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Aim: to compare the efficacy and safety of Adalimumab(ADA) and Infliximab(IFX), in a large Romanian population and to identify predictors of response. Methods We performed a national retrospective cohort study including 265 patients (136 ADA, 129 IFX) between 2008-2014. Binary logistic regression was performed with the statistical program Minitab. Results: Patients were half women, with a median age of 36, a median disease duration of 2.5 years, 80% received Azathioprine. Mean therapy duration was 20 months in ADA group and 36 months in IFX group. Complete response to Adalimumab respectively Infliximab was recorded in 77%vs.65%, secondary loss of response in 18%vs.28%, statistically comparable. We failed to identify predictors of response. In 79.2%of patients with secondary loss of response to ADA, the dose was escalated, 12.5% were switched to Infliximab. In 70%of patients that lost response to IFX, the dose was increased, 30% were switched to Adalimumab. Conclusions: Adalimumab and Infliximab have similar efficacy, with a complete response rate of~70%. In case of secondary loss of response to IFX, the best solution is to switch to ADA, with 83% response rate, while in case of secondary loss of response to ADA, increasing the dose leads to 84 % response rate. [ABSTRACT FROM AUTHOR]

Aim: We evaluated the influence of the type of needle and the operator's experience on the quality of the specimen obtained at liver biopsy (LB). Material and method: We performed a multicentre, prospective study in four university hospitals, including LBs performed using either 'cutting' (TruCut) or 'suction' (Menghini) needles. According to their experience, we considered the operators as 'junior' (<100 LBs) or 'senior' (>100 LBs). Results: A total number of 745 LBs were evaluated, 413 performed with suction needles and 332 with cutting needles. Of all LBs, 473 where performed by 'senior' and 272 by 'junior' operators. The mean length of the fragment obtained was larger in LBs performed by senior (23.5±11.6 mm) vs. junior operators (15.9±9.8 mm, p<0.001) and also if modified Menghini needles were used (23.7±12.1 mm) vs. TruCut (13.0±5.2 mm, p<0.001). The number of portal tracts (PT) was higher in LBs performed by 'senior' (14.3±8.8 PT) vs. 'junior' operators (8.8±6.8 PT, p<0.001); and with Menghini needles (17.2±9.7 PT) vs. TruCut (8.6±5.0 PT, p<0.001). Conclusion: Our study demonstrates that optimal biopsy samples are obtained by two intrahepatic passages with Menghini needles and that 'senior' operators obtain better tissue samples than 'junior' ones. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to characterize the dynamics of the Romanian waiting list (WL) for liver transplantation (LT) over two periods: 2004-2007 vs. 2008-2011. Methods: 1,085 patients listed for LT during the time period 2004-2011 were included in our analysis. Results: Death on the WL was significantly higher before 2008 (37% vs. 26.4%, p=0.0001) and risk of dying while on WL was 60% higher. Waiting time on the WL was 75% longer and time until LT was 102% longer before 2008 compared to the second time period (p=0.0001). After 2008, 62.3% of patients were listed for LT with Child Pugh class C compared to 22.1% before 2008 (p<0.0001). Conclusion: A significant reduction of mortality has been registered on the Romanian WL for LT after 2008, despite the increased severity of liver disease in patients listed for LT. [ABSTRACT FROM AUTHOR]

We present the case of a previously healthy 62 year old man who developed primary non-Hodgkin lymphoma of the liver. Biopsy confirmed that it was a diffuse large anaplastic T-cell lymphoma of an extremely rare type. The diagnosis of this type of lesions is suggested by the presence of a hepatic mass without lymphadenopathy, splenomegaly or bone marrow involvement associated with normal tumor markers (carcinoembryonic antigen, alpha-fetoprotein and CA 19-9 levels). Histological examination of tissue is essential to confirm the diagnosis. Treatment options are surgical resection and/or chemotherapy but the rate of response to treatment varies widely. Some patients can achieve prolonged remission. [ABSTRACT FROM AUTHOR]

