Journal of gastrointestinal and liver diseases : JGLD最新文献

{"title":"Metabolic Dysfunction-associated Steatotic Liver Disease in Romania: A Multidisciplinary Position Paper on Prevalence, Clinical Spectrum, Prevention, Screening and Management.","authors":"Liliana-Simona Gheorghe, Jeffrey V Lazarus, Heiner Wedemeyer, Nancy Reau, Corina Pop, Vlad Ratziu, Anca Trifan, Ines Mega, Dragos Bumbacea, Gindrovel Dumitra, Dan Gheonea, Lucia Grijac, Razvan Hainarosie, Gener Ismail, Ioana Lupescu, Ligia Mosneaga, Bogdan Obrisca, Roxana Rimbas, Anca Sirbu, Roxana Sirli, Mihaela Udrescu, Dragos Vinereanu, Mihaela Vladu, Sorina Diaconu, Laura Huiban, Dan Dumitrascu, Speranta Iacob","doi":"10.15403/jgld-7454","DOIUrl":"10.15403/jgld-7454","url":null,"abstract":"<p><strong>Background and aims: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease globally and a rising cause of cirrhosis, hepatocellular carcinoma, liver transplantation, cardiovascular events and impaired quality of life. In Romania, a 30-33% adult prevalence would correspond to approximately 4.5-5.1 million adults with MASLD, including an estimated 225,000-410,000 with the progressive phenotype of metabolic dysfunction-associated steatohepatitis (MASH) with fibrosis. In May 2026, a national multidisciplinary initiative was launched to support a coordinated response aligned with the World Health Assembly. draft resolution on steatotic liver disease.</p><p><strong>Methods: </strong>The 3rd Romanian Forum of Metabolic Hepatology (Bucharest, 12 March 2026), co-hosted by Romanian Society of Gastroenterology and Hepatology (SRGH) and Romanian Association for Liver Diseases (RoALD), convened hepatology, primary care, metabolic, cardiovascular, renal, respiratory, ENT, transfusion medicine, public health, policy and patient representatives. Evidence, Romanian estimates, EASL-EASD-EASO 2024 guidance and policy documents were reviewed and refined into ten consensus statements.</p><p><strong>Results: </strong>The statements address burden, nomenclature, policy gaps, MASLD phenotypes, metabolic dysfunction and alcohol-associated liver disease (MetALD), integration within the cardio-reno-hepato-metabolic/non-communicable diseases framework, fibrosis-4 index (FIB-4) based case-finding, cross-specialty prescribing, a Romanian clinical care pathway and a national action plan including quality-of-life outcomes and access to EU-approved resmetirom for eligible adults with non-cirrhotic MASH and F2-F3 fibrosis.</p><p><strong>Conclusions: </strong>This position paper provides a Romanian framework for MASLD prevention, detection and care, requiring coordinated action by professional societies, health authorities, the Romanian National Health Insurance Agency (CNAS), primary care, patient organisations and civil society.</p>","PeriodicalId":94081,"journal":{"name":"Journal of gastrointestinal and liver diseases : JGLD","volume":" ","pages":"482-491"},"PeriodicalIF":2.0,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time Trends and Impact on Treatment Outcomes of Psychiatric Diagnoses in Patients with Eosinophilic Esophagitis.","authors":"Alexandra A Weir, Stefani Aleman, Sean S LaFata, Timothy S Gee, Angelica R Lackey, Arjun K Juneja, Hannah L Thel, Brenderia A Cameron, Justin McCallen, Christopher J Lee, Gustaf N Hendrick, Jose C Bermudez, Daniel Song, Trevor S Barlowe, Walker D Redd, Cary C Cotton, Craig C Reed, Evan S Dellon","doi":"10.15403/jgld-7110","DOIUrl":"10.15403/jgld-7110","url":null,"abstract":"<p><strong>Background and aims: </strong>While mental illness is common in eosinophilic esophagitis (EoE), it is unknown whether psychiatric diagnosis frequency has varied over time or impacts treatment outcomes. We aimed to determine time trends in psychiatric diagnoses in EoE and whether such diagnoses affect EoE treatment outcomes.</p><p><strong>Methods: </strong>In this retrospective cohort study of newly diagnosed EoE patients, medical records were examined to determine psychiatric diagnoses and psychoactive medication use. For patients who also had treatment with either a topical corticosteroid (tCS) or diet elimination and had a follow-up endoscopy with biopsy, histologic, endoscopic, and symptom responses were assessed. We evaluated time-trends in psychiatric diagnoses over >2 decades and compared tCS and diet elimination treatment response between patients with and without psychiatric diagnoses.