Obesity is a growing health burden worldwide, increasing the risk for several diseases featuring the metabolic syndrome – type 2 diabetes mellitus, dyslipidemia, non-alcoholic fatty liver disease and cardiovascular diseases. With the increasing epidemic of obesity, a new pathologic condition has emerged as a component of the metabolic syndrome – that of non-alcoholic fatty pancreas disease (NAFPD). Similar to non-alcoholic fatty liver disease (NAFLD), NAFPD comprises a wide spectrum of disease – from deposition of fat in the pancreas – fatty pancreas, to pancreatic inflammation and possibly pancreatic fibrosis. In contrast with NAFLD, diagnostic evaluation of NAFPD is less standardized, consisting mostly in imaging methods. Also the natural evolution of NAFPD and its association with pancreatic cancer is much less studied. Not least, the clinical consequences of NAFPD remain largely presumptions and knowledge about its metabolic impact is limited. This review will cover epidemiology, pathogenesis, diagnostic evaluation tools and treatment options for NAFPD, with focus on practices for clinicians.
Introduction. H. pylori infection occurs secondary to the bacterial colonisation of the stomach and the first portion of the small intestine. Patients infected with H. pylori can develop gastritis, peptic ulcer, gastric cancer, and MALT lymphoma. H. pylori infection is defined as a type I carcinogen by the WHO, and its role in gastric carcinogenesis is sustained by many studies.
Objectives. The objective of this study was the description and correlation of the endoscopic aspect of the gastric mucosa in the Helicobacter pylori infection and the incidence in a selected patient group.
Material and method. The study was conducted in the “Dr Carol Davila” Central Military University Emergency Hospital, Section of Gastroenterology, Department of digestive endoscopy, during a period of 12 months (2012--2013) on 1690 consecutive examinations on patients with ages between 18 and 92 years, with a retrospective cohort analytic study. As diagnosis method of the individuals infected with H. pylori, upper digestive endoscopy was used.During the intervention, biopsieswere taken and rapid urease tests were performed.
Results. Regarding the variation of these endoscopic aspects within the examined population, we determined the fact that we encounter in the highest percentage gastritis with all its forms according to the Sidney classification (described below) which represents 59.3%, followed by endoscopic determination with a normal aspect in 18.8% of cases, then follows ulcer with a percentage of 10.33%, followed by duodenitis with 8.67%, and finally the most severe conditions, gastric cancer and lymphoma, reaching only 2.70% and 0.18%, respectively, of the general population examined endoscopically.
Background. Celiac disease (CD) is significantly underdiagnosed, despite significant efforts made in the last decades to increase its diagnostic rate. This has lead to a high need for developing new diagnostic strategies. Our aim was to evaluate the diagnostic performance of two routine hematologic indices for CD. Methods. In a prospective observational study, 34 newly diagnosed CD patients, 34 age-sex matched controls with irritable bowel syndrome (IBS) and 16 treated CD patients were assessed regarding the differences in mean lymphocyte count (LY), red blood cell distribution width (RDW) and their ratio (RDW/LY). Results. Elevated RDW (>14) and lymphopenia (<1.5 x 10e9/L) were more frequently seen in newly diagnosed CD patients compared to IBS control group and treated CD patients. Newly diagnosed CD patients had significantly higher mean values of RDW/LY - 10.09, compared to 7.72 in the CD-treated group and 6.79 in IBS controls (p<0.01). Subgroup analysis revealed that RDW/LY was higher in patients with destructive histology (Marsh≥3a), 10.54 vs. 7.99. For a value over 7, RDW/LY had a sensitivity of 88.24% (95% CI 72.55-96.70%) and AUROC of 0.785 (95% CI 0.683- 0.887). Conclusions. RDW/LY ratio is a widely available tool which could be used routinely in clinical practice for CD screening.
Background. Colonoscopy is a common performed procedure in Gastroenterology, and it’s widely used for diagnosis, treatment and surveillance of a wide range of conditions and symptoms. Properly performed, it’s generally safe, more accurate than a virtual colonoscopy and well-tolerated by patients. The completion of a colonoscopy is defined by cecal intubation with the visualization of colonic mucosa and distal terminal ileum when it’s possible.
Patients and methods. We reviewed retrospectively all consecutive endoscopies database of the lower digestive tract, done over a period from 2014-2017 in our clinic. The recommended completion based on the latest guidelines ranges from 90-95% completion rate according to the indication.
