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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.

Inflammatory bowel disease (IBD) comprises two types of chronic intestinal disorders: Crohn's disease and ulcerative colitis. In long-standing ulcerative colitis disease activity, histological persistent inflammation has been linked to an increased risk of relapse, and long-term corticosteroid use, even when endoscopic remission is reached. In Crohn's disease, the discontinuous nature of lesions and transmural inflammation have limited the standardized histological assessment. The current evidence from research proposes that besides clinical and endoscopic healing, the achievement of histological healing constitutes an endpoint to assess disease activity and remission in IBD patients concerning better long-term disease outcomes. Histological alterations may persist even in the absence of endoscopic lesions. For these reasons, new advanced techniques promise to revolutionize the field of IBD by improving the endoscopic and histologic assessment, disease characterization, and ultimately patient care, with an established role in daily practice for objective assessment of lesions. This review outlines the importance of including microscopic evaluation in IBD, highlighting the clinical benefits of a deep state of disease remission using validated diagnostic methods and scoring systems for daily clinical practice.

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.

Background and Objectives: The COVID-19 pandemic has had a considerable impact on inflammatory bowel disease (IBD) patients by limiting their access to medical services due to restrictions and the reorganization of the healthcare systems, which affects their quality of life (QoL). We aimed to assess the impact of the COVID-19 pandemic on the QoL of patients with IBD. Materials and Methods: We conducted a descriptive observational study, which included 90 adult patients diagnosed with IBD. The study sample consisted of two subgroups: a retrospective-pre-pandemic group (group A) and a prospective-pandemic group (group B). Group A included 45 IBD patients who were evaluated in 2018. Group B included 45 patients with confirmed diagnosis of IBD, evaluated between June and December 2021—the period of the COVID-19 pandemic (prospective), consecutively recruited. All the patients filled in a QoL assessment questionnaire—IBDQ-32. Subsequently, the two samples were comparatively assessed. Results: The average values of the IBDQ scores were significantly lower in 2021 compared to those recorded in 2018: 145.56 vs. 128.3 (p < 0.05). We also we found significant differences between the subscores: IBDQ1 (p = 0.043), IBDQ2 (p = 0.034), IBDQ3 (p = 0.045), IBDQ4 (p = 0.025). Conclusions: IBDQ scores were significantly lower in 2021 compared to 2018 (p < 0.05), showing that during the COVID-19 pandemic, patients with IBD had a more influenced QoL.

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.

Background and Aims: Identifying the risk factors for extraintestinal manifestations (EIMs) in inflammatory bowel diseases (IBD) may optimize the therapeutic decision. We aimed to assess the prevalence of EIMs in IBD patients in Romania and to determine the risk factors., Methods: We analyzed 2,626 patients registered in the Romanian IBD Prospect National Registry. We performed a descriptive cross-sectional study to assess the point prevalence of EIMs, calculating global prevalence and analyzing the different types of EIMs and their respective frequencies were carried out. Demographic and clinical risk factors were researched as possible predictors for EIMs development, based on the results of the univariate and multivariate logistic regression analysis., Results: The overall point prevalence of EIMs was 16.3%. A significantly higher frequency of EIMs in Crohn's disease (CD) was noted in comparison to ulcerative colitis (UC) and IBD unclassified (IBDU) (23.2% vs 11.3% and 16.3%, respectively, p<0.001). The most frequent type of EIM was peripheral arthropathy (8.3%), significantly associated with CD (p<0.001). Univariate analysis highlighted the significant independent common predictive risk factors for EIMs, in both CD and UC patients: female gender, patient's urban area of origin, anemia, hypoalbuminemia, and high level of C-reactive protein (CRP), while significant independent IBD phenotype-related risk factors were ileocolonic location and concomitant involvement of upper gastrointestinal tract for CD, non-smoker status and both moderate and severe disease activity for UC (p<0.05). Multivariate analysis determined that female CD patients with moderate or severe disease activity, with other than isolated ileal disease, and female UC patients with moderate or severe extensive colitis are the most likely to develop EIMs., Conclusions: IBD patients are experiencing EIMs in a large proportion, with higher rates for CD. As EIMs negatively affect patient outcomes, foreseeing the risk by identifying independent and associated predictive factors could be a first step to optimal work-up and treatment.

Background: Colonoscopy with biopsy is the "gold" standard for evaluating disease activity in inflammatory bowel diseases (IBD). Current research is geared toward finding non-invasive, cost-efficient methods that estimate disease activity. We aimed to develop a neural network (NN) model for the non-invasive prediction of histologic activity in IBD using routinely available clinical-biological parameters., Methods: Standard clinical-biological parameters and histologic activity from 371 ulcerative colitis (UC) and 115 Crohn's disease (CD) patient records were collected. A training set, a test set, and a validation set were used for building/validating 2 models for each disease. All models had binary output predicting the active/inactive histologic disease status. For both diseases, the first model used both clinical and biological inputs, while the second used only biological data., Results: First UC model obtained an accuracy of 95.59% on the test set and 96.67% on the validation set. The second UC model achieved accuracies of 88.24% and 86.67% on the test and validation sets, respectively. The First CD classifier resulted in 90.48% accuracy on the test set and 91.67% on the validation set. Finally, the second CD classifier obtained an accuracy of 85.71% on the test set and 91.67% on the validation set., Conclusions: An accurate and non-invasive artificial intelligence system to predict histologic disease activity in IBD is designed. Our models achieved similar or better results compared to the documented performance of fecal calprotectin (the best non-invasive IBD biomarker to date). Given these favorable results, we anticipate the future utility in the clinical setting of a non-invasive disease activity prediction.

