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Rațiu I, Lupușoru R, Lungeanu D, Popescu A, Sporea I, Goldiș A, Dănilă M, Miuțescu B, Moga T, Barbulescu A, Tăban S, Dema A, Șirli R. Diagnosis of malignant biliary obstruction: pondering over the ERCP, MRCP and histology. J Int Med Res 2022; 50:3000605221076924. [PMID: 35170356 PMCID: PMC8855398 DOI: 10.1177/03000605221076924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To compare the diagnostic accuracy of endoscopic retrograde
cholangiopancreatography (ERCP), magnetic resonance pancreatography (MRCP)
and histological examination for malignant biliary obstruction. Methods This retrospective study included patients admitted for biliary obstruction
caused by biliary tree malignancy that underwent ERCP, MRCP and histological
examination. Data were collected from the medical records. The primary
endpoints were the area under the receiver operating characteristic (AUROC)
curve value, sensitivity, specificity and overall diagnostic accuracy of the
three procedures in terms of a final diagnosis of obstructive biliary
malignancy; and the agreement between ERCP, MRCP and histological
examination with the final diagnosis. Results A total of 160 patients were included in the study (85 males, 53.1%;
mean ± SD age, 69.31 ± 10.96 years). Considering the final diagnosis, the
performance of MRCP, ERCP and histology in assessing biliary tumours
produced AUROC values of 0.88 (95% confidence interval [CI] 0.75, 0.90),
0.94 (95% CI 0.85, 0.99) and 0.80 (95% CI 0.70, 0.82), respectively. ERCP
presented higher sensitivity, overall diagnostic accuracy and agreement with
the final diagnosis than MRCP and histological examination. Conclusion These current data suggest that invasive methods such as ERCP with biopsy
remain more reliable than non-invasive methods.
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Affiliation(s)
- Iulia Rațiu
- Advanced Regional Research Centre in Gastroenterology and Hepatology, Department of Internal Medicine II, Discipline of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Raluca Lupușoru
- Advanced Regional Research Centre in Gastroenterology and Hepatology, Department of Internal Medicine II, Discipline of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania.,Centre for Modelling Biological Systems and Data Analysis, Department of Functional Sciences, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Diana Lungeanu
- Centre for Modelling Biological Systems and Data Analysis, Department of Functional Sciences, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Alina Popescu
- Advanced Regional Research Centre in Gastroenterology and Hepatology, Department of Internal Medicine II, Discipline of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Ioan Sporea
- Advanced Regional Research Centre in Gastroenterology and Hepatology, Department of Internal Medicine II, Discipline of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Adrian Goldiș
- Advanced Regional Research Centre in Gastroenterology and Hepatology, Department of Internal Medicine II, Discipline of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Mirela Dănilă
- Advanced Regional Research Centre in Gastroenterology and Hepatology, Department of Internal Medicine II, Discipline of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Bogdan Miuțescu
- Advanced Regional Research Centre in Gastroenterology and Hepatology, Department of Internal Medicine II, Discipline of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Tudor Moga
- Advanced Regional Research Centre in Gastroenterology and Hepatology, Department of Internal Medicine II, Discipline of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Andreea Barbulescu
- Advanced Regional Research Centre in Gastroenterology and Hepatology, Department of Internal Medicine II, Discipline of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Sorina Tăban
- ANAPATMOL Research Centre, Discipline of Morphopathology, Department of Microscopic Morphology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Alis Dema
- ANAPATMOL Research Centre, Discipline of Morphopathology, Department of Microscopic Morphology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Roxana Șirli
- Advanced Regional Research Centre in Gastroenterology and Hepatology, Department of Internal Medicine II, Discipline of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
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2
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Rațiu I, Lupușoru R, Vora P, Popescu A, Sporea I, Goldiș A, Dănilă M, Miuțescu B, Barbulescu A, Hnatiuc M, Diaconescu R, Tăban S, Lazar F, Șirli R. Opportunistic Colonoscopy Cancer Screening Pays off in Romania-A Single-Centre Study. Diagnostics (Basel) 2021; 11:diagnostics11122393. [PMID: 34943629 PMCID: PMC8700238 DOI: 10.3390/diagnostics11122393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 12/09/2022] Open
Abstract
