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Bridging the gap:Unveiling the crisis of physical inactivity in inflammatory bowel diseases

World Journal of Gastroenterology 2024年第10期30卷 1261-1265页

作者： Remus Stafie Ana-Maria Singeap Adrian Rotaru carol stanciu Anca Trifan Department of Gastroenterology Faculty of Medicine“Grigore T.Popa”University of Medicine and PharmacyIasi 700115Romania Institute of Gastroenterology and Hepatology “St.Spiridon”University HospitalIasi 700111Romania

In this editorial we comment on the article titled“Inflammatory bowel diseases patients suffer from significant low levels and barriers to physical activity:The BE-FIT-IBD study”published in a recent issue of the World Journal of Gastroen-terology 2023;29(41):*** bowel diseases(IBD)are emerging as a significant global health concern as their incidence continues to rise on a global scale,with detrimental impacts on quality of *** many advances have been made regarding the management of the disease,physical inactivity in these patients represents an underexplored issue that may hold the key for further and better understanding the ramifications of *** pain,fatigue,and fear of exacerbating symptoms promotes physical inactivity among IBD patients,while the lack of clear guidelines on safe exercise regimens contributes to a norm of physical *** activity(PA)is accepted to have a positive effect on disease outcomes and quality of life,while inactivity exacerbates comorbidities like cardiovascular disease and mental health ***“BE-FIT-IBD”study,focusing on PA levels and barriers in IBD patients of Southern Italy,revealed that a significant proportion(42.9%)were physically *** lack of PA is attributed to barriers such as fear of flare-ups and misconceptions about exercise exacerbating the *** study also highlighted the need for better communication between healthcare providers and patients regarding the benefits of PA and safe incorporation into ***,physical inactivity may also contribute to disability in IBD patients,having a great impact on employment *** note is the fact that IBD also comes with an important psychological burden with relevant evidence suggesting that regular PA can improve mood,reduce anxiety,and enhance mental ***“BE-FIT-IBD”study advocated for the integration of PA into IBD management,emphasizing the bidirectional link between PA and *** exe

关键词： Inflammatory bowel disease Physical activity Disability Psychological burden Body composition Quality of life

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Checkmate to liver biopsy in chronic hepatitis C?

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World Journal of Gastroenterology 2012年第39期18卷 5514-5520页

作者： Anca Trifan carol stanciu "Gr.T.Popa" University of Medicine and Pharmacy "St.Spiridon" University HospitalIndependentei 1700111 IasiRomania

Liver biopsy (LB) has traditionally been considered the gold standard for pretreatment evaluation of liver fibrosis in patients with chronic hepatitis C (CHC). However, LB is an invasive procedure with several shortcomings (intra-and interobserver variability of histopathological interpretation, sampling errors, high cost) and the risk of rare but potentially life-threatening complications. In addition, LB is poorly accepted by patients and it is not suitable for repeated evaluation. Further-more, the prevalence of CHC makes LB unrealistic to be performed in all patients with this disease who are candidates for antiviral therapy. The above-mentioned drawbacks of LB have led to the development of non-invasive methods for the assessment of liver fibrosis. Several noninvasive methods, ranging from serum marker assays to advanced imaging techniques, have proved to be excellent tools for the evaluation of liver fibrosis in patients with CHC, whereas the value of LB as a gold standard for staging fibrosis prior to antiviral therapy has become questionable for clinicians. Despite significant resistance from those in favor of LB, noninvasive methods for pretreatment assessment of liver fibrosis in patients with CHC have become part of routine clinical practice. With protease inhibitors-based triple therapy already available and substantial improvement in sustained virological response, the time has come to move forward to noninvasiveness, with no risks for the patient and, thus, no need for LB in the assessment of liver fibrosis in the decision making for antiviral therapy in CHC.

