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We present the case of a 71-year-old male who suffered an episode of acute renal failure caused by the uncommon association of two different diseases (Clostridioides difficile infection and McKittrick-Wheelock syndrome). He presented with hypovolemic shock, severe hypokalemia, hyponatremia, metabolic acidosis and acute renal failure; consequences of secretory diarrhea caused by a giant rectal tumor revealed from colonoscopy. The biopsy results revealed tubulo-villous adenoma with low/high grade dysplasia. After correction of electrolyte imbalances and azotemia, the patient underwent surgical resection with full subsequent recovery. In the literature review, including papers published from which January 1945 to April 2021, we found only one case-report of acute renal failure associated with Clostridioides difficile infection and McKittrick-Wheelock syndrome. [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]

The Montreal consensus recognizes chronic cough as an extra-esophageal manifestation of gastroesophageal reflux disease. We performed a meta-analysis to assess the effects of acid-suppressive medications in adults with non-specific chronic cough. The protocol was registered on PROSPERO (CRD42022368769). Placebo-controlled randomized trials evaluating the impact of acid-suppressive medications on persistent cough were included. The systematic search was performed on the 1st of November 2022 in three databases. A random-effects model was used for the calculations. The effect size was the standardized mean difference (SMD) with 95% confidence interval (CI). A total number of 11 double-blinded placebo-controlled randomized trials were included in the meta-analysis. Data showed that compared to placebo, PPIs decreased the severity of cough (SMD 0.33; CI 0.05; 0.61). Therapeutic response was not different in patients with non-specific chronic cough only, compared to those with laryngopharyngeal reflux. Prolonged treatment durations did not result in greater symptomatic improvement, with SMD 0.33 (CI − 0.22; 0.88), 0.31 (CI − 1.74; 2.35), 0.32 (CI − 0.29; 0.93) and 0.34 (CI − 0.16; 0.85), following 4, 6, 8 and 12 weeks of treatment, respectively. The pooled analysis of the improvement in quality of life with PPIs found an SMD of 0.39 (CI − 0.51; 1.29). PPIs mildly decrease the severity of non-specific chronic cough, irrespective of treatment duration. [ABSTRACT FROM AUTHOR]

Irritable bowel syndrome (IBS) has a global prevalence of around 4.1% and is associated with a low quality of life and increased healthcare costs. Current guidelines recommend that IBS is diagnosed using the symptom-based Rome IV criteria. Despite this, when patients seek medical attention, they are usually over-investigated. This issue might be resolved by novel technologies in medicine, such as the use of Artificial Intelligence (AI). In this context, this paper aims to review AI applications in IBS. AI in colonoscopy proved to be useful in organic lesion detection and diagnosis and in objectively assessing the quality of the procedure. Only a recently published study talked about the potential of AI-colonoscopy in IBS. AI was also used to study biofilm characteristics in the large bowel and establish a potential relationship with IBS. Moreover, an AI algorithm was developed in order to correlate specific bowel sounds with IBS. In addition to that, AI-based smartphone applications have been developed to facilitate the monitoring of IBS symptoms. From a therapeutic standpoint, an AI system was created to recommend specific diets based on an individual's microbiota. In conclusion, future IBS diagnosis and treatment may benefit from AI. [ABSTRACT FROM AUTHOR]

Patients undergoing ablation for atrial fibrillation may be at increased risk of developing gastroesophageal reflux disease. We prospectively studied the presence of symptomatic gastroesophageal reflux disease in naïve patients who underwent atrial fibrillation ablation. Methods: The presence of typical symptoms suggestive of gastroesophageal reflux disease was clinically assessed by the gastroenterologist at baseline and at 3 months after ablation. In addition to that, all patients underwent upper gastrointestinal endoscopy. Results: Seventy-five patients were included in two groups: 46 patients who underwent atrial fibrillation ablation (study group) and 29 patients without ablation (control group). Patients with atrial fibrillation ablation were younger (57.76 ± 7.66 years versus 67.81 ± 8.52 years; p = 0.001), predominantly male (62.2% versus 33.3%; p = 0.030) and with higher body mass index (28.96 ± 3.12 kg/m2 versus 26.81 ± 5.19 kg/m2; p = 0.046). At three months after the ablation, in the study and control groups, there were 88.9% and 57.1% patients in sinus rhythm, respectively, (p = 0.009). Symptomatic gastroesophageal reflux disease was not more frequent in the study group (42.2% versus 61.9%; p = 0.220). There was no difference in terms of sinus rhythm prevalence in patients with versus without symptomatic gastroesophageal reflux disease (89.5% versus 88.5%; p = 0.709). Conclusion: In this small prospective study, typical symptoms suggestive of gastroesophageal reflux disease were not more frequent three months following atrial fibrillation ablation. [ABSTRACT FROM AUTHOR]

