BACKGROUND AND AIMS:The coexistence of liver steatosis in patients with chronic viral hepatitis B (CHB) is growing relevant as the global epidemic of obesity and type 2 diabetes mellitus (T2DM). The aim of this study was to identify the metabolic risk factors linked to steatotic liver disease (SLD) in Romanian patients with CHB. METHODS:In this prospective study, we evaluated 320,000 individuals in the LIVE(RO)2 nationwide screening program in Romania from 2021 to 2023. The majority of the patients had undergone transient elastography using controlled attenuation parameter (CAP) to diagnose liver steatosis, and they belonged to vulnerable categories. Exclusion criteria included heavy alcohol consumption, any other liver disease unrelated to CHB, and the lack of CAP evaluation. RESULTS:5,321 individuals (1.67%) were found with CHB in the screening program. In the final analysis we included 1,970 patients, with a mean age of 55.87±13.84 years; 57.9% of them were males, with a mean body mass index (BMI) level of 27.26 kg/m², and 61.9% of the patients were vulnerable. The prevalence of SLD was 42.2% in the group of vulnerable individuals, compared with non-vulnerable participants, who had a prevalence of SLD of 26.4%. Moreover, patients with vulnerable conditions have a higher prevalence of T2DM (11.5%), hypertension (41.3%), and raised BMI levels ≥25 kg/m² (71.3%). In our study, vulnerable subjects had a higher prevalence of hepatitis B virus e antigen (HBeAg) positivity of 3%, and it was found to be a protective risk factor for hepatic steatosis development (aOR=0.397). Also, these patients had a higher prevalence of severe liver fibrosis (≥ F3) of 17.1%, compared with those non-vulnerable, with a prevalence of 9.7% of severe liver fibrosis. More than that, we find that the presence of HBeAg-positive increases the risk of severe liver fibrosis progression 6 times higher. CONCLUSIONS:In our study we found a prevalence of hepatic steatosis of 42.2% in the cohort of vulnerable untreated patients with CHB, and the prevalence of severe fibrosis was 17.1%. Presence of HBeAg-positive was found to be a protective risk factor for hepatic steatosis but accelerates the development of severe fibrosis along with T2DM, which is more common in the vulnerable CHB cohort.
BACKGROUND AND AIMS:Acute pancreatitis (AP) is an inflammatory disease with a wide range of severity. Disruption of the intestinal barrier and translocation of gut flora increase the risk of infectious complications. Our study evaluates the impact of infections on in-hospital outcomes among admitted AP patients. METHODS:Hospitalized adult AP patients were identified from the National Inpatient Sample (NIS) database (2016-2022) using ICD-10 codes. Patients with missing demographic or mortality data were excluded, and those remaining were stratified by infection type. Demographics, AP etiology, comorbidities, and clinical outcomes were analyzed. The primary outcome was in-hospital mortality by infection type. Secondary outcomes included sepsis, shock, acute kidney injury (AKI), intensive care unit (ICU) admission, deep vein thrombosis (DVT), pulmonary embolism (PE), and portal vein thrombosis (PVT). RESULTS:Among 2,467,233 patients with AP, 392,255 (15.9%) developed infectious complications. Urinary tract infections (UTIs) were most common (51%), followed by pneumonia (29.7%), cholangitis (14.5%), Clostridioides difficile infection (CDI) (7.9%), cellulitis (5.6%), and spontaneous bacterial peritonitis (SBP) (1.9%). SBP had the highest mortality (21.1%), followed by pneumonia (12.8%), whereas mortality was lower with UTI (4.5%), cholangitis (5.2%), CDI (6.9%), and cellulitis (5.9%). AP patients with infections had higher in-hospital mortality after adjusting for confounding factors (6.7% vs 1.6%, p < 0.001). CONCLUSIONS:Infectious complications, particularly SBP and pneumonia, were associated with significantly worse in-hospital outcomes in patients with AP, highlighting the importance of early recognition and management.
