Publications by authors named "Dan Dumitrascu"

208 Publications

Metabolic biomarkers related to cardiac dysfunction in metabolic-dysfunction-associated fatty liver disease: a cross-sectional analysis.

Nutr Diabetes 2022 Jan 18;12(1). Epub 2022 Jan 18.

2nd Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400006, Cluj-Napoca, Romania.

Introduction: Hepatic steatosis is associated with cardiac systolic and diastolic dysfunction. Therefore, we evaluated metabolites and their potential cardiovascular effects in metabolic-dysfunction-associated fatty liver disease (MAFLD).

Materials And Methods: We conducted a cross-sectional study involving 75 participants (38 MAFLD and 37 controls). Hepatic steatosis was confirmed by hepatic ultrasonography and SteatoTest. Cardiac function was assessed using echocardiography. Metabolomic analysis was conducted using ultra-high-performance liquid chromatography-mass spectrometry.

Results: The median age for participants' age was 45 (IQR 30-56.5), with gender distribution of 35 males and 40 females. MAFLD patients had lower levels of glycyl tyrosine (p-value < 0.001), lysophosphatidylcholine (LPC) (18:2/0:0) (p-value < 0.001), LPC (22:6) (p-value < 0.001), and ceramide (Cer) (d18:0/23:0) (p-value 0.003) compared to controls. MAFLD patients presented lower left ventricular ejection fraction (LVEF), E/A ratio, E/e' ratio, and average global longitudinal strain (GLS) values, with a p-value of 0.047, <0.001, 0.008, and <0.001, respectively. Decreased glycyl tyrosine levels were significantly correlated with reduced LVEF, even after performing multiple linear regression with 95% CI (1.34-3.394, p-value < 0.001). Moreover, decreased LPC (18:2/0:0) levels remained significantly associated with E/A ratio, even after adjusting for confounding factors with 95% CI (0.008-0.258, p-value = 0.042).

Conclusion: MAFLD patients are at risk for developing cardiac systolic and subclinical systolic dysfunctions, as well as diastolic dysfunction. Decreased glycyl tyrosine levels correlate with reduced LVEF and LPC (18:2/0:0) levels with diastolic dysfunction, even after adjusting for confounding factors, suggesting their potential to be used as metabolic biomarkers in detecting cardiovascular risk.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41387-022-00182-7DOI Listing
January 2022

Gut microbiota in inflammatory bowel disease: a target for therapy not to be missed.

Minerva Gastroenterol (Torino) 2021 Dec;67(4):357-368

Department of Health Sciences, Magna Græcia University, Catanzaro, Italy.

In the last years, the gut microbiota achieved great importance, since several studies demonstrated its correlation with the immune system and with the maintenance of intestinal homeostasis, as well as with the regulation of the integrity of the epithelium and the intestinal motility. An imbalance in microbial species promotes a dysbiosis, which has been associated with chronic diseases such as metabolic syndrome, inflammatory diseases, and some behavior disorders. The association with gut microbiota and dysbiosis has been demonstrated mostly in inflammatory bowel disease (IBD). Several studies investigated the application of antibiotics, prebiotics, probiotics, and fecal microbiota transplantation in the treatment strategies for IBD. In this review, we discuss the recent findings on the potential role of the gut microbiota manipulation, with particular attention to bacterial microbiota, which could be implicated for a successful IBD therapeutic approach.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.23736/S2724-5985.21.02907-7DOI Listing
December 2021

Integrated Relaxation Pressure Classification and Probe Positioning Failure Detection in High-Resolution Esophageal Manometry Using Machine Learning.

Sensors (Basel) 2021 Dec 30;22(1). Epub 2021 Dec 30.

Second Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400027 Cluj-Napoca, Romania.

High-resolution esophageal manometry is used for the study of esophageal motility disorders, with the help of catheters with up to 36 sensors. Color pressure topography plots are generated and analyzed and using the Chicago algorithm a final diagnosis is established. One of the main parameters in this algorithm is integrated relaxation pressure (IRP). The procedure is time consuming. Our aim was to firstly develop a machine learning based solution to detect probe positioning failure and to create a classifier to automatically determine whether the IRP is in the normal range or higher than the cut-off, based solely on the raw images. The first step was the preprocessing of the images, by finding the region of interest-the exact moment of swallowing. Afterwards, the images were resized and rescaled, so they could be used as input for deep learning models. We used the InceptionV3 deep learning model to classify the images as correct or failure in catheter positioning and to determine the exact class of the IRP. The accuracy of the trained convolutional neural networks was above 90% for both problems. This work is just the first step in fully automating the Chicago Classification, reducing human intervention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/s22010253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8749817PMC
December 2021

Nursing procedures for advanced dementia: Traditional techniques versus autonomous robotic applications (Review).

Exp Ther Med 2022 Feb 7;23(2):124. Epub 2021 Dec 7.

Second Medical Department, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca 400000, Romania.

The purpose of this study was to perform a comparative analysis of traditional nursing techniques and autonomous robotic applications used for managing patients with advanced stages of dementia. PubMed, Cochrane Library, EMBASE, and WILEY databases were searched for relevant articles concerning nursing techniques applied in the treatment of patients with advanced dementia. The search terms included: (advanced dementia OR severe dementia) AND [artificial intelligence (AI) OR robotic OR robots OR neural networks OR deep learning OR automated procedures OR autonomous application]. This search identified a total of 2,679 articles and 298 articles were selected. Finally, 23 articles were included in this systematic review, out of which 8 studies analyzed traditional nursing techniques and 15 studies analyzed autonomous robotic applications. Significant evidence was revealed, demonstrating that autonomous robotic applications used for patients with advanced stages of dementia are a feasible, cost-efficient solution and represent an excellent benefit for patients and the healthcare system.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3892/etm.2021.11047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8713171PMC
February 2022

The Visceral Adiposity Index in Non-Alcoholic Fatty Liver Disease and Liver Fibrosis-Systematic Review and Meta-Analysis.

