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Traditional methods have their limitations when it comes to unraveling the mysteries of the small bowel, an area historically seen as the "black box" of the gastrointestinal tract. This is where capsule endoscopy and enteroscopy have stepped in, offering a remarkable synergy that transcends the sum of their individual capabilities. From their introduction, small bowel capsule endoscopy and device-assisted enteroscopy have consistently evolved and improved, both on their own and interdependently. Each technique's history may be told as a success story, and their interaction has revolutionized the approach to the small bowel. Both have advantages that could be ideally combined into a perfect technique: safe, non-invasive, and capable of examining the entire small bowel, taking biopsies, and applying therapeutical interventions. Until the realization of this perfect tool becomes a reality, the key for an optimal approach lies in the right selection of exploration method. In this article, we embark on a journey through the intertwined development of capsule endoscopy and enteroscopy, exploring the origins, technological advancements, clinical applications, and evolving inquiries that have continually reshaped the landscape of small bowel imaging. [ABSTRACT FROM AUTHOR]

Background: Despite numerous advances that have aimed to increase the safety of endoscopic retrograde cholangiopancreatography (ERCP), post-ERCP pancreatitis (PEP) still remains a major issue. We aimed to assess the rate of PEP as well as the relation to the cannulation techniques in our unit, a high-volume center in north-eastern Romania. Methods: ERCPs performed in our unit from March to August 2022 were retrospectively included. Data concerning demographic information, presence of difficult cannulation, the technique used for cannulation, as well as immediate complications, were gathered from the electronic database. Results: 233 ERCPs were included. PEP was diagnosed in 23 (9.9%) of cases. Precut sphincterotomy (PS), transpancreatic sphincterotomy (TPBS), and a combination of TPBS and PS were performed in 6.4%, 10.3%, and 1.7% of cases, respectively, while an Erlangen precut papillotomy was performed in one case. Both in patients with PS and TPBS the rate of PEP was 20%. When the two techniques were associated, the rate of PEP was 25%. TPBS and PS represented risk factors for PEP (OR 1.211 for a CI of 0.946–1.551, p = 0.041, and OR 1.124 for a CI of 0.928–1.361, p = 0.088, respectively). No PEP-associated deaths were found. Conclusions: Both PS and TPBS presented a similar risk of PEP. [ABSTRACT FROM AUTHOR]

Inflammatory bowel diseases (IBD) represent a global phenomenon, with a continuously rising prevalence. The strategies concerning IBD management are progressing from clinical monitorization to a targeted approach, and current therapies strive to reduce microscopic mucosal inflammation and stimulate repair of the epithelial barrier function. Intestinal permeability has recently been receiving increased attention, as evidence suggests that it could be related to disease activity in IBD. However, most investigations do not successfully provide adequate information regarding the morphological integrity of the intestinal barrier. In this review, we discuss the advantages of confocal laser endomicroscopy (CLE), which allows in vivo visualization of histological abnormalities and targeted optical biopsies in the setting of IBD. Additionally, CLE has been used to assess vascular permeability and epithelial barrier function that could correlate with prolonged clinical remission, increased resection-free survival, and lower hospitalization rates. Moreover, the dynamic evaluation of the functional characteristics of the intestinal barrier presents an advantage over the endoscopic examination as it has the potential to select patients at risk of relapses. Along with mucosal healing, histological or transmural remission, the recovery of the intestinal barrier function emerges as a possible target that could be included in the future therapeutic strategies for IBD. [ABSTRACT FROM AUTHOR]

Introduction. Suspected small-bowel bleeding may be overt or occult. In the absence of clinically obvious hemorrhagic manifestations, the anemic syndrome secondary to chronic occult loss is often the alarm signal. We present the case of a patient with severe iron deficiency anemia, diagnosed by small-bowel capsule endoscopy (SBCE) with hemorrhagic ileal polyp, with further succesfull surgical solution. Clinical presentation. 74-year-old male patient with significant associated cardiovascular diseases - arterial hypertension, permanent atrial fibrillation, heart failure NYHA class III, undergoing oral anticoagulant therapy. The worsening of the cardiac symptoms lead to the detection of a severe iron deficiency anemia (Hb 6.4/dL), with no overt bleeding. Consequently, the exploration of the gastrointestinal tract was decided. After negative upper gastrointestinal endoscopy, colonoscopy, and abdominal CT examination, SBCE was performed. An irregular sessile protruding lesion, developped on less than a quarter of the circumference, with active bleeding, in the distal third of the small intestine, was seen. Consequently, the surgeon performed a cuneiform ileal resection, with anatomo-pathological result of ulcerated hyperplastic polyp. The immediate and long-term postoperative evolution was favorable, both clinically and biologically, with the amelioration and then remission of the anemia. Conclusions. Infrequent benign tumors, with extremely rare sporadic occurrence, ileal hyperplastic polyps may present with occult hemorrhage as complication, probably having as risk factor the associated anticoagulant treatment, with occult hemorrhage, responsible for severe secondary iron deficiency anemic syndrome. Applying the investigational algorithm for unexplained iron deficiency anemia allows the etiological diagnosis and the application of the curative therapeutic intervention. [ABSTRACT FROM AUTHOR]

Introduction. Gastric duplication cysts (GDCs) are rare congenital anomalies that are characterized by the presence of cystic structures within the gastric wall. The diagnostic is challenging as these lesions often present clinical as well as radiological findings common with other gastric lesions. In this report, we present a case of GDC in a young patient presenting for recurrent epigastric pain. Case presentation. A 25-year-old woman presented for recurrent epigastric pain. An upper digestive endoscopy was performed showing a 2 cm submucosal lesion located in the body of the stomach. Subsequently, an endoscopic ultrasound was performed, thus a well-defined cystic lesion was identified. The lesion presented all layers of the gastric wall; therefore, a gastric duplication cyst was suspected. Fine needle aspiration (FNA) was considered but refused by the patient. For further characterization of the lesion, a magnetic resonance investigation (MRI) of the abdomen was carried out. The result confirmed the presence of a lobulate cyst of 18 mm diameter without apparent communication with the gastric lumen. Surgical treatment was discussed with the patient but follow-up was agreed upon. Discussion. GDCs are rare entities, as only 2-8% of digestive tract duplications are found in the stomach. Although they can be symptomatic, most often these lesions are found during examinations performed for other indications. EUS is essential for the characterization of gastric submucosal lesions as it allows the differentiation between cystic and noncystic lesions and it indicates the layer of origin of the lesion. Moreover, FNA can be performed thus aiding in the final diagnostic. In our case, the combination between EUS and MRI played a crucial role in the diagnosis and management of the GDC. EUS allowed the rapid characterization of the lesion and MRI offered detailed anatomical information as well as the relation to adjacent structures without the need for ionizing radiation. Although most patients receive surgical or endoscopic treatment, follow-up is possible, especially in the setting of small GDCs. Conclusion. This case underlines the importance of EUS and MRI in the evaluation of gastric submucosal tumors and for the identification of rare lesions such as GDCs. Both techniques present good accuracy in the characterization of these lesions and allow for a timely diagnosis, preventing the need for more invasive procedures and allowing for subsequent management decisions to be taken. [ABSTRACT FROM AUTHOR]

Flexible digestive endoscopes are used for the management of various conditions with hundreds of thousands of therapeutic procedures performed worldwide each year. Duodenoscopes are indispensable tools for the delivery of minimally invasive vital care of numerous pancreaticobiliary disorders. Despite the fact that nosocomial infections after endoscopic retrograde cholangiopancreatography (ERCP) have always been among the most frequently cited postprocedural complications, recent emergence of duodenoscope-transmitted multiple drug-resistant bacterial infections has led to intense research and debate yet with no clearly delineated solution. Duodenoscope-transmitted nosocomial infections have become one of the most visible topics in the recent literature. Hundreds of high-impact articles have therefore been published in the last decade. This review article discusses how such infections were seen in the past and what is the current situation in both research and practice and thus tries to solve some of the unanswered questions for the future. With the persistence of nosocomial infections despite strict adherence to both manufacturer-issued reprocessing protocols and international guidelines and regulations, an urgent and proper microbiologically driven common action is needed for controlling such nosocomial worldwide threat. [ABSTRACT FROM AUTHOR]

The article examines on the effectiveness of endoscopic retrograde colangiopancreatography (ERCP) for pancreatitis diagnostic examination. An overview on the endoscopic method in the management of pancreatic and biliary diseases in the U.S., is provided. Also emphasized are the efforts on how to prevent post (ERCP) pancreatitis.

