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Introduction. There are an inverse association between Helicobacter Pylori (H. pylori) infection and prevalence of IBD [5, 10,11,12]. Also studies have reported an inverse association between H. pylori prevalence and disease severity of IBD [13]. H. pylori is one of the environmental infections causing changes in gut microbiota and immune system dysregulation, which may affect IBD activity. The current study aimed to compare the clinical, laboratory, and histological severity of the newly diagnosed IBD with the presence or absence of H. pylori infection. Methods. This was a retrospective study that included 50 newly diagnosed inflammatory bowel disease patients (30 ulcerative colitis patients and 20 Crohn's disease patients). Diagnosis of IBD was based on both endoscopy/colonoscopy and biopsy. Also, for assesing Disease activity was quatified by CDAI for Crohn disease and UCDAI dor ulcerative colitis. Also, fecal calprotectine was evaluated. The presence of H. pylori was evaluated by the H. pylori stool antigen test (HpSA). Results: The overall positivity of H. pylori infection in patients with IBD was 19.2%. Patients with HpSA had a significantly lower fecal calprotectine (145.57 ± 28.12 vs. 320.57 ± 67.54 (μg/mg); P= 0.02), Mayo score (4.12 ± 1.09 vs. 8.01 ± 1.23; P < 0.001) and CDAI score (112 ± 67 vs. 198 ± 89; P < 0.001) compared to those with negative HpSA. Conclusion. We reported a significantly lower H. pylori infection rate in IBD patients. H. pylori-positive IBD patients have a milder disease with less activity compared to H. pylori-negative IBD patients. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease (IBD) is a chronic disease that affects both young adults and also the elderly. This article emphasises the particularities related to age in the epidemiology, diagnosis, natural course of the disease, prognosis and therapy of adult patients with IBD. Even though the main characteristics in geriatric populations with IBD may not differ much from those in younger patients, distinct problems exist. The majority of IBD studies were performed on young subjects, younger than 40 years of age. The optimal therapeutic choice in young individuals with IBD is a challenge for the physician who needs to take in account the risk of untreated or suboptimally treated chronic intestinal inflammation, long term prognosis, quality of life, the impact of side-effects of aggressive therapeutic approaches, the impact on pregnancy, as well as personal and healthcare costs. The diagnosis in elderly patients can be challenging due to the large number of conditions that mimic IBD. The treatment options are those used in younger patients, but a series of considerations related to potential pharmacological interactions and side effects of the drugs must be taken in account. The risks associated with the use of some IBD medications may be increased in older patients, but so is the risk of under-treated IBD and surgery. [ABSTRACT FROM AUTHOR]

Inflammatory bowel diseases (IBDs) affect over 4.9 million individuals worldwide. Colonoscopy (CS) is the gold-standard technique for diagnosis. The remissive–recurrent pattern of evolution raises the need for non-invasive techniques to monitor disease activity. This review aims to present the advantages of intestinal ultrasound (IUS) in managing IBDs. Our search was conducted on the PubMed, Embase, and Cochrane (CENTRAL) databases, selecting original studies comparing IUS with other imaging and invasive monitoring methods. Our search yielded 8654 results, of which 107 met the inclusion criteria. Increased bowel wall thickness (BWT) and colour Doppler signal (CDS) are discriminative for disease activity. IUS can predict disease outcomes and detect response to treatment or postoperative recurrence. Contrast-enhanced ultrasound (CEUS) and elastography help differentiate fibrotic from inflammatory stenoses. The difficult rectal assessment limits the use of IUS in ulcerative colitis (UC). Transmural healing may develop as a therapeutic target as it is associated with better outcomes. Patients are compliant with this technique, and its results correlate well with CS and other imaging methods. In conclusion, IUS proves to be essential in assessing IBD activity and treatment response, predicting outcomes and detecting complications. CEUS and elastography are researched to improve the diagnostic values of IUS. [ABSTRACT FROM AUTHOR]