Biomedicines 2021 Dec 13;9(12). Epub 2021 Dec 13.

2nd Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania.

(1) Background: In order to avoid a liver biopsy in non-alcoholic fatty liver disease (NAFLD), several noninvasive biomarkers have been studied lately. Therefore, we aimed to evaluate the visceral adiposity index (VAI) in NAFLD and liver fibrosis, in addition to its accuracy in predicting NAFLD and NASH. (2) Methods: We searched PubMed, Embase, Scopus, and Cochrane Library, identifying observational studies assessing the VAI in NAFLD and liver fibrosis. QUADAS-2 was used to evaluate the quality of included studies. The principal summary outcomes were mean difference (MD) and area under the curve (AUC). (3) Results: A total of 24 studies were included in our review. VAI levels were significantly increased in NAFLD (biopsy-proven and ultrasound-diagnosed), simple steatosis vs. controls, and severe steatosis vs. simple steatosis. However, no significant MD was found according to sex, liver fibrosis severity, simple vs. moderate and moderate vs. severe steatosis, pediatric NAFLD, and NASH patients. The VAI predicted NAFLD (AUC 0.767) and NASH (AUC 0.732). (4) Conclusions: The VAI has a predictive value in diagnosing NAFLD and NASH, with significantly increased values in adult NAFLD patients, simple steatosis compared to controls, and severe steatosis compared to simple steatosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/biomedicines9121890DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8698356PMC
December 2021

Neuromodulators in the Brain-Gut Axis: their Role in the Therapy of the Irritable Bowel Syndrome.

J Gastrointestin Liver Dis 2021 Nov 23;30(4):517-525. Epub 2021 Nov 23.

Center for Education and Practice of Biopsychosocial Care, Drossman Gastroenterology, University of North Carolina, Chapel Hill, NC, USA; The Rome Foundation, Raleigh, NC, USA.

Irritable bowel syndrome (IBS) is a clinically well-defined chronic condition that is now understood as a disorder of gut-brain regulation, as established in the work of the Rome IV committees coordinated by Drossman, 2016. People with IBS often report high disability levels and poor health-related quality of life. Drug therapy focuses on reducing main symptoms and disability and improving health-related quality of life. Central neuromodulators reduce IBS symptoms by targeting dysregulated pain and motility related to gut-brain dysregulation. It can also treat associated mental health symptoms. Based on their multiple effects on central and peripheral mechanisms, neuromodulators have been used to treat IBS patients. This review presents the rationale supporting medication treatments for specific IBS symptoms, discusses evidence-based management of IBS with central neuromodulators, and reviews the progress in the research for new neuromodulators.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.15403/jgld-4090DOI Listing
November 2021

Relationship between Adipokines and Cardiovascular Ultrasound Parameters in Metabolic-Dysfunction-Associated Fatty Liver Disease.

J Clin Med 2021 Nov 7;10(21). Epub 2021 Nov 7.

2nd Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania.

(1) Background: The role of adipokines such as adiponectin and visfatin in metabolic-dysfunction-associated fatty liver disease (MAFLD) and cardiovascular disease remains unclear. Therefore, we aim to assess serum adiponectin and visfatin levels in MAFLD patients and associated cardiovascular parameters. (2) Methods: A cross-sectional study involving 80 participants (40 MAFLD patients, 40 controls), recruited between January and September 2020, was conducted, using both hepatic ultrasonography and SteatoTestTM to evaluate hepatic steatosis. Echocardiographic and Doppler parameters were assessed. Serum adipokines were measured using ELISA kits. (3) Results: Adiponectin and visfatin levels were not significantly different in MAFLD vs. controls. Visfatin was associated with mean carotid intima-media thickness (-value = 0.047), while adiponectin was associated with left ventricular ejection fraction (LVEF) (-value = 0.039) and E/A ratio (-value = 0.002) in controls. The association between adiponectin and E/A ratio was significant in the univariate analysis at 95% CI (0.0049-0.1331, -value = 0.035), but lost significance after the multivariate analysis. Although LVEF was not associated with adiponectin in the univariate analysis, significant values were observed after the multivariate analysis (95% CI (-1.83--0.22, -value = 0.015)). (4) Conclusions: No significant difference in serum adiponectin and visfatin levels in MAFLD patients vs. controls was found. Interestingly, although adiponectin levels were not associated with LVEF in the univariate analysis, a significant inversely proportional association was observed after the multivariate analysis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm10215194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8584895PMC
November 2021

Prevalence of Gastrointestinal Symptoms in Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Results of the Prospective Controlled Multinational GI-COVID-19 Study.

Am J Gastroenterol 2022 01;117(1):147-157

Ege University Department of Infectious Diseases, Izmir, Turkey.

Introduction: Gastrointestinal (GI) symptoms in coronavirus-19 disease (COVID-19) have been reported with great variability and without standardization. In hospitalized patients, we aimed to evaluate the prevalence of GI symptoms, factors associated with their occurrence, and variation at 1 month.