Background and objectives: The biological treatment is a promising therapeutic option for ulcerative colitis (UC) patients, being able to induce subclinical and long-term remission. However, the relatively high costs and the potential toxicity have led to intense debates over the most appropriate criteria for starting, stopping, and managing biologics in UC. Our aim was to build a machine learning (ML) model for predicting disease activity at one year in UC patients treated with anti-Tumour necrosis factor α agents as a useful tool to assist the clinician in the therapeutic decisions. Materials and Methods: Clinical and biological parameters and the endoscopic Mayo score were collected from 55 UC patients at the baseline and one year follow-up. A neural network model was built using the baseline endoscopic activity and four selected variables as inputs to predict whether a UC patient will have an active or inactive endoscopic disease at one year, under the same therapeutic regimen. Results: The classifier achieved an excellent performance predicting the disease activity at one year with an accuracy of 90% and area under curve (AUC) of 0.92 on the test set and an accuracy of 100% and an AUC of 1 on the validation set. Conclusions: Our proposed ML solution may prove to be a useful tool in assisting the clinicians' decisions to increase the dose or switch to other biologic agents after the model's validation on independent, external cohorts of patients.

Background/aims: Stress, in its various forms, plays an important role in the development and evolution of inflammatory bowel disease (IBD). For patients with IBD, the evidence related to the effects of various types of psychological therapies remains inconclusive. This study aimed to evaluate whether cognitive behavioral therapy, in combination with educational counseling, influenced disease activity and quality of life (QoL) among patients with IBD., Materials and Methods: We conducted a randomized controlled trial with 60 patients diagnosed with IBD. All patients completed the IBD questionnaire-32 (IBDQ-32) and the Big Five Inventory. Group A (experimental group) received specialized educational and psychological counseling (SEPC), and group B (control group) was treated according to the current medical practice. All patients were reassessed after 12 months., Results: After the SEPC, there was no improvement in disease activity as estimated by fecal calprotectin levels. However, the QoL of patients in group A was significantly improved. The highest mean difference between the initial and final IBDQ scores was found among patients whose main personality trait was openness to experience (48.58±28.80), and the lowest mean difference between these 2 scores was found among patients whose main personality trait was closedness to experience (3.33±2.97, p=0.009)., Conclusion: Although there was no improvement in disease activity after the SEPC, this therapy improved patients' QoL in terms of both emotional and social functions, especially among patients whose dominant personality trait was openness to experience or neuroticism.

The aim of the paper was to propose a score for performance evaluation in colonoscopy units., Method: We proposed a score ( CDCD score - C ecal intubation, polyp D etection rate, C leansing and D ocumentation 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 = (3×cecal intubation rate+3×polyp detection rate+1×photo documentation+1×BBPS 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.

Acute pancreatitis (AP) is a frequent presentation to the emergency departments with a rising incidence and a great variability in clinical severity and outcome. The aim of this review is to offer a succinct presentation on acute pancreatitis scoring systems and the use of different imaging methods in severity prediction: Ranson criteria, Glasgow criteria, Hong Kong Score, Acute Physiology and Chronic Health Evaluation II (APACHE II), computed tomography scoring systems, Bedside Index of Severity in Acute Pancreatitis (BISAP) score, Panc 3, Japanese Severity Score (JSS), Harmless Acute Pancreatitis Score (HAPS), Pancreatitis Outcome Prediction (POP), Sequential Organ Failure Assessment (SOFA). This article also describes the Revised Atlanta Classification of AP (2012) and the correlation with computed tomography.

Unlabelled: Gastroesophageal reflux disease (GERD) with extradigestive manifestations is a disorder increasingly recognized both by gastroenterologists, pneumologists, otolaryngologists and cardiologists., Aim: To evaluate the demographical, clinical, biological and endoscopic features of the patients with gastroesophageal reflux disease and extradigestive manifestations (chronic laryngitis, asthma, pseudoangina)., Material and Methods: Prospective case-control study, including 137 patients selected from patients referred to the Iasi Institute of Gastroenterology and Hepatology between July 2014-September 2015. In the presence of typical GERD symptoms (heartburn or regurgitation), the patients were assessed by upper digestive endoscopy for the detection or exclusion of esophagitis. Despite the absence of esophageal lesions, the patients were further assessed by impedance-pHmetry., Results: Depending on the dominant extradigestive manifestation, the patients were assigned into 3 groups: 94 chronic laryngitis patients, 24 asthma patients and 19 pseudoangina patients. Females were more frequent among pseudoangina patients (68.4%). Mean age of the male patients with dysphonia or asthma was lower (p=0.002), the majority (78.1%) living in urban areas. Obesity was predominant in pseudoangina group (52.6%), as compared to dysphonia group (16%) the differences being statistically significant (p=0.002). A share of 57.9% of pseudoangina patients were dyslipidemic, in contrast to dysphonia (24.5%) or asthma group (37.5%) (p=0.013). Esophagitis was also more frequent at pseudoangina group (84.2%), but with no significant statistical difference between the study groups (79.8% and 75%, respectively) (p=0.115). It seems that Helicobacterpylori infection tends to be protective in patients with GERD and pseudoangina (RR=0.61), but it can not be extrapolated to the general population (p=0.459)., Conclusion: GERD with extradigestive manifestations is a prevalent and heterogeneous disease. There are demographic, clinical, biological and endoscopic differences between patiens with extradigestive GERD.

