1. HOW MANY VALID MEASUREMENTS ARE NECESSARY TO … file2 1. how many valid measurements are...

2

1. HOW MANY VALID MEASUREMENTS ARE NECESSARY TO ASSESS

LIVER STIFFNESS USING TWO-DIMENSIONAL TIME-HARMONIC?................... 8

Alexandru Popa, Raluca Lupusoru, Tudor Moga, Andrea Zschätzsch, Meghana Enumula,

Alina Popescu, Roxana Sirli, Mirela Danila, Ioan Sporea ..................................................... 8

Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine

and Pharmacy Timișoara, Timişoara, Romania .................................................................... 8

2. SYMPTOMS, ANTHROPOMERIC AND METABOLIC PROFILE IN

CHILDREN WITH GENETIC PREDISPOSITION TO PRIMARY LACTOSE

INTOLERANCE ...................................................................................................................... 8

Corina Pienar1,2

, Edward Seclaman3, Marilena Lazarescu

1, Radmila Costachescu

1, Alina

Popescu2, Ioan Sporea

2, Liviu Pop

1 ....................................................................................... 8

1Pediatrics Department, 2

nd Pediatrics Clinic, “Victor Babes” University of Medicine and

Pharmacy, Timisoara, Romania ............................................................................................ 8 2Gastroenterology Department, “Victor Babes” University of Medicine and Pharmacy,

Timisoara, Romania ............................................................................................................... 8 3Biochemistry Department, “Victor Babes” University of Medicine and Pharmacy,

Timisoara, Romania ............................................................................................................... 8

3. INCIDENCE RATES OF COLONIC DIVERTICULOSIS AND ACUTE

DIVERTICULITIS AMONG ADULT POPULATION – A SINGLE CENTER

EXPERIENCE ......................................................................................................................... 9

Cristina Muzica1,2

, Carol Stanciu1, Laura Huiban

1,2, Oana Stoica

1,2, Georgiana Frunzuc

1,

Tudor Cuciureanu1,2

, Irina Girleanu1,2

, Ana-Maria Singeap1,2

, Stefan Chiriac1,2

, Anca

Trifan1,2

.................................................................................................................................. 9

1. Institute of Gastroenterology and Hepatology, Iasi, Romania .......................................... 9

2. “Grigore T Popa“ University of Medicine and Pharmacy ............................................... 9

4. THE IMPACT OF LONG-TERM ANTIPLATELET THERAPY ON THE

UPPER GASTRO-INTESTINAL TRACT TO ELDERLY PATIENTS ......................... 10

Laura Huiban1,2

, Cristina-Maria Muzica1,2

, Tudor Cuciureanu1,2

, Ştefan Chiriac1,2

, Ana-

Maria Sîngeap1,2

, Irina Gîrleanu1,2

, Oana Petrea1,2

, Carol Stanciu2 , Anca Trifan

1,2 .......... 10

5. MULTIDRUG RESISTANCE INFECTIONS IN CIRRHOTIC PATIENTS ...... 10

Department of Gastroenterology and Hepatology, " Victor Babeș" University of Medicine

and Pharmacy Timișoara, Romania .................................................................................... 10

6. ULTRASOUND EXAMINATION VERSUS CONTROLLED ATENUATION

PARAMETER FOR THE ASSESSMENT OF LIVER STEATOSIS IN THE HANDS

OF BEGINNER ...................................................................................................................... 11

Silviu George Nistorescu, Ioan Sporea, Felix Bende, Mirela Danila1, Roxana Sirli, Alina

Popescu ................................................................................................................................ 11

"Victor Babes" University Of Medicine And Pharmacy Timisoara, Timisoara, Romania .. 11

7. PERFOMANCE OF A 2D-SWE IMPLEMENTED ON A NEW SYSTEM FOR

PREDICTING DIFFERENT STAGES OF LIVER FIBROSIS USING TRANSIENT

ELASTOGRAPHY AS THE REFERENCE METHOD.................................................... 11

Felix Bende, Ioan Sporea, Alina Popescu, Roxana Șirli, Mirela Danilă, Renata Fofiu, Alin

Lazăr, Silviu Nistorescu ....................................................................................................... 11

3

Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy

Timișoara, Romania ............................................................................................................. 12

8. A NEW SCORE FOR PREDICTING VARICEAL BLEEDING IN LIVER

CIRRHOTIC PATIENTS ..................................................................................................... 12

Barbulescu Andreea, Ioan Sporea, Raluca Lupusoru, Roxana Sirli, Mirela Danila, Alina

Popescu, Iulia Ratiu ............................................................................................................. 12

Department of Gastroenterology and Hepatology, " Victor Babes" University of Medicine

and Pharmacy Timisoara, Romania .................................................................................... 12

9. THERAPEUTIC ENDOSCOPIC RETROGRADE

CHOLANGIOPANCREATOGRAPHY FOR CHOLEDOCHOLITHIASIS IN

PATIENTS 80 YEARS OF AGE AND OLDER: EFFICACY AND SAFETY ............... 13

Catalin Victor Sfarti, Gheorghe Balan, Stefan Chiriac, Irina Garleanu, Anca Trifan, Carol

Stanciu.................................................................................................................................. 13

10. 2D-SHEAR WAVE ELASTOGRAPHY OF THE SPLEEN STIFFNESS - A

NONINVASIVE MARKER FOR PREDICTING HIGH RISK VARICES IN

PATIENTS WITH COMPENSATED LIVER CIRRHOSIS ............................................ 13

Renata Fofiu, Ioan Sporea, Felix Bende, Mirela Danila, Alina Popescu, Roxana Șirli ...... 13


Victor Babes Timisoara, Timisoara, Romania .................................................................... 13

11. SOLID PSEUDOPAPILLARY NEOPLASM OF THE PANCREAS - A

DIFFERENT VASCULAR PATTERN OF CONTRAST-ENHANCED

ULTRASONOGRAPHY (CEUS) ........................................................................................ 14

Sabo Cristina Maria¹, Calian Ioana², Caraiani Cosmin¹, Rusu Ioana², Breazu Caius¹˒²,

Bartos Adrian², Ciobanu Lidia¹˒² ......................................................................................... 14

1. University of Medicine and Pharmacy, “Iuliu Hatieganu”, Cluj-Napoca, Romania ..... 14

2. Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania .......... 14

12. TERAPIA CU INFLIXIMAB LA COPIII CU BOALA INFLAMATORIE

INTESTINALĂ ...................................................................................................................... 15

S.Boroghină1, A.Constantinescu

2, A-M Marcu

2 , M.Gîlice

1 ............................................... 15

U.M.F.Carol Davila, Bucuresti, Catedra Pediatrie ............................................................ 15

Clinica de Pediatrie, Institutul Clinic Fundeni,București,Romania .................................... 15

13. PERFORMANCE OF A THED SYSTEM FOR RULING IN/ RULING OUT

LIVER CIRRHOSIS AS COMPARED WITH TRANSIENT ELASTOGRAPHY........ 15

Tudor Moga, Raluca Lupusoru, Alexandru Popa, Andrea Zschätzsch, Meghana Enumula,

Alina Popescu, Roxana Sirli, Mirela Danila, Ioan Sporea ................................................... 15

UMF Victor Babes, Timisoara ............................................................................................. 15

14. TUMORILE NEUROENDOCRINE GASTROINTESTINALE LA VÂRSTNICI

– CAZ CLINIC ....................................................................................................................... 16

Mihaela Dimache1,2

, Carmen Anton1,2

, Sandina Duduman1, Roxana Eleonora Onofrei

1,

Florin Grecu2,3

...................................................................................................................... 16

1 Institutul de Gastroenterologie și Hepatologie, Spitalul “Sf. Spiridon” Iași ................... 16

2 Universitatea de Medicină și Farmacie “Gr. T. Popa”, Iași ........................................... 16

4

3 Clinica aIII-a Chirurgie, Spitalul “Sf. Spiridon” Iași ...................................................... 16

15. PARTICULARITIES OF ELDERLY INFLAMMATORY BOWEL DISEASE

PATIENTS IN A TERTIARY REFFERAL CENTER ...................................................... 17

Oana Petrea1,2

, Anca Trifan1,2

, Ana-Maria Singeap1,2,

Irina Gîrleanu1,2

, Laura Huiban1,

,

Cristina Muzica1,2

, Cătălin Sfarti1,2

, Carol Stanciu2............................................................. 17

1“Grigore T. Popa” University of Medicine and Pharmacy, Iasi ....................................... 17

2“St. Spiridon” Emergency Hospital, Institute of Gastroenterology and Hepatology ....... 17

16. DAY-4 LILLE SCORE IN EARLY PREDICTION OF CORTICOSTEROID

RESPONSE FOR PATIENTS WITH SEVERE ACUTE ALCOHOLIC HEPATITIS-

PRELIMINARY RESULTS ................................................................................................. 17

Camelia Foncea, Alina Popescu, Raluca Lupusoru, Tudor Moga, Cotrau Radu, Roxana

Sirli, Mirela Danila, Ioan Sporea ......................................................................................... 18

Department of Gastroenterology and Hepatology, “Victor Babes” University of Medicine

and Pharmacy Timisoara, Timisoara, Roman ..................................................................... 18

17. THE USEFULNESS OF M AND XL PROBES IN TRANSIENT

ELASTOGRAPHY FOR LIVER STIFFNESS ASSESSMENT IN PATIENTS WITH

TYPE 2 DIABETES MELLITIUS ....................................................................................... 18

Ruxandra Mare, Ioan Sporea, Silviu Nistorescu, Roxana Șirli, Alina Popescu, Romulus

Timar 18


Timișoara, Romania ............................................................................................................. 18

Department of Metabolic Diseases, University of Medicine and Pharmacy Timișoara,

Romania ............................................................................................................................... 18

18. FERRITIN IN EVALUATION OF PATIENTS WITH NONALCOHOLIC

FATTY LIVER DISEASE .................................................................................................... 19

Stefan Stojkovic ................................................................................................................... 19

e-mail:[email protected] ..................................................................................... 19

Mentor: Prof. dr. Tamara Milovanovic ................................................................................ 19

Department of gastroenterology and hepatology, Faculty of Medicine University of

Belgrade ............................................................................................................................... 19

19. HOW MANY HCV CIRRHOTIC PATIENTS GO BELOW CIRRHOTEIC

CUT-OFF VALUEA IN TRANSIENT ELASTOGRAPHY AFTER DIRECT ACTING

AGENTS TREATMENT? .................................................................................................... 19

Alin Lazăr, Ioan Sporea, Raluca Lupușoru, Alina Popescu, Isabel Dan, Alexandra Deleanu,

Roxana Șirli ......................................................................................................................... 20

Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine

and Pharmacy Timișoara, Romania .................................................................................... 20

20. COMPLETION RATE OF SMALL BOWEL CAPSULE ENDOSCOPY IN

SUSPECTED CROHN’S DISEASE .................................................................................... 20

Ana-Maria Singeap1,2

, Irina Girleanu1,2

, Stefan Chiriac1,2

, Carol Stanciu2, Anca Trifan

1,2. 20

1“Grigore T. Popa” University of Medicine and Pharmacy, Iasi ....................................... 20

2“St. Spiridon” Emergency Hospital, Institute of Gastroenterology and Hepatology ........ 20

5

21. THE ROLE OF INFLAMMATION IN ACUTE-ON CHRONIC LIVER

FAILURE (ACLF) IN PATIENTS WITH DECOMPENSATED LIVER CIRRHOSIS21

Chiriac Stefan1,2

, Stanciu Carol2*

, Singeap Ana-Maria1,2

, Girleanu Irina1,2

, Cuciureanu

Tudor1, Huiban Laura

1, Trifan Anca

1,2 ................................................................................ 21

1“Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania ...................... 21

2 St. Spiridon University Hospital, Institute of Gastroenterology and Hepatology, Iasi,

Romania ............................................................................................................................... 21

22. GASTROINTESTINAL BLEEDING – A POSSIBLE SIDE EFFECT OF

INTERFERON FREE THERAPY IN ELDERLY PATIENTS? ...................................... 22

Tudor Cuciureanu1,2

, Laura Huiban1,2,

Stefan Chiriac1,2

Cristina-Maria Muzica 1,2

Ana-

Maria Singeap1,2

, Irina Girleanu1,2


1,2 ..................................... 22

1.“Grigore T Popa“University of Medicine and Pharmacy ............................................... 22

2.Institute of Gastroenterology and Hepatology, Iasi, Romania ......................................... 22

23. PANCREATITĂ CRONICĂ CU SINDROM NEURASTENIC ȘI

COMORBIDITĂȚI GASTROINESTINALE ..................................................................... 22

Violetta Ucraințev1, Ion Țîbîrnă

1, Veronica Cazacu

2, Ludmila Condrațchi

1 ....................... 22

1. Universitatea de Stat de Medicină și Farmacie „N. Testemițanu”, Chișinău, Republica

Moldova ............................................................................................................................... 22

2. IMSP Spitalul Clinic Municipal „Sf. Arh. Mihail”, Chișinău, Republica Moldova ........ 22

24. CROHN’S DISEASE AND NEUROFIBROMATOSIS TYPE 1 : A RARE

ASSOCIATION OF TWO DISORDERS WITH GENETIC BACKGROUND .