Methods: The GI-COVID-19 is a prospective, multicenter, controlled study. Patients with and without COVID-19 diagnosis were recruited at hospital admission and asked for GI symptoms at admission and after 1 month, using the validated Gastrointestinal Symptom Rating Scale questionnaire.

Results: The study included 2036 hospitalized patients. A total of 871 patients (575 COVID+ and 296 COVID-) were included for the primary analysis. GI symptoms occurred more frequently in patients with COVID-19 (59.7%; 343/575 patients) than in the control group (43.2%; 128/296 patients) (P < 0.001). Patients with COVID-19 complained of higher presence or intensity of nausea, diarrhea, loose stools, and urgency as compared with controls. At a 1-month follow-up, a reduction in the presence or intensity of GI symptoms was found in COVID-19 patients with GI symptoms at hospital admission. Nausea remained increased over controls. Factors significantly associated with nausea persistence in COVID-19 were female sex, high body mass index, the presence of dyspnea, and increased C-reactive protein levels.

Discussion: The prevalence of GI symptoms in hospitalized patients with COVID-19 is higher than previously reported. Systemic and respiratory symptoms are often associated with GI complaints. Nausea may persist after the resolution of COVID-19 infection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.14309/ajg.0000000000001541DOI Listing
January 2022

Prognostic performance of the 'DICA' endoscopic classification and the 'CODA' score in predicting clinical outcomes of diverticular disease: an international, multicentre, prospective cohort study.

Gut 2021 Oct 26. Epub 2021 Oct 26.

Ospedale Valle d'Itria, Martina Franca, Italy.

Objective: To investigate the predictive value of the Diverticular Inflammation and Complication Assessment (DICA) classification and to develop and validate a combined endoscopic-clinical score predicting clinical outcomes of diverticulosis, named Combined Overview on Diverticular Assessment (CODA).

Design: A multicentre, prospective, international cohort study.

Setting: 43 gastroenterology and endoscopy centres located in Europe and South America.

Participants: 2215 patients (2198 completing the study) at the first diagnosis of diverticulosis/diverticular disease were enrolled. Patients were scored according to DICA classifications.

Interventions: A 3-year follow-up was performed.

Main Outcome Measures: To predict the acute diverticulitis and the surgery according to DICA classification. Survival methods for censored observation were used to develop and validate a novel combined endoscopic-clinical score for predicting diverticulitis and surgery (CODA score).

Results: The 3-year cumulative probability of diverticulitis and surgery was of 3.3% (95% CI 2.5% to 4.5%) in DICA 1, 11.6% (95% CI 9.2% to 14.5%) in DICA 2 and 22.0% (95% CI 17.2% to 28.0%) in DICA 3 (p<0.001), and 0.15% (95% CI 0.04% to 0.59%) in DICA 1, 3.0% (95% CI 1.9% to 4.7%) in DICA 2 and 11.0% (95% CI 7.5% to 16.0%) in DICA 3 (p<0.001), respectively. The 3-year cumulative probability of diverticulitis and surgery was ≤4%, and ≤0.7% in CODA A; <10% and <2.5% in CODA B; >10% and >2.5% in CODA C, respectively. The CODA score showed optimal discrimination capacity in predicting the risk of surgery in the development (c-statistic: 0.829; 95% CI 0.811 to 0.846) and validation cohort (c-statistic: 0.943; 95% CI 0.905 to 0.981).

Conclusions: DICA classification has a significant role in predicting the risk of diverticulitis and surgery in patients with diverticulosis, which is significantly enhanced by the CODA score.

Trial Registration Number: NCT02758860.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/gutjnl-2021-325574DOI Listing
October 2021

Acute Coronary Syndromes and Inflammatory Bowel Disease: The Gut-Heart Connection.

J Clin Med 2021 Oct 14;10(20). Epub 2021 Oct 14.

2nd Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania.

(1) Background: Inflammatory bowel disease (IBD) induces a process of systemic inflammation, sharing common ground with acute coronary syndromes (ACS). Growing evidence points towards a possible association between IBD and an increased risk of ACS, yet the topic is still inconclusive. Therefore, we conducted a systematic review aiming to clarify these gaps in the evidence. (2) Methods: We conducted a systematic search on EMBASE, Cochrane Library, and PubMed, identifying observational studies published prior to November 2020. The diagnosis of IBD was confirmed via histopathology or codes. Full articles that fulfilled our criteria were included. Quality assessment was performed using the Newcastle-Ottawa scale (NOS). (3) Results: We included twenty observational studies with a total population of ~132 million subjects. Fifteen studies reported a significant association between ACS and IBD, while the remaining five studies reported no increase in ACS risk in IBD patients. (4) Conclusions: ACS risk in IBD patients is related to hospitalizations, acute active flares, periods of active disease, and complications, with a risk reduction during remission. Interestingly, a general increase in ACS risk was reported in younger IBD patients. The role of corticosteroids and oral contraceptive pills in increasing the ACS risk of IBD patients should be investigated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm10204710DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8538087PMC
October 2021

Value of GastroPanel in the diagnosis of atrophic gastritis.

Exp Ther Med 2021 Nov 22;22(5):1347. Epub 2021 Sep 22.

Second Medical Department, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania.