</p><p><strong>Results: </strong>Of 1291 newly diagnosed patients with EoE, 29% had a concomitant psychiatric diagnosis (18% depression; 24% anxiety) and 25% were on psychiatric medications. Over the 2-decade study timeframe, there was a slight overall increase in psychiatric diagnoses. However, diagnoses spiked in 2020 to >50% during the coronavirus disease 2019 (COVID-19) pandemic. There was no worsening in response rates for those with psychiatric diagnoses for either tCS or diet elimination treatment.</p><p><strong>Conclusions: </strong>Psychiatric diagnoses demonstrate a slight increase in EoE over the past 2 decades, though rates spiked during the COVID-19 pandemic, substantiating the burden of depression and anxiety during this time. Interestingly, the presence of a psychiatric disorder did not impact treatment outcomes to either tCS or diet elimination, so either option is viable in EoE patients with these diagnoses.</p>","PeriodicalId":94081,"journal":{"name":"Journal of gastrointestinal and liver diseases : JGLD","volume":" ","pages":"329-334"},"PeriodicalIF":2.0,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13524413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peri-procedural Lidocaine Administration for Radiofrequency Ablation of Hepatocellular Carcinoma: A Pilot Study.","authors":"Sergiu Sargarovschi, Zeno Adrian Sparchez, Alexandru Leonard Alexa, Andreea Paunescu, Ioana Rucsanda, Dan Valean, Andreea Benea, Daniela Ionescu","doi":"10.15403/jgld-7414","DOIUrl":"10.15403/jgld-7414","url":null,"abstract":"<p><strong>Background and aims: </strong>Radiofrequency ablation (RFA) is a curative option for early-stage hepatocellular carcinoma (HCC) when liver resection or transplantation is not a suitable option. This study evaluated whether a peri-procedural intravenous lidocaine infusion could reduce neutrophil extracellular trap formation (NETosis), neutrophil-to-lymphocyte ratio (NLR) and improve 1-year outcomes after RFA.</p><p><strong>Methods: </strong>In this single-centre, randomized trial, 50 adult HCC patients undergoing RFA were allocated 1:1 to receive propofol-fentanyl sedation alone (PF group, n=25) or combined with intravenous lidocaine (1.5 mg/kg bolus, then 1 mg/kg/h for 24 hours; PF-L group, n=25). Serum citrullinated histone H3 (H3Cit), NLR, and C-reactive protein (CRP) were assessed at baseline and 24 hours post-ablation. The primary endpoint was the change in H3Cit expression. Secondary endpoints included changes in NLR and C-reactive protein (CRP), as well as 1-year overall mortality, disease-free survival, and local recurrence rates.</p><p><strong>Results: </strong>24 patients in PF-L group and 25 patients in PF group completed the study. Intra-group H3Cit levels significantly decreased from baseline at 24 hours only in the PF-L group (p=0.031). However, the between-group difference in H3Cit variation levels was not significant (p=0.352). Postoperative NLR changes were also comparable between groups (p=0.354). The overall 1-year mortality rate was 12%, with no significant variance between the two arms.</p><p><strong>Conclusions: </strong>Adding intravenous lidocaine to sedation resulted in an intra-group reduction in H3Cit expression following RFA but did not produce a statistically significant reduction compared to standard propofol-fentanyl sedation alone. 1-year survival and local recurrence rates did not differ between groups. However, our preliminary findings justify the need for larger, baseline-balanced trials to evaluate periprocedural NETosis modulation by sedation regimen.</p>","PeriodicalId":94081,"journal":{"name":"Journal of gastrointestinal and liver diseases : JGLD","volume":" ","pages":"400-406"},"PeriodicalIF":2.0,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Peroral Endoscopic Myotomy (POEM) for Achalasia in Post-Bariatric Surgery Patients: A Systematic Review and Meta-Analysis.","authors":"Amany Mahmoud Genidy, Lara Hamzeh Hamzeh, Dania Mohammad AbuHawas, Mohamed Karam Allah Elkholy, Mohamed Abdelhalim, Omer Hussein Alwi Bin-Sahel, Salman Farooq Dar, Jawad Mahmood","doi":"10.15403/jgld-6743","DOIUrl":"10.15403/jgld-6743","url":null,"abstract":"<p><strong>Background and aims: </strong>Peroral endoscopic myotomy (POEM) is an emerging process that turned out to be a highly favored minimally invasive technique for achalasia treatment even in the presence of anatomical alteration as in bariatric surgery. POEM applications on bariatric patients showed promising results in the term of technical success and symptom improvement. We evaluated the available evidence regarding the effectiveness and safety of POEM therapy for patients with achalasia who have previously undergone bariatric surgery.