CLINICAL PRESENTATION ............................................................................................. 23

25. COMPARISON BETWEEN THE PERFORMANCE OF TWO-DIMENSIONAL

AND POINT SHEAR WAVE ELASTOGRAPHY FOR THE NONINVASIVE

ASSESSMENT OF LIVER CIRRHOSIS USING FIBROSCAN TRANSIENT

ELASTOGRAPHY AS REFERENCE METHOD ............................................................. 23

Victor Bâldea, Raluca Lupușoru, Mirela Dănilă, Roxana Şirli, Alina Popescu, Ioan Sporea

24


„Victor Babes” Timisoara, Romania .................................................................................. 24

26. LIVER STIFFNESS MEASUREMENT USING 2D SHEAR WAVE

ELASTOGRAPHY IS AN INDEPENDENT PREDICTOR OF LIVER

DECOMPENSATION AND SURVIVAL ........................................................................... 24

Tjesic-Drinkovic I1, Madir A

1, Balen I

1, Bozin T

1, Mustapic S

1, Lucijanic M

2, Grgurevic I

1

24 1Departement of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital

Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia ................................ 24 2Departement of Hematology, University Hospital Dubrava, University of Zagreb School

of Medicine, Zagreb, Croatia............................................................................................... 24

27. INTESTINAL DYSBIOSIS AMONG CHILDREN WITH FUNCTIONAL

DIGESTIVE CONDITIONS ................................................................................................ 25

Belei Oana, Olariu Laura, Simedrea Ioan, Marginean Otilia .............................................. 25

6

First Pediatric Clinic UMF Victor Babes Timisoara, Romania .......................................... 25

28. CHANGE OF APPETITE IN DIGESTIVE DISORDERS .................................... 26

Adela Turcanu ...................................................................................................................... 26

State University Of Medicine And Pharmacy ...................................................................... 26

Methods: This prospective study included 78 patients with functional digestive disorders

(FGD), which were seen as outpatients in the gastroenterology office. Before a patient’s

inclusion in the study, a full evaluation must have failed to yield any organic cause for the

patient’s complaints. In the study predominantly was female (76%); aged 39.6± 12.3 years,

who all filled out a Rome IV questionnaire for the evaluation of functional digestive

disorders. The patients were classified into three groups: those with no change in appetite,

those with appetite loss, and those with increased appetite. ................................................ 26

29. CLINICAL CONSIDERATION OF IRRITABLE BOWEL SYNDROME

COMORBIDITY ON QUALITY OF LIFE ........................................................................ 26

Alexandru Babin .................................................................................................................. 26

State Medical and Pharmaceutical University “Nicolae Testemitanu”, ............................. 27

Republic of Moldova, Kishinev ............................................................................................ 27

30. ENDOSCOPIC FINDINGS AND CORRELATION WITH CLINICAL SCORES

IN PATIENTS WITH LIVER CIRRHOSIS ....................................................................... 27

Dunja Knežević1, Ivana Novaković

2, Vladimir Nikolić

3, Tamara Milovanović

1, 2 ............. 27

1Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade, Serbia.

27 2School of Medicine, University of Belgrade, Belgrade, Serbia. ......................................... 27

3Institute of Epidemiology, School of Medicine, University of Belgrade, Belgrade, Serbia27

31. EVALUATION OF THE RISK OF SPONTANEOUS BACTERIAL

PERITONITIS CIRRHOTIC PATIENTS TREATED WITH PROTON PUMP

INHIBITORS ......................................................................................................................... 28

32. PREDICTORS OF IN-HOSPITAL MORTALITY IN A COHORT OF

ELDERLY CIRRHOTIC PATIENTS WITH VARICEAL BLEEDING ....................... 28

33. COLORECTAL CARCINOMA IN THE AGING POPULATION ...................... 29

Verica Zoric, Daniela Turkoanje ......................................................................................... 29

Health Center ȚVrsacȚ, Primary Care Practice, Abraseviceva BB, Vrsac, Serbia ............ 29

34. SCREENING STRATEGY FOR PANCREATIC ADENOCARCINOMA AND

USE OF TUMOR MARKERS AS PREDICTORS FOR UNRESECTABILITY .......... 30

Dragasevic S1,2

, Milovanovic T 1,2

, Kmezic S2, Djuranovic S

1,3, Lukic S

1,3, Lalosevic

Stojkovic M1, Stojkovic S

1, Radenkovic D

2,3 Knezevic S

2,3, Knezevic Dj

2,3, Popovic D

1,330

1Clinic for gastroenterology and hepatology, Clinical Center Serbia, 11000 Belgrade,

Serbia 30 2Clinic for digestive surgery-First surgical Clinic, Clinical Center Serbia, 11000 Belgrade,

Serbia 30 3School of medicine, University of Belgrade, 11000 Belgrade, Serbia .............................. 30

7

35. SERUM HEPCIDIN LEVELS IN PATIENTS WITH DECOMPENSATED

ALCOHOLIC LIVER CIRRHOSIS.................................................................................... 30

Milica Stojkovic Lalosevic1, Milos Stulic

1, Sanja Dragasevic

1,2, Ivan Rankovic

1, Nina

Pejic1, Mirjana Stojkovic

1,2, Aleksandra Pavlovic Markovic

1,2, Tamara Milovanovic

1,2 .... 30

1Clinical center of Serbia, Clinic of Gastroenterology and Hepatology, Belgrade, Serbia 30

2Faculty of medicine, Belgrade University, Belgrade, Serbia ............................................. 30

36. Phenotypic features of patients with Post-Infectious Irritable Bowel Syndrome . 31

Flaviu Rusu .......................................................................................................................... 31

Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania ................. 31

37. Prevalence, clinical characteristics and associated diseases of male patients with

Post-Infectious Irritable Bowel Syndrome .......................................................................... 32

Flaviu Rusu, Lorena Mocanu, Dan Lucian Dumitraşcu ...................................................... 32

Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania ................ 32

38. NON VARICEAL ACUTE UPPER GASTROINTESTINAL BLEEDING IN

ELDERLY PATIENTS ......................................................................................................... 33

Camelia Cojocariu 1,2

, Ana Maria Singeap1,2

, Diana Sahawneh1, Irina Girleanu

1,2, Oana

Stoica1,2


1,2 .............................................................................. 33

“Grigore T. Popa” University of Medicine and Pharmacy1, “St. Spiridon” Emergency

Clinical Hospital, Institute of Gastroenterology and Hepatology2, Iasi, Romania; ............ 33

39. HELICOBACTER PYLORI: OLD AND NEW CHALLENGES IN THE

MICROBIOLOGICAL DIAGNOSIS .................................................................................. 33

Ioana Alina COLOSI1, Carmen COSTACHE

1, Simona GRAD

2, Cosmin GRAD

2, Diana

Maria LUCA3, Horaţiu Alexandru COLOSI

4, Dan L. DUMITRAŞCU

2 ............................ 33

1 Department of Molecular Sciences, Division of Microbiology, Iuliu Hațieganu University

of Medicine and Pharmacy, Cluj-Napoca, Romania ........................................................... 33 2

Department of Internal Medicine, 2nd

Medical Clinic, Iuliu Hațieganu University of

Medicine and Pharmacy, Cluj-Napoca, Romania ............................................................... 33 3

Unirea Medical Center, Cluj-Napoca, Romania ............................................................... 33 4

Department of Medical Education, Division of Medical Informatics and Biostatistics,

Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania ............... 33

8

1. HOW MANY VALID MEASUREMENTS ARE NECESSARY TO ASSESS

LIVER STIFFNESS USING TWO-DIMENSIONAL TIME-HARMONIC?

Alexandru Popa, Raluca Lupusoru, Tudor Moga, Andrea Zschätzsch, Meghana Enumula,

Alina Popescu, Roxana Sirli, Mirela Danila, Ioan Sporea

Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and

Pharmacy Timișoara, Timişoara, Romania

Introduction: While most ultrasound elastography methods employ transient stimulation methods, the new

time-harmonic elastography (THED) relies on time-harmonic vibrations in the same manner as magnetic

resonance elastography. According to the manufacturer's recommendations, to obtain reliable liver stiffness

values, 10 valid measurements need to be performed. The aim of this study is to evaluate how many

measurements are needed for non-invasive assessment of liver stiffness (LS) by means of Two-Dimensional

Time-Harmonic Elastography (THED)

Material and methods: We evaluated by means of THED and Transient Elastography(TE) a group of 70

patients: Each subject has been fasting for more than 6 hours before evaluation. 10 valid LS measurements were

performed in the same day, both with THED and with TE, considered to be the reference method. Quality

criteria recommended by the manufacturer: SR≥60%, IQR<30% have been used for each subject.

Results: From our study group, 34 were women and 36 men. Mean age 55.2±11.7, mean IBM 27.8±6.2. Of the

70 patients, according to TE, 15.8% (11/70) were F4, 25.7% (18/70) were F2-3, 58.5 % (41/70) were F0-1.

Reliable LS measurements were obtained in all 70 subjects that had been evaluated first by TE, with the THED

system. There were no significant differences between the mean LS values obtained by THED if 5

measurements vs. 10 measurements were considered: 1.65 m/s ±0.18 vs 1.65 m/s ±0.17, p=0.49. The correlation

of LS assessed by TE with THED values was similar when we used the mean value of 10 valid THED

measurements or the mean value of 5 valid THED measurements: r=0.73, r=0.67, p=0.24.

Conclusion: Five valid measurements may be enough to quantify liver stiffness by two-dimensional time-

harmonic elastography, without significant loss of accuracy, thus reducing the examination time.

Keywords: THED, liver stiffness, 5 vs 10 measurements

2. SYMPTOMS, ANTHROPOMERIC AND METABOLIC PROFILE IN

CHILDREN WITH GENETIC PREDISPOSITION TO PRIMARY

LACTOSE INTOLERANCE

Corina Pienar1,2

, Edward Seclaman3, Marilena Lazarescu

1, Radmila Costachescu

1, Alina

Popescu2, Ioan Sporea

2, Liviu Pop

1

1Pediatrics Department, 2

nd Pediatrics Clinic, “Victor Babes” University of Medicine and

Pharmacy, Timisoara, Romania 2Gastroenterology Department, “Victor Babes” University of Medicine and Pharmacy,

Timisoara, Romania 3Biochemistry Department, “Victor Babes” University of Medicine and Pharmacy,

Timisoara, Romania

Background: Primary lactose intolerance (PLI) is caused by a genetically programmed and progressive loss of

lactase expression. PLI is the ancestral variant, while lactase persistence is caused by 2 polymorphisms: the

dominant C/T13910 and G/A22018. Homozygotes (CC or GG) have undetectable lactase levels. In clinical

practice only half of people with PLI have symptoms. Recent studies have linked lactase persistence with higher

anthropometric indices. Still, the relationship between lactase persistence and obesity and metabolic

abnormalities is yet to be defined. Aims: To investigate whether genetic predisposition to PLI is associated with

typical symptoms. To assess whether genetic predisposition to PLI has an influence on children’s

anthropometric and metabolic profile.

Material and methods: We conducted a prospective study, recruiting consecutive children evaluated in our unit

in May-August 2016. We enrolled 87 children aged 6-17 years (mean age 10.64±3.51 years), 45 (51.72%) girls.

Subjects were asked to complete an analogue visual scale of symptoms. We measured weight, height, blood

9

pressure (BP) and calculated BMI. Metabolic markers included blood glucose, triglycerides (TG) and HDL

cholesterol (HDLc) levels. We used strip genotyping to identify genetic predisposition to IPL. According to the

results, we grouped our study population into lactose tolerant (LT, n= 45) and genetically predisposed to lactose

intolerance (LiT, n= 42).

Results: 45 (51.7%) subjects had a CC genotype. 30 (34.5%) subjects had a GG genotype. 15 (17.4%) children

were homozygous for both. Our results were consistent with Hardy-Weinberg equilibrium. 5 children did not

complete the scale of symptoms. 75.6% of children (62/82) showed no or mild symptoms. We found similar

symptom profiles in LT and LiT children (p= 0.25). We found no differences in weight (42.9±16.94 vs

39.07±17.41 kg, p= 0.37), height (148.67±18.06 vs 144.37±18.38 kg, p= 0.27), BMI (19±5.08 vs 17.99±4.65

kg/m2, p= 0.44) and BP (systolic: 99.8±5.49 vs 98.43±6.87 mmHg, p= 0.33; diastolic: 67.74±10.47 vs

68.25±8.51 mmHg, p= 0.85) across study groups. Glucose (85.47±13.5 vs 87±9.3 mg/dl, p= 0.46), TG

(79(52.39) vs 63.5(63.86) mmol/l, p= 0.39) and HDLc (45(21.75) vs 43(13) mmol/l, p= 0.19) levels were

similar in LT and LiT children.

Conclusions: Genetic predisposition to IPL was not associated with typical symptoms. Genetic predisposition

to IPL did not influence children’s anthropometric and metabolic profile.

Keywords: lactose intolerance, symptoms, anthropometry, metabolic markers, children

3. INCIDENCE RATES OF COLONIC DIVERTICULOSIS AND ACUTE

DIVERTICULITIS AMONG ADULT POPULATION – A SINGLE

CENTER EXPERIENCE

Cristina Muzica1,2

, Carol Stanciu1, Laura Huiban

1,2, Oana Stoica

1,2, Georgiana Frunzuc

1,

Tudor Cuciureanu1,2

, Irina Girleanu1,2

, Ana-Maria Singeap1,2

, Stefan Chiriac1,2

, Anca Trifan1,2

1. Institute of Gastroenterology and Hepatology, Iasi, Romania

2. “Grigore T Popa“ University of Medicine and Pharmacy

INTRODUCTION: Diverticulosis is defined by the presence of one or more diverticula which occur in weaker

portions of the colonic wall where the vasa recta infiltrate the circular muscular layer. Associated with the

Western diet and life style, colonic diverticulosis is one of the clinically and economically most significant

conditions in gastroenterology.

AIM: To evaluate the incidence of colonic diverticulosis and acute diverticulitis in the adult population referred

to a gastroenterology medical center from North Eastern Romania.

METHODS: We performed a retrospective analysis of 2500 colonoscopies between January 1st 2018 and

November 31st 2018 in the Institute of Gastroenterology and Hepatology, Iasi.

RESULTS: Our study included 2500 patients investigated by colonoscopy during the mentioned period. The

main reasons for performing colonoscopy were: motility disorders in 34% cases (constipation and diarrhea in

25% respectively 9% cases), lower GI bleeding in 32% cases (rectorrhagia, melena and hematochezia in 17%,

12% and 3% cases), iron deficiency anemia (12%), colorectal cancer screening (9%), follow-up in inflammatory

bowel disease (5%), polypectomy (5%), polyps follow-up (3%). From all, 450 (18%) patients were diagnosed

with colonic diverticula, of which 239 (53%) were females and 211 (47%) males, mean age 68 years, 324 (72%)

from urban area and 126 (28%) from rural area. The diverticula localization was predominantly in the sigmoid

colon (195- 43%), left colon (120-27%) and the entire colon (76-17%). The other locations were: descending

colon transverse colon (36-8%), ascending colon (21-4.5%), cecum (2-0.5%). Diverticulitis specific signs were

found in 11 (2.5%) patients, of which 7 (64%) associated peridiverticular inflammation.

CONCLUSION: Recent studies show that the incidence of diverticular disease is increasing in developing

countries and affects younger patients, which implies an increased risk of life-threatening complications. Our

study shows a high incidence of diverticula in patients evaluated by colonoscopy, with a worrying percentage of

patients with acute diverticulitis.

Key words: incidence, diverticulosis, diverticulitis

10

4. THE IMPACT OF LONG-TERM ANTIPLATELET THERAPY ON THE

UPPER GASTRO-INTESTINAL TRACT TO ELDERLY PATIENTS

Laura Huiban1,2

, Cristina-Maria Muzica1,2

, Tudor Cuciureanu1,2

, Ştefan Chiriac1,2

, Ana-

Maria Sîngeap1,2

, Irina Gîrleanu1,2

, Oana Petrea1,2

, Carol Stanciu2 , Anca Trifan

1,2

1“Grigore T. Popa “ University of Medicine and Pharmacy, Iasi

2 Institute of Gastroenterology and Hepatology, Iasi, Romania

Objectives. In recent years there has been an increased incidence of cardiovascular diseases and therefore an

increased number of patients with antiplatelet therapy, which led to bleeding complications. Aim. Evaluation of

potential hemorrhagic lesions of the upper digestive tract in patients receiving long-term antiplatelet treatment

(over 6 months).