Analysis of serum biomarkers for the assessment of atrophic gastritis (AG), considered as precursor of the intestinal type of gastric cancer, is of growing interest. The combination of pepsinogen (PG), gastrin-17 (G17) and anti- () antibody serological assays (panel test) is a non-invasive tool for the diagnosis of atrophic gastritis. However, the diagnostic reliability of this test remains uncertain. The aim of our study was to assess the diagnostic performance of the serum panel test (GastroPanel) for the diagnosis of atrophic gastritis. From dyspeptic patients, endoscopic biopsy samples (two from the gastric corpus and two from the antrum) and blood samples were collected. The determination of sPGI, sPGII, sG17 and IgG antibodies to (H.p IgG) was performed using an enzyme-linked immunosorbent assay (GastroPanel; Biohit Oyj). Histopathology results were compared with GastroPanel values. Sixty patients were included: 35 (58.3%) females and 25 (41.66%) males; mean age 67.63±9.36 years; 45% -positive. A total of 65% of patients had atrophic gastritis. There were no significant differences between the levels of biomarkers and localization of atrophy. The ratio PG1/PG2 was lower in patients with multifocal atrophy; the difference being close to the threshold of statistical significance. In cases of intestinal metaplasia the values of G17, PG1, PG2, H.p IgG were not statistically altered compared to those without intestinal metaplasia; only the ratio PG1/PG2 was lower in intestinal metaplasia; the difference being almost of statistical significance. Our results revealed that, GastroPanel values did not differ depending on the severity of the atrophy. Biomarkers used by GastroPanel do not have enough accuracy for use in the diagnosis of atrophy in the population studied. A low accuracy only for the ratio PG1/PG2 in patients with multifocal atrophy was found. However, our data revealed a correlation in detecting intestinal metaplasia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3892/etm.2021.10782DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8495588PMC
November 2021

United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on functional dyspepsia.

Neurogastroenterol Motil 2021 09;33(9):e14238

Gastroenterology Unit, Departmento of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.

Background: Functional dyspepsia (FD) is one of the most common conditions in clinical practice. In spite of its prevalence, FD is associated with major uncertainties in terms of its definition, underlying pathophysiology, diagnosis, treatment, and prognosis.

Methods: A Delphi consensus was initiated with 41 experts from 22 European countries who conducted a literature summary and voting process on 87 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus (defined as >80% agreement) was reached for 36 statements.

Results: The panel agreed with the definition in terms of its cardinal symptoms (early satiation, postprandial fullness, epigastric pain, and epigastric burning), its subdivision into epigastric pain syndrome and postprandial distress syndrome, and the presence of accessory symptoms (upper abdominal bloating, nausea, belching), and overlapping conditions. Also, well accepted are the female predominance of FD, its impact on quality of life and health costs, and acute gastrointestinal infections, and anxiety as risk factors. In terms of pathophysiological mechanisms, the consensus supports a role for impaired gastric accommodation, delayed gastric emptying, hypersensitivity to gastric distention, Helicobacter pylori infection, and altered central processing of signals from the gastroduodenal region. There is consensus that endoscopy is mandatory for establishing a firm diagnosis of FD, but that in primary care, patients without alarm symptoms or risk factors can be managed without endoscopy. There is consensus that H. pylori status should be determined in every patient with dyspeptic symptoms and H. pylori positive patients should receive eradication therapy. Also, proton pump inhibitor therapy is considered an effective therapy for FD, but no other treatment approach reached a consensus. The long-term prognosis and life expectancy are favorable.

Conclusions And Inferences: A multinational group of European experts summarized the current state of consensus on the definition, diagnosis and management of FD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/nmo.14238DOI Listing
September 2021

Epidemiology of Irritable Bowel Syndrome in Albania.

J Gastrointestin Liver Dis 2021 09 21;30(3):334-338. Epub 2021 Sep 21.

2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania.

Background And Aims: Irritable bowel syndrome (IBS) is a chronic condition, with a relatively high prevalence and represents a burden for the healthcare budgets. Knowing the prevalence of IBS is important for scientific and practical estimation of its impact. The recent Rome IV global study has shed light on the prevalence of IBS in many countries, but reports are lacking from other countries. The aim of this study was to assess the prevalence of IBS in Albania, a country from which we do not have relevant information.

Method: A prospective study was carried out in order to find out the prevalence of IBS in Albania. The target population was a sample of at least 500 Albanian adults (from a population of 2.2 million adults in this country. The questionnaires were distributed to the general population through three University centers from different areas of the country, through family doctors, chosen randomly, and by door to door by volunteer medical students. The questionnaires were self-completed by the participants and included 29 items: biographical data, IBS symptoms based on the Rome IV criteria, the symptoms that accompany IBS and the quality of life (QoL). The prevalence of IBS in the studied population, the sex ratio, the subtypes of IBS and the prevalence of different symptoms were calculated.

Results: We sent out 550 questionnaires and we received answers from 502 subjects (response rate 91%, 312 females, median age: 42 years). IBS was present in 43 cases (8.6%), without gender predominance. The IBS subtypes had the following values: IBS-C 58%, IBS-D 28% and IBS-M 14%. Women had a relatively higher risk for subtype IBS predominant constipation (OR=1.13, 95%CI: 0.32-3.95, p=0.84) but men appeared to be more prone to IBS predominant diarrhea (OR=1.3, 95%CI: 0.33-5.08, p=0.7). The most affected age was over 50 years and the least affected was between 18-30 years. Bloating was present in 81.4% of IBS respondents. The pain significantly influenced the daily activity in IBS: OR=12.9:1 (95% CI: 6.18-27.31, p<0.0001). Education seems to be an important risk factor; people with only middle school education or less had an OR=4.5 (95% CI: 2-10.54, p=0.0003) of developing IBS than people with a higher education.