Colorectal cancer (CRC) is the third most diagnosed cancer in men (after prostate and lung cancers) and in women (after breast and lung cancer). It is the second cause of cancer death in men (after lung cancer) and the third one in women (after breast and lung cancers). It is estimated that, in EU-27 countries in 2020, colorectal cancer accounted for 12.7% of all new cancer diagnoses and 12.4% of all deaths due to cancer. Our study aims to assess the opportunistic colorectal cancer screening by colonoscopy in a private hospital. A secondary objective of this study is to analyse the adenoma detection rate (ADR), polyp detection rate (PDR), and colorectal cancer (CRC) detection rate. We designed a retrospective single-centre study in the Gastroenterology Department of Saint Mary Hospital. The study population includes all individuals who performed colonoscopies in 2 years, January 2019–December 2020, addressed to our department by their family physician or came by themselves for a colonoscopy. One thousand seven hundred seventy-eight asymptomatic subjects underwent a colonoscopy for the first time. The mean age was 59.0 ± 10.9, 59.5% female. Eight hundred seventy-three polyps were found in 525 patients. Five hundred and twenty-five had at least one polyp, 185 patients had two polyps, 87 had three polyps, and 40 patients had more than three polyps. The PDR was 49.1%, ADR 39.0%, advanced adenomas in 7.9%, and carcinomas were found in 5.4% of patients. In a country without any colorectal cancer screening policy, polyps were found in almost half of the 1778 asymptomatic patients evaluated in a single private center, 39% of cases adenomas, and 5.4% colorectal cancer. Our study suggests starting screening colonoscopy at the age of 45. A poor bowel preparation significantly impacted the adenoma detection rate.
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Affiliation(s)
- Iulia Rațiu
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
| | - Raluca Lupușoru
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
- Center for Modeling Biological Systems and Data Analysis, Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence: ; Tel.: +40-733912028
| | - Prateek Vora
- Department of Gastroenterology, Saint Mary Hospital, 300203 Timisoara, Romania;
| | - Alina Popescu
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
| | - Ioan Sporea
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
| | - Adrian Goldiș
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
| | - Mirela Dănilă
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
| | - Bogdan Miuțescu
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
| | - Andreea Barbulescu
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
| | - Madalina Hnatiuc
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
| | - Razvan Diaconescu
- Department of Surgery, Faculty of Medicine, “Vasile Goldiş” Western University of Arad, 310025 Arad, Romania;
| | - Sorina Tăban
- ANAPATMOL Research Center, Discipline of Morphopathology, Department of Microscopic Morphology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Fulger Lazar
- Department X, 2nd Surgical Clinic, Researching Future Chirurgie 2, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timisoara, Romania;
| | - Roxana Șirli
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
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Goldiș A, Lupușoru R, Gheorghe L, Gheorghe C, Trifan A, Dobru D, Cijevschi C, Tanțău A, Constantinescu G, Iacob R, Goldiș R, Diculescu M. Geographic Distribution, Phenotype and Epidemiological Tendency in Inflammatory Bowel Disease Patients in Romania. Medicina (Kaunas) 2019; 55:medicina55100704. [PMID: 31635181 PMCID: PMC6843626 DOI: 10.3390/medicina55100704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 02/05/2023]
Abstract
Background and objective: The incidence of inflammatory bowel disease (IBD) over the past years in Romania has been on the rise, but epidemiologic data are lacking. The aim of this study was to define the characteristics of IBD, the trends and phenotype among IBD patients in Romania. Material and methods: We conducted a prospective study over a period of 12 years, from 2006 to 2017. All patients diagnosed with IBD on clinical, radiological, endoscopic and histological features were included. We divided the country into eight regions: west (W), north-east (NE), north-west (NW), south-east (SE), south-west (SW), south (S), central (C) and Bucharest-Ilfov (B), and data were analyzed accordingly. Results: A total of 2724 patients were included in this database, but only 2248 were included in the final analysis, with all data available. Of the 2248 patients, 935 were Crohn's disease (CD), 1263 were ulcerative colitis (UC) and 50 were IBD-undetermined. In UC phenotypes we observed more frequent left-sided colitis (50.5%, p < 0.0001), and in CD phenotype we observed more frequent colonic and ileo-colonic localization (37.8% and 37.6%, p < 0.0001). The region with the most IBD cases was NE (25.1%) and with the least IBD cases was SW (4.9%). UC was found more frequently in NE (32%), while CD was found more frequently in Bucharest (28.6%). Conclusions: In Romania, ulcerative colitis is more frequent than CD. UC is predominant in the northern part of Romania, while CD has become predominant in the southern part of the country. IBD occurs more in the male population, and in urban and industrialized areas. There are differences between the regions in Romania regarding IBD phenotypes, gender distributions, age distribution, treatment, smoking status and complications.