Background: Antiviral therapy for chronic hepatitis D (delta) is not yet satisfactory, although it appears to be the only means to alter the progressive natural course of chronic hepatitis D virus (HDV) infection. Aim: To assess safety and efficacy, evaluated by virological, biochemical and histological end-of-treatment (EOT) and end-of-follow-up (EOF) response to Peg-Interferon α-2b 1.5μg/kg body weight weekly in a Romanian cohort of naïve patients with chronic hepatitis delta. Results: 49 Caucasian patients (55.1% men, 44.9% females) with a mean age of 37.95 years received study medication; per-protocol population consisted of 36 subjects. Virological EOT response was present in 33.3% and EOF response was maintained in 25% of patients. 50% of study population showed normalization of ALT level at EOT and 25% at EOF. A combined biochemical and virological response was observed in 19.4% of patients at EOT and in 16.7% at EOF. At baseline, the necroinflammation quantified by histological activity index (HAI) score was 9.72 and the mean fibrosis score was 2.03; there was a significant decrease of HAI score to 7.44 (p=0.01) at EOT, but not for fibrosis score (1.33, p=0.37). However, only 8.3% of patients at EOT and 19.4% at EOF had progressive histological disease. Conclusions: Treatment with Peg-Interferon α-2b succeeded in obtaining a negative HVD RNA in 25% of patients after 104 weeks of follow-up, although combined biochemical and virological response was present in only 16.7%. Necroinflammation decreased significantly in treated patients. Longer treatment periods with pegylated interferon or combination regimen peginterferon-nucleotide analogues should be tested in order to increase efficacy. [ABSTRACT FROM AUTHOR]

Introduction. Chronic HCV infection represents a public health problem in Romania, with a prevalence of 3.23-4.56%, and more than 5,000 patients on the waiting lists for antiviral therapy. Aim: To perform an evaluation of the severity of chronic HCV infection genotype 1b, and a quantification of patients with a low viral load, in order to quantify the number of patients who may be considered for shortened treatment duration. Material: Histological assessment and viral load were performed in 1,220 consecutive patients from the waiting list for antiviral therapy in 2009. The severity of chronic hepatitis was assessed by histological evaluation (the necrotic-inflammatory index - Metavir and the fibrosis score - Metavir). Viral load was measured by PCR and 400,000UI/ml and 600,000UI/ml were defined as thresholds for low versus high viral load We assessed the influence of age, sex, and viral load on necro-inflammatory activity and fibrosis. Results: The mean age of the patients included was 48 ±10.69 years and females predominated (58%). Many of them (60%) were in stage F3, with a high potential for disease progression in the next 10 years (necro-inflammatory activity was moderate to severe in over 90%). Almost half of the patients had low viral load, below 600,000 copies/ml. The viral load was significantly associated with the age (p< 0.001) and sex (p< 0.001) of the patients. Conclusion: Chronic HCV hepatitis in patients on the waiting lists for antiviral therapy in Romania has a high severity with important predictable consequences on the duration of life, complications and treatment costs. The strategy of shortening the duration of treatment would be beneficial for almost 50% of the patients. [ABSTRACT FROM AUTHOR]

Aims: This study was aimed at determining the seroprevalence of hepatitis C virus (HCV) infection in Romania and the possible risk factors and modality of HCV transmission. Methods: A nationwide cross-sectional survey among the adult population was conducted between 2006-2008 in Romania through a population multicenter stratified random cluster sampling. Serum samples from 13,460 subjects were tested with a 3rd generation ELISA and a standardized questionnaire concerning the socio-demographic characteristics and potential risk factors was used. Results: The prevalence rate of HCV infection in Romanian adult population was 3.23% with significant differences between the main geographical regions (Moldavia 4.25%, Wallachia & Dobrogea 3.35% and Transylvania & Banat 2.63%), as well as between different counties (maximum 7.19%, minimum 0.56%). Overall participation rate to the survey of the selected subjects was 74.69%. Risk factors for HCV infection were: blood/blood products transfusions (p=0.0001), previous surgery (elective and emergency, p=0.0001 and p=0.043, respectively), frequent hospitalizations (p=0.0001), injections at home (p=0.0001), accidents/trauma (p=0.0001), occupational hazard related to blood exposure (p=0.025), intravenous drug administration (p=0.002), a partner chronically infected with HCV/hepatitis B virus (HBV) (p=0.046), first sexual intercourse <18 years (p=0.019), familial exposure to HCV/HBV infection (p=0.001) or to chronic HBV/HCV liver disease (p=0.001), personal history of chronic HBV infection (p=0.001). HCV RNA positivity was detected in 91% of the anti HCV positive subjects. Conclusions: Overall HCV prevalence in Romania is 3.23%. Both nosocomial and non-nosocomial routes are implicated as risk factors for HCV infection. [ABSTRACT FROM AUTHOR]

