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Background/Aims: Disruptions in tight junction (TJ) protein expression leading to duodenal epithelial barrier impairment may contribute to increased intestinal permeability, potentially playing a role in functional dyspepsia (FD) pathophysiology. Currently published studies evaluated the role of several TJ proteins in FD patients with inconsistent results. Therefore, we conducted this systematic review and metaanalysis to evaluate the duodenal mucosal expression of several TJ proteins in FD. Methods: We performed a systematic electronic search on PubMed, EMBASE, and Scopus using predefined keywords. Diagnosis of FD by Rome III or Rome IV criteria was considered acceptable. Full articles satisfying our inclusion and exclusion criteria were included. The principal summary outcome was the mean difference of several TJ proteins in FD patients and control subjects. Results: A total of 8 and 5 studies were included in our qualitative and quantitative synthesis, respectively, with a total population of 666 participants, out of which 420 were FD patients. No significant differences were observed between FD patients and controls in the expression of claudin-1 (-0.102 [95% CI, -0.303, 0.099]), claudin-2 (0.161 [95% CI, -0.134, 0.456)], claudin-3 (0.278 [95% CI, -0.280, 0.837]), claudin-4 (0.045 [95% CI, -0.264, 0.354]), ZO-1 (-0.221 [95% CI, -0.683, 0.241]), ZO-2 (-0.070 [95% CI, -0.147, 0.007]), ZO-3 (-0.129 [95% CI, -0.376, 0.118]), ß-catenin (-0.135 [95% CI, -0.484, 0.214]), E-cadherin (-0.083 [95% CI, -0.229, 0.063]), and occludin (-0.158 [95% CI, -0.409, 0.093]). Conclusions: The expressions of all evaluated proteins including claudin-1, claudin-2, claudin-3, claudin-4, ZO-1, ZO-2, ZO-3, ß-catenin, E-cadherin, and occludin did not significantly differ between FD patients and controls. However, due to the limited number of included studies, results should be interpreted with caution. [ABSTRACT FROM AUTHOR]

The initial clinical manifestation of acute mesenteric ischemia poses a diagnostic challenge, often leading to delays in identification and subsequent surgical intervention, contributing to adverse outcomes. Serum biomarkers, offering insights into the underlying pathophysiology, hold promise as prognostic indicators for acute mesenteric ischemia. This systematic review comprehensively explores the role of blood biomarkers in predicting clinical outcomes during follow-up for patients with mesenteric ischemia. A thorough literature search across the PubMed, Cochrane Library, and EMBASE databases yielded 33 relevant publications investigating the efficacy of serum biomarkers in predicting outcomes for mesenteric ischemia. Numerous studies underscore the utility of blood biomarkers in swiftly and accurately differentiating between causes of mesenteric ischemia, facilitating a prompt diagnosis. Elevated levels of specific biomarkers, particularly D-dimers, consistently correlate with heightened mortality risk and poorer clinical outcomes. While certain serum indicators exhibit substantial potential in associating with mesenteric ischemia, further research through rigorous human trials is imperative to enhance their consistent predictive ability during the follow-up period. This study underscores the diagnostic and prognostic significance of specific biomarkers for mesenteric ischemia, emphasizing the necessity for standardized procedures in future investigations. [ABSTRACT FROM AUTHOR]

Currently being the seventh most prevalent form of cancer worldwide, and the fifth most common cause of cancer-related death, based on GLOBOCAN 2020 data, gastric cancer is still an important public health problem, despite its dropping incidence. Regions around the world are still at high-risk, mostly in populations with a high prevalence of Helicobacter pylori infection or a carcinogenic favorable diet. Gastric cardia cancer incidence is on the rise in some areas. Great steps were made in the last decades in understanding the pathogenesis of gastric cancer and its risk factors. Host genetic polymorphisms play a quintessential role in disease outcome. Helicobacter pylori eradication and endoscopic surveillance are the most effective options to further decrease gastric cancer incidence. Surgery is required for a curative treatment in most cases. This review summarizes the latest worldwide epidemiological data of gastric cancer and aims to provide an accessible and credible source of evidence for physicians who assess risk factors for gastric cancer. [ABSTRACT FROM AUTHOR]