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Affiliation(s)
- Adrian Goldiș
- Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania.
| | - Raluca Lupușoru
- Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania.
- Department of Functional Sciences, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania.
| | - Liana Gheorghe
- Department of Gastroenterology and Hepatology, "Carol Davila" University of Medicine and Pharmacy, Fundeni Clinical Institute, 020021 Bucharest, Romania.
| | - Cristian Gheorghe
- Department of Gastroenterology and Hepatology, "Carol Davila" University of Medicine and Pharmacy, Fundeni Clinical Institute, 020021 Bucharest, Romania.
| | - Anca Trifan
- Gastroenterology and Hepatology Institute, "Grigore T. Popa" University of Medicine and Pharmacy, 700019 Iași, Romania.
| | - Daniela Dobru
- Municipal Hospital, Gastroenterology, University of Medicine and Pharmacy, 540139 Târgu-Mureș, Romania.
| | - Cristina Cijevschi
- Gastroenterology and Hepatology Institute, "Grigore T. Popa" University of Medicine and Pharmacy, 700019 Iași, Romania.
| | - Alina Tanțău
- "Iuliu Hațieganu" University of Medicine and Pharmacy, 3rd Medical Clinic, 400012 Cluj-Napoca, Romania.
| | - Gabriel Constantinescu
- Department of Gastroenterology and Hepatology, "Carol Davila" University of Medicine and Pharmacy, Floreasca Emergency Hospital, 020021 Bucharest, Romania.
| | - Răzvan Iacob
- Department of Gastroenterology and Hepatology, "Carol Davila" University of Medicine and Pharmacy, Fundeni Clinical Institute, 020021 Bucharest, Romania.
| | | | - Mircea Diculescu
- Department of Gastroenterology and Hepatology, "Carol Davila" University of Medicine and Pharmacy, Fundeni Clinical Institute, 020021 Bucharest, Romania.
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4
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Ciocîrlan M, Ciocîrlan M, Iacob R, Tanțău A, Gheorghe L, Gheorghe C, Dobru D, Constantinescu G, Cijevschi C, Trifan A, Goldiș A, Diculescu M. Malnutrition Prevalence in Newly Diagnosed Patients with Inflammatory Bowel Disease - Data from the National Romanian Database. J Gastrointestin Liver Dis 2019; 28:163-168. [PMID: 31204412 DOI: 10.15403/jgld-176] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Prevalence of malnutrition in inflammatory bowel diseases (IBD) varies between 16% and 75%. Data on the nutritional status at initial diagnosis of ulcerative colitis (UC) or Crohn's Disease (CD) are scarce. It is believed that more than 50% of IBD patients suffer significant weight loss prior to diagnosis. The aims of our study were to assess malnutrition in patients recently diagnosed with IBD and to determine its predictive factors. METHODS We retrospectively included 625 IBD patients registered in the Romanian "IBD Prospect" database between January 2006 and July 2017. All patients were diagnosed within 6 months prior to registration. We defined malnutrition as weight loss of more than 5% of the initial weight during the 3 months prior to registration. RESULTS There were 361 new cases of UC, 241 CD and 23 cases of unclassified IBD. There was a slight male predominance (M/F=1.2). Prevalence of overall malnutrition was 36.3%. It was significantly more frequent in CD than in UC patients (41.1% vs. 32.4%, p=0.031). In multivariate analysis, malnutrition in UC patients was associated with male gender (p=0.001), more severe disease (p<0.0001) and more extensive disease (p=0.027), while in CD it was associated with younger age (p=0.013) and more severe disease (p<0.0001). CONCLUSIONS About 1 in 3 newly diagnosed IBD patients presents with malnutrition at the time of diagnosis.