Conclusions: These are the first reported data on IBS in Albania. IBS in Albania is of 8.6%, more than the average data in the Rome IV global study, but in the range obtained from other studies. The most common type is IBS-C; there is no gender predominance; it is more common in less educated persons; the influence of pain on daily activity is higher in IBS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.15403/jgld-3828DOI Listing
September 2021

Eosinophilic esophagitis and esophageal motility changes.

Med Pharm Rep 2021 Aug 10;94(Suppl No 1):S72-S75. Epub 2021 Aug 10.

2 Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Farmacy, Cluj-Napoca, Romania.

Eosinophilic esophagitis is a chronic condition that can affect any age, with an increasing prevalence in the last years. Esophageal symptoms are accompanied by normal endoscopic findings or changes suggestive for the disease, like rings, furrows, exudates, or strictures. The definitive diagnosis is based on esophageal biopsies, with identification of at least 15 eosinophils/high power field. In about 1/3 of patients esophageal motility abnormalities are observed. Ineffective esophageal motility is the most frequent. In some cases, major motility disorders, such as achalasia can be observed. The treatment depends on the patients' preferences and on symptoms severity, and usually a step-up approach is used. A diet change can be helpful in more than half of patients, some respond to proton pump inhibitors. In non-responders, short courses of topical corticosteroids are recommended. Endoscopic procedures might be helpful in patients with obstructive motility changes, non-responding to medical therapy. This review discusses the motility changes observed in patients with eosinophilic esophagitis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.15386/mpr-2236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8411821PMC
August 2021

Gaucher disease - bone involvement.

Med Pharm Rep 2021 Aug 10;94(Suppl No 1):S61-S63. Epub 2021 Aug 10.

2 Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.

Gaucher disease (GD) is a rare genetic disease caused by the enzymatic deficiency of beta-glucocerebrosidase. This will lead to the accumulation of sphingolipids in various organs, such as liver, spleen, bone marrow. Bone involvement is frequent in Gaucher patients, leading to bone pain, necrosis and even fractures or growth deficiency in children, with painful surgeries and progressively decreasing quality of life. The early treatment initiation in symptomatic patients is very important in lowering bone complications frequency and improve general status. We present the case of a young patient whose first manifestation of GD was a bone cystic lesion and the clinical evolution until treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.15386/mpr-2233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8411829PMC
August 2021

Gaucher disease: an update.

Authors:
Dan L Dumitrascu

Med Pharm Rep 2021 Aug 10;94(Suppl No 1):S54-S56. Epub 2021 Aug 10.

2Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.

Gaucher disease is a lysosomal storage disease affecting the bone marrow, spleen, liver, and nervous system. In Romania we follow up over 70 adult patients with Gaucher disease, who benefit from fully covered therapy. There is a need to screen for Gaucher disease, to diagnose early the condition and to use the best available therapy. This is a review of recent studies on Gaucher disease and is dedicated to trainees in medicine.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.15386/mpr-2231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8411812PMC
August 2021

Gaucher disease - therapeutic aspects in Romania.

Med Pharm Rep 2021 Aug 10;94(Suppl No 1):S51-S53. Epub 2021 Aug 10.

2 Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.

Gaucher disease is a rare autosomal recessive disease caused by the beta-glicosidase activity deficiency, which will lead to substrate accumulation mainly in the liver, spleen or bone marrow. The main symptoms are liver and spleen enlargement, anemia and low platelet count, bone crisis and fatigue. Several treatment options are available, as enzyme replacement therapy, substrate reduction therapy, or chaperones treatment whose effect is still studied. There are 77 adult patients treated at this time in Romania, 54 with intravenous enzyme replacement ant 23 with oral substrate reduction therapy. No severe adverse effects have been reported by now. All patients had improved disease related symptoms after the receiving of the treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.15386/mpr-2230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8411810PMC
August 2021

The need for continuous medical training in the field of rare diseases.

Authors:
Dan L Dumitrascu

Med Pharm Rep 2021 Aug 10;94(Suppl No 1):S7. Epub 2021 Aug 10.

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

View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8411818PMC
August 2021

Microbiota and the irritable bowel syndrome.

Minerva Gastroenterol (Torino) 2021 Dec 13;67(4):377-384. Epub 2021 Sep 13.

Second Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania.

Gut microbiota plays a vital role in human health. The number of microorganisms inhabiting the gastrointestinal (GI) tract has been estimated to exceed 10. The dominant genera in the human intestine are Firmicutes (more than 180 species of Lactobacillus), Actinobacteria (among others the Bifidobacteriae), Bacteroidetes (the most important is B. fragilis) and Proteobacteria (E. coli, Salmonella, Yersinia, Shigella, Vibrio, Haemophilus, etc.), but the composition of the flora varies individually, as well as in relation to factors such as host genetics, stress, diet, antibiotics and early childhood experiences. Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders (FGIDs), which has now been renamed disorders of gut-brain interaction, which affect a large number of people worldwide. It is characterized by abdominal pain and altered bowel habits in the absence of obvious anatomic or physiologic abnormalities. It poses a negative economic impact to the global health care system in addition to reducing the quality of life in patients. The pathophysiology of IBS is not fully understood. In IBS subjects gut microbiota relative to healthy controls was observed with an increase in Enterobacteriaceae, Ruminococcus, Clostridium, Dorea species and a decrease of Lactobacillus, Bifidobacterium, and Faecalibacterium species. IBS with diarrhea predominance (IBS-D) IBS with mixed bowel habits (IBS-M) share similarities in the microbial profile. Recent studies suggest that perturbations within "brain-gut-microbiota" axis may lead to IBS development. The aim of this review was to highlight the potential role of gut microbiota on pathophysiological mechanisms underlying IBS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.23736/S2724-5985.21.02923-5DOI Listing
December 2021

Pharmacological Management of Peptic Ulcer: A Century of Expert Opinions in Cecil Textbook of Medicine.

