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BACKGROUND AND AIMS: THERE HAVE BEEN DESCRIBED INCREASED MUCOSAL DENSITIES OF SEROTONIN POSITIVE NEUROENDOCRINE CELLS IN INFLAMMATORY BOWEL DISEASE (IBD). THE AIM OF OUR STUDY IS TO DETERMINE THE SEROTONIN POSITIVE NEUROENDOCRINE CELLS DENSITIES IN COLONIC MUCOSA OF PATIENTS WITH IBD. METHODS: COLONIC BIOPSIES FROM 18 PATIENTS WITH IBD (8 ULCERATIVE COLITIS, 10 CHRON'S DISEASE) AND 16 HEALTHY CONTROLS WERE EVALUATED HISTOPATOLOGIC WITH HEMATOXYLINEOSIN AND IMMUNOHISTOCHEMICAL WITH SEROTONIN ANTIBODIES. RESULTS: NE CELLS POSITIVE FOR 5-HT WERE COUNTED ON A TOTAL MEDIAN NUMBER OF 20.7 (1,80) CRYPTS IN IBD GROUP AND 25.65(2,64) CRYPTS IN CONTROLS. THE TOTAL DENSITIES/SUBJECT OF 5-HT POSITIVE CELLS WERE SIGNIFICANTLY HIGHER IN IBD GROUP COMPARED TO CONTROLS: 0.56(0.11,1.87) FOR IBD GROUP AND 0.28(0.14,0.71) FOR CONTROLS, P=0.004. CONCLUSION: OUR STUDY SHOWED AN INCREASED DENSITY OF SEROTONIN POSITIVE NEUROENDOCRINE CELLS IN IBD COLITIS WHEN COMPARED TO HEALTHY CONTROLS. [ABSTRACT FROM AUTHOR]

BACKGROUND AND AIMS: SEVERAL PUBLISHED STUDIES ON HUMAN AND ANIMAL MODELS SHOWED INCREASED DENSITIES OF NEUROENDOCRINE CELLS (NE)CELLS IN COLONIC MUCOSA OF INFLAMMATORY BOWEL DISEASE (IBD) COLITIS. THE AIM OF OUR STUDY IS TO DETERMINE THE (NE) CELLS DENSITIES IN COLONIC MUCOSA OF PATIENTS WITH (IBD). METHODS: COLONIC BIOPSIES FROM 18 PATIENTS WITH IBD (8 ULCERATIVE COLITIS, 10 CHRON'S DISEASE) AND 16 HEALTHY CONTROLS WERE EVALUATED HISTOPATOLOGIC WITH HEMATOXYLINEOSIN AND IMMUNOHISTOCHEMICAL WITH CHROMOGRANIN A (CGA) AND SYNAPTOHYSIN(SYN) ANTIBODIES. RESULTS: NE CELLS WERE COUNTED ON A TOTAL MEDIAN NUMBER OF 24.1(7,56) CRYPTS FOR CGA, 24(5,57) FOR SYN IN IBD GROUP AND 29 (11,64) CRYPTS FOR CGA AND 29,2(11.52) CRYPTS FOR SYN IN CONTROLS. THE TOTAL DENSITIES/SUBJECT OF NE CELLS WERE SIGNIFICANTLY HIGHER IN IBD GROUP COMPARED TO CONTROLS FOR BOTH CGA AND SYN: 1.45(0.72,2.78) AND 0.86(0.43,1.73) FOR CGA (P= 0,006), 0.89(0.22,1.63) AND 0.63(0.28,1.28) FOR SYN (P=0,025). CONCLUSIONS: OUR STUDY SHOWED AN INCREASED DENSITY OF CGA AND SYN POSITIVE NEC IN PATIENTS WITH IBD. [ABSTRACT FROM AUTHOR]

Background: Esophageal xanthoma is a very rare lesion which can be incidentally discovered during endoscopy. Only eleven cases have been reported, including ours. Case reports: We present two new cases of esophageal xanthoma localized in the lower esophagus in a 56-year-old woman and a 62-year-old man. Endoscopically, esophageal xanthoma appears as yellowish granular spots or a slightly elevated lesion. Microscopically, it consists of fat accumulation in foamy histiocytes beneath the squamous epithelium. Conclusions: The clinical and pathological importance of these lesions and what they mean in patients is discussed, along with a review of the literature. [ABSTRACT FROM AUTHOR]

