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Through its specific biological, epidemiological, diagnostic and infection management features, Clostridium difficile infection (CDI) can be considered a major health concern, especially in inflammatory bowel disease (IBD) patients. In this particular infection, many IBD risk factors are triggered due to bowel inflammation, antibiotics use, microbiota changes, immunosuppressive therapy use and surgical intervention. Thus, each IBD and diarrhea patient must be tested for CDI. Clinical features show different initial infectious stages such as mild, fulminate and refractory. It has been shown that CDI presents recurrent episodes. CDI treatment consists of metronidazole, vancomycin or fidaxomicin, as well as prophylactic measures. It was recently shown that antibiotic doses must be gradually reduced in order to avoid CDI relapses. Fecal transplantation, effective in CDI management, remains controversial in CDI patients with concurrent IBD.

Background & Aims: The burnout syndrome (BOS) is commonly seen in healthcare professionals, particularly in physicians who are exposed to a high level of stress at work and has a negative impact on the medical activity. Physicians with BOS manifest a negative attitude, a reduction in compassion at work, and suboptimal patient care experiences. These all can lead to absenteeism, poor performance and more frequent medical errors. We aimed to assess the level of BOS in a tertiary gastroenterology university center in Romania. Methods: This observational study involved 40 physicians from a tertiary gastroenterology university center. An online questionnaire assessed the presence of BOS using the Maslach Burnout Inventory. Results: A total of 40 physicians responded to the questionnaire. The prevalence of overall BOS of 87.5%. In terms of high burnout, 15 doctors (37.5%) had emotional exhaustion, 10 doctors (25%) had depersonalization, and 30 doctors (80%) scored low for personal achievement. Men presented more frequently emotional exhaustion and women lower personal achievement scores, but there was no significant statistical difference. No significant relationship was found between marital status or the number of children and BOS. We identified multiple risk factors associated to BOS, the most important one being strict internal regulations. Conclusions: Physicians presented an increased risk for BOS. The high rate of BOS among physicians found in our study requires careful attention. Further studies aiming to identify other factors that contribute to BOS and to identify measures to combat this syndrome are necessary. [ABSTRACT FROM AUTHOR]

Ixekizumab is one of the three biologic agents including Secukinumab and Brodalumab that targets the Interleukin-17 (IL-17) pathway to reduce inflammation in psoriasis and ankylosing spondylitis. In this report we present the case of 42-year-old woman, who was diagnosed with psoriasis and psoriatic arthritis. One week after first administration of Ixekizumab, she developed diffuse abdominal pain, bloody diarrhea (7-8 stools/day) and fever. Following imaging (colonoscopy, computed tomography) and laboratory investigations, she was diagnosed with acute severe ulcerative colitis complicated with toxic megacolon. The medical treatment (first corticotherapy, then infliximab) has failed and the patient needed emergency colectomy. Based on the immunological mechanisms and the observation from other studies, Ixekizumab should be considered an etiology for new-onset inflammatory bowel disease. [ABSTRACT FROM AUTHOR]

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Background. Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are perceived different pathologies, one organic and the other functional, which influence the quality of life (QOL). We aimed to compare the relative impact of the disease on QOL in two groups of outpatients suffering from IBS and IBD attending our outpatient clinic at a university hospital in Romania and to compare them with a healthy group of students. Methods. The studied groups completed an SF-36 quality of life form, the associations between gastrointestinal (GI) symptoms, psychosocial score (PS) and mental status (MS) were analyzed by multiple linear regressions. Results. QOL appears to be similarly reduced in both disease groups (global mean SF-36 value: 57.2 +/- 14.2 in IBS patients versus 55.4 +/- 17.3 in IBS patients IBD: P > 0.05) compared with the control group. GI symptoms were associated with changes in the PS, but not with the MS in both groups, significantly lower than in the control group (p<0.01). The most important predictor of the change in the mental score was depression (p<0.01). Anxiety significantly contributed to the decrease of the three scores (GI, PS, MS) in all studied groups. Conclusions. Patients with IBS present healthrelated quality of life, mental distress and psychosocial status similar to those with IBD. Anxiety and depression change the psychosocial and mental status even in healthy patients. [ABSTRACT FROM AUTHOR]