Materials and methods. We performed a retrospective descriptive study which included all patients with upper

gastrointestinal bleeding (haematemesis or melena) who were admitted to the Emergency County Hospital “St.

Spiridon” Gastroenterology and Hepatology Center Iasi and were receiving chronic antiplatelet treatment during

the period of 1 January to 31 December 2018. Patients were assessed emergency endoscopic within 12 hours of

the presentation.

Results. From a total of 850 cases of upper gastrointestinal bleeding (upper gastrointestinal hemorrhage), 45

cases (32.8%) were receiving antiplatelet treatment. The average age was 71 years, with male predominance and

a ratio of 1.3. The diseases for which they received antiplatelet therapy were: 72% cardiovascular diseases and

18% strokes. 38 (17.1%) were smokes and chronic alcohol consumption was encountered in 29 (13.05%)

patients. 23 (10.35%) of patients received intermittent treatment with NSAI and 19 (8.55%) patients had

associated antiplatelet therapy with a proton pump inhibitor (PPI). Upper gastrointestinal hemorrhage type

Forrest II was detected in 78% of patients. The main endoscopic lesions were the duodenal bulbar ulcers in 30

cases (66.6%), followed by acute hemorrhagic gastritis in 8 cases (17.7%), angiodysplasia in 1 case (2.22%),

gastric cancer in 2 cases (4.44%), Mallory-Weiss syndrome in 3 patients (6.66%) and oesophageal ulcer in 1

patient (2.22%).

Conclusions. Despite the widespread use of antiplatelet therapy and its beneficial effects for elderly patients, the

long-term use is encumbered by digestive complications requiring gastroenterological supervision and

association of proton pump inhibitors during treatment.

5. MULTIDRUG RESISTANCE INFECTIONS IN CIRRHOTIC PATIENTS

Rațiu I, Licker M, Bărbulescu A, Apetrei C, Lupușoru R, Danilă M, Miuțescu B, Sporea I

Department of Gastroenterology and Hepatology, " Victor Babeș" University of Medicine

and Pharmacy Timișoara, Romania

Background and aims

An increased frequency of infections by multiresistant bacteria has been described in hospitalized patients. The

aim of this study was to evaluate the bacterial resistance profile in infected cirrhotic patients.

Methods

This is a retrospective observational study. We assessed the antimicrobial susceptibility of 335 bacterias isolates

from cirrhotic patients admitted in our Department of Hepatology from ian 2017 to sept 2018, analysing the

bacterial resistance in cirrhotic versus noncirrhotic patients

Results

Of the isolates of patients with and without cirrhosis, 72/167 (43.1%) and 33/168 (19.6%) were multiresistant,

respectively (p < 0.0001). In the cirrhotic group, E Coli was the most common multiresistant bacteria 25/72

(34.7%), followed by Klebsiella sp 15/72 (20.8%) and Enterococcus Fecalis 11/72 (15.2%). In the cirrhotic

11

group, antibiotic resistance: 56/72 (77.7%) were resistant to ciprofloxacin, 47/72 (65.2%) to levofloxacin, 39/72

(54.1%) to the third generation of cefalosporines and 41 (56.9%) isolates were resistant to both quinolones and

3rd generation cefalosporines.In the cirrhotic group we have 49/167 (29.3%) compensated and 118 (70.7%)

decompensated patients. All multidrug resistent isolates were in the decompensated batch 72/118 (61%)

p<0.0001. 60/72 (83.3%) of those multiresistant infections were responsive to carbapenems.

Conclusionsș In decompensated cirrhotic patients the majority of infections are multiresistant, with a high

prevalence of resistance to quinolones and 3rd generation of cefalosporines recomended by the AASLD and

EASL guidelines as empirical treatment. Further studies are needed, but it may be the time to start with

carbapenems in decompensated liver cirrotic patients with infections.

Key words: liver cirrhosis, infections, multiresistant bacteria

6. ULTRASOUND EXAMINATION VERSUS CONTROLLED

ATENUATION PARAMETER FOR THE ASSESSMENT OF LIVER

STEATOSIS IN THE HANDS OF BEGINNER

Silviu George Nistorescu, Ioan Sporea, Felix Bende, Mirela Danila1, Roxana Sirli, Alina

Popescu

"Victor Babes" University Of Medicine And Pharmacy Timisoara, Timisoara, Romania

Objectives: The aim of this study is to assess the value of ultrasound compared to CAP (controlled attenuation

parameter) for the quantification of liver steatosis in a beginners hands.

Materials and methods: A total of 390 patients aged 22-84 (55.8±12.9), 45.6% male (178/390), 54,4% female

(212/390) with different hepatopathies were retrospectively analyzed. All patients enrolled in this study were

assessed by ultrasound examination and CAP during the same session in fasting conditions.We used the

following cut-offs for the quantification of liver steatosis by means of CAP: 250, 270 and 290 db/m for mild,

moderate and severe steatosis (S1,S2,S3 respectively). Ultrasound classification of liver steatosis was based on

the comparison between liver and renal cortex echogenicity; grade 0 when the echogenicity of the liver

parenchyma is slightly greater or equal to that of the renal cortex, grade 1 when the echogenicity is just

increased, grade 2 when the echogenic liver obscures the echogenic walls of portal vein branches and grade 3

when the echogenic liver obscures the diaphragmatic outline.

Results: Based on the cut-offs proposed 19.3% (75/390) had no steatosis, 9.2% (36/390) had mild steatosis,

13.3% (52/390) had moderate steatosis and 58.2% (227/390) had severe steatosis. By means of ultrasound 13%

(51/390) had no steatosis, 27.7% (108/390) had mild steatosis, 32.3% (126/390) had moderate steatosis and

27%(105/390) had severe steatosis. When we correlated the CAP value after applying the correction formula

with the ultrasound stratification of steatosis we found r=0.55, p< 0.0001.

Conclusion: Ultrasound assessment of liver steatosis seems to be a fair method even in the hands of a beginner

in ultrasound.

Bibliography:

1. Karlas, Thomas et al.Individual patient data meta-analysis of controlled attenuation parameter (CAP)

technology for assessing steatosis; Journal of Hepatology, Volume 66, Issue 5, Pages 1022 - 1030

7. PERFOMANCE OF A 2D-SWE IMPLEMENTED ON A NEW SYSTEM

FOR PREDICTING DIFFERENT STAGES OF LIVER FIBROSIS USING

TRANSIENT ELASTOGRAPHY AS THE REFERENCE METHOD

Felix Bende, Ioan Sporea, Alina Popescu, Roxana Șirli, Mirela Danilă, Renata Fofiu, Alin

Lazăr, Silviu Nistorescu

12


Timișoara, Romania

Keywords: liver stiffness, liver elastography, shear wave elastography

Aim: To evaluate the performance of 2D Shear-Wave Elastography from General Electric (2D-SWE.GE),

implemented on the new LOGIQ P9 system, for the non-invasive assessment of liver fibrosis, and to identify

liver stiffness (LS) cut-off values for predicting different stages of fibrosis, using Transient Elastography (TE)

as the reference method.

Material and Method: Our study included 234 consecutive subjects, with or without chronic hepatopathies, in

whom LS was evaluated in the same session by means of two elastographic techniques: TE (FibroScan,

EchoSens) and 2D-SWE.GE (LOGIQ P9, GE Healthcare). Reliable liver stiffness measurements (LSM) were

defined for TE as the median value of 10 measurements with an interquartile range/median ratio (IQR/M)<0.30

and for 2D-SWE.GE as the median value of 10 measurements acquired in a homogenous area, with an

IQR/M<0.30. To discriminate between fibrosis stages by TE we used the following cut-offs: F2 - 7 kPa; F3 - 9.5

kPa and F4 - 12 kPa.

Results: Reliable LS measurements were obtained in 217/234 (92.7%) subjects by 2D-SWE.GE and in 222/234

(94.8%) by TE, so the final analysis included 205 subjects (p= 0.454). 36% (74/205) of subjects included in the

study were healthy liver subjects. Based on TE [1] cut-off values we divided the rest of our cohort into 4 groups:

F<2: 40/131 (30.5%); F2: 24/131 (18.3%); F3=22/131 (16.8%); F4=45/131 (34.4%). The mean LS values for

normal subjects for 2D-SWE-GE was 5.05±0.83 kPa and for TE 4.4±0.87 kPa. A very good correlation was

found between the LS values obtained by 2D-SWE.GE and TE: r=0.81, p<0.0001. The best 2D-SWE.GE cut-off

value for F≥2 it was 6.8 kPa (AUROC 0.93, Sensitivity 83.5%. Specificity 91.2%), for F≥3 it was 7.6 kPa

(AUROC 0.94, Sensitivity 86.5%, Specificity 92.7%) and for F=4 it was 9.3 kPa (AUROC 0.91, Sensitivity

75.5%, Specificity 92.5%).

Conclusion: The mean LS values for normal subjects for 2D-SWE-GE (P9) was 5.05±0.83 kPa.

The best 2D-SWE.GE (P9) cut-off values for predicting F≥2, F≥3 and F=4 were 6.8 kPa, 7.6 kPa and 9.3 kPa.

8. A NEW SCORE FOR PREDICTING VARICEAL BLEEDING IN LIVER

CIRRHOTIC PATIENTS

Barbulescu Andreea, Ioan Sporea, Raluca Lupusoru, Roxana Sirli, Mirela Danila, Alina

Popescu, Iulia Ratiu

Department of Gastroenterology and Hepatology, " Victor Babes" University of Medicine

and Pharmacy Timisoara, Romania

Introduction and aim

Diagnostic and therapeutic developments have led to a significant improvement in the prognosis of variceal

bleeding over the past two decades. However, early mortality after an episode of acute variceal bleeding remains

high. The aim of this study was to develop a predicting score for variceal bleeding in liver cirrhotic patients.

Material and method

The study included 652 cirrhotic patients admitted in our department with or without variceal bleeding. Subjects

characteristics, epidemiological data and biochemical tests were recorded. Variables tested for the association

with variceal bleeding were: TGO, TGP, albumin, bilirubin, INR, cholinesterase, presence of ascites, liver

cirrhosis decompensation. Variable associated with variceal bleeding in univariate analysis were used in the

multivariate analysis to create the score.

Results

13

Out of 652 patients, 246 (37.7%) were women, 406 (62.3%) men, mean age 59.5±10.6. 407/652 (62.4%) were

with decompensated liver cirrhosis (parenchymal and vascular) and 181/652 (27.7%) patients were with variceal

bleeding. In univariate analysis, TGP, albumin, INR, cholinesterase, presence of ascites and liver cirrhosis

decompensation were associated with the presence of variceal bleeding (p=0.03, p<0.0001, p<0.0001, p<0.0001,

p<0.0001 and p<0.0001 respectively). In multivariate analysis, the model including TGP, albumin, INR,

cholinesterase, presence of ascites and liver cirrhosis decompensation had all p-values <0.05. Using this factors

as predictors, by multiple regression analysis we obtained the following score: Variceal bleeding score= 0.3

*Albumin+0.06 (in case of ascites) + 0.2* cholinesterase + 0.07 * INR +0.26 (in case of decompensation of any

type) -0.0003 * TGP- 0.4. The score had a cut-off value > 0.25, an AUROC=0.81, 95% CI (0.78-0.84,

p<0.0001), Se=70.2%, Sp=83%, PPV=61.7%, NPV=88.3%

Conclusion

TGP level, albumin, INR, cholinesterase, presence of ascites and liver cirrhosis decompensation were associated

with the presence of variceal bleeding. Variceal bleeding score can be an useful score to rule out patients who

aren’t predispose to variceal bleeding.

Key words: liver cirrhosis, variceal bleeding, predicting score

9. THERAPEUTIC ENDOSCOPIC RETROGRADE

CHOLANGIOPANCREATOGRAPHY FOR CHOLEDOCHOLITHIASIS

IN PATIENTS 80 YEARS OF AGE AND OLDER: EFFICACY AND

SAFETY

Catalin Victor Sfarti, Gheorghe Balan, Stefan Chiriac, Irina Garleanu, Anca Trifan, Carol

Stanciu

Background & Aim: Choledocholithiasis is common in octogenarians and open surgery for its treatment has

high operative risks; therefore, therapeutic endoscopic retrograde cholangiopancreatography (ERCP) has

become the method of choice for management of such patients. The aim of this study is to evaluate the efficacy

and safety of therapeutic ERCP for choledocholithiasis in octogenarians.

Methods: Data of 1325 patients who underwent therapeutic ERCP for choledocholithiasis from January 2014 to

December 2018 was reviewed. Out of these, 111 patients were 80 years or older (study group) and the

assessment of efficacy and safety of therapeutic ERCP was compared to that of 130 patients aged 51-60 (control

group) randomly selected during the same period. Patient demographics, laboratory parameters, complications

of the procedure, as well as post ERCP outcome were carefully reviewed in both groups.

Results: The elderly group had significantly higher incidence of cormobidities that the younger group (82.8%

vs. 65.3%). Common bile duct cannulation was successful in 89,9% of patients in the octogenarian group and in

87,1% in the younger group (p = NS). The rate of ERCP-related complications was different in the two groups

(4,1% vs. 9,5%). The rates of pancreatitis particularly were significantly lower in the elderly compared to the

younger patients (4,1% vs. 7,3%, p = 0.0004). Fewer elderly patients died from non-ERCP causes (non-

procedural). Procedure related mortality was zero in both age groups. Successful stone extraction was not

significantly different between the two age groups.

Conclusion: Therapeutic ERCP for choledocholithiasis is an effective and safe procedure in patients 80 years of

age and older comparable to its use in those younger than 60 years of age.

10. 2D-SHEAR WAVE ELASTOGRAPHY OF THE SPLEEN STIFFNESS -

A NONINVASIVE MARKER FOR PREDICTING HIGH RISK VARICES

IN PATIENTS WITH COMPENSATED LIVER CIRRHOSIS

Renata Fofiu, Ioan Sporea, Felix Bende, Mirela Danila, Alina Popescu, Roxana Șirli


Victor Babes Timisoara, Timisoara, Romania

14

Background and aim: Ultrasound based elastographic methods and biological markers can be used as non-

invasive tools for predicting the presence of high risk varices (HRV) defined as grade II, III esophageal and

gastric varices, in patients with compensated liver cirrhosis. . The aim of the study was to determinate the utility

of spleen stiffness (SS) values measured by 2D-SWE - GE as non-invasive marker for prediction of HRV, in

patients with compensated liver cirrhosis.