Acute necrotizing pancreatitis is a severe condition associating with high morbidity and mortality. In most cases, supportive therapy is the only available therapeutic option. Herein, we report a case of a 29-year-old male who presented with severe acute necrotizing pancreatitis caused by hypertriglyceridemia, who consequently developed acute respiratory distress syndrome and multi-organ failure. We used an off-label C-reactive protein apheresis to target the sterile inflammatory reactions additional to optimal supportive therapy with invasive ventilation, prone positioning, continuous veno-venous hemodialysis using a CytoSorb™ particle filter, antibiotics, vasopressors, and fluids. After 18 days of intensive care treatment and 11 days of normal care treatment, the patient could be discharged alive.
Background and Aims: Radiofrequency ablation (RFA) is a curative option for early-stage hepatocellular carcinoma (HCC) when liver resection or transplantation is not a suitable option. This study evaluated whether a peri-procedural intravenous lidocaine infusion could reduce neutrophil extracellular trap formation (NETosis), neutrophil-to-lymphocyte ratio (NLR) and improve 1-year outcomes after RFA. Methods: In this single-centre, randomized trial, 50 adult HCC patients undergoing RFA were allocated 1:1 to receive propofol-fentanyl sedation alone (PF group, n=25) or combined with intravenous lidocaine (1.5 mg/kg bolus, then 1 mg/kg/h for 24 hours; PF-L group, n=25). Serum citrullinated histone H3 (H3Cit), NLR, and C-reactive protein (CRP) were assessed at baseline and 24 hours post-ablation. The primary endpoint was the change in H3Cit expression. Secondary endpoints included changes in NLR and C-reactive protein (CRP), as well as 1-year overall mortality, disease-free survival, and local recurrence rates. Results: 24 patients in PF-L group and 25 patients in PF group completed the study. Intra-group H3Cit levels significantly decreased from baseline at 24 hours only in the PF-L group (p=0.031). However, the between-group difference in H3Cit variation levels was not significant (p=0.352). Postoperative NLR changes were also comparable between groups (p=0.354). The overall 1-year mortality rate was 12%, with no significant variance between the two arms. Conclusions: Adding intravenous lidocaine to sedation resulted in an intra-group reduction in H3Cit expression following RFA but did not produce a statistically significant reduction compared to standard propofol-fentanyl sedation alone. 1-year survival and local recurrence rates did not differ between groups. However, our preliminary findings justify the need for larger, baseline-balanced trials to evaluate periprocedural NETosis modulation by sedation regimen.
BACKGROUND AND AIM:Empirical data suggest that women submitted to silicone breast implant surgery report bloating after intervention. We aimed to look to this phenomenon in a retrospective study. METHODS:An online ad-hoc survey was created. It included 22 items aiming to collect essential biographical data and occurrence of gastrointestinal symptoms after esthetic surgery. Subjects invited to fill the questionnaire were people from a data base of a busy esthetic clinic. Respondents were included in two groups: one group with breast implant surgery and a control group with other interventions without silicone implantation. Participants filling criteria for disorders for gut brain interaction including functional bloating were excluded from the analysis. RESULTS:The group with silicone implants included 32, the control group included 34 women. Both groups had no baseline differences. The group with silicone breast implants presented significantly higher odds [6.3 (95% CI 2.0 - 22.9, p=0.003)] of bloating than the control group, after adjustment for confounders (age, previous disorders of gut-brain interactions). Symptoms occurred in the first postoperative days and lasted 1-3 weeks. CONCLUSIONS:This is a retrospective study based on an online survey confirming the onset of bloating after silicone breast surgery in the absence of functional bloating. This study brings evidence to endorse empirical reports. Potential mechanisms of this association are discussed.
