Institute Of Gastroenterology Research Articles

The role of endoscopic ultrasound in assessment of physiological cardia insufficiency during diagnosis of hiatal hernia

Background. The aim of the study: to determine the role of endoscopic ultrasound (EUS) in assessing the failure of the physiological cardia in the diagnosis of hiatal hernias (HH). Materials and methods. At the Department of Digestive Surgery of the State Institution “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine” in 2023, we have performed surgical treatment of 33 patients with HH: axial HH were diagnosed in 21 (63.6 %) cases (I type), paraesophageal HH — in 12 (36.4 %) patients (II type) (ICD-10 code is K44). Control group included 20 practically healthy people. Results. All patients underwent an X-ray and endoscopic examination of the esophagus, stomach, duodenum, and EUS. All 33 (100.0 %) patients underwent an X-ray to confirm the diagnosis and an endoscopic examination to detect changes in the esophageal mucosa. EUS was performed in 31 (93.9 %) patients. The thickness of the esophageal wall was assessed using EUS, which made it possible to determine the state of the structures of the phy­siological cardia in HH: the displacement of part of the stomach above the diaphragm, location of the gastroesophageal junction relative to the legs of the diaphragm and relative to each other; the distance between the legs of the diaphragm (area of the HH) and their length; the cross-sectional area of the HH (hernial sac). The data obtained during EUS influenced the choice of the method for surgical correction of the physiological cardia with HH. Conclusions. Thus, with HH, EUS makes it possible to evaluate pathological changes of the main structures in the failure of the physiological cardia, to improve diagnosis for the types of HH, the location of the gastroesophageal junction, with determination of dimensions of the esophageal hiatus, the distance between the legs of the physiological cardia, localization and cross-section of the hernial sac, which influenced the choice of the surgery for physiological cardia in HH.

Impact on Long-term Survival of a Standardized Histopathological Protocol on the R1 Incidence in Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma.

Background: Pancreatic Ductal Adenocarcinoma (PDAC) is a pathology with a very poor prognostic, the only curative treatment option being surgery, in association with chemotherapy. This study aims to assess the influence that the use of a standardized pathology report after a pancreaticoduodenectomy (PD) has on the R1 margins rate and the impact that this has on long term survival. Material and Methods: We included 116 patients admitted to the Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor Cluj Napoca, who underwent PD for PDAC (Pancreatic Ductal Adenocarcinoma) between January 2012 and May 2017. We divided them in two groups: 59 patients for which a nonstandardized histopathological protocol was used and 57 patients for which a standardized protocol was implemented. We considered a margin to be R1 when there were tumor cells at ¤ 1 mm from the resection margin. Results: The R1 percentage in the first group of patients was of 39%, while the R1 resection rate in the second group was of 68.4%. The median survival rate was similar in the two groups, with no statistically significant difference between them, but in the prospective study when comparing R0 vs R1 margins there was a statistically differences in 5 year OS with a p-value = 0.03. Conclusion: The use of a standardized pathology report reveals a significant increase in R1 resection rates. Also study revealed not only increasing R1 incidence when using a standardized histopathology report, but also that those margins (R1) playing a determinant role in 5-year OS. The mesopancreas is the most frequently R1 resection margin.

The relationship between morphological manifestations, clinical and hematological indicators and lymphocyte indices in ulcerative colitis