Background & Aims: The burnout syndrome (BOS) is commonly seen in healthcare professionals, particularly in physicians who are exposed to a high level of stress at work and has a negative impact on the medical activity. Physicians with BOS manifest a negative attitude, a reduction in compassion at work, and suboptimal patient care experiences. These all can lead to absenteeism, poor performance and more frequent medical errors. We aimed to assess the level of BOS in a tertiary gastroenterology university center in Romania. Methods: This observational study involved 40 physicians from a tertiary gastroenterology university center. An online questionnaire assessed the presence of BOS using the Maslach Burnout Inventory. Results: A total of 40 physicians responded to the questionnaire. The prevalence of overall BOS of 87.5%. In terms of high burnout, 15 doctors (37.5%) had emotional exhaustion, 10 doctors (25%) had depersonalization, and 30 doctors (80%) scored low for personal achievement. Men presented more frequently emotional exhaustion and women lower personal achievement scores, but there was no significant statistical difference. No significant relationship was found between marital status or the number of children and BOS. We identified multiple risk factors associated to BOS, the most important one being strict internal regulations. Conclusions: Physicians presented an increased risk for BOS. The high rate of BOS among physicians found in our study requires careful attention. Further studies aiming to identify other factors that contribute to BOS and to identify measures to combat this syndrome are necessary. [ABSTRACT FROM AUTHOR]

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

Background & Aims: The burnout syndrome (BOS) is commonly seen in healthcare professionals, particularly in physicians who are exposed to a high level of stress at work and has a negative impact on the medical activity. Physicians with BOS manifest a negative attitude, a reduction in compassion at work, and suboptimal patient care experiences. These all can lead to absenteeism, poor performance and more frequent medical errors. We aimed to assess the level of BOS in a tertiary gastroenterology university center in Romania. Methods: This observational study involved 40 physicians from a tertiary gastroenterology university center. An online questionnaire assessed the presence of BOS using the Maslach Burnout Inventory. Results: A total of 40 physicians responded to the questionnaire. The prevalence of overall BOS of 87.5%. In terms of high burnout, 15 doctors (37.5%) had emotional exhaustion, 10 doctors (25%) had depersonalization, and 30 doctors (80%) scored low for personal achievement. Men presented more frequently emotional exhaustion and women lower personal achievement scores, but there was no significant statistical difference. No significant relationship was found between marital status or the number of children and BOS. We identified multiple risk factors associated to BOS, the most important one being strict internal regulations. Conclusions: Physicians presented an increased risk for BOS. The high rate of BOS among physicians found in our study requires careful attention. Further studies aiming to identify other factors that contribute to BOS and to identify measures to combat this syndrome are necessary. [ABSTRACT FROM AUTHOR]

Ixekizumab is one of the three biologic agents including Secukinumab and Brodalumab that targets the Interleukin-17 (IL-17) pathway to reduce inflammation in psoriasis and ankylosing spondylitis. In this report we present the case of 42-year-old woman, who was diagnosed with psoriasis and psoriatic arthritis. One week after first administration of Ixekizumab, she developed diffuse abdominal pain, bloody diarrhea (7-8 stools/day) and fever. Following imaging (colonoscopy, computed tomography) and laboratory investigations, she was diagnosed with acute severe ulcerative colitis complicated with toxic megacolon. The medical treatment (first corticotherapy, then infliximab) has failed and the patient needed emergency colectomy. Based on the immunological mechanisms and the observation from other studies, Ixekizumab should be considered an etiology for new-onset inflammatory bowel disease. [ABSTRACT FROM AUTHOR]

