, while the rest presented paraclinical normalization at discharge and mean duration of liver injury of approximately 7 days. Follow-up examination revealed abnormal liver function tests in twenty-four patients, most of which presented with mild liver injury. All patients with severe COVID-19 at index hospitalization presented with abnormal liver function tests at follow-up examination. Conclusions. By performing a complete clinical and paraclinical 6-month followup study, with a specific focus on 34.6% of patients in which we noted a persistence of liver function tests abnormality, we could analyzse a possible long-term effect of SARS-CoV-2 infection over liver function and also raise awareness of liver function tests monitoring and therapeutic management in post COVID-19 patients. Long-term follow-up studies of COVID-19 multi-organ sequelae are therefore mandatory in order to improve the practice of consultant gastroenterologists. [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 : The European Society of Gastrointestinal Endoscopy (ESGE) has developed a core curriculum for high quality optical diagnosis training for practice across Europe. The development of easy-to-measure competence standards for optical diagnosis can optimize clinical decision-making in endoscopy. This manuscript represents an official Position Statement of the ESGE aiming to define simple, safe, and easy-to-measure competence standards for endoscopists and artificial intelligence systems performing optical diagnosis of diminutive colorectal polyps (1 - 5 mm). METHODS : A panel of European experts in optical diagnosis participated in a modified Delphi process to reach consensus on Simple Optical Diagnosis Accuracy (SODA) competence standards for implementation of the optical diagnosis strategy for diminutive colorectal polyps. In order to assess the clinical benefits and harms of implementing optical diagnosis with different competence standards, a systematic literature search was performed. This was complemented with the results from a recently performed simulation study that provides guidance for setting alternative competence standards for optical diagnosis. Proposed competence standards were based on literature search and simulation study results. Competence standards were accepted if at least 80 % agreement was reached after a maximum of three voting rounds. RECOMMENDATION 1:  In order to implement the leave-in-situ strategy for diminutive colorectal lesions (1-5 mm), it is clinically acceptable if, during real-time colonoscopy, at least 90 % sensitivity and 80 % specificity is achieved for high confidence endoscopic characterization of colorectal neoplasia of 1-5 mm in the rectosigmoid. Histopathology is used as the gold standard.Level of agreement 95 %. RECOMMENDATION 2:  In order to implement the resect-and-discard strategy for diminutive colorectal lesions (1-5 mm), it is clinically acceptable if, during real-time colonoscopy, at least 80 % sensitivity and 80 % specificity is achieved for high confidence endoscopic characterization of colorectal neoplasia of 1-5 mm. Histopathology is used as the gold standard.Level of agreement 100 %. CONCLUSION : The developed SODA competence standards define diagnostic performance thresholds in relation to clinical consequences, for training and for use when auditing the optical diagnosis of diminutive colorectal polyps. [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]

Introduction: Surgery has an important role in the curative therapy of gastric cancer along with multimodal strategies. The paper aims to highlight the advantages of using the LigaSure devices (LigaSure Atlas 20 cm and LigaSure Small Jaw) in performing "en bloc " subtotal gastrectomy and lymphadenectomy. Materials and methods: We present the case of a 48 year old patient admitted in the Surgical Clinic 1, Emergency County Hospital Târgu Mureş, with a diagnosis of antral gastric cancer. We performed a subtotal gastric resection (4/5) without using ligatures, and "en bloc" D1 lymphadenectomy, using for hemostasis and lymphodissection LigaSure devices (LigaSure Atlas 20cm, LigaSure Small Jaw). Results: The postoperative radiologic control showed anastomotic complex functionality. The patient's postoperative evolution was favourable and the histopathological findings confirmed the diagnosis of undifferentiated antropyloric gastric carcinoma(pT3N2). Conclusions: The advantages of using LigaSure devices in gastric cancer surgery are: D1 and "extended" D1 lymphadenectomy, efficient haemostasis and lymphostasis, subtotal gastric resection and "en bloc" lymphadenectomy. [ABSTRACT FROM AUTHOR]