BACKGROUND AND AIMS:Inflammatory bowel disease (IBD) requires reliable non-invasive biomarkers to monitor mucosal healing, systemic inflammation, and gut-liver axis involvement. This study evaluated the diagnostic potential of accessible clinical parameters, including fecal calprotectin (FC), hemogram-derived ratios, and composite albumin-integrating and liver fibrosis scores, alongside standardized endoscopic severity findings. METHODS:This retrospective observational study included 36 adult IBD patients [21 with Crohn's disease (CD), 15 with ulcerative colitis (UC) receiving biological therapy. Systemic inflammatory indices [e.g., neutrophil-lymphocyte ratio (NLR)], nutritional scores [e.g. prognostic nutritional index (PNI)], and hepatic fibrosis scores [e.g. aspartate aminotransferase to platelet ratio index (APRI), fibrosis 4 (FIB-4), platelet-albumin-bilirubin (PALBI)] were assessed. Receiver operating characteristic (ROC) curve analysis evaluated the diagnostic performance, reported as area under the curve (AUC), of these biomarkers. RESULTS:Routine laboratory parameters and non-invasive liver fibrosis indices showed no statistically significant differences between CD and UC patients. Biologic treatment initiation differed significantly between the groups (p<0.001). Endoscopically, CD presented marked phenotypic heterogeneity with predominantly ileocolonic involvement, whereas active UC was characterized mainly by pancolitis. Fecal calprotectin concentrations were notably higher in UC (median 1000 μg/g) compared to CD (310 μg/g). Diagnostically, FC demonstrated the highest predictive capacity for differentiating the conditions (AUC=0.74). Furthermore, albumin-integrating scores, specifically the PALBI score (AUC = 0.686) and PNI (AUC = 0.657), alongside NLR (AUC=0.632), outperformed traditional hepatic indices in capturing the systemic inflammatory toll. Complex composite inflammatory formulas unexpectedly underperformed. CONCLUSIONS:FC remains the most robust non-invasive marker for localized mucosal inflammation. Albumin-integrating scores and simple hemogram-derived ratios better reflect the systemic inflammatory burden than pure hepatic fibrosis indices, but their moderate diagnostic accuracies preclude independent clinical application. Effective IBD management requires integrating these non-invasive adjunctive tools with standard endoscopic assessments within a personalized, multiparametric framework.
BACKGROUND AND AIMS:Gastroesophageal reflux disease (GERD) is a common chronic condition, with variable prevalence worldwide and with a substantial impact on patients' quality of life (QoL). Data on the Albanian population are scarce and outdated. The aim of this study was to estimate the prevalence of probable GERD in a convenience sample of Albanian adults, explore its associations with demographic, socioeconomic, anthropometric and lifestyle factors and assess the impact of the condition on health-related quality of life. METHODS:A cross-sectional study was conducted between March and May 2025 in Albania among 505 participants, recruited through convenience sampling. The sample was predominantly young and concentrated in Korce region. Data were collected through a semi-structured, self-administered online, questionnaire. GERD symptoms were assessed using the GerdQ questionnaire and a score of ≥8 was used to define probable GERD. Score for GERD-related QoL was obtained through the 16-item GERD-QoL questionnaire. Demographic, anthropometric, dietary and lifestyle variables were analyzed as potential factors associated probable GERD. Logistic regression models were used to obtain odds ratio (ORs) with 95% confidence intervals (CIs). RESULTS:The prevalence of probable GERD in the study sample was 31.1%. Probable GERD was more frequent among men (45.7%) and participants aged 25-34 years. In multivariable analysis male gender (aOR=2.08, 95%CI: 1.27-3.39), 25-34 year-age group (aOR=1.84, 95%CI: 1.06-3.21), urban residence (aOR=2.16, 95%CI: 1.30-3.59) and frequent alcohol consumption (aOR=2.83, 95%CI: 1.61-4.96) were independently associated with probable GERD. Body mass index (BMI) and smoking status were no longer significant after adjustment. In unadjusted analysis, consumption of ≥2 coffees /day was associated with higher odds of probable GERD compared with no or rare consumption (OR=5.05, 95%CI: 2.88-8.85). The inverse associations observed for citrus juices and tomato-based products may reflect symptom-based dietary avoidance rather than a true protective effect. Probable GERD was independently associated with a 15.90-point lower total QoL score (95%CI: -20.74 to -11.05, p<0.001). Among participants with probable GERD, women reported lower QoL scores than men across all domains while male gender was independently associated with a 12.36-point higher total QoL score. CONCLUSIONS:In this predominantly young, urban and geographically concentrated sample, probable GERD prevalence was higher than previously data reported in Albania. Male gender, age 25-34 years, urban residence and frequent alcohol consumption were independently associated with probable GERD. Probable GERD was also independently associated with lower health-related QoL. Among GERD-positive participants, women reported lower QoL scores than men across all domains.