According to new research, a possible association between inflammatory bowel disease (IBD) and an increased risk of ischemic heart disease (IHD) has been demonstrated, but this concern is still debatable. The purpose of this review is to investigate the link between IHD and IBD, as well as identify further research pathways that could help develop clinical recommendations for the management of IHD risk in IBD patients. There is growing evidence suggesting that disruption of the intestinal mucosal barrier in IBD is associated with the translocation of microbial lipopolysaccharides (LPS) and other endotoxins into the bloodstream, which might induce a pro-inflammatory cytokines response that can lead to endothelial dysfunction, atherosclerosis and acute cardiovascular events. Therefore, it is considered that the long-term inflammation process in IBD patients, similar to other chronic inflammatory diseases, may lead to IHD risk. The main cardiovascular risk factors, including high blood pressure, dyslipidemia, diabetes, smoking, and obesity, should be checked in all patients with IBD, and followed by strategies to reduce and manage early aggression. IBD activity is an important risk factor for acute cardiovascular events, and optimizing therapy for IBD patients should be followed as recommended in current guidelines, especially during active flares. Large long-term prospective studies, new biomarkers and scores are warranted to an optimal management of IHD risk in IBD patients. [ABSTRACT FROM AUTHOR]

Introduction/Aim. The aim of this study was to assess the prevalence of cognitive impairments and their association with sleep patterns in a cohort of patients diagnosed with chronic liver disease (CLD). Material and methods. The present paper is a prospective cohort study, carried out over a period of 12 months, among patients with various stages of CLD. We evaluated the cognitive function through psychometric hepatic encephalopathy score (PHES), while sleep was assessed by actigraphy and two self-reported questionnaires: Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). Results. Seventy-four patients with CLD were considered eligible and were enrolled between December 2020–November 2021. The prevalence of minimal hepatic encephalopathy (MHE) in the entire cohort was 41.9%, and the diagnosis was considered for PHES scores ≤ −3. Patients with cirrhosis recorded significantly lower PHES scores compared to patients with other CLDs but without cirrhosis (−3.19 ± 3.89 vs. 0.19 ± 2.92, p < 0.05). Patients who exhibited MHE suffered from poor sleep, daytime somnolence, disturbed nighttime sleep, and low overall sleep efficacy. Patients diagnosed with MHE and undergoing treatment with lactulose and/or rifaximin for prevention of overt hepatic encephalopathy (HE) showed better results in terms of sleep parameters compared to patients diagnosed with MHE but without treatment. Conclusions. This research increases awareness regarding the connection between sleep features and MHE in patients with cirrhosis and other CLDs. A deeper insight into the subclinical stages of HE and associated sleep disturbances is warranted in future studies. [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.

Colonoscopy is the "gold" standard for evaluating disease activity in ulcerative colitis (UC). An important area of research is finding a cost-efficient, non-invasive solution for estimating disease activity. We aimed to develop and validate a neural network (NN) model that uses routinely available clinical–biological variables to predict UC activity. Standard clinical–biological parameters and endoscopic Mayo score from 386 UC patient records were collected. A training set (n = 285), a test set (n = 71) and a validation set (n=30) were used for constructing and validating three NN models. The first two models predicted the active/inactive endoscopic disease status through a binary output. The third model estimated the complete endoscopic Mayo score through a categorical output. First model (with seven categorical and 13 continuous input variables) obtained an accuracy of 94.37% on the test set and 93.33% on the validation set. The second model (with 12 biological input parameters) achieved an accuracy of 88.73% on the test set and 83.33% on the validation set. The third model used the same input variables as the first model obtaining an accuracy of 76.06% on the test set and 80% on the validation set. We designed an accurate and non-invasive artificial intelligence solution to estimate disease activity, other than colonoscopy. Our NN model achieved better results than pooled performance metrics of fecal calprotectin (the best non-invasive marker to date) investigated in UC. Given these promising results, we envision introducing of a non-invasive algorithm for routinely predicting disease activity shortly. [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]