</p><p><strong>Methods: </strong>We followed the PRISMA guidelines for meta-analysis. We included studies reporting on bariatric patients with achalasia who underwent POEM. Our primary outcomes were technical Success, clinical Success, post-POEM Eckardt Score, Eckardt Score Change, and complications such as post-procedure leak and intra-procedural bleeding. We used the Joanna Briggs Institute's (JBI) Critical Appraisal Tool for quality assessment.</p><p><strong>Results: </strong>Twelve studies were included in this review. The mean Eckardt Score Change was -5.09 (95%CI: -6.05 to -3.67). The clinical and technical success were 95% (95%CI: 0.88-1.00) and 99% (95%CI: 0.93-1.00). The total adverse events rate was 5% (95%CI: 0-0.12). The pooled proportion for postprocedural leak was 2% (95%CI: 0-0.10). The mortality rate was 0% (95% CI: 0-0.06).</p><p><strong>Conclusions: </strong>Our systematic review and meta-analysis demonstrated that POEM seems to be an effective and safe treatment for achalasia in patients with prior bariatric surgery. Further prospective studies with standardized protocols and longer follow-up are needed to support our initial findings, refine patient selection, optimize technique, and establish the long-term durability of outcomes.</p>","PeriodicalId":94081,"journal":{"name":"Journal of gastrointestinal and liver diseases : JGLD","volume":" ","pages":"421-434"},"PeriodicalIF":2.0,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deaths Due to Second Hematological Malignancies Following Gastrointestinal Cancers: A Nationwide 25-Year Cross-Sectional Analysis.","authors":"Shree Rath, Amar Lal, Ahmed Hasan, Muhammad Ali, Iffat Ambreen Magsi, Umama Alam, Mishaim Khan","doi":"10.15403/jgld-6802","DOIUrl":"10.15403/jgld-6802","url":null,"abstract":"<p><strong>Background and aims: </strong>Cancer survivors, particularly those treated for gastrointestinal (GI) cancers, face an elevated risk of developing secondary hematological malignancies (SHMs) such as leukemia, lymphoma, and myelodysplastic syndromes. This study aimed to analyze national trends in mortality due to SHMs among older adults with GI malignancies over 25 years.</p><p><strong>Methods: </strong>We conducted a descriptive analysis of SHM-related deaths in patients with GI malignancies using CDC-WONDER death certificate data from 1999 to 2023. Age-adjusted mortality rates (AAMRs) were calculated, and annual percent change (APC) and average annual percent change (APC) were determined using the JoinPoint Regression to identify significant temporal changes.</p><p><strong>Results: </strong>A total of 22,668 deaths occurred due to hematological and GI malignancies. The AAMR increased from 21.88 in 1999 to 25.55 in 2023. Significant trends were observed, with an initial decline from 1999 to 2017, followed by a sharp increase from 2017 to 2023 (AAPC: 5.49; 95%CI: 3.63-8.61). Males exhibited a higher average AAMR compared to females. Crude mortality rates increased with age, with the lowest in the 65-74 age group and the highest in the 85+ age group. Non-Hispanic Whites had the highest average AAMR (22.35), followed by Blacks (18.84). Non-metropolitan areas consistently had higher AAMRs (23.37; 95%CI: 19.89-26.85) compared to metropolitan areas (19.98; 95%CI: 18.46-21.50).</p><p><strong>Conclusion: </strong>This study highlighted significant temporal trends in SHM-related mortality among GI-cancer patients aged 65 and older. The increasing mortality rates, particularly post-2017, call for targeted interventions to address disparities and improve outcomes for vulnerable populations.