Functional dyspepsia (FD), a widespread and debilitating digestive disease, is thought to originate from disrupted gut-brain communication. The cause of FD is not completely understood, but recent evidence suggests it could be due to multiple factors and can vary among different patient groups. Factors like gut motility changes, increased sensitivity to pain in the gut, ongoing low-level inflammation, and increased gut permeability have all been linked to the development of FD. Additionally, changes in the gut microbiome have been suggested to play a significant role in the disease. The gut microbiota in the duodenum could either be a cause or a result of the immune and nervous system issues seen in FD, but the ways in which the gut flora in the small intestine affects gut function, digestive metabolites and symptoms are not yet clear, more studies being needed in order to completely assess the relationship between gastrointestinal microbiota and development and progression of FD. This review summarizes the available research on the relationship between FD and the microbiota and examines the various treatments, including probiotics, that have been shown to relieve symptoms. Finally, suggestions for improving diagnosis and treatment for those with FD are presented. [ABSTRACT FROM AUTHOR]

Background & Aims: Focal liver lesions (FLLs) are defined as abnormal solid or liquid masses differentiated from normal liver, frequently being clinically asymptomatic. The aim of this systematic review is to provide a comprehensive overview of current artificial intelligence (AI) applications, deep learning systems and convolutional neural networks, capable of performing a completely automated diagnosis of FLLs. Methods: We searched PubMed, Cochrane Library, EMBASE, and WILEY databases using predefined keywords. Articles were screened for relevant publications about AI applications capable of automated diagnosis of FLLs. The search terms included: (focal liver lesions OR FLLs OR hepatic focal lesions OR liver focal lesions OR liver tumor OR hepatic tumor) AND (artificial intelligence OR machine learning OR neural networks OR deep learning OR automated diagnosis OR ultrasound OR US OR computer scan OR CT OR magnetic resonance imaging OR MRI OR computer-aided diagnosis OR automated computer tomography OR automated magnetic imaging). Results: Our search identified a total of 32 articles analyzing complete automated imagistic diagnosis of FLLs, out of which 14 studies analyzing liver ultrasound images, 8 studies analyzing computer tomography images and 10 studies analyzing images obtained from magnetic resonance imaging. Conclusions: We found significant evidence demonstrating that implementing a complete automated system for FLLs diagnosis using AI-based applications is currently feasible. Various automated AI-based applications have been analyzed. However, there is no clear evidence about the superiority of any of the systems. [ABSTRACT FROM AUTHOR]

(1) Background: Proton pump inhibitors (PPIs) are commonly prescribed for gastric disorders. In patients with liver cirrhosis, PPI use is associated with an increased risk of spontaneous bacterial peritonitis and increased mortality rates; therefore, they should be used with caution. This study aims to evaluate the appropriateness of PPI prescriptions in hospitalized cirrhotic patients against current clinical guidelines to identify patterns of misuse and guide better prescribing practices. (2) Methods: A retrospective study was conducted on liver cirrhosis inpatients in an internal medicine department from January 2022 to May 2023. The primary measure was the proportion of PPI prescriptions aligned with clinical guidelines. Medical files were entirely reviewed by researchers to assess the appropriateness of PPI prescriptions using the current guidelines. Outcomes included the identification of common reasons for PPI prescription and the rate of inappropriate PPI use among the study population. (3) Results: The study included 189 cirrhotic patients, with PPIs prescribed to 95 (50.2%) patients during hospitalization and 75 (39.7%) patients at discharge. Among those, 47.4% of the inpatients and 34.7% at discharge had no valid indication for PPI administration. The most common reason for PPI prescription during hospital stays was gastritis, followed by antiplatelet use in high-risk patients, ulcers, and upper gastrointestinal bleeding. The most common inappropriate indication was portal hypertensive gastropathy (PHG), followed by treatment with corticosteroids and anticoagulants alone. We did not find an association between PPI administration during hospital stays and infections. Only in 4% of cases patients should have received PPIs and did not. (4) Conclusions: There is a concerning overprescription of PPIs in cirrhotic patients, often deviating from established guidelines. It subjects patients to unnecessary risks. There is an urgent need for increased awareness and adherence to clinical guidelines regarding PPI prescriptions in cirrhotic patients. [ABSTRACT FROM AUTHOR]

The irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder (FGID), also called disorders of the gut-brain interaction (DGBI). Over the years, the definition and classification of IBS suffered several conceptual changes. The work of the Rome Committees has largely contributed to the progress in knowledge and awareness of IBS. This paper is an overview of the evolution of diagnosis and classification criteria of IBS. Background: The majority of the complaints causing presentation to the general gastroenterological centers are represented by FGID. IBS is the most frequent among them. IBS is not a uniform condition but includes an array of particular forms called subtypes. Criteria for the identification of the IBS subtypes have suffered several changes in parallel with the accumulation of scientific evidence about this disorder. Classification of IBS subtypes relies on symptoms. Summary: This is a review of the evolution of the criteria for diagnosis and classification of IBS subtypes. Starting with older names given to IBS, some changes in definition and diagnosis have been operated by each edition of the Rome criteria. These changes have led to the better identification of patients with IBS. The management of IBS depends on subtypes and should be individualized. Key Messages: IBS is the main FGID, called also DGBI. It is not a homogenous disorder but a generic name for an array of subtypes with common features but with clinical differences. The diagnosis and classification of IBS subtypes have evolved in time, in accordance with the progress of the knowledge on pathogenesis. It is important for healthcare providers to recognize the subtypes and to use a common nomenclature (that offered by the Rome Committees work). [ABSTRACT FROM AUTHOR]

Background: delayed gastric emptying is detectable in 20-40% of patients with type 1 and type 2 diabetes. The prevalence of symptoms suggestive for diabetic gastroparesis is much lower. The aim of the study was to evaluate the gastric emptying and to correlate the results with dyspeptic symptoms. Methods: we included 55 patients with diabetes mellitus (32F/ 23M; mean age 60.34 ±4.71) and 50 controls (30F/20M; mean age 58.55 ±4.78). Gastric emptying was assessed using gastric emptying scintigraphy (GES). Dyspeptic symptoms were assesed using Gastroparesis Cardinal Symptom Index (GCSI). Results: 49% reported one or more gastrointestinal symptoms from the scale. From these, 55,5% reported fullness and/or early satiety, 29,6% reported bloating, 14,8% reported vomiting or nausea. 31 patients (56,33%) had abnormal gastric emptying on scintigraphy at 2 hr and 24 patients had normal GES. From subgroup with abnormal GES, only 53,33% reported gastrointestinal symptoms previous to the evaluation, and only 3 from the 9 symptoms of the GCSI had a significant correlation with the severity of the gastric emptying. Conclusion: there was a positive but non significant correlation between symptom score in patients with delayed GE compared to patients with normal GE, except correlation between early satiety and delayed GE. [ABSTRACT FROM AUTHOR]

In recent years, in Western countries have accumulated epidemiological and experimental arguments for involvment of negative events caused by physical and sexual abuse in the pathogenesis of irritable bowel syndrome and other functional digestive disorders. There are no data in our area about the involvment of sexual abuse in pathogenesis of IBS. The aim of this study was to look after sexual abuse in women with IBS and the prevalence of IBS in children with physical and sexual abuse. From 125 females investigated only one claim that she had "an undesired sexual contact". From 15 physical or sexual abused children, 7 children (46,6%) meet Rome III criteria for IBS. The prevalence of sexual abuse in romanian women with IBS is under 1%, as opposed to data from the U.S.A and Western Europe - were the prevalence is about 40%. Romanian women did not report sexual abuse history. Prevalence of IBS in abused children is similar to that described in Western literature. [ABSTRACT FROM AUTHOR]

We present the case of a female patient admitted for an abdominal tumoral mass corresponding to large liver metastases. The abdominal ultrasonography detected a solid intestinal tumor. The capsule endoscopy showed a vegetative tumor on the terminal ileum. After intestinal and partial liver resection, the histologic examination identified a neuroendocrine tumor. The patient responded incompletely to standard chemotherapy. In the presence of large hypoechoic liver metastases, a neuroendocrine tumor should be suspected. [ABSTRACT FROM AUTHOR]