Background/aims: Direct assessment by endoscopic examination has become a "gold standard" in monitoring patients with ulcerative colitis. However, it is an invasive method, with risks and discomfort for the patients. The aim is therefore to identify a less invasive method of assessing ulcerative colitis activity compared to colonoscopy., Materials and Methods: A prospective study was conducted among 103 patients with ulcerative colitis. Calprotectin was measured by a semi-quantitative rapid test. For each patient, a complete blood count was performed; liver and kidney functions, glycaemia, serum proteins, and inflammatory markers were also evaluated., Results: The Mayo score showed direct correlations with fecal calprotectin, C-reactive protein, and the erythrocyte sedimentation rate (p<0.05) and indirect correlations with hemoglobin (p=0.139). The sensitivity and specificity of calprotectin were 98.0% and 76.7%, respectively. Subsequently, combined analysis of the markers' sensitivity/specificity was conducted., Conclusion: The semi-quantitative rapid test proved to be a good predictor for differentiating the endoscopic active disease from the inactive one. The individual use of fecal calprotectin presents the highest sensitivity in determining the endoscopic activity. Nevertheless, in monitoring patients, combined determination of the three inflammatory markers studied [C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), calprotectin] is more useful in reducing unnecessary colonoscopies.

Laryngopharyngeal reflux has been recognized since 2006 (Montreal Consensus) as an extradigestive manifestation of gastroesophageal reflux disease. However, despite numerous research studies, the relationship between these two pathologies is yet to be fully understood. The aim of this paper is to review the literature of the last five years available via the PubMed database, looking at the controversies about the prevalence, pathophysiology and diagnosis of laryngopharyngeal reflux.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal malignancies of the digestive tract. We present the case of a 61-year-old male patient liver metastasis of a GIST with primary location at the level of sigmoid colon. Like in the majority of cases, the symptomatology in this patient has long been faint and when it became manifest, it was nonspecific. Imagery wise, the computer tomography (CT) scan was the most efficient, showing the origin of the tumor from large bowel, its dimensions, as well as the relations with the other abdominal viscera and the liver metastasis. Surgery in this patient was en-bloc, according to the principles of GIST and for the metastasis he followed treatment with Imatinib. The histological aspect is characterized by a proliferation of spindle cells positive for CD117 and CD34. Despite complete microscopic resection, the exhibit of liver metastasis remains an important relapse factor.

Unlabelled: Crohn's disease is an inflammatory disease of the gastro-intestinal tract with an evolution marked by activity and remission periods. Lately, the incidence and evolution models of Crohn's disease significantly changed, an increasing number of patients presenting more severe forms. The aim of the study is to analyze Crohn's disease in its phenotypic classification and to establish correlation between the localization, the behavior and the activity of Crohn's disease., Material and Methods: A transversal study on 53 patients with Crohn's disease was conducted., Results: from the 53 patients, 56.6% were males, 85% from the urban areas. Under the phenotype aspect, the colonic localization (49.1%) and the inflammatory behavior (52.8%) were predominant. More severe forms of activity were discovered to patients with ileal localization (57.1%) or with penetrant phenotype (33.3%)., Conclusions: Male patients from urban areas were predominant. The most frequent forms are the colonic and ileocolonic forms. From a behavioral point of view, we observed an obvious predominance of the inflammatory phenotype. The moderate--severe activity was predominant for the ileal localization and the mild-- moderate activity for the colonic and ileocolonic localization. A mild--moderate activity is present for the stenosing forms and a moderate--severe one for the penetrant forms.

Unlabelled: In Romania, minimal hepatic encephalopathy (MHE) is underdiagnosed and undertreated in patients with liver cirrhosis. The psychometric hepatic encephalopathy score (PHES) is recommended as the first-line tool for the diagnosis of MHE., Aim: To use PHES in a group of Romanian cirrhotic patients and highlight the relationships between demographic and biological factors and tests results., Materials and Methods: Of the 148 patients with liver cirrhosis admitted to the Iaşi Institute of Gastroenterology and Hepatology between August 2014 and February 2015 only 80 who met the eligibility criteria were enrolled and completed the study. Blood samples for routine tests and serum ammonia were collected from all patients on the day of PHES evaluation., Results: In the study group (n = 80) mean age was 57.7 ± 8.5 years, and the average number of years of education was 11.2 ± 2.7. The main causes of cirrhosis were alcohol consumption (31 patients--38.8%), hepatitis C virus infection (29 patients--36.3%) and hepatitis B virus infection (17 patients--21.3%). Age, number of years of education, severity of liver disease (measured by using Child-Pugh and MELD scores) and some biological constants (albumin, bilirubin, International Normalized Ratio-INR) were significantly correlated (p < 0.05) with most psychometric tests., Conclusions: PHES is a practical, objective and useful method for the diagnosis of MHE. Demographic and biological factors correlated with the results of the psychometric test. The PHES requires standardization before applying it in Romanian cirrhotic patients.