Material and method: A prospective study was performed in 55 subjects with compensated liver cirrhosis, who

underwent both spleen stiffness measurements (SSM) with a 2D-SWE technique from General Electric (Logiq

E9) and upper endoscopy in the same admission. Spleen stiffness was performed with patient in supine position

and the SWE evaluation box was placed in the middle of the spleen, avoiding large vessels. Reliable SSM were

defined as the median value of 10 measurements acquired in a homogenous area and an interquartile

range/median (IQR/M) <0.30. Compensated liver cirrhosis was diagnosed based on clinical, biological and

elastographic criteria (FibroScan > 12,5 kPa) [1].

Results: We obtained reliable SSM in 53/55 subjects (96.4%). 28/55 (51 %) subjects had HRV. The mean SS

values for patients with HRV were significantly higher as compared to those with first grade or no varices (18.6

± 4.3 kPa vs. 15.7 ± 2.8 kPa with p=0.0056). The best SS cut-off value measured with 2D-SWE-GE for

predicting the presence of HRV in our study group was: 17.2 kPa (AUROC – 0.80; sensitivity-67.8%;

specificity- 92%; PPV- 91%; NPV- 71,9%).

Conclusion: Using the SS cut-off value >17.2 kPa obtained by means of 2D-SWE-GE we can rule in the

presence of HRV with a positive predictive value of 91%.

Key words: portal hypertension, esophageal varices, spleen stiffness

11. SOLID PSEUDOPAPILLARY NEOPLASM OF THE PANCREAS - A

DIFFERENT VASCULAR PATTERN OF CONTRAST-ENHANCED

ULTRASONOGRAPHY (CEUS)

Sabo Cristina Maria¹, Calian Ioana², Caraiani Cosmin¹, Rusu Ioana², Breazu Caius¹˒², Bartos

Adrian², Ciobanu Lidia¹˒²

1. University of Medicine and Pharmacy, “Iuliu Hatieganu”, Cluj-Napoca, Romania

2. Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania

INTRODUCTION. Solid pseudopapillary neoplasm (SPN) is a rare pancreatic tumor which is frequently found

in the tail of the pancreas. SPN are considered to have a typically contrast-enhanced ultrasound (CEUS) pattern:

peripheral-rim enhancement in the arterial phase. The purpose of this case report was to present a different

vascular pattern detected on CEUS for a SPN.

MATERIALS AND METHODS. We are going to present a case of a 21-year-old woman who was referred to

our institution to investigate a subhepatic mass found during a medical examination. Abdominal ultrasound

sonography (mode B) revealed a 5 cm tumor in the superior retroperitoneum, posterior of pancreatic head, near

the right kidney. The tumor was well delineated, hypoechoic, inhomogeneous and presented Doppler signal

inside. The contrast enhanced ultrasound (CEUS) showed an intense central uptake of the contrast agent in the

early arterial phase with a rapid washout in the venous phase. The staging contrast enhanced CT depicted a

progressively arterial and venous enhancement of the solid area. EUS-Fine needle aspiration was performed.

Histopathology confirmed the diagnosis of SPN following positive stains on immunohistochemistry with

vimentin, beta-catenin, CD 10. The patient underwent a cephalic duodenopancreatectomy with favorable

outcome at 1 year folow up.

RESULTS AND CONCLUSION. This case highlighted a different vascular patterns depicted by CEUS than

previous described in the literature for SPN which is similar to neuroendocrine tumor. The vascular pattern

described by d’Onofrio is similar with those identified by CT scan: a large well-encapsulated mass with varying

solid-cystic and hemorrhagic areas and early peripheral heterogeneous enhancement with progressive fill-in on

dynamic contrast-enhanced examination. Another CEUS vascular pattern was described by Caraiani: a

15

multiseptated cystic pancreatic mass with small vessels in the cystic walls and septa and the contrast agent was

visualized in both the arterial and venous phase. These diferent vascular patterns are probably explained by the

heterogeneous histological aspects of this tumor.

Keywords: solid pseudopapillary neoplasm, contrast-enhanced ultrasonography (CEUS), vascular pattern.

12. TERAPIA CU INFLIXIMAB LA COPIII CU BOALA INFLAMATORIE

INTESTINALĂ

S.Boroghină1, A.Constantinescu

2, A-M Marcu

2 , M.Gîlice

1

1 U.M.F.Carol Davila, Bucuresti, Catedra Pediatrie

1 Clinica de Pediatrie, Institutul Clinic Fundeni,București,Romania

Cuvinte cheie: Infliximab, copii, BIC (boala inflamatorie colonică)

INTRODUCERE:

Acest studiu clinic descrie experiența clinicii de Pediatrie a I.C. Fundeni în tratarea cazurilor de boală

inflamatorie colonică cu Infliximab (anticorpul monoclonal IgG al factorului de necroză tumorală alfa) în

perioada 2004-2018.

MATERIAL &METODE:

Am inclus copiii cu boală Crohn formă refractară și colită ulcerativă, tratați în principal cu Infliximab, indicat

pentru cazurile de boli inflamatorii colonice refractare (cu rezistenta/dependență medicamentoasă) la liniile

tradiționale de tratament.

Au fost selecționați bolnavii cu forma refractară sau steroid dependentă de boală Crohn și cu colită ulcerativă

care au fost tratați cu Infliximab. Toți pacienții au primit un tratament cu trei perfuzii intravenoase de Infliximab

(0, 2 și 6 săptămâni), 5mg / kg și apoi terapie de întreținere cu Infliximab, perfuzii la fiecare 8 săptămâni.

Pacienții primiseră anterior tratament pe termen lung a azatioprină sau corticosteroizi. Indicele pediatric

activitate al bolii Crohn (PCDAI), variabilele serice nutriționale și de activitate inflamatorie au fost evaluate

înainte si după începerea tratamentului și de asemenea s-a practicat tuturor ileocolonoscopie (cu histologie).

REZULTATE & CONCLUZII:

După 8 săptămâni de tratament s-a evaluat remisiunea clinică ( PCDAI <sau = 10 puncte). La toți pacienții s-a

observat o creștere semnificativă în greutate și înălțime. Au fost monitorizate reacțiile adverse imediate

(controlate prin ameliorarea tehnicii de administrare) și, evolutiv, cele la distanță. De asemenea a fost

monitorizat răspunsul la terapie ( în principal remisiunea de lungă durată, apariția recăderilor) și modularea

terapiei biologice.

Infliximab este un tratament eficient la copii și adolescenți cu ambele boli severe, refractare-boala Crohn si

colita ulceroasă (chiar și în formele cu complicații asociate de genul psoriazis sau artropatii). Este un tratament

sigur și valoros în inducerea remisiei și promovarea unei bune evoluții staturo-ponderaleStudiile randomizate

controlate sunt obligatorii pentru a evalua eficacitatea pe termen lung și strategia terapeutică a tratamentului cu

Infliximab la copii cu boala inflamatorie colonica.

13. PERFORMANCE OF A THED SYSTEM FOR RULING IN/ RULING

OUT LIVER CIRRHOSIS AS COMPARED WITH TRANSIENT

ELASTOGRAPHY

Tudor Moga, Raluca Lupusoru, Alexandru Popa, Andrea Zschätzsch, Meghana Enumula,

Alina Popescu, Roxana Sirli, Mirela Danila, Ioan Sporea

UMF Victor Babes, Timisoara

16

Introduction

While most ultrasound elastography methods employ transient stimulation methods, the new time harmonic

elastography (THED) relies on time-harmonic vibrations in the same manner as magnetic resonance

elastography. The aim of our study was to assess the performance of the THED system for ruling in/out liver

cirrhosis (LC) considering transient elastography (TE) as the reference method, as well as and the correlation of

THED values with TE.

Material&Method

We evaluated by THED a group of 70 patients. Each subject has been fasting for more than 6 hours before

evaluation. 10 valid LS measurements were performed in the same day, both by THED and by TE. We used the

TE cut-off values published by Tsochatzis (1): significant fibrosis (F≥2)- 7.0kPa and for LC (F=4)- 12kPa as

reference values. Quality criteria recommended by the manufacturer: SR≥60%, IQR<30% have been used for

each subject. For a better work flow we transformed the measurement units also in KPa.

Results

From the 70 patients, 34 were women and 36 men. Mean age 55.2±11.7, mean BMI 27.8±6.2 kg/m2. Of the 70

patients, 15.8% (11/70) were F4, 25.7% (18/70) were F2-3, 58.5 % (41/70) were F0-1.We had 100% feasibility

for all the patients that were previously evaluated by TE. The cut-off for ruling out LC by THED measurements

on our study group was < 1.5 m/s (7.2 KPa), AUROC=0.83, 95%CI (0.73-0.91), P<0.0001, Se=100%,

Sp=35.1%, PPV=31.4%, NPV=100%. The cut-off for ruling in LC by THED measurements was >2 m/s (11.9

kPa). AUROC=0.83, 95%CI (0.73-0.91), P<0.0001, Se=18%, Sp=100%, PPV=100, NPV=80.6%. There was a

direct, positive and strong correlation between LS measurements by THED and TE evaluated with Pearson

correlation coefficient, r=0.73, p<0.001.

Conclusions

In our study, the cut-of values to rule-out and rule-in LC by LS measurements with THED system were <7.2

KPa and >11.9 kPa, respectively. There was a strong correlation between the LS values obtained by the two

elastographic methods.

1.Tsochatzis EA, Gurusamy KS, Ntaoula S et al. Elastography for the diagnosis of severity of fibrosis in chronic

liver disease: a meta-analysis of diagnostic accuracy. Hepatol. 2011 Apr;54(4):650-9.

Key words: THED, rule in/out, Liver cirrhosis, Transient Elastography

14. TUMORILE NEUROENDOCRINE GASTROINTESTINALE LA

VÂRSTNICI – CAZ CLINIC

Mihaela Dimache

1,2, Carmen Anton

1,2, Sandina Duduman

1, Roxana Eleonora Onofrei

1, Florin

Grecu2,3

1 Institutul de Gastroenterologie și Hepatologie, Spitalul “Sf. Spiridon” Iași

2 Universitatea de Medicină și Farmacie “Gr. T. Popa”, Iași

3 Clinica aIII-a Chirurgie, Spitalul “Sf. Spiridon” Iași Introducere: Tumorile neuroendocrine (TNE) gastrointestinale reprezintă 2% din totalul tumorilor digestive

maligne și se clasifică în funcție de secreția endocrină în funcționale și nonfuncționale, tabloul clinic fiind

influențat de tipul și localizarea acesteia.

Material si metoda: Prezentăm cazul unui pacient în vârstă de 72 de ani, hipertensiv și diabetic, internat în

Spitalul “Sf. Spiridon” Iași – Centrul de Gastroenterologie în luna noiembrie 2018 pentru rectoragii în cantitate

importantă, dureri abdominale cu localizare în hipocondrul drept și astenie fizică, simptomatologie debutată

progresiv cu aproximativ o săptămână anterior internării. Pacientul a fost explorat prin investigații de laborator,

ecografie abdominală, colonoscopie și angio-CT abdominal.

Rezultate: Colonoscopia efectuată fără pregătire prealabilă evidențiaza mucoasa colonică tapetată cu sânge roșu

proaspăt până la 40 de cm de marginea anală de unde explorarea se oprește din cauza lipsei vizibilității.

https://www.ncbi.nlm.nih.gov/pubmed/?term=Tsochatzis%20EA%5BAuthor%5D&cauthor=true&cauthor_uid=21146892

https://www.ncbi.nlm.nih.gov/pubmed/?term=Gurusamy%20KS%5BAuthor%5D&cauthor=true&cauthor_uid=21146892

https://www.ncbi.nlm.nih.gov/pubmed/?term=Ntaoula%20S%5BAuthor%5D&cauthor=true&cauthor_uid=21146892

https://www.ncbi.nlm.nih.gov/pubmed/21146892

17

Examenul angio-CT nu deceleaza focare de sângerare activă în momentul examinării, dar descrie o formațiune

tumorală hipercontrastantă la nivelul valvei ileo-cecale ce asociază adenopatii ileo-colice – aspect sugestiv

pentru o tumoră carcinoidă. Pacientul este transferat la Clinica aIII-a Chirurgie a Spitalului “Sf. Spiridon” Iași,

unde se practică hemicolectomie dreaptă, cu rezecția în bloc a ileonului terminal și limfadenectomie. Examenul

histopatologic și cel imunohistochimic al piesei de rezecție susțin diagnosticul de tumoră neuroendocrină (G2)

de ileon terminal în stadiul T3N1G2L1V1PnO.

Concluzii: Cel mai frecvent, TNE se localizează la nivelul ileonului terminal, tabloul tipic de prezentare fiind

dominat de fenomene ocluzive și dureri abdominale. În cazul nostru, simptomatologia a debutat cu rectoragii, o

modalitate mai puțin comună de manifestare a tumorilor carcinoide. Managementul chirurgical precoce

(hemicolectomie, cu rezecția ileonului terminal și limfadenectomie) a fost urmat de o evoluție favorabilă a

statusului pacientului.

Cuvinte cheie: Tumori neuroendocrine, ileon terminal

15. PARTICULARITIES OF ELDERLY INFLAMMATORY BOWEL

DISEASE PATIENTS IN A TERTIARY REFFERAL CENTER

Oana Petrea1,2

, Anca Trifan1,2

, Ana-Maria Singeap1,2,

Irina Gîrleanu1,2

, Laura Huiban1,

,

Cristina Muzica1,2

, Cătălin Sfarti1,2

, Carol Stanciu2

1“Grigore T. Popa” University of Medicine and Pharmacy, Iasi

2“St. Spiridon” Emergency Hospital, Institute of Gastroenterology and Hepatology

Introduction: Inflammatory bowel diseases (IBD) are traditionally diagnosed in younger people, but IBD is

relatively common in elderly individuals due to the chronic nature of the disease. Data on the elderly population

with IBD are scarce. The aim of this study is to assess the clinical features and particularities of elderly patients

with IBD in a tertiary refferal center.

Material and Methods: Our study included all IBD patients admitted in our tertiary referral center in North

East Romania between January 2011 and December 2016. Demographic, clinical, laboratory characteristics and

disease severity along with type of medication were carefully collected from the patients’ medical charts.

Results: A total of 332 hospitalized-patients with IBD were analyzed. The elderly group consisted of 40 patients

aged 65 years or more, among them 34 (85%) had ulcerative colitis (UC) and 6 (15%) Crohn´s disease (CD).

