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Irritable bowel syndrome (IBS) has a global prevalence of around 4.1% and is associated with a low quality of life and increased healthcare costs. Current guidelines recommend that IBS is diagnosed using the symptom-based Rome IV criteria. Despite this, when patients seek medical attention, they are usually over-investigated. This issue might be resolved by novel technologies in medicine, such as the use of Artificial Intelligence (AI). In this context, this paper aims to review AI applications in IBS. AI in colonoscopy proved to be useful in organic lesion detection and diagnosis and in objectively assessing the quality of the procedure. Only a recently published study talked about the potential of AI-colonoscopy in IBS. AI was also used to study biofilm characteristics in the large bowel and establish a potential relationship with IBS. Moreover, an AI algorithm was developed in order to correlate specific bowel sounds with IBS. In addition to that, AI-based smartphone applications have been developed to facilitate the monitoring of IBS symptoms. From a therapeutic standpoint, an AI system was created to recommend specific diets based on an individual's microbiota. In conclusion, future IBS diagnosis and treatment may benefit from AI. [ABSTRACT FROM AUTHOR]

Ulcerative colitis (UC) is a chronic inflammatory condition, with a relapsing-remitting course. The case presented poses some valid questions regarding short-term and long-term management of patients with UC, and if the outcome (colectomy) could have been delayed or even prevented. Rectal bleeding is a cardinal symptom in patients with UC and it occurs among all patients during active disease. Massive rectal bleeding is an uncommon, but serious, complication of UC accounting for 0.1-1.4% of admissions. It is, nonetheless, noteworthy that instances of acute significant lower gastrointestinal bleeding accompanied by hemodynamic instability are infrequent. The rate of colectomy appears to be positively impacted by biological treatment. However, a refractory condition is still the primary reason for surgery, indicating a pressing need for new treatment approaches. Here we present the case of a young male patient who developed massive rectal bleeding and underwent emergent colectomy with ileostomy while having clinical and biological remission (normal calprotectin levels) at week 10 of Vedolizumab treatment. [ABSTRACT FROM AUTHOR]

Aim: The present study aims to determine the rate of mucosal recovery and predictors of persistent mucosal damage after gluten free diet (GFD). Background: Celiac disease (CD) is a complex multi-systemic autoimmune disease triggered by exposure to dietary gluten in genetically predisposed individuals. There is still little evidence on the best method for assessing GFD adherence and mucosal recovery during treatment. Methods: The retrospective study included only adult patients (age≥18 years old), with biopsy-proven CD evaluated at a tertiary referral centre between 2016 and 2021. We performed a logistic regression analysis to identify factors associated with partial mucosal recovery (MR) after GFD. We included in the multivariate analysis parameters available at the time of CD diagnosis. Results: A total of 102 patients were enrolled, two thirds were females, median age of 39 years (yrs). The initial biopsy analysis showed different stages of villous atrophy (VA) in 79 (77.4%) cases, while in 23(22.5%) cases showed mild enteropathy (Marsh 1, 2). After at least 12 months of GFD, 26 (25.5%) patients had persistent VA despite good or excellent adherence to GFD. Younger patients (< 35yrs), who showed severe mucosal damage (Marsh 3c lesions) and who had increased anti-gliadin antibody (AGA) levels were at risk for failure to obtain mucosal recovery (MR). Logistic regression analysis demonstrated that complete mucosal atrophy (P=0.007) and high AGA antibody levels (cutoff 129 U/ml, P=0.001) were independent risk factors for lack of mucosal improvement after at least 12 months of GFD. Interestingly, genotype, tTG-IgA antibody levels, or duration of GFD levels did not influence the occurrence of MR. Conclusion: Although AGA seropositivity has lost much of their diagnostic significance in recent years due to the introduction of the more sensitive and specific antibody tests, our study reported that patients aged < 35 yrs, who showed severe mucosal damage (Marsh 3c lesions) and who had increased AGA antibody levels at diagnosis were at risk for failure to obtain MR. The elevated AGA levels at diagnosis could be used as a prognostic tool for assessing MR. [ABSTRACT FROM AUTHOR]