Globally, metabolic diseases such as obesity, type 2 diabetes mellitus and non-alcoholic fatty liver disease pose a major public health threat. Many studies have confirmed the causal relationship between risk factors and the etiopathogenesis of these diseases. Despite this, traditional therapeutic management methods such as physical education and diet have proven insufficient. Recently, researchers have focused on other potential pathways for explaining the pathophysiological variability of metabolic diseases, such as the involvement of the intestinal microbiota. An understanding of the relationship between the microbiome and metabolic diseases is a first step towards developing future therapeutic strategies. Currently, much attention is given to the use of biotics family members such as prebiotics (lactolose, soy oligosaccharides, galactooligosaccharides, xylooligosaccharides or inulin) and probiotics (genera Lactobacillus, Bifidobacterium, Lactococcus, Streptococcus or Enterococcus). They can be used both separately and together as synbiotics. Due to their direct influence on the composition of the intestinal microbiota, they have shown favorable results in the evolution of metabolic diseases. The expansion of the research area in the biotics family has led to the discovery of new members, like postbiotics. In the age of personalized medicine, their use as therapeutic options is of great interest to our study. [ABSTRACT FROM AUTHOR]

Gastroesophageal reflux disease (GERD) is one of the most commonly encountered disorders in clinical practice nowadays, with an increasing burden on healthcare systems worldwide. GERD-related respiratory symptoms such as unexplained chronic cough, bronchial asthma or chronic obstructive pulmonary disease (COPD) with frequent exacerbations often pose diagnostic and therapeutic challenges and may require a multidisciplinary approach. Moreover, a potential role of GERD as a risk factor has been proposed for chronic rejection in patients who underwent lung transplantation. Pepsin has gained considerable attention from the scientific community in the last few years as a possible surrogate biomarker for GERD. The aim of this narrative review was to provide an overview of the potential utility of pepsin detection as a marker of micro-aspiration in various biological fluids retrieved from patients with suspected GERD-induced respiratory manifestations and in lung transplant patients with allograft dysfunction. Data on the subject remains highly contradictory, and while certain studies support its applicability in investigating atypical GERD manifestations, at the moment, it would be realistic to accept a modest utility at best. A major lack of consensus persists regarding topics such as the optimal timeframe for fluid collection and cut-off values. Further research is warranted in order to address these issues. [ABSTRACT FROM AUTHOR]

Hereditary hemorrhagic telangiectasia is a rare autosomal dominant vascular disease defined by the presence of mucosal and cutaneous telangiectasia and visceral arterio-venous malformations. The latter are abnormal capillary-free direct communications between the pulmonary and systemic circulations with the following consequences: arterial hypoxemia caused by right-to-left shunts; paradoxical embolism with transient ischemic attack or stroke and brain abscess caused by the absence of the normally filtering capillary bed; and hemoptysis or hemothorax due to the rupture of the thin-walled arterio-venous malformations (particularly during pregnancy). It is frequently underdiagnosed, commonly presenting as complications from shunting through arterio-venous malformations: dyspnea, chronic bleeding, or embolism. Arterio-venous malformations are present not only in the lungs, but can also be found in the liver, central nervous system (mainly in the brain), nasal mucosa, or the gastrointestinal tract. The first choice of therapy is embolization of the afferent arteries of the arterio-venous malformations, a minimally invasive procedure with a high efficacy, a low morbidity, and low mortality. Other therapeutic modalities are surgery (resection) or stereotactic radiosurgery (using radiation). Routine screening for arterio-venous malformations is indicated in patients diagnosed with this condition and can prevent severe complications such as acute hemorrhages, brain abscesses, or strokes. Clinicians should provide a long-term follow-up for patients with arterio-venous malformations, in an effort to detect their growth or reperfusion in case of previously treated malformations. In spite of two experts' consensuses, it still possesses multiple therapeutic challenges for physicians, as several aspects regarding the screening and management of arterio-venous malformations still remain controversial. Multidisciplinary teams are especially useful in complex cases. [ABSTRACT FROM AUTHOR]