Introduction: Surgery has an important role in the curative therapy of gastric cancer along with multimodal strategies. The paper aims to highlight the advantages of using the LigaSure devices (LigaSure Atlas 20 cm and LigaSure Small Jaw) in performing "en bloc " subtotal gastrectomy and lymphadenectomy. Materials and methods: We present the case of a 48 year old patient admitted in the Surgical Clinic 1, Emergency County Hospital Târgu Mureş, with a diagnosis of antral gastric cancer. We performed a subtotal gastric resection (4/5) without using ligatures, and "en bloc" D1 lymphadenectomy, using for hemostasis and lymphodissection LigaSure devices (LigaSure Atlas 20cm, LigaSure Small Jaw). Results: The postoperative radiologic control showed anastomotic complex functionality. The patient's postoperative evolution was favorable and the histopathological findings confirmed the diagnosis of undifferentiated antropyloric gastric carcinoma(pT3N2). Conclusions: The advantages of using LigaSure devices in gastric cancer surgery are: D1 and "extended" D1 lymphadenectomy, efficient haemostasis and lymphostasis, subtotal gastric resection and "en bloc" lymphadenectomy. [ABSTRACT FROM AUTHOR]

This manuscript represents an official Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) aiming to guide general gastroenterologists to develop and maintain skills in optical diagnosis during endoscopy. In general, this requires additional training beyond the core curriculum currently provided in each country. In this context, ESGE have developed a European core curriculum for optical diagnosis practice across Europe for high quality optical diagnosis training. 1:  ESGE suggests that every endoscopist should have achieved general competence in upper and/or lower gastrointestinal (UGI/LGI) endoscopy before commencing training in optical diagnosis of the UGI/LGI tract, meaning personal experience of at least 300 UGI and/or 300 LGI endoscopies and meeting the ESGE quality measures for UGI/LGI endoscopy. ESGE suggests that every endoscopist should be able and competent to perform UGI/LGI endoscopy with high definition white light combined with virtual and/or dye-based chromoendoscopy before commencing training in optical diagnosis. 2:  ESGE suggests competency in optical diagnosis can be learned by attending a validated optical diagnosis training course based on a validated classification, and self-learning with a minimum number of lesions. If no validated training course is available, optical diagnosis can only be learned by attending a non-validated onsite training course and self-learning with a minimum number of lesions. 3:  ESGE suggests endoscopists are competent in optical diagnosis after meeting the pre-adoption and learning criteria, and meeting competence thresholds by assessing a minimum number of lesions prospectively during real-time endoscopy. ESGE suggests ongoing in vivo practice by endoscopists to maintain competence in optical diagnosis. If a competent endoscopist does not perform in vivo optical diagnosis on a regular basis, ESGE suggests repeating the learning and competence phases to maintain competence.Key areas of interest were optical diagnosis training in Barrett's esophagus, esophageal squamous cell carcinoma, early gastric cancer, diminutive colorectal lesions, early colorectal cancer, and neoplasia in inflammatory bowel disease. Condition-specific recommendations are provided in the main document. [ABSTRACT FROM AUTHOR]

Background and aim. The management of patients with inflammatory bowel diseases (IBD) has been changed during the COVID-19 pandemic, when many hospitals have been designated COVID-19 support. We performed a comparative retrospective analysis of the management of IBD patients treated in Gastroenterology Clinic in two distinct periods: before the pandemic (between 2016 and 2019) and during the pandemic (between 2020 and 2022). Methods: We collected data regarding IBD extension and severity, therapy, and type of medical visits over a period of seven years. Results. A total number of 146 patients were included, 101 with ulcerative colitis (UC), and 45 with Crohn disease (CD). 27 patients with UC had proctitis, 38 left sided colitis, and 36 pancolitis. Among CD patients 14 had colonic involvement, 13 ileal involvement, and 18 ileo-colonic disease. 99 patients with UC were on aminosalicylates, 18 on immunomodulators (Azathioprine), and 19 on biologic therapy. Biologics were used in 17 patients with CD, Azathioprine in 15 patients, aminosalicylates in 42 patients. We registered a total of 1755 hospital visits, from which 958 (54.6%) were in the pre-pandemic period. Patients with UC had the highest number of hospital visits (1159, 66%). We noticed a progressive increase in the number of visits in pre-pandemic years until 2019 (23.42%), followed by a decrease in 2020 (16%), then a further increase in 2021 (25.98%). The majority of visits (850, 48.4%) consisted in one-day hospitalizations, 637 (36.3%) were outpatient visits, and 268 (15.3%) ward hospitalizations. In pre-pandemic years a significant higher admission rate was for patients with UC, while during the pandemic for CD patients (p< 0.05). Before 2020 patients were more frequently referred for mild (225, 23.5%) to moderate IBD flares (270, 28.2%); 36 (3.75%) ward hospitalizations for severe flare were registered. During the pandemic, IBD remission was noted in most hospital visits (396, 49.6%, p<0.05). Ward hospitalizations were indicated only for severe IBD flare (57, 7.2%). There was a significantly higher rate of ward hospitalizations (173, 65%) and oneday hospitalizations (470, 55.3%) before 2020, and a significant increase in the number of outpatient visits (322, 50.5%, p<0.05) during the pandemic. Presentation at the hospital for the purpose of administering biological therapy was prevalent in the pandemic (460, 57.7%). Conclusions. Although hospital referrals have declined during the pandemic years, we optimized therapy and maintained IBD remission at a significant rate. There was a significant shift to outpatient visits, enforced by the pandemic restrictions. [ABSTRACT FROM AUTHOR]