Background: An overall prevalence rate of HCV infection in Romanian adult population was recently estimated to be 3.23%. The proportion of treated patients with chronic hepatitis C in our country has never been assessed. Aims: 1) to analyze the quality and quantity of antiviral therapy delivery; 2) to determine the proportion of patients being annually and ever treated with antiviral therapy in Romania and 3) to identify barriers against treatment of HCV infected-population in Romania. Results: The number of annually treated patients remained relatively stable between 2002 and 2007 (1,813 patients treated with pegylated interferon and ribavirin in 2002 and 2,446 in 2007). There was a doubled increase in reimbursed treatment in 2008 and 2009 (4,503 and respectively 4,701 treated patients) due to a special campaign organized to increase awareness and prevention of HCV transmission. The median time to therapy approval varies from county to county; overall it is 10.23 months. A total number of 25,318 patients with chronic C hepatitis were treated between 2002-2009, corresponding to a cumulative proportion of 4.1% of the prevalent cases of HCV infection treated in Romania until 1st January 2010. The main limiting factor of access to antiviral therapy for hepatitis C in Romania remains the lack of funds. Conclusions: This is the first analysis of the nationwide practice for treatment of hepatitis C in Romania. Increased public health efforts are required to improve access to antiviral therapy for hepatitis C in Romania. [ABSTRACT FROM AUTHOR]

Background: Small nodules (<3 cm) detected on ultrasound (US) in cirrhotics represent the most challenging category for noninvasive diagnosis of hepatocellular carcinoma (HCC). Aim: To evaluate real-time sonoelastography as a noninvasive tool for the diagnosis of small HCC nodules in cirrhotic patients. Methods: 42 cirrhotic patients with 58 nodules (1-3 cm) were evaluated with real-time elastography (Hitachi EUB-6500); the mean intensity of colors red, blue, green were measured using a semi-quantitative method. Analysis of histograms for each color of the sonoelastography images was performed for quantifying the elasticity of nodule tissue in comparison with the cirrhotic liver tissue. AUROC curves were constructed to define the best cut-off points to distinguish malignant features of the nodules. Univariate and multivariate logistic regression analysis was performed. Results: 595 sonoelastography images from 42 patients (25 men; 17 women) were analyzed. The mean age was 56.4±10.7 years and 69% patients were in Child-Pugh class A, 19% class B, 11% class C. For the mean intensity of green color AUROC=0.81, a cut-off value of <108.7 being diagnostic for HCC with a Sp=91.1%, Se=50%, PPV=92.1%, NPV=47.1%. Mean intensity of blue color proved to be an excellent diagnostic tool for HCC (AUROC=0.94); for a cut-off value>128.9, Sp=92.2%, Se=78.9%, PPV=95.4%, NPV=68%. Independent predictive factors of HCC for a small nodule in cirrhotic patients were: blue color>128.9 at sonoelastography and hypervascular appearance at Doppler US. Conclusions: US elastography is a promising method for the non-invasive diagnosis of early HCC. Blue color at elastography and hypervascular aspects are independent predictors of HCC. [ABSTRACT FROM AUTHOR]

The paper is concerned with the determination of blood permittivity and conductivity in Poiseuille and Couette simple shear flows. The experimental procedure, based on dielectric spectroscopy, evidences the sensitivity of blood electric properties to the applied frequency and local shear rate magnitude. The method evidences the possibility to correlate (for well‐defined flow geometry) magnitude of shear rate, and consequently the shear stress level, with spectra permittivity of blood. [ABSTRACT FROM AUTHOR]