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Affiliation(s)
- Maria Ciocîrlan
- Carol Davila University of Medicine and Pharmacy, Fundeni Clinical Institute, Department of Gastroenterology and Hepatology, Bucharest, Romania
| | - Mihai Ciocîrlan
- Carol Davila University of Medicine and Pharmacy, Agrippa Ionescu Clinical Emergency Hospital, Department of Gastroenterology and Hepatology, Bucharest, Romania
| | - Răzvan Iacob
- Carol Davila University of Medicine and Pharmacy, Fundeni Clinical Institute, Department of Gastroenterology and Hepatology, Bucharest, Romania
| | - Alina Tanțău
- Iuliu Hațieganu University of Medicine and Pharmacy, 4th Medical Clinic, Cluj-Napoca, Romania
| | - Liana Gheorghe
- Carol Davila University of Medicine and Pharmacy, Fundeni Clinical Institute, Department of Gastroenterology and Hepatology, Bucharest, Romania
| | - Cristian Gheorghe
- Carol Davila University of Medicine and Pharmacy, Fundeni Clinical Institute, Department of Gastroenterology and Hepatology, Bucharest, Romania
| | - Daniela Dobru
- University of Medicine and Pharmacy, Municipal Hospital, Gastroenterology, Târgu-Mureș, Romania
| | - Gabriel Constantinescu
- Carol Davila University of Medicine and Pharmacy, Floreasca Emergency Hospital, Department of Gastroenterology and Hepatology, Bucharest, Romania
| | - Cristina Cijevschi
- Grigore T. Popa University of Medicine and Pharmacy, Gastroenterology and Hepatology Institute, Iași, Romania
| | - Anca Trifan
- Grigore T. Popa University of Medicine and Pharmacy, Gastroenterology and Hepatology Institute, Iași, Romania
| | - Adrian Goldiș
- Victor Babeș University of Medicine and Pharmacy, District Hospital, Department of Gastroenterology and Hepatology, Timișoara, Romania
| | - Mircea Diculescu
- Carol Davila University of Medicine and Pharmacy, Fundeni Clinical Institute, Department of Gastroenterology and Hepatology, Bucharest, Romania
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Lazăr DC, Avram MF, Romoșan I, Văcariu V, Goldiș A, Cornianu M. Malignant hepatic vascular tumors in adults: Characteristics, diagnostic difficulties and current management. World J Clin Oncol 2019; 10:110-135. [PMID: 30949442 PMCID: PMC6441663 DOI: 10.5306/wjco.v10.i3.110] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 02/23/2019] [Accepted: 03/12/2019] [Indexed: 02/06/2023] Open
Abstract
Malignant vascular tumors of the liver include rare primary hepatic mesenchymal tumors developed in the background of a normal liver parenchyma. Most of them are detected incidentally by the increased use of performing imaging techniques. Their diagnosis is challenging, involving clinical and imaging criteria, with final confirmation by histology and immunohistochemistry. Surgery represents the mainstay of treatment. Liver transplantation (LT) has improved substantially the prognosis of hepatic epithelioid hemangioendothelioma (HEHE), with 5-year patient survival rates of up to 81%, based on the European Liver Intestine Transplantation Association-European Liver Transplant Registry study. Unfortunately, the results of surgery and LT are dismal in cases of hepatic angiosarcoma (HAS). Due to the disappointing results of very short survival periods of approximately 6-7 mo after LT, because of tumor recurrence and rapid progression of the disease, HAS is considered an absolute contraindication to LT. Recurrences after surgical resection are high in cases of HEHE and invariably present in cases of HAS. The discovery of reliable prognostic markers and the elaboration of prognostic scores following LT are needed to provide the best therapeutic choice for each patient. Studies on a few patients have demonstrated the stabilization of the disease in a proportion of patients with hepatic vascular tumors using novel targeted antiangiogenic agents, cytokines or immunotherapy. These new approaches, alone or in combination with other therapeutic modalities, such as surgery and classical chemotherapy, need further investigation to assess their role in prolonging patient survival. Personalized therapeutic algorithms according to the histopathological features, behavior, molecular biology and genetics of the tumors should be elaborated in the near future for the management of patients diagnosed with primary malignant vascular tumors of the liver.
