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Introduction: In some cases, there may be a discrepancy between the symptomatology alleged by Crohn's disease (CD) patients and the results of laboratory tests or imaging investigations. Ileocolonoscopy with biopsy is the primary investigation for diagnosing and monitoring CD patients. Cross-sectional imaging techniques such as CT or MR enterography (MRE) and intestinal ultrasonography (IUS) have been proposed as complementary methods to colonoscopy for a complete evaluation of this category of patients. This study aims to identify the role of IUS, contrast-enhanced ultrasound (CEUS) and MRE in evaluating ileal CD activity, using clinical severity scores (Crohn's disease activity index—CDAI, Harvey–Bradshaw index—HBI) and faecal calprotectin or C-reactive protein (CRP) levels as reference methods. Materials and Methods: A total of 44 adult patients with ileal CD confirmed using an ileocolonoscopy with biopsy and histopathological examination were assessed by IUS, CEUS and MRE. The evaluation of the disease activity based on the results obtained from the cross-sectional imaging tests was carried out by using some severity scores available in the literature. The sensitivity and specificity of IUS + CEUS and MRE for differentiating active from inactive forms of CD were determined using CDAI, HBI, faecal calprotectin and CRP as reference methods. The accuracy of the results was assessed by the receiver operating characteristics method. The Pearson correlation coefficient was used to determine the types of correlation. A p-value less than 0.05 suggested a statistically significant relationship. Results: Compared to CDAI, the best correlation was identified for Limberg score (r = 0.667, 95% confidence interval (CI) [0.46, 0.8], p < 0.001), followed by MaRIAs score (r = 0.614, 95% CI [0.39, 0.77], p < 0.001). A sensitivity of 93.33% and a specificity of 71.43% (AUC = 0.98) were demonstrated in the case of Limberg score for differentiating patients with active disease from those in remission and for MaRIAs score a sensitivity of 100.00% and a specificity of 57.14% (AUC = 0.97). Regarding HBI, the best correlation was observed for MaRIAs score (r = 0.594, 95% CI [0.36, 0.76], p < 0.001). Also, faecal calprotectin showed the best correlation with MaRIAs score (r = 0.697, 95% CI [0.46, 0.84], p < 0.001), but in the case of CRP, there was only a weak correlation for all evaluated scores. Conclusions: Although magnetic resonance imaging does not appear to be superior to ultrasonography in terms of accuracy for differentiating active forms of CD from those in remission, the results of our study suggest that MRE associates a better correlation with clinical severity scores and faecal calprotectin levels compared to ultrasonography. More studies are needed to validate these results. [ABSTRACT FROM AUTHOR]

The diagnosis of inflammatory bowel disease (IBD) can sometimes be challenging. By corroborating clinical, imaging and histological data, the two main entities of IBD, ulcerative colitis and Crohn's disease (CD), can be differentiated in most cases. However, there remains 10–20% of patients where the diagnosis cannot be accurately established, in which case the term "IBD unclassified" is used. The imaging techniques most used to evaluate patients with IBD include colonoscopy, ultrasonography and magnetic resonance imaging. Endoscopic ultrasonography is mainly recommended for the evaluation of perianal CD. Through this work, we aim to identify other uses of this method in the case of patients with IBD. [ABSTRACT FROM AUTHOR]

Background: In the last 30 years, we have seen an increase in the incidence of inflammatory bowel disease (IBD). Most cases are diagnosed in the 2nd and 3rd decades of life, a population group that is most familiar with the latest innovations in technology. Patients want to obtain more information about their disease and have complete control over the pathology, while reducing physical meetings with their doctor. Starting from these ideas, the present study aimed to develop a mobile application (app) to support IBD patients on symptoms/events reporting and on treatment administration monitoring. Methods: A multidisciplinary team was created to document and develop the app requirements and design its functionality. The app was beta-tested by several IBD patients. Their feedback was used to further refine the app. Results: We developed connected apps for both smartphones and smartwatches, with dedicated sections for event reporting and medication administration reminders/reporting. Conclusions: The development of apps dedicated to IBD patients is still in early progress. By creating this app, we aim to improve the evolution and compliance of IBD patients and to obtain new information that will have a beneficial impact on the management of these patients and open the door for personalized medicine. [ABSTRACT FROM AUTHOR]

Crohn's disease represents an inflammatory bowel disease of unknown etiology, with chronic evolution, which may affect any segment of the digestive tract. The main classes of drugs used in patients with inflammatory bowel disease include: aminosalicylates, corticosteroids, immunosuppressants, biological agents and antibiotics. Biological therapy with anti-TNF-α agents offers significant therapeutic benefits, but their use requires caution, as they can also be associated with numerous side effects. We present the case of a female patient known with Crohn's disease, under going biological therapy with adalimumab, who develop [ABSTRACT FROM AUTHOR]