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Copyright of Acta Medica Transilvanica is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Cardiovascular symptoms often lead patients to seek medical attention, yet occasionally, such presentations reveal unexpected underlying pathologies. Case Report: We present a case of a 64-year-old patient who initially presented to the general practitioner with dyspnoea and asthenia. The physical examination showed hepatomegaly, with a liver span of 20 cm, and a following cardiology consult disclosed sinusal tachycardia. In this context, the patient was recommended a gastroenterology consult. Further assessment revealed severe hepatomegaly, with a palpable liver up to the level of the left hypochondrium, respectively the right iliac spine, with a liver of hard consistency, and irregular contour with sharp edge, that prompted further exploration. The serological tests showed a moderate microcytic anemia, cholestasys, a very high level of Carcinoembrionar Antigen (CEA) and a negative Fecal Occult Blood Test (FOBT). Liver ultrasonography indicated numerous hypoechoic and hyperechogenic lesions of 1-4 cm in size and undilated intrahepatic bile ducts, suggesting a differential diagnosis of hepatocellular carcinoma or metastasis. A subsequent computed tomography (CT) scan revealed an infiltrative tumor formation in the right hemicolon, near the ileo-cecal valve, with distant adenopathy, peritoneal carcinomatosis and extensive hepatic metastases. Additionally, acute segmental and subsegmental pulmonary thromboembolism was identified. The successive colonoscopy identified the tumor on the ascending colon and the biopsy of the lesions showed moderately differentiated colonic adenocarcinoma. Discussions : The advanced stage of colon cancer was not expected given the patient's mild and non-specific symptoms, including lacking a change in bowel habits or abdominal pain. This case underscores the significance of meticulous evaluation in the face of seemingly unrelated clinical manifestations, presenting the relevance of thorough investigative strategies, as well as broad differential considerations and the importance of the colon cancer screening in the general population. Conclusions: Early recognition and interdisciplinary collaboration are pivotal in optimizing patient outcomes, particularly in cases involving metastatic malignancies, where timely intervention and screening programs can significantly influence disease trajectory and treatment efficacy. [ABSTRACT FROM AUTHOR]

Clostridioides difficile infection (CDI) in clinical practice represents a challenge for its management and also prevention of recurrence. Even though there are updated guidelines for infection prevention, control and treatment, CDI remains a leading cause of healthcare acquired diarrhea with increasing incidence in the community. We present here a synthesis of the most recent international guidelines on the management of CDI. In 2021 updated guidelines on the treatment of CDI in adults were published by the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA), American College of Gastroenterology (ACG) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). These guidelines focused on CDI management in adults, including new data on the clinical efficacy of Fidaxomicin (FDX) and Bezlotoxumab. The 2017 publication of IDSA and SHEA - Clinical Practice Guidelines for Clostridium difficile infection also included pediatric treatment recommendations that are not a part of the 2021 update. Vancomycin (VAN) treatment for an initial CDI episode remains an acceptable alternative to FDX, considering the monetary and logistical challenge of acquiring FDX. There is growing literature on fecal microbiota transplantation (FMT) and the 2021 guidelines describe its role in severe complicated refractory CDI cases and for which surgical management is not feasible. Moreover, there are new data on the secondary prophylaxis with VAN in refractory CDI in patients with risk factors who receive broad spectrum antibiotics. [ABSTRACT FROM AUTHOR]