Background. The purpose of the study was to identify correlational parallels between morphological manifestations, clinical and hematological indicators and lymphocyte indices in patients with ulcerative colitis (UC). Materials and methods. Ninety patients with UC were examined. Morphologically, the degree of damage to the intestinal mucosa, the presence of crypt abscesses, atrophic changes, and changes in crypt architectonics were determined. The number of cells of the inflammatory infiltrate, linear measurements of the mucosa were assessed by morphometric method. Clinical blood parameters were evaluated in the inpatients of the department of intestinal diseases at the Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine. The severity of the disease was assessed according to the Mayo score. Statistical processing of the results was carried out using the Statistica 6.1 program. Results. In patients with UC, histological changes in the intestinal mucosa were found. The activity of the disease was evaluated by the presence of an increased number of inflammatory cells in the infiltrate of the mucosa: neutrophils (212.20 ± 20.93), lymphocytes (2922.80 ± 76.63), eosinophils (332.50 ± 17.24), macrophages (369.70 ± 16.21). Multiple crypt abscesses, deformation of the musocal epithelium in the form of erosions and ulcers were also noted. Clinical indicators of peripheral blood also confirmed the exacerbation of the disease (anemic state, increased inflammatory markers). An increased depth of the crypts correlated with such a morphometric indicator as mucosal thickness (r = 0.46; p < 0.01). At the same time, correlations were found between mucosal thickness and the height of the surface epithelium (r = 0.35; p < 0.01). There was a relationship between the morphological and clinical and hematological indicators of UC: mucosal thickness and erythrocyte sedimentation rate (r = 0.38; р < 0.01), band cells (r = 0.37; р < 0.01) and blood neutrophils (r = 0.21; p < 0.05). The Mayo core, as an indicator of the severity of the disease, correlated with the height of the epithelium (r = 0.37; p < 0.05); neutrophils (r = 0.49; p < 0.01) and basophils (r = 0.28; p < 0.05) of the intestinal mucosa; N/L tissue index (r = 0.50; p < 0.01). Conclusions. Correlative parallels were found, which confirm our assumption regarding the connection between morphological manifestations and clinical and hematological indicators of UC. The use of T/L and N/L indices in both tissue and peripheral blood can be used as a marker of the activity of inflammatory processes in UC.

Cytokines in Liver Cirrhosis (Their Importance in Assessing Activity and Decompensation)

Aim: studying the role of pro-inflammatory and anti-inflammatory cytokines in the pathogenesis of liver cirrhosis progression.Materials and methods. The material of the study was the data of clinical-instrumental, biochemical, virological studies of 109 patients with liver cirrhosis of various etiologty, who were hospitalized in the clinic of the Institute of Gastroenterology (Dushanbe, Republic of Tajikistan). The diagnosis of the underlying disease was established according to the clinical recommendations of the Russian Society for the Study of the Liver and the Russian Gastroenterological Association for the diagnosis and treatment of liver fibrosis and cirrhosis and their complications (2021); decompensated liver cirrhosis was established according to the 1996 Child — Pugh classification. The age of the patients ranged from 17 to 79 years (36.9 ± 0.8 years), there were 55 men and 54 women.Results. Among the examined patients, compensated liver cirrhosis (Class A) according to Child — Pugh was detected in 18 persons, subcompensated (Class B) — in 14, decompensated (Class C) — in 77. The study of the content of pro-inflammatory and anti-inflammatory cytokines in the blood serum of patients with Class A liver cirrhosis showed, that levels of tumour necrosis factor alpha (TNF-α), interleukin-2, interleukin-6 were statistically higher compared to healthy individuals, while the concentration of anti-inflammatory interleukin-10 was lower (30.7 ± 4.7 pg/mL) in comparison with the control group. In patients with Class B liver cirrhosis, the level of TNF-α increased to 75.0 ± 4.5 pg/mL (p < 0.001), interleukin-2 — to 328.7 ± 23.9 pg/mL (p < 0.05), and interleukin-6 — to 95.4 ± 7.7 pg/mL (p < 0.001). Serum interleukin-10 decreased compared with the control group (23.1 ± 2.8 pg/mL; p > 0.05). At the decompensated stage of Class C cirrhosis, a huge release of pro-inflammatory cytokines occurs — the content of TNF-α increases by 80 times, of interleukin-2 — by more than 60 times, аs for interleukin-10, its content is progressively reduced.Conclusion. In liver cirrhosis, there is a significant disruption in the synthesis of pro-inflammatory cytokines, which is manifested by a sharp increase in the content of TNF-α, interleukin-2 and interleukin-6. High levels of proinflammatory cytokines in blood serum in liver cirrhosis correlate with the activity and degree of decompensation, which indicates their important role in the pathogenesis and progression of the pathological process.

A Randomized, Controlled Trial, comparing the Total Enteroscopy Rate and Diagnostic Efficacy of Novel Motorized Spiral Enteroscopy and Single Balloon Enteroscopy in patients with Small-Bowel Disorders - THE MOTOR TRIAL (NCT 05548140).