关键词： Liver biopsy Fibrosis Noninvasive methods

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Portal vein thrombosis in cirrhotic patients-it is always the small pieces that make the big picture

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World Journal of Gastroenterology 2018年第39期24卷 4419-4427页

作者： Irina Girleanu Anca Trifan carol stanciu Cǎtǎlin Sfarti Department of Gastroenterology “Grigore T Popa”University of Medicine and PharmacyIa.i 700115Romania Institute of Gastroenterology and Hepatology “St.Spiridon”University HospitalIa.i 700115Romania

Portal vein thrombosis(PVT) is a frequent and serious complication in patients with liver cirrhosis(LC). Recently, a new classification of PVT was proposed, although the functional component was not completed included. The status of liver disease(compensated/decompensated) should be added to this classification. Reduced portal flow velocity and the acquired hypercoagulable status associated with LC are the main risk factors for PVT development, although endothelial dysfunction may play an important role that needs to be further evaluated. The European Association for the Study of the Liver and the American Association for the Study of Liver Disease recommend that the anticoagulant treatment should be consider in cirrhotic patients with PVT. Low molecular weight heparin and vitamin K antagonists proved their efficacy and relatively safety in PVT treatment, although in addition to recanalization rates, more complex endpoints such as mortality and decompensation rate should be evaluated. The new oral anticoagulant therapies offers the advantage of oral administration in the absence of laboratory monitoring, however, there are a few reports regarding their use in cirrhotic patients, most of them referring to compensated isolated cases. Transjugular intrahepatic portosystemic shunt could be an alternative if thrombosis progresses despite anticoagulatant therapy and/or when PVT is associated with portal hypertension complications. The aim of this editorial is to discuss the different aspects of pathophysiology, clinical relevance, diagnosis and management of PVT in patients with LC.

关键词： Portal vein thrombosis Liver cirrhosis Classification Risk factors Anticoagulation

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Impact of Clostridium difficile infection on inflammatory bowel disease outcome: A review

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World Journal of Gastroenterology 2014年第33期20卷 11736-11742页

作者： Anca Trifan carol stanciu Oana Stoica Irina Girleanu Camelia Cojocariu "Gr. T. Popa" University of Medicine and Pharmacy "St. Spiridon" Emergency Hospital Institute of Gastroenterology and Hepatology 7000111 Iasi Romania "St. Spiridon" Emergency Hospital Institute of Gastroenterology and Hepatology 7000111 Iasi Romania "Gr. T. Popa" University of Medicine and Pharmacy 7000111 Iasi Romania

Although a considerable number of studies support a substantial increase in incidence, severity, and healthcare costs for Clostridium difficile infection (CDI) in inflammatory bowel disease (IBD), only few evaluate its impact on IBD outcome. Medline and several other electronic databases from January 1993 to October 2013 were searched in order to identify potentially relevant literature. Most of the studies showed that IBD patients with CDI present a greater proportion of worse outcomes than those without CDI. These patients have longer length of hospital stay, higher rates of colectomies, and increased mortality. Patients with ulcerative colitis are more susceptible to CDI and have more severe outcomes than those with Crohn’s disease. However, studies reported variable results in both short- and long-term outcomes. Contrasting results were also found between studies using nationwide data and those reporting from single-center, or between some North-American and European studies. An important limitation of all studies analyzed was their retrospective design. Due to contrasting data often provided by retrospective studies, further prospective multi-center studies are necessary to evaluate CDI impact on IBD outcome. Until then, a rapid diagnosis and adequate therapy of infection are of paramount importance to improve IBD patients’ outcome. The aim of this article is to provide up to date information regarding CDI impact on outcome in IBD patients.

关键词： Clostridium difficile infection Ulcerative colitis Crohn's disease Outcome

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Hepatocellular carcinoma after direct-acting antiviral hepatitis C virus therapy:A debate near the end

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World Journal of Gastroenterology 2020年第43期26卷 6770-6781页

作者： Cristina Maria Muzica carol stanciu Laura Huiban Ana-Maria Singeap Catalin Sfarti Sebastian Zenovia Camelia Cojocariu Anca Trifan Department of Gastroenterology Grigore T.Popa University of Medicine and PharmacySt.Spiridon Emergency HospitalIasi 700115Romania

Direct acting antivirals(DAAs)have revolutionized the treatment of hepatitis C virus(HCV)infection,achieving high rates(≥95%)of sustained virological response,with a good safety profile and high compliance ***,it had been expected that viral clearance will reduce morbidity and mortality rates,as well as the risk of hepatocellular carcinoma(HCC).However,since 2016,concerns have been raised over an unexpected high rate of HCC occurrence and recurrence after DAA therapy,which led to an avalanche of studies with contradictory *** aimed to review the most recent and relevant articles regarding the risk of HCC after DAA treatment and identify the associated risk factors.