Wilson disease (WD) is an autosomal recessive disorder caused by mutations in the ATP7B gene, resulting in impaired biliary copper excretion and progressive copper accumulation in multiple tissues. Ocular manifestations represent some of the most characteristic and clinically valuable features of the disease, contributing to diagnosis, monitoring, and assessment of neurological involvement. This narrative review summarizes current knowledge regarding the pathophysiology, clinical presentation, and imaging characteristics of ocular involvement in WD. Copper deposition within the eye occurs primarily through the aqueous humor, leading to accumulation in the corneal Descemet membrane and lens capsule. Kayser-Fleischer rings remain the most prevalent ocular sign being strongly associated with neurological disease, while sunflower cataracts represent a less common but highly characteristic manifestation. Anterior segment optical coherence tomography and in vivo confocal microscopy have recently improved the detection and monitoring of these lesions. Beyond copper deposition, growing evidence indicates that WD is associated with retinal and optic nerve neurodegeneration. Optical coherence tomography studies consistently demonstrate thinning of the retinal nerve fiber layer, ganglion cell complex, and macular structures, particularly in patients with neurological involvement. Electrophysiological investigations, including visual evoked potentials and electroretinography, reveal delayed neural conduction and retinal dysfunction, supporting the concept of widespread neuro-ophthalmological impairment. Optical coherence tomography angiography further identifies microvascular alterations affecting retinal and peripapillary capillary networks. Importantly, several ocular abnormalities correlate with neurological severity and may serve as non-invasive biomarkers of disease progression. Current treatments, including copper chelators and zinc therapy, can induce regression of Kayser-Fleischer rings and sunflower cataracts. Ocular assessment therefore provides a valuable window into systemic and neurological disease activity, highlighting the importance of multidisciplinary management and the potential role of emerging imaging biomarkers in Wilson disease.
BACKGROUND AND AIMS:Underwater endoscopic mucosal resection (U-EMR) and conventional endoscopic mucosal resection (C-EMR) are the primary techniques for the removal of colorectal polyps. The purpose of this study is to conduct a meta-analysis on the safety and efficacy of the two procedures, U-EMR and C-EMR. METHODS:We searched multiple databases for randomized controlled trials (RCTs) comparing U-EMR and C-EMR for the resection of sessile or flat colorectal polyps. Standard meta-analytic methods were employed using random-effects, and I² % was used to assess heterogeneity. RESULTS:A total of seven RCTs were included. Regarding the en bloc resection rate, U-EMR was superior to C-EMR [Risk Ratio (RR) 1.13, 95% confidence interval (CI): 1.02-1.24]. Subgroup analysis showed that the higher en bloc resection rate of U-EMR was mainly manifested in 10-20 mm polyps (RR=1.16, 95%CI: 1.07-1.25). In the analysis of R0 resection rate, U-EMR outperformed C-EMR (RR=1.28, 95%CI: 1.02-1.61). In terms of the incidence of adverse events and recurrence rate, U-EMR showed a trend lower than C-EMR in terms of intraoperative bleeding [odds ratio (OR) 0.83, 95%CI: 0.45-1.54), delayed bleeding (OR=0.61, 95%CI: 0.28-1.32), and recurrence rate (OR=0.53, 95%CI: 0.24-1.18), but none of them reached statistical significance. For procedure time, U-EMR demonstrated shorter resection times than C-EMR [mean difference (MD) -3.05 minutes, 95%CI: -5.17 to -0.92). CONCLUSIONS:For sessile or flat colorectal polyps measuring ≥10 mm in diameter, U-EMR demonstrates superior efficacy compared with C-EMR.
