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Background and Objectives: This study aimed to assess the impact of coronavirus disease 2019 (COVID-19) on patients with acute cholangitis (AC) by comparing outcomes, complications, and hospital stays in a tertiary Gastroenterology department. Materials and Methods: This retrospective observational cohort study was conducted in a tertiary gastroenterology department, collecting data from all AC and AC + COVID-19 patients between April 2020 and February 2022. Data included clinical and demographic information, COVID-19-specific details, acute cholangitis presentation, medical records, laboratory results, and interventions. AC was diagnosed using Tokyo Guidelines 2018 (TG18) criteria, with all patients undergoing bile culture sampling. Results: The study included 241 patients, 30 in the COVID group and 211 in the non-COVID group. The COVID group's mean age was significantly higher (74.3 vs. 67.3 years, p < 0.009). Abdominal pain was more common in the COVID group (90% vs. 70.6%, p < 0.025). Length of hospital stay was longer for COVID patients (13.5 vs. 7.9 days, p < 0.001). COVID patients had higher incidences of malignant causes of AC, with pancreatic cancer being the most common (30%). Pseudomonas spp. was significantly more prevalent in COVID patients (16.7% vs. 5.7%, p = 0.028). Conclusions: Our study results show that COVID-19 affected the duration of hospitalization for patients with AC. Furthermore, this study presents observations regarding the impact of COVID-19 on AC, revealing differences in microbial profiles. [ABSTRACT FROM AUTHOR]

The gut microbiota has acquired significant attention in recent years for its potential as a diagnostic biomarker for colorectal cancer (CRC). In this literature review, we looked at the studies exploring alterations in gut microbiota composition associated with CRC, the potential mechanisms linking gut dysbiosis to CRC development, and the diagnostic approaches utilizing gut microbiota analysis. Our research has led to the conclusion that individuals with CRC often display alterations in their gut microbiota composition compared to healthy individuals. These alterations can include changes in the diversity, abundance, and type of bacteria present in the gut. While the use of gut microbiota as a diagnostic biomarker for CRC holds promise, further research is needed to validate its effectiveness and standardize testing protocols. Additionally, considerations such as variability in the microbiota composition among individuals and potential factors must be addressed before microbiota-based tests can be widely implemented in clinical practice. [ABSTRACT FROM AUTHOR]

Helicobacter pylori (H. pylori) infection is a widespread global health issue and a primary cause of diseases like gastritis, gastroduodenal ulcers, and gastric cancer. This study examines the prevalence of H. pylori infection in patients undergoing upper endoscopy and assesses the efficacy of bismuth quadruple therapy (BQT) and levofloxacin triple therapy. A retrospective analysis of 507 gastroscopies was conducted, with indications including epigastric pain, heartburn, postprandial fullness, early satiation, and regurgitation. Rapid urease tests were performed, and endoscopic findings documented. Two treatment regimens were used: BQT as the first-line therapy and levofloxacin triple therapy as the second-line. Of the 507 patients, 68.8% were infected with H. pylori. Gastric ulcer patients had significantly higher H. pylori prevalence compared to those with small polyps, Barrett's esophagus, or normal endoscopy. Among the 310 patients who participated in follow-up interviews, 11.9% did not initiate therapy and 5.1% discontinued due to intolerance. The overall eradication rate was 88.6%, with BQT showing a higher eradication rate (89.4%) compared to levofloxacin triple therapy (83.8%). The study highlights the high prevalence of H. pylori among patients with gastrointestinal symptoms and the effectiveness of BQT as a first-line treatment. [ABSTRACT FROM AUTHOR]

Background and Objectives: Diminutive polyps present a unique challenge in colorectal cancer (CRC) prevention strategies. This study aims to assess the characteristics and variables of diminutive polyps in a Romanian cohort, intending to develop a combined resect-and-retrieve or resect-and-discard strategy that reduces the need for an optical diagnosis. Materials and Methods: A prospective cohort study was conducted at two endoscopy centers in Romania from July to December 2021. Adult patients undergoing colonoscopies where polyps were identified and resected were included. Endoscopic procedures employed advanced diagnostic features, including blue-light imaging (BLI) and narrow-band imaging (NBI). Logistic regression analysis was utilized to determine factors impacting the probability of adenomatous polyps with high-grade dysplasia (HGD). Results: A total of 427 patients were included, with a mean age of 59.42 years (±11.19), predominantly male (60.2%). The most common indication for a colonoscopy was lower gastrointestinal symptoms (42.6%), followed by screening (28.8%). Adequate bowel preparation was achieved in 87.8% of cases. The logistic regression analysis revealed significant predictors of HGD in adenomatous polyps: age (OR = 1.05, 95% CI: 1.01–1.08, p = 0.01) and polyp size (>5 mm vs. ≤5 mm, OR = 4.4, 95% CI: 1.94–10.06, p < 0.001). Polyps classified as Paris IIa, Ip, and Isp were significantly more likely to harbor HGD compared to the reference group (Is), with odds ratios of 6.05, 3.68, and 2.7, respectively. Conclusions: The study elucidates significant associations between the presence of HGD in adenomatous polyps and factors such as age, polyp size, and Paris classification. These findings support the feasibility of a tailored approach in the resect-and-discard and resect-and-retrieve strategies for diminutive polyps, potentially optimizing CRC prevention and intervention practices. Further research is warranted to validate these strategies in broader clinical settings. [ABSTRACT FROM AUTHOR]