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Affiliation(s)
- Daniela Cornelia Lazăr
- Department of Internal Medicine I, University Medical Clinic, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Romania
| | - Mihaela Flavia Avram
- Department of Surgery X, 1st Surgery Clinic, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Romania
| | - Ioan Romoșan
- Department of Internal Medicine I, University Medical Clinic, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Romania
| | - Violetta Văcariu
- Department of Internal Medicine I, University Medical Clinic, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Romania
| | - Adrian Goldiș
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Romania
| | - Mărioara Cornianu
- Department of Pathology, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Romania
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6
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Trifan A, Gheorghe C, Marica Sabo C, Diculescu M, Nedelcu L, Singeap AM, Sfarti C, Gheorghe L, Sporea I, Tanțău M, Scripcariu V, Goldiș A, Gheonea D, Manuc M, Stanciu C, Scarpignato C, Dumitrascu DD. Diagnosis and Treatment of Colonic Diverticular Disease: Position Paper of the Romanian Society of Gastroenterology and Hepatology. J Gastrointestin Liver Dis 2018; 27:449-457. [PMID: 30574628 DOI: 10.15403/jgld.2014.1121.274.rom] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Diverticular disease of the colon is a common clinical condition in developed countries, and is associated with significant (direct and indirect) economic burden. The aim of this Position Paper is to provide clinical guidance for appropriate definition, prevalence, risk factors, diagnosis, and treatment of colonic diverticular disease. METHODS A working group of recognized experts established by the Board of the Romanian Society of Gastroenterology and Hepatology (RSGH) screened the literature and the available guidelines on colonic diverticular disease. Statements were formulated based on literature evidence. These statements were discussed within the working group and decision for each of them was taken by consensus. RESULTS Thirty two statements were elaborated. The grade of recommendation, according to the level of evidence was established for each statement. Short comments with literature support accompany each statement. CONCLUSION This Position Paper represents a practical guide for clinicians dealing with patients affected by colonic diverticular disease.
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Affiliation(s)
- Anca Trifan
- Grigore T. Popa University of Medicine and Pharmacy, Dept. Gastroenterology, Iasi, Romania
| | - Cristian Gheorghe
- Center of Gastroenterology, Fundeni Hospital, Carol Davila University of Medicine and Pharmacy Bucharest, Romania
| | - Cristina Marica Sabo
- Iuliu Hatieganu University of Medicine and Pharmacy, 2nd Medical Dept. Cluj-Napoca, Romania
| | - Mircea Diculescu
- Center of Gastroenterology, Fundeni Hospital, Carol Davila University of Medicine and Pharmacy Bucharest, Romania
| | | | - Ana Maria Singeap
- Grigore T. Popa University of Medicine and Pharmacy, Dept. Gastroenterology, Iasi, Romania
| | - Cătălin Sfarti
- Grigore T. Popa University of Medicine and Pharmacy, Dept. Gastroenterology, Iasi, Romania
| | - Liana Gheorghe
- Center of Gastroenterology, Fundeni Hospital, Carol Davila University of Medicine and Pharmacy Bucharest, Romania
| | - Ioan Sporea
- Victor Babeș University of Medicine and Pharmacy, Dept. Gastroenterology and Hepatology, Timișoara, Romania
| | - Marcel Tanțău
- Iuliu Hatieganu University of Medicine and Pharmacy, Prof. Octavian Fodor Institute of Gastroenterology and Hepatology Cluj-Napoca, Romania
| | - Viorel Scripcariu
- Grigore T. Popa University of Medicine and Pharmacy, Dept. Gastroenterology, Iasi, Romania
| | - Adrian Goldiș
- Victor Babeș University of Medicine and Pharmacy, Dept. Gastroenterology and Hepatology, Timișoara, Romania
| | - Dan Gheonea
- University of Medicine and Pharmacy, Dept. Gastroenterology, Craiova, Romania
| | - Mircea Manuc
- Center of Gastroenterology, Fundeni Hospital, Carol Davila University of Medicine and Pharmacy Bucharest, Romania
| | - Carol Stanciu
- Grigore T. Popa University of Medicine and Pharmacy, Dept. Gastroenterology, Iasi, Romania
| | - Carmelo Scarpignato
- Clinical Pharmacology and Digestive Pathophysiology Unit, Dept.Clinical and Experimental Medicine, University of Parma, Italy
| | - Dan D Dumitrascu
- Iuliu Hatieganu University of Medicine and Pharmacy, 2nd Medical Dept. Cluj-Napoca, Romania
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7
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Lazăr DC, Avram MF, Romoșan I, Cornianu M, Tăban S, Goldiș A. Prognostic significance of tumor immune microenvironment and immunotherapy: Novel insights and future perspectives in gastric cancer. World J Gastroenterol 2018; 24:3583-3616. [PMID: 30166856 PMCID: PMC6113718 DOI: 10.3748/wjg.v24.i32.3583] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 06/05/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023] Open