Percutaneous endoscopic gastrostomy with jejunal extension (PEG/J) was first described in 1998 and has become the standard technique for fixing the tube in place for levodopa carbidopa intestinal gel (LCIG) infusion. The Romanian Society of Digestive Endoscopy (RSDE) decided to create a consensus paper to meet the needs in medical training and practice. After reviewing the available published data and existing recommendations, a consensus process was carried out involving the leaders of opinion in this field. The resulting text and recommendations were approved, after reaching expert consensus, and reflects the views of the RSDE for the best practice of PEG/J tube placement. The pull through method ("pull technique") is the prevailing PEG-tube placement procedure in Romania. The procedure can be performed with intravenous sedation combined with local anesthesia. Although minor complications are common, serious complications are infrequent, and the tube insertion procedures have a good safety record. Redo procedures are sometimes necessary and clinicians should be aware of these situations. [ABSTRACT FROM AUTHOR]

The objective of the current study is to evaluate the complication rates (embolic and hemorrhagic events) in deep venous thrombosis (DVT) patients on different types of oral anticoagulation therapy (OAC): direct oral anticoagulant therapy and vitamin K antagonist therapy. Methods: A number of 62 DVT patients were included and divided in two groups, depending on the type of oral anticoagulation therapy administered. The first group was composed of patients treated with direct oral anticoagulant treatment (Dabigatran, Rivaroxaban) and the second group was composed of patients treated with vitamin K antagonist (Acenocumarol). General data, including BMI and comorbidities were noted. Embolic and hemorrhagic events were noticed. Results: in the first group of patients (DOAC therapy), a number of 34 patients were included (14 of them with BMI higher than 25 kg/m2 and 14 with concomitant atrial fibrillation), while the second group comprised of 28 patients treated with VKA (21 of them with a high BMI and only 3 of them with atrial fibrillation). After a mean period of 36 months of anticoagulant therapy, complications were present in 17 patients, hematuria (8 episodes) and pulmonary embolism (4 cases) were the most frequent, with no difference regarding the treatment applied. Conclusion: No statistically significant difference was encountered regarding embolic and hemorrhagic event rates in our deep vein thrombosis patients. [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. The incidence of acute pouchitis after total proctocolectomy with ileal pouch reconstruction is currently at 20% after 1 year, and more than 30% after 5 years. The current guidelines in pouchitis include recurrent bouts of antibiotic treatment, and in spite of this, more than 10% of patients will develop antibiotic refractory pouchitis, which represents a therapeutic challenge. Case report. A 59-years old female patient, diagnosed with severe ulcerative pancolitis which required total colectomy with ileo-rectal pouch anastomosis after developing toxic megacolon (1995) presents to the Gastroenterology Department with 8-10 semsiolid stools per day, rectorrhagia and fatigue. Paraclinical examination showed a severe iron deficiency anemia (Hgb 6,5 g/dL, HCT 27%), increased inflammatory markers (CRP, ESR, fibrinogen count, and fecal calprotectin of 1200 ug/g). Rectoscopy with intubation of the ileal pouch shoed fibrin-covered pouch ulceration (1,5-2 cm in diameter), perilesional edema and acute congestion, with the presence of loss of vascular markings, superficial erosions at the level of the rectal stump. She received treatment with IV corticosteroids and prolonged bouts of antibiotic treatment, together with Rifaximin and probiotic therapy. Repeated rectoscopy at 2 months showed a slight decrease of the fibrin-covered pouch ulceration but the persistence of perilesional edema and of mucosal changes at the level of the rectal stump and recurrent anemic syndrome resistant to iron supplementation and repeated blood transfusions. Discussions. Current guidelines recommend initial cephalosporins and for non-responders, such as our patient, ciprofloxacin plus rifaximin. In the case of chronic antibiotic refractory pouchitis, current guidelines recommend the use of immunomodulator treatments and biological agents such as Vedolizumab, Ustekinumab and Infliximab, which show promising results, but were all administered off label or in clinical trials. Conclusions. Pouch complications are increasingly common and require urgent care, especially in chronic antibiotic refractory pacients. Effective national guidelines are required in order to allow an easier access to optimal medical care. [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]