Unlabelled: The aim of the study is to assess the impact of Crohn's Disease (CD) on quality of life (QoL) patients with and to identify the significant modifications in QoL, depending on both the development particularities of CD and the epidemiologic parameters., Material and Methods: a prospective study was conducted at the Institute of Gastroenterology and Hepathology Iaşi, between October 2011 and August 2014. The study enrolled 63 patients with CD. The CD diagnosis was based on clinical, biological, endoscopic and histological criteria. QoL was assessed by means of the IBDQ-32 questionnaire (Inflammatory Bowel Disease Questionnaire)., Results: The total IBDQ score varied from 70 to 200, registering a slightly higher value in female patients. Parameters such as age, sex and smoking/non-smoking status did not present significant differences in the IBDQ score. The values of the IBDQ score were in indirect, mild correlation with the CDAI score; over 49% of the subjects with higher CDAI had a lower IBDQ score., Conclusions: Except for the disease activity periods, the results of the studies investigating the impact of the various factors on the QoL in patients with CD are contradictory. Further research is needed in order to define the subgroups of patients likely to suffer from poorer QoL.

Minimal hepatic encephalopathy (MHE) defines the presence of neurocognitive impairments in patients with cirrhosis or portal-systemic shunting that show a normal neurologic and psychiatric status on clinical examination. Although ammonia has the central role in MHE pathogenesis, factors such as infection, oxidative stress, manganese or intestinal bacterial overgrowth contribute to the development of the neurocognitive deficits associated with this disease. Many methods have proven useful in identifying MHE but because of the major drawbacks (standardization requirements, high price, sophisticated equipment, and limited access) a gold-standard test is still missing. Although beneficial, the treatment of MHE is not routinely recommended and should be taken into consideration in patients at risk for accidents and in those with cognitive complaints or decline in work performance.

Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), doesn't affect only the intestinal tract, but also involve other organs such as: eyes, skin, joints, liver and biliary tracts, kidneys, lungs, vascular system. It is difficult to differentiate the true extraintestinal manifestations from secondary extraintestinal complications. The pathogenetic autoimmune mechanisms include genetic susceptibility, antigenic display of autoantigen, aberrant self-recognition and immunopathogenetic autoantibodies against organ-specific cellular antigens shared by colon and extra-colonic organs. An important role is owned by microbes due to molecular mimicry. This paper reviews the frequency, clinical presentation and therapeutic implications of extraintestinal symptoms in inflammatory bowel diseases.

Aim: To describe the relationship between vitamin D levels and inflammatory bowel disease (IBD) characteristics in northeastern Romanian patients., Methods: This was a prospective study of 47 consecutive IBD patients admitted to The Institute of Gastroenterology and Hepatology in Iasi, Romania between March 2011 and June 2012. The diagnosis of IBD was established based on endoscopic, histologic and radiologic findings. Demographic data, disease characteristics, ongoing treatments and biological parameters of patients (including markers of inflammation: C-reactive protein level, fibrinogen level, and erythrocyte sedimentation rate) were recorded. Serum vitamin D levels were measured and compared with age- and sex-matched healthy volunteers from the same geographic area. Vitamin D levels were defined as sufficient (> 30 ng/mL), insufficient (20-30 ng/mL), or severely deficient (< 20 ng/mL)., Results: Thirty-three of the IBD patients included in this study had ulcerative colitis (UC) and 14 had Crohn's disease (CD). Only 24% of the UC patients and 21% of the CD patients had sufficient vitamin D levels. The vitamin D levels were significantly lower in the CD patients with moderate to severe disease activity compared to the CD patients in remission or with mild disease activity (16 ± 6 ng/mL vs 26 ± 7 ng/mL; 16 ± 6 ng/mL vs 31 ± 9 ng/mL, respectively, P < 0.05). Vitamin D levels in the UC patients were not influenced by disease activity and no correlation was observed with the inflammation markers tested (C-reactive protein, fibrinogen, and erythrocyte sedimentation rate). No association was observed between vitamin D levels and smoking status or ongoing medication (5ASA, steroids, and anti-TNFα). Newly diagnosed IBD patients had lower vitamin D levels than patients with established cases, though these differences were not significant (UC: 22 ± 9 ng/mL vs 26 ± 12 ng/mL; CD: 18 ± 6 ng/mL vs 27 ± 11 ng/mL, respectively). Although no association was found between the season during which the visit was scheduled and vitamin D levels, the UC patients assessed during the winter tended to have lower levels than those assessed during the summer (22 ± 9 ng/mL vs 28 ± 13 ng/mL, respectively)., Conclusion: Vitamin D levels are significantly reduced in IBD patients in northeastern Romania, with the lowest levels occurring in CD patients with moderate to severe disease activity.

The relationship between nutrition and inflammatory bowel disease (IBD) is a complex one, the evaluation and correction of nutritional deficits being integral part of therapy in these patients. The diet that consists in excessive consumption of meat, sugar, fats (with a higher 0 6 /o) 3 polyunsaturated fatty acids ratio) are factors involved in the epidemiology and pathogenesis of IBD. Malnutrition is present among most IBD patients, being the result of multiple mechanisms from digestive symptoms to inflammatory process, intestinal resection and administration of medications. Oral diet is high-calorie, high protein at correcting the vitamin and mineral deficiencies. Enteral diet has both an adjuvant role and that of inducing and maintaining remission as single treatment, particularly in children. Parenteral nutrition is reserved for patients with obstruction, fistula, toxic megacolon, short bowel syndrome, severe malabsorption, and other conditions that make enteral nutrition impossible or inefficient.

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.