BACKGROUND AND AIMS:Antispasmodics and antidepressants are standard therapies for managing both the gastrointestinal symptoms and psychological comorbidities associated with irritable bowel syndrome (IBS). However, direct comparative evidence regarding their efficacy across different symptom domains is scarce. This systematic review and network meta-analysis aimed to assess the relative effectiveness of these agents on abdominal pain, psychological outcomes, overall IBS symptom severity, and quality of life (QoL). METHODS:We conducted a comprehensive search of PubMed, EMBASE, and Scopus to identify relevant randomized controlled trials evaluating antispasmodics and antidepressants for IBS. Eligible studies underwent quality assessment and were synthesized using network meta-analysis. We calculated standardized mean differences (SMDs) with 95% confidence intervals (CIs) for pain outcomes (VAS), anxiety, depression, the IBS Severity Scoring System (IBS-SSS), and QoL. RESULTS:Twenty-nine studies were included in the analysis. Significant reductions in pain (VAS) were observed with imipramine (SMD -34.06; 95%CI -51.89 to -16.22) and the alverine/simethicone combination (SMD -6.23; 95%CI -9.93 to -2.53), while mebeverine and anise oil showed benefits in specific IBS subgroups. The most substantial improvements in anxiety occurred with flupentixol-melitracen (SMD -6.63; 95%CI -10.13 to -3.13), followed by small-intestinal release peppermint oil, fluoxetine, and vortioxetine. Imipramine was most effective for depressive symptoms (SMD -9.40; 95%CI -10.29 to -8.51), followed by venlafaxine, flupentixol-melitracen, desipramine, and vortioxetine. Amitriptyline was the only agent to show significant improvement in IBS-SSS scores (SMD -23.70; 95%CI -43.27 to -4.13). The largest gains in QoL were associated with otilonium bromide (SMD 30.90; 95%CI 26.62 to 35.18), followed by venlafaxine, amitriptyline, and cumin sofouf. CONCLUSIONS:Imipramine and alverine/simethicone were superior for reducing abdominal pain, whereas flupentixol-melitracen, peppermint oil, fluoxetine, and vortioxetine demonstrated the strongest anxiolytic effects. Effective options for depression included imipramine, venlafaxine, flupentixol-melitracen, desipramine, and vortioxetine. Notably, amitriptyline uniquely improved overall IBS severity scores, while otilonium bromide, venlafaxine, amitriptyline, and cumin sofouf provided the greatest benefits for QoL. These findings clarify comparative efficacy and may guide tailored pharmacotherapy strategies for IBS patients.
BACKGROUND AND AIMS:To evaluate the diagnostic performance of texture analysis parameters obtained from non-contrast liver magnetic resonance imaging (MRI) in staging liver fibrosis in patients with chronic hepatitis B. METHODS:Non-contrast MRI examinations of 66 patients with chronic hepatitis B were retrospectively evaluated. The protocol included in-phase T1-weighted (IP-T1W), out-of-phase T1-weighted (OP-T1W), fat-suppressed T1-weighted (FS-T1W), fat-suppressed T2-weighted (FS-T2W), and T2-weighted (T2W) sequences. Histogram-based texture features were extracted from regions of interest placed in the liver parenchyma. For each sequence, the most informative features were selected from 20 candidate variables using the minimal-redundancy maximal-relevance (mRMR) algorithm, and multivariable logistic regression models were constructed. Fibrosis was categorized as early fibrosis (F0-F2) or significant fibrosis (F3-F6). Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis and area under the curve (AUC), and model generalizability was evaluated by 10-fold cross-validation. RESULTS:Sixty-six patients were included (early fibrosis, n=43; significant fibrosis, n=23). ROC analysis showed that the highest discriminatory performance was obtained with the OP-T1W sequence (AUC=0.789, 95%CI: 0.677-0.900, p<0.001), while the IP-T1W sequence also demonstrated acceptable diagnostic performance (AUC=0.723, 95%CI: 0.600-0.846, p=0.002). The FS-T1W, FS-T2W, and T2W sequences showed lower AUC values of 0.686, 0.674, and 0.657, respectively. DeLong test comparisons revealed no statistically significant differences between the AUC values of the models derived from different MRI sequences (all p>0.05). Based on the Youden index-derived thresholds, the OP-T1W sequence achieved the highest diagnostic accuracy (72.31%) and sensitivity (79.17%), whereas the FS-T1W sequence demonstrated the highest specificity (83.72%). In 10-fold cross-validation, the highest mean AUC was observed for OP-T1W (0.785±0.168), followed by FS-T2W (0.760±0.168), whereas IP-T1W showed a lower mean AUC (0.653±0.128). CONCLUSIONS:Texture analysis parameters derived from routine non-contrast MRI sequences in patients with chronic hepatitis B may provide additional quantitative information for the noninvasive assessment of liver fibrosis. These findings suggest that texture analysis may serve as a complementary tool within routine liver MRI. However, given the single-center design and limited sample size of the present study, further studies with larger cohorts and external validation are needed before clinical application.