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]

Colorectal cancer is an important health issue, both in terms of the number of people affected and the associated costs. Colonoscopy is an important screening method that has a positive impact on the survival of patients with colorectal cancer. The association of colonoscopy with computer-aided diagnostic tools is currently under researchers' focus, as various methods have already been proposed and show great potential for a better management of this disease. We performed a review of the literature and present a series of aspects, such as the basics of machine learning algorithms, different computational models as well as their benchmarks expressed through measurements such as positive prediction value and accuracy of detection, and the classification of colorectal polyps. Introducing computer-aided diagnostic tools can help clinicians obtain results with a high degree of confidence when performing colonoscopies. The growing field of machine learning in medicine will have a big impact on patient management in the future. [ABSTRACT FROM AUTHOR]

Background: Abdominal manifestations of the hereditary angioedema (HAE) attacks are usually misdiagnosed until the correct diagnosis is established based on low levels of C1 inhibitor activity. Material and methods: The Romanian registry includes 94 HAE patients diagnosed in the past 12 years. Data about the start of symptoms, date of HAE confirmation by C1 INH measurements, diagnoses in the emergency departments, proposals for abdominal surgery and performed abdominal interventions before the correct diagnosis were also registered. The past 12 months events update was made by phone. Results: Of the 94 HAE patients, 88 could be contacted and have responded to our questionnaire. The mean delay of the diagnosis of HAE was 16.49 years. We have recorded 951 peripheral, 799 abdominal, 175 facial and 90 upper respiratory attacks in the last 12 months. 86 patients presented with abdominal attacks during their lifetime. 25 patients have had likely unnecessary surgeries. Ascites was a common feature found during these interventions, strongly suggesting those procedures were inappropriate. Misdiagnosis before confirmation of the C1 INH deficiency was reported by 76 patients, the most common errors being gastroenteritis, appendicitis, cholecystitis and pancreatitis. Proposals for abdominal surgery were reported by 24 HAE patients. 27 patients are taking Danazol (mostly 100 mg every 2-3 days) and we can observe that the frequency and severity of acute abdominal attacks during danazol treatment shows a major improvement than without this drug. Conclusions: Abdominal attacks are characteristic for the HAE clinical pattern, occurring in more than 90% of HAE patients. Misdiagnosis is associated with inadequate treatments, including unnecessary surgical procedures. [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]

The aim of the paper was to propose a score for performance evaluation in colonoscopy units. Method. We proposed a score (CDCD score - Cecal intubation, polyp Detection rate, Cleansing and Documentation of cecal intubation) based on the following parameters that assess the quality of colonoscopy units: total colonoscopies rate, polyp detection rate, rate of cecal intubation photo record, rate of recorded Boston bowel preparation scale (BBPS) (rated 1 to 5 stars). The mean score obtained based on the above mentioned criteria was used as a quality parameter of the endoscopy unit. We applied and calculated this score in all screening colonoscopies performed in our Endoscopy Department during the last 4 years. Results. The study group included 856 screening colonoscopies. The rate of total colonoscopies was 92.1% (789/856 cases) and the polyp detection rate was 23.9%. Regarding the quality of bowel preparation, the BBPS was recorded in 51.1% cases. The cecal intubation was photo recorded in 44% of cases. We considered that of the 4 parameters, the highest weight for an excellent quality belonged to the cecal intubation rate, followed by the polyp detection rate, because they evaluate the endoscopic technique, while the other 2 are more administrative. Thus, for the unit's assessment we used the following equation: UNIT'S QUALITY CDCD SCORE = (3xcecal intubation rate+3xpolyp detection rate+1xphoto documentation+1xBBPS documentation)/8. Thus, the CDCD Score for our unit was ≈4 stars (3.7 stars). Conclusion. The proposed CDCD score may be an objective tool for the quality assessment in different endoscopy units. [ABSTRACT FROM AUTHOR]

The article discusses the quality improvement initiative of the European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) for the identification of upper gastrointestinal endoscopy (UGI) performance measures. Topics include the aim of the UGI working group, the performance measures accepted for upper gastrointestinal endoscopy, and the use of Delphi process in distinguishing the key performance measures.