IBD patients from the elderly group had predominantly a mild form of disease activity compared with younger

patients (48.5% vs 39.1%, p=0.550). Elderly patients had more comorbidities than the younger ones (74.05% vs

25.9%, p=0.001). There were no significant differences between the 2 groups regarding biological parameters. A

few proportion of the elderly patients required surgey compared to younger study group (7.89% vs. 92.1%,

p=0,403). The elderly patients tend to receive less immunomodulatory treatment (3.8.% vs 96.2%, p=0.010),

biologics (1.4% vs 98.5%, p=0.002), or corticosteroids (10.9% vs 89.1%, p=0.396). There were no significant

differences between the two study groups regarding length of hospital stay (9.9±4.6 days vs 8.6±5.6 days,

p=0.145).

Conclusions: Clinical features and laboratory parameters were similar between the elderly and the younger

patients with IBD, except the fact that elderly patients had more comorbidities.

Elderly patients with IBD tend to present mild form of disease activity compared to younger ones.

Keywords: elderly, inflammatory bowel disease, conorbidities

16. DAY-4 LILLE SCORE IN EARLY PREDICTION OF

CORTICOSTEROID RESPONSE FOR PATIENTS WITH SEVERE

ACUTE ALCOHOLIC HEPATITIS- PRELIMINARY RESULTS

18

Camelia Foncea, Alina Popescu, Raluca Lupusoru, Tudor Moga, Cotrau Radu, Roxana Sirli,

Mirela Danila, Ioan Sporea

Department of Gastroenterology and Hepatology, “Victor Babes” University of Medicine

and Pharmacy Timisoara, Timisoara, Roman

Background and Aims: In addition to general supportive care, corticosteroids are indicated for patients with

severe acute alcoholic hepatitis (SAH), defined by a Maddrey`s discriminat function (MDF) score >32.

However, patients on corticosteroid therapy have a high risk of developing infections and other complications,

especially during hospitalization. The introduction of Lille score helps in finding the steroid responders (<0.45)

and non-responders (>0.45) after 7 days of treatment. The aim of this study is to evaluate whether using Lille

score at day 4 (LM4) is as useful as Lille at day 7 (LM7), in order to determine response to therapy earlier.

Method: A retrospective study was performed including all patients with SAH during October 2015-October

2018 in a tertiary Department of Gastroenterology and Hepatology. All consecutive patients with SAH and

MDF >32, without contraindications to corticosteroids were enrolled. All patients received 40 mg of Prednisone

per day and response was assessed with LM4 and LM7, according to the validated cut-off (<0.45 responder and

>0.45 non responder).

Results: A total of 28 patients out of 82 (34%) with acute alcoholic hepatitis had MDF>32 and received

corticosteroid therapy (2 female and 26 male, mean age 52.2±9.28). All included patients had liver cirrhosis

.15/28 (54%) had Child Pugh C score. The median value MDF was 52.16±30. The mean value for Lille score at

4 days was 0.67±0.29, vs 0.61±0.33 for Lille score at 7 days, p=0.47. There were no differences between the

proportion of patients who responded at treatment at 4 days and at 7 days (21.4 vs 35.7, p=0.37).

Conclusion: LM4 could be used instead of LM7 in predicting the response to corticosteroids therapy in SAH to

avoid a prolonged use of this therapy, but validation is required on a larger cohort of patients.

Key Words: Lille score, alcoholic hepatitis, corticosteroid therapy

17. THE USEFULNESS OF M AND XL PROBES IN TRANSIENT

ELASTOGRAPHY FOR LIVER STIFFNESS ASSESSMENT IN

PATIENTS WITH TYPE 2 DIABETES MELLITIUS

Ruxandra Mare, Ioan Sporea, Silviu Nistorescu, Roxana Șirli, Alina Popescu, Romulus Timar


Timișoara, Romania

Department of Metabolic Diseases, University of Medicine and Pharmacy Timișoara,

Romania

The aim of the study was to assess liver fibrosis in patients with type 2 diabetes mellitus (DZ 2), using different

cut-offs values for M and XL probes, knowing that liver stiffness values obtained with the XL probe are

consistently lower than those obtained with the M probe.

Material and methods: The study included 576 DZ 2 patients, who were prospectively included (every first 6

patients who were referred to the Metabolic Disease Outpatient Clinic on a consultation day) and evaluated in

the same session by means of TE (FibroScan, EchoSens) to assess liver fibrosis. Reliable liver stiffness

measurements (LSM) were defined as the median value of 10 LSM with an IQR/median <30%. For TE, M and

XL probes were used. A cut-off value of 8.7 kPa was used to define severe fibrosis (F≥3) using M probe and 7.2

kPa using XL probe (Wong et al. 2012)

Results: Out of the 576 diabetics screened, after the exclusion of patients with associated chronic viral hepatitis,

of those with an AUDIT-C score ≥8 and with unreliable LSM, the final analysis included 403 subjects (59.3%

19

women, mean age 60.4±9.5). Reliable LSM were obtained in 40.2% (162/403) subjects with the M probe and in

59.8% (241/403) subjects with the XL probe. The mean BMI in patients evaluated by M probe was 26.2±4

kg/m2, while for the XL probe, was 34.5±4.9 kg/m

2 (p<0.001). In our cohort, severe fibrosis was observed in

16% (26/162) of cases using the M probe and in 42% (101/241) using the XL probe (p<0.0001).

Conclusions: In our cohort, using different cut-offs values for M and XL probes in DZ 2 patients, we observed

a huge difference in the prevalence of severe fibrosis in the two subgroups. Future studies are needed to find

which are the really correct cut-offs.

18. FERRITIN IN EVALUATION OF PATIENTS WITH NONALCOHOLIC

FATTY LIVER DISEASE

Stefan Stojkovic

e-mail:[email protected]

Mentor: Prof. dr. Tamara Milovanovic

Department of gastroenterology and hepatology, Faculty of Medicine University of Belgrade

Introduction: Nonalcoholic fatty liver disease (NAFLD) is a chronic liver condition characterized by insulin

resistance, dysregulation of hepatic enzymes and fat accumulation in the liver leading to hepatic inflammation

and fibrosis. Elevated level of serum ferritin (SFL) as an acute phase reactant protein is registered in liver

necrosis and inflammation. Connections of SFL and NAFLD are still disputed. The aim of this study was to

examine the association of the serum ferritin values and NAFLD stage.

Materials and Methods: We analyzed clinical data of 94 patients hospitalized in the Gastroenterology and

Hepatology Clinic, Clinical Center of Serbia, in period 2013-2017 with pathohistologically confirmed diagnosis

of nonalcoholic steatohepatitis and without alcoholic, malignant, viral, autoimmune liver disease.

Results: According to the values of NAFLD Activity Score (NAS), patients were divided in group A with NAS

< 5 and group B with NAS > 5. SFL were similar in both groups (206,5±208,3 vs 197,4±98,4, p=0,877). Group

B had higher AST levels (59,5 + 27,9 vs. 40,4 + 18,8 p=0,0159 ), higher cholesterol levels (5,8 +1,7 vs 4,6 + 1,2

p=0,0186) and higher APRI score (0,93 + 0,51 vs 0,55 + 0,5 p=0,0231 ). Positive correlation was found betwen

SFL and APRI (p=0,001) and SFL and FIB4 score (p=0,022).

Conclusion: As there was no statistically significant difference in SFL of patients with NAFLD with NAS score

less that 5 and those with NAS score 5-8, we conclude that SFL is not correlated with severity of NAFLD.

Keywords: nonalcoholic fatty liver disease, ferritin, nonalcoholic steatohepatitis

19. HOW MANY HCV CIRRHOTIC PATIENTS GO BELOW CIRRHOTEIC

CUT-OFF VALUEA IN TRANSIENT ELASTOGRAPHY AFTER

DIRECT ACTING AGENTS TREATMENT?

20

Alin Lazăr, Ioan Sporea, Raluca Lupușoru, Alina Popescu, Isabel Dan, Alexandra Deleanu,

Roxana Șirli

Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and

Pharmacy Timișoara, Romania

Introduction: Liver stiffness (LS) measurements by Transient Elastography (TE) has been accepted as a tool

for fibrosis assessment. The aim of the study was to evaluate what happens with liver stiffness values after

DAA (Direct-acting antivirals) therapy, in patients with compensated HCV (hepatitis C virus) cirrhosis, who

had sustained virologic response (SVR) and to highlight in how many LS values become lower than the

accepted cut-off for cirrhosis.

Material and Method: A number of 167 patients with compensated HCV cirrhosis who had LS > 12 kPa at

baseline, underwent a 12 weeks DAA therapy (Viekirax/Exviera) and had SVR, of whom 56 patients were

followed up at 24 weeks (SVR 24) from EOT (end of treatment) at 48 weeks of EOT (SVR 48) and a subgroup

of 28 patients were followed at 96 weeks from EOT (SVR 96). LS values were assessed by means of TE

(FibroScan, Echosens) at the start of treatment (ST), and at SVR 12 (12 weeks from EOT), SVR 24, SVR 48,

SVR 96, respectively. In each session, 10 valid liver stiffness measurements (LSM) were obtained and reliable

LSM were defined as median value of 10 measurements with Interquartile range/median (IQR/M)≤30%.

Results: In the group of 56 patients, LS mean values from SVR12 decreased significantly compared to baseline (16.6±6.87 kPa vs 21.3±8.8, p = 0.002) and compared to SVR12, at SVR24 and

SVR48 the values decreased but without significance (16.6±6.87 kPa vs 16.9±6.87, p = 0.81;

14.6±5.3 kPa vs 16.6±6.87, p = 0.08). In these patients, 14.2% (8 patients) had LS values <12

kPa at SVR12, 16% (9 patients) at SVR 24 and 26.7% (15 patients) at SVR 48.

In the subgroup of 28 patients, LS mean values at SVR 96 decreased significantly compared

to SVR12 (11.6±4.6 vs. 15.5±6.2 kPa, p = 0.009), 46.4% (13 patients) had LS <12 kPa in this

moment.

Conclusion: In compensated HCV cirrhotic patients, the mean liver stiffness values significantly decreased at

SVR12, remained in a „plateau" at SVR24 and SVR48 and continued to decrease at SVR96. 26.7% patients had

LS <12 kPa at week 12 and 46.4% at week 96. These results are important because the follow-up screening for

HCC (hepatocellular carcinoma) in these patients must be continued, despite they have liver stiffness

measurement below the liver cirrhosis cut-off values.

Keywords: liver stiffness, direct-acting antivirals, compensated HCV cirrhosis

20. COMPLETION RATE OF SMALL BOWEL CAPSULE ENDOSCOPY IN

SUSPECTED CROHN’S DISEASE

Ana-Maria Singeap1,2

, Irina Girleanu1,2

, Stefan Chiriac1,2


1,2

1“Grigore T. Popa” University of Medicine and Pharmacy, Iasi

2“St. Spiridon” Emergency Hospital, Institute of Gastroenterology and Hepatology

Keywords: small bowel capsule endoscopy, Crohn’s disease, completion rate

21

Introduction: As there is no unique gold standard diagnostic test for Crohn’s disease, small bowel capsule

endoscopy (SBCE) results may play a decisive diagnostic role. Crohn’s disease may affect any part of the

gastrointestinal tract, so complete visualization of the small bowel is of utmost importance. Our study aimed to

assess the completion rate of SBCE in suspected Crohn’s disease, and estimate if it could possibly limit the

SBCE performance.

Material and method: Our study included all SBCE examinations indicated for suspected Crohn’s disease, in

a three-year period in our tertiary referral center in North East Romania. Incomplete examinations of the small

bowel were excluded, and the diagnostic yield (DY) for Crohn’s disease was assessed. Another hypothetical DY

was calculated taking into account the incomplete examinations – as if they had all showed significant findings,

in the non-visualized segments.

Results: Ninety-six SBCE examinations were performed for suspected Crohn’s disease, of which 82 were

complete exams, and 14 failed to reach the caecum within the battery life, resulting in a completion rate of 85%.

Crohn’s disease was diagnosed in 28 cases, the DY being 34% if reported only to valid examinations, even

lower (29%) if reported to all 96 examinations. If all the 14 examinations would have been diagnostic for

Crohn’s disease, a new DY should be the calculated, and this would be 44%. Completion rate was lower in

patients aged 65 or older and in diabetic patients.

Conclusion: Completion rate is an influence factor for the performance of SBCE in suspected Crohn’s disease.

Incomplete visualization is more frequent in older and in diabetic patients, so especially in these cases, some

measures should be adopted, as additional preparation or prokinetics use. In the same time, technical progresses

in battery life might contribute in the future to overcome this limitation.

21. THE ROLE OF INFLAMMATION IN ACUTE-ON CHRONIC LIVER

FAILURE (ACLF) IN PATIENTS WITH DECOMPENSATED LIVER

CIRRHOSIS

Chiriac Stefan1,2

, Stanciu Carol2*

, Singeap Ana-Maria1,2

, Girleanu Irina1,2

, Cuciureanu

Tudor1, Huiban Laura

1, Trifan Anca

1,2

1“Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania

2 St. Spiridon University Hospital, Institute of Gastroenterology and Hepatology, Iasi,

Romania

Introduction: Acute-on chronic liver failure (ACLF), a syndrome diagnosed in cirrhotic patients with acute

decompensation, has been associated with high rates of organ failure and short-term mortality. The systemic

inflammatory response syndrome (SIRS) has been associated with a poor prognostic and with high risk for

developing ACLF. We investigated the predictive role of SIRS in patients with decompensated liver cirrhosis

hospitalized in our gastroenterology unit with regarding to ACLF and outcome.

Patients and Methods: Consecutive patients hospitalized for decompensation of their liver cirrhosis were

included between 2015 and 2016. Diagnosis of ACLF was established in the setting of organ failure, according

to the CLIF Consortium Organ Failure Score. Patients were followed for 90 days.

Results: One hundred forty five patients were included, mean age 63.5 ± 7.7 years, mostly men, 88 (60.7%).

MELD and Child-Pugh scores were 29.32 ± 11.77 and 6.96 ±2.5, respectively. ACLF was diagnosed in 98

(67.6%) of the participants. SIRS was found in 92 (63.4%) of all the patients included and in 82 (83.7%) of the

ones with ACLF. Univariate analysis showed that patients with SIRS had a high risk for ACLF (OR=3.93; 95%

CI, 2.25-6.86, P<0.05) and a high risk for 28-day and 90-day mortality (OR=1.76; 95% CI, 1.35-2.29, P<0.05,

and OR=1.98; 95% CI, 1.32-2.96, P<0.05, respectively). ROC analysis showed good specificity and sensitivity

for C-reactive protein in predicting ACLF with the area under the curve of 0.890.