关键词： Hepatocellular carcinoma Direct acting antivirals therapy Hepatitis C virus infection Sustained virological response Risk factors of hepatocellular carcinoma Review

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Ulcerated intussuscepted jejunal lipoma-uncommon cause of obscure gastrointestinal bleeding: A case report

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World Journal of Clinical Cases 2019年第22期7卷 3765-3771页

作者： Tudor Cuciureanu Laura Huiban Stefan Chiriac Ana-Maria Singeap Mihai Danciu Florin Mihai carol stanciu Anca Trifan Nutu Vlad Department of Gastroenterology “Grigore T.Popa”University of Medicine and Pharmacy“St.Spiridon”Emergency HospitalIasi 700115Romania Department of Pathology “Grigore T.Popa”University of Medicine and Pharmacy“St.Spiridon”Emergency HospitalIasi 700115Romania Department of Radiology “Grigore T.Popa”University of Medicine and Pharmacy“St.Spiridon”Emergency HospitalIasi 700115Romania Department of General Surgery “Grigore T.Popa”University of Medicine and Pharmacy“St.Spiridon”Emergency HospitalIasi 700115Romania

BACKGROUND Intestinal lipomas are rare benign gastrointestinal(GI)tumors,usually asymptomatic,but may become symptomatic as the result of some complications such as intussusception,intestinal obstruction,volvulus or *** can occur at any site along the entire GI tract,more frequent in colon and rarely in small *** patient reported here is a very rare case of jejunal lipoma,ulcerated and intussuscepted,diagnosed in an adult investigated for a chronic iron deficiency anemia(IDA),and successfully managed by segmental jejunal *** SUMMARY A 63-year-old male was referred to“***”Hospital,Institute of Gastroenterology and Hepatology,Iasi,to investigate an obscure GI bleeding with an *** upper GI endoscopy and colonoscopy were performed,excluding potentially bleeding lesions,videocapsule endoscopy was then carried out,revealing fresh blood and a protruding lesion in proximal jejunum,findings confirmed by a single-balloon *** biopsies were taken from the lesion,but histological results were ***,contrast-enhanced computed tomography was performed showing jejunal polypoid mass with homogenous fat density,suggestive for lipoma.A week later a laparotomy was performed revealing the intussuscepted jejunal segment which was resected enbloc,and sent for further histopathologic *** patient made an uneventful recovery and was discharged seven days later,and at six months follow-up he had no complains and his hemoglobin returned to normal *** Lipomas are very rarely located in the jejunum,usually asymptomatic,but they may lead to complications such as intussusception and *** resection remains the treatment of choice.

关键词： Lipoma Intussusception Computed tomography Video capsule endoscopy Gastrointestinal bleeding Case report

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Role of ammonia in predicting the outcome of patients with acuteon- chronic liver failure

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World Journal of Clinical Cases 2021年第3期9卷 552-564页

作者： Stefan Chiriac carol stanciu Camelia Cojocariu Ana-Maria Singeap Catalin Sfarti Tudor Cuciureanu Irina Girleanu Razvan Alexandru Igna Anca Trifan Department of Gastroenterology “Grigore T.Popa”University of Medicine and PharmacyIasi 700115Romania Institute of Gastroenterology and Hepatology "St.Spiridon"Emergency HospitalIasi 700111Romania Intensive Care “Grigore T.Popa”University of Medicine and PharmacyIasi 700115Romania

BACKGROUND High venous ammonia(VA)values have been proven to be a part of the mechanism of hepatic encephalopathy in patients with liver cirrhosis(LC)as well as acute ***,VA has been associated with poor prognosis and high mortality in these clinical ***,the role of ammonia in acuteon-chronic liver failure(ACLF)has not yet been clearly *** To assess the role of VA in predicting the outcome of cirrhotic patients with ACLF in a tertiary care *** We performed a retrospective observational study including consecutive patients with LC hospitalized for acute non-elective indications such as ascites,hepatic encephalopathy(HE),upper gastrointestinal bleeding,or bacterial infections that fulfilled the Asian Pacific Association for the Study of the Liver(APASL)criteria for *** study was conducted in“***”University Hospital,Iasi,Romania,a tertiary care center,between January 2017 and January *** APASL ACLF Research Consortium(AARC)score was calculated and ACLF grade was established ***-haven classification was used for *** analysis was performed using IBM SPSS version *** Four hundred and forty-six patients were included,aged 59(50-65)years,57.4%***-Pugh,model for end-stage liver disease(MELD)and AARC scores were 11(10-12),19.13±6.79,and 7(6-8),respectively.66.4%had ACLF grade I,31.2%ACLF grade II,and 2.5%ACLF grade *** was diagnosed in 83.9%,34%grade I,37.2%grade II,23.5%grade III,and 5.3%grade *** mortality was 7.8%.VA was 103(78-148)μmol/*** operating characteristic analysis showed good accuracy for the prediction of in-hospital mortality for the AARC score[Area under the curve(AUC)=0.886],MELD score(AUC=0.816),VA(AUC=0.812)and a fair accuracy for the Child-Pugh score(AUC=0.799).Subsequently,a cut-off value for the prediction of mortality was identified for VA(152.5μmol/L,sensitivity=0.706,1-specificity=0.190).Univariate analysis found acute kidney in