Background: Clinical presentation in microscopic colitis (MC) is similar in many cases to that of diarrhea-predominent irritable bowel syndrome (IBS-D). The proper differential diagnosis requires total colonoscopy with multiple biopsies from normal-appearing mucosa and a detailed histopathological exam. Specific treatment may improve symptomatology. Aim: To evaluate the prevalence of MC in patients with an initial diagnosis of IBS-D, to analyse demographic and clinical features of MC patients and to assess the efficacy of specific treatment. Material and methods: Our retrospective study analyzed patients diagnosed with microscopic colitis in clinic during a three-year period. Diagnosis was established on histological exams of the samples obtained during colonoscopy in patients previously thought to have IBS-D. We evaluated clinical manifestations, time lapsed from their onset to definitive diagnosis, the association of MC with autoimmune diseases or with prior medication and the efficacy of treatment with budesonide or mesalazine. Results: From 247 patients considered to have IBS-D, 15 patients (6.07%) had actually MC (13 lymphocytic colitis and 2 collagenous colitis). MC was associated with nonsteroidal antiinflammatory drugs (3 patients), Lansoprazole (2 patients) and autoimmune diseases (6 patients). Watery, non-bloody diarrhea was present in all patients with MC. Other frequent complaints were nocturnal diarrhea (11 patients), abdominal pain (8 patients), abdominal bloating and flatulence (8 patients) and slight weight loss (6 patients). The diagnostic samples were obtained from the right colon in 6 cases and from rectosigmoid or transverse colon in 9 patients. Treatment was initial symptomatic in all patients, but there were 5 patients that required mesalazine and/or Budesonide, with favourable outcome. Conclusions: All the patients thought to have diarrhea-irritable bowel syndrome should be evaluated for microscopic colitis. Symptomatology is almost superimposable, but a few distinct features can be noticed. The proper and early diagnosis and the specific treatment may lead to significant clinical improvement in some difficult cases of the so-called "irritable bowel syndrome". [ABSTRACT FROM AUTHOR]

Squamous cell carcinoma and basal cell carcinoma are two types of neoplasms that rarely affect the perianal region, and their etiology is still a matter for debate. We present the case of a 75 year old patient with a 26 year history of perianal fistula, who presents with purulent and fecal perianal discharge and swelling at this level. Physical examination and anoscopy detected low transsphincteric fistula. The biopsy revealed the diagnosis of squamous cell carcinoma, for which a local excision was performed followed by adjuvant radiotherapy. Two years after this event, the patient presented with another perianal lession, which according to the histopathological result was a basal cell carcinoma; local excision was the only treatment performed for this malignancy. [ABSTRACT FROM AUTHOR]

Objectives: The aims of the present study are: assessing the frequency of lesions in the upper digestive tract in inflammatory bowel diseases, endoscopic and histological characterization of these lesions and revealing their significance in the evolution of patients with inflammatory bowel disease. Methodology: We realized a retrospective study that included 52 patients hospitalized in the Fundeni Gastroenterology and Hepatology Department between 2009-2012, diagnosed with Crohn's disease and respectively ulcerative colitis, in which upper gastrointestinal endoscopy was performed. For statistical analysis we used Fisher's exact test and Mann-Whitney. Results: 19.23 % of ulcerative colitis patients had duodenal lesions and 15.26 % gastric lesions. In Crohn's disease we found gastric lesions in 23.08% of the cases and duodenal lesions in 15.38 %, the only types of histological lesions described being focal gastritis and focal duodenitis. In ulcerative colitis there were present three types of lesions: focal gastritis 11,53%, diffuse gastritis 3,84% and diffuse duodenitis 19,23%. Conclusions: Upper digestive tract impairement is present both in Crohn's disease and ulcerative colitis, and correlates with extended forms: ileocolonic localization in Crohn's Disease (p=0,001) and pancolitis in ulcerative colitis (p=0,003) and with severe flairs of activity in both inflammatory bowel diseases (p=0,03). [ABSTRACT FROM AUTHOR]