Conclusions: ACLF was frequently diagnosed in cirrhotic patients with acute decompensation. SIRS was a

common finding among patients with decompensated liver cirrhosis and was associated with ACLF, and with a

high risk of mortality both at 28 and at 90 days. High CRP values could represent markers for poor prognosis

and clinical prediction of ACLF development.

22

Key Words: acute-on chronic liver failure, inflammation, liver cirrhosis

22. GASTROINTESTINAL BLEEDING – A POSSIBLE SIDE EFFECT OF

INTERFERON FREE THERAPY IN ELDERLY PATIENTS?

Tudor Cuciureanu1,2

, Laura Huiban1,2,

Stefan Chiriac1,2

Cristina-Maria Muzica 1,2

Ana-Maria

Singeap1,2

, Irina Girleanu1,2


1,2

1.“Grigore T Popa“University of Medicine and Pharmacy

2.Institute of Gastroenterology and Hepatology, Iasi, Romania

Introduction: Gastrointestinal bleeding (GB) related to portal hypertension is a serious complication and a

long-term burden in management of patients with liver cirrhosis.

Most patients with liver cirrhosis with virus C (LC VC) bleed from esophageal or gastric varices, but bleeding

from portal hypertensive gastropathy (PHG) is also possible.

Oral antiviral treatment indicated in decompensated LC VC requires careful follow-up of this category of

patients at risk of complications, including potential adverse effects of therapy.

Aim: Our purpose was to evaluate the rate of GB and other possible adverse effects of oral antiviral therapy

with Ledipasvir / Sofosbuvir ± Ribavirin (Led/Sof ± Rib) in elderly patients with decompensated LC VC.

Methodology: : We conducted a study between June 2017 and February 2018 in which we included patients

with decompensated LC VC hospitalized in the department of Gastroenterology and Hepatology at Saint

Spiridon Hospital, Iasi. The patients received antiviral treatment with Led/Sof ± Rib. We analyzed the frequency

of GB among other severe side effects, including decompensation of liver disease.

Results: 88 patients were included in the study, out of which 52 women (59%), 37 men (41%), mean age 56.28

years (34-80 years). 18 (20.4%) patients had significant side effects during treatment: 3 (21.4%) cases of upper

GB out of which 2 esophageal varices bleeding and one case of PHG bleeding, 4 (28.5%) cases of clinically

significant hepatic encephalopathy, 3 (21.4%) cases of refractory ascites , 1 (7.1%) portal thrombosis case, 1

(7.1%) severe thrombocytopenia case, 1 (7.1%) case of epileptic seizure. The most severe side effects including

GB were seen in patients over 65 years old Child Pugh B score.

Conclusion: Although interferon free therapy has a safe profile among patients with LC VC, GB may be

considered a severe side effect with an increased occurrence in elderly patients.

KEYWORDS: VIRUS C, BLEEDING , ANTIVIRAL

23. PANCREATITĂ CRONICĂ CU SINDROM NEURASTENIC ȘI

COMORBIDITĂȚI GASTROINESTINALE

Violetta Ucraințev1, Ion Țîbîrnă

1, Veronica Cazacu

2, Ludmila Condrațchi

1

1. Universitatea de Stat de Medicină și Farmacie „N. Testemițanu”, Chișinău, Republica

Moldova

2. IMSP Spitalul Clinic Municipal „Sf. Arh. Mihail”, Chișinău, Republica Moldova

Introducere. Există o creștere a incidenței pancreatitei cronice (PC) datorită expunerii crescute la factorii de

risc (consumul de alcool, tabagismul, stresul și al.), dar și unele comorbidități gastrointestinale, mai des

afecțiunilor organelor adiacente. Metodele contemporane de diagnostic instrumental și de laborator permit

de a efectua diagnosticul diferențial între maladiile cronice a pancreasului, stomacului, duodenului, ficatului

și a vezicii biliare, dar și pentru a evolua schimbările gastrointestinale, care apar concomitent în PC cu

sindrom neuroastenic.

Scopul lucrării. Studierea prezenței comorbidităților gastrointestinale la pacienții cu PC, forma algică cu

sindrom neurastenic.

23

Material și metode. Lotul de studiu a fost alcătuit din 50 pacienți cu PC, din care 22 pacienți cu forma

algică de PC cu sindrom neurastenic confirmat clinic și prin chestionarea Hamilton și Beck, internați în

Spitalul Clinic Municipal „Sf. Arh. Mihail”, mun. Chișinău, în anul 2018. Pentru determinarea

comorbidităților gastrointestinale s-a efectuat fibrogastroduodenoscopia, colonoscopia și ultrasonografia

abdomenală.

Rezultate.Refluxului duodenogastroesofagian cu conținut de bilă în stomac s-a depistat la 63,6% de pacienți

cu sdrindrom neurastenic, la 22,7% gastrită eritematos-exudativă și la 13,6% congestie de mucoasa gastrică.

De menționat că la pacienții cu reflux duodenogastroesofagian mai fregvent (35,7%) s-a constatat bulbită

erozivă și mai rar (21,4%) gastrita eroziv-eritematosă. La 36,3% de pacienți s-a depistat dischinezia vezicii

biliare, la 27,2% sindromul intestinului iritabil.

Concluzii. Comorbiditățile gastrointestinale în PC, forma algică cu sindrom neurastenic sunt prezente în

cantitate defirită. Este necesar de a utiliza metode paraclinice în PC cu sindrom neurastenic pentru depistarea

afecțiunilor organelor adiacente și indicarea tratamentului complex.

Cuvinte cheie: pancreatita, comorbiditatea, neurastenic.

24. CROHN’S DISEASE AND NEUROFIBROMATOSIS TYPE 1 : A RARE

ASSOCIATION OF TWO DISORDERS WITH GENETIC

BACKGROUND . CLINICAL PRESENTATION

Carmen Anton1,2

, Mihaela Dimache1,2

, Roxana Eleonora Onofrei2

, Codrina Ancuţa1

1. Grigore T. Popa University of Medicine and Pharmacy Iasi, Romania

2. Institute of Gastroenterology and Hepatology, St.Spyridon Hospital, Iasi, Romania

Key words: Crohn disease, neurofibromatosis

Introduction: Neurofibromatosis type-1 (NF-1), also known as von Recklinghausen disease, is a common

autosomal dominant condition that can be associated with gastrointestinal neoplasms in 2-25% of patients.

Material and method: Man of 45 years old, known with von Recklinghausen NF-1 was admitted in the

Gastroenterology Institute for diffuse abdominal pain and 6 diarrheal stools per day. Physical examination

revealed several „cafe au lait” spots and multiple subcutaneous nodules on the trunk and lower limbs, cognitive

disturbances and gait impairment. Abdominal palpation indicated right lower abdominal pain. Laboratory

findings showed mild hypochromic microcytic anemia with leucopenia and fecal calprotectin=293 µg/g .

Results: Abdominal ultrasound shows thickness of the entire bowel wall and colonoscopy describes congestive

mucosa starting with 35 cm from the anal edge, aphtous ulcers at 60 cm, 80 cm and inflammatory lesions of the

cecal region and ileocecal valve. Histopathological examination indicates severe inflammatory-type changes

compatible with Crohn’s disease (CD) confirmed by significant elevated levels of fecal calprotectin. Upper

digestive endoscopy reveals aphtous ulcers in the lower third esophagus and pangastritis. Abdominal CT scan

describes segmentation thickening of the colon and areas with an inflammatory pattern including the terminal

ileum and cecal area, pleading for CD.Treatment with mesalazine and steroids resulted in prompt improvement

of the clinical and endoscopic picture. Since then, the disease continued with remissions and exacerbations who

responded well to the treatment.

Conclusions: CD could appear on the ground of von Recklinghausen disease.This association of two diseases

with strong genetic background still points the importance of genetic factors involved in the etiopathogenesis of

CD.

25. COMPARISON BETWEEN THE PERFORMANCE OF TWO-

DIMENSIONAL AND POINT SHEAR WAVE ELASTOGRAPHY FOR

THE NONINVASIVE ASSESSMENT OF LIVER CIRRHOSIS USING

FIBROSCAN TRANSIENT ELASTOGRAPHY AS REFERENCE

METHOD

24

Victor Bâldea, Raluca Lupușoru, Mirela Dănilă, Roxana Şirli, Alina Popescu, Ioan Sporea


„Victor Babes” Timisoara, Romania

Background and aim: The goals of this study were to compare the noninvasive diagnostic performance of two

elastography techniques for the diagnosis of liver cirrhosis in a cohort of patients with known hepatitis C virus

using Transient Elastography as the method of reference.

Material and methods: The study included 122 patients aged 38-80 (62±7.9), 35% male (43/122), 65% female

(79/122) with known hepatitis C virus in whom liver stiffness was evaluated during the same session by means

of three elastography methods: Point Shear Wave Elastography (pSWE) using virtual touch

quantification(VTQ) technology Siemens Acuson S2000TM, Two-Dimensional Shear Wave Elastography (2D-

SWE) embedded in General Electrics LOGIQ E9 and Transient Elastography(TE;FibroScan, EchoSens).

Reliable liver stiffness measurements were defined as following: for both VTQ and 2D-SWE.GE the median

value of 10 measurements acquired in a homogenous area of liver parenchyma and an interquartile

range/median(IQR/MED) <30% and for TE(M or XL probe) were considered the median value of 10

measurements with and IQR/MED <30%. For diagnosing liver cirrhosis we used the TE cut-off value of 12.5

kPa.The areas under receiver operating characteristic curve(AUROC) were used to assess the diagnostic

performance of VTQ and 2D-SWE. GE.

Results: Reliable liver stiffness measurements were obtained in 93% (114/122) of cases by means of TE, 88%

(107/122) of cases by means of VTQ and 87% (106/122) of cases by means of 2D-SWE.GE. In the final

analysis we included 93 patients which had reliable stiffness measurements with all methods.The AUROCS

were calculated considering TE as the reference method. The optimal cutoff of VTQ for cirrhosis was

1.77m/s(SE:83%SP:88%; AUC:0.89) and for 2D-SWE.GE was 10.2 kPa(SE:86%;SP:77%;AUC:0.89). No

statistical differences were found between both methods(p<0.96).

Conclusion: Both methods offer similar performance when compared to TE in evaluating patients with liver

fibrosis.

Key Words: Liver Elastography, p-SWE, 2D-SWE

26. LIVER STIFFNESS MEASUREMENT USING 2D SHEAR WAVE

ELASTOGRAPHY IS AN INDEPENDENT PREDICTOR OF LIVER

DECOMPENSATION AND SURVIVAL

Tjesic-Drinkovic I1, Madir A

1, Balen I

1, Bozin T

1, Mustapic S

1, Lucijanic M

2, Grgurevic I

1

1Departement of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital

Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia 2Departement of Hematology, University Hospital Dubrava, University of Zagreb School of

Medicine, Zagreb, Croatia

INTRODUCTION: The aim of this study was to evaluate potential impact of liver stiffness measurements

(LSM) and spleen stiffness measurements (SSM) using two dimensional shear wave elastography (2DSWE) on

the development of complications of liver disease and patients’ survival.

MATERIAL AND METHODS: We have conducted a database search for patients who underwent LSM

and/or SSM by using 2DSWE (Aixplorer® US system, Supersonic imagine) between 2011 and 2013, whose

clinical outcomes including liver decompensation, HCC development, liver transplantation or death could have

been traced up to 2018. Patients with biliary obstruction, congestive heart failure and malignant disease were

excluded from the study. Enrolled patients were categorized based on liver disease etiology, co-morbidities and

clinical outcomes.

25

RESULTS: In total 154 patients were analyzed, 63.6% male and 36.4% female, median age 59 years (IQR 51 –

65.8). Alcohol and chronic viral hepatitis B/C were identified as causes of liver disease in 17.5% and 22.1% of

patients respectively. Median LSM was 10.3 kPa, IQR (7.2-20 kPa), and median SSM was 27 kPa, IQR (23-33

kPa). Both LSM and SSM differed significantly among subgroups of patients with different etiology of liver

disease. Patients with alcoholic liver disease had the highest LSM and SSM. Median follow up was 77 months.

Patients with initial LSM values > 9.5 kPa had significantly lower survival rates (HR 3.28; P=0.001) and shorter

event-free periods for liver decompensation or death (HR 29.8; P<0.001). Furthermore, they had higher number

of hospitalizations per year during follow up (median 0.07 vs 0 per year; P<0.001). LSM and presence of

chronic renal failure (CRF) remained independent predictors of shorter survival (HR 3.35; P=0.001 for LSM and

HR 2.17; P=0.036 for CRF) in multivariate analysis after adjustment for age, sex, comorbidities and alcoholic

etiology. Furthermore, LSM, CRF and alcoholic etiology were independent predictors of shorter event-free

periods for liver decompensation or death (HR 23.7; P=0.002 for LSM; HR 2.75; P=0.023 for CRF and HR

2.82; P=0.010 for alcoholic etiology). Contrastingly, patients who had SSM values > 30 kPa had significantly

shorter survival rates (HR 2.27; P=0.048), albeit SSM did not influence time to decompensation nor did it affect

the number of hospitalizations during follow up. In a multivariate survival analysis SSM did not hold up as an

independent predictor of adverse outcome.

CONCLUSION: Liver stiffness measurement values obtained using 2DSWE can identify patients with risk of

liver decompensation and shorter survival.

Keywords: liver, spleen, elastography

27. INTESTINAL DYSBIOSIS AMONG CHILDREN WITH FUNCTIONAL

DIGESTIVE CONDITIONS

Belei Oana, Olariu Laura, Simedrea Ioan, Marginean Otilia

First Pediatric Clinic UMF Victor Babes Timisoara, Romania

Introduction: Non-celiac gluten sensitivity (NCGS) is characterized by intestinal symptoms (bloating, diarrhea

and abdominal pain) that occurs after ingestion of gluten in subjects in whom infectious enterocolitis,

inflammatory bowel diseases, celiac disease and wheat allergy have been ruled out.Gastro-esophageal reflux

disease (GERD) is often diagnosed in children and treated with proton pump inhibitors (PPI).Long term PPI can

alter intestinal bacterial population by suppressing the gastric acid barrier and may cause diarrhea.

Objectives: The aim was to evaluate the incidence of small intestinal bacterial overgrowth (SIBO) assessed by

glucose hydrogen breath test (GHBT) among children that received 12 weeks of PPI treatment with or without

probiotics associated, compared to children with NCGS that did not received PPI and a control lot.

Methods: We performed GHBT to 182 consecutive children: 64 with GERD who received PPI for 12 weeks, 58

children with NCGS in absence of PPI treatment and 60 healthy control subjects.The children with GERD were

randomized in two groups:32 who received only PPI and 32 who received PPI and probiotics (Lactobacillus

reuteri) for 12 weeks.In children with GERD, GHBT was performed before treatment and after 12 weeks of

treatment.