Background and Objectives: Liver cancer poses a significant global health threat, ranking among the top three causes of cancer-related deaths. Patients with hepatocellular carcinoma (HCC) often present with symptoms associated with neoplasms or unusual clinical features such as paraneoplastic syndromes (PNS), including hypoglycemia, hypercholesterolemia, thrombocytosis, and erythrocytosis. Our study aimed to investigate the prevalence, clinical characteristics, and survival outcomes associated with PNS in HCC patients and assess each PNS's impact on patient survival. Materials and Methods: We conducted a retrospective analysis of PNS clinical features and survival among consecutive HCC patients diagnosed at our department over seven years, comparing them with HCC patients without PNS. The study involved a retrospective data evaluation from 378 patients diagnosed with HCC between January 2016 and October 2023. Results: We obtained a PNS prevalence of 25.7%, with paraneoplastic hypercholesterolemia at 10.9%, hypoglycemia at 6.9%, erythrocytosis at 4.5%, and thrombocytosis at 3.4%. Patients with PNS tended to be younger and predominantly male. Multivariate analysis revealed a strong correlation between PNS and levels of alpha-fetoprotein and tumor size, with diabetes also showing a significant statistical association (p < 0.05). Subgroup analysis based on specific paraneoplastic syndromes demonstrated shorter survival in patients with PNS, albeit without significant statistical differences, except for hypoglycemia (p < 0.0001). Matched analysis indicated a shorter survival rate for patients with PNS, although no significant statistical differences were observed. Conclusions: PNS are frequently observed in HCC cases and are associated with unfavorable prognoses and decreased survival rates due to their correlation with increased tumor burdens. However, they do not independently predict poor survival. The impact of individual PNS on HCC prognosis varies. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is globally recognized as a prevalent malignancy known for its significant mortality rate. Recent years have witnessed a rising incidence trend in colorectal cancer, emphasizing the necessity for early diagnosis. Our study focused on examining the impact of the SMAD7 gene variant rs4939827 on the risk of colorectal cancer occurrence. The composition of our study group included 340 individuals, comprising 170 CRC diagnosed patients and 170 healthy controls. We performed genotyping of all biological samples using the TaqMan assay on the ABI 7500 Real-Time PCR System (Applied Biosystems, Waltham, MA, USA). This investigation focused on the rs4939827 gene variant, assessing its association with CRC risk and clinicopathological characteristics. Genotyping results for the SMAD7 gene variant rs4939827 revealed a 42.6% prevalence of the C allele in CRC patients (p = 0.245) and a 22.8% prevalence of the T allele in control subjects (p = 0.109). This study concluded that there was an elevated risk of CRC in the dominant model for CC/CT+TT, with a p-value of 0.113 and an odds ratio (OR) of 2.781, within a 95% confidence interval (CI) of 0.998 to 3.456. The findings of our research indicate a correlation between variants of the SMAD7 gene and the likelihood of developing colorectal cancer in our study population. Consequently, these results could be instrumental in facilitating early diagnosis of colorectal cancer utilizing information on single-nucleotide polymorphism (SNP) and genetic susceptibility to the disease. [ABSTRACT FROM AUTHOR]

Acute pancreatitis (AP) remains a challenging medical condition, where a deeper metabolic insight could pave the way for innovative treatments. This research harnessed serum metabolomics to discern potential diagnostic markers for AP and distinguish between its biliary (BAP) and alcohol-induced (AAP) forms. Leveraging high-performance liquid chromatography coupled with mass spectrometry, the metabolic signatures of 34 AP patients were contrasted against 26 healthy participants, and then between different etiologies of AP. The results identified metabolites primarily from glycerophospholipids, glycerolipids, fatty acyls, sterol lipids, and pteridines and derivative classes, with the Human Metabolome Database aiding in classification. Notably, these metabolites differentiated AP from healthy states with high AUROC values above 0.8. Another set of metabolites revealed differences between BAP and AAP, but these results were not as marked as the former. This lipidomic analysis provides an introduction to the metabolic landscape of acute pancreatitis, revealing changes in multiple lipid classes and metabolites and identifying these metabolites. Future research could add and discover new diagnostic biomarkers and therapeutic strategies enhancing the management of acute pancreatitis. [ABSTRACT FROM AUTHOR]