Background: Irritable bowel syndrome (IBS) patients' use of the Internet for health information interacts with the way they trust their gastroenterologist. No standardized measure has targeted IBS patients and gastroenterologists specifically, nor their use of the Internet. The aims of this paper were as follows: the development of a scale that measures an IBS patient's trust in their gastroenterologist, the development of a scale measuring an IBS patient's reliance on Internet health information, and testing the hypothesis that IBS patients, who use the Internet for IBS‐related information, trust their gastroenterologist less than those who do not. Method: A total of 82 patients (mean age 49, SD = 14.62) diagnosed with IBS completed two questionnaires: one about trust in their gastroenterologist and the other about the reliance on Internet health information regarding IBS. The two questionnaires were built using current literature as well as our previous qualitative research. The statistical computations were performed using the SPSS 20 program. Key Results: Both questionnaires proved to be reliable in measuring gastroenterologist‐IBS patient trust (alpha = 0.87) and Internet information reliance (alpha = 0.88), respectively. The IBS patients who did not look for information about IBS over the Internet had significantly higher trust in their gastroenterologist compared with those who did (U = 535.5; z = −2.26; P < 0.05). Conclusions: We developed two ready‐to‐use scales to measure both the gastroenterologist‐IBS patient's trust and the IBS patient's reliance on the Internet. Further studies will be able to explore the interaction among all variables in IBS patients' trust. [ABSTRACT FROM AUTHOR]

A case study is presented on a 37 year old male with a history of binge alcohol consumption who went to the emergency department for several symptoms including nausea, sweating, and vomiting. Laboratory findings revealed an elevated bilirubin, C reactive protein, and serum glucose. Ophthalmoscopy of both eyes showed cotton wool spots while fluorescein angiography showed capillary leakage. The patient was diagnosed with Purtscher's like retinopathy, a complication of acute pancreatitis.

Background & Aims. Recent papers highlight the role of the diet in irritable bowel syndrome (IBS), but very few population-based studies have evaluated this. The aim of the study was to determine the prevalence of IBS in the general urban population and to evaluate the type of diet associated with IBS symptoms. Methods.A randomized sample of subjects (n=300) from a general urban population in Romania selected from family doctors' patient lists was invited for interview in the doctor's office. Selected subjects were evaluated for the diagnosis of IBS using Rome III criteria and for their eating habits and diet using a food frequency questionnaire. Socio-demographic factors and general medical history were also included in the interview together with standard weight measurements. Results from logistic regression were presented as odd ratios and 95 % confidence intervals. Results. From the selected sample, 193 subjects (80 males, 113 women, mean age 50.8±16.2) agreed to participate (rate 64.3%). Prevalence of IBS was 19.1 % (19.4% for females and 18.7 % for males). IBS was associated with older age (1.05, 1.02-1.08, p<0.001) and past history of digestive diseases (5.0, 2.0-12.7, p<0.01). IBS subjects eat significantly more frequently canned food (23.74, 3.17-177.7, p<0.01), processed meat (4.7, 1.6-14.1, p<0.01), pulses (legumes) (4.0, 1.3-16.3, p<0.01), whole cereals (8.7, 2.0-37.8, p<0.01), confectionary (5.7, 1.8-23.2, p<0.01), fruit compotes (canned or not) (7.4, 2.5-23.1, p<0.001) and herb teas (4.0, 1.3-16.3, p<0.001). Conclusions. This study updates prevalence data and reveals a possible association between diet and irritable bowel syndrome. [ABSTRACT FROM AUTHOR]