Background and Aim: Some studies suggest that narrow-band imaging (NBI) can be more accurate at diagnosing gastric intestinal metaplasia and dysplasia than white-light endoscopy (WLE) alone. We aimed to assess the real-time diagnostic validity of high resolution endoscopy with and without NBI in the diagnosis of gastric premalignant conditions and to derive a classification for endoscopic grading of gastric intestinal metaplasia (EGGIM).Methods: A multicenter prospective study (five centers: Portugal, Italy, Romania, UK, USA) was performed involving the systematic use of high resolution gastroscopes with image registry with and without NBI in a centralized informatics platform (available online). All users used the same NBI classification. Histologic result was considered the diagnostic gold standard.Results: A total of 238 patients and 1123 endoscopic biopsies were included. NBI globally increased diagnostic accuracy by 11 percentage points (NBI 94 % vs. WLE 83 %; P < 0.001) with no difference in the identification of Helicobacter pylori gastritis (73 % vs. 74 %). NBI increased sensitivity for the diagnosis of intestinal metaplasia significantly (87 % vs. 53 %; P < 0.001) and for the diagnosis of dysplasia (92 % vs. 74 %). The added benefit of NBI in terms of diagnostic accuracy was greater in OLGIM III/IV than in OLGIM I/II (25 percentage points vs. 15 percentage points, respectively; P < 0.001). The area under the curve (AUC) of the receiver operating characteristic (ROC) curve for EGGIM in the identification of extensive metaplasia was 0.98.Conclusions: In a real-time scenario, NBI demonstrates a high concordance with gastric histology, superior to WLE. Diagnostic accuracy higher than 90 % suggests that routine use of NBI allows targeted instead of random biopsy samples. EGGIM also permits immediate grading of intestinal metaplasia without biopsies and merits further investigation. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 64-year old white male who was diagnosed with gastric adenocarcinoma. Topics discussed include the upper gastrointestinal (GI) endoscopy, surgical removal of the tumor, and prognosis. Also mentioned are the existence of intestinal metaplasia with small, irregular, tubular structures based on the histopathological examination, narrow band imaging (NBI), and use of biopsy.

Narrow band imaging represents a promising endoscopic technique which allows real time characterization of colonic lesions by assessment of mucosal and vascular patterns. Due to the ability to make an optical biopsy, NBI could become a useful tool in clinical decisions regarding therapy and surveillance. The aim of this paper is to review the current knowledge on the optical diagnosis of colonic lesions by using NBI endoscopy. We reviewed research articles, reviews and meta-analyses from the PubMed and MEDLINE containing relevant data in this field. The validity of endoscopic criteria for the differentiation of adenoma and hyperplastic polyps, as well as of invasive cancer, has been evaluated in recent studies. Based on the prediction of polyp histology, new potential cost saving strategies have been proposed. Many reports are focused on the accuracy of optical biopsy by using NBI for predicting colonoscopy surveillance intervals and adenomatous histology in diminutive polyps, according to the Preservation and Incorporation of Valuable Endoscopic Innovations statement. Optical diagnosis is still under evaluation, and cannot yet be endorsed in routine practice. The high level of performance achieved by expert endoscopists needs to be replicated in the community utilizing reliable and standardized endoscopic criteria. [ABSTRACT FROM AUTHOR]

Background and Aim: Gastric intestinal metaplasia represents a risk factor for intestinal type of gastric cancer. Gastric intestinal metaplasia seems to be associated with Helicobacter pilory infection in relatives of patients with gastric cancer. The aim of this study was to determine the prevalence, clinical, endoscopic and histological features of gastric intestinal metaplasia. Material and Methods: We retrospectively analyzed the esophagogastroduodenoscopies with biopsies performed between January 1, 2014 and October 31, 2014. Collected and analyzed data included age, gender, symptoms, endoscopic and histological findings. Results: Four hundred eighty-two patients were included in the study. One hundred thirty-seven patients had gastric intestinal metaplasia, which presented a prevalence was 28,4%. A similar distribution between gender was observed with a significant increase of gastric intestinal metaplasia with age (p=0,0001). Regarding the indication for endoscopy, the prevalence of gastric intestinal metaplasia was: 17 % among patients with dyspeptic syndrome, 2 % in patients with anemia and 5 % in patients examined for other symptoms. Endoscopic findings showed gastric intestinal metaplasia was significantly associated with atrophic gastritis (p=0.0001), erythematous gastritis (p=0.0079), while there was no association with erosive gastritis (p=0.24) and peptic ulcer (p=0.19). Conclusions: Gastric intestinal metaplasia is frequently recorded in patients undergoing in esophagogastroduodenoscopies with associated biopsies. Endoscopic findings like erythema and atrophy is strongly associated with gastric intestinal metaplasia emphasizing the importance of sampling biopsies. [ABSTRACT FROM AUTHOR]