Device-assisted enteroscopy (DAE) has revolutionized the management of Small Bowel Disorders (SBD). No study to date has compared both Novel Motorized Spiral Enteroscopy (NMSE) and Single Balloon Enteroscopy (SBE) as a randomized controlled trial. Hence, this study was planned to include patients having SBD with the primary aim to compare the Total Enteroscopy Rate (TER). This study was conducted at the Asian Institute of Gastroenterology (AIG Hospitals), Hyderabad, India from 20th September 2022 to 15th December 2022. All consecutive patients, aged more than 18 years with suspected SBD, and planned for Total Enteroscopy (TE) were screened for inclusion. The primary outcome was to compare the TER and secondary outcomes were to compare the technical success, time taken to reach the Depth of Maximal Insertion (DMI), withdrawal time, total procedure time, diagnostic yield, therapeutic success, and adverse events. Seventy-two patients out of the 110 patients screened, were randomized in either of NMSE (n=35) or SBE (n=37) group. The most common indication for the procedures was obscure GI bleed (48%), others being unexplained abdominal pain with indeterminate radiologic findings (32%) and chronic diarrhea (20%). In NMSE group the TER was 71.4%; while in the SBE group, it was 10.8%, (p<0.0001). The total procedure time (min) was much lesser with NMSE (58.17±21.5 min) versus SBE (114.2±33.5 min), (p<0.0001). The diagnostic yield of NMSE (80%) was comparatively higher than SBE (62.1%), (p = 0.096). Minor adverse events (Grade I) were observed in both the groups: NMSE (3/35, 8.5%) and SBE (2/37, 5.4%). This RCT shows that with NMSE higher TER can be achieved in shorter duration with minimal adverse events, compared to SBE.

The impact of COVID-19 on national program of colorectal cancer screening in Tehran, Iran: a multicenter study

BackgroundThe COVID-19 pandemic has affected all aspects of the healthcare system, including prevention, treatment, rehabilitation of diseases and health education; access to essential therapies; allocation of finance & facilities to health issues, and governance of diseases, including COVID-19 and other diseases. Consequently, the burden of COVID-19 was not only attributable to the multiorgan involvement and detailed presentation of the disease but also to the inadequate management of other diseases resulting from the exclusive allocation of resources and medical personnel to the pandemic crisis. Over the mentioned period, one observed deficiency was the lack of public and official favor for conventional screening protocols. To this end, this study aims to evaluate the impact of the COVID-19 pandemic on colorectal cancer (CRC) screening protocols at Shahid Beheshti University of Medical Sciences in Tehran, Iran, in an effort to identify individuals at risk for CRC and provide them with intensive screening and therapy.MethodsThis is an observational study comparing the number of candidates for CRC screening referred to primary, secondary, and tertiary health-care centers under supervision of Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran in a 2-year interval before and after COVID-19 pandemics. Patients with intermediate- and high-risk criteria for colorectal cancer were included in the study and were screened by fecal immunochemical test. Patients with positive or indeterminate fecal test results were further evaluated with colonoscopy in research institute for gastroenterology and liver diseases where is a tertiary referral center for CRC screening. Finally, the decrease percentage of screening tests and endoscopic findings during the pandemic period compared to pre-pandemic period was calculated and interpreted.ResultsA significant decrease in the number of performed fecal immunochemical tests (FITs), referred positive FITs, and referred patients with positive alarm signs to the Research Institute of Gastroenterology and Liver Diseases (RIGLD) center inevitably led to a considerable decrease in the number of endoscopic findings, including high-risk adenomas, sessile serrated polyps, and even early-stage colorectal cancers (CRCs).ConclusionThe disruption of screening protocols caused by the COVID-19 pandemic appears to increase the number of patients with high-grade and end-stage CRCs referred in the near future.

Nutrition and health in infants and children: old and new challenges after the lockdown

aInstitute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel bLMU – Ludwig-Maximilians-Universität Munich, Div. Metabolic and Nutritional Medicine, Department Pediatrics, Dr von Hauner Children's Hospital, LMU University Hospitals, Munich, Germany Correspondence to Prof. Raanan Shamir, Director, Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Professor of Pediatrics, Chair, Eduarda and Dr Moshe Ishay Institute for the Study of the Effects of Natural Food on Quality of Life and Human Health, Lea and Arieh Pickel Chair for Pediatric Research, Faculty of Medicine, Tel Aviv University, Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, 14 Kaplan St. Petach Tikva, Tel Aviv 4920227, Israel. E-mail: [email protected]

Xanthomas and precancerous changes of the stomach: an accidental combination or an important prognostic endoscopic marker?