Background & Aims: Both inflammatory bowel diseases (IBD) and ankylosing spondylitis (AS) can be considered chronic immune disorders sharing common etiopathogenetic mechanisms. Changes in the composition of the intestinal microbiota, which can lead to an abnormal mucosal response, could be the missing link between these two diseases. Our study evaluate the composition of intestinal microbiota and to characterize gut dysbiosis in patients with IBD and AS. Methods: We conducted a prospective case-control study that enrolled 124 patients [20 Crohn's disease (CD), 27 ulcerative colitis (UC), 28 AS, 17 IBD + AS and 32 controls). Intestinal microbiota analysis was performed by real-time polymerase chain reaction in stool samples. Results: The total quantity of bacteria was decreased in all investigated groups compared to the control group. In studied groups, we noticed an increased percentage of Bacteroides and Escherichia coli (E.coli) and a decreased percentage of Clostridium coccoides, Clostridium leptum, and Faecalibacterium prausnitzii compared to the control group. The percentages of Bifidobacterium (p=0.010) as well as Lactobacillus group (p=0.023) were higher in the L3 form of CD patients. In the E2 form of UC, the quantity of Bacteroides was much higher compared to the E3 form (p=0.004). In AS patients, significant correlations were observed only for the Bifidobacterium species, significantly increased in the axial form compared to peripheral disease (p=0.035). Statistically significant correlations were demonstrated between the Crohn Disease Activity Index score and the total bacterial group (p=0.023, r=-0.507), respectively Bacteroides (p=0.021, r=-0.511) and between the Mayo score and Lactobacillus (p=0.001), respectively E. coli (p=0.001). In IBD + AS group, the Crohn Disease Activity Index score was inversely correlated with the total bacterial group (p=0.010) and directly correlated with Lactobacillus (p=0.047). Conclusions: Intestinal dysbiosis is associated with both IBD and AS. In the association of IBD with AS, dysbiosis is intermediate, but it is associated with the more severe articular disease. Bifidobacterium and Lactobacillus (commonly used as probiotics!) were found to be increased in the association between active IBD and active AS. Further studies are needed to understand how dysbiosis regulates the gut immune system and contributes to intestinal and articular inflammation. [ABSTRACT FROM AUTHOR]

Pancreatic pseudocysts are frequent complications of both acute and chronic pancreatitis. By contrast, pancreatico-pleural fistula is rare. Here we report a case of massive pleural effusion secondary to a fistula in the left hemi-diaphragm, between a pancreatic pseudocyst and the left pleura, in a patient with a right kidney tumor and bilateral massive pulmonary thromboembolism. This fistula developed after several episodes of un-investigated acute pancreatitis. The pleural effusion was treated by three thoracocenteses, without recurrence. [ABSTRACT FROM AUTHOR]

Objectives. Inflammatory bowel disease (IBD) are part of a pathology that has an ascending incidence both in Romania and around the world. It is well known that intestinal inflammation in IBD is not limited to the intestinal epithelium. Sometimes, extraintestinal manifestations (EIM) may have a more severe clinical expression than the intestinal disorder or may even encourage an increased morbidity. The research motivation focused on the development of specific clinical and epidemiological data for patients diagnosed with IBD who associate EIM. Material and methods. We performed a retrospective study including 517 patients with intestinal inflammation (Crohn disease - CD, ulcerative colitis - UC or undifferentiated colitis - NC) diagnosed during 1975-2016 in the N-E region of Romania. All the cases were extracted from the national database (IBD Prospect). Results. In our study the prevalence of UC versus CD cases prevailed. There were 368 cases (71.2%) of UC, 135 cases (26.1%) of CD and 10 cases of NC (1.9%). The prevalence of EIM in IBD patients in N-E Romania was 9,9% which was quite low. In the study group, EIMs occurred with a higher frequency in patients diagnosed with CD compared to UC. Thus, of the 51 cases of IBD and EIM, 27 (52.9%) belonged to the CD's phenotype and 24 cases (47.1%) of the UC's phenotype. Discussions. Both patients with CD and UC experienced a greater risk than the rest of patients for developing EIM. The most frequent EIMs were highlighted at the level of musculoskeletal system. Among EIM, there were 38 cases (74,5%) with articular manifestations (of which 26 had peripheral manifestations - arthritis, 12 cases developed axial manifestations - sacroiliitis/ankylosing spondylitis - SI/AS). Also, cases with multiple EIM had at least one articular manifestation. Conclusions. Our results sustain, once again, the fact that inflammation in IBD is not limited at the level of gastrointestinal tract. The presence of EIM, especially joint involvement, is a certainty validated by the results of many clinical trials. [ABSTRACT FROM AUTHOR]