(1) Background: Irritable bowel syndrome (IBS) is a common disease, with multiple pathophysiological mechanisms involved. A single treatment for all the patients with IBS is not possible. Prebiotics may have a beneficial effect on IBS patients with constipation. (2) Methods: A randomized cross-over case-control study was conducted, including patients with IBS and constipation (IBS-C), who were randomized into two groups receiving a specific constipation diet with or without a food supplement containing inulin, choline and silymarin (Stoptoxin®, Fiterman Pharma, Iasi, Romania). Patients were evaluated at baseline, after four and eight weeks, using a questionnaire to assess IBS symptoms. (3) Results: 51 IBS-C patients were included, of which 47 patients finished the trial (33 women, mean age 52.82 years). Adding Stoptoxin® to a diet for constipation brought extra benefits. Abdominal pain severity improved by 68.3% after the diet and Stoptoxin® (p = 0.004) and abdominal bloating severity parameter improved by 34.8% (p = 0.040). The stool number per week and the stool consistency according to the Bristol scale were improved, but without statistical significance between groups (p > 0.05). (4) Conclusions: The combination of inulin, choline and silymarin associated with a specific-constipation diet had obvious clinical beneficial effects on IBS-C patients in terms of bowel movement, abdominal pain and bloating. [ABSTRACT FROM AUTHOR]

Artificial intelligence, a computer-based concept that tries to mimic human thinking, is slowly becoming part of the endoscopy lab. It has developed considerably since the first attempt at developing an automated medical diagnostic tool, today being adopted in almost all medical fields, digestive endoscopy included. The detection rate of preneoplastic lesions (i.e., polyps) during colonoscopy may be increased with artificial intelligence assistance. It has also proven useful in detecting signs of ulcerative colitis activity. In upper digestive endoscopy, deep learning models may prove to be useful in the diagnosis and management of upper digestive tract diseases, such as gastroesophageal reflux disease, Barrett's esophagus, and gastric cancer. As is the case with all new medical devices, there are challenges in the implementation in daily medical practice. The regulatory, economic, organizational culture, and language barriers between humans and machines are a few of them. Even so, many devices have been approved for use by their respective regulators. Future studies are currently striving to develop deep learning models that can replicate a growing amount of human brain activity. In conclusion, artificial intelligence may become an indispensable tool in digestive endoscopy. [ABSTRACT FROM AUTHOR]

Introduction. Gastric antral vascular ectasia (GAVE) is an uncommon but often severe cause of upper gastrointestinal (GI) bleeding, responsible of about 4% of non-variceal upper GI haemorrhage. The diagnosis is mainly based on endoscopy. GAVE is characterized by a pathognomonic endoscopic pattern, mainly represented by red spots organized in stripes radially departing from pylorus, defined as watermelon stomach, or arranged in a diffused-way. Case report. We report the case of a 83 years old female patient admitted for chest pain associated with difficulty in breathing and fatigue, the symptoms subside at rest. Acute myocardial infarction was excluded but severe anemia was detected with a haemoglobin of 5.9 g/dl. The patient was known with paroxysmal atrial fibrillation controlled by amiodarone, rheumatoid arthritis for which the patient administered methotrexate, the treatment was ceased several years ago due to the reduction of disease activity. Due to CHADs-VASc score of 5, the patient was under chronic anticoagulation with DOAC. In order to identify the source of the supposed bleeding, a Upper Digestive Endoscopy was performed. The investigation revealed grade I esophageal varices without signs of recent bleeding and antral vascular ectasia. Due to local conditions, endoscopic band ligation was preferred. After the management of the anemia the patient was discharged with a haemoglobin of 9 g/dl. After a month from the EBL the patient restarted administration of DOAC which lead to a new episode of acute GI bleeding, a second session of EBL was performed with the recommendation not to administer anticoagulants until a third session which was set after 2 months. Discussion. The first line treatment is considered argon plasma coagulation (APC), given its wider availability, safety, efficacy and cost-effectiveness, though different types of endoscopic treatments are available. Given the condition of a specific patient, the physician can choose which is more appropriate for a better management. Conclusion. A patient with multiple comorbidities must have a comprehensive approach and a good understanding of bleeding versus thrombotic risks. [ABSTRACT FROM AUTHOR]