Objective. Assessment of the histological and endoscopic features of the colo-rectal polyps is requered for the application of the new diagnostic and therapeutical strategies in the managment of the diminutive polyps. Methods. This paper is a descriptive retrospective study on 52 pacients reffered for colonoscopy in Gastroenterology Clinic - Clinical County Hospital Targu Mures from January until September 2014. 80 polyps were assessed. Narrow band imaging examination targeted on the protrusive lezions allowed NICE (Narrow Band Imaging International Colorectal Endoscopic) classification and corroboration of the histology prediction and pathological assessment. Results. Polyp detection rate was 48,58%, given the quality of bowel preparation in hospital fair in 84,5%. The predominant histological type was the tubular adenoma (46,25%), and 40% of the polyps were located in the sigmoid. Among the diminutive polyps, 58,33% were hyperplastic(p<0,0001), mainly in the recto-sigmoid (66,67%); the incidence of high grade displasia or cancer was 0. Real -time prediction of the histology of the colorectal polyps using NBI established: NICE 1: 19 polpyps, histology- 16 hyperplastic, (p<0,0001, sensitivity: 100%, specificity: 95%), NICE 2: 59 polyps, histology- 53 adenomatous, (p<0,0001, sensitivity: 96%, specificity: 76%), NICE 3: 2 polyps- histology-cancer. Conclusions. We did not observe any distribution pattern in the topography of the diminutive polyps. Histologicaly the predominant type was the hyperplastic type. NBI was accurate in real-time prediction of the histology of the colo-rectal polyps. The results are relevant for application of the new strategies in the managment of the diminutive polyps. [ABSTRACT FROM AUTHOR]

Background and aim: Hepatocellular carcinoma (HCC) is one of the most important health problem, with an increasing incidence worldwide. The aim of the present study was to determine the factors that predict HCC occurrence in a group of patients with liver cirrhosis developed on various etiologies. Material and Methods: A total of 282 consecutive patients with liver cirrhosis seen between January 1, 2013 and July 31, 2014 were enrolled in a prospective study. Data from patient's history, physical exams, laboratory tests and abdominal ultrasound were collected. Results: 282 patients were included in the study with a median age of 59.6 and a male/female ratio of 1.38/1; 12.41% (35) were diagnosed with HCC. Alcohol consumption was documented in 19 cases (54.28%), without statistical association (p=0.621), and 7 (20%) were smokers (p=0.403). According to etiological factors of liver cirrhosis: 7 (20%) had background B virus infection, 15 (42.85%) HCV infection and 11 (31.42%) cases incriminated other causes of cirrhosis (alcohol). Chi2 test identified a statistically significant association between the occurrence of HCC and viral etiology of cirrhosis (p = 0.001, r = 18,830). No statistical association was found between Child Pugh scoring of cirrhosis and HCC (p=0.774) and a statistically significant association but inversely proportional was identified between neoplasia and obesity (p=0.008, r= -0.157). Conclusion: In conclusion the viral etiology of liver cirrhosis is found to be an important risk factor for HCC, and liver cancer was inversely associated with nutritional status. [ABSTRACT FROM AUTHOR]

The diagnosis of dysplasia and early neoplasia in Barrett's esophagus by conventional endoscopy is based on a four- quadrant random biopsies protocol that is prone to sampling errors. Novel endoscopic techniques have been developed to enhance the detection of premalignant and malignant lesions by real time assessment of microvasculare architecture and mucosal structure. Chromoendoscopy with magnification has improved the visualization of lesions, but the dye application impairs a clear evaluation of vascular network. Narrow band imaging endoscopy enhances vascular imaging by using narrow bandwidth lights, with penetration to superficial mucosal structures. Different classification systems of mucosal and vascular patterns have been developed to improve the diagnostic accuracy of non-dysplastic and dysplastic BE, as well as of early esophageal cancer. This article is focused on both the clinical benefits and controversies surrounding conventional and advanced endoscopic methods used for screening and surveillance of patients with Barrett's esophagus. Current evidence shows that the adoption of new technology in routine practice requires a high level of performance as well as the standardization of various classification systems. [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.