Celiac disease (CD) is a common autoimmune enteropathy elicited by the ingestion of gluten peptides among HLA DQ2 or DQ8-positive individuals. The spectrum of gluten-induced signs and symptoms is quite wide, varying from classical CD to more difficult-to-diagnose subtypes such as potential CD (PCD). Recent epidemiological studies report that PCD represents one-fifth of the total CD diagnoses. According to the Oslo definitions, PCD is defined by the presence of specific celiac autoimmunity, anti-tissue transglutaminase IgA, and anti-endomysium IgA, along with HLA-DQ2 and/or - DQ8 positivity, and non-atrophic mucosal changes (Marsh 0 or Marsh I). Several questions remain unanswered regarding the diagnostic and therapeutic dilemma of the potential celiac patient. Is PCD an intermediate stage towards true CD? It may be safe to assume that PCD and active CD are variants of the same disease. Are we risking underdiagnosing or over-diagnosing CD in potential celiac patients? Further research is still needed to answer these questions and to help identify the PCD patients who will progress towards overt CD, and whether these patients would benefit from an early implementation of the GFD. Time of diagnosis, amount of gluten exposure, and the microbiome are risk factors worth exploring. [ABSTRACT FROM AUTHOR]

Biliary hamartoma or von Mayenburg complex (VMCs) is a rare benign congenital malformation of the biliary duct. Patients are usually asymptomatic. Hepatic lesions are incidentally discovered on ultrasonography (US) and subsequent radiological methods are necessary for confirmation. A correct diagnosis is established when typical imaging findings are present, otherwise histological confirmation might be needed [ABSTRACT FROM AUTHOR]

Association of adenocarcinoma and tuberculosis (TB) of the sigmoid colon is a rare clinical condition even in an endemic country as Romania, with challenging diagnosis and treatment. Case report. We present the case of a 57-year-old female patient who was admitted on emergency basis for a diagnosis of obstructive sigmoid adenocarcinoma. The patient was operated on and it an obstructive sigmoid tumor with serosal invasion, adherent (invading) to the body of uterus and left adnexa and urinary bladder serosa, no liver or peritoneal metastases. A sigmoidectomy was performed "en bloc" with subtotal hysterectomy, left adnexectomy and extramucosal cistectomy. The histopathological exam showed a moderately differentiated, ulcerated adenocarcinoma, widely infiltrating the colon wall invading the myometrium. Ziehl Neelsen (ZN) stain identified the presence of metachromatic bacillary structures in the colonic wall, lymph nodes and adnexal areas. Postoperative course was uneventful and the patient was discharged 10 days postoperatively in good clinical condition. After one year when the patient completed the full course of anti-tubercular drugs, a thorough work-up was performed. Colonoscopy, CT of the thorax, abdomen, pelvis showed no signs of recurrence while tumoral marker CEA (1.62 ng/ml - n<3.4) and QFT (Quantiferon-TB Gold) test were within normal range. Discussion and conclusion. Although digestive tuberculosis is included in differential diagnosis for those patients presenting abdominal pain or obstructive digestive symptoms in endemic regions, in this case the absence of TB infection criteria and positive endoscopic biopsy for colonic adenocarcinoma did not allow a complete pre- or perioperative diagnosis.

Aim: To evaluate the experience of a single coeliac center over a 10-year-observational period., Material and Methods: Between January 2003 and December 2013 a total of 195 consecutive patients admitted with celiac disease were tested by multiple duodenal biopsies, anti-tissue transglutaminase and anti-gliadin antibodies, and baseline demographic, clinical, biological and immunological parameters., Results: Patients were divided into two major groups according to the clinical features and number of signs and symptoms present upon admission: gastrointestinal (131, 67.17%) and non-gastrointestinal (64, 32.8%). Anti-tissue transglutaminase and anti-gliadin antibodies showed seropositivity in 109/158. Histological samples were available in 152 cases, according to Marsh-Oberhuber classification 11.18% being type 0, 17.76%, type I-II, and 71.05% type III. Correlations between anti-tissue transglutaminase antibody titers and Marsh-Oberhuber classification were found to be statistically significant. Body mass index was available in 96 cases. We found that severe atrophy was predominant in patients with a BMI<18 kg/m2., Conclusions: Celiac disease has an increasing prevalence and can be diagnosed at any age. Histology samples were indicative of different stages of villous atrophy. The disease prevalence is significantly higher among women. There was no statistically significant correlation between Marsh classification and BMI values.