Vibration-controlled transient elastography (VCTE) was the first non-invasive method used for assessing liver fibrosis in patients with chronic liver disease. Over the years, many studies have evaluated its performance. It is now used globally, and, in some countries, it represents the primary step in evaluating liver fibrosis. The aim of this study is to assess the feasibility of VCTE and highlight the prevalence of liver fibrosis stages assessed by VCTE in a large cohort of patients at a single study center. We also aimed to observe the trends in liver stiffness (LS) values over the years according to each type of hepatopathy. A retrospective study was conducted over a period of 13 years (2007–2019) and included patients who presented to our clinic for LS measurements (LSMs), either with known liver diseases or with suspected liver pathology who were undergoing fibrosis screening. The database contained a total of 23,420 measurements. Valid LSMs were obtained in 90.91% (21,291/23,420) of the cases, while 2129 (9.09%) of the measurements were either failed or unreliable. In untreated patients with chronic viral hepatitis, LS values tended to increase during the years, while in patients undergoing antiviral therapy LS values significantly decreased. Our comprehensive study, one of the largest of its kind spanning 13 years, emphasizes the reliability and significance of VCTE in real-world clinical settings. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the impact of COVID-19 infection on patients with decompensated liver cirrhosis (DLC) in terms of acute-on-chronic liver failure (ACLF), chronic liver failure acute decompensation (CLIF-AD), hospitalization, and mortality. In this retrospective study, we analyzed patients with known DLC who were admitted to the Gastroenterology Department with COVID-19. Clinical and biochemical data were obtained to compare the development of ACLF, CLIF-AD, days of hospitalization, and the presence of independent factors of mortality in comparison with a non-COVID-19 DLC group. All patients enrolled were not vaccinated for SARS-CoV-2. Variables used in statistical analyses were obtained at the time of hospital admission. A total of 145 subjects with previously diagnosed liver cirrhosis were included; 45/145 (31%) of the subjects were confirmed with COVID-19, among which 45% had pulmonary injury. The length of hospital stay (days) was significantly longer in patients with pulmonary injury compared to those without (p = 0.0159). In the group of patients with COVID-19 infection, the proportion of associated infections was significantly higher (p = 0.0041). Additionally, the mortality was 46.7% in comparison with only 15% in the non-COVID-19 group (p = 0.0001). Pulmonary injury was associated with death during admission in multivariate analysis in both the ACLF (p < 0.0001) and the non-ACLF (p = 0.0017) group. COVID-19 significantly influenced disease progression in patients with DLC in terms of associated infections, hospitalization length, and mortality. [ABSTRACT FROM AUTHOR]