Objectives. Inflammatory bowel disease (IBD) are part of a pathology that has an ascending incidence both in Romania and around the world. It is well known that intestinal inflammation in IBD is not limited to the intestinal epithelium. Sometimes, extraintestinal manifestations (EIM) may have a more severe clinical expression than the intestinal disorder or may even encourage an increased morbidity. The research motivation focused on the development of specific clinical and epidemiological data for patients diagnosed with IBD who associate EIM. Material and methods. We performed a retrospective study including 517 patients with intestinal inflammation (Crohn disease - CD, ulcerative colitis - UC or undifferentiated colitis - NC) diagnosed during 1975-2016 in the N-E region of Romania. All the cases were extracted from the national database (IBD Prospect). Results. In our study the prevalence of UC versus CD cases prevailed. There were 368 cases (71.2%) of UC, 135 cases (26.1%) of CD and 10 cases of NC (1.9%). The prevalence of EIM in IBD patients in N-E Romania was 9,9% which was quite low. In the study group, EIMs occurred with a higher frequency in patients diagnosed with CD compared to UC. Thus, of the 51 cases of IBD and EIM, 27 (52.9%) belonged to the CD's phenotype and 24 cases (47.1%) of the UC's phenotype. Discussions. Both patients with CD and UC experienced a greater risk than the rest of patients for developing EIM. The most frequent EIMs were highlighted at the level of musculoskeletal system. Among EIM, there were 38 cases (74,5%) with articular manifestations (of which 26 had peripheral manifestations - arthritis, 12 cases developed axial manifestations - sacroiliitis/ankylosing spondylitis - SI/AS). Also, cases with multiple EIM had at least one articular manifestation. Conclusions. Our results sustain, once again, the fact that inflammation in IBD is not limited at the level of gastrointestinal tract. The presence of EIM, especially joint involvement, is a certainty validated by the results of many clinical trials. [ABSTRACT FROM AUTHOR]

Background. Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are perceived different pathologies, one organic and the other functional, which influence the quality of life (QOL). We aimed to compare the relative impact of the disease on QOL in two groups of outpatients suffering from IBS and IBD attending our outpatient clinic at a university hospital in Romania and to compare them with a healthy group of students. Methods. The studied groups completed an SF-36 quality of life form, the associations between gastrointestinal (GI) symptoms, psychosocial score (PS) and mental status (MS) were analyzed by multiple linear regressions. Results. QOL appears to be similarly reduced in both disease groups (global mean SF-36 value: 57.2 +/- 14.2 in IBS patients versus 55.4 +/- 17.3 in IBS patients IBD: P > 0.05) compared with the control group. GI symptoms were associated with changes in the PS, but not with the MS in both groups, significantly lower than in the control group (p<0.01). The most important predictor of the change in the mental score was depression (p<0.01). Anxiety significantly contributed to the decrease of the three scores (GI, PS, MS) in all studied groups. Conclusions. Patients with IBS present healthrelated quality of life, mental distress and psychosocial status similar to those with IBD. Anxiety and depression change the psychosocial and mental status even in healthy patients. [ABSTRACT FROM AUTHOR]