Abstract
Despite a decrease in gastric cancer incidence, the development of novel biologic agents and combined therapeutic strategies, the prognosis of gastric cancer remains poor. Recently, the introduction of modern immunotherapy, especially using immune checkpoint inhibitors, led to an improved prognosis in many cancers. The use of immunotherapy was also associated with manageable adverse event profiles and promising results in the treatment of patients with gastric cancer, especially in heavily pretreated patients. These data have led to an accelerated approval of some checkpoint inhibitors in this setting. Understanding the complex relationship between the host immune microenvironment and tumor and the immune escape phenomenon leading to cancer occurrence and progression will subsequently lead to the identification of prognostic immune markers. Furthermore, this understanding will result in the discovery of both new mechanisms for blocking tumor immunosuppressive signals and pathways to stimulate the local immune response by targeting and modulating different subsets of immune cells. Due to the molecular heterogeneity of gastric cancers associated with different clinico-biologic parameters, immune markers expression and prognosis, novel immunotherapy algorithms should be personalized and addressed to selected subsets of gastric tumors, which have been proven to elicit the best clinical responses. Future perspectives in the treatment of gastric cancer include tailored dual immunotherapies or a combination of immunotherapy with other targeted agents with synergistic antitumor effects.
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Affiliation(s)
- Daniela Cornelia Lazăr
- Department of Internal Medicine I, University Medical Clinic, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Timiş County, Romania
| | - Mihaela Flavia Avram
- Department of Surgery X, 1st Surgery Clinic, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Timiş County, Romania
| | - Ioan Romoșan
- Department of Internal Medicine I, University Medical Clinic, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Timiş County, Romania
| | - Mărioara Cornianu
- Department of Pathology, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Timiş County, Romania
| | - Sorina Tăban
- Department of Pathology, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Timiş County, Romania
| | - Adrian Goldiș
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Timiş County, Romania
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Surdea-Blaga T, Băncilă I, Dobru D, Drug V, Frățilă O, Goldiș A, Grad SM, Mureșan C, Nedelcu L, Porr PJ, Sporea I, Dumitrașcu DL. Mucosal Protective Compounds in the Treatment of Gastroesophageal Reflux Disease. A Position Paper Based on Evidence of the Romanian Society of Neurogastroenterology. JGLD 2016; 25:537-546. [DOI: 10.15403/jgld.2014.1121.254.dea] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Background & Aims: Gastroesophageal reflux disease (GERD) therapy is challenging and suppression of acid secretion or prokinetics do not cure all cases. Some drugs with protective action on the esophageal mucosa have been used alternatively or in association with proton pump inhibitors (PPIs) and/or prokinetics. The Romanian Society of Neurogastroenterology undertook an Evidence-Based analysis, from which this position paper evolved.
Methods: We performed a systematic literature search in PubMed until October 2015, using the terms: sucralfate, guaiazulene, gaiazulene, dimethicone, alginate, antacids and gastroesophageal reflux. Forty-seven papers were included and analyzed. Several statements were elaborated regarding the use of these drugs in GERD. The evidence and recommendations were discussed between the authors.
Results: There is evidence in the medical literature suggesting the benefit of these drugs in GERD. In patients with persistent or mild reflux symptoms antacids rapidly relieve heartburn. Alginate-antacid combination is superior both over placebo and antacids to treat mild reflux symptoms, and can be used to treat persistent reflux symptoms despite acid suppressant therapy. Sucralfate is superior over placebo in alleviating GERD symptoms and can be used as maintenance therapy. Guaiazulene-dimethicone improves the quality of life in patients with GERD.
Conclusions: Drugs used to protect the esophageal mucosa against acid are useful in alleviating chronic heartburn, especially in patients with mild reflux symptoms.
Abbreviations: CS: Chondroitin sulfate; DA: Double Action; EE : Erosive esophagitis ; GERD: Gastroesophageal reflux disease; HA: Hyaluronic acid; H2RA: Histamine 2 receptor antagonist; ITT: Intention to treat; IM: Irsogladine maleate; NERD: Non-erosive reflux disease; PPIs: Proton pump inhibitors; RCT: Randomized controlled trial; RDQ: Reflux disease questionnaire; QoL: Quality of life.
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