Background. Burnout syndrome is a commonly seen in healthcare professionals, particularly in physicians who are exposed to a high level of stress at work and has a negative impact on the medical activity. The physicians who had have high burnout levels have been shown to commit more medical errors. Aim: To assess the level of the burnout syndrome in a tertiary university centre of gastroenterology in Romania. Methods. This observational study involved physicians from a tertiary gastroenterology university centre. An online questionnaire assessed the presence of burnout using the Maslach Burnout Inventory (MBI). Results. A total of 64 physicians responded to the questionnaire. In terms of high burnout, 11 doctors (17.18%) had emotional exhaustion, 13 doctors (20.3%) had depersonalization, and 58 doctors (90.62%) scored low for personal achievement. There were statistically significant correlations between the personal accomplishment and exhausting scores and between the personal accomplishment and depersonalization scores, respectively (P=0.007, and P<0.001, respectively). Conclusion. Physicians present an increased risk for burnout relative to workers in other fields. The high rate of burnout among physicians found by our study requires careful attention. Further studies aiming to identify other factors that contribute to burnout and as well as measures to combat burnout are necessary. Professional societies should get involved in studying the factors that generate burnout among physicians as well as to find solutions to reduce them. [ABSTRACT FROM AUTHOR]

Introduction. Fecal calprotectin (FC) is the most popular and well-studied non-invasive biomarker in diagnosing and monitoring inflammatory bowel disease (IBD) patients and it is routinely tested and widely used in clinical practice. Aim. to evaluate the usefulness of FC in predicting clinical relapse in IBD patients treated with anti-TNF agents, during one year of follow-up. Methods. We conducted a retrospective study including 50 IBD patients treated with anti-TNF agents (Infliximab, Adalimumab), in clinical remission (defined according to clinical Mayo and CDAI score) for at least 6 months, evaluated in a tertiary center between April 2021 through April 2022. For each patient, demographic and clinical parameters, data on the extent of the disease, type of treatment and FC value were collected. The patients included in the study were reevaluated 1 year later after the initial evaluation, regarding clinical remission/relapse. Results. There were 29 patients with ulcerative colitis (UC) (58 %) and 21 with Crohn's disease (CD) (42 %)), with a mean age of 42 years (21-63 years). 28 patients (18 with UC and 10 with CD) were treated with Infliximab and 22 (11 UC, 11 CD) with Adalimumab. Out of 50 IBD patients, 28 (56%) had FC <50 μg/g, 15 (30%) had FC between 50 - 150 μg/g and 7 (14%) had FC ≥ 150 μg/g. After 12 months, we observed persistent clinical remission rates of 82.75% (24) for UC and 71.42% (15) for CD. Clinical relapse was present in no patient with FC <50 μg/g, in 47% of patients with FC between 50 - 150 μg/g, and in 71.42% of the patients with FC ≥ 150 μg/g. All UC who relapsed had initial FC value more than 150 μg/g. There were no differences in clinical relapse in patients treated with Infliximab vs Adalimumab. Conclusion. FC more than 150 μg/g is a good noninvasive marker for 1 year clinical relapse in IBD patients treated with anti-TNF. The predictive role is more obvious for patients with UC compared to CD, regardless of the type of anti-TNF used. [ABSTRACT FROM AUTHOR]