BACKGROUND AND AIMS:Helicobacter pylori (H. pylori) is an obligate pathogen affecting approximately 50% of the world population. With rising antibiotic resistance rates in H. pylori and increasing dropout rates from eradication therapies due to adverse effects, H. pylori treatment is increasingly challenged. Saccharomyces boulardii (S. boulardii), a probiotic yeast, was shown to reduce infection- and therapy-associated adverse events and increase H. pylori eradication rates. Our meta-analysis summarizes the beneficial effects of S. boulardii supplementation on H. pylori eradication and therapy-associated side effects. METHODS:We conducted a systematic literature review and meta-analysis on PubMed, Cochrane Library, and Google Scholar from inception (1993) to October 24, 2024. Research and analysis were performed in accordance with the 'Preferred Reporting Items of Systematic Reviews and Meta-Analyses' (PRISMA) guidelines. RESULTS:The supplementation of S. boulardii to H. pylori therapy caused a significant increase in overall eradication rates and a significant decrease in overall diarrhea, nausea, and epigastric pain rates. Subgroup analysis showed that S. boulardii supplementation also decreased taste disturbance rates in patients receiving triple therapy. Symptoms, such as meteorism, vomiting, and urticaria/rash, were not significantly reduced through the supplementation of S. boulardii. CONCLUSIONS:S. boulardii was shown to be an effective add-on to H. pylori eradication therapy. Significant improvements in eradication and frequency of the most common adverse events were observed. However, more studies are needed to validate those findings for patients receiving bismuth-based quadruple therapy.
Intrahepatic cholangiocarcinoma (ICC) is a type of primary liver cancer that is highly aggressive. In recent years, its incidence has continued to increase around the globe, yet outcomes remain poor and stagnant. Although surgical resection is the only treatment option capable of curing the cancer, most patients present with either advanced disease or unresectable tumors. Over the past decade, our understanding of ICC biology has evolved rapidly, with improved molecular classification and the clinical introduction of targeted therapies and immunotherapies. As a result of these advances, neoadjuvant, conversion, and downstaging strategies have been developed to redefine resectability and improve long‑term survival. Patients with selected tumors achieve good control with locoregional approaches, such as transarterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC), and radiotherapy. At the same time, the routine use of next-generation sequencing (NGS) has allowed for personalized treatment of tumors with fibroblast growth factor receptor 2 gene (FGFR2) fusions, isocitrate dehydrogenase 1 (IDH1) mutations, and immunogenic profiles. Even though procedures have come a long way, challenges remain. Treatment protocols differ from one institution to another, and criteria for what constitutes “biological resectability” are not standardized. High-quality prospective evidence exists but is nevertheless limited. As such, it is still unclear when the optimal timing for surgery is after systemic or locoregional therapy. This review focuses on the currently available clinical, molecular, and surgical aspects of intrahepatic cholangiocarcinoma to propose a precision-multimodal treatment algorithm.
BACKGROUND AND AIMS:Publications influence selection into competitive gastroenterology fellowships, yet drivers of research productivity among current trainees are not well characterized. We evaluated whether training stage, institutional pedigree, and degree pathway are associated with research output among United States of America gastroenterology fellows. METHODS:We performed a cross-sectional study of fellows listed on publicly available rosters from Accreditation Council for Graduate Medical Education (ACGME)-accredited adult gastroenterology fellowship programs (October-November 2025). PubMed-indexed publications were identified and categorized by training stage (medical school, residency, fellowship) and gastroenterology (GI)-specificity. Group comparisons used Mann-Whitney U tests. Poisson generalized estimating equation models clustered by program estimated adjusted incidence rate ratios (IRRs) for total publication counts. RESULTS:Among 776 fellows from 125 programs, PGY6 fellows had more GI-specific publications than PGY4 fellows (median 3 vs 2) and greater fellowship-period output. Training in top-ranked environments was associated with higher total and GI-specific publication counts, with the largest differences observed for top 20 fellowship environments. In adjusted analyses, top-ranked training affiliations remained independently associated with higher total publication output. Women had approximately 15% lower total publication output than men (adjusted IRR ≈0.85). International medical graduates had higher publication counts than non-IMGs, whereas U.S. DO graduates had lower counts. CONCLUSIONS:Research productivity among United States of America gastroenterology fellows varies by training stage, training environment, and degree pathway, likely reflecting opportunity and infrastructure as well as individual aptitude.