Unlabelled: The aim of the paper was to evaluate the national availability of colonoscopy and the quality parameters of this procedure in our country., Material and Method: During a 6 months period (01.07- 31.12.2009), we performed a prospective multicenter study in which 76 centers were invited to respond to a questionnaire regarding colonoscopy, 39 centers agreeing to participate. We assessed: the number of colonoscopies, the number of total colonoscopies and the causes of incomplete colonoscopies., Results: During the study period, 16,083 colonoscopies were performed, 12,294 (76.4%) of them total colonoscopies. In 1,191 cases, stenosis was the cause of incomplete colonoscopy. If we consider this an objective reason for an incomplete colonoscopy, there were 12,294 total colonoscopies (82.4%). Comparing university centers with non-university ones, the proportion of total colonoscopies was 10,400/12,475 (83.4%) vs. 1,894/2,417 (78.4%) (p less then 0.0001). However, comparing the present study with previous ones, performed in 2003 and 2007, the proportion of total colonoscopies increased from 70.5% to 76.9% and 82.4% respectively (2003 vs. 2007 p less then 0.0001; 2007 vs. 2009 p less then 0.0001), while the quality difference between university and non-university hospitals persisted., Conclusions: the quality of colonoscopy in Romania increased in the last 5 years, while the quality difference between university and non-university hospitals persisted., (Celsius.)

Unlabelled: Inflammatory bowel disease (IBD) is associated with increased prevalence of bone demineralization. One of the risk factors for low bone density is the inadequate level of 25-OH vitamin D., Aim: To determine the degree of bone demineralization in patients with IBD and the main causes leading to this condition., Material and Methods: A prospective study was carried out between April, 2011 and October, 2012 in 143 patients diagnosed with IBD at the Gastroenterology and Hepatology Centre of Iaşi.The IBD diagnosis was made on clinical, biological, and endoscopic criteria and confirmed histologically. The diagnosis of osteopenia/osteoporosis was based on World Health Organization criteria., Results: Osteopenia was found in 48.07% of the patients with ulcerative colits (UC) and in 56.41% of the patients with Crohn's disease (CD); osteoporosis was present in 18.26% of the patients with UC and 15.38% of those with CD. The main causes identified were inadequate vitamin D level, extended high-dose corticotherapy in patients with CD, BMI < 18.5 kg/m2, and smoking, especially in the patients with UC., Conclusions: Bone demineralization and hypovitaminosis D are frequently associated with IBD and require specific treatment.

Unlabelled: Anemia is a frequent complication of inflammatory bowel diseases (IBD). The main incriminated mechanisms are the iron deficiency and the chronic inflammation. The aim of this study was to determine the prevalence of anemia in IBD patients and to identify the main causes., Material and Methods: A prospective study was carried out between April 1st 2011 and April 30th 2012 on a batch of 144 IBD patients diagnosed in the Gastroenterology and Hepatology Center of lasi. The IBD diagnosis was based on clinical, biological, endoscopic and histological criteria. The anemia diagnosis was based on the World Health Organization criteria., Results: Anemia was present in 40.27 % of IBD patients. The main cause identified was mixed type anemia, followed by iron deficiency and inflammation. Iron deficiency anemia was present especially in patients with ulcerative colitis with long evolution, frequent activity spurts and extended forms of diseases; an inflammatory anemia emerged mainly in patients with exterided and moderate-severe forms of the diseases., Conclusions: Anemia remains a frequently associated pathology to the inflammatory bowel disease that requires specific management.

Aim: To assess the efficiency of the dosage of the semi-quantitative calprotectin rapid test in evaluating the activity of inflammatory bowel diseases., Material and Methods: The prospective study included 87 patients with BII (50 with ulcerative colitis, 37 with Crohn disease) hospitalized between January 2011 - May 2012. The diagnosis was confirmed by colonoscopy and histological examination. Fecal calprotectin was measured by means of a semi-quantitative rapid test., Results: There were 50 patients with UC and 37 with BC. 96% of the UC patients were evaluated during the active disease. 21 of them had a severe episode of active disease, 16 had a moderate one, while 10 had a mild activity episode. The correlation between the calprotectin values and lesions localization was analyzed, without finding any statistical differences. The data have shown a very strong correlation between the severity of the active disease, assessed through the UCDAI (Mayo) score, and the calprotectin value. Patients with CD manifested a linear correlation between the severity of the active disease and the calprotectin value., Conclusions: The rapid test for assessing calprotectin could be a useful non-invasive marker in appreciating the severity of clinical and biological disease activity.

Unlabelled: Patients with inflammatory bowel disease (IBD) have to live with the perspective of a potential disability, which may lead in time to impaired quality of life (QoL). In order to fully understand the impact of IBD on patients and their careers we need to quantify the QoL., Aim: To evaluate HRQol in ulcerative colitis patients as opposed to the general population and to identify the significant changes of HRQoL in accordance with the specific progression of UC., Methods: The prospective study (January 2010 - December 2012), included 105 patients with ulcerative colitis (UC). Disease activity was quantified by means of the Truelove and Witts score (mild, moderate and severe). All patients were administered a self-completed IBD questionnaire (IBDQ). Lower scores were related to a worse QoL. Statistical analysis was performed and di fferences were considered significant when p < or = 0.05., Results: Ninety-one percent (91%) were admitted with a flare, while they were asked to fill in the IBDQ. Proctitis was met in 2.94% of the cases, left-sided colitis in 71.1% and pancolitis in 26%. There were 32 patients with mild activity, 62 with moderate activity and only 3 with severe activity. The range score for QoL was 90-180. In proctitis: 80-190, in left-side colitis: 120-200, in pancolitis: 70-160 (p>0.05). The patients with severe form had a lower score (50-140) than patients in remission (130-180) (p<0.01)., Conclusion: Patients with UC have significantly influenced the QoL as compared to the general population. We found no significant differences regarding the extension of the lesions. The severity of the flare had a significant impact on the QoL.

Pruritus, fatigue and osteoporosis are the main symptoms of the extra hepatic manifestations of chronic cholestasis that affect patients' quality of life. Pruritus affects more often female patients, varies as intensity during a day and for longer period of time, typically can be localized on the palms of hands and soles of feet or can be generalized. Pruritus can be treated with anions resines exchange--cholestiramine, the pregnanne X receptor agonist Rifampicine, Naltrexone. Liver transplantation can be considered if severe pruritus remains refractory to all medical treatments. Fatigue is the most disabling complain in chronic colestasis. No specific therapies are available for fatigue and liver transplantation doesn't improve it. Osteoporosis and the risk of fractures are more severe with the duration and severity of hepatic disease. For treatment are recommended regular physical exercise, vitamin D and Ca supplimentation and bisphosphonates (Alendronate 70 mg/week) in severe cases. Only patients with atherosclerotic risk and hyperlipemia can be treated with statines. Fat soluble vitamin supplementation can be administrated only in symptomatic and proved vitamin deficiency.

Abnormal hemostasis tests and bleeding are often associated in liver cirrhosis. In these patients the balance between hypo- and hypercoagulation status is more fragile than in healthy people. In the hemostatic abnormalities associated with chronic liver disease are two main chategory factors: favoring hemorrage and favoring thrombosis. The main factors that favoring hemorrage are: low platelet count, impaired platelet function, decreased levels coagulation factors (II, V, VII, IX, X, XI), quantitative and qualitative abnormalities of fibrinogen, vitamin K defiency, low levels of trombin activable fibrinolisis inhibitor, activat plasminogenic tisular. The factors favoring thrombosis are elevated levels of factors VIII and von Willebrand, decreased levels of protein C, protein S, antithrombin, decreased levels of plasminogen. Traditionally it was thought that arterial and venous thrombosis is rare events in cirrhotic patients but recent studies have indicated that thrombotic complications can paradoxically occur even if clinically an increased risk of hemorrhage is considered. Treatment of venous thrombosis in patients with cirrhosis using routine anticoagulation with heparin and vitamin K antagonists has been described but with a high level of bleeding complications. So, based on the limited data available, AASLD guidelines stated no recommendations for or against the use of anticoagulation in cirrhotic patients with portal thrombosis. Although abnormal hemostasis tests and bleeding are often associated in patients with chronic liver disease it is a relatively poor correlation between hemorrhagic risk and routine diagnostic tests of hemostasis. Management of bleeding complications in liver cirrhosis varies and no general guidelines are available. The main therapeutic strategies are: red cell concentrate, plasma, platelet concentrate, recombinant factor VIIa, factor concentrates, desmopressin, antifibrynolitic agents, thrombopoietin receptor agonists, antibiotics. Clinical studies examining safety and efficacy of the various products for the different bleedeing or trombotic complications of liver cirrhosis need to be initiaded.

Cirrhotic cardiomyopathy is a condition recently known in liver cirrhosis consisting of systolic dysfunction to stress factors, diastolic dysfunction and electrophysiological abnormalities in the absence of cardiac disease. The prevalence of cirrhotic cardiomyopathy remains unknown until now. It can be diagnosed by using a combination of electrocardiograph, 2-dimensional echocardiography, and various serum markers (brain natriuretic factor--BNP, proBNP, TnI). Pathogenic mechanisms underlying cirrhotic cardiomyopathy development include abnormal signaling betaadrenergic, cardiomyocites membrane fluidity changes, interstitial fibrosis, myocardial hypertrophy, altered transmembrane ion channels as intervention with negative inotropic effect of different substances whose concentration is increased in cirrhosis. Major stresses on the cardiovasculary system such as liver transplantations, infections, insertion of transjugular portosystemic stent-shunt (TIPSS) have been demonstrated to put in evidence the presence of cirrhotic cardiomyopathy. Heart failure is a significant cause of mortality after liver transplantation but the improvement of liver function determines cardiac abnormalities reversal. Current management recommendations include empirical, nonspecific and mainly supportive measures, no specific treatment can be recommended, and cardiac failure should be treated as in non-cirrhotic patients with sodium restriction, diuretics, and oxygen therapy when necessary. The exact prognosis remains unclear. The extent of cirrhotic cardiomyopathy generally correlates to the degree of liver insufficiency. Reversibility is possible (either pharmacological or after liver transplantation), but further studies are needed.

Unlabelled: The aim of the study was to assess the symptoms manifested in patients with gastritis (gastropathies) due to excessive alcohol consumption., Material and Method: The study sample consisted of 117 cases admitted in the Town Hospital Dorohoi, Botoşani County, between 2002-2006., Results: Data were collected using special epidemiological questionnaires and statistical records of the hospital and Public Health Office. Anamnesis, clinical examination, following by endoscopy and histological and radiological examination completed the diagnosis. Although interventions regarding prevention methods were permanently applied, their efficiency was suboptimal for most of the patients suffering from chronic gastritis and excessive alcohol consumption.

Hemorrhagic complications are common in patients with liver diseases and contribute to the morbidity and mortality associated to this condition. The liver plays a central role in the hemostatic process as here all clotting factors and their inhibitors are synthetized. Liver damage is commonly associated with variable impairment of hemostasis due to multiple causes: decreased synthesis of clotting and inhibitor factors, decreased clearance of activated factors, hyperfibrinolysis, accelerated intravascular coagulation, quantitative and qualitative platelet defects. Their clinical implications remain to be elucidated, so further studies addressing this issue are needed.

Eosinophilic esophagitis (EE) is a disease whose presence has exploded in clinical practice. Because of its relative novelty, the epidemiology, pathogenesis, clinical manifestations, diagnosis and treatment of EE are constantly evolving. EE was first recognized as a disease predominantly of children, but the publications in the last few years describe it like an adult disease, too. It is not known if its frequency is truly increasing in an antigen underexposed society or the disease was previously not recognized. The diagnosis requires the histologic finding of more than 20 eosinophils per high powered field in esophageal squamous mucosa. The specific antigens that initiate EE are unknown, but both food and aeroallergens are involved. The mechanisms by which EE induces esophageal dis-motility, chronic inflammation with fibrosis, and stricture formation are still unclear. The mucosa of the patients affected by EE contains increased numbers of CD8 lymphocytes, tumor necrosis factor alpha, I1-5 and eotaxin. The main symptoms in adult are: dysphagia and food impaction. Endoscopy commonly reveals strictures, mucosal rings, linear furrowing, corrugation, and white plaques. The common treatment regimens in children and adults involve the ingestion of topical corticosteroids.

The role of Helicobacter pylori (HP) in some digestive diseases (gastritis, ulcer, gastric cancer, MALT lymphoma) is well known. It has been suggested relatively recently that infection with HP can be involved in various extra-digestive conditions: respiratory disorders (chronic obstructive pulmonary disease, bronchiectasis, lung cancer, pulmonary tuberculosis, bronchial asthma); vascular disorders (ischaemic heart disease, stroke, primary Raynaud phenomena, primary headache); autoimmune disorders (Sjogren syndrome, Henoch-Schonlein purpura, autoimmune thrombocytopenia, autoimmune thyroiditis, Parkinson's disease, idiopathic chronic urticaria, rosacea, alopecia areata); other disorders (iron deficiency anaemia, growth retardations, liver cirrhosis). Case studies, small patient series and non-randomized trials that have shown a beneficial effect of HP eradication in different conditions are not convincing. According to Mastricht III the only conditions where HP eradication is indicated are immune thrombocytopenic purpura and iron deficiency anaemia.

Unlabelled: Patients with cardio-vascular surgery are at risk for upper digestive bleeding due to several factors., Aim: To determine the utility of medication and endoscopy in preventing gastrointestinal bleeding (GB) after cardiovascular surgery., Material and Method: 79 patients (60 males and 19 women, mean age 61 +/- 16.1 years) were prospectively included in the study from the 850 patients operated in the period 2004 - 2006. Inclusion criteria were: patients with digestive symptoms (dyspepsia) and with risk for GB (personal history of peptic ulcer, gastroduodenitis, esophagitis, hiatus hernia, gastric cancer, gastric surgery and GB). All patients with symptoms and partially patients with risk were evaluated by endoscopy. Patients received standard medication for prevention of GB., Results: Prophylactic medication was partially efficient in GB prophylaxis vs. no prophylaxis (7% vs. 11% p < 0.05). Patients with endoscopy examination before surgery had significantly lower incidence of bleeding (6.6% vs. 10.9%, p < 0.05%)., Conclusions: Gastrointestinal bleeding may occur despite prophylactic medication. Gastrointestinal endoscopy prior surgery may be useful in preventing the bleeding.

Variceal bleeding in liver cirrhosis is a medical emergency with a high mortality. The therapeutic options in patients with portal hypertension are: treatment of acute bleeding from varices, prevention of the first bleeding episode and prevention of rebleeding. Treatment of acute bleeding from varices includes: blood volume restitution, use of antibiotics for preventing bacterial infections, vasoactive drug therapy (terlipressin, somatostatin, vapreotide, octreotide), endoscopic band ligation for acute esophageal bleeding and endoscopic therapy with tissue adhesive (cyanoacrylate) for acute gastric variceal bleeding. Endoscopic treatments are best used in association with pharmacological therapy. In primary prophylaxis non-selective beta- blocker therapy and endoscopic band ligation are useful. Beta blockers, band ligation or both should be used for prevention of recurrent bleeding. In patients who fail endoscopic and pharmacological treatment for prevention of rebleeding TIPS and transplantation should be considered.

Biliary stasis can occur in many different diseases. Pruritus, metabolic bone disease, deficiencies of fat-soluble vitamins, steatorrhea, hyperlipidemia and fatigue represent the major extra-hepatic manifestations of cholestatic liver disease that considerably affect the patient's quality of life. The present article reviews pathogenetic and clinical aspects of and current therapeutic approaches to extra-hepatic manifestations of cholestatic liver disease.

Both primary and secondary liver tumors are common problems. Hepatocellular carcinoma (HCC) is a tumor with rapid progression and poor prognosis. The standard in the treatment of liver tumors is surgical resection. The majority of patients with primary or metastatic hepatic tumors are not candidates for resection because of tumor size, location near major intrahepatic blood vessels precluding a margin-negative resection, multifocality, or inadequate hepatic function due to coexistent cirrhosis. Only 20-30% of patients undergoing potentially curative liver resection will not suffer from tumor recurrence. Radiofrequency ablation (ARF) is an evolving technology used to treat patients with non-removable primary and metastatic hepatic cancers. ARF produces coagulative necrosis of tumor through local tissue heating. Liver tumors are treated percutaneously, laparoscopically, or during laparotomy using ultrasonography to identify their position and guide the ARF needle electrode. The indications, treatmentplanning, and limitations of hepatic ARF must be defined. ARF of hepatic malignancies is a safe and promising technique to produce coagulative necrosis of non-removable hepatic malignancies. Experience with this treatment is not yet rich enough to establish long-term outcomes.

Different factors may be involved in the occurrence of gastro-esophageal reflux disease (GERD) symptoms. This review presents the importance of psychic factors in GERD symptom genesis, especially in patients with no esophagitis. In addition, these factors could be involved in the pharmacological therapy, with educational and behavioral implications increasing the cost-efficacy of the therapy.

Autoimmune hepatitis is a self-perpetuating hepatocellular inflammation. The diagnosis is established by a number of diagnostic criteria, defined by the International Autoimmune Hepatitis Group, and the exclusion of other causes of chronic hepatitis. There are two fundamental goals in therapy: induction of remission and maintenance of remission. The standard initial treatment is prednisone monotherapy or combination therapy with prednisone and azathioprine, which induce a clinical, biochemical and histologic remission in 65-87% of patients within 3 years. Other typical treatment endpoints in autoimmune hepatitis are an incomplete response, treatment failure and intolerance of the administrated drugs. If the treatment results are unsatisfactory, liver transplantation and alternative drugs such as Cyclosporin A, tacrolimus, cyclophosphamide, mycophenolate mofetil, budesonide, ursodeoxycholic acid should be considered; however, efficacy in clinical trials has not been shown. Future investigations must focus on the clarification of pathogenic mechanisms, characterization of target autoantigens, identification of host susceptibility factors, and assessment of alternative treatment strategies.

AIDS, still present with severe prognosis at the beginning of the 3rd Millennium, may present gastrointestinal and hepatic involvement. Even they have not a fatal prognosis, in order to improve the quality of life of AIDS patients we need a broad knowledge of and to treat the gastrointestinal and hepatic manifestation of the disease.

NASH (Nonalcoholic Steatohepatitis) and ASH (Alcoholic Steatohepatitis) are both diseases with increase frequency which may complicate up to 50% of liver cirrhosis. They are considered as risk factors for liver carcinoma. In order to diminish the incidence of liver cancer, NASH and ASH need a close follow-up. These two entities need to be known not only by gastroenterologist, but also by general practitioners, endocrinologists, nutritionists and cardiologists.

This complication described rather late and theoretically and practically under-evaluated occurs in long term evolution of ascitic hepatic cirrhosis. The positive diagnosis is indicated by the following elements: more than 250 polymorphonuclear count in ascitic fluid, under 1 g/dl protein concentration ascitic fluid, a positive culture for a unique bacterium. Treatment of SBP is made with third generation cephalosporins with immediate favorable evolution. Antibiotic prophylaxis appears to be effective in the prevention of the first SBP episode and long term norfloxacin administration appeared to be very effective in the prevention of the recurrence. The survivors of SBP episode should be recommended for a potential liver transplant.

Portal hypertension is a dramatic complication in liver cirrhosis by efraction of the varices localized more frequently in the esophagus. It has been an actual subject due to physiopathological research (endotelin system, nitric system etc), diagnosis (echoendoscopy, color Doppler), and therapeutically progress. Propranolol, available at a low cost, is efficient and unanimously accepted in the prophylactic treatment of medium and large varices which have never bled as well as in the hemorrhage due to variceal efraction which stopped therapeutically or spontaneously. This drug diminishes the risk of rebleeding. Besides the pharmacological treatment, terlipresine, octreotid, sclerotherapy and bandlegation are used in active hemorrhage due to variceal efraction. If this fails other methods for haemostasis are used: portosystemic transjugular shunt, mechanical tamponade, selective surgery and ideally hepatic transplant. Except for the hepatic transplant, none of the mentioned methods can improve the rate of survival in-patients, which depends on the state of the hepatic failure.

According to literature the gastroenterologic consultations for iron-deficiency anemia are quite frequent. The aim was the evaluation of the part played by gastrointestinal examinations for the diagnosis of iron-deficiency anemia. There were 115 patients admitted in the Medical Clinic between 1998-1999, with iron-deficiency anemia in the absence of macroscopic bleeding who carried out upper or lower endoscopy. A digestive lesion which account for iron deficiency anemia was identified in 35% of the cases. In the upper digestive tract there were 60%, in decreasing order of frequency: peptic ulcer, gastric cancer, erosive gastritis, angiodysplasia. In the lower digestive tract were 35% of the cases (colorectal cancer, polyps, angiodysplasia and hemorrhoids). In 5% of the cases there were found synchronization of the digestive tract lesions. So the digestive tract examination is worth doing because it establishes the diagnosis in 35% of the cases with few symptoms. The digestive tract lesions are more frequent in the upper tract, but they are more severe in the lower digestive tract. The possibility of the synchronization of lesions proves the necessity of carrying out the complete examination of the whole digestive tract.