Results: There weren’t any patient detected with SIBO among children with GERD before treatment.After 12

weeks of treatment, we detected SIBO among 56% of children treated with PPI only(18/32), compared to 6% of

26

children treated with PPI and probiotics(2/32), (p<0,001).SIBO was detected in 20% of patients with NCGS

(12/58) and 5% of healthy control subjects (3/60).There was a significant difference regarding SIBO prevalence

between children with GERD treated with PPI only and those with NCGS or healthy control subjects (p <

0,001).Children with GERD treated with PPI and probiotics had a significant lower prevalence of SIBO, similar

to control lot.

Conclusions: SIBO assessed by GHBT occurred significantly more frequently among children with GERD

treated with long term PPI compared to children with NCGS or control subjects. Association of probiotics

decreased the rate of SIBO among children with GERD treated with PPI. Being a functional disorder that

request long term PPI, GERD may benefit by acid suppression inhibition combined with probiotics in order to

decrease the risk of dysbiosis.

Keywords: children, intestinal bacterial overgrowth

28. CHANGE OF APPETITE IN DIGESTIVE DISORDERS

Adela Turcanu

State University Of Medicine And Pharmacy

Background and Aims: We have limited studies which are investigated the interaction between eating

problems and functional digestive disorders. Aim of our study are to evaluate and to analyze the eating

disorders, in special change of appetite in functional digestive disease.

Methods: This prospective study included 78 patients with functional digestive disorders (FGD), which were

seen as outpatients in the gastroenterology office. Before a patient’s inclusion in the study, a full evaluation

must have failed to yield any organic cause for the patient’s complaints. In the study predominantly was female

(76%); aged 39.6± 12.3 years, who all filled out a Rome IV questionnaire for the evaluation of functional

digestive disorders. The patients were classified into three groups: those with no change in appetite, those with

appetite loss, and those with increased appetite.

Results: 47.5% patients reported change of appetite; 27.5% patients reported a decrease in appetite and 25%

patients reported an increase in appetite. Appetite was not affected in 52.5% of patients. Increased appetite was

associated with heartburn and decreased appetite was associated with irritable bowel syndrome (41.3%), chronic

constipation (29.4%); chronic abdominal pain (32.3%), early satiety (23.3%) and chronic vomiting (2.9%).

Patients with decreased appetite are older (P< 0.01), had a lower BMI (P < 0.01) and anxiety symptoms (P <

0.001) compared with patients with increased appetite.

Conclusions: Change of appetite are observed in half of patients with functional digestive disorders. We

suggest that these alterations aggravate the evolution of FGD, thus requiring a longer time for recovery of these

patients.

Key words: appetite, irritable bowel syndrome, functional disorders

29. CLINICAL CONSIDERATION OF IRRITABLE BOWEL SYNDROME

COMORBIDITY ON QUALITY OF LIFE

Alexandru Babin

27

State Medical and Pharmaceutical University “Nicolae Testemitanu”,

Republic of Moldova, Kishinev

Introduction: Epidemiological studies in recent years reflect the considerable comorbidity IBS

(defined according to ROME-IV criteria as psychosomatic disease) with other organic diseases:

GERD, disturbance of microbiota intestinal and gastric, IBD etc.

The aim of this study was to assess the influence clinical of irritable bowel syndrome comorbidity on

quality of life (HRQoL) in the age aspect.

Methods: In the prospective study 36 patients were examined with comorbidity IBS with GERD vs.

29 patients with „isolated” IBS, representing the control group (the diagnosis was established

according to the criteria of Rome IV, as well after the exclusion of Crohn's disease, ulcerative colitis

and colorectal cancer. The mean age was 49±2,2 years, the female/male ratio was 3,4:2.

All patients underwent Fibrocolonoscopy (FCS) with biopsy, FEGDS with Hp testing, Stool Ag – test,

calprotectin quantitative, onco-markers (CEA, CA-19,9, CA-15,3).

Patients were also assessed for their quality of life and for the IBS and GERD (using IBS- QoL

questionnaire: - Dysphoria, - Interference with Activity, - Body Image, - Health Worry, Avoiding

Food (AF) and Bristol Scale).

Results: IBS QoL assessed: - Dysphoria (DY) in 77,8% (28 pct) in comorbidity vs. 62,1% (18 pct) in

control group; Interference with daily activity (IN) in 86,1% (31 pct) vs 75,9% (22 pct); Body image

(BI) in 83,3% (30 pct) vs 72,4% (21 pct); Health worries (HW) in 88,9% (32 pct) vs 65,5% (19 pct);

FA in 91,7% (33 pct) vs 55,2% (16 pct).

There was a tendency to increase the average age in patients with IBS with comorbid diseases, as well

as in patients with isolated IBS.

Conclusions: The comorbidity of IBS with GERD has additive action. IBS + GERD have a

considerable impact on the quality of life (significant of FA). There was a tendency to increase the

average age in patients with IBS with comorbid diseases, as well as in patients with isolated IBS.

Key words: Comorbidity, IBS, Quality of life.

30. ENDOSCOPIC FINDINGS AND CORRELATION WITH CLINICAL

SCORES IN PATIENTS WITH LIVER CIRRHOSIS

Dunja Knežević1, Ivana Novaković

2, Vladimir Nikolić

3, Tamara Milovanović

1, 2

1Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade, Serbia.

2School of Medicine, University of Belgrade, Belgrade, Serbia.

3Institute of Epidemiology, School of Medicine, University of Belgrade, Belgrade, Serbia

Introduction: Liver cirrhosis is a frequent and dangerous disease with variety of complication and portal

hypertension is the central driver of it’s complications. The features of the portal hypertension vary. Variceal

haemorrhage is a major complication of portal hypertension that still causes high mortality in these group of

patiens. We aimed to analyze findings of upper endoscopy and correlate them with scores used for risk-

stratification for the prediction of cirrhosis-related mortality.

Material and method: Total number of patients included in this study was 100. All of them had endoscopic

examination of the upper digestive tract. The diagnosis of liver cirrhosis was based on findings of physical

examination, imaging results, and if possible liver biopsy. All patients were evaluated based on various

prognostic scores, including Child Pugh, MELD, CLIF AD, which were calculated at the time of endoscopic

28

examination. For normal variables, means and standard deviations were calculated. χ2test and independent-

sample t-test were used to assess the differences between the groups.

Results and conclusion: Of the total number of respondents was mostly male patients. The average age of

patients was 58 years. Class A according to Child-Pugh classification had 53%, class B 36% and class C 11% of

patients. The most frequent diagnoses in the group with the liver cirrhosis included oesophagus varices (78%),

portal hypertension gastropathy (63%), gastritis (48%), gastric varices (13%), the peptic ulcer of the

gastroduodenum (9%) and angiodysplasia (4%). There is no statistically significant difference in distribution of

findings in upper endoscopy examination in addition to class by Chlid-Pugh score. Clinical scores do not imply

the degree of portal hypertension (PH) and complications of the same. A new score should be developed that

will include the PH data in order to list the patients more adequately and prepare for transplantation in time

Key words: cirrhosis, endoscopic examination

31. EVALUATION OF THE RISK OF SPONTANEOUS BACTERIAL

PERITONITIS CIRRHOTIC PATIENTS TREATED WITH PROTON

PUMP INHIBITORS

Irina Girleanu, Carol Stanciu, Dan Teodorescu, Oana Cristina Petrea, Camelia Cojocariu,

Ana Maria Singeap, Catalin Sfarti, Andreea Teodorescu, Roxana Nemteanu, Stefan Chiriac,

Laura Huiban, Cristina Muzica, Tudor Cuciureanu, Anca Trifan

“Gr. T. Popa” University of Medicine and Pharmacy

Institute of Gastroenterology and Hepatology

Introduction: Proton pump inhibitors (PPI) are widely used in patients with advanced live disease. PPI can

significantly improve the gastrointestinal symptoms and prevent gastrointestinal bleeding. However, PPIs have

been reported to disrupt the gastrointestinal acidic conditions and decrease the function of gut barrier,

subsequently leading to the breed of intestinal flora and abdominal infection. The present study aimed to

determine whether PPI administration will increase the risk of SBP in cirrhotic patients.

Material and methods: We retrospectively analyze the clinic data of 714 cirrhotic patients, who were

diagnosed in our hospital from January 2014 to January 2014. Out of them 324 received PPI before and during

the admission. The enrolled patients were free of infection within 7 days of admission and did not receive

antibiotics treatment before SBP.

Result: Out of the 324 patients that developed SBP, 13 (4.01%) cases received PPI. The utilization rate of PPI

was not significantly higher in patients with SBP than that without SBP (P = 0.082). The Logistic regression

analysis showed that the incidence of SBP cirrhotic patients was associated with the usage of PPI (OR = 0.535,

CI = 0.335- 0.856; P = 0.009) with PPI as a protective factor.

Conclusion: There is no relationship between PPI usage and SBP occurrence in cirrhotic patients, which merits

further investigation.

32. PREDICTORS OF IN-HOSPITAL MORTALITY IN A COHORT OF

ELDERLY CIRRHOTIC PATIENTS WITH VARICEAL BLEEDING

Irina Girleanu, Anca Trifan, Andreea Teodorescu, Camelia Cojocariu, Oana Cristina Petrea,

Ana Maria Singeap, Catalin Sfarti, Stefan Chiriac, Laura Huiban, Tudor Cuciureanu, Cristina

Muzica, Carol Stanciu

29

“Grigore T. Popa” University of Medicine and Pharmacy, “St. Spiridon” University

Hospital, Institute of Gastroenterology and Hepatology, Iași, Romania;

Introduction: Variceal bleeding (VB) is a frequent complication of liver cirrhosis with high rates of morbidity

and mortality, especially in elderly population. Early identification and management of the factors predicting in-

hospital mortality might decrease mortality . The aim of this study is to evaluate the predictive factors for in-

hospital mortality in elderly cirrhotic patients with variceal bleeding.

Material and methods: Cirrhotic patients aged ≥65 years presented with VB from January 2017 to December

2017 in our hospital, were included in the study . The patients with a past history of endoscopic treatment,

variceal hemorrhage, Child-Pugh classification of C, extra- hepatic metastasis of hepatocellular carcinoma

(HCC) and/or portal vein tumor thrombosis of HCC were excluded. Their clinical data were investigated

retrospectively.

Results: In this study we included 48 elderly cirrhotic patients addmited with VB, most of them females

(60.4%), mean age 71.2±5.9 years, viral hepatitis being the most frequent ethiology. Esophageal varices were

the most common source of bleeding (87.5%). Of the 48 patients, 11 (22.9%) critically ill patients were initially

admitted to intensive care unit due to hemodynamic instability which was not corrected by initial resuscitation,

disturbed consciousness, and/or associated sever comorbidities. In-hospital mortality rate of the elderly patients

was 20.8%. The multivariate analysis demonstrated that increasing age (OR 1.59, CI 1.029-1.866, P=0.011),

hemodynamic instability at presentation (OR 11.51, CI 1.078-133.41, P=0.043), co-morbidities (especially

diabetes mellitus and chronic kidney disease)(OR 4.918, CI 1.954-12.637, P=0.001), and failure to control

bleeding( OR 2.031, CI 1.388-16.227, P=0.029) were independent risk factors, significantly associated with in-

hospital mortality among cirrhotic elderly patients presented with VB.

Conclusions: In-hospital mortality rate was 22.9% and the predictive factors of in-hospital mortality for the

cirrhotic elderly patients were: increasing age, hemodynamic instability at presentation, comorbidities and

failure to control bleeding.

Keywords: liver cirrhosis, elderly, variceal bleeding

33. COLORECTAL CARCINOMA IN THE AGING POPULATION

Verica Zoric, Daniela Turkoanje

Health Center ȚVrsacȚ, Primary Care Practice, Abraseviceva BB, Vrsac, Serbia

Introduction: Colorectal carcinoma is the leading cause of morbidity and mortality in the world. It is one of the

most common epithelial tumors in human pathology, and incidence increases with age. Positive family history

and the presence of hereditary colorectal mutation add up the risk by as much as 70%. Serbia belongs to

countries with high incidence (27%) and mortality (16.6%) rate of Colorectal carcinoma.

Material and Methods: A retrospective, observational study of diagnosed colorectal carcinoma was performed

on the territory of the municipality of Vrsac, over a period of one year. Basic epidemiological data (age, gender,

hematohesia, significant body weight loss, microcitic anemia, positive Fecal Occult Blood Test, positive family

history) and clinical presentation (localization and Dukes Stages) were analyzed. All colorectal carcinomas were

included, a histological examination -microscopic biopsies were taken during total colonoscopy and flexible

rectosigmoidoscopy, as well as macroscopic preparations - after surgery (patients in the ileus who have not

previously been endoscoped). The data were collected from a colonoscopy report.

Results and Conclusions: From 80 patients, age 60-79years, men’s were 43(53.7%) and 37(46.3%) were

women’s. By Duke Staging of Colorectal carcinoma, Stage A was found at one(1.2%) patient, B – 17(21.2%)

patients, C – 15(18.8%) patients and no Stage D was found. There was a greater incidence of colorectal

carcinoma in proximal colon partitions 19 patients(23.7%), but without statistically significant difference.

30

Recognizing risk factors and regular screening (Fecal Occult Blood Test, Fecal DNA testing) for Colorectal

carcinoma in patients 50years and older, is important for early detection of cancer. A healthy lifestyle

modification and physical activity, would prevent the occurrence of 23% of cases of carcinoma. Colonoscopy

with polypectomy greatly reduces the incidence of Colorectal carcinoma, and provide a better outcome if the

disease is already present.

Key words: colorectal carcinoma, screening test, colonoscopy

34. SCREENING STRATEGY FOR PANCREATIC ADENOCARCINOMA

AND USE OF TUMOR MARKERS AS PREDICTORS FOR

UNRESECTABILITY

Dragasevic S1,2

, Milovanovic T 1,2

, Kmezic S2, Djuranovic S

1,3, Lukic S

1,3, Lalosevic

Stojkovic M1, Stojkovic S

1, Radenkovic D

2,3 Knezevic S

2,3, Knezevic Dj

2,3, Popovic D

1,3

1Clinic for gastroenterology and hepatology, Clinical Center Serbia, 11000 Belgrade, Serbia

2Clinic for digestive surgery-First surgical Clinic, Clinical Center Serbia, 11000 Belgrade,

Serbia 3School of medicine, University of Belgrade, 11000 Belgrade, Serbia

Introduction: The rising incidence and mortality of pancreatic cancer (PC) has been reported in European

populations, requiring regular screening programme and surveillance. The aim of the study was to investigate

the impact of risk factors (smoking, alcohol abuse, body mass index, previous pancreatic disease, high levels of

dietery holesterol) on the age onset in PC and to to asses the association between preoperative values of

carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (Ca 19-9) and Ca 72-4 and unresectability.

