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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]

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. 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: 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 & Aims: Elimination of hepatitis C worldwide is more feasible if micro-elimination screening strategies are adopted. We aimed to screen hepatitis C virus (HCV) in specific high-risk populations in certain sub-regions of Romania and link them to antiviral treatment. Methods: A multicenter prospective study was conducted among the hospitalized or ambulatory adult patients from March 2019 to March 2020 in more than 20 medical institutions from 4 Romanian cities (Bucharest, Iasi, Timisoara, Cluj-Napoca). A rapid diagnostic test for HCV diagnosis was performed to all admitted patients and the positive ones were sent to gastroenterology departments for confirming the active infection, staging and treatment prescription. Results: In total, 25,141 subjects signed the informed consent and were consequently enrolled into the study. The prevalence of anti-HCV antibodies was 1.39% (95%CI: 1.25-1.54) and increased with the number of risk factors presented by one subject. There was a positive association between the presence of anti-HCV antibodies and female gender (p<0.001), rural area of residence (p<0.001), advanced age (p<0.001), as well as a negative association with the education level (p<0.001). Conclusions: In a hospital-based screening micro-elimination program in Romania, HCV prevalence was lower than previously reported. This is a first step towards a cost-effective screening in a well-defined group of persons at risk and provides sufficient capacity to deliver access to HCV treatment and linkage to care in Romania. [ABSTRACT FROM AUTHOR]

Introduction. Despite the high efficacy of direct acting antivirals (DAAs) in curing chronic HCV infection, there is a concern regarding a more aggressive phenotype of hepatocellular carcinoma (HCC) after DAA treatment. Although there are many clinical cohort studies that have evaluated the incidence and recurrence of HCC in these patients, data on the tumor characteristics of HCC after DAAs are not sufficient to establish a clear conclusion. A promising index was recently developed for the evaluation of HCC aggressiveness (AGI) which comprises 4 tumor-related parameters: maximum tumor diameter (MTD), number of tumor nodules, portal vein thrombosis (PVT) and serum AFP levels. Aim. We aimed to investigate the usefulness of AGI in assessing the pattern of HCV-related HCC after DAAs and the predictive value in survival. Material&methods. We carried out a retrospective comparative observational study in which we included patients treated with DAAs for HCV infection and diagnosed with HCC in the Institute of Gastroenterology and Hepatology from Iași, Romania, between January 1st, 2017 and December 31, 2019. Patients were matched based on age and sex with a historic cohort consisting of patients with HCV-related HCC without DAA therapy. Based on AGI, patients were divided into three aggressiveness classes: class A (low aggressiveness), B (intermediate aggressiveness) and C (high aggressiveness). Results. Among the 124 patients with chronic HCV infection diagnosed with HCC, 66 (53.2%) patients were males and 58 (46.8%) were female, with a mean age of 62.38 ± 9.88 years. According to DAAtreated and DAA-naive status, patients were divided into 2 groups: the DAA group included 30 treated patients and the non-DAA group included 94 DAAnaive patients. In the DAA group, the frequency of single HCC was much higher (73.3%) than in naïve patients (53.2%) (p = 0.052), as well as smaller tumor sizes (41.07 ± 18.116mm vs. 61.79 ± 34.477mm, p=0.001) and lower rates of malignant PVT (20% vs. 36%, p = 0.146). According to AGI, class B was the most frequently observed (42.6%) in DAA-naïve patients, followed by class A (31.9%) and class C (25.5%), whilst in DAA-treated patients the most frequent was class A (46.7%), closely followed by class B (40.0%), and class C in 13.3% of cases. The 3-year survival probability for AGI class A vs. B vs. C was 66.9% vs 40.2% vs 8.4%; p=0.001, from the time of diagnosis by Kaplan-Meier plot. There was a significantly higher survival rate in the DAA group compared to DAA-naïve patients (75.3% vs. 52.4%, p = 0.008). [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is currently the most severe form of liver disease consisting of malignant processes following fibrotic and cirrhotic damage. Despite there are several validated scores for assessing the overall risk to develop HCC in patients diagnosed with chronic liver diseases, most of these are designed for patients with viral hepatitis B and C and subsequently rely on specific measurements, such as viral load or viral profiling. PAGE-B is commonly used to predict HCC risk in patients with viral hepatitis B. In this context, this study aimed to evaluate the applicability of PAGE-B in different liver diseases predisposing to HCC. On a series of 104 consecutive patients, PAGE-B was calculated according to standard guidelines. Based on the collected data, the applicability of PAGE-B was evaluated in several liver pathologies predisposing to HCC, such as alcoholic liver disease, chronic viral hepatitis C, and non-alcoholic fatty liver disease. The mean age of the patients was 67,65 ± 1,15 years, while the sex distribution was 57,28 % males to 42,72 % females. The selected cohort consisted of 11 patients with alcoholic liver disease (10,57 %), 54 patients with chronic viral hepatitis C (51,92 %), and 39 patients with non-alcoholic fatty liver disease (37,5 %). We found that the patients with alcoholic liver disease patients scored highest for PAGE-B (20,09 ± 0,45), while non-alcoholic fatty liver disease patients score lowest (17,89 ± 0,47), significantly different from one another (p = 0,021). In conclusion, our results suggested that PAGE-B could be useful in evaluating HCC risk in chronic liver diseases, but further studies are needed to find a suitable scoring system to predict the overall risk to develop HCC in patients that are diagnosed with nonalcoholic fatty liver disease. [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]

Background & Aims: Diverticular disease of the colon is a common clinical condition in developed countries, and is associated with significant (direct and indirect) economic burden. The aim of this Position Paper is to provide clinical guidance for appropriate definition, prevalence, risk factors, diagnosis, and treatment of colonic diverticular disease. Methods: A working group of recognized experts established by the Board of the Romanian Society of Gastroenterology and Hepatology (RSGH) screened the literature and the available guidelines on colonic diverticular disease. Statements were formulated based on literature evidence. These statements were discussed within the working group and decision for each of them was taken by consensus. Results: Thirty two statements were elaborated. The grade of recommendation, according to the level of evidence was established for each statement. Short comments with literature support accompany each statement. Conclusion: This Position Paper represents a practical guide for clinicians dealing with patients affected by colonic diverticular disease. [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]

The latest technological progress provided significant changes in the approach of several areas of daily life, healthcare, and research. In this context, there are many solutions based on artificial intelligence (AI) that were designed to provide assistance in repetitive, ultraprecision, and high-performance data analysis tasks. While the benefits of using AI in Medicine are suggestive, they are shadowed by potential limitations based on the perception of the targeted users due to lack of awareness, mistrust, and human versus machine controversy. Thus, we aimed to find the current opinion of the medical workers and students regarding the modern applications of AI in medical care and research. Using an online specialised platform, we conducted a survey addressed to the members of academic and healthcare community. They were invited to answer specific questions evaluating their knowledge on AI, and their availability to accept and use AI-based applications in daily life and profession. Also, they were challenged to identify advantages and weaknesses of AI-based applications in healthcare and medical research. We found that the responses regarding the use of AI-based solutions in daily life and healthcare suggested several differences in awareness. Also, some of the participants identified several possible sources of inequity in receiving medical care when intelligence-based applications were used in decision making demarche. Similarly, despite that AI-based resources could offer high performance solutions to medical care and research consequent to technology progress, the participants pointed out that the main negative outcome of artificial would be the lack of empathy involved in patients' management. AI-based solutions in medical care could offer significant improvements of the medical act and in biomedical research. However, there are still many limitations that should be addressed when adapting AI resources in Medicine. [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]

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 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]