Background. The article deals with the study of gastric xanthomas, benign accidental formations with an unknown etiopathogenesis, which, according to the literature, are associated with a number of pathological conditions (atrophic gastritis, intestinal metaplasia, dysplasia, gastric cancer, dyslipidemia, etc.). The purpose was to study the prevalence of gastric xanthomas in patients with atrophic gastritis and to analyze their relationship with endoscopic changes in the stomach, including precancerous conditions. Materials and methods. Esophagogastroduodenoscopy was performed using the EVIS EXERA III video endoscopy system with the Olympus 190 gastroscope (Japan) in 120 patients with atrophic gastritis undergoing examination and treatment at the Institute of Gastroenterology of the National Academy of Sciences of Ukraine. The presence of duodenogastric reflux, the prevalence and severity of mucosal atrophy, changes in the relief of the gastric mucosa (including nodules and bumps), the presence of hyperplasia, polyps, hemorrhages, erosions, ulcers, xanthomas in the stomach were assessed. When using the narrow-band imaging and close focus, the presence and prevalence of intestinal metaplasia, the presence of gastric dysplasia were evaluated. Comparative and statistical analysis of endoscopic data was conducted depending on the presence of gastric xanthomas. Results. The heterogeneity of endoscopic changes in atrophic gastritis was revealed (prevalence and severity of atrophy, intestinal metaplasia, changes in the mucosal relief, presence of hyperplasia, polyps, ulcers, etc.). Gastric xanthomas were found in more than a third of patients with atrophic gastritis (36.7 % of cases), with predominant localization in the antral region (90.9 %). As a rule (95.5 %), they were single. In patients with atrophic gastritis associated with xanthomas, diffuse atrophic changes in gastric mucosa were detected significantly more often, as well as mucosal nodules and bumps, mucosal hyperplasia, intestinal metaplasia and the mucosal dysplasia, which was confirmed morphologically (p &lt; 0.05). Rare cases of gastric ulcers and gastric cancer were diagnosed only in patients with xanthomas (p &gt; 0.05). Conclusions. The obtained results indicate that gastric xanthoma is an important diagnostic marker of precancerous changes in the gastric mucosa: widespread atrophy, intestinal metaplasia, dysplasia, and can be used as an important prognostic marker for the development of gastric cancer. Patients with xanthoma-associated atrophic gastritis require a thorough examination using modern endoscopic equipment and dynamic observation, with a focus on changes in the gastric relief by the type of nodules and bumps.

Editorial introductions.

Editorial introductions.

Association between calprotectin and volatile fatty acids in patients with inflammatory bowel diseases

Aim. To evaluate the content of calprotectin and volatile fatty acids (VFAs) in feces of patients with inflammatory bowel disease (IBD). Materials and methods. 61 patients (33 men and 28 women) with IBD aged 20 to 66 years (the mean indicator was 41.80 ± 1.14 years) were examined. The patients were treated in the Department of Intestinal Diseases of SI “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine”. All the patients were divided into two groups: Group I – 46 patients with ulcerative colitis (UC) and Group II – 15 patients with Crohn’s disease (CD). The control group consisted of 10 practically healthy people (donors). Calprotectin detection in fecal samples was carried out using a kit “Immundiagnostik”, Germany. Fecal VFAs were analyzed using a hardware-software complex for medical research with a gas chromatograph Chromatek-Crystal 5000. Results. A significant increase in the content of fecal calprotectin was found. Its amount depended on the disease nosology and was more expressed in patients with UC (3.5 times higher (P &lt; 0.05) than that in patients with CD). The observed changes were accompanied by an increase in the content of propionic (C3) acid and a decrease in acetic (C2), butyric (C4) acids in coprofiltrates of the examined patients. The detected imbalance in the fecal content of VFAs in patients led to an increase in the amount of fatty acids, which was more pronounced in patients with CD. An association between calprotectin levels and fecal VFA content was identified. Thus, correlation analysis allowed to establish a relationship between calprotectin levels and propionic acid content in patients with IBD (r = 0.370; P = 0.046). Conclusions. In the case of active bowel inflammation, there is the increase in the fecal content of calprotectin and the decrease in VFAs (acetic and butyric acids) in accordance with the degree of disease activity, which allows the use of these indicators to assess the efficacy of therapies.