Introduction. There are an inverse association between Helicobacter Pylori (H. pylori) infection and prevalence of IBD [5, 10,11,12]. Also studies have reported an inverse association between H. pylori prevalence and disease severity of IBD [13]. H. pylori is one of the environmental infections causing changes in gut microbiota and immune system dysregulation, which may affect IBD activity. The current study aimed to compare the clinical, laboratory, and histological severity of the newly diagnosed IBD with the presence or absence of H. pylori infection. Methods. This was a retrospective study that included 50 newly diagnosed inflammatory bowel disease patients (30 ulcerative colitis patients and 20 Crohn's disease patients). Diagnosis of IBD was based on both endoscopy/colonoscopy and biopsy. Also, for assesing Disease activity was quatified by CDAI for Crohn disease and UCDAI dor ulcerative colitis. Also, fecal calprotectine was evaluated. The presence of H. pylori was evaluated by the H. pylori stool antigen test (HpSA). Results: The overall positivity of H. pylori infection in patients with IBD was 19.2%. Patients with HpSA had a significantly lower fecal calprotectine (145.57 ± 28.12 vs. 320.57 ± 67.54 (μg/mg); P= 0.02), Mayo score (4.12 ± 1.09 vs. 8.01 ± 1.23; P < 0.001) and CDAI score (112 ± 67 vs. 198 ± 89; P < 0.001) compared to those with negative HpSA. Conclusion. We reported a significantly lower H. pylori infection rate in IBD patients. H. pylori-positive IBD patients have a milder disease with less activity compared to H. pylori-negative IBD patients. [ABSTRACT FROM AUTHOR]

Acute pancreatitis (AP) is a frequent presentation to the emergency departments with a rising incidence and a great variability in clinical severity and outcome. The aim of this review is to offer a succinct presentation on acute pancreatitis scoring systems and the use of different imaging methods in severity prediction: Ranson criteria, Glasgow criteria, Hong Kong Score, Acute Physiology and Chronic Health Evaluation II (APACHE II), computed tomography scoring systems, Bedside Index of Severity in Acute Pancreatitis (BISAP) score, Panc 3, Japanese Severity Score (JSS), Harmless Acute Pancreatitis Score (HAPS), Pancreatitis Outcome Prediction (POP), Sequential Organ Failure Assessment (SOFA). This article also describes the Revised Atlanta Classification of AP (2012) and the correlation with computed tomography.

Unlabelled: The aim of the study is to assess the impact of Crohn's Disease (CD) on quality of life (QoL) patients with and to identify the significant modifications in QoL, depending on both the development particularities of CD and the epidemiologic parameters., Material and Methods: a prospective study was conducted at the Institute of Gastroenterology and Hepathology Iaşi, between October 2011 and August 2014. The study enrolled 63 patients with CD. The CD diagnosis was based on clinical, biological, endoscopic and histological criteria. QoL was assessed by means of the IBDQ-32 questionnaire (Inflammatory Bowel Disease Questionnaire)., Results: The total IBDQ score varied from 70 to 200, registering a slightly higher value in female patients. Parameters such as age, sex and smoking/non-smoking status did not present significant differences in the IBDQ score. The values of the IBDQ score were in indirect, mild correlation with the CDAI score; over 49% of the subjects with higher CDAI had a lower IBDQ score., Conclusions: Except for the disease activity periods, the results of the studies investigating the impact of the various factors on the QoL in patients with CD are contradictory. Further research is needed in order to define the subgroups of patients likely to suffer from poorer QoL.

Unlabelled: Crohn's disease is an inflammatory disease of the gastro-intestinal tract with an evolution marked by activity and remission periods. Lately, the incidence and evolution models of Crohn's disease significantly changed, an increasing number of patients presenting more severe forms. The aim of the study is to analyze Crohn's disease in its phenotypic classification and to establish correlation between the localization, the behavior and the activity of Crohn's disease., Material and Methods: A transversal study on 53 patients with Crohn's disease was conducted., Results: from the 53 patients, 56.6% were males, 85% from the urban areas. Under the phenotype aspect, the colonic localization (49.1%) and the inflammatory behavior (52.8%) were predominant. More severe forms of activity were discovered to patients with ileal localization (57.1%) or with penetrant phenotype (33.3%)., Conclusions: Male patients from urban areas were predominant. The most frequent forms are the colonic and ileocolonic forms. From a behavioral point of view, we observed an obvious predominance of the inflammatory phenotype. The moderate--severe activity was predominant for the ileal localization and the mild-- moderate activity for the colonic and ileocolonic localization. A mild--moderate activity is present for the stenosing forms and a moderate--severe one for the penetrant forms.