Imaging techniques like entero-RM and GIUS (gastrointestinal endoscopy) were developed as complementary methods to colonoscopy for a better and complete assessment of patients with Crohn's disease. GIUS has the advantage that it can be repeated whenever needed to monitor the evolution and response to treatment. Our aim is to evaluate the severity of intestinal damage in patients with ileal Crohn's disease using GIUS and MR-enterography. This study included 10 patients with ileal Crohn's disease with a mean age of 36 years. Patients were evaluated via GIUS + CEUS, using a Hitachi Arieta ultrasonography system with a 7.5 MHz linear transducer. The contrast agent used was SonoVue, 4,8 ml. The assessed parameters included: the thickness of the intestinal wall, parietal stratification, motility, the presence of lymph nodes and mesenteric fat, color Doppler parameters. Using a dedicated software CEUS parameters were assessed: Peak enhancement (PE), Wash-in area under the curve (WiAUC), Rise time (RT), Mean transit time (MTT), Wash-in rate (WiR), etc. The MR-enterography was performed using a Philips Ingenia 3T device, and for the quantification of severity we used the modified MaRIA index. The mean severity index (CDAI, respectively HBI-Harvey-Bradshaw Index) was 173.8 (STDEV 109.06) for CDAI and 6.8 (STDEV 4.18) for HBI. The parameters that were statistically correlated with the activity and severity of the disease assessed by CDAI and HBI are: thickening of the intestinal wall over 4 mm, the presence of Doppler signal at the level of intestinal wall (Limberg classification) and enhancement parameters on CEUS. On GIUS, the average thickness of the terminal ileum wall was 6.28 mm (STDEV 1.13). The average for the Limberg score was 2 (STDEV 0.94), and for the modified MaRIA score was 7.40 (STDEV 5.05). We found that there are correlations between GIUS parameters, entero-RM parameters and the severity of the disease. Intestinal ultrasound has been shown to be useful in assessing the severity of ileal Crohn's disease and response to treatment comparable to MR-enterography. Entero-RM seems to be superior to GIUS in detecting proximal stenosis of ileum. [ABSTRACT FROM AUTHOR]

(1) Background: The assessment of mortality and rebleeding rate in upper gastrointestinal bleeding (UGIB) is essential, and several prognostic scores have been proposed. Some patients with UGIB did not undergo endoscopy, either because they refused the procedure, suffered from alcohol withdrawal symptoms or altered general status, or because the bleeding was severe enough to cause death before the endoscopy. The mortality risk in the subgroup of patients without endoscopy is poorly evaluated in the literature. (2) Methods: The purpose of the study was to identify the most useful scores for the assessment of in-hospital mortality in patients with UGIB with no endoscopy performed and no known etiology. A total of 198 patients with UGIB and no endoscopy performed were admitted between January 2017 and December 2021 and the accuracy of 12 prognostic scores and the Charlson comorbidity index for in-hospital mortality prediction were analyzed, as well as Child–Pugh Turcotte (CPT) and Meld scores in patients with cirrhosis. (3) Results: The mortality rate was 37.9%, higher than in variceal (21.9%, p < 0.0001) and non-variceal bleeding (7.4%, p < 0.0001). The most accurate scores by AUC were the International Bleeding score (INBS, 0.844), Glasgow Blatchford (0.783), MAP score (0.78), Iino (0.766), AIM65 and modified N-score (0.745 each), modified Glasgow-Blatchford (0.73), H3B2 and N-score (0.701); Rockall, Baylor, and T-score had an AUC below 0.7. MELD score was superior to CPT in patients with cirrhosis (AUC 0.811 versus 0.670). (4) Conclusions: The mortality rate in UGIB with no endoscopy was higher than in both variceal and non-variceal bleeding and was higher in the pandemic period but with no statistical significance (45.3% versus 32.14%, p = 0.0586), mainly because of positive cases. Only one case of rebleeding was noted; the hospitalization period was significantly shorter. The most accurate score was International Bleeding Score; the MELD score had a higher but moderate accuracy compared with CPT in patients with cirrhosis. [ABSTRACT FROM AUTHOR]

Inflammatory Bowel Disease (IBD) encompasses a cluster of chronic inflammatory disorders affecting the gastrointestinal tract. The primary objective of IBD treatment is the management of inflammation, symptom control, and the induction and sustenance of remission. Therapeutic interventions commonly encompass medications, dietary modifications, and, in certain instances, surgical procedures; however, a definitive cure remains elusive. While several nations have established national IBD registries, Romania has not. The responsibility of the implementation of such a registry was assumed by a non-profit organization, the "Clubul Român de Boală Crohn și Colită Ulcerativă", resulting in the creation of the registrul-ibd.ro platform. Given the absence of a curative remedy for IBD, it falls within the realm of personalized medicine. In light of this, the University of Medicine and Pharmacy of Craiova has developed a mobile application, IBDMonitor, intricately linked with the IBD registry. This innovative application empowers patients to meticulously record critical data, encompassing medication administration, symptomatology, lifestyle habits, as well as physiological, pathological, and daily occurrences. Medical professionals are granted real-time access to these patient-generated reports, enabling them to make prompt treatment adjustments. Following a successful pilot phase, various insights have emerged, notably revealing a relatively low long-term adherence rate to the application. Consequently, advocating for the widespread adoption of both the application and the registry on a national scale holds the potential to significantly enhance the utilization of these invaluable tools in the management of IBD. [ABSTRACT FROM AUTHOR]