A88 EVALUATING THE ACCEPTABILITY AND EFFICACY OF CYTOSPONGE FOR BARRETT'S ESOPHAGUS: A SINGLE CENTRE CROSS-SECTIONAL STUDY

Abstract Background Barrett's Esophagus (BE) is a pre-malignant condition defined by the presence of metaplastic columnar epithelial cells above the gastroesophageal junction. Currently, diagnoses is made by endoscopy. Once metaplasia is present, there is 0.5% annual risk of progression to dysplasia and ultimately adenocarcinoma. Cytosponge is a new device and technique to diagnose BE. Furthermore, this test has a strong safety profile. Research has suggested increased patient tolerance for the Cytosponge compared to endoscopy; this has not been demonstrated in a Canadian healthcare setting. Before Cytosponge test can be integrated in Canada, ideally, patient acceptability of this device should be evaluated. Purpose To assess patient acceptability, tolerability and integration of Cytosponge in the diagnosis of Barrett's Esophagus in a Canadian healthcare setting. We also assessed the ease of use and familiarity with Cytosponge. Method A single-centre, prospective cross-sectional study was conducted to evaluate the acceptability and comfort of patients undergoing Cytosponge procedure. Outpatients referred for EGD for Barrett's Esophagus at St. Paul’s Hospital between 03/21-07/22 were included. 36 patients with BE have been enrolled in this project. Acceptability was evaluated through Visual Analogue Scale (VAS), Spielberger State Trait Anxiety Inventory (STAI), and Impact of Events Scale (IOES) on the day of procedure, day 7 post procedure and day 90 post procedure. Data from health care providers administering the Cytosponge were collected using the System Usability Scale (SUS). One-way ANOVA and Tukey’s Honestly Significant Difference tests were completed to assess score differences between follow up. Result(s) A total of 36 patients met the inclusion criteria and consented to participate. Of these patients 81.6% were successful in swallowing Cytosponge, 18.4% were unsucessful. ANOVA test revealed statistically significant difference in VAS scores, F(3, 140) = 12.59, p &amp;lt; 0.0000005. There were significant differences in VAS between Day 0 and Day 7, p=0.0032. This was also seen in VAS between Day 0 vs Day 90, p=0.0017. There were no statistically significant difference in mean STAI scores between different time points, F(3, 140) = 12.59, p=0.44. ANOVA test also showed statistical difference in IOES scores, F(2, 111) = 8.76, p&amp;lt;0.0005. There was statistical difference between day 0 compared to day 7 and between day 0 and day 90, p=0.0045, and p=0.00045 respectively. Conclusion(s) Our results demonstrate that Cytosponge is a well tolerated in a Canadian healthcare setting. Follow up scores of VAS and IOES were lower compared to day 0 suggesting that patients found Cytosponge acceptable. A score of 68 and above is considered to be above average on the SUS which measures usability of Cytosponge. The average SUS score in this sample was 65.3, this may suggest that there is a learning curve for health care providers to become familiar with Cytosponge. There were no complications with Cytosponge in this sample. Please acknowledge all funding agencies by checking the applicable boxes below Other Please indicate your source of funding; Gastroenterology Institute of Research Institute Disclosure of Interest None Declared

Mycobacterium avium subsp. paratuberculosis and Crohn's disease: characterization of the interaction with different aspects of the disease.

Crohn's disease (CD) is a chronic granulomatous inflammatory bowel disease with no fully understood etiology and cure. Mycobacterium avium subspecies paratuberculosis (MAP), the etiologic agent of paratuberculosis, is also isolated from samples from human patients with CD. Paratuberculosis is characterized by persistent diarrhea and progressive weight loss and primarily affects ruminants, which eliminate the agent via feces and milk. The involvement of MAP in the pathogenesis of CD and other intestinal diseases is unclear. Thus, the present study aimed to analyze immunological, socioepidemiological, biochemical, and therapeutic variables that may be related to the occurrence of MAP in blood samples and CD patients. The sampling was random, and the population of origin was the patients from the Bowel Outpatient Clinic of the Alpha Institute of Gastroenterology (IAG), Hospital das Clínicas, Universidade Federal de Minas Gerais (HC-UFMG). Blood samples were collected from 20 patients with CD, eight with ulcerative rectocolitis (UCR), and 10 control patients without inflammatory bowel diseases. Samples were subjected to real-time PCR for detection of MAP DNA, oxidative stress analyses, and socioepidemiological variables. MAP was detected in 10 (26.3%) of the patients, seven (70%) were CD patients, 2 (20%) were URC patients, and one (10%) was a non-IBD patient. MAP was found more frequently among CD patients, but not restricted to CD patients. The presence of MAP in the blood of these patients occurred simultaneously with an inflammatory response with an increase in neutrophils and significant alterations in the production of antioxidant enzymes such as catalase and GST.