Am J Ther 2021 Aug 17;28(5):e552-e559. Epub 2021 Aug 17.

Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj, Romania.

Background: Advances in drug therapy for peptic ulcer have had a significant impact on quality of life and work potential of many millions of affected persons and have contributed to a remarkable decrease in the prevalence of the disease, frequency and severity of complications, hospitalizations, and mortality.

Study Question: What are the milestones of the changes in the expert approach to the pharmacological management of peptic ulcer in the past century?

Study Design: To determine the changes in the experts' approach to the management of peptic ulcer, as presented in a widely used textbook in the United States.

Data Sources: The chapters presenting the management of peptic ulcer in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020.

Results: Acid neutralization with alkalies was the only pharmacological intervention recommended in the textbooks published from 1927 to 1975. Atropine and other antimuscarinic agents were mainly used to relieve pain and acid secretion according to the paradigm "no acid no ulcer." The shift to the acid suppression paradigm started with the introduction of the histamine-2 receptor antagonist cimetidine in 1979, the proton-pump inhibitor omeprazole in 1988, and the prostaglandin agonist misoprostol in 1992. Finally, the eradication of Helicobacter pylori was codified in 1996.

Conclusions: The pharmacological management of peptic ulcer has remained archaic well into the 20th century. Fundamental progress occurred in a very short period (1979-1996) and was due to paradigm shifts from acid neutralization to acid suppression and later the recognition of the role of H. pylori infection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MJT.0000000000001439DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8415507PMC
August 2021

European guideline on indications, performance, and clinical impact of hydrogen and methane breath tests in adult and pediatric patients: European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Neurogastroenterology and Motility, and European Society for Paediatric Gastroenterology Hepatology and Nutrition consensus.

United European Gastroenterol J 2021 Aug 25. Epub 2021 Aug 25.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University, Graz, Austria.

Introduction: Measurement of breath hydrogen (H ) and methane (CH ) excretion after ingestion of test-carbohydrates is used for different diagnostic purposes. There is a lack of standardization among centers performing these tests and this, together with recent technical developments and evidence from clinical studies, highlight the need for a European guideline.

Methods: This consensus-based clinical practice guideline defines the clinical indications, performance, and interpretation of H -CH -breath tests in adult and pediatric patients. A balance between scientific evidence and clinical experience was achieved by a Delphi consensus that involved 44 experts from 18 European countries. Eighty eight statements and recommendations were drafted based on a review of the literature. Consensus (≥80% agreement) was reached for 82. Quality of evidence was evaluated using validated criteria.

Results: The guideline incorporates new insights into the role of symptom assessment to diagnose carbohydrate (e.g., lactose) intolerances and recommends that breath tests for carbohydrate malabsorption require additional validated concurrent symptom evaluation to establish carbohydrate intolerance. Regarding the use of breath tests for the evaluation of oro-cecal transit time and suspected small bowel bacterial overgrowth, this guideline highlights confounding factors associated with the interpretation of H -CH -breath tests in these indications and recommends approaches to mitigate these issues.

Conclusion: This clinical practice guideline should facilitate pan-European harmonization of diagnostic approaches to symptoms and disorders, which are very common in specialist and primary care gastroenterology practice, both in adult and pediatric patients. In addition, it identifies areas of future research needs to clarify diagnostic and therapeutic approaches.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ueg2.12133DOI Listing
August 2021

Serum Visfatin Levels in Nonalcoholic Fatty Liver Disease and Liver Fibrosis: Systematic Review and Meta-Analysis.

J Clin Med 2021 Jul 7;10(14). Epub 2021 Jul 7.

2nd Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania.

(1) Background: Recently, adipokines, including visfatin, have been studied in nonalcoholic fatty liver disease (NAFLD). Several studies evaluated visfatin levels in NAFLD, the presence and severity of hepatic steatosis, liver fibrosis, lobar inflammation, nonalcoholic steatohepatitis (NASH), and gender differences. However, inconclusive results have been reported. Accordingly, we performed a systematic review and meta-analysis, aiming to address these gaps in evidence. (2) Methods: We performed a systematic electronic search on PubMed, EMBASE, and Cochrane Library using predefined keywords. Diagnosis of NAFLD by liver biopsy or imagistic investigations was accepted. Full articles satisfying our inclusion and exclusion criteria were included. NHLBI quality assessment tools were used to evaluate included studies. The principal summary outcome was the mean difference in visfatin levels. (3) Results: There were 21 studies involving 1923 individuals included in our qualitative assessment, while 14 studies were included in the quantitative assessment. No statistical significance was found assessing visfatin levels in NAFLD [3.361 (95% CI -0.175-6.897)], simple steatosis [7.523 (95% CI -16.221-31.267)], hepatic steatosis severity [-0.279 (95% CI -1.843-1.285)], liver fibrosis [4.133 (95% CI -3.176-11.443)], lobar inflammation [0.358 (95% CI -1.470-2.185)], NASH [-2.038 (95% CI -6.839-2.763)], and gender [(95% CI -0.554-0.556)]. (4) Conclusions: In conclusion, visfatin levels are not associated with NAFLD, presence or severity of hepatic steatosis, liver fibrosis, lobar inflammation, NASH, and gender. However, due to the limited methodological quality of the included studies, results should be interpreted with caution.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm10143029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8306785PMC
July 2021

Disorders of the brain-gut interaction and eating disorders.