Background & Aims: Evaluation of severity and extension of gastric atrophy and intestinal metaplasia is recommended to identify subjects with a high risk for gastric cancer. The inter-observer agreement for the assessment of gastric atrophy is reported to be low. The aim of the study was to evaluate the inter-observer agreement for the assessment of severity and extension of gastric atrophy using oriented and unoriented gastric biopsy samples. Furthermore, the quality of biopsy specimens in oriented and unoriented samples was analyzed. Methods: A total of 35 subjects with dyspeptic symptoms addressed for gastrointestinal endoscopy that agreed to enter the study were prospectively enrolled. The OLGA/OLGIM gastric biopsies protocol was used. From each subject two sets of biopsies were obtained (four from the antrum, two oriented and two unoriented, two from the gastric incisure, one oriented and one unoriented, four from the gastric body, two oriented and two unoriented). The orientation of the biopsy samples was completed using nitrocellulose filters (Endokit®, BioOptica, Milan, Italy). The samples were blindly examined by two experienced pathologists. Inter-observer agreement was evaluated using kappa statistic for inter-rater agreement. The quality of histopathology specimens taking into account the identification of lamina propria was analyzed in oriented vs. unoriented samples. The samples with detectable lamina propria mucosae were defined as good quality specimens. Categorical data was analyzed using chi-square test and a two-sided p value <0.05 was considered statistically significant. Results: A total of 350 biopsy samples were analyzed (175 oriented / 175 unoriented). The kappa index values for oriented/unoriented OLGA 0/I/II/III and IV stages have been 0.62/0.13, 0.70/0.20, 0.61/0.06, 0.62/0.46, and 0.77/0.50, respectively. For OLGIM 0/I/II/III stages the kappa index values for oriented/unoriented samples were 0.83/0.83, 0.88/0.89, 0.70/0.88 and 0.83/1, respectively. No case of OLGIM IV stage was found in the present case series. Good quality histopathology specimens were described in 95.43% of the oriented biopsy samples, and in 89.14% of the unoriented biopsy samples, respectively (p=0.0275). Conclusion: The orientation of gastric biopsies specimens improves the inter-observer agreement for the assessment of gastric atrophy. [ABSTRACT FROM AUTHOR]

Introduction. Celiac disease (CD) malabsorption may provoke various extraintestinal features like neurological disorders with a powerful impact on the patient's life. Gluten enteropathy diagnosis may be delayed and therewith the cancer risk may increase. Case presentation. A 35-year old epileptic male patient was admitted with newly onset abdominal pain, vomiting, jaundice and weight loss. The abdominal ultrasonography (US) showed ductal criteria for chronic pancreatitis (CP): irregular duct contour, visible side branches, hyperechoic duct margins and dilated main duct. Besides hepatic cholestasis and cytolysis, the blood tests showed significant lipase elevation, suggesting acute pancreatitis (AP). The upper digestive endoscopy using the side-viewing endoscope revealed the loss of duodenal folds with scalloping appearance. Advancing towards the second part of the duodenum this aspect became more irregular with an infiltrative and stenosing appearance. The biopsies showed poorly differentiated duodenal adenocarcinoma with diffuse areas of signet ring cells, respectively marked villous atrophy: Corazza-Villanacci grade B2. The tTGA were positive at high titer, same as HLA DQ2. Cephalic pancreaticoduodenectomy was performed, with clear resection margins - G3, pT3N0M0. Following surgery, besides the jaundice remission, the patient's neurological status considerably improved under optimized treatment and gluten free diet (GFD). At 6 months follow-up there were no signs of tumor residue, the patient gained weight, US revealed no signs of pancreatitis and the seizures bouts were less frequent. Discussions. There is a 60-to 80-fold increased risk of small bowel carcinoma in patients with celiac disease (CD), a long-standing or refractory disease increasing even more the risk of malignancy. In this case the morbidity was higher due to development of acute pancreatitis episodes on CP, caused by the ampular obstruction. Patients with CD have an increased risk of CP and AP, but the strength of these associations as well as the implied mechanisms are not very well clarified. A Swedish retrospective study found that patients with CD had a 3-fold increased risk of developing pancreatitis, with a lower hazard ratio for gallstone related AP comparative with nongallstone related AP. We consider that the association with the neurological disorder might be only incidental since the imaging found no occipital calcifications specific to a seizure syndrome associated with CD. Conclusions. Gluten enteropathy is a complex disease associating multiple extraintestinal symptoms. An early diagnosis with early GFD reduce the risk of small bowel carcinoma and definitely can prevent other extraintestinal manifestations. [ABSTRACT FROM AUTHOR]

The assessment of tissue healing has emerged as an important treatment goal in patients with inflammatory bowel disease. In patients with ulcerative colitis (UC), mucosal healing may represent the ultimate therapeutic goal due to the fact that the inflammation is limited to the mucosal layer. Mucosal and histological healing may indicate a subset of UC patients in long-term clinical, endoscopic and histological remission in whom immunomodulators, biologics, and even aminosalicylates may be withdrawn. Confocal laser endomicroscopy allows the assessment of residual cellular inflammation, crypt and vessel architecture distortion during ongoing endoscopy, and therefore permits a real-time evaluation of histological healing in patients with ulcerative proctitis. Images of conventional optical microscopy and confocal laser endomicroscopy in patients with ulcerative proctitis in remission are presented. [ABSTRACT FROM AUTHOR]