Aim: To describe the relationship between vitamin D levels and inflammatory bowel disease (IBD) characteristics in northeastern Romanian patients., Methods: This was a prospective study of 47 consecutive IBD patients admitted to The Institute of Gastroenterology and Hepatology in Iasi, Romania between March 2011 and June 2012. The diagnosis of IBD was established based on endoscopic, histologic and radiologic findings. Demographic data, disease characteristics, ongoing treatments and biological parameters of patients (including markers of inflammation: C-reactive protein level, fibrinogen level, and erythrocyte sedimentation rate) were recorded. Serum vitamin D levels were measured and compared with age- and sex-matched healthy volunteers from the same geographic area. Vitamin D levels were defined as sufficient (> 30 ng/mL), insufficient (20-30 ng/mL), or severely deficient (< 20 ng/mL)., Results: Thirty-three of the IBD patients included in this study had ulcerative colitis (UC) and 14 had Crohn's disease (CD). Only 24% of the UC patients and 21% of the CD patients had sufficient vitamin D levels. The vitamin D levels were significantly lower in the CD patients with moderate to severe disease activity compared to the CD patients in remission or with mild disease activity (16 ± 6 ng/mL vs 26 ± 7 ng/mL; 16 ± 6 ng/mL vs 31 ± 9 ng/mL, respectively, P < 0.05). Vitamin D levels in the UC patients were not influenced by disease activity and no correlation was observed with the inflammation markers tested (C-reactive protein, fibrinogen, and erythrocyte sedimentation rate). No association was observed between vitamin D levels and smoking status or ongoing medication (5ASA, steroids, and anti-TNFα). Newly diagnosed IBD patients had lower vitamin D levels than patients with established cases, though these differences were not significant (UC: 22 ± 9 ng/mL vs 26 ± 12 ng/mL; CD: 18 ± 6 ng/mL vs 27 ± 11 ng/mL, respectively). Although no association was found between the season during which the visit was scheduled and vitamin D levels, the UC patients assessed during the winter tended to have lower levels than those assessed during the summer (22 ± 9 ng/mL vs 28 ± 13 ng/mL, respectively)., Conclusion: Vitamin D levels are significantly reduced in IBD patients in northeastern Romania, with the lowest levels occurring in CD patients with moderate to severe disease activity.

The relationship between nutrition and inflammatory bowel disease (IBD) is a complex one, the evaluation and correction of nutritional deficits being integral part of therapy in these patients. The diet that consists in excessive consumption of meat, sugar, fats (with a higher 0 6 /o) 3 polyunsaturated fatty acids ratio) are factors involved in the epidemiology and pathogenesis of IBD. Malnutrition is present among most IBD patients, being the result of multiple mechanisms from digestive symptoms to inflammatory process, intestinal resection and administration of medications. Oral diet is high-calorie, high protein at correcting the vitamin and mineral deficiencies. Enteral diet has both an adjuvant role and that of inducing and maintaining remission as single treatment, particularly in children. Parenteral nutrition is reserved for patients with obstruction, fistula, toxic megacolon, short bowel syndrome, severe malabsorption, and other conditions that make enteral nutrition impossible or inefficient.