关键词： Venous ammonia Hepatic encephalopathy Acute-on-chronic liver failure Asian Pacific Association for the Study of the Liver Acute-on-chronic Liver Failure Research Consortium score Cirrhosis Mortality

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Proton pump inhibitors therapy and risk of Clostridium difficile infection: Systematic review and meta-analysis

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World Journal of Gastroenterology 2017年第35期23卷 6500-6515页

作者： Anca Trifan carol stanciu Irina Girleanu Oana Cristina Stoica Ana Maria Singeap Roxana Maxim Stefan Andrei Chiriac Alin Ciobica Lucian Boiculese Institute of Gastroenterology and Hepatology “St.Spiridon”Hospital“Grigore T.Popa”University of Medicine and Pharmacy Institute of Gastroenterology and Hepatology “St.Spiridon”Hospital Department of Research Faculty of Biology“Alexandru Ioan Cuza”University of Iasi Department of Preventive Medicine and Interdisciplinarity “Grigore.T.Popa”University of Medicine and Pharmacy

AIM To perform a systematic review and meta-analysis on proton pump inhibitors(PPIs) therapy and the risk of Clostridium difficile infection(CDI). METHODS We conducted a systematic search of MEDLINE/Pub Med and seven other databases through January 1990 to March 2017 for published studies that evaluated the association between PPIs and CDI. Adult case-control and cohort studies providing information on the association between PPI therapy and the development of CDI were included. Pooled odds ratios(ORs) estimates with 95% confidence intervals(CIs) were calculated using the random effect. Heterogeneity was assessed by I^2 test and Cochran's Q *** publication bias was evaluated via funnel plot, and quality of studies by the Newcastle-Otawa Quality Assessment Scale(NOS). RESULTS Fifty-six studies(40 case-control and 16 cohort) involving 356683 patients met the inclusion criteria and were analyzed. Both the overall pooled estimates and subgroup analyses showed increased risk for CDI despite substantial statistical heterogeneity among studies. Meta-analysis of all studies combined showed a significant association between PPI users and the risk of CDI(pooled OR = 1.99, CI: 1.73-2.30, P < 0.001) as compared with non-users. The association remained significant in subgroup analyses: by design-case-control(OR = 2.00, CI: 1.68-2.38, P < 0.0001), and cohort(OR = 1.98, CI: 1.51-2.59, P < 0.0001); adjusted(OR = 1.95, CI: 1.67-2.27, P < 0.0001) and unadjusted(OR = 2.02, CI: 1.41-2.91, P < 0.0001); unicenter(OR = 2.18, CI: 1.72-2.75, P < 0.0001) and multicenter(OR = 1.82, CI: 1.51-2.19, P < 0.0001); age ≥ 65 years(OR = 1.93, CI: 1.40-2.68, P < 0.0001) and < 65 years(OR = 2.06, CI: 1.11-3.81, P < 0.01). No significant differences were found in subgroup analyses(test for heterogeneity): P = 0.93 for case-control vs cohort, P = 0.85 for adjusted vs unadjusted, P = 0.24 for unicenter vs multicenter, P = 0.86 for age ≥ 65 years and < 65 years. There was significant hetero

关键词： Proton pump inhibitors Clostridium difficile infection Risk Systematic review Meta-analysis

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Update on adrenal insufficiency in patients with liver cirrhosis

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World Journal of Gastroenterology 2013年第4期19卷 445-456页

作者： Anca Trifan Stefan Chiriac carol stanciu "Gr.T.Popa" University of Medicine and Pharmacy Institute of Gastroenterology and Hepatology"St.Spiridon" University Hospital