</p>","PeriodicalId":94081,"journal":{"name":"Journal of gastrointestinal and liver diseases : JGLD","volume":" ","pages":"414-420"},"PeriodicalIF":2.0,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-volume PEG-citrate-simethicone versus Standard 4L PEG for Bowel Preparation before Colonoscopy: A Prospective Real-world Study.","authors":"Teodora Surdea-Blaga, Andrei-Vasile Pop, Dan L Dumitrascu, Flaviu Rusu, Stefan-Lucian Popa, Cristina-Maria Sabo, Alexandra Chira, Abdulrahman Ismaiel, Simona Grad","doi":"10.15403/jgld-7158","DOIUrl":"https://doi.org/10.15403/jgld-7158","url":null,"abstract":"<p><strong>Background and aims: </strong>Adequate bowel preparation is essential for high-quality colonoscopy, yet no single preparation regimen has demonstrated clear superiority. Low-volume polyethylene glycol (PEG)-based solutions are increasingly used to improve patient tolerability, but real-world comparative data remain limited. We aimed to compare bowel cleansing quality and patient tolerability between a low-volume [2 liters (L)] PEG-citrate-simethicone regimen (2L-PEG-CS) and a standard 4-L PEG regimen in routine clinical practice.</p><p><strong>Methods: </strong>This prospective, open-label, comparative study included consecutive adult patients undergoing diagnostic colonoscopy. Bowel preparation quality was assessed using the Boston bowel preparation scale (BBPS) and the Ottawa bowel preparation scale (OBPS). The primary endpoint was bowel cleansing quality; secondary outcomes included patient-reported tolerability, satisfaction, and willingness to repeat the preparation.</p><p><strong>Results: </strong>A total of 124 patients were included in the analysis (47.6% received 2L-PEG-CS; 52.4% received 4-L PEG). Mean total BBPS scores were slightly higher in the 2L-PEG-CS group than in the 4-L PEG group (7.6±1.2 vs. 7.1±1.5; p=0.03). Adequate bowel preparation (BBPS ≥ 6) was achieved in 98.3% of patients receiving 2L-PEG-CS and 84.6% receiving 4-L PEG (p=0.01), while rates of high-quality preparation were similar between groups. Total OBPS scores did not differ significantly between regimens (4.2±3.2 vs. 5.0±3, p=0.14). Foam scores were lower in the 2L-PEG-CS group (p<0.001). Patients receiving 2L-PEG-CS reported higher satisfaction, better taste, greater completion of the prescribed preparation, and a higher willingness to repeat the same regimen if needed.</p><p><strong>Conclusions: </strong>Low-volume PEG-citrate-simethicone showed bowel cleansing quality comparable to standard 4-L PEG, with more favorable patient-reported tolerability. These findings suggest that it may be a reasonable alternative in routine clinical practice.</p>","PeriodicalId":94081,"journal":{"name":"Journal of gastrointestinal and liver diseases : JGLD","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of Gastric Cancer Screening in Vulnerable Populations: A Comprehensive Analysis of the TOGAS Qualitative Study in the Romanian Roma Community.","authors":"Radu Alexandru Farcas, Dan L Dumitrașcu, Tessa Groen, Noa E A Kapteijn, Doina Olteanu, Anda Păcurar, Teodora Surdea-Blaga, Liliana David, Janet Takens, Wessel Van de Veerdonk, Judith Honing, Manon Spaander, Mārcis Leja, Marlon Van Loo","doi":"10.15403/jgld-7343","DOIUrl":"https://doi.org/10.15403/jgld-7343","url":null,"abstract":"<p><strong>Background and aims: </strong>Gastric cancer (GC) remains a formidable global health burden. While incidence rates have declined in Europe, substantial differences between countries exist. In Romania, GC remains the sixth most prevalent cancer. This epidemiological divide is driven largely by the high prevalence of Helicobacter pylori (H. pylori), a class I carcinogen. Despite the proven efficacy of \"screen-and-treat\" strategies in high-incidence Asian cohorts, the European Union currently lacks organized, population-based GC screening programs. The Romanian Roma community experiences profound socioeconomic marginalization, resulting in starkly unequal access to preventative screening opportunities.</p><p><strong>Methods: </strong>A qualitative, co-creative focus-group study was conducted in Cluj County, Romania, to assess the perception and the acceptability of GC screening among Roma adults. Utilizing a convenience sampling strategy, 36 participants (aged 18-75) were recruited. The study employed a sequential, two-stage design comprising an initial educational session to establish foundational health literacy regarding gastric anatomy and H. pylori, followed by a semi-structured focus group discussion. Data were analyzed using a modified grounded theory approach to identify core themes regarding screening knowledge, diagnostic preferences, and communication barriers.