Unlabelled: Inflammatory bowel disease (IBD) is associated with increased prevalence of bone demineralization. One of the risk factors for low bone density is the inadequate level of 25-OH vitamin D., Aim: To determine the degree of bone demineralization in patients with IBD and the main causes leading to this condition., Material and Methods: A prospective study was carried out between April, 2011 and October, 2012 in 143 patients diagnosed with IBD at the Gastroenterology and Hepatology Centre of Iaşi.The IBD diagnosis was made on clinical, biological, and endoscopic criteria and confirmed histologically. The diagnosis of osteopenia/osteoporosis was based on World Health Organization criteria., Results: Osteopenia was found in 48.07% of the patients with ulcerative colits (UC) and in 56.41% of the patients with Crohn's disease (CD); osteoporosis was present in 18.26% of the patients with UC and 15.38% of those with CD. The main causes identified were inadequate vitamin D level, extended high-dose corticotherapy in patients with CD, BMI < 18.5 kg/m2, and smoking, especially in the patients with UC., Conclusions: Bone demineralization and hypovitaminosis D are frequently associated with IBD and require specific treatment.

Unlabelled: Anemia is a frequent complication of inflammatory bowel diseases (IBD). The main incriminated mechanisms are the iron deficiency and the chronic inflammation. The aim of this study was to determine the prevalence of anemia in IBD patients and to identify the main causes., Material and Methods: A prospective study was carried out between April 1st 2011 and April 30th 2012 on a batch of 144 IBD patients diagnosed in the Gastroenterology and Hepatology Center of lasi. The IBD diagnosis was based on clinical, biological, endoscopic and histological criteria. The anemia diagnosis was based on the World Health Organization criteria., Results: Anemia was present in 40.27 % of IBD patients. The main cause identified was mixed type anemia, followed by iron deficiency and inflammation. Iron deficiency anemia was present especially in patients with ulcerative colitis with long evolution, frequent activity spurts and extended forms of diseases; an inflammatory anemia emerged mainly in patients with exterided and moderate-severe forms of the diseases., Conclusions: Anemia remains a frequently associated pathology to the inflammatory bowel disease that requires specific management.

Unlabelled: Patients with inflammatory bowel disease (IBD) have to live with the perspective of a potential disability, which may lead in time to impaired quality of life (QoL). In order to fully understand the impact of IBD on patients and their careers we need to quantify the QoL., Aim: To evaluate HRQol in ulcerative colitis patients as opposed to the general population and to identify the significant changes of HRQoL in accordance with the specific progression of UC., Methods: The prospective study (January 2010 - December 2012), included 105 patients with ulcerative colitis (UC). Disease activity was quantified by means of the Truelove and Witts score (mild, moderate and severe). All patients were administered a self-completed IBD questionnaire (IBDQ). Lower scores were related to a worse QoL. Statistical analysis was performed and di fferences were considered significant when p < or = 0.05., Results: Ninety-one percent (91%) were admitted with a flare, while they were asked to fill in the IBDQ. Proctitis was met in 2.94% of the cases, left-sided colitis in 71.1% and pancolitis in 26%. There were 32 patients with mild activity, 62 with moderate activity and only 3 with severe activity. The range score for QoL was 90-180. In proctitis: 80-190, in left-side colitis: 120-200, in pancolitis: 70-160 (p>0.05). The patients with severe form had a lower score (50-140) than patients in remission (130-180) (p<0.01)., Conclusion: Patients with UC have significantly influenced the QoL as compared to the general population. We found no significant differences regarding the extension of the lesions. The severity of the flare had a significant impact on the QoL.

Aim: To assess the efficiency of the dosage of the semi-quantitative calprotectin rapid test in evaluating the activity of inflammatory bowel diseases., Material and Methods: The prospective study included 87 patients with BII (50 with ulcerative colitis, 37 with Crohn disease) hospitalized between January 2011 - May 2012. The diagnosis was confirmed by colonoscopy and histological examination. Fecal calprotectin was measured by means of a semi-quantitative rapid test., Results: There were 50 patients with UC and 37 with BC. 96% of the UC patients were evaluated during the active disease. 21 of them had a severe episode of active disease, 16 had a moderate one, while 10 had a mild activity episode. The correlation between the calprotectin values and lesions localization was analyzed, without finding any statistical differences. The data have shown a very strong correlation between the severity of the active disease, assessed through the UCDAI (Mayo) score, and the calprotectin value. Patients with CD manifested a linear correlation between the severity of the active disease and the calprotectin value., Conclusions: The rapid test for assessing calprotectin could be a useful non-invasive marker in appreciating the severity of clinical and biological disease activity.