Outcomes of surgical treatment for physiological cardia insufficiency in hiatal hernias andgastroesophageal reflux disease

Background. The purpose was to determine the effectiveness of the developed method of surgical treatment for insufficiency of the physiological cardia in hiatal hernias (HH) and gastroesophageal reflux disease (GERD). Materials and methods. From January 2013 to September 2021, 141 patients were treated laparoscopically for HH and GERD at the clinic of the Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine, 44 (31.2%) men and 97 (68.8%) women aged 21–70 (36.5±4.2) years. To evaluate the immediate and long-term results in the follow-up period lasting from 11 months to 3 years, a randomized comparative study was conducted between groupI— 45 patients after classical antireflux operations and group II— 34 patients after surgery to restore the physiological cardia. X-ray examination of the esophagus and stomach was performed to diagnose HH. Endoscopic examination was used to evaluate the condition of the mucous membrane of the esophagogastroduodenal zone. Results. In 141 patients, the following types of laparoscopic surgical interventions were performed: Nissen fundoplication— in 84 (59.6%), Toupet fundoplication— in 12 (8.5%), Dor fundoplication— in 11 (7.8%), restoration of the physiological cardia according to the proposed method, namely, medial cruroplication, anterior cardiogastroplication with gastrodiaphragmopexy,— in 34 (24.1%) cases. Crurorrhaphy was carried out in 100.0% of patients: posterior— in 64 (45.4%), anterior and posterior (combined)— in 27 (20.1%), medial cardiocrurorrhaphy and lateral cardiofundocrurorrhaphy according to the proposed method— in 34 (19.1%). Alloplasty of the esophageal hiatus was performed in 16 (11.3%) cases. By the frequency of intraoperative and early postoperative complications, a significant difference was detected in favor of group II (5 (11.1%) vs. 1 (2.9%), p&lt;0.05, and 14 (31.1%) vs. 2 (5.8%), p&lt;0.05, respectively, Fisher’s exact test). Depending on the frequency of anatomical (5.8 vs. 17.7%, p=0.003, χ2 test), functional (5.8 vs. 13.3%, p=0.045, χ2 test) and a combination of anatomical and functional (11.1 vs. 2.9%, p=0.003, χ2 test) relapses, a significant difference is revealed in favor of group II. In terms of the frequency of pylorospasm and dysphagia, a significant difference was detected in favor of groupII (2.9 vs. 17.7%, p=0.009, and 2.9 vs. 28.9%, p=0.007, respectively, Fisher’s exact test). Conclusions. The analysis of the immediate results of using the proposed method of surgical treatment for the restoration of the physiological cardia has shown that it ensures the elimination of pathological changes in HH, in comparison with classical antireflux methods, reduces the frequency of intraoperative (2.9 vs. 11.1%) and early postoperative (5.8 vs. 31.1%) complications. In the long-term period after surgical treatment of HH with the proposed method, the frequency of HH recurrence is reliably reduced compared to the outcomes when using classical antireflux methods, particularly the frequency of anatomical (5.8 vs. 17.7%, p=0.003, χ2 test) and functional (5.8 vs. 13.3%, p=0.045, χ2 test) relapses.

Predictive Factors for the Prognosis of Alcoholic Liver Cirrhosis.