Results. 11214 consecutive colonoscopies were done. Overall cecal intubation was successful in 9456 procedures (87.3%). If we exclude the interventional procedures (414 procedures), where cecal intubation was not necessary, the main reasons of non-intubation were due to intolerance of the patients (388 patients), followed on the second place by patients with obstructive cancer (299 patients). The presence of diverticulosis, poor preparation for colonoscopy and post-surgical adhesions were significant findings in non-successful procedures.
Conclusions. In normal daily practice, colonoscopy is completed in 88.01% of the procedures but we think that this result will stimulate the efforts to incorporate more quality measures and time in our endoscopy laboratory.
Acute pancreatitis (AP) represents an inflammatory condition,-with a wide spectrum of local and systemic complications. Early stratification of severity of pancreatitis is an important step in guiding the management of the disease and improving outcomes. Throughout the years many researchers have looked at various risk stratification parameters which could be used from the admission of patients, however current available scores are cumbersome.
Our aim was to evaluate the role of biochemical and hematological parameters in the early stratification of severity of AP, regarding the length of hospitalization.
We conducted an observational study which included 100 patients with AP admitted to the Gastroenterology Department over a period 18 months. AP diagnosis was set according to 2013 ACG criteria. Demographic, clinical and imaging data related to the pancreatitis flare were collected from their charts. Length of hospital stay was used as surrogate marker for severity of AP. We evaluated different biochemical and hematological parameters which influenced the length of hospitalization.
Several hematological parameters and ratio did not correlate with length of hospital stay in our study cohort, however there was a significant relation of hyperglycemia and alkaline phosphatase levels with hospitalization duration.
Early risk stratification in AP remains difficult with routine blood work done at admission. Glycemic control and serum level of alkaline phosphatase seems to be correlated with length of hospital stay.
The prevalence of obesity is rising, becoming a medical problem worldwide. Also GERD incidence is higher in obese patients compared with normal weight, with an increased risk of 2.5 of developing symptoms and erosive esophagitis. Different treatment modalities have been proposed to treat obese patients, but bariatric surgery due to its complex interactions via anatomic, physiologic and neurohormonal changes achieved the best long-term results, with sustained weight loss and decrease of complications and mortality caused by obesity. The bariatric surgical procedures can be restrictive: laparoscopic adjustable gastric band (LAGB) and laparoscopic sleeve gastrectomy (LSG), or malabsorptive-restrictive such as Roux-en-Y gastric bypass (RYGB). These surgical procedures may influence esophageal motility and lead to esophageal complications like gastroesophageal reflux disease (GERD) and erosive esophagitis. From the literature we know that the RYGB can ameliorate GERD symptoms, and some bariatric procedures were finally converted to RYGB because of refractory reflux symptoms. For LAGB the results are good at the beginning, but some patients experienced new reflux symptoms in the follow-up period. Recently LSG has become more popular than other complex bariatric procedures, but some follow-up studies report a high risk of GERD after it. This article reviews the results published after LSG regarding gastroesophageal reflux and the mechanisms responsible for GERD in morbidly obese subjects.
Background. Groove pancreatitis or paraduodenal pancreatitis represents a rare type of pancreatitis, and can be classified into cystic dystrophy of the duodenal wall in heterotopic pancreas, paraduodenal cyst or myoadenomatosis.
Case presentation. We present a case of a 58 year old man, drinker and smoker who was admitted in the Department of Gastroenterology for abdominal pain, weight loss and nausea. From his history we have noticed frequent presentations of recurrent acute pancreatitis in the last two years. Laboratory tests have revealed cholestasis, high value of lipase and high value of amylase, with normal value of CA 19.9. The magnetic resonance from the last two years showed the same appearances: a large and edematous head of pancreas, a thickening of the wall of adjacent duodenum and an inhomogeneous area with cystic transformation in the head of the pancreas. We performed endoscopic ultrasound with fine needle aspiration. The histopathological result showed only inflammatory cells. We have established the diagnosis of groove pancreatitis.
Conclusion. Groove pancreatitis represents a rare condition, with an incidence of 0.4%-14% on biopsies. Endoscopic ultrasound is the best method for diagnosis, it could evaluate also the duodenal wall.