Materials and Methods: The single-center retrospective study was conucted at Clinic for digestive surgery,

Clinical center Serbia including 161 patients with pancreatic adenocarcinoma. The values of serum tumor

markers were determined by commercial radioimmunoassay kits. The assesment of patients clinical

characteristics and previous risk factors was made for age subgroupes (≤50 and >50) and familial and sporadic

PC.

Results and conclusion: Out of 161 patients with pancreatic adenocarcinoma. (103 male, 58 female) 23,5% had

an earlier age onset and 76.8% were older than 50 at the time of diagnosis. The mean age of onset was 61±13.

Familial settings was found in 31.5% of patients. No significant association was registered between smoking

history, alcohole abuse, values of body mass index in subgroupe analysis (p>0.05). High levels of dietary

cholesterol were associated with later age oneset of PC (p= 0.004). Statistically significant association was

registred between previous pancreatic diseses and PC in patients with positive family history (p=0.001).

Curative resection was performed in 102 patients, while 36.6% were found unresectable. No statistically

significant association was found between unresectable pancreatic adenocarcinoma and the preoperative values

of CEA (p =0.33), Ca19-9 (p =0.62) and Ca 72-4 (p=0.5). Developing successful prediction models for beter

surveillance may fasciliate stratification of patients for future clinical trials, contribute to better management of

resectable pancreatic cancer and use of multiagent systemic therapies.

35. SERUM HEPCIDIN LEVELS IN PATIENTS WITH DECOMPENSATED

ALCOHOLIC LIVER CIRRHOSIS

Milica Stojkovic Lalosevic1, Milos Stulic

1, Sanja Dragasevic

1,2, Ivan Rankovic

1, Nina Pejic

1,

Mirjana Stojkovic1,2

, Aleksandra Pavlovic Markovic1,2

, Tamara Milovanovic1,2

1Clinical center of Serbia, Clinic of Gastroenterology and Hepatology, Belgrade, Serbia

2Faculty of medicine, Belgrade University, Belgrade, Serbia

31

Background and Aim: Iron metabolism is regulated by hepcidin, polypeptide synthetized primarily by

hepatocytes. Production of hepcidin could be altered due to hypoxia, inflammation, erythropoiesis and other

multiple factors which have influence on iron metabolism. Our aim was to evaluate serum hepcidin levels in

patients with decompensated alcoholic liver cirrhosis.

Methods: Cross sectional study included 30 patients with decompensated alcoholic liver cirrhosis treated at

Clinic of Gastroenterology and Hepatology, Clinical Center of Serbia and 30 matched healthy subjects. All data

were obtained from patients medical records including history, biochemical, ultrasonography and UE findings.

Blood was obtained from cubital vein of patients and controls after an overnight fast in BD Vacutainer tubes

with Heparin. After blood collection, the samples were left to settle for 30 minutes and then centrifuged for 10

minutes at 2000 rpm. 2 mL of plasma were pipetted into eppendorfs and frozen at -80°C until assayed. Serum

levels hepcidin were determined with commercially available ELISA kit. Statistical analyses were performed

using SPSS software version 20.0 for Windows.

Results: There was high statistically significant difference in serum levels of hepcidin between patients and

healthy controls(p<0.01). Serum hepcidin was significantly higher in patients with alcoholic liver cirrhosis than

in control group (9.77±2.71 vs. 6.40±2.42 ng/ml, p=0.00). Serum ferritin was significantly higher in patients

with alcoholic liver cirrhosis than in control group (394±515 vs. 119±124 ng/ml, p=0.00). Serum hepcidin to

ferritin ratio was also significantly higher in patients group comparing to controls (0.34±0.17 vs 0.22±0.09,

p=0.02). Serum hepcidin negatively correlated with γGT (r= -0.586) and serum sodium concentrations (r=-

0.485), and positively correlated with serum ferritin (r=0.752).

Conclusion: Hepcidin were significantly higher in patients with decompensated alcoholic liver cirrhosis

compared to control group. These differences could be explained by the systemic inflammation; hence serum

hepcidin could be additional inflammatory markers in patients with liver cirrhosis.

36. Phenotypic features of patients with Post-Infectious Irritable Bowel

Syndrome

Flaviu Rusu

Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania

Background: Although about Irritable Bowel Syndrome there are many published data in the literature, there

are only a few data on the long term evolution of patients with post infectious irritable bowel syndrome (PI-IBS)

and of associated conditions.

Aims: The purpose of our research was to study the evolution of PI-IBS patients in a single tertiary center

during four years.

Study Design: Our research was a longitudinal retrospective study

Methods: We carried out this study based on the survey of the patients records. We recruited two groups of

patients: patients with classical IBS and patients with PI-IBS. The IBS diagnosis was established using ROME

III criteria, which were used at that time. We compared the two groups of patients by analyzing the demographic

data, comorbidities, treatment that was prescribed, and evolution after treatment for a period of 48 month in

average.

Results: From a total of 592 patients that were diagnosed with IBS between 2013-2016, we identified a

subgroup of 64 patients with PI-IBS. These patients were also divided into two subgroups, depending on the

main symptoms, 51 with PI-IBS – diarrhoea and 13 of them with PI-IBS-constipation. IBS is the most

commonly diagnosed among women. 45 patients were women and 15 were men. Regarding the frequency of

occurrence of a certain subtype by gender, no significant differences were observed in both IBS and PI-IBS.We

noticed a higher incidence of patients residents of an urban community in both groups.

The main symptoms were: abdominal pain and bowel disorders (constipation, diarrhea).

32

There is a significant difference between the two groups regarding the onset of the symptoms. From the total of

64 patients with PI-IBS, 88.3% presented a sudden onset of symptoms (mainly abdominal pain) unlike the other

group where 81% of them presented a progressive onset, with an insidious progress and sporadic exacerbation.

Most patients (65.63%) presented an improvement after the treatment, 25.56% oscillating periods but with a

significant decrease of intensity of symptoms, and 7.8% did not show improvement after treatment.

The most common associated diseases were depression and anxiety (34.37%).

Conclusion: IBS is generally present in approximately 11 % of the population, with PI-IBS patients accounting

for approximately 10 % of them. Female gender is more common in both IBS and PI-IBS. Patients with PI-IBS

are a burden in the health system in terms of the important economic resources used for diagnosis and treatment.

37. Prevalence, clinical characteristics and associated diseases of male patients

with Post-Infectious Irritable Bowel Syndrome

Flaviu Rusu, Lorena Mocanu, Dan Lucian Dumitraşcu

Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania

Background: There is many published data in the literature about Irritable Bowel Syndrome which has a

prevalence of about 10% in the general population, but there is little data on the prevalence, clinical

characteristics and associated diseases in male patients with Post-Infectious Irritable Bowel Syndrome (PI-IBS).

Aims: The purpose of our research was to study the prevalence, clinical characteristics and associated diseases

in male patients with of PI-IBS patients in a single tertiary center during four years.

Study Design: Our research was a longitudinal retrospective study.

Methods: We carried out this study based on the survey of the patients records. We recruited two groups of

patients: patients with classical IBS and patients with PI-IBS. The IBS diagnosis was established using ROME

III criteria, which were used at that time. The PI-IBS patients were also divided into two subgroups: male

patients and female patients with PI-IBS. We compared the two PI-IBS subgroups of patients by analyzing the

prevalence, clinical characteristics and comorbidities, for a period of 48 month in average.

Results: From a total of 592 patients that were diagnosed with IBS between 2013-2016, we identified a

subgroup of 64 patients with PI-IBS: 19 male and 45 female patients with PI-IBS. These patients were also

divided into two subgroups, depending on the main symptoms, 51 with PI-IBS – diarrhoea (15 male and 36

female ) and 13 of them with PI-IBS-constipation ( 4 male and 9 female). IBS is present in approximately 11 %

of the population, with PI-IBS patients accounting for approximately 10 % of them. PI-IBS is the most

commonly diagnosed among women. Regarding the frequency of occurrence of a certain subtype by gender, no

significant differences were observed in both male and female PI-IBS groups. We noticed a higher incidence of

patients residents of an urban community in both groups.

The main symptoms were: abdominal pain and bowel disorders (constipation, diarrhea).

There is no significant difference between the two groups regarding the onset of the symptoms. From the total of

64 patients with PI-IBS, 87.5 % (56 patients), presented a sudden onset of symptoms, mainly abdominal pain

(16 male and 40 female). The most common associated diseases were depression and anxiety (22 patients, 5

male and 17 female).

Conclusion: The prevalence of PI-IBS is approximately 10 % of IBS patients and represent approximately

1,1% of the general population. Female gender is more common in PI-IBS. There is no significant difference

between the two groups regarding the main symptoms. Depression and anxiety where the most common

associated diseases. Patients with PI-IBS are a burden in the health system in terms of the important economic

resources used for diagnosis and treatment.

33

38. NON VARICEAL ACUTE UPPER GASTROINTESTINAL BLEEDING IN

ELDERLY PATIENTS

Camelia Cojocariu 1,2

, Ana Maria Singeap1,2

, Diana Sahawneh1, Irina Girleanu

1,2, Oana

Stoica1,2


1,2

“Grigore T. Popa” University of Medicine and Pharmacy1, “St. Spiridon” Emergency

Clinical Hospital, Institute of Gastroenterology and Hepatology2, Iasi, Romania;

INTRODUCTION

Acute upper gastrointestinal bleeding (AUGIB) is one of the most common causes of emergency hospitalization

in gastroenterology. In the last decades the cases of non variceal upper gastrointestinal bleeding (NVUGIB)

increased due to the change of life expectancy levels and the growth of administrating multiple drugs associated

with a lot of digestive adverse events.

AIM: To evaluate the etiology, demographic characteristics, clinical and laboratory parameters, clinical

outcome and factors related to mortality of acute upper gastrointestinal bleeding in elderly patients.

METHODS: We analysed the records of all patients hospitalised with AUGIB in the Institute of

Gastroenterology and Hepatology of "St. Spiridon" Emergency Clinical Hospital from January 2018 to

December 2018. The patients were divided into three groups according to age: Group A (18-64 years old),

Group B (65-79 years old), Group C (over 80 years old).

Our main interest was in observing demographic characteristics, hemodynamic and laboratory parameters on

admission, endoscopic features, smoking and alcohol habits, associated comorbidities, Rockall score, medical

history, consumption of non-steroidal anti-inflammatory drugs (NSAIDs), anti-platelets or anticoagulants.

RESULTS: 463 patients were hospitalized because of NVUGIB. According to age: Group A included 293

patients (63.3%), Group B - 119 patients (25.7%) and Group C - 51 patients (11%).

Co-morbidity was common in Group B and C patients (p=0.04). The main cause of bleeding was the same in all

groups, gastric lesions: 44.1%, followed by duodenal 36.9% and esophageal 19.0% lesions. Active bleeding was

significantly high in group B patients (p=0.0001).

Emergency surgery was required only in 6% of patients with no statistically differences among our groups.

Mortality rate was 6.9%, greater, but not significant, in elderly patients (9.8%).

In multivariate analysis, the presence of severe co-morbidity, age over 80 years (p=0.012) and esofagial

bleeding p=0.029 (Mallory Weiss syndrome) were independently related to mortality.

CONCLUSION

NVUGIB is a common emergency hospitalization cause in gastroenterology; we observed through time that the

usual patients are elders with associated pathology and with risk-associated treatment for GI bleeding.

Significant co-morbidity and esophageal bleeding (non variceal) are the main factors of adverse outcome.

KEY WORDS: elderly patients, non variceal upper gastrointestinal bleeding, co-morbidity co-morbidity

39. HELICOBACTER PYLORI: OLD AND NEW CHALLENGES IN THE

MICROBIOLOGICAL DIAGNOSIS

Ioana Alina COLOSI1, Carmen COSTACHE

1, Simona GRAD

2, Cosmin GRAD

2, Diana

Maria LUCA3, Horaţiu Alexandru COLOSI

4, Dan L. DUMITRAŞCU

2

1 Department of Molecular Sciences, Division of Microbiology, Iuliu Hațieganu University of

Medicine and Pharmacy, Cluj-Napoca, Romania 2

Department of Internal Medicine, 2nd

Medical Clinic, Iuliu Hațieganu University of

Medicine and Pharmacy, Cluj-Napoca, Romania 3

Unirea Medical Center, Cluj-Napoca, Romania 4

Department of Medical Education, Division of Medical Informatics and Biostatistics, Iuliu

Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania

34

Background and aim. Helicobacter pylori (HP) is an oncogenic agent, involved in preventable upper digestive

malignant or premalignant conditions. The use of antibiotic therapy to eradicate HP infection, as indicated by

guidelines, may be ineffective if resistance to them is unknown. The aim of this work was to cultivate HP from

gastric biopsies and to perform antibiotic susceptibility testing.

Material and methods. Between June and December 2018, a sample of patients with suggestive gastric

symptoms consulted at the 2nd

Medical Clinic in Cluj-Napoca, Romania, who exhibited positive HP fecal

antigen and agreed to undergo gastric endoscopy and prelevation of biopsy specimens for bacterial culture, have

been included in this study. Biopsy specimens collected for bacterial culture were transported to the laboratory

for cultivation. Special growth conditions have been ensured: microaerobic atmosphere, selective media, and

longer growth time compared to other bacteria (10-14 days).

For all isolated strains antibiotic susceptibility testing was performed using E-tests for clarithromycin,

levofloxacin, metronidazole, amoxicillin and disc diffusion method for tetracycline and rifampin.

Results. Twenty-four adult patients (7 men, 17 women) underwent gastric endoscopies and gastric biopsies

during the recruitment period. After sample processing and culture, only 6 strains of HP were obtained, despite

the fact that all investigated patients presented positive HP fecal antigen. Two strains were resistant to 2

antibiotics, 4 strains to one antibiotic. Five of the six isolated HP strains were resistant to metronidazole

(83.33%), two were resistant to levofloxacin (33.33%) and one was resistant to amoxicillin (16.67%).

Conclusions. Isolation of HP after gastric biopsy allows for antibiotic susceptibility testing, however, successful

cultivation of HP raises a number of difficulties. Given the small number of HP strains isolated so far in this

study, the above figures regarding antibiotic resistance are a very rough and preliminary approximation that will

be refined as our study continues.

Key words: Helicobacter pylori, antibiogram, antibiotic resistance

1. HOW MANY VALID MEASUREMENTS ARE NECESSARY TO … file2 1. how many valid measurements are...

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