Introduction: Functional dyspepsia is one of the most common functional gastrointestinal diseases, its global prevalence is currently estimated at 7.1%. In Romania, the current prevalence stands at 7.4%. Functional dyspepsia is further divided into epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS). No structural disease that is likely to explain the symptoms is a major criterion for diagnosis. Materials & methods: We aimed to provide updated clinical and epidemiological data on the current status of functional dyspepsia in Romania. We conducted a retrospective study using our tertiary care center's database of 144 patients diagnosed with functional dyspepsia in the Second Medical Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania from January 2021 to April 2023. Results and conclusions: Out of 1368 upper gastrointestinal endoscopies performed in our department between 2021 to 2023, we identified 170 patients with a primary diagnosis of functional dyspepsia admitted in our department that underwent upper endoscopic examination. Twentysix patients were excluded from the final study due to Helicobacter pylori being present in their gastric biopsies. The final study included 144 patients. 16.6 % of patients were men and 83.4% were women. The mean age at admission was 52.5 years, while the distribution of age varied from 25 to 73 years. 69.4% of patients met the criteria for EPS, while 30.6% of them were diagnosed with PDS. The most common endoscopic findings in functional dyspepsia were erythematous gastritis (94;65.2%), normal endoscopy (36;25%), and congestive gastritis (14, 9.7%). Antrum was the most common site affected, in 96 (57%) patients with gastritis. Patients with functional dyspepsia can have associated mild gastrointestinal diseases that do not explain their symptoms. [ABSTRACT FROM AUTHOR]

AGAT deficiency is a rare and treatable autosomal recessive disorder. The symptoms are early-onset developmental mild to moderate intellectual disability, delayed speech acquisition, behavioral problems or proximal muscle weakness. Biochemical screening for creatine, creatinine and urinary guanidinoacetate and genetic tests are used for diagnosis. Electromyography may be normal or may have a myopathic pattern with low amplitude polyphasic waves. Muscle biopsy may show abnormalities including small myocytes. Creatine supplementation can fully prevent the neurological disability, if the treatment is started early in life; the muscular function improves irrespective of the supplementation moment. [ABSTRACT FROM AUTHOR]

Creatine has become the most popular dietary supplement in sport and exercise physiology. In humans creatine is synthesized by the kidneys, pancreas and liver and transported mainly into brain, skeletal and cardiac muscle. Phosphocreatine is a high-energy content molecule, essential for the ADP to ATP conversion during intensive physical activity. Creatine and phosphocreatine are crucial in the energy shuttle system of high-energy phosphates between the mitochondrial ATP production and the cytosolic ATP consumption. Creatine supplementation increases lean body mass acting on myogenic regulatory factors. During muscular recovery, creatine supplementation regulates the regeneration process by reduction of muscle damage-induced inflammation and oxidative stress, activation and proliferation of satellite cells and regulation of calcium transport in muscle. The effects of creatine supplementation on muscle physiology are beneficial in anaerobic/aerobic exercises. In several muscle disorders (muscular dystrophies, in idiopathic inflammatory myopathies) creatine improved functional performance, but apparently not in metabolic myopathies; in McArdle diseases it may even have paradoxical effects. More research is warranted to better understand the short and long-term effects and safety of creatine supplementation among adolescents or elderly, as well as in different types of muscle diseases; for the two enzymatic genetic defects of creatine biosynthesis – arginine:glycine amidinotransferase (AGAT) and guanidinoacetate methyltransferase (GAMT), respectively – normal neurodevelopment has been achieved in early initiation of creatine therapy. [ABSTRACT FROM AUTHOR]