Background. Burnout syndrome is a commonly seen in healthcare professionals, particularly in physicians who are exposed to a high level of stress at work and has a negative impact on the medical activity. The physicians who had have high burnout levels have been shown to commit more medical errors. Aim: To assess the level of the burnout syndrome in a tertiary university centre of gastroenterology in Romania. Methods. This observational study involved physicians from a tertiary gastroenterology university centre. An online questionnaire assessed the presence of burnout using the Maslach Burnout Inventory (MBI). Results. A total of 64 physicians responded to the questionnaire. In terms of high burnout, 11 doctors (17.18%) had emotional exhaustion, 13 doctors (20.3%) had depersonalization, and 58 doctors (90.62%) scored low for personal achievement. There were statistically significant correlations between the personal accomplishment and exhausting scores and between the personal accomplishment and depersonalization scores, respectively (P=0.007, and P<0.001, respectively). Conclusion. Physicians present an increased risk for burnout relative to workers in other fields. The high rate of burnout among physicians found by our study requires careful attention. Further studies aiming to identify other factors that contribute to burnout and as well as measures to combat burnout are necessary. Professional societies should get involved in studying the factors that generate burnout among physicians as well as to find solutions to reduce them. [ABSTRACT FROM AUTHOR]

Background: Fatty liver disease became the most prevalent hepatic disease worldwide. The differential diagnosis of focal fatty lesions (FFL) may be challenging in clinical practice. To establish the role of contrast-enhanced ultrasound (CEUS) in focal fatty lesions (FFL) characterization in metabolic associated fatty liver disease (MAFLD) vs non-alcoholic fatty liver disease (NAFLD) patients. The retrospective study was conducted over a period of 5 years. It has included patients with hepatic steatosis and FFL (focal fat deposition and focal fatty sparing) diagnosed on B-mode ultrasound. CEUS was performed in all patients. The contrast vascular pattern of focal liver lesions was followed, according to the EFSUMB guidelines. The focal fatty alterations were considered when the same enhancement pattern as the surrounding liver parenchyma was noticed. In all cases, the final diagnostic was confirmed by computed tomography (CT) or magnetic resonance imaging (MRI). Patients were included in two groups according to the presence/absences of obesity, type 2 diabetes mellitus, and metabolic disturbances: MAFLD group vs NAFLD group. 47 patients (28 women and 19 men, mean age 53 years) were enrolled. According to the biological parameters and anamnesis 30 patients were in MAFLD and 17 in the NAFLD group. The CEUS results were: 39 nodules were diagnosed with FFL, 2 with hepatocarcinoma, 2 with metastasis, 3 hemangiomas, and 1 focal nodular hyperplasia. The final diagnosis (after CT/MRI) was FFL in 37 patients, hepatocarcinoma in 4 patients, metastasis in 2 patients, hemangioma in 2 patients, and focal nodular hyperplasia in 2 patients. The performance of CEUS correct diagnosis of focal steatosis was 94.88% (100% in the MASH group and 93.34% in the NASH group). The most misdiagnosed focal lesions in steatosis patients were hepatocarcinoma and hemangioma. CEUS is a good method for focal fatty liver lesions characterization in patients with hepatic steatosis. A focal liver lesion in patients with steatosis is more probable to be FFL in MAFLD compared with NAFLD patients. [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]

Multiple focal liver lesions can generate diagnosis difficulties in daily practice. This paper present the case of a 53 years old patient with multiple hyperechoic liver lesions suggestive for hepatic hemangiomas, detected during the ultrasonographic exam. Contrast enhanced ultrasonography indicated focal hepatic steatosis, while computed tomography proposed possible liver metastasis. The histological diagnosis was focal nodular hyperplasia associated with hepatic steatosis. The peculiarity of the case was the association of multiple focal nodular hyperplasia lesions with hepatic steatosis and atypical imaging findings that required histological confirmation. [ABSTRACT FROM AUTHOR]

Infection with Strongyloides stercoralis (S. stercoralis) is rarely reported in temperate countries. In addition, there are few reported cases of patients with ascites with S. stercoralis worldwide, usually in immunocompromised subjects. We present the case of a young patient with alcoholic liver disease and acute pancreatitis, who developed ascites with S. stercoralis. The patient had no evident immunosupression (HIV negative and absence of immunosupressive therapy). This is the first reported case where acute pancreatitis could have precipitated infection of ascitic fluid with S. stercoralis. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the diagnostic and therapeutic challenges of gastric bezoars in the Institute of Gastroenterology and Hepatology in Iasi, Romania.