Introduction: A renal biopsy represents the gold standard in the diagnosis, prognosis, and management of patients with glomerulonephritis. So far, non-invasive elastographic techniques have not confirmed their utility in replacing a biopsy; however, the new and improved software from Hologic Supersonic Mach 30 is a promising method for assessing the renal tissue's stiffness and viscosity. We investigated whether this elastography technique could reveal renal tissue fibrosis in patients with chronic glomerulonephritis. Materials and methods: Two-dimensional-shear wave elastography (SWE) PLUS and viscosity plane-wave ultrasound (Vi PLUS) assessments were performed in 40 patients with chronic glomerulopathies before being referred for a renal biopsy. For each kidney, the mean values of five stiffness and viscosity measures were compared with the demographic, biological, and histopathological parameters of the patients. Results: In total, 26 men and 14 women with a mean age of 52.35 ± 15.54 years, a mean estimated glomerular filtration rate (eGFR) of 53.8 ± 35.49 mL/min/1.73m2, and a mean proteinuria of 6.39 ± 7.42 g/24 h were included after providing their informed consent. Out of 40 kidney biopsies, 2 were uninterpretable with inappropriate material and were divided into four subgroups based on their fibrosis percentage. Even though these elastography techniques were unable to differentiate between separate fibrosis stages, when predicting between the fibrosis and no-fibrosis group, we found a cut-off value of <20.77 kPa with the area under the curve (AUC) of 0.860, a p < 0.001 with 88.89% sensitivity, and a 75% specificity for the 2D SWE PLUS measures and a cut-off value of <2.8 Pa.s with an AUC of 0.792, a p < 0.001 with 94% sensitivity, and a 60% specificity for the Vi PLUS measures. We also found a cut-off value of <19.75 kPa for the 2D SWE PLUS measures (with an AUC of 0.789, p = 0.0001 with 100% sensitivity, and a 74.29% specificity) and a cut-off value of <1.28 Pa.s for the Vi PLUS measures (with an AUC 0.829, p = 0.0019 with 60% sensitivity, and a 94.29% specificity) differentiating between patients with over 40% fibrosis and those with under 40%. We also discovered a positive correlation between the glomerular filtration rate (eGFR) and 2D-SWE PLUS values (r = 0.7065, p < 0.0001) and Vi PLUS values (r = 0.3637, p < 0.0211). C reactive protein (CRP) correlates with the Vi PLUS measures (r = −0.3695, p = 0.0189) but not with the 2D SWE PLUS measures (r = −0.2431, p = 0.1306). Conclusion: Our findings indicate that this novel elastography method can distinguish between individuals with different stages of renal fibrosis, correlate with the renal function and inflammation, and are easy to use and reproducible, but further research is needed for them to be employed routinely in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Many of the patients presenting with metabolic syndrome (MetS) also have liver steatosis (NAFLD) and some of them could develop liver fibrosis. Purpose: To develop a simple score that could rule out fibrosis, especially significant fibrosis (F≥ 2) and could be used in daily practice in patients with MetS, in order to identify patients at risk. Patients and Methods: A total of 204 patients with MetS were prospectively enrolled. Evaluation of liver fibrosis was made using Vibration Controlled Transient Elastography while evaluation of steatosis was achieved using ultrasound (US). Results: Out of 204 patients with MetS, 179 patients (87.7%) had reliable liver stiffness measurements and 22.9% (41/179) had F ≥ 2. To formulate the fibrosis predicting score, all clinical variables associated with F ≥ 2 in the univariate analysis were considered in a multivariate regression model. According to the power of correlation, by consensus, we attributed 1 point for BMI > 31.4 kg/m2, 1 point for female gender, 1 point for HDLc < 47mg/dL, 1 point for mild steatosis at US, 1.5 point for moderate and 2 points for severe steatosis. Conclusion: At an optimal cut-off value of < 3.5, our score could be used to rule-out the risk for developing at least significant fibrosis with a high negative predictive value (NPV 89.2%) in patients with MetS. [ABSTRACT FROM AUTHOR]

Acute pancreatitis (AP) is the most common gastrointestinal indication requiring hospitalisation. Severe hypertriglyceridaemia (HTG) is the third most common aetiology of AP (HTGAP), with a complication rate and severity that are higher than those of other aetiologies (non-HTGAP). The aim of this study was to evaluate the supposedly higher complication rate of HTGAP compared to non-HTGAP. The secondary objectives were to find different biomarkers for predicting a severe form. This was a retrospective study that included patients admitted with AP in a tertiary department of gastroenterology and hepatology. The patients were divided into two groups: HTGAP and non-HTGAP. We searched for differences regarding age, gender, the presence of diabetes mellitus (DM), the severity of the disease, the types of complications and predictive biomarkers for severity, hospital stay and mortality. A total of 262 patients were included, and 11% (30/262) of the patients had HTGAP. The mean ages were 44.4 ± 9.2 in the HTGAP group and 58.2 ± 17.1 in the non-HTGAP group, p < 0.0001. Male gender was predominant in both groups, at 76% (23/30) in the HTGAP group vs. 54% (126/232) in non-HTGAP, p = 0.02; 53% (16/30) presented with DM vs. 18% (42/232), p < 0.0001. The patients with HTG presented higher CRP 48 h after admission: 207 mg/dL ± 3 mg/dL vs. non-HTGAP 103 mg/dL ± 107 mg/dL, p < 0.0001. Among the patients with HTGAP, there were 60% (18/30) with moderately severe forms vs. 30% (71/232), p = 0.001, and 16% (5/30) SAP vs. 11% (27/232) in non-HTGAP, p = 0.4 Among the predictive markers, only haematocrit (HT) and blood urea nitrogen (BUN) had AUCs > 0.8. According to a multiple regression analysis, only BUN 48 h was independently associated with the development of SAP (p = 0.05). Diabetes mellitus increased the risk of developing severe acute pancreatitis (OR: 1.3; 95% CI: 0.1963–9.7682; p = 0.7). In our cohort, HTGAP more frequently had local complications compared with non-HTGAP. A more severe inflammatory syndrome seemed to be associated with this aetiology; the best predictive markers for complicated forms of HTGAP were BUN 48 h and HT 48 h. [ABSTRACT FROM AUTHOR]