Chronic infection with hepatitis C virus is nowadays responsible for many cases of liver disease. According to recent research, it seems to be characterized by a great deal of metabolic abnormalities, most of them due to insulin resistance, which is present in the virus C-induced disease more often than in chronic hepatitis B or in the general population. As insulin resistance significantly impairs the natural course of the viral disease by reducing the efficacy of antiviral treatment and aggravating the development of fibrosis, it becomes more and more plausible that therapeutic intervention aiming to reduce it might contribute to a better course in many patients. Hepatic steatosis is also a frequent feature of chronic hepatitis C, being either induced by the infection with genotype 3 or by a predisposing metabolic background. The relation between steatosis and viral disease prognosis is controversial, probably due to the various factors inducing lipid accumulation. A better understanding of the metabolic substrate of chronic hepatitis C would help developing new approaches in its diagnosis and therapy, hopefully providing a better future to many patients.

Cirrhotic cardiomyopathy is a condition recently known in liver cirrhosis consisting of systolic dysfunction to stress factors, diastolic dysfunction and electrophysiological abnormalities in the absence of cardiac disease. The prevalence of cirrhotic cardiomyopathy remains unknown until now. It can be diagnosed by using a combination of electrocardiograph, 2-dimensional echocardiography, and various serum markers (brain natriuretic factor--BNP, proBNP, TnI). Pathogenic mechanisms underlying cirrhotic cardiomyopathy development include abnormal signaling betaadrenergic, cardiomyocites membrane fluidity changes, interstitial fibrosis, myocardial hypertrophy, altered transmembrane ion channels as intervention with negative inotropic effect of different substances whose concentration is increased in cirrhosis. Major stresses on the cardiovasculary system such as liver transplantations, infections, insertion of transjugular portosystemic stent-shunt (TIPSS) have been demonstrated to put in evidence the presence of cirrhotic cardiomyopathy. Heart failure is a significant cause of mortality after liver transplantation but the improvement of liver function determines cardiac abnormalities reversal. Current management recommendations include empirical, nonspecific and mainly supportive measures, no specific treatment can be recommended, and cardiac failure should be treated as in non-cirrhotic patients with sodium restriction, diuretics, and oxygen therapy when necessary. The exact prognosis remains unclear. The extent of cirrhotic cardiomyopathy generally correlates to the degree of liver insufficiency. Reversibility is possible (either pharmacological or after liver transplantation), but further studies are needed.

Unlabelled: There are some controverces regarding alcohol intake and gastritis., Aim: To investigate the effect of chronic alcohol intake on development of gastritis and their interrelationship., Material and Methods: The study was conducted of 1566 patients of urban and rural Dorohoi areal (alcohol consumers), during the 2002-2006., Results: The prevalence of chronic alcohol gastritis has statistic significant difference along the years. The alcohol intake was recorded in the age group 40-50 years, in urban patients. In most patients (59%) alcohol intake was daily, the quantity used more frecquently 150-200 mL., Conclusion: Chronic alcohol consumtion induce the apparition of gastritis, in correlation with the consumption, ritmicity and alcohol amount.

Unlabelled: The aim of the study was to assess the symptoms manifested in patients with gastritis (gastropathies) due to excessive alcohol consumption., Material and Method: The study sample consisted of 117 cases admitted in the Town Hospital Dorohoi, Botoşani County, between 2002-2006., Results: Data were collected using special epidemiological questionnaires and statistical records of the hospital and Public Health Office. Anamnesis, clinical examination, following by endoscopy and histological and radiological examination completed the diagnosis. Although interventions regarding prevention methods were permanently applied, their efficiency was suboptimal for most of the patients suffering from chronic gastritis and excessive alcohol consumption.