Background: Small nodules (<3 cm) detected on ultrasound (US) in cirrhotics represent the most challenging category for noninvasive diagnosis of hepatocellular carcinoma (HCC). Aim: To evaluate real-time sonoelastography as a noninvasive tool for the diagnosis of small HCC nodules in cirrhotic patients. Methods: 42 cirrhotic patients with 58 nodules (1-3 cm) were evaluated with real-time elastography (Hitachi EUB-6500); the mean intensity of colors red, blue, green were measured using a semi-quantitative method. Analysis of histograms for each color of the sonoelastography images was performed for quantifying the elasticity of nodule tissue in comparison with the cirrhotic liver tissue. AUROC curves were constructed to define the best cut-off points to distinguish malignant features of the nodules. Univariate and multivariate logistic regression analysis was performed. Results: 595 sonoelastography images from 42 patients (25 men; 17 women) were analyzed. The mean age was 56.4±10.7 years and 69% patients were in Child-Pugh class A, 19% class B, 11% class C. For the mean intensity of green color AUROC=0.81, a cut-off value of <108.7 being diagnostic for HCC with a Sp=91.1%, Se=50%, PPV=92.1%, NPV=47.1%. Mean intensity of blue color proved to be an excellent diagnostic tool for HCC (AUROC=0.94); for a cut-off value>128.9, Sp=92.2%, Se=78.9%, PPV=95.4%, NPV=68%. Independent predictive factors of HCC for a small nodule in cirrhotic patients were: blue color>128.9 at sonoelastography and hypervascular appearance at Doppler US. Conclusions: US elastography is a promising method for the non-invasive diagnosis of early HCC. Blue color at elastography and hypervascular aspects are independent predictors of HCC. [ABSTRACT FROM AUTHOR]

Most of the studies showed that IBD patients inflammatory bowel diseases (IBD) with CDI have more of the whole range of short- and long-term worst outcomes than those without CDI. Initial infection with the BI/NAP1/027 epidemic clone was found to be a significant risk factor for relapse. However, current literature is suggesting increasingly that for patients with infections that fail to resolve with traditional antibiotic regimens, FMAT's average cure rate of >90%. We report a case of a 40-year-old man, diagnosed with ulcerative colitis (UC) in 2012 who presented in our clinic for 20 watery stools per day with mucus and blood, hypogastric pain, pyrexia and chills. Rectosigmoidoscopy and histopathological examination diagnosed a ctive lesions of ulcerative colitis with Clostridium difficile toxins A/B enzyme immunoassays (EIA) testing initially negative. The patient was non-responder at day 10 of intravenous (iv) corticotherapy and received induction therapy with Infliximab 5 mg/kg. EIA testing for Clostridium difficile was repeated at day 12 of hospitalization with positive results for toxins A/B, and associated oral therapy with Vancomycin and Metronidazole was initiated without clinical response in day 7, reasons for what intravenously therapy with Tigecycline was started with good response. Patient was discharged after 10 days of Tigecycline, but came back twice for two relapses of Clostridium difficile colitis treated successfully with Tigecycline, reasons for what fecal transplantation was performed in Matei Bals Institute, which induced remission of both CDI and UC.

Aim: To evaluate the efficiency of the treatment with Peginterferon alfa 2a 180 mcg/week, 48 weeks in patients with chronic hepatitis or compensated liver cirrhosis HDV and predictive factors of response to treatment., Material and Methods: Prospective study that enrolled 50 patients with chronic hepatitis or compensated cirrhosis HDV between the 1st of January 2011 - 3st of December 2011. The diagnosis of chronic HDV infection was made based on the presence of detectable anti HDV IgG antibodies and HDV-RNA. Patients were evaluated at baseline by CBC, liver function tests, HBV profile, HDV RNA, and by liver biopsy/Fibrotest for evaluating fibrosis and necroinflammatory activity. At 24 weeks CBC (count blood cells), liver function tests, quantitative HBsAg and at 48 and 72 weeks biochemical tests, HDV RNA, HBV DNA, quantitative HBsAg, were performed. Adverse reactions to the treatment were recorded., Results: SVR (sustained virologic response) was recorded in 12 patients (24%) and biochemical response in 28 patients (56%). SVR was correlated with low-grade fibrosis, age, the aminotransferase value and the value of HBsAg at the beginning of the treatment. In week 48 HDV RNA was undetectable in 20 patients (40%). The therapy was well tolerated, except two patients for whom the discontinuation of the treatment was decided for severe exacerbation of cytolysis, respectively hepatic decompensation., Conclusions: In a representative group of patients, the treatment with Peginterferon once again proves its efficacy in treating chronic HDV.