Liver cirrhosis is a major cause of mortality worldwide,often with severe sepsis as the terminal *** the last two decades,several studies have reported that in septic patients the adrenal glands respond inappropriately to stimulation,and that the treatment with corticosteroids decreases mortality in such *** cirrhosis and septic shock share many hemodynamic abnormalities such as hyperdynamic circulatory failure,decreased peripheral vascular resistance,increased cardiac output,hypo-responsiveness to vasopressors,increased levels of proinflammatory cytokines [interleukine(IL)-1,IL-6,tumor necrosis factor-alpha] and it has,consequently,been reported that adrenal insufficiency(AI) is common in critically ill cirrhotic *** may also be present in patients with stable cirrhosis without sepsis and in those undergoing liver *** term hepato-adrenal syndrome defines AI in patients with advanced liver disease with sepsis and/or other complications,and it suggests that it could be a feature of liver disease per se,with a dif-ferent pathogenesis from that of septic *** AI is the term given to inadequate cortisol response to *** recently,another term is used,namely "critical illness related corticosteroid insufficiency" to define "an inadequate cellular corticosteroid activity for the severity of the patient's illness".The mechanisms of AI in liver cirrhosis are not completely understood,although decreased levels of high-density lipoprotein cholesterol and high levels of proinflammatory cytokines and circulatory endotoxin have been *** prevalence of AI in cirrhotic patients varies widely according to the stage of the liver disease(compensated or decompensated,with or without sepsis),the diagnostic criteria defining AI and the methodology *** effects of corticosteroid therapy on cirrhotic patients with septic shock and AI are *** review aims to summarize the existing published information rega

关键词： Liver cirrhosis Adrenal insufficiency Septic shock Corticosteroid therapy

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Did the severe acute respiratory syndrome-coronavirus 2 pandemic cause an endemic Clostridium difficile infection?

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World Journal of Clinical Cases 2021年第33期9卷 10180-10188页

作者： Camelia Cojocariu Irina Girleanu Anca Trifan Andrei Olteanu Cristina Maria Muzica Laura Huiban Stefan Chiriac Ana Maria Singeap Tudor Cuciureanu Catalin Sfarti carol stanciu Department of Gastroenterology “Grigore T.Popa”University of Medicine and Pharmacy“St.Spiridon”University HospitalInstitute of Gastroenterology and HepatologyIasi 700115Romania

BACKGROUND Clostridium difficile infection(CDI)has increased in prevalence during the last *** coronavirus disease 2019(COVID-19)pandemic has negatively influenced patient *** majority of the severe acute respiratory syndrome-coronavirus 2(SARS-CoV-2)-infected patients received antibiotics during *** To analyze the factors that influenced CDI development after SARS-CoV-2 *** Between March 2020 to December 2020,we performed a prospective observational study including 447 patients diagnosed with CDI who were admitted to our tertiary referral university *** diagnosis of CDI was based on the presence of diarrhea(≥3 watery stools within 24 h)associated with Clostridium difficile toxins A or *** excluded patients with other etiology of acute *** Among the total 447(12.5%)patients with CDI,most were male(54.3%)and mean age was 59.7±10.8 ***-six(17.0%)had history of COVID-19,most being elderly(COVID-19:62.6±14.6 years vs non-COVID-19:56.8±17.6 years,P=0.007),with history of alcohol consumption(43.4%vs 29.4%,P=0.017),previous hospitalizations(81.6%vs 54.9%,P<0.001)and antibiotic treatments(60.5%vs 35.5%,P<0.001),requiring higher doses of vancomycin and prone to recurrent disease(25.0%vs 13.1%,P=0.011).Age over 60 years[odds ratio(OR):2.591,95%confidence interval(CI):1.452-4.624,P=0.001],urban residence(OR:2.330,95%CI:1.286-4.221,P=0.005),previous antibiotic treatments(OR:1.909,95%CI:1.083-3.365,P=0.025),previous hospitalizations(OR:2.509,95%CI:1.263-4.986,P=0.009)and alcohol consumption(OR:2.550,95%CI:1.459-4.459,P=0.001)were risk factors of CDI in *** CDI risk is unrelated to history of SARS-CoV-2 ***,previous COVID-19 may necessitate higher doses of vancomycin for CDI.

关键词： COVID-19 infection Clostridium difficile infection Risk factors Antibiotic use Pandemic Recurrence

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