Introduction. Multichannel intraluminal esophageal impedance combined to pH-metry (pH-MII) is a sensitive tool for evaluating gastroesophageal reflux disease (GERD). The impedance-pH monitoring diagnostic test determines the frequency of reflux episodes (both acid or nonacid and liquid, gas or mixed) and the time relationship of reflux episodes and symptoms. Extradigestive manifestations and refractory GERD are two of the main recommendations for the assessment of upper digestive tract by pH-MII. Material and method. We conducted a prospective study between January 2022 - March 2023 at our tertiary referral center in North-Eastern Romania that included 26 patients suspected of GERD. All patients were investigated through pHMII. We used a ZepHr® system from Sandhill Scientific and single-use catheters with one pH electrode and 6 impedance electrodes. Patients who underwent MII-pH testing for refractory GERD were tested on proton pump inhibitor (PPI), while patients with no previous evidence of GERD were assessed off PPI. The diagnosis of GERD and phenotypes were based on Lyon metrics. Results. Out of the 26 patients, 14 (53.8%) were male and 12 (46.2%) female, with a mean age of 48.6±13.5 years. Nineteen patients (73.07%) presented with extradigestive GERD symptoms, of whom 7 patients (36.8%) with chronic cough, 7 patients (36.8%) with chronic laryngitis, 4 patients (21.05%) with non-cardiac chest pain and 1 patient (5.26%) with bronchial asthma. The rest of 7 (26.92%) patients were investigated for refractory GERD. After the final analysis of pH-MII tracks, we found GERD in 10 (38.5%) patients, functional heartburn in 6 (23.1%) patients and hypersensitive esophagus in 3 (15.4%) patients. All the 10 patients diagnosed with GERD had acid reflux, with a mean DeMeester Score of 46.7±83.8 and a mean AET of 12.8±20.9%. The mean total number of GERD episodes was 100.3±7.5 and the mean longest reflux episode was of 53.7±85.7 minutes. Conclusion. Multichannel intraluminal esophageal impedance combined to pH-metry represents an important instrument for assessing extradigestive GERD and refractory GERD. [ABSTRACT FROM AUTHOR]

Introduction. High-resolution manometry (HRM) is one of the most notable recent advances in the field of esophageal function. In the absence of organic lesions, HRM provides measurements of esophageal function, identifies the pathology and guides the treatment. The aim of this study was to assess the HRM particularities of diagnosis, clinical features and therapeutic management in patients evaluated for esophageal motor dysfunction. Material and Methods. Our study included all patients suspected of esophageal motility disorders, admitted in our tertiary referral center in North-Eastern Romania between July 2022 and March 2023. Demographic, clinical and laboratory characteristics were carefully collected from the patients' medical charts. All patients were investigated by upper digestive endoscopy and barium esophagogram prior to HRM. Patients diagnosed with eosinophilic esophagitis were excluded from the study. An ISOLAB HR® system from Standard Instruments, with a 36-pressure channels solid-state catheter was used. The HRM diagnosis of esophageal motor diseases was established based on Chicago 4 protocol and classification. Results. Out of the 38 patients included in the study, 15 (39.5%) were female and 23 (60.5%) male, with a mean age of 61.2±11.9. Regarding clinical features, the majority of patients presented with dysphagia (80.4%). Seven (18.4%) patients associated significant weight loss and 6 (15.8%) reported non-cardiac chest pain. Esophageal motility disorders were found in 29 patients (76.3%), 9 patients (23.6%) having a normal HRM aspect. Achalasia was identified in 15 patients (39.5%), with type I in 3 patients (7.9%), type II in 7 patients (18.4%) and type III in 5 patients (13.2%). Distal esophageal spasm was found in 4 patients (10.5%), hypercontractile esophagus in 2 patients (5.3%), esophagogastric junction outflow obstruction (EGJOO) in 2 patients (5.3%), ineffective esophageal motility in 1 patient (2.6%), absent contractility in 4 patients (10.5%) and dyshagia lusoria was identified in only one patient (2.6%). Regarding therapeutic management, endoscopic dilation was performed in 10 patients (26.3%) and 3 patients (7.8%) were referred to surgery. Conclusion. Esophageal HRM remains an important tool for assessing esophageal motor dysfunction. The esophageal motility disorders still represent a diagnostic and therapeutic challenge in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction. High-resolution manometry (HRM) is one of the most notable recent advances in the field of esophageal function. In the absence of organic lesions, HRM provides measurements of esophageal function, identifies the pathology and guides the treatment. The aim of this study was to assess the HRM particularities of diagnosis, clinical features and therapeutic management in patients evaluated for esophageal motor dysfunction. Material and Methods. Our study included all patients suspected of esophageal motility disorders, admitted in our tertiary referral center in North-Eastern Romania between July 2022 and March 2023. Demographic, clinical and laboratory characteristics were carefully collected from the patients' medical charts. All patients were investigated by upper digestive endoscopy and barium esophagogram prior to HRM. Patients diagnosed with eosinophilic esophagitis were excluded from the study. An ISOLAB HR® system from Standard Instruments, with a 36-pressure channels solid-state catheter was used. The HRM diagnosis of esophageal motor diseases was established based on Chicago 4 protocol and classification. Results. Out of the 38 patients included in the study, 15 (39.5%) were female and 23 (60.5%) male, with a mean age of 61.2±11.9. Regarding clinical features, the majority of patients presented with dysphagia (80.4%). Seven (18.4%) patients associated significant weight loss and 6 (15.8%) reported non-cardiac chest pain. Esophageal motility disorders were found in 29 patients (76.3%), 9 patients (23.6%) having a normal HRM aspect. Achalasia was identified in 15 patients (39.5%), with type I in 3 patients (7.9%), type II in 7 patients (18.4%) and type III in 5 patients (13.2%). Distal esophageal spasm was found in 4 patients (10.5%), hypercontractile esophagus in 2 patients (5.3%), esophagogastric junction outflow obstruction (EGJOO) in 2 patients (5.3%), ineffective esophageal motility in 1 patient (2.6%), absent contractility in 4 patients (10.5%) and dyshagia lusoria was identified in only one patient (2.6%). Regarding therapeutic management, endoscopic dilation was performed in 10 patients (26.3%) and 3 patients (7.8%) were referred to surgery. Conclusion. Esophageal HRM remains an important tool for assessing esophageal motor dysfunction. The esophageal motility disorders still represent a diagnostic and therapeutic challenge in clinical practice. [ABSTRACT FROM AUTHOR]