Background: Clinical presentation in microscopic colitis (MC) is similar in many cases to that of diarrhea-predominent irritable bowel syndrome (IBS-D). The proper differential diagnosis requires total colonoscopy with multiple biopsies from normal-appearing mucosa and a detailed histopathological exam. Specific treatment may improve symptomatology., Aim: To evaluate the prevalence of MC in patients with an initial diagnosis of IBS-D, to analyse demographic and clinical features of MC patients and to assess the efficacy of specific treatment., Material and Methods: Our retrospective study analyzed patients diagnosed with microscopic colitis in clinic during a three-year period. Diagnosis was established on histological exams of the samples obtained during colonoscopy in patients previously thought to have IBS-D. We evaluated clinical manifestations, time lapsed from their onset to definitive diagnosis, the association of MC with autoimmune diseases or with prior medication and the efficacy of treatment with budesonide or mesalazine., Results: From 247 patients considered to have IBS-D, 15 patients (6.07%) had actually MC (13 lymphocytic colitis and 2 collagenous colitis). MC was associated with nonsteroidal antiinflammatory drugs (3 patients), Lansoprazole (2 patients) and autoimmune diseases (6 patients). Watery, non-bloody diarrhea was present in all patients with MC. Other frequent complaints were nocturnal diarrhea (11 patients), abdominal pain (8 patients), abdominal bloating and flatulence (8 patients) and slight weight loss (6 patients). The diagnostic samples were obtained from the right colon in 6 cases and from rectosigmoid or transverse colon in 9 patients. Treatment was initial symptomatic in all patients, but there were 5 patients that required mesalazine and/or Budesonide, with favourable outcome., Conclusions: All the patients thought to have diarrhea-irritable bowel syndrome should be evaluated for microscopic colitis. Symptomatology is almost superimposable, but a few distinct features can be noticed. The proper and early diagnosis and the specific treatment may lead to significant clinical improvement in some difficult cases of the so-called "irritable bowel syndrome".

Introduction: Confocal LASER endomicroscopy (CLE) is a newly developed endoscopic technique which allows subsurface in vivo histological assessment during ongoing endoscopy and targeted biopsies. Ultrasound endoscopy (EUS) is a useful tool in staging upper GI malignant lesions. We describe for the first time the use of both techniques during the same endoscopic session, in a pilot study, in order to increase the diagnostic yield of histological assessment and provide the staging of the gastric neoplastic lesions thus decreasing the time to therapeutic decision., Aims & Methods: CLE has been performed with the Pentax EG-3870CIK confocal endomicroscope after a 5 ml intravenous 10% fluorescein injection; EUS has been performed subsequently, during the same endoscopic Propofol sedation session, using a standard radial EUS-scope., Results: Eleven patients have been investigated, 4 females, 7 males, mean age 59.7 +/- 12.3 years. The indication of CLE/EUS exploration was the presence of a gastric polypoid lesion in 37% of cases, atypical gastric ulcer in 27% of patients, gastric lymphoma 18%, suspicion of gastric cancer recurrence after resection 9% and infiltrating type gastric cancer 9%. Histological assessment after targeted biopsy has established the diagnosis of gastric adenocarcinoma in 55% of cases, gastric lymphoma in 18% of cases, gastric adenoma, gastric GIST and gastric foveolar hyperplasia in 9% of cases respectively. CLE has allowed targeted biopsies in 81.8% of cases. In 2 patients - one case with suspected recurrent gastric cancer after surgery and one case of gastric lymphoma, CLE has indicated normal gastric mucosa. The EUS evaluation has shown TO lesion in two cases, T1 in 3 cases, T2 in 3 cases, T3 in one case. The EUS evaluation showed in one gastric lymphoma patient a lesion interesting the mucosa and submucosa with regional adenopathy and a submucosal lesion with regional adenopathy in the other gastric lymphoma case. The therapeutic decision was surgery in 73% of cases, chemotherapy and follow-up in 18% of cases and follow-up in 9% of cases. No complications were registered during the CLE/EUS explorations., Conclusion: CLE and EUS can be successfully associated during the same endoscopic session, for upper GI neoplastic lesions allowing targeted biopsies for histological assessment and disease staging for optimal therapeutic decision.