Alcoholic liver cirrhosis (ALC) is a disease with multiple complications and is associated with poor prognosis and significant mortality. Identifying risk factors associated with a poor outcome is important to ensure effective treatment and increase life expectancy. We aimed to evaluate the predictive values of complications regarding mortality in ALC. We retrospectively analyzed 1429 patients with ALC hospitalized between January 2019 and April 2022 at the Institute of Gastroenterology and Hepatology Iasi. The electronic medical records were interrogated to obtain information about demographic data, complications, comorbidities, and prognostic scores: MELD-Na (model for end-stage liver disease-sodium) and CTP (Child−Turcotte−Pugh). Based on uni- and multivariate analysis, independent predictors of mortality were identified. The mean age at diagnosis was 56.15 ± 11.49 years with a ratio of 2:1 in favor of males. There were 296 deaths (20.8%), most of them during the first hospitalization (208/14.6%). It was observed during the univariate analysis that complications of the disease negatively affected the survival rate, significant values being related to infections (sepsis; OR = 21.98; p < 0.001; spontaneous bacterial peritonitis (SBP) (OR = 11.94; p < 0.001) and hepatorenal syndrome (HRS) (OR = 9.35; p < 0.001). The independent predictors, confirmed by multivariate analysis, were the association of variceal bleeding, infections, and hepatic encephalopathy or ascites, each combination being responsible for two out of 10 of the deaths during the first admission. The prognosis of the disease was negatively influenced by the worsening of liver dysfunction and the appearance of complications. The main predictors of mortality were infections, hepatic encephalopathy, variceal bleeding, and hepatorenal syndrome. Improving compliance and strict application of specific follow-up and treatment strategies could contribute to a better prognosis of patients with alcoholic liver cirrhosis.

Economic impact of industry-sponsored clinical trials in inflammatory bowel diseases: Results from the national institute of gastroenterology "Saverio de Bellis".

Introduction: The majority of the money spent on possible new medications' clinical trials is accounted for by the innovative pharmaceutical sector, which also stimulates the economy of a nation. The objective of this study was to evaluate the impact of pharmaceutical industry-sponsored clinical trials (ISCTs) in inflammatory bowel diseases (IBDs) towards the national health service (NHS) in terms of avoided costs and leverage effect. Methodology: The research was conducted at National Institute of Gastroenterology, "Saverio De Bellis", Castellana Grotte (Apulia, Italy) collecting data from profit ISCTs of pharmaceutical products conducted over the time period 2018-2020 with focus on inflammatory bowel diseases. After the quantification of health services and drug costs from the latter studies, avoided costs and leverage effects were then estimated. Results: The results on the avoided costs for healthcare facilities deriving from the conduct of clinical studies show that, in relation to the sample of five drug companies participating in our 2018-2020 analysis, out of a total of 235,102.46 €, identified as direct investment, 628,158.21 € of avoided costs for the NHS were measured, with an additional saving (leverage effect) for the NHS of 3.67 € for each € invested by the companies promoting clinical trials. Conclusion: Conducting profit clinical trials has practical benefits and a favourable macroeconomic impact that, by completing its limited resources, helps to sustain one country NHS thanks to the avoided costs while also contributing to locational and industrial policy while guaranteeing novel therapeutics and health services for the patients enrolled.

Possibilities of cryosurgery in the treatment of the abdominal cavity diseases

Aim. To study the immediate results of the use of cryosurgical instruments and ultra-low temperature liquid nitrogen in diseases of abdominal organs.Materials and research methods. The article presents the results of surgical treatment using ultra-low temperature liquid nitrogen (196oC) for 308 patients with diseases of the abdominal organs in the Department of Liver and Pancreas Surgery of the Institute of Gastroenterology of the Republic of Tajikistan from 2016 to 2022.The results and discussion. The authors proposed an algorithm for the use of the ultra-low temperature of liquid nitrogen in the treatment of diseases of the abdominal organs after the development of the latest cryogenic equipment. It turned out that the resulting cryodestruction leads to the death of parasitic elements of alveococcosis, echinococcosis, and liver tuberculosis, as well as to cytolysis of atypical calls in hepatocellular carcinoma. The most important advantage of liver cryosurgery, especially in concomitant chronic viral hepatitis and liver cirrhosis, is a reliable parenchymal haemo-and cholestasis, a decrease in intraoperative blood loss, an increase in the radicality of an operation, and reliable prevention of intraoperative dissemination of malignant and parasitic diseasesConclusion. The accumulated experience of surgeries for various diseases of the abdominal organs using ultra-low temperature liquid nitrogen allows concluding that cryosurgery of the abdominal organs has an undoubted prospect. The positive characteristic of using cryotechnology in the treatment of severe diseases of abdominal organs suggests that it is advisable to introduce the method into clinical practice on a wide scale.