Introduction. Systemic amyloidosis represents the extracellular deposition of amyloid fibrils that can generate heart failure, nephrotic syndrome and hepatomegaly. The diagnosis of amyloidosis can be suggested by the clinical manifestations of the patient, but the diagnostic method is tissue biopsy. Case report. We present the case of a 70-year-old woman with a history of breast cancer that was admitted at the Internal Medicine Department for progressive abdominal distension. At clinical examination the patient presented enlarged abdomen. The laboratory findings showed cholestasis, and proteinuria. The abdominal ultrasound revealed hepatomegaly, splenomegaly and moderate ascites, with no signs of cirrhosis. The peritoneal fluid examination revealed transudate. To investigate the cause of ascites, a viral or autoimmune etiology was excluded by laboratory tests. A computed tomography scan was performed that showed bilateral pleural effusion, retroperitoneal adenopathy and moderate ascites. Considering the malignancy history of the patient, we investigated peritoneal carcinomatosis, or a possible ovarian cancer as a cause for ascites, by evaluating the serum CA 125 that had an elevated level. Next a diagnostic laparoscopy was performed which showed no signs of a malignant disease or cirrhosis. The cardiac etiology of ascites was investigated by echocardiography and magnetic resonance imaging which showed restrictive cardiomyopathy. Considering the clinical, laboratory and imaging findings, the suspicion of amyloidosis was raised and for reaching the diagnosis a rectosigmoidoscopy with biopsy was performed. The histopathologic examination with Congo red stain viewed under polarized light showed amyloid deposits, and urine protein electrophoresis test revealed the presence of free light chain proteins. Discutions. In the differential diagnosis of ascites, amyloidosis is seldom investigated and should be considered in a patient with multiple serous cavity effusion, heart failure and proteinuria. The early exclusion of ovarian cancer as a cause of ascites is important for the treatment management, but serum CA 125 is a non-specific marker that has been shown to increase in patients with ascites and chronic congestive heart failure. In patients with ascites, the rise of CA 125 value might be the product of peritoneal cells when stretched by the ascitic fluid. Conclusion. Systemic amyloidosis with cardiac involvement can generate cardiomyopathy with heart failure. The significant increase of serum CA 125 value indicate a poor prognosis in patients with light chain amyloidosis. Awareness should be raised to relevant clinical manifestations that indicate amyloidosis for the early diagnosis and treatment for the improvement of the prognosis. [ABSTRACT FROM AUTHOR]

Background and Aims: Celiac disease (CD) is an autoimmune disorder that targets the small intestine, triggered by the ingestion of gluten in genetically predisposed individuals, causing damage to the villi and impairing nutrient absorption. Despite increased awareness and improved diagnostic techniques, CD remains significantly underdiagnosed, with many individuals suffering from unexplained symptoms or misdiagnosed conditions. This study aims to investigate the prevalence and demographic characteristics of CD in a Romanian population using rapid diagnostic tests followed by histological confirmation., Methods: This cross-sectional study aimed to determine the prevalence of CD in Romania using the BIOHIT Celiac Quick Test among adult participants recruited from tertiary healthcare centers and medical institutions. The prevalence of CD was calculated by dividing the number of confirmed positive cases by the total number of participants, with further evaluation including endoscopy and histological examination for those with positive quick test results. To our knowledge, this is the first prospective study in Romania to assess the prevalence of CD using a serological test., Results: Out of 713 participants from Romania, 9 tested positive for CD using a rapid diagnostic test, confirmed by histological examination, resulting in a prevalence rate of 1.26%. The mean age of the CD-positive group was significantly younger (30.3 years) compared to the general population (49.2 years), and they had a lower mean BMI (22.2 vs. 28.1). Most CD-positive patients were female (66.7%) and resided in urban areas (55.6%)., Conclusions: Our study found the prevalence of CD in a Romanian population to be slightly higher than the global average, highlighting the effectiveness of rapid diagnostic tests followed by histological confirmation. The significant regional variability in CD prevalence suggests the need for further research into environmental, dietary, and genetic factors, along with enhanced awareness and improved diagnostic protocols to better manage and prevent long-term complications of CD.

Non-alcoholic fatty liver disease (NAFLD) is characterized by an accumulation of hepatic fat, diagnosed histologically or radiologically (ultrasound), in the absence of a secondary cause of steatosis, especially alcohol consumption. Its prevalence is estimated to be approximately 25%. This high prevalence is correlated with the risk factors attributed to the metabolic syndrome. Non-alcoholic steatohepatitis (NASH) is a progressive form of NAFL and it can lead to end-stage liver disease in some patients. Once diagnosed, lifestyle changes must be initiated to lower hepatic fat accumulations in the liver. Physical exercise and diet play the most important role in achieving the desired weight loss goal.

Stress is considered a risk factor for the irritable bowel syndrome (IBS). One of the main stress sources is represented by the negative life events and trauma suffered in childhood. Several papers have endorsed the hypothesis that youth submitted to stress are prone to develop IBS. We have undertaken a review of the literature, searching all Pubmed papers pertinent to child abuse and IBS. The data suggest that indeed, children submitted to physical, psychological and sexual abuse are at risk to develop IBS as adults. However, cultural diffferences exist.