Background & Aims: Over the past few decades, the incidence of adenocarcinomas of the gastroesophageal junction has rapidly increased. Barrett's esophagus is a risk factor for esophageal adenocarcinoma, but the role of intestinal metaplasia of the gastric cardia as a precursor in cardia-related cancer is controversial. The aims of the present study were to examine the prevalence of intestinal metaplasia in the gastroesophageal junction and to evaluate the clinical, endoscopical and histological features of patients with intestinal metaplasia in the gastric cardia and patients with Barrett's esophagus. Methods: 286 consecutive patients undergoing gastroduodenoscopy were enrolled in a prospective study. Biopsy specimens were performed in the distal esophagus, squamocolumnar junction, gastric cardia, gastric corpus and antrum. Results: We identified 44 patients (15.3%) with intestinal metaplasia in biopsies from gastric cardia and 24 patients (8.3%) with Barrett's esophagus. Cardia intestinal metaplasia was significantly associated with older age (p=0.03), with intestinal metaplasia in the antrum (p=0.017) and H. pylori infection (p<0.0001). Severe chronic cardia inflammation increased the presence of cardia intestinal metaplasia 6.2 fold (OR=6.288; p<0.0001). Patients with Barrett's esophagus were predominantly men. Barrett's esophagus presence significantly correlated with reflux symptoms(p<0.0001), endoscopic esophagitis (p<0.0001) and hiatal hernia >2 cm (p=0.002). No patient had dysplasia in the gastroesophageal region. Conclusions: Presence of intestinal metaplasia at the gastroesophageal region correlated with reflux symptoms and endoscopic signs of reflux disease in patients with Barrett's esophagus and with H.pyloriinfection and distal intestinal metaplasia in patients with cardia intestinal metaplasia. [ABSTRACT FROM AUTHOR]

The COVID-10 pandemic has slowed the pace of our lives in all aspects, temporarily halting screening and prophylaxis measures in every area, including health. Gastrointestinal (GI) cancers account for more than a quarter (26%) of the overall incidence of cancer and more than a third (35%) of all cancer deaths, which is why sustained efforts are needed to detect these neoplasms in situ, or even the discovery of the related precursors. Therefore, the resumption of screening programs and the recovery of the delayed period represent an extremely important and necessary objective. [ABSTRACT FROM AUTHOR]

Healthcare Information Systems (HIS) generally rely on large databases that store medical data. Apart from the specific issues related to the design of the data structures, these systems present a challenge to the developer regarding the architecture of the external level of the database, closely related to the building of the user interface. This paper discusses three specific issues related to the user interface of a medical database (The Temporal Property, The Allocation Process and The Open Attribute List Specialization) using a data-oriented approach for the external level. The approach is mostly based on data views, constructed on the server side and on the client application side. A small number of stored procedures however is necessary to implement the full functionality of the system. In our approach, most of the complexity of these processes is embedded in the queries that are run against the database. These queries can often be complex and time consuming. Two major issues arise from here: first, complexity can lead to inconsistent presentation of the same data (we are considering large information systems) and second, large queries can severely affect overall performance. These are the factors which the designers of such a system must control in order to reach an acceptable balance. By using the presented techniques, software developers can easily build user interfaces that present basic or medium-complex functionality, while having the benefits of standardization. For highly complex functionality, more advanced patterns and technologies are needed, which will be presented in a future paper. [ABSTRACT FROM AUTHOR]

In our past work, we have developed a data structuring technique based on trees and multitrees to model clinical research data. In this paper, we try to assess the suitability of this model for keeping an electronic laboratory notebook by comparing its strengths and weaknesses with the products of some of the leading software providers on the market. The comparison focuses on five critical aspects: customizability, the use of tree-like structures, the use of patterns or templates, the techniques used to retrieve the data and functions that support collaboration. In the last two sections of the paper, we discuss our findings and draw some conclusions that will serve as guidelines for our future work. [ABSTRACT FROM AUTHOR]