The role of endoscopic ultrasound investigation in the diagnosis of submucosal neoplasms of the stomach and duodenum (literature review and our clinical observations)

Submucosal neoplasms of the stomach and duodenum include a group of diseases with different etiology, clinical symptoms, diagnosis and management. Conventional gastroduodenoscopy helps detect submucosal formations in 0.36–4% of cases, while the stomach is the most common site of submucosal lesions (up to 60%). Endoscopy and ultrasound endoscopic examination are important tools for the diagnosis of submucosal tumors of the esophagus, stomach, duodenum, both benign (polyps, submucosal formations, extraorganic compression, cysts) and malignant neoplasms of the gastrointestinal tract, especially small and accidentally detected. It is important not only to diagnose the tumor, but also to determine from which layers it comes, what level germinates, whether there is damage to regional lymph nodes. Only endoscopic ultrasonography (EUS) can answer these questions. EUS combines the capabilities of two studies: endoscopic and ultrasound, which significantly increased the informativeness of endoscopic examination, as it was possible to determine the site of the pathological process and the degree of intramural invasion, and also made it possible to carry out the differential diagnosis of submucosal tumors and pathological processes in organs adjacent to the esophagus, stomach, duodenum. The article presents examinations of patients with submucous formations of the stomach and duodenum at the Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine. With the help of EUS, the diagnosis was confirmed in one patient, and in another one, the submucosal neoplasms was excluded.

Clinical symptoms, endoscopic findings, and lower esophageal sphincter characteristics in patients with absent contractility.

Absent contractility is a rare esophageal motility disorder defined by high-resolution manometry which remains poorly understood in pathogenesis and management. We investigated the clinical symptoms, upper gastrointestinal endoscopy findings, and lower esophageal sphincter (LES) characteristics in adult patients diagnosed with absent contractility on high resolution manometry and factors associated with erosive esophagitis that were found on endoscopy in these patients. A cross-sectional study was conducted in patients with absent contractility who were examined at the Institute of Gastroenterology and Hepatology, Vietnam between March 2018 and December 2020. Clinical symptoms, endoscopic findings, and LES metrics were collected and compared between individuals with and without erosive esophagitis. Logistic regression analysis was used to examine a variety of factors associated with erosive esophagitis. Among 7519 patients who underwent high resolution manometry, 204 (2.7%) were diagnosed with absent contractility. The mean age of the study sample was 45.9 years, 65.7% were women, and none had systemic sclerosis. The most common symptoms were regurgitation, belching, epigastric pain, and bloating. On endoscopy, 50% had erosive esophagitis, mostly Los Angeles grade A (42.9%). On manometry, 44.6% of the patients had LES hypotension and 68.1% had low integrated relaxation pressure in 4 seconds (IRP4s). Male sex (adjusted odds ratio = 2.01, 95% confidence interval: 1.04-3.89) and an IRP4s < 5 mm Hg (adjusted odds ratio = 2.21, 95% confidence interval: 1.12-4.37) were significantly associated with erosive esophagitis. Absent contractility was present in many patients without known systemic diseases. Erosive esophagitis was common and associated with male sex and low IRP4s.

The influence of Staphylococcus infections on the evolution of hospitalized patients: The experience of the surgical department of IRGH Cluj-Napoca

Despite recent scientific advances in diagnosis and treatment of human infections, bacterial infections continue to affect human health. The rate of morbidity and mortality caused by staphylococcal infections remains high and continues to be a threat to public health worldwide. Staphylococcal infections affect the population at risk regardless the level of country development. The highest risk categories include people with immunodeficiency, those with prolonged antibiotic treatment and repeated hospitalizations, patients with implanted medical devices or undergoing medical invasive procedures. The objective of this study was to analyse the influence of staphylococcal infection diagnosed during hospitalization on the evolution of patients admitted during two consecutive years, in surgical and intensive care wards in IRGH (Regional Institute of Gastroenterology and Hepatology) Cluj-Napoca, Romania, having as main diagnosis of hospitalization surgical digestive diseases along with other comorbidities. The occurrence of staphylococcal infection was associated with increased morbidity and mortality rates in patients included in the study.

Proceedings of the 48th scientific session of the Central Research Institute of Gastroenterology "Children's roots of adult problems". 2022 Mar 3-4, Moscow.

Proceedings of the 48th scientific session of the Central Research Institute of Gastroenterology "Children's roots of adult problems". 2022 Mar 3-4, Moscow.