World J Gastroenterol 2021 Jun;27(24):3668-3681

Department of The Second Medical, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca RO 400174, Cluj, Romania.

Background: Eating disorders (ED) involve both the nervous system and the gastrointestinal tract. A similar double involvement is also found in disorders of the brain-gut interaction (DGBI) and symptoms are sometimes similar.

Aim: To find out where there is an association and a cause-effect relationship, we looked for the comorbidity of DGBI and ED.

Methods: A systematic review was undertaken. A literature search was performed. Inclusion criteria for the articles retained for analysis were: Observational cohort population-based or hospital-based and case-control studies, examining the relationship between DGBI and ED. Exclusion criteria were: Studies written in other languages than English, abstracts, conference presentations, letters to the Editor and editorials. Selected papers by two independent investigators were critically evaluated and included in this review.

Results: We found 29 articles analyzing the relation between DGBI and ED comprising 13 articles on gastroparesis, 5 articles on functional dyspepsia, 7 articles about functional constipation and 4 articles on irritable bowel syndrome.

Conclusion: There is no evidence for a cause-effect relationship between DGBI and ED. Their common symptomatology requires correct identification and a tailored therapy of each disorder.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3748/wjg.v27.i24.3668DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8240049PMC
June 2021

The impact of the coronavirus (COVID-19) pandemic on individuals with gastrointestinal disorders: A protocol of an international collaborative study.

J Psychosom Res 2021 09 29;148:110561. Epub 2021 Jun 29.

Swinburne University of Technology, Melbourne, Victoria, Australia.

Objective: The COVID-19 pandemic has had a significant impact on mental health across the globe. People living with a chronic gastrointestinal (GI) disorder might be particularly at risk of mental health complications given higher rates of comorbid anxiety and depression compared to the healthy population. As GI disorders affect up to 40% of the population worldwide, this international collaborative study seeks to evaluate the extent of the impact of the COVID-19 pandemic on GI symptoms specifically and more generally on the well-being of those living with chronic GI conditions.

Methods: A longitudinal survey with three time points (baseline, 6-month, and 12-month) will be conducted online. Adult participants with GI disorders from multiple countries will be recruited via patient associations, social media advertising, utilizing snowball sampling. Participants will be invited to complete a battery of questionnaires including demographic and health parameters, and measures of gastrointestinal symptoms, fear of COVID-19, perceived impact of COVID-19, illness perceptions, coping, depression, anxiety, stress, catastrophizing, and quality of life, using validated measures where available. Statistical analyses will include univariate descriptive models, multivariate models utilizing regression, mediation, and moderation, and latent growth models.

Conclusions: This project may present novel information to the field of psychogastroenterology and may provide crucial information regarding the areas of impact for individuals with GI disorders during and following the pandemic. Further, this information can guide healthcare providers and patient associations on how to target support related to the pandemic mental health sequelae for these patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpsychores.2021.110561DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8240440PMC
September 2021

Non-Alcoholic Fatty Liver Disease: Implementing Complete Automated Diagnosis and Staging. A Systematic Review.

Diagnostics (Basel) 2021 Jun 12;11(6). Epub 2021 Jun 12.

2nd Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania.

Background: Non-alcoholic fatty liver disease (NAFLD) is a fast-growing pathology around the world, being considered the most common chronic liver disease. It is diagnosed based on the presence of steatosis in more than 5% of hepatocytes without significant alcohol consumption. This review aims to provide a comprehensive overview of current studies of artificial intelligence (AI) applications that may help physicians in implementing a complete automated NAFLD diagnosis and staging.

Methods: PubMed, EMBASE, Cochrane Library, and WILEY databases were screened for relevant publications in relation to AI applications in NAFLD. The search terms included: (non-alcoholic fatty liver disease OR NAFLD) AND (artificial intelligence OR machine learning OR neural networks OR deep learning OR automated diagnosis OR computer-aided diagnosis OR digital pathology OR automated ultrasound OR automated computer tomography OR automated magnetic imaging OR electronic health records).

Results: Our search identified 37 articles about automated NAFLD diagnosis, out of which 15 articles analyzed imagistic techniques, 15 articles analyzed digital pathology, and 7 articles analyzed electronic health records (EHC). All studies included in this review show an accurate capacity of automated diagnosis and staging in NAFLD using AI-based software.

Conclusions: We found significant evidence demonstrating that implementing a complete automated system for NAFLD diagnosis, staging, and risk stratification is currently possible, considering the accuracy, sensibility, and specificity of available AI-based tools.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/diagnostics11061078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8231502PMC
June 2021

What is the world record of alpha-fetoprotein level?

J Gastrointestin Liver Dis 2021 06 19;30(2):212. Epub 2021 Jun 19.

2 nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.15403/jgld-3440DOI Listing
June 2021

European guideline on indications, performance and clinical impact of C-breath tests in adult and pediatric patients: An EAGEN, ESNM, and ESPGHAN consensus, supported by EPC.

United European Gastroenterol J 2021 06 14;9(5):598-625. Epub 2021 Jun 14.

Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.

Introduction: C-breath tests are valuable, noninvasive diagnostic tests that can be widely applied for the assessment of gastroenterological symptoms and diseases. Currently, the potential of these tests is compromised by a lack of standardization regarding performance and interpretation among expert centers.