Gardner syndrome is a neoplasic disease that associates intestinal polyposis and colorectal adenocarcinoma with osteomas and soft tissue tumors determined by germline mutations in the APC gene. The early diagnosis and identification of high-risk individuals are important because patients have a 100% risk of colon cancer. We present the case of a family with Gardner syndrome. Cephalometric, panoramic X-rays and CBCT of the proband and her brother showed multiple osteomas affecting the skull bones, mandible and paranasal sinuses. The detailed family history showed an autosomal dominant transmission with the presence of the disease in the mother and maternal grandfather of the proband. Both had the typical signs of disease and died in the fourth decade of life. Based on these aspects the clinical diagnosis was Gardner syndrome. By gene sequencing, a novel pathogenic variant c.4609dup (p.Thr1537Asnfs*7) in heterozygous status was identified in the APC gene in both siblings. We reviewed literature data concerning the correlation between the localization of mutations in the APC gene and the extracolonic manifestations of familial adenomatous polyposis as well as their importance in early diagnosis and adequate oncological survey of patients and families based on abnormal genomic variants. [ABSTRACT FROM AUTHOR]

The Terahertz's wavelength is located between the microwave and the infrared region of the electromagnetic spectrum. Because it is non-ionizing and non-invasive, Terahertz (THz)-based detection represents a very attractive tool for repeated assessments, patient monitoring, and follow-up. Cancer acts as the second leading cause of death in many regions, and current predictions estimate a continuous increasing trend. Of all types of tumors, digestive cancers represent an important percentage and their incidence is expected to increase more rapidly than other tumor types due to unhealthy lifestyle habits. Because it can precisely differentiate between different types of molecules, depending on water content, the information obtained through THz-based scanning could have several uses in the management of cancer patients and, more importantly, in the early detection of different solid tumors. The purpose of this manuscript is to offer a comprehensive overview of current data available on THz-based detection for digestive cancers. It summarizes the characteristics of THz waves and their interaction with tissues and subsequently presents available THz-based technologies (THz spectroscopy, THz-tomography, and THZ-endoscope) and their potential for future clinical use. The third part of the review is focused on highlighting current in vitro and in vivo research progress in the field, for identifying specific digestive cancers known as oral, esophageal, gastric, colonic, hepatic, and pancreatic tumors. [ABSTRACT FROM AUTHOR]