</p><p><strong>Results: </strong>The analysis revealed a significant \"concept gap,\" with the term \"screening\" being unrecognizable to most participants. While theoretical willingness to participate in the program was high, it was heavily stratified by testing modality. The majority of participants demonstrated a decisive preference for serology and urea breath test due to familiarity of serology and perceived non-invasiveness of the breath test. Conversely, stool antigen testing was viewed with reluctance due to logistical barriers related to sanitation and dignity. Acceptance of invasive gastroscopy was conditional, dependent entirely on the recommendation of a trusted general practitioner (GP).</p><p><strong>Conclusions: </strong>Implementing organized GC screening in the Roma community requires a paradigm shift from population invitation models to flexible, community-centered approaches. Successful implementation will require reframing \"screening\" as a \"stomach health check,\" utilizing GPs as the primary recruitment node, and deploying Roma health mediators to bridge the literacy and trust gap. These findings underscore the necessity of precision in public health that adapts clinical guidelines to the social realities.</p>","PeriodicalId":94081,"journal":{"name":"Journal of gastrointestinal and liver diseases : JGLD","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bloating after Silicone Breast Implants.","authors":"Dinu Iuliu Dumitrascu, Lucia Timis, Daniel Corneliu Leucuta","doi":"10.15403/jgld-7566","DOIUrl":"10.15403/jgld-7566","url":null,"abstract":"<p><strong>Background and aim: </strong>Empirical data suggest that women submitted to silicone breast implant surgery report bloating after intervention. We aimed to look to this phenomenon in a retrospective study.</p><p><strong>Methods: </strong>An online ad-hoc survey was created. It included 22 items aiming to collect essential biographical data and occurrence of gastrointestinal symptoms after esthetic surgery. Subjects invited to fill the questionnaire were people from a data base of a busy esthetic clinic. Respondents were included in two groups: one group with breast implant surgery and a control group with other interventions without silicone implantation. Participants filling criteria for disorders for gut brain interaction including functional bloating were excluded from the analysis.</p><p><strong>Results: </strong>The group with silicone implants included 32, the control group included 34 women. Both groups had no baseline differences. The group with silicone breast implants presented significantly higher odds [6.3 (95% CI 2.0 - 22.9, p=0.003)] of bloating than the control group, after adjustment for confounders (age, previous disorders of gut-brain interactions). Symptoms occurred in the first postoperative days and lasted 1-3 weeks.</p><p><strong>Conclusions: </strong>This is a retrospective study based on an online survey confirming the onset of bloating after silicone breast surgery in the absence of functional bloating. This study brings evidence to endorse empirical reports. Potential mechanisms of this association are discussed.</p>","PeriodicalId":94081,"journal":{"name":"Journal of gastrointestinal and liver diseases : JGLD","volume":" ","pages":"350-354"},"PeriodicalIF":2.0,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148709277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ocular Manifestations of Wilson Disease: Pathophysiology, Clinical and Paraclinical Features.","authors":"Valeria Coviltir, Cristina Sabo, Ariadna Patricia Nicula, Maria Cristina Marinescu","doi":"10.15403/jgld-7494","DOIUrl":"https://doi.org/10.15403/jgld-7494","url":null,"abstract":"<p><p>Wilson disease (WD) is an autosomal recessive disorder caused by mutations in the ATP7B gene, resulting in impaired biliary copper excretion and progressive copper accumulation in multiple tissues. Ocular manifestations represent some of the most characteristic and clinically valuable features of the disease, contributing to diagnosis, monitoring, and assessment of neurological involvement. This narrative review summarizes current knowledge regarding the