Introduction. Climate change and its impact on the environment are matters of high concern. Thus, recent European recommendations for environmental sustainability in endoscopy have been published. We aimed to assess the real-life perception of those recommendations as well as the level of implementation in a tertiary-care center in North-Eastern Romania. Methods. We included medical personnel from a tertiary-care center in North-Eastern Romania, namely senior and junior gastroenterologists, residents, and endoscopy nurses. An online survey was developed, that included the statements from the latest British Society of Gastroenterology (BSG), Joint Accreditation Group (JAG), and Centre for Sustainable Health (CSH) joint consensus on practical measures for environmental sustainability. Participants were asked to provide their opinion on the statements choosing their position from strong disagreement, disagreement, agreement, strong agreement, and no opinion. The results were collected confidentially and analyzed. Results. There were 29 participants, aged 36.9 ± 8.17 years old, mostly women (42.5%). Among the respondents 11 were senior gastroenterologists, 6 were junior gastroenterologists, 8 were residents, and 4 were endoscopy nurses. Most participants agreed that endoscopy was an important source of waste (65.5%) and that measures are needed to reduce the negative impact of endoscopy on the environment (62%). Concerning the need for strict adherence to professional guidelines when considering the indication for endoscopy 44.8% of the respondents strongly agreed while 34.5% agreed. Sustainable alternatives to conventional diagnostic endoscopy were favored however by only 48% of the respondents while 27.6% strongly disagreed. Trainee involvement based on methods including simulation and online image libraries was mostly disagreed upon (51.7%). All participants agreed that both upper and lower digestive endoscopies should be grouped on the same day and 86.2% of the respondents considered that the use of single-use endoscopes should be restricted to select indications. More than 50% of the participants strongly agreed on the need for sustainability in new decontamination units. Most participants agreed that the judicious use of sterile water is necessary to reduce the impact on the environment as well as the minimization of histopathology use. With one exception, all respondents agreed that endoscopy accessories should be carefully considered and planned pre-procedure to minimize waste. Over 50 % of the respondents strongly agreed that the judicious use of NO as well as paperless protocol use and optimization of PPE should be implemented. Over 60% agreed that, when possible, personnel should be able to work from home. However, most participants did not agree with the proposed lowflow devices on water taps. The use of renewable energy sources as well as energy-efficient lighting of the endoscopy unit was agreed upon by most participants as well as efficient waste management. All participants agreed that heating, ventilation, and air conditioning would be turned off when endoscopy rooms were not in use. Over 70% agreed that patients should bring their cups to the hospital. More than 80% considered that remote consultation could be the default means of providing post-endoscopy follow-up. However, only 25% considered that alternative investigations would eventually replace endoscopy. Concerning the implementation of these measures, only 34% agreed that they were already implemented in Romania, while over 50% considered that they could be implemented in our country. Conclusions. All in all, most of the proposed measures for environmental sustainability in endoscopy were agreed upon by the participants. There was however disagreement concerning the replacement of endoscopy by alternative investigations as well as the use of methods other than endoscopy for trainees to reduce the number of procedures. [ABSTRACT FROM AUTHOR]

Introduction: Alcohol consumption (AC) represents a widespread cause of liver diseases affecting 10–20% of the population. The study aimed to evaluate the relationship between advanced liver fibrosis (ALF) measured by transient elastography (TE), laboratory parameters, and the amount of AC depending on non-modifiable risk factors such as age and gender. Methods: We examined 689 patients with an average age of 49.32 ± 14.31 years, 72.9% males, without liver pathology, who admitted a moderate/high consumption (female ≤ 7 versus > 7 drinks/week; male ≤ 14 versus > 14 drinks/week) for at least five years. The fibrosis level was adjusted according to transaminase levels. Predictive factors were established using univariate regression analysis. Results: ALF (≥F3) was detected in 19.30% of subjects, predominantly males (14.1%) and patients over 55 years (12.5%). Excessive consumption of distilled spirits is associated with ALF in females (OR = 4.5), males (OR = 6.43) and patients over 55 years (OR = 3.73). A particularity highlighted in both genders, regardless of the age group, was the negative correlation between the decrease in the number of platelets, the albumin concentration, and the appearance of AFL. Conclusions: Screening using TE represents an approach for early detection of ALF in asymptomatic populations and the development of a risk stratification scheme. [ABSTRACT FROM AUTHOR]

Background. Inadvertent injection of a contrast agent into the pancreatic duct is an important contributor factor to post-ERCP pancreatitis. Aim. To compare the incidence of post-ERCP pancreatitis and the success rate of biliary cannulation using guide-wire cannulation or the standard contrast injection technique. Methods. A total of 128 patients with choledocholithiasis who underwent either guide-were cannulation (n=70) or contrast injection (n=58) were retrospectively reviewed. Outcome measurements were post-ERCP pancreatitis and rate of successful common bile duct (CBD) cannulation. Results. Three patients (4.3%) in the guide-wire cannulation group and five patients (8.6%) in the contrast injection group had post-ERCP pancreatitis (p>0.05). Successful CBD cannulation was achieved in 91.4% with guide-wire cannulation and in 88% with conventional contrast cannulation (p>0.05). Conclusion. Our study failed to show significant reduction in the rate of post-ERCP pancreatitis with the use of guide-wire, although there was a downward trend. The success rate of cannulation was comparable between the two techniques. [ABSTRACT FROM AUTHOR]

Background: Extrahepatic cholestasis that is caused by benign and malignant diseases has been reported to increase liver stiffness (LS), as measured by transient elastography (TE). Objectives: The aim of this study was to evaluate LS in patients with extrahepatic cholestasis due to choledocholithiasis before and after endoscopic sphincterotomy and stone removal. Patients and Methods: LS was measured by TE (Fibroscan) in patients with extrahepatic cholestasis that was caused by choledocholithiasis before and 1 month after endoscopic sphincterotomy and successful stone removal. Results: We studied 12 patients (7 females, 5 males), aged 36 to 76 years (mean age 57.1 ± 11.6 years), with extrahepatic cholestasis that was caused by choledocholithiasis.LS was increased in all patients (range: 6.2-18.4 kPa; mean: 8.9 ± 3.5 kPa) before endoscopic therapy. Successful biliary drainage was effected by sphincterotomy and stone removal in all patients, which led to a significant decline in LS to 3.9-8.1 kPa (Mean: 5.6 ± 1.2 kPa; p < 0.001) within a mean observation time of 29 days. The decrease in LS values correlated significantly with a decline in serum total bilirubin levels (r = 0.691; p < 0.0001). Conclusions: Extrahepatic cholestasis due to choledocholithiasis increases LS and should be excluded before assesing liver fibrosis by transient elastography. [ABSTRACT FROM AUTHOR]

Background and Aim: Gastroparesis and/or dyspeptic symptoms occur in around 50% of type 1 diabetic patients. The aim of our study was to evaluate the prevalence of gastroparesis in patients with type 1 diabetes using 13Coctanoic acid breath test (13C-OBT) and the relationship between dyspeptic symptoms and gastric emptying. Methods: Gastric emptying of solids was evaluated prospectively in euglycemic conditions in 69 type 1 diabetic patients (male/female: 36/33; mean age 49.5 ± 14.2 years; mean duration of diabetes 20.4 ± 8.2 years) and 40 healthy volunteers (male/female 17/23; mean age 34.3 ± 16 years) using 13C-OBT. Dyspeptic symptoms, autonomic nerve function and Helicobacter pylori (H. pylori) status were assessed. Results: Solid gastric emptying was slower in diabetic patients (T1/2=125.36 ± 31.5min) than in healthy subjects (T1/2=88.5 ± 27.3 min) (p<0.05). Gastric emptying was slower in diabetic female compared to diabetic male patients (p<0.05). Body mass index (BMI) was the only independent predictor for delayed solid gastric emptying in a logistic regression model testing HbA1c, BMI, age, diabetes duration, H. pylori status, peripheral neuropathy, retinopathy, nephropathy, and autonomic neuropathy. Abdominal bloating and upper abdominal pain were associated with delayed gastric emptying. Conclusions: We found that 33.7% of type 1 diabetic patients had delayed gastric emptying that correlated with female gender, increased BMI, abdominal bloating and upper abdominal pain. [ABSTRACT FROM AUTHOR]

Atrial fibrillation is frequently diagnosed in patients with liver cirrhosis, especially in those with non-alcoholic steatohepatitis or alcoholic etiology. Anticoagulant treatment is recommended for thromboembolic protection in patients with atrial fibrillation. Considering the impaired coagulation balance in liver cirrhosis, predisposing patients to bleed or thrombotic events, the anticoagulant treatment is still a matter of debate. Although patients with liver cirrhosis were excluded from the pivotal studies that confirmed the efficacy and safety of the anticoagulant treatment in patients with atrial fibrillation, data from real-life cohorts demonstrated that the anticoagulant treatment in patients with liver cirrhosis could be safe. This review aimed to evaluate the recent data regarding the safety and efficacy of anticoagulant treatment in patients with decompensated liver cirrhosis. Direct oral anticoagulants are safer than warfarin in patients with compensated liver cirrhosis. In Child–Pugh class C liver cirrhosis, direct oral anticoagulants are contraindicated. New bleeding and ischemic risk scores should be developed especially for patients with liver cirrhosis, and biomarkers for bleeding complications should be implemented in clinical practice to personalize this treatment in a very difficult population represented by decompensated liver cirrhosis patients. [ABSTRACT FROM AUTHOR]

Chronic hepatitis C infection is a systemic disease that affects over 71 million patients all over the world and it is to be considered nowadays as a new cardiometabolic risk factor. This study aimed to evaluate the weight and metabolic changes after viral eradication in patients with hepatitis C virus (HCV) infection. We conducted a prospective study between October 2017 to December 2021, in a tertiary care center, in which we included 132 patients with HCV or cirrhosis. All patients received treatment with direct antivirals (DAAs) and achieved sustained viral response at 12 weeks (SVR12). During the study, clinical laboratory data and Fibroscan examinations were recorded in all patients. The study group was evaluated at the initiation of antiviral treatment, at SVR12, and within an average follow-up period of 6 months to 12 months after the previous evaluation. Evaluation at SVR12 and the data recorded in the post-SVR surveillance period show a further increase in BMI compared with baseline measurements with a statistically significant difference (27.11 ± 3.22 vs. 27.415 ± 3.03 vs. 28.04 ± 1.11 kg/m2, p = 0.012). The same observation was noticed for waist circumference (WC) at post-SVR evaluation (87.6 ± 13.1 vs. 88.4 ± 13.6 cm, p = 0.031). Moreover, the study population registered an increase in the average total cholesterol (TC) values at post-SVR evaluation (177.01 ± 42.2 mg/dL, p = 0.014) compared to baseline. In addition, the serum level of triglycerides had been modified after viral clearance, with a minimal decrease in the mean values of triglycerides (TGD) at SVR-12 assessment (133.48 ± 41.8 mg/dL, p = 0.78), followed by a significant increase to the mean value of 145.4 ± 47.2 mg/dL (p = 0.026) in the third evaluation. Our study highlights that HCV eradication does not improve the lipid profile in the short term, and these patients still have an additional cardiovascular risk factor due to high levels of TC, TGD, and weight gain. [ABSTRACT FROM AUTHOR]

Background and Aims: Inflammatory bowel diseases (IBD) are frequently associated with extraintestinal manifestations, hepatic injury being of concern in these patients. Current literature reports an increased prevalence of liver steatosis and fibrosis in subjects with IBD and the pathophysiology is yet to be completely understood. The aim of this study was to assess the prevalence of non-alcoholic fatty liver disease (NAFLD) in patients with IBD, as well as to determine the factors that connect these two disorders. Methods: From September 2021 to June 2022, 82 consecutive IBD patients were enrolled from a tertiary care center hospital in Iasi. Vibration-Controlled Transient Elastography with Controlled Attenuation Parameter (CAP) was used to assess the presence of NAFLD, with a cut-off score for CAP of 248 dB/m. Significant liver fibrosis was considered at a cut-off for liver stiffness measurements (LSM) of 7.2 kPa. Results: In total, 82 IBD patients (54.8% men, mean age of 49 ± 13 years) were included, 38 (46.3%) of them being diagnosed with NAFLD, with a mean CAP score of 286 ± 35.4 vs. 203 ± 29.7 in patients with IBD only. Age (β = 0.357, p = 0.021), body mass index (BMI) (β = 0.185, p = 0.048), disease duration (β = 0.297, p = 0.041), C—reactive protein (β = 0.321, p = 0.013), fasting plasma glucose (β = 0.269, p = 0.038), and triglycerides (β = 0.273, p = 0.023) were strongly associated with the presence of liver steatosis. The multivariate analysis showed that older age, BMI, and disease duration were strongly associated with significant liver fibrosis in our group. Conclusions: NAFLD is a multifaced pathology with growing prevalence among IBD patients. Additional studies are needed to completely understand this problem and to create a solid evidence-based framework for more effective preventative and intervention strategies. [ABSTRACT FROM AUTHOR]

Infections and sepsis represent severe liver cirrhosis (LC) complications and the precipitating factors of hepatic encephalopathy (HE). The early diagnosis and treatment of infections in patients with LC and HE can significantly increase their survival. Presepsin is a serum biomarker evaluated for the early diagnosis of infections and sepsis in the general and cirrhotic populations. This study aimed to evaluate the role of presepsin in the early diagnosis of infections in patients with LC and HE. This prospective observational study included all consecutive cirrhotic patients admitted to our tertiary university center with overt HE. The patients were follow-up until discharge. In this study, we included 365 patients with a median age of 59 years, of whom 61.9% were male. Infections were diagnosed in 134 patients (36.7%). The presepsin level was higher in patients with infections than those without infections (3167 vs. 500, p < 0.001). The ROC analysis results demonstrated that the best cut-off value for presepsin in infections detection was 980 pg/mL with a sensitivity of 80.17%, specificity of 82.5% (AUROC 0.869, CI 95%: 0.819–0.909, p < 0.001, Youden index J of 0.622), a positive predictive value of 40.63%, and a negative predictive value of 96.53%. In conclusion, in patients with LC and overt HE, presepsin levels >980 pg/mL could enhance the suspicion of bacterial infections. Presepsin may be an adequate non-invasive tool for the early diagnosis of infections in patients with LC and overt HE. [ABSTRACT FROM AUTHOR]

Non-alcoholic fatty liver disease (NAFLD) is a common finding among patients with type 2 diabetes mellitus (T2DM). Between NAFLD and T2DM exist a bidirectional relationship. Patients with T2DM are at high risk for NAFLD, and evidence suggests that T2DM is linked to progressive NAFLD and poor liver outcomes. NAFLD promotes the development of T2DM and leads to a substantial increase in the risk of T2DM complications. This study aimed to assess the prevalence of liver steatosis and fibrosis in patients with T2DM from north-eastern Romania by using Vibration-Controlled Transient Elastography (VCTE) with Controlled Attenuation Parameter (CAP), which is a non-invasive method and can assess simultaneously liver steatosis and fibrosis. In total, 424 consecutive patients with T2DM were enrolled and evaluated using VCTE with CAP from January 2020 to January 2022. Clinical and laboratory data were recorded in all patients. For the CAP score, we used the following cut-offs: mild steatosis (S1)—274 dB/m, moderate steatosis (S2)—290 dB/m, and severe steatosis (S3)—302 dB/m. For liver fibrosis, to differentiate between fibrosis stages, the cut-off values were F ≥ 8.2 kPa for significant fibrosis (F2), F ≥ 9.7 kPa for advanced fibrosis (F3), and F ≥ 13.6 kPa for cirrhosis (F4). In total, 380 diabetic patients (72.6%) had liver steatosis (51.3% females, the mean age of 55.22 ± 10.88 years, mean body mass index (BMI) 29.12 ± 5.64 kg/m2). Among them, 26 (8.4%) patients had moderate liver steatosis (S2) and 242 (78.5%) patients had severe hepatic steatosis (S3). According to VCTE measurements, 176 (57.14%) patients had liver fibrosis, 36 (11.7%) of them had advanced fibrosis (F3), and 42 (13.6%) diabetic patients had cirrhosis (F4). Univariate analyses showed that severe steatosis was significantly associated with ferritin (β = 0.223, p = 0.022), total cholesterol (β = 0.159, p = 0.031), and HDL-cholesterol (β = −0.120, p = 0.006). In multivariate analyses, BMI (β = 0.349, p < 0.001), fasting plasma glucose (β = 0.211, p = 0.006), and triglycerides (β = 0.132, p = 0.044) were predictors of S3. Patients with T2DM have a high prevalence of severe steatosis and advanced fibrosis which can lead to the development and progression of complications with high morbidity and mortality rates. Hence, it is necessary to implement screening strategies to prevent advanced liver disease in patients with T2DM. [ABSTRACT FROM AUTHOR]

Non-alcoholic fatty liver disease (NAFLD) has had, over the past few decades, a progressively growing prevalence among the general population all over the world, in parallel with metabolic conditions such as type 2 diabetes mellitus (T2DM), dyslipidemia, and obesity. However, NAFLD is also detected in 10–13% of subjects with a body mass index (BMI) ≤ 25 kg/m² (lean-NAFLD), whose major risk factors remain unknown. In this study, we aimed to characterize the clinical features and associated risk factors of lean-NAFLD in comparison with obese-NAFLD patients. Consecutive patients diagnosed with NAFLD by vibration-controlled transient elastography and controlled attenuation parameter were prospectively enrolled. Biological and clinical data obtained from the participants were stratified according to their BMI in two groups: lean-NAFLD and obese-NAFLD. In total, 331 patients (56.8% males) were included in the final analysis. Most of the subjects were obese-NAFLD (n = 258, 77.9%) and had a higher prevalence of T2DM, dyslipidemia, and components of the metabolic syndrome, together with abnormal biological parameters. Regarding liver stiffness measurements, the proportion of subjects with at least significant fibrosis (≥F2) was approximately twofold higher among obese-NAFLD (43.81%) in comparison with lean-NAFLD patients (23.29%). Moreover, obese individuals had a higher risk for liver fibrosis (OR = 2.6, 95%, CI 1.5–4.42, p < 0.001) than lean individuals. Although associated metabolic conditions and at least significant liver fibrosis were present in approximately one-quarter of the patients, these were more frequent among obese-NAFLD patients. Therefore, individualized screening strategies for NAFLD should be established according to BMI. [ABSTRACT FROM AUTHOR]

Chronic hepatitis C virus (HCV) infection induces hepatic steatosis due to viral and host factors. However, information regarding the effects of direct-acting antivirals (DAAs) therapy on liver steatosis and fibrosis is limited. Vibration-controlled transient elastography (VCTE) with a controlled attenuation parameter (CAP) represents a non-invasive method, which has been used in the last few years for the detection of hepatic steatosis and fibrosis before and at a sustained virological response at 12 weeks (SVR12). The aim of this study was to assess the modifications of liver steatosis and fibrosis in HCV-infected patients who achieved SVR12. Consecutive patients with chronic HCV infection that were treated with DAAs in a tertiary gastroenterology center from Romania were included. Demographics, laboratory data, and VCTE evaluation were recorded in all patients. Patients with previous hepatic decompensation and those who did not achieve SVR were excluded. Two hundred and eighty patients (67.1% females) who achieved SVR12 were included. Regarding the changes in biological parameters, including liver enzymes such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST), reduced to normal levels at SVR12 compared to the baseline (28.72 ± 24.71 U/L vs. 40.72 ± 27.34 U/L for ALT, p < 0.013 and 27.21 ± 11.15 U/L vs. 33.35 ± 23.37 U/L for AST, p = 0.029). On the contrary, the levels of triglycerides increased significantly from the baseline to SVR12 (124.03 ± 113.49 mg/dL to 153.78 ± 94.53, p = 0.004). Regarding hepatic steatosis by CAP evaluation, at SVR12, 186 (66.4%) of the individuals had a CAP score of ≥248 dB/m, an increase of 4.6% from the baseline. After viral eradication with DAAs, we observed an increase in hepatic steatosis. Hence, a long-term follow-up is mandatory to identify HCV-infected patients with hepatic steatosis post-SVR and the risk factors for more severe outcomes. [ABSTRACT FROM AUTHOR]

Vibration-Controlled Transient Elastography (VCTE) with Controlled Attenuation Parameter (CAP) is a widely used non-invasive technique for concomitant assessment of liver steatosis and fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). We aimed to evaluate the level both of hepatic steatosis and fibrosis as well as the associated risk factors in patients referred to our unit with clinically suspected NAFLD or diagnosed by abdominal ultrasonography. Two hundred four patients were prospectively included in this study and assessed by VCTE with CAP. The final analysis included 181 patients with reliable liver stiffness measurements (LSMs) (53% female, mean age 57.62 ± 11.8 years and BMI 29.48 ± 4.85 kg/m2). According to the cut-off values for steatosis grading, there were 10 (5.5%) patients without steatosis (S0), 30 (16.6%) with mild (S1), 45 (24.9%) moderate (S2), and 96 (53%) severe (S3) steatosis. Based on LSM, there were 73 (40.3%) patients without fibrosis (F0), 42 (23.2%) with mild (F1), 32 (17.7%) significant (F2), 19 (10.5%) advanced (F3) fibrosis, and 15 (8.3%) with cirrhosis (F4). In addition, we found an association between several metabolic components and hepatic steatosis and fibrosis. Thus, in the multivariate analysis, higher BMI, fasting plasma glucose, triglycerides, low-density lipoprotein cholesterol, and serum uric were associated with increased CAP. Furthermore, higher serum uric acid and alpha-fetoprotein together with lower platelets count and albumin levels were associated with increased LSM. The assessment of steatosis and fibrosis using VCTE and CAP should be performed in all patients with suspected or previously diagnosed NAFLD in units with available facilities. [ABSTRACT FROM AUTHOR]

Background: Considering the excellent safety profile and the high efficacy rates, great benefits were expected with the availability of the new direct-acting antivirals (DAAs) in treating hepatitis C virus (HCV) infection. Following the publication of two articles in 2016 on the high incidence rates of HCC following DAAs, several papers revealed contradictory results, thereby casting shadows on the role of DAAs in hepatocarcinogenesis. Objectives: The present study aimed to assess the incidence and risk factors of HCC in patients with HCV genotype 1b infection and compensated cirrhosis with the sustained virological response (SVR) following DAAs. Methods: This multicentric prospective study encompassed 479 patients with HCV genotype 1b compensated cirrhosis treated with paritaprevir/ritonavir/ombitasvir and dasabuvir (PrOD) +/- ribavirin (RBV) for 12 weeks in two tertiary centers in Northeastern Romania. The patients were prospectively followed up in the Institute of Gastroenterology Iasi, Romania, from November 2015 to December 2020. Results: During the follow-up period (mean 60.11-3.87 months), 23 patients (4.8%) developed HCC. The 1-, 3-, and 5-year cumulative incidence rates of HCC were 1.1, 1.9, and 2.6%, respectively. At the time of the diagnosis, 15 patients (65%)had a single tumor, 12 patients (52.2%)were within the Milan criteria, and nine persons (39%) had Barcelona liver cancer stage 0-A. In this regard, the mean AFP level was 35.3-93.1 ng/mL. A multivariate analysis, age above 65 years, and a cutoff point of AFP≥ 10 ng/mL at the end of treatment were independent factors associated with HCC. A majority of the patients (n = 11, 47.8%) received curative treatment by surgical resection. In this study, histopathological examination identified a moderately differentiated tumor (G2) in 5 patients, five patients had a poorly differentiated tumor (G3), and only one patient had a well-differentiated tumor (G1). Conclusions: Our study revealed no evidence of the high incidence rate of HCC after the long-term follow-up of patients with HCV-related liver cirrhosis and SVR following DAA treatment. However, the cumulative 5-year risk remained above the cutoff point, and this makes the HCC screening cost-effective. The HCC occurrence appears to be associated with aging and a moderately increased AFP level at EOT (≥ 10 ng/mL). [ABSTRACT FROM AUTHOR]

The article reports that Hepatitis C virus (HCV) is one of the leading causes of chronic liver disease and liver-related deaths, and worldwide. Topics include the revolution in HCV treatment with direct acting antiviral agents (DAAs) since 2014 has entirely changed the landscape of HCV therapy, and the disease that was cured only in less than half of patients with a long therapy and with side effects is now a disease that can be eradicated.

Background. There is no unique diagnostic test for Crohn's disease, and the diagnosis of isolated small bowel Crohn's disease (SBCD) is even more challenging, due to non-patognomonic clinical picture and low availability of accurate exploration methods. Small bowel capsule endoscopy (SBCE) revolutionized the approach of middle gastrointestinal tract, becoming the first investigation tool when small bowel pathology is suspected. Objective of the study. The aim of our study was to assess the value of SBCE in diagnosing isolated SBCD. Materials and Methods. We retrospectively studied the patients undergoing SBCE for suspected isolated SBCD, in a six-year period, including in our analysis only the patients with a minimum one-year follow-up period. We calculated the diagnostic yield of SBCE, defined as number of capsule endoscopy exams whith positive findings, and we also assessed its yearly variation in time over the six-year period. Subsequently, analyzing follow-up data, positive and negative predictive values were assessed. Results. 78 patients were investigated by SBCE for suspected isolated SBCD. SBCE showed lesions compatible with the diagnosis of SBCD in 49 patients, corresponding to a specific diagnostic yield of 62.8%, while for the remaining 29 patients (37.2%), no CD lesions were found. Following additional investigations, three of the 49 patients initially thought as having isolated SBCD were reclassified as SB lymphoma, eosinophilic gastroenteritis and intestinal tuberculosis, respectively, corresponding to a positive predictive value of 93.8%. During followup, none of the 29 patients with negative SBCE was diagnosed with CD, corresponding to a negative predictive value of 100%. We found a progressively increase of the diagnostic yield over time (from 42.6% in the first year to 70.2% in the last year of the analyzed period), corresponding the most probably to the refinement of the indication. Conclusions. Despite a relatively low diagnostic yield, SBCE has a good positive predictive value for isolated SBCD. However, as CE is a purely visual technique with no capability of taking biopsies, final diagnosis needs confirmation by additional investigations. Nevertheless, SBCE has a 100% negative predictive value, being an excellent tool for rulling out isolated SBCD. Refinement of the indication could ensure a better diagostic yield. [ABSTRACT FROM AUTHOR]

Introduction. Non-alcoholic fatty liver disease (NAFLD) is usually associated with type 2 diabetes mellitus (T2DM). The limited number of NAFLD treatment options is well known. Semaglutide, a GLP-1 receptor agonist approved to treat T2DM, is crucial for obtaining a healthy weight. Additionally, may constitute a cutting-edge therapy option for T2DM patients with NAFLD. In this study, liver steatosis and fibrosis in T2DM patients are measured using vibration-controlled transient elastography (VCTE) with controlled attenuation parameter (CAP). Material and Methods. Fifty-seven consecutive patients with T2DM and NAFLD receiving oral semaglutide were enrolled from September 2022 to February 2023 and evaluated by VCTE with CAP. Clinical and analytical data for every subject were recorded. Oral semaglutide was initiated at a dose of 3 mg once daily and subsequently increased to 7 mg at 4 weeks, and 14 mg at 8 weeks in accordance with the diabetologist's recommendations. Results. VCTE analysis showed that 40 diabetic people (70.2%) had significantly lower CAP levels after 24 weeks compared to baseline. Only 14 (24.5%) diabetic patients experienced a significant decrease in liver fibrosis. Regarding body mass index (BMI), aspartate aminotransferase (AST) and alanine aminotransferase (ALT), have improved significantly compared to the baseline (mean BMI 28.72±5.43 kg/m2 to 25.67 ±6.11 kg/m2, mean AST 58.17 ± 16.33 IU/L to 34.54 ± 13.8 IU/L, mean ALT 63.31 ± 12.66 IU/L to 39.17 ± 14.3 IU/L). The mean hemoglobin A1c (HbA1c) value reduced significantly from baseline to 24 weeks (from 8.9% to 7.4%). A significant correlation existed between changes in CAP values and fasting plasma glucose (p=0.31, p=0.52), as well as AST (p=0.188, p=0.48), and BMI (p=0.274, p=0.44). Nausea and diarrhea were the most often reported side effects. Conclusion. In individuals with T2DM with NAFLD, oral semaglutide therapy has improved glycemic control, liver enzymes, body weight, and liver steatosis. These findings suggest that semaglutide may be useful in the treatment of NAFLD patients, therefore more studies concerning liver fibrosis are necessary. [ABSTRACT FROM AUTHOR]

Introduction. The overall burden of B / D and C viral hepatitis remains substantial, despite the major advances in the prevention and treatment of patients in recent years, due to comorbidities and complications associated with liver disease. In this context, the national screening program LIVE (RO) 2 aims to further assess all patients identified as positive for one of the hepatitis B / D / C viruses. Objectives. The study aimed to identify fortuitous pathologies discovered in patients with chronic viral B / D / C infection diagnosed in the LIVE (RO) screening program 2. Materials and Methods. We conducted a prospective study that included people from vulnerable groups (poor, uninsured, rural people, people in foster care, homeless, Roma population, people with disabilities, and suffering from alcohol or drug addiction) in different areas of North-Eastern Romania, between July 2021 - December 2022, during the national screening program LIVE (RO) 2-EAST. We also investigated the presence of newly discovered conditions in patients who tested positive and directed to the Institute of Gastroenterology and Hepatology in Iasi for the staging of liver disease and the establishment of antiviral treatment. Results. The study group included 1176 patients, of which 422 men (35.8%) and 754 women (64.1%), aged between 35 and 83 years, with a mean age of 56.32 years. The predominant source of origin was rural (73.1%). Of the patients with positive RDTs, 635 (53.9%) patients were detected with HBsAg, 521 (44.3%) patients with anti-HCV antibodies, and 20 (1.7%) patients with anti-HVD antibodies. Of these, 215 patients (18.2%) were diagnosed with a new pathology associated with B / D / C viral infection. The most common pathologies discovered incidentally were liver cirrhosis (94, 43.7%), liver cysts (35, 16.2%), liver hemangiomas (29, 13.4%), gallstones (24, 11.1%), type II diabetes mellitus (T2DM) (15, 6.9%), uterine fibroids (9, 4.1%), hepatocellular carcinoma (7, 3.2%), choledochal lithiasis (2, 0.9%). In addition, the presence of fortuitous pathologies was higher among patients with HBV infection than in those with HCV infection (65.3% vs. 42.1%, p = 0.012). Among the risk factors associated with hepatocellular carcinoma (HCC) are chronic alcohol consumption (43%, compared to 19% in the group of patients without HCC), and the association of T2DM in 3 patients (31%, compared to 10% in the group of patients with HCC). Conclusions. Patients with chronic B / D / C viral infection had a high prevalence of incidentally detected comorbidities, which necessitates the need for public health policies in vulnerable groups to promote access to existing health services to reduce the future burden of chronic diseases but also secondary complications of chronic liver disease. [ABSTRACT FROM AUTHOR]

Introduction. In recent decades, alcohol consumption, as part of an unhealthy lifestyle, which has been on the rise in many parts of the world, is a key factor that explains the constant upward trend of mortality associated with this etiology. This study aimed to investigate the prevalence of liver fibrosis in the asymptomatic alcohol-consuming population. Objectives. The purpose of the study was to evaluate the relationship between advanced liver fibrosis measured by transient elastography, laboratory parameters, and the amount of alcohol consumed depending on non-modifiable risk factors such as age and gender. Material and method. Between January 2022 and December 2022, we examined patients with day hospitalization in the Institute of Gastroenterology and Hepatology in Iasi, without liver history, who admitted a moderate or high consumption (women <7 versus >7 drinks/week; men <14 versus >14 drinks/week) for at least one year. The classification of the fibrosis stage by transient elastography was adjusted according to transaminase values. The results were analyzed by univariate analysis and logistic regression to establish models of prediction. Results: The study included 689 patients with an average age of 49.32±14.31 years, a proportion of 63.7% represented by men. Advanced fibrosis (F3) was detected in 19.30% of the examined patients, predominantly in men (14.1%) and patients over 55 years old (12.5%). Excessive alcohol consumption is associated 2 times more with advanced fibrosis in women (OR=5.08; CI 95%: 3.45-9.50) and the group under 40 years old (OR=6.29; CI 95%: 1.67-9.43) compared to men (OR=2.27; CI 95%: 1.76-3.81) respectively patients over 55 years old (OR=3.21; CI 95%: 2.28-4.45) (p<0.05). Using logistic regression, it was demonstrated that there was a strong correlation between advanced fibrosis, excessive alcohol consumption, low serum albumin level and the reduction of triglycerides in men (R2 Nagelkerke = 0.854; p<0.001) supplemented with the reduction of cholesterol in the age group 40-55 years (R2 Nagelkerke = 0.785; p<0.001), respectively of ferritin in those over 55 years old (R2 Nagelkerke = 0.804; p<0.001). The association of excessive alcohol consumption, age, low levels of albumin, LDL-cholesterol and C-reactive protein generated a significant predictive model (R2 Nagelkerke = 0.784; p<0.001) for female patients. Conclusion. Screening using transient elastography represents an approach that could provide early diagnosis of advanced liver fibrosis in an asymptomatic population, with the possibility to prevent the evolution of ALD and the development of complications of cirrhosis. [ABSTRACT FROM AUTHOR]

Introduction. A frequent problem in daily practice that gastroenterologists have to confront with is Helicobacter pylori infection. The stomach is where H. pylori infection naturally occurs, this bacterium being the cause of pathologies such as gastritis, peptic ulcer, MALT lymphoma and stomach cancer. Additionally, there is proof connecting the bacteria to a number of extra-gastric pathologies. Case report. We report the case of a 55 year old patient from a rural area, with no significant heredocollateral antecedents, with a history of cardiovascular pathology (Hypertension and Chronic Coronary Syndrome) investigated for digestive bleeding (intermitent hematochezia), important physical astenia, loss of appetite, diffuse abdominal pain and weight loss (5 kg/one month). Clinical investigation reveals: good general condition, pale teguments and mucous membranes, koilonychia, tachycardia (115 bpm), decreased left-based vesicular murmur. Laboratory examinations reveal hipochromic microcyte anemia, negative viral and autoimmunity markers, normal kidney function, normal tumor markers, except increased carcinoembryonic antigen (CEA) (9,2 ng/ml). An upper digestive endoscopy is being performed, which reveals anthral gastritis, a spastic pylorus and a congestive bulb with a 1,5 cm diameter ulcer located on the anterior wall, Forrest III. Due to its position and difficulty to reach, no biopsy for H. pylori was taken from the ulcer, however, the IgG H. pylori antibodies and fecal antigen were positive, which determined the initiation of treatment in order to eradicate the infection. Colonoscopy shows an isolated ulcerated lesion, easily bleeding when touched with the colonoscope, but with no active bleeding focus, located in the right colon. Pathology of the biopsy material was suggestive for adenocarcinoma, which determined the patient's redirection to the surgery clinic for the surgical treatment to be performed. Discussion. The particularity of the case is the association of a duodenal ulcer H. pylori positive with right colon neoplasm, but without any other declared risk factors, H. pylori being a recognized class of human carcinogens and there are numerous studies in literature that have looked into the connection between H. pylori infection and colorectal cancer. Conclusion. Finding out how this organism plays a role in various pathologies can be aided by eradicating this infection and reevaluating individuals who have recovered from it. It is yet unclear what the underline pathophysiology of this association is, so more fundamental research in this area is needed. [ABSTRACT FROM AUTHOR]

Introduction. Gastrointestinal bleeding is one of the most important medical-surgical emergencies. Upper gastrointestinal bleeding (UGIB), defined as hemorrhage having its origin above Treitz'angle, is the most frequent type, and is suspected when the patient present with hemethemesis and/or melena. Etiological diagnosis is vital for the patients'prognosis, and it relies mostly on upper gastrointestinal endoscopy (UGIE). However, endoscopy can show more than one bleeding or potentially bleeding lesion. Aim. The objective of our study was to analyze the frequence of multiple potentially bleeding lesions as seen in emergencies upper gastrointestinal endoscopies. Material and Methods. We performed a retrospective study on patients with acute UGIB presented in the Emergency Department of „St. Spiridon" Clinical County Hospital, investigated by UGIE, in the last six months; epidemiological, clinical and biologic data were recorded, as well as the results of UGIE. Furthermore, correlations between the presence of multiple potentially bleeding lesions and clinical and biological factors were made. Results. 480 patients with suspected acute UGIB were investigated by emergency UGIE. The bleeding source was found in 375 (78%) patients; among them, 278 (58%) patients had one single bleeding lesion, while in 97 (14%) patients more than one potentially bleeding lesion was found. For the remaining 105 (22%) patients, no obvious causal lesion were found, and they were further investigated. The most frequent unique lesions were peptic ulcers and gastro-oesophageal varices, while the most encountered associations were Mallory-Weiss syndrome and peptic ulcer, and gastrooesophageal varices and gastro-duodenal ulcer. The factors correlated with the presence of multiple potentially bleeding lesions were: age, alcohol consumption, the presence of cirrhosis and Charleson comorbidity index. Conclusions. Even if in most cases UGIE is diagnostic for UGIB, there are cases when no lesions are found and also cases with more than one potentially bleeding lesion. Older age, the alcohol consumption, cirrhotic patients and the presence of comorbidities are associated with multiple potentially bleeding lesion. Thorough clinical examination and accurate endoscopic exam are mandatory for the right diagnosis and treatment, to ensure the most favorable patients' outcome. [ABSTRACT FROM AUTHOR]

Background. Specific Baveno VII consensus recommendations are based on the reliability of noninvasive criteria to rull out or rull in clinically significant portal hypertension (CSPH). Aim. We aimed to assess the translation into the real-world clinical practice of the main Baveno VII consensus recommendations. Material and Methods. We launched a brief online survey, and we invited physicians to respond to several questions related to advanced chronic liver disease patients' care (the use of non-invasive criteria to avoid endoscopy when CSPH is rulled out, the prevention of decompensation when CSPH is rulled in, and the type of non-selective beta-blocker). Results. 108 gastroenterologist and hepatologist practitionners answered our survey. According to the type of the medical unit in which they developed their clinical activity, there was an uniform distrubution between municipal, county and universitary hospitals. For clarity and reproducibility, we present the questions and answers as they were originally formulated. Question A. Do you perform an upper gastrointestinal endoscopy for variceal screening to patients with Thrombocyte count <150.000/mmc and liver stiffness measurement < 15 kPa? Answers: 1. Yes: 67 (62%); 2. No: 41 (38%). Question B. Do you initiate non-selective beta-blockers to your patients when liver stifness measurement is more than 25 kPa, for the prevention of the decompensation? Answers: 1. Yes: 99 (85%); 2. No: 9 (15%). Question C. If yes, what NSBB do you prefer? Answer: 1. Carvedilol: 92 (85%); 2. Propranolol: 16 (15%). Conclusions. Baveno VII consensus recommendation regarding avoidance of UGIE in patients with NIT rulling out CSPH is not generally adopted in the clinical practice. The majority of gastroenterologists and hepatologists preffer however performing UGIE, which can be explained by the fear of possibly missing oesophageal varices, and also by the wide acessibility of UGIE in Romania, both in general hospitals, but especially in universitary centers. However, the NSBB (Carvedilol being the most frequently the first choice) are generally recommended by non-invasive criteria, proving the awareness of the practitioners regarding the prevention of decompensation BAVENO VII takeaway message. [ABSTRACT FROM AUTHOR]

Background and Aims. Inflammatory bowel diseases (IBD) are caused by a dysregulated immune response in the hosts, favored by genetic susceptibility. In addition to symptoms related to the digestive tract, about 40% of patients with IBD also experience extraintestinal manifestations. Although, non-alcoholic fatty liver disease (NAFLD) has been frequently associated with IBDs, the relationship between these two pathologies remains unclear. The aim of this study was to investigate the prevalence of NAFLD among IBD patients, as well as the factors that connect these two conditions. Material and methods. From January 2022 to November 2022, consecutive IBD patients were enrolled from a tertiary care center hospital in Iasi. Patients' demographic information, clinical characteristics including blood pressure, biological parameters, and anthropometric measurements were collected. Following informed consent, participants underwent a fibroscan evaluation for liver stiffness measurement (LSM) and controlled attenuation parameter (CAP). Results. 93 patients with IBD were enrolled (65,3% men, 55,6% with ulcerative colitis). 45 (48,3%) of them were diagnosed with NAFLD, with a mean CAP score of 283 ± 33.4 vs. 215 ± 23.7 in patients with IBD only. Regarding liver fibrosis, mean LSM value in the NAFLD group was 6.8 ± 1.9 kPa vs. 5.7 ± 2.3 kPa in the non-NALFD group. Subjects with NAFLD exhibited higher body mass indexes than those with IBD only (26.2 vs. 33.1, p<0.05). In addition, the prevalence of diabetes was much greater among this group (27.5% vs. 0%; p=0.0001), as was the prevalence of elevated HbA1c levels in the absence of a diabetes diagnosis (14% vs. 7.35%; p=0.23). They also had a non-significantly higher mean systolic blood pressure and greater incidences of hypertension. Compared to those without NAFLD, the NAFLD cohort had higher rates of diagnosed hypercholesterolaemia, were older with a higher mean disease duration and had a higher nonsignificant level of triglycerides. The 10-year risk of myocardial infarction or death estimated by the Framingham risk scores for hard coronary heart disease was higher in the NAFLD group (2.32% vs. 4.27%, p=0.0024). Conclusions. NAFLD is a multifaceted condition that is becoming more common in IBD patients. Although the present evidences in the literature suggest a small risk for the advance of liver fibrosis, the cardiovascular risk seems to be of a greater interest. Considering the above data, patients with IBD should be evaluated with a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Background and Aims. Non-alcoholic fatty liver disease (NAFLD) and obesity are independently related to an increased risk for atherosclerotic cardiovascular disease (ASCVD), the primary cause of mortality in NAFLD patients. Even though many subjects with NAFLD are normal weight, it still remains uncertain whether their ASCVD risk is of major importance. The aim of this study is to assess and compare the ASCVD risk between lean and obese patients with NAFLD. Methods. Normal weight and obese patients were evaluated between January 2020 and February 2023 and their data was analyzed. NAFLD was diagnosed by vibration-controlled transient elastography (VCTE) with controlled attenuation parameter (CAP) and the American College of Cardiology/American Heart Association guidelines was used to evaluate the ASCVD risk. Results. In the obese group, 104 (63.8%) patients were diagnosed with NAFLD, compared to 32 (12.3%) in the lean population. In comparison to those with obese NAFLD, subjects with lean NAFLD had significantly higher ASCVD scores (mean 15.3% vs 22.7%, p<0.001). Moreover, subjects with lean NAFLD and significant liver fibrosis had a higher risk of ASCVD events, compared to their obese counterparts (OR, 2.51 vs 1.95, p=0.034). Regarding the presence of the components of the metabolic syndrome, the prevalence of type 2 diabetes mellitus was higher the obese group, while changes in the lipid profile and higher systolic blood pressure were more frequently found in lean subjects. Conclusions: Subjects with lean NAFLD had an ASCVD score that were significantly higher than those with obese NAFLD. In both study groups, the presence of significant liver fibrosis was an essential risk factor associated with an ASCVD event, but the effects were more pronounced in lean individuals. [ABSTRACT FROM AUTHOR]

Introduction. In order to meet the requirements of the WHO, namely - the eradication of viral hepatitis by 2030, UMF "Grigore T. Popa" from Iasi together with ARAS and the Hospital "St. Spiridon" from Iasi, carries out since 2020 the project "LIVE(RO) 2 - Integrated regional program for prevention, early detection (screening), diagnosis and targeting treatment of patients with chronic liver disease secondary to viral infections with liver viruses B/D and C in the North-East and South-East regions". This study aimed to assess the epidemiological characteristics of the vulnerable population in the eastern part of the country diagnosed with chronic B/D and C viral infection. Materials and Methods. Between July 2021 and December 2022, we performed a prospective screening of chronic viral hepatitis B/D and C in vulnerable people in the counties of North-East and South-East of Romania, within the national program LIVE(RO) 2 - EST. Rapid diagnostic tests were used to detect HBs antigen (HBsAg) and anti-HCV antibodies (HCVA): HBV (Wama Immuno-Rapid HBV®) and HCV (Wama Immuno-Rapid HCV®). Rapid test-positive patients were tested for HBV DNA and HCV RNA and those eligible under the national protocol were treated with antivirals. Results. The study included 55593 individuals tested rapidly, of which 2160 (3.8%) patients were tested positive (1120 women, 1040 men, mean age 55.86 ± 6.023 years, predominantly rural background - 76.19%). Of these, 1077 (49.8%) were HBsAg positive, 918 (42.5%) with HCV positive needle, 37 (1.7%) HBV/HCV coinfection and 128 (5.9%) HBV/VHD coinfection. HBV-DNA was performed in 724 (67.3%) individuals, of which 452 (62.5%) subjects > 2,000 children/ml. Also, 518 (54.3%) patients with HCV-positive Ac had detectable HCV RNA, of which 375 (72.3%) received antiviral treatment. Depending on the ethnicity, the prevalence of viral infection was 4.29% in Roma people and 3.23% in Romanian people. Among the vulnerable groups determined by work, inactive people (27.7%), uninsured people (11.2%), unskilled people (1.87%), unemployed people (0.6%) and people working in agriculture (0.59%) were predominantly tested. Among the special vulnerable groups, people with disabilities (3.99%), people addicted to alcohol (2.43%) and people with a minimum income (1.21%) were predominantly tested. Conclusions. The high prevalence of B/D and C viral infection in the vulnerable population tested in the North-East and South-East Region of Romania compared to the rest of the population, indicates the significant viral spread of the infection in these people, a condition that requires further testing and the need for policies public health in vulnerable groups to promote access to existing health services and early initiation of optimal antiviral treatment. [ABSTRACT FROM AUTHOR]

We present the case of a 72 years old male patient hospitalised within the Diabetes and Metabolic Diseases Departament for weight loss and severe diabetes mellitus imbalance. The patient underwent transabdominal ultrasonography which detected an abdominal mass of approx. 40mm in the epigastric region followed by abdominal contrast-enhanced CT scan which has confirmed a 47/40mm solid tumour in the gastrosplenic ligament and a suspected right adrenal mass of 25mm. The patient has been referred for EUS and FNB. EUS evaluation confirmed the positioning of a 46mm solid tumour in contact with the splenic hilum. Moreover, a hypoechoic, poorly delineated lesion as been observed in the left adrenal area. FNB of both lesions showed a CD4+, CD114+, DOG1+ tumour interpreted as EGIST (extra digestive-GIST). However, despite it's metastatic character, Ki67 was of less than 2%. [ABSTRACT FROM AUTHOR]

We present the case of a 66 years old female patient referred for upper GI endoscopy evaluation for weight loss and epigastric pain. Endoscopic evaluation showed an elevated lesion of approx. 3cm in the gastric body with normal adjacent mucosa and a central depression highly suggestive for a GIST. CTscan confirmed a gastric GIST and no metastases. The oncology team suggested EUS-FNB so that the patient underwent EUS which showed a 2.9/3/7cm lesion originating from the 3rd layer (submucosal space). FNB followed by histopathology and imunohistochemistry evaluation showed a large volume G2 neuroendocrine tumour. The case stresses the importance of EUS and FNB evaluation of gastric subepithelial lesions as not all lesions can be easily evaluated only be upper GI endoscopy and CT scanning despite localised disease. [ABSTRACT FROM AUTHOR]

Introduction. Metabolic syndrome (MS) patients are at increased risk for severe liver fibrosis and nonalcoholic fatty liver disease. However, there aren't any recommendations until this moment for screening MS patients. This study aimed to evaluate the diagnostic precision of non-invasive tests in identifying advanced liver fibrosis (F3) and cirrhosis (F4) in MS patients using vibration-controlled transient elastography (VCTE) as a standard quantification method. Materials and Methods. Between September 2022 to March 2023, we prospectively enrolled MS patients at the Gastroenterology and Hepatology Institute Iasi who had undergone evaluation using noninvasive tests like the aspartate aminotransferase to platelet ratio index (APRI) score, fibrosis-4 (FIB-4) index, and NAFLD fibrosis score (NFS). When compared to liver stiffness measures (LSM), we assessed the specificity, sensitivity, negative predictive value (NPV), and positive predictive value (PPV) for each of these indicators in the identification of at least advanced liver fibrosis (=F3). Results. Of the 116 MS patients included in this study, who had a mean BMI of 27.82±4.62 kg/m2 and at least three metabolic conditions, 69 individuals (59.5%) were females. Using a cut-off of 9.7 kPa, 35 (30.2%) patients had at least advanced fibrosis (=F3) according to LSM measurements. VCTE examinations present a higher correlation with the FIB-4 index (r=0.566), NFS (r=0.585), and APRI score (r=0.624) (p< 0.001). The NPV for the FIB-4 index was the highest (90.38%), followed by the NPV for the NFS score (87.84%). The main result of our research showed that all the biomarkers had reasonably high NPV (>85%) and accuracy (>83%) for predicting advanced liver fibrosis, with moderate specificity (80%) and PPV (75%). Conclusion. To prevent progressive fibrosis in MS patients, the FIB-4 index and NFS score seem to be the most suitable surrogate VCTE biomarkers. It may be necessary to take action and further evaluation of liver fibrosis in a tertiary care center for populations at risk after these non-invasive and affordable screening tests are used in primary care settings. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the risk factors and outcome of Clostridium difficile infection in hospitalized octogenarian patients. Methods: A retrospective analysis of risk factors and outcome of C. difficile infection in hospitalized octogenarians was carried out at two academic centers in Romania from January 2014 to September 2016. Demographic, clinical and laboratory characteristics; antibiotics and proton pump inhibitors use in‐hospital and 2 months before admission; comorbidities; length of hospital stay; treatment; and outcome were carefully collected from the patients' medical charts and compared with those from octogenarians hospitalized during the same period. Results: A total of 286 octogenarians were hospitalized during the study period and among them 79 (27.6%) were diagnosed with C. difficile infection. On multivariate logistic regression analyses, the previous 2 months' hospitalizations (OR 10.231, 95% CI 1.769–58.965, P = 0.009), antibiotic use 2 months before admission (OR 12.596, 95% CI 1.024–15.494, P = 0.048), antibiotic treatment during hospitalization (OR 6.302, 95% CI 3.510–11.316, P < 0.0001), arterial hypertension (OR 11.228, 95% CI 1.917–65.783, P = 0.007), chronic kidney disease (OR 4.474, 95% CI 1.037–19.299, P = 0.045) and chronic cardiac failure (OR 7.328, 95% CI 2.068–25.967, P = 0.002) were independently associated with infection. Patients with infection had longer length of hospital stay than those without (15.3 ± 5.1 vs 11.1 ± 4.3 days, P < 0.0001). None of the patients with infection had severe disease, none required surgery and none died during hospitalization. Conclusions: Hospitalized octogenarians with comorbidities, recently hospitalized or receiving antibiotic treatment are at risk for C. difficile infection. Clinicians evaluating such patients should have a high index of suspicion for this infection. Geriatr Gerontol Int 2018; 18: 315–320. [ABSTRACT FROM AUTHOR]

We aimed to compare the difference in case fatality rate between more developed and very high Human Development Index (HDI) regions, less developed and low HDI regions, and Romania. The incidence and mortality rates for digestive cancers were obtained from the IARC/WHO 2012 database. World mean mortality-to-incidence ratios registered the highest values in pancreatic cancer (0.97/0.94), and liver cancer (0.93/0.96) in males/females, respectively. The lowest values were recorded in colorectal cancer (0.48 in both sexes). Mortality-to-incidence ratios were generally higher in less developed areas, low HDI populations, and in Romania. The difference in case fatality rate between different areas showed higher variations for colorectal, gastric and gallbladder cancers, and smaller variations for esophageal, liver, and pancreatic cancers. In summary, mortality-to-incidence ratios of digestive cancers were high in 2012; higher values were registered in less developed and low HDI regions, and in Romania. Mortality-to-incidence ratios were similar in both sexes, even though the incidence was generally higher in men. Digestive cancer mortality variation suggests the necessity of finding better strategies for prevention, early diagnosis and treatment of digestive cancers. [ABSTRACT FROM AUTHOR]

Since its introduction to clinical practice in 2001, small-bowel capsule endoscopy (SBCE) has become an important investigation procedure in many small bowel pathologies, including both suspected and known Crohn's disease (CD). SBCE has higher diagnostic yield than other radiologic and endoscopic modalities used in evaluation of patients with suspected CD. In addition, SBCE has proved useful, in a non-invasive and safe manner, as a monitoring method for evaluating the severity and extent of lesions, postoperative recurrence, and mucosal healing in patients with known CD. Monitoring of colonic inflammation in patients with ulcerative colitis (UC) using second-generation of colon capsule endoscopy (CCE-2) has also been reported. Besides its advantages, CE also has several limitations such as the inability to obtain biopsies and lack of therapeutic capabilities, hopefully to be overcome in the near future by advances in modern technologies. [ABSTRACT FROM AUTHOR]

Since its introduction to clinical practice in 2001, small-bowel capsule endoscopy (SBCE) has become an important investigation procedure in many small bowel pathologies, including both suspected and known Crohn's disease (CD). SBCE has higher diagnostic yield than other radiologic and endoscopic modalities used in evaluation of patients with suspected CD. In addition, SBCE has proved useful, in a non-invasive and safe manner, as a monitoring method for evaluating the severity and extent of lesions, postoperative recurrence, and mucosal healing in patients with known CD. Monitoring of colonic inflammation in patients with ulcerative colitis (UC) using second-generation of colon capsule endoscopy (CCE-2) has also been reported. Besides its advantages, CE also has several limitations such as the inability to obtain biopsies and lack of therapeutic capabilities, hopefully to be overcome in the near future by advances in modern technologies. [ABSTRACT FROM AUTHOR]

The true incidence of drug-induced liver injury (DILI) is difficult to discern because of an unknown denominator of individuals receiving a drug, lack of a simple objective test for the diagnosis of DILI, lack of consensus on what liver test abnormalities constitute DILI, difficulty in attribution of causation to a single drug in those on many medicines, and lack of systematic reporting. Over 1000 medications and herbal products have been involved in causing liver injury, and the list continues to grow. Regarding the biologic therapy with infliximab, according to specialized studies, usually there were mild to moderate elevations of liver enzymes. Hereby, we present a clinical case of drug-induced hepatitis, after the administration of monoclonal antibodies over six months, with a remarkable contrast between the major biochemical changes and the absence of any symptoms. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 37-year-old patient who developed hepatic toxicity following the administration of infliximab for the treatment of psoriasis vulgaris. The treatment of the patient with topical medications after skin biopsy ruled out a pustular type of psoriasis. A discussion on the incidence and management of drug-induced liver injury (DILI) is provided.

Vibration-Controlled Transient Elastography (VCTE) with Controlled Attenuation Parameter (CAP) is used as a non-invasive method for evaluating liver steatosis and fibrosis simultaneously. In this prospective study, we aimed to assess the prevalence of liver steatosis and fibrosis, as well as the associated risk factors in Romanian medical students by VCTE and CAP score. We used a cut-off CAP score of ≥248 dB/m for the diagnosis of mild steatosis (S1), ≥268 dB/m for moderate steatosis (S2), and ≥280 dB/m to identify severe steatosis (S3). For liver fibrosis, the cut-off values were: ≤5.5 kPa, indicating no fibrosis (F0), 5.6 kPa for mild fibrosis (F1), 7.2 kPa for significant fibrosis (F2), 9.5 kPa for advanced fibrosis (F3), and 12.5 kPa for cirrhosis (F4). In total, 426 Romanian medical students (67.8% females, mean age of 22.22 ± 1.7 years) were evaluated. Among them, 352 (82.6%) had no steatosis (S0), 32 (7.5%) had mild steatosis (S1), 13 (3.1%) had a moderate degree of steatosis (S2), and 29 (6.8%) had severe steatosis (S3). Based on liver stiffness measurements (LSM), 277 (65%) medical students did not have any fibrosis (F0), 136 (31.9%) had mild fibrosis (F1), 10 (2.4%) participants were identified with significant fibrosis (F2), 3 (0.7%) with advanced fibrosis (F3), and none with cirrhosis (F4). In conclusion, the prevalence of liver steatosis and fibrosis is low among Romanian medical students. [ABSTRACT FROM AUTHOR]

Background and Aims: Small bowel tumors (SBTs) are rare, accounting for 1-3% of all gastrointestinal malignancies. Since the introduction of capsule endoscopy (CE), several studies have suggested that their frequency may be substantially higher. The present study is aimed at evaluating the prevalence, clinical presentation, laboratory parameters, endoscopic appearance, and diagnostic work-up of SBTs in patients undergoing CE in a single referral center. Patients and Methods: During 2003 - 2009, 102 patients underwent CE. For each patient with lesions suggesting SBT at CE, with subsequent diagnostic/ therapeutic work-up leading to histological confi rmation, we registered: clinical presentation, hemoglobin level, small bowel follow-through, red blood cells scintigraphy, CT-enterography, enteroscopy, histological confi rmation and management. Results: SBTs were detected in 5 patients (mean age 55.2 ± 15.8 years) of 102 undergoing CE (4.9%). The main indication for CE was obscure gastrointestinal bleeding, occult or overt. All patients had undergone, before CE, at least one procedure evaluating the small bowel after negative upper endoscopy and colonoscopy. All patients had iron-defi ciency anemia, three had abdominal pain, two had episodes of nausea /vomiting and one had diarrhoea and abdominal distension. The main SBT type was gastrointestinal stromal tumor. After CE, 3 patients underwent single-balloon enteroscopy; surgery was performed in all patients. Mean follow-up time was 19 ± 17 (range 2- 36) months; one patient died during follow-up. No retention of capsule occurred. Conclusions: CE could be used as fi rst choice for diagnostic investigation in patients suspected to have SBTs. [ABSTRACT FROM AUTHOR]

Background: Endoscopic retrograde cholangiopancreatography (ERCP) has been one of the most intensely studied endoscopic procedures due to its overall high complication rates when compared to other digestive endoscopy procedures. The safety and outcome of such procedures have been linked to multiple procedure- or patient-related risk factors. The aim of our study is to evaluate whether the morphology of the major duodenal papilla influences the ERCP outcomes and complication rates. Methods: A total of 322 patients with a native papilla have been included in the study over an eight month period. Morphology of the papilla has been classified into normal papilla and four anatomical variations (Type I-IV). All patients have been prospectively monitored over a 15 day period after ERCP. Procedural outcomes and complication rates have been registered. Results: Morphology of the papilla influences both overall complication rates (95%CI, p = 0.0066) and post-ERCP pancreatitis rates (95%CI, p = 0.01001) in univariate analysis. Type IV papillae have proven to be independent risk factors for post-ERCP pancreatitis in multivariate analysis (OR = 12.176, 95%CI, p = 0.005). Type I papillae have been significantly linked to difficult cannulation (AUC = 0.591, 95%CI, p = 0.008); Conclusions: In the monitored cohort morphology of the major duodenal papilla has significantly influenced both ERCP outcomes and post-procedural complication rates. [ABSTRACT FROM AUTHOR]

Objectives: Duodenoscopes have been widely used for both diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) procedures, but recently, numerous outbreaks of multidrug-resistant organisms (MDRO) infections have been reported which has led to extensive research for their possible causes. Consequently, the aim of this study is to search for possible duodenoscope surface damages that could provide an alternative and plausible source of infections. Materials and Methods: In order to assess both outer and inner surfaces, a duodenoscope was dismantled and samples were taken from the outer resin polymer and from the air/water, elevator, and working (biopsy) channels that were characterized by FTIR, DSC, TGA, AFM, SEM techniques and the antimicrobial activity were tested. Results: Alterations were noticed on both the coating and working channel polymers, with external alterations increasing progressively from the proximal sample to the distal sample near the tip of the scope. However, the results showed that the coating surface was still efficient against bacterial adhesion. Changes in surface texture and also morphological changes were shown. Conclusions: The study describes the impact of routine procedural use and reprocessing cycles on the duodenoscope, showing that these may possibly make it susceptible to bacterial contamination and MDRO biofilm formation due to difficult reprocessing of the altered surfaces. [ABSTRACT FROM AUTHOR]