Methods: This consensus-based clinical practice guideline defines the clinical indications, performance, and interpretation of C-breath tests in adult and pediatric patients. A balance between scientific evidence and clinical experience was achieved by a Delphi consensus that involved 43 experts from 18 European countries. Consensus on individual statements and recommendations was established if ≥ 80% of reviewers agreed and <10% disagreed.

Results: The guideline gives an overview over general methodology of C-breath testing and provides recommendations for the use of C-breath tests to diagnose Helicobacter pylori infection, measure gastric emptying time, and monitor pancreatic exocrine and liver function in adult and pediatric patients. Other potential applications of C-breath testing are summarized briefly. The recommendations specifically detail when and how individual C-breath tests should be performed including examples for well-established test protocols, patient preparation, and reporting of test results.

Conclusion: This clinical practice guideline should improve pan-European harmonization of diagnostic approaches to symptoms and disorders, which are very common in specialist and primary care gastroenterology practice, both in adult and pediatric patients. In addition, this guideline identifies areas of future clinical research involving the use of C-breath tests.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ueg2.12099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8259225PMC
June 2021

Greater Overlap of Rome IV Disorders of Gut-Brain Interactions Leads to Increased Disease Severity and Poorer Quality of Life.

Clin Gastroenterol Hepatol 2021 May 27. Epub 2021 May 27.

Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.

Background And Aims: Conditions such as irritable bowel syndrome (IBS), functional dyspepsia, and functional constipation are among the prevalent gastrointestinal (GI) disorders classified as disorders of gut-brain interaction (DGBI), which can adversely affect the lives of sufferers. This study aimed to assess the degree and consequences of overlapping DGBI in a large population-based global scale.

Methods: Internet survey data from 54,127 adults (49.1% women) in 26 countries were analyzed by 4 GI anatomic regions (esophageal, gastroduodenal, bowel, and anorectal). The number of DGBI-affected GI regions was assessed, including associations with sex, age, disease severity, quality of life, psychosocial variables, and health care utilization.

Results: A total of 40.3% of surveyed individuals met Rome IV criteria for a DGBI. The percentages with 1-4 DGBI-affected GI regions were 68.3%, 22.3%, 7.1%, and 2.3%, respectively. The IBS symptom severity score increased significantly from 1 (207.6) to 4 (291.6) regions, as did non-GI symptom reporting (somatization), anxiety and depression, concerns and embarrassment about bowel function, doctor visits, medications, and abdominal surgeries (all P < .0001). Quality of life decreased with increasing number of DGBI regions (P < .0001). In a logistic mixed model, non-GI symptoms (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.08-1.10), being very vs not concerned (OR, 2.55; 95% CI, 2.27-2.90), being very vs not embarrassed about bowel function (OR, 1.20; 95% CI, 1.08-1.33), and mean number of doctor visits (OR, 1.23; 95% CI, 1.115-1.32) were most strongly associated with number of DGBI regions.

Conclusions: DGBI in multiple anatomic GI regions is associated with increased psychological comorbidity, health care utilization, and IBS severity. Physician awareness of overlap could improve quality of care, prevent unnecessary interventions, and yield more positive health outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cgh.2021.05.042DOI Listing
May 2021

Gut microbiota and cardiovascular diseases axis: a review.

Minerva Med 2021 May 10. Epub 2021 May 10.

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

Gut microbiota, a term that includes microorganisms present in the gastrointestinal tract, has become very attractive lately due to its propensity to act as a virtual organ with endocrine functions, generating various bio-active metabolites, while playing an important role in human health and diseases, including cardiovascular diseases (CVDs). Focusing on the latter field, gastrointestinal dysbiosis, that is the imbalance in the gut microbiota composition, has been linked to various pathologies such as hypertension, atherosclerosis, myocardial infarction and heart failure. Several pathways were demonstrated to play a role in the complex and intertwined association between the gut microbiota and host, including metabolic endotoxemia, alteration of pattern recognition receptors and short-chain fatty acids, uremic toxins, bile acids and trimethylamine-N-oxide levels, leading to CVDs. Understanding these pathways can allow to identifying metabolites that could be useful predictors for detecting incipient CVDs stages and potential therapeutic targets. In this review, we summarize the pathways associating the gut microbiota with CVDs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.23736/S0026-4806.21.07527-3DOI Listing
May 2021

Romanian Guidelines for Nonpharmacological Therapy of IBS.

J Gastrointestin Liver Dis 2021 06 18;30(2):291-306. Epub 2021 Jun 18.

Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; 2nd Department of Internal Medicine, Cluj-Napoca, Romania.

Background And Aims: The nonpharmacological therapy in irritable bowel syndrome (IBS) is expanding rapidly. Practitioners and medical educators need to be aware of progress and changes in knowledge of this topic. The Romanian Society of Neurogastroenterology aimed to create guidelines based on best evidence on the use of nonpharmacological therapy in IBS.

Methods: A group of experts was constituted. This was divided in eleven subgroups dedicated to eleven categories of nonpharmacological therapy. The subgroups searched the literature and formulated statements and recommendations. These were submitted to vote in order to obtain consensus.

Results: The outcome of this activity is represented by the guidelines of the Romanian Society of Neurogastroenterology, presented in this paper. The recommendations are seen as complementary to the pharmacological therapy and are not intended to recommend avoiding pharmacological drugs.

Conclusions: These guidelines were elaborated by a Delphi process and represent a useful tool for physicians managing patients with IBS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.15403/jgld-3581DOI Listing
June 2021
-->