Background. Bevacizumab (Bev) is approved in Europe and USA in combination with chemotherapy (CTH) based on fluoropirimidine (FP) in the treatment of adult patients with metastatic colorectal cancer (mCRC) in the first line of therapy, as maintenance treatment, postprogression, and in the second line of therapy. It was performed a retrospective analysis on mCRC patients treated with CTH + Bev in succesive lines in the Medical Oncology Department of the Fundeni Clinical Institute, Bucharest. Method. We collected demografic and clinical data: the disease stage at diagnosis, histopathology data, duration and CTH line, grade 3/4 adverse events, response rate (RR), progression-free survival (PFS), and overall survival (OS). Between August 2007 and December 2018 there had been treated with Bev 516 patients. At 3-6 months from the diagnosis, 384 patients (67.4%) presented synchronous metastases and 168 patients (32.6%) presented metachronous metastases. Results. A total of 358 patients (69.2%) received Bev in the first line of the treatment, of which 260 patients (72.6%) received FP + oxaliplatin (OX): FOLFOX/CAPOX, and 86 patients (24%) received FP + irinotecan(IRI): FOLFIRI/ CAPIRI. Four patients received FOLFOXIRI in the first line, and eight patients received only FP. As maintenance therapy, it was administered Bev/Bev+FP in 88 patients (79.3%) in the OX group and in 20 patients (18%) in the IRI group. A total of 128 patients (35.8%) received Bev beyond progression, of which 99 patients (79.8%) in the OX group and 22 patients (17.7%) in the IRI group; 137 patients (38.3%) received subsequent therapy lines after Bev failure. The medium chemotherapy duration for patients who received OX was 9.9 months (95% CI; 8.67-11.18), and 9.2 months (95% CI; 6.72-11.62) for those who received IRI. A total of 219 patients presented a therapy response, with a RR of 75.34% on OX, and a RR of 24.65% on IRI. The median PFS was 8.12 months (95% CI; 6.89-9.35) for OX and 8.35 months (95% CI; 6.6-10.1) for IRI, with p=0.034. The median OS was 17.03 months (95% CI; 14.66-19.40) for OX and 18.87 months (95% CI; 15.28-22.46) for IRI, with p=0.900. Conclusions. In our experience, Bev-OX had a similar efficacy as Bev-IRI regarding both PFS and OS, but with a higher response rate for those treated with OX. [ABSTRACT FROM AUTHOR]

Background & Aims: Hepatocellular carcinoma (HCC) is a significant public health issue, with an increasing incidence and prevalence and a high incidence-to-mortality ratio. The prognosis of HCC depends on two competing factors, tumor burden and underlying liver disease severity, encompassed in the Barcelona Clinic Liver Cancer (BCLC) classification. To assess HCC staging and the way staging affects eligibility for treatment at the time of the first diagnosis in Romania in the setting of opportunistic diagnosis, in the absence of a national HCC screening policy. Methods: Data regarding HCC staging, underlying liver disease, and eligibility for treatment at the time of diagnosis was analyzed using a prospectively maintained multicentric database, which included patients from the five largest tertiary care hepatology units in the country between June 2016 and February 2020. Results: A consecutive series of 477 patients was included. The distribution within BCLC classes was as follows: very early (0) 7.1%, early (A) 34.3%, intermediate (B) 19.4%, advanced (C) 14.2%, terminal (D) 24.7%. At the time of the diagnosis, 198 (41.5%) were eligible for a curative intent treatment, while 359 (75.2%) were eligible for a disease-modifying therapy. 228 patients (47.8%) had decompensated liver disease at the time of diagnosis, the most common decompensating event being ascites (78.1%). Conclusions: A large proportion of HCC cases are diagnosed at the time of a decompensating event, severely restricting the therapeutic potential. Proactive diagnostic strategies should be implemented to improve the rate of actionable diagnosis. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article on the diagnosis of clostridium difficile infection in gastroenterology in the previous issue.

A letter to the editor is presented in response to an article about the reactions of somatic mutation (V617F) in the Janus tyrosine kinase-2 (JAK2) gene of Budd-Chiari syndrome which appeared in the September 2009 issue.

The article discusses the prevalence and mildness of inflammatory bowel diseases (IBD) in South Eastern Europe. The authors had reported the low incidence and low prevalence of IBD in Romania. They compare the characteristic of IBD in Romania and Turkey and noted that most patients had ulcerative colitis and some had Crohn's disease.

Background. The influence of co-infection with hepatitis D and B viruses on the prognosis of patients with liver cirrhosis is not well established. It is generally considered that hepatic insufficiency in co-infected (HBV+HDV) patients is more severe and rapidly progressive, the evolution being aggravated by numerous complications. Aim. The aim of our study was to compare the long term evolution of patients with liver cirrhosis secondary to viral hepatitis B and D co-infection with that of cirrhotic patients with only hepatitis B virus infection. Methods. Patients were enrolled consecutively from cases admitted in our department during one year (2005) and diagnosed then for the first time with compensated cirrhosis secondary to VHB+VHD co-infection (first group) and VHB mono-infection (second group) respectively. We followed the patients from inclusion (at cirrhosis diagnosis) until death, liver transplantation or until the end of study period (31 December 2013). The occurrence of complications of cirrhosis (hepatocellular carcinoma, refractory ascites, hepatic encephalopathy, upper digestive bleeding, portal vein thrombosis, hepatorenal syndrome, spontaneous bacterial peritonitis) and the causes of death were noted. Survival curves were calculated using Kaplan Meier method and compared using the log-rank test. Results. We enrolled 75 patients with HVD+HBV cirrhosis and 75 patients with HBV cirrhosis. In HDV+HBV group 49.34% were men, with the mean age 43.86 +/-11.66 and in HBV group 66.67% were men with mean age 48.20 +/-11.82. At diagnosis mean MELD score was similar in both groups: 9.45 ± 1.99 for HDV+HBV and 8.14 ± 1.34 for HBV group. Patient mortality during follow-up was predicted (in univariate analysis) by: the presence of HBV and HDV coinfection, Child Pugh class C, MELD score and by the following complications of cirrhosis: hepatocellular carcinoma, refractory ascites, hepatic encephalopathy, upper digestive bleeding, jaundice, portal vein thrombosis, hepatorenal syndrome. Although patients with HDV+HBV related cirrhosis had a significantly lower survival compared to HBV related cirrhosis (p=0.01) in multivariate analysis the only independent predictors for patient death were: the presence of hepatocellular carcinoma, refractory ascites and presence of hepatic encephalopathy episodes. Liver transplantation was performed in 12 patients; 9 patients with HDV+HBV related cirrhosis and only 3 patients with HBV cirrhosis (p=0.13). Conclusion. The presence of HVD+HVB co-infection is not an independent risk factor for mortality [ABSTRACT FROM AUTHOR]

Several biologic treatments are available in addition to intravenous also in subcutaneous form for treatment of chronic diseases. Benefits of the subcutaneous application of drugs include self-administration by the patient, shorter time of application process with less infusion related adverse events and consequently lower healthcare costs. With appropriate education and support patients are able to administer their treatments at home. This leads to improvement of quality of life, reduction of time needed to travel to the healthcare institution and consequently also reduces costs also for the patient. Over one million residents in the USA and 2.5 million in Europe are estimated to have inflammatory bowel disease (IBD), with substantial costs for health care. These estimates do not factor in the 'real' price of IBD, which can impede career aspirations, instil social stigma and impair quality of life in patients. The Virtual Community Meeting, which offered an exchange of experience and opinions from healthcare professionals who are active in treating IBD, and patients with this chronic disease, revealed in-depth arguments and answers to some essential questions: which patients prefer subcutaneous over intravenous dosing; which patients continue to favour intravenous infusions; what are the limitations regarding both applications; what is the patient's role in therapeutical decision-making and how does IBD affect the patient's work, finances and quality of life? The aim of this article is to discuss the differences between subcutaneous and intravenous dosing from the health-economic, scientific, and personal perspectives. The meeting offered strong confirmation that most of the patients and healthcare professionals prefer subcutaneous over intravenous drug administration but emphasise the management of risks associated with treatment compliance. Patient education provided by the IBD team in this regard is mandatory. Quality of life of patients is poorer during active disease, but the findings that it can improve over time, including as a result of home- or self-administration of biologics, may be encouraging for individuals with this chronic disease. [ABSTRACT FROM AUTHOR]

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

Background & Aims: The evidence regarding the use of anticoagulant (AC) agents in portal vein thrombosis (PVT) is increasing and, most patients undergo chronic treatment with low molecular weight heparin (LMWH) or vitamin K antagonists (VKA). Nevertheless, there are no clear data about who should receive antithrombotic therapy, when to initiate it, how long and what dose should be used for this set of patients. The aim of the study was to assess the outcome of patients with cirrhosis and portal vein thrombosis who received AC therapy, in terms of thrombus regression, bleeding events and survival rates. Methods: This observational and retrospective study included 107 cirrhotic patients diagnosed with PVT in a single tertiary center between 2010-2019. 54 received low molecular weight heparin or vitamin K antagonist (AC treatment group) and 53 were untreated. All patients were periodically follow-up to assess the evolution of PVT (regression, progression, stable thrombus) and potential occurrence of bleeding events. Results: The regression of portal vein thrombosis was significantly higher in the AC treatment group (OR=2.430; 95% CI=1.11-6.167; p=0.026), more than 50% of on-treatment patients experiencing regression of the thrombus. However, bleeding events were significantly more frequent in the AC treatment group (18.5% vs. 7.5%) and the risk of bleeding was associated with thrombocytes less than 50x103/mm3 (OR=8.266; 95%CI: 2.310-39.211; p=0.002). Survival was better in the AC treatment group (68.4% vs 48.7% at 5 years and 92.7% vs 77.8% at 1 year, p=0.038) and was lower in patients that experienced bleeding events (37.22% survival at 5 years, mean time survival 44 months, p=0.008). Conclusions: In our cohort of cirrhotic patients with PVT more than 50% of patients receiving AC therapy presented regression of the thrombus; most of them obtained partial recanalization. The bleeding complication rate was higher than expected, reaching 18%. The overall mortality was lower in the treated group. [ABSTRACT FROM AUTHOR]

Background & Aims: Inflammatory bowel diseases (IBD) patients management has been challenging during the ongoing coronavirus disease 2019 (COVID-19) pandemic, due to lockdowns, limitation of access to medical facilities and new recommendations regarding patient management. The implications of the COVID-19 pandemic on IBD patients' management were assessed in our Tertiary Gastroenterology Center in Bucharest, Romania. Methods: Medical records of IBD patients admitted between 15th of March and 15th of August 2020 were retrospectively reviewed and compared to a control cohort of consecutive IBD patients admitted to our unit during the corresponding period of 2019. Results: There was a highly significant shift towards one-day hospitalization during the referral period in 2020 for IBD cases (91% in 2020 vs 82.2% in 2019, p=0.0001). There was no statistically significant difference between the distribution of patient's gender, IBD phenotype or newly diagnosed IBD cases. A significantly lower proportion of admitted patients received 5-aminosalicylic acid (29% vs 41.2%, p=0.0001), whereas a substantially higher number of patients were prescribed biological therapy in 2020 in comparison to the corresponding 2019-time frame (79.5% vs 57.9%, p<0.0001). The distribution of the biological agent used was significantly different in 2019 in comparison to the 2020 period mainly due to the increase in vedolizumab prescription in 2020 (p<0.0001). During the study period in 2020, seven IBD patients (1.7%) were diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infection, all of them with mild symptoms without impact on the IBD course. Conclusions: The COVID-19 pandemic led to reorganizing medical care, limiting the hospital admissions in favor of severe IBD cases, favoring telemedicine for mild disease and optimization of treatment for moderate to severe IBD with an increased use of biologicals aimed to maximize the risk/benefit ratio. Incidence of SARS-Cov2 infection during the first wave of COVID-19 infection in our study group was 1.7% and did not adversely impact the IBD disease course. [ABSTRACT FROM AUTHOR]

Background and Aim. The number of patients with hepatocellular carcinoma (HCC) listed for liver transplant (LTx) has increased significantly and many of them are now receiving transarterial chemoembolization (TACE) to prevent disease progression. The aim of the study is to analyze the course of disease in patients with HCC who received TACE before LTx. Methods. Patients and tumor characteristics were compared between recipients who received TACE and those who did not. Kaplan-Meier method was used to compare patient survival. Results. Thirty-one patients treated with sequential TACE of a total of 63 patients with proven HCC that underwent LTx between 2013 and 2018 were included in the study. Altogether, 51 TACE procedures were accomplished (range 1-6). Twenty two patients (70.9%) received TACE with Lipiodol while the rest were treated with Debdox. Forty patients were within the Milano criteria and twelve patients (19.04%) had a complete response after TACE. Follow up duration was 72.3 months (62-114) and thirteen patients (20.6%) developed HCC recurrence after LTx. The recurrence free survival was 85.7 %, 69.6% and 58.9% at 1, 3 and 5 years, respectively. There was no significant difference in survival in patients that received TACE compared to those that did not (p=0.455). In the univariate analysis an AFP value greater than 100ng/mL, absence of tumor tissue at the time of LTx and a tumor within Milan criteria were found to be predictive factors for survival but only Milan criteria was significantly associated with survival in multivariate analysis (p=0.007; CI 95%: 0.1262 to 0.7266). Conclusion. TACE is an effective method for the therapy of the HCC before LTx in selected patients Milano criteria is the best predictive factor for survival in HCC patients undergoing liver transplant. [ABSTRACT FROM AUTHOR]

Nonalcoholic liver disease (NAFLD) is a hot topic for gastroenterologists and hepatologists and clinical practitioners must be kept abreast with the rapid progress of knowledge in this field. The Romanian Society of Gastroenterology and Hepatology (RSGH) has elaborated this review dedicated to evidence-based data on pathogenesis, diagnosis and therapy of this condition. The term NAFLD includes two distinct conditions, with different histologic features and prognosis: nonalcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH), the second with the highest risk of evolution to cirrhosis and its complications, including hepatocellular carcinoma (HCC). Non-alcoholic fatty liver disease is considered the hepatic manifestation of the metabolic syndrome. Therefore, NAFLD is associated not only with an increase of liver-related mortality, but also of the overall mortality, especially cardiovascular and malignancies. Noninvasive techniques, such as biological tests and elastography can be used for the evaluation of NAFLD patients. Liver biopsy should be recommended in selected cases, for diagnostic, therapeutic and prognostic purposes. Patients with NAFLD would benefit from their lifestyle changes by progressive weight loss through exercise and low fat and sugar diet. Pharmacotherapy should be reserved for patients with NASH, particularly for those with significant fibrosis. Until now, there are no FDA approved therapies for NASH. [ABSTRACT FROM AUTHOR]

Introduction. In the last decade, bariatric surgery has proven to be the only effective method for weight loss (WL) in patients with morbid obesity. Objective. To determine the factors that influence optimal WL after sleeve gastrectomy in patients with morbid obesity. Material and method. 72 patients with BMI >40 kg/m2 or BMI 35-39.9 kg/m2 with severe comorbidities were included in the study. The patients were evaluated clinical, biochemical, immunological, imaging and histological preoperative and postoperative (on average 8.7 months after the surgical intervention). WL were assessed by calculated the percentage of excess body mass index loss (%EBMIL) using the following formulas %EBMIL=(BMI1-BMI2) / (BMI1-25) x100; Optimal treatment response was considered a decrease in %EBMIL >50 Results. The patient had a mean age of 44.78±10.5 years, an average BMI and preoperative waist of 47.05 kg/m2 (between 33.3 and 70.1), respectively 130 cm (between 90 and 180cm). The results of our study showed a mean decrease in %EBMIL of 69.9 ± 27.6 (14.6-144.47), the value that shows an optimal response of postoperative weight loss. Using the univariate analysis we noted a negative correlation between % EBMIL and both the age and initial BMI of the patients (r=-0.438, p<0.01, r2=0.19). Patients with optimal WL have statistically significantly lower preoperative values of FG (U= 95.5, z=-2.25, p<0.05), TNFα (U=53, z=-2.5, p<0.05) and IL-6 (U=79, z=-2.3, p<0.05) compared to patients without clinical response (%EBMIL<50%). A negative correlation between %EBMIL and the presence of NASH was also found. Patients with preoperative NASH had a significantly lower %EBMIL than those with simple steatosis (U=56, z=-2.2, p<0.05). Conclusions. Sleeve gastrectomy was an effective bariatric surgery to treat obesity. Preoperative BMI, excess weight, age, TNF α, IL-6 and the presence of diabetes and steatohepatitis were predictive factors for optimal weight loss in patients with morbid obesity after sleeve gastrectomy. [ABSTRACT FROM AUTHOR]

Background and Aims. Elimination of viral hepatitis represents a WHO objective that Romania undertook to fulfill it through the National Framework Plan for the control of viral hepatitis. Microelimination programs are recommended by WHO in order to reach the targets. Prisoners represent a population at risk for viral infection, considering multiple vulnerabilities: PWID, high-risk sexual behaviours and violence and the absence of screening upon incarceration. There are no standard protocols for HCV/HBV testing in Romanian prisons. A pilot study of HCV/HBV screening and linkage to care in prison setting was conducted using mobile medical teams in different prison facilities in three regions of Romania. Method. Multidisciplinary mobile teams were set up, coordinated by three University Hepatology Centers. A point-of-care anti-HCV and HBs-Ag tests and medical history were performed to prisoners and to staff. Only those positive for HBV/HCV rapid tests had blood collected for viremia and non-invasive tests and were selected for the hospital visit, for liver disease staging and treatment initiation. Results. For two years, multidisciplinary teams visited 18 detention centers in three regions of Romania - S-M, S-E, and N-E. Local awareness campaigns preceded every test visit. A number of 9950 persons deprived of liberty (PDL) and a number of 427 penitentiary staff were tested. The global prevalence of hepatitis B infection was 2.48 % and of hepatitis C infection was 9.9% with important diferences between centres and regions - 11,49% HCV infection vs 2,08% in the detention centres from the south part of the country and the N-E region, respectively. The greater part of tested were men (94%), with secondary education (51.7%) from urban areas (54.2%). 85.3% did not know they had hepatitis and had not been treated previously. Were highlighted 18.4% former PWID. 3.7% of PDL declared blood transfusions in the past, and a percentage of 28,2% declared previous surgical interventions. We specify these are interim data, the project being ongoing. Patients' medical records were processed and the eligible subjects started antiviral treatment after the hospital visit for complet diagnosis and staging. Conclusion. The prevalence of HCV and HBV in prisoners is significantly higher than in the general population. This ongoing project is a proof of concept that detection of incarcerated HCV/HBV positive patients and their linkage to care, in the prison environment in Romania, is feasible, prisons providing a rare opportunity for viral hepatitis microelimination. [ABSTRACT FROM AUTHOR]

Background & aims. In our country prospective studies to establish the prevalence of obesity and non-alcoholic fatty liver disease (NAFLD) are lacking. We prospectively assessed the prevalence and severity of NAFLD in a cohort of asymptomatic patients attending the national screening programme for colorectal cancer. Methods. Screening for NAFLD was performed using abdominal ultrasound and Fibroscan with CAP module. Also antropometric parameters, comorbidities like diabetes and arterial hypertension, and risk behaviours like smoking and alcohol consumption were evaluated Results. We screened 70 patients with FIT positive tests, attending for colonoscopy. The mean age was 60 ± 7.0 years, 48.5% were male, the mean BMI was 28.46 ± 4.54 kg/m2, and 37,1% were obese. The prevalence of NAFLD as evaluated as any degree of steatosis on Fibroscan with CAP module was 79.7% and the prevalence of severe steatosis was 26.6%. Significant fibrosis (F =2) was present in 13.8%. In a multivariable logistic analysis, the only factor associated with the presence of NAFLD was waist cirumference at high risk (>102 cm in men and >88 cm in women) Conclusion. The obesity and NAFLD incidence rate in asymptomatic general population is high and worrying. Abdominal obesity seems to be more predictable than BMI for the diagnosis of fatty liver. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Gastric heterotopic pancreas: an unusual case and review of the literature," by A. Trifan and colleagues in the 2012 issue.

The article describes the case of a 56-year old woman who was diagnosed with alpha fetoprotein (AFP)-producing colon cancer. The patient underwent blood tests, upper endoscopy, colonoscopy, computed tomography scan of the thorax, abdomen and pelvis, liver and colon biopsy. Blood test results revealed increased liver enzymes, mild cholestasis and inflammatory syndrome, while immunohistochemistry results included tubulo-papillary pattern, liver metastasis and synaptophysin positive cells.