An important issue in the management of inflammatory bowel disease (IBD) is the risk for lymphatic or extracolonic malignancies reported in patients receiving prolonged immunosuppressive therapy and/or therapies with biological agents. Azathioprine (AZA), 6-mercaptopurine (6-MP), methotrexate. and anti-TNF (infliximab, adalimumab) are reference drugs for IBD forms unresponsive to conventional therapies. The administration of these drugs is a high responsibility because IBD itself is associated with an increased risk for cancer, namely colon cancer. The possibility of a drug-induced additional risk remains controversial, the relative risk for lymphoma being estimated at 1.2%. For extracolonic malignancies, there are variations in standardized incidence per reference population in terms of location (skin, liver and biliary tract, uterine cervix, prostate, etc.), and also IBD phenotype (ulcerative colitis or Crohn's disease). The uncertainty regarding the occurrence of neoplasia in IBD patients for many years on immunosuppressive therapy and/or biological agents is a strong argument both for treatment discontinuation and it's monitoring by inclusion in screening programs. In this paper we aimed to approach the conceptual model risk-benefit in the therapy with imunosuppressive and biological agents given the controversies in the literature generated by the drug-induced risk for malignant lymphatic and extracolonic tumor in patients with IBD.

Aim: Malignant tumors localized in the digestive tract have a tendency to local growth and invasion with lymph node metastasis. Distant metastases through blood with prevalent liver location are detected late in disease progression, in an advanced stage, when therapeutic possibilities are often limited to palliative therapy., Material and Methods: The study included a series of 139 patients with liver metastases admitted to the Center of Gastroenterology and Hepatology lasi between January 1 and October 10, 2011 for the identification of primitive tumor. The patients were investigated by endoscopy, imaging, laboratory tests including tumor markers., Results: At 99 of the patients (71%) we identified primitive digestive tumors, in 19 patients (13.6%) we found tumors with extradigestive location and in 21 patients (15%) the primitive tumor could not be identified. Primitive.tumor was located in various segments of the digestive tract, liver, and pancreas was follows: esophagus 4 - (4%), eso-cardial-tuberositary 2 - (2%), eso-cardial-tuberositary with pancreatic invasion 1 -(1%), stomach 15 - (15%), ileocolon 1 - (1%), colon 19 - (19%), rectum 12 - (12%), liver, multicentric hepatolcellular carcinoma 23 - (23%) billiary tract - cholangiocarcinoma 2 (2%), pancreas 2 - (20%). In a series of 586 patients with malignant tumors of the digestive organs referred to the Iasi Oncology Outpatient Unit between January 1 and September 30, 2011, 132 patients (23%) had liver metastases at the time of diagnosis; the most common locations were the stomach 41% cases (42/119 patients), followed by the pancreas, 35%, and colon 31% patients (28/79 patients and 37/119 patients, respectively). Males were most affected, regardless of primitive tumor., Conclusions: Although diagnostic and therapeutic methods have made remarkable progress in recent years, these tumors, by their frequency and advanced stage at diagnosis, remain both an oncologic and public health problem mainly due to the limitations of curative treatment.

Helicobacter pylori (H. pylori) is the bacterium that causes the most common infection in the world. Epidemiological studies show that over 50% of the population is infected, there are areas where virtually the entire population present the infection since childhood. Although the stomach seems to be a "hostile" environment for the development of microorganisms due to the acid pH not fit for life, it may be infected; the first spiral organisms were described at this level as early as 1874. These microorganisms were isolated by Waren and Marshall in 1982 and named Campylobacter pyloridis. In 1989 Goodwin renamed the bacterium Helicobacter pylori. Helicobacter pylori is thus a bacterium which "manages" to survive in gastric acid environment producing an infection which, untreated, is likely to persist the entire life. This feature explains the high rate in the spread of the infection. The infection manifests itself in different ways, depending on the pathogenic strain and the host response, the majority of those infected being asymptomatic or paucysymptomatic. The great achievement of Warren and Marshall,who were rewarded with a Nobel prize in 2005, was to demonstrate that H. pylori can lead to gastric cancer, the bacteria being categorized as an oncogene agent. The anti H. pylori "campaign" was only a step away... and yet, the bacterium has been living in the stomach for centuries. We will try to list the pros and cons of H. pylori infection, when and how the infection should be treated, clearly indicating groups of patients in which eradication is absolutely mandatory. Key words:

Unlabelled: Helicobacter pylori (H. pylori) and diabetes mellitus are the most important causes of dyspepsia. The aim of this study was to evaluate the prevalence of H. pylori infection in patients with diabetes mellitus, and to assess whether the infection was associated with severity of dyspeptic syndrome and metabolic glycemic control., Material and Method: 100 patients with diabetes mellitus type 1 and 2 (41 men and 59 women, mean age 58.59 ani) were included in our study. Each patient completed a self-report questionnaire to obtain information concerning the presence and severity of upper gastrointestinal tract symptoms. H. pylori status was confirmed by serological test and histophatology study of gastric biopsy or 13C-urea breath test., Results: Prevalence of H. pylori infection was found not to be significantly higher in diabetics than in controls (70% vs 73% ). 49% H. pylori positive diabetics had type 2 insulinonecesitant diabetes mellitus, 27% had type 1 diabetes mellitus and 24% had type 2 diabetes mellitus, with no statistically significant difference (p > 0.05). We found no statistically significant difference in the symptoms score between H. pylori positive and H. pylori negative diabetic patients. The main value of HbA1 levels in H. pylori--infected diabetics was 7.31% and 7.47% in H. pylori non-infected diabetics, without significant difference., Conclusion: There was no statistically significant difference in the prevalence of H. pylori infection between diabetics and non-diabetics patients and no difference in the symptoms score between H. pylori positive and H. pylori negative diabetic patients. H. pylori in diabetics appears no influence glycemic status.

Gastroparesis is a disorder characterized by a delay in gastric emptying of a meal in the absence of a mechanical gastric outlet obstruction. Diagnosis of gastroparesis is based on the presence of symptoms ( nausea, vomiting, postprandial abdominal fullness), excluded mechanical obstruction (endoscopy) and on objectively determined delay in gastric emptying. Gastric emptying can be assessed by scintigraphy and stable isotope breath tests. The true prevalence of gastroparesis is unknown. The aetiology of gastroparesis is diverse. In approximately one third of cases, gastroparesis is related to the presence of diabetes mellitus; one third of case is of unknown cause (idiopathic). Mild disease will respond to dietary and life style measures and prokinetics (domperidone, metoclopramide, erytromicyne). Severe disease can benefit from intrapyloric botulinum toxin injection, gastric pacing or more radical surgical interventions (partial or total gastrectomy).

Achalasia is a mortality disorder described in 1674 by Willis. It has a small incidence in the general population. The main symptom is dysphagia. The golden standard for diagnosis is esophageal manometry. Esophageal scintigraphy is a non-invasive method of exploration: the technique is simple, it lasts five minutes and is more sensitive than the radiologic exam. The esophageal scintigraphy was made in the Nuclear Medicine Laboratory of the Sf. Spiridon Hospital using a gamma scann Diacam--Siemens. The parameters measured with esophageal scintigraphy are: esophageal transit time, residuary radioactivity. Our study included a number of 37 patients with achalasia with ages between 16 and 80 years (the average--47, 3 years). Our conclusions are the same with the data from literature.

The esophageal scintigraphy is a technique used to evaluate the motility and the clearance of the esophagus. The patients with achalasia of the cardia were evaluated, before treating them with pneumatic dilatation and after. The reason is to evaluate the efficiency of the pneumatic dilatation technique in the treatment of esophageal achalasia. The pneumatic dilatation with an instrument type Rigiflex is a well/handled and used technique in our clinic. In the study 22 patients were included and we had in view the esophageal transit time and the residuary radioactivity before and after the pneumatic dilatation. We established an important statistical improvement of the data obtained after the dilatation comparative with the data before the treatment (p < 0.01).