pathophysiology, clinical presentation, and imaging characteristics of ocular involvement in WD. Copper deposition within the eye occurs primarily through the aqueous humor, leading to accumulation in the corneal Descemet membrane and lens capsule. Kayser-Fleischer rings remain the most prevalent ocular sign being strongly associated with neurological disease, while sunflower cataracts represent a less common but highly characteristic manifestation. Anterior segment optical coherence tomography and in vivo confocal microscopy have recently improved the detection and monitoring of these lesions. Beyond copper deposition, growing evidence indicates that WD is associated with retinal and optic nerve neurodegeneration. Optical coherence tomography studies consistently demonstrate thinning of the retinal nerve fiber layer, ganglion cell complex, and macular structures, particularly in patients with neurological involvement. Electrophysiological investigations, including visual evoked potentials and electroretinography, reveal delayed neural conduction and retinal dysfunction, supporting the concept of widespread neuro-ophthalmological impairment. Optical coherence tomography angiography further identifies microvascular alterations affecting retinal and peripapillary capillary networks. Importantly, several ocular abnormalities correlate with neurological severity and may serve as non-invasive biomarkers of disease progression. Current treatments, including copper chelators and zinc therapy, can induce regression of Kayser-Fleischer rings and sunflower cataracts. Ocular assessment therefore provides a valuable window into systemic and neurological disease activity, highlighting the importance of multidisciplinary management and the potential role of emerging imaging biomarkers in Wilson disease.</p>","PeriodicalId":94081,"journal":{"name":"Journal of gastrointestinal and liver diseases : JGLD","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Crohn᾿s Disease and Ulcerative Colitis: The Role of Endoscopic, Hemogram-derived, Nutritional, and Hepatic Scores.","authors":"Abdulrahman Ismaiel, Maya Ștefania Borlan, Daniel-Corneliu Leucuta, Stefan-Lucian Popa, Simona Grad, Teodora Surdea-Blaga, Nahlah Al Srouji, Mohamed Abosheisha, Mohamed Ismaiel, Dinu Iuliu Dumitrascu","doi":"10.15403/jgld-7495","DOIUrl":"10.15403/jgld-7495","url":null,"abstract":"<p><strong>Background and aims: </strong>Inflammatory bowel disease (IBD) requires reliable non-invasive biomarkers to monitor mucosal healing, systemic inflammation, and gut-liver axis involvement. This study evaluated the diagnostic potential of accessible clinical parameters, including fecal calprotectin (FC), hemogram-derived ratios, and composite albumin-integrating and liver fibrosis scores, alongside standardized endoscopic severity findings.</p><p><strong>Methods: </strong>This retrospective observational study included 36 adult IBD patients [21 with Crohn's disease (CD), 15 with ulcerative colitis (UC) receiving biological therapy. Systemic inflammatory indices [e.g., neutrophil-lymphocyte ratio (NLR)], nutritional scores [e.g. prognostic nutritional index (PNI)], and hepatic fibrosis scores [e.g. aspartate aminotransferase to platelet ratio index (APRI), fibrosis 4 (FIB-4), platelet-albumin-bilirubin (PALBI)] were assessed. Receiver operating characteristic (ROC) curve analysis evaluated the diagnostic performance, reported as area under the curve (AUC), of these biomarkers.</p><p><strong>Results: </strong>Routine laboratory parameters and non-invasive liver fibrosis indices showed no statistically significant differences between CD and UC patients. Biologic treatment initiation differed significantly between the groups (p<0.001). Endoscopically, CD presented marked phenotypic heterogeneity with predominantly ileocolonic involvement, whereas active UC was characterized mainly by pancolitis. Fecal calprotectin concentrations were notably higher in UC (median 1000 μg/g) compared to CD (310 μg/g). Diagnostically, FC demonstrated the highest predictive capacity for differentiating the conditions (AUC=0.74). Furthermore, albumin-integrating scores, specifically the PALBI score (AUC = 0.686) and PNI (AUC = 0.657), alongside NLR (AUC=0.632), outperformed traditional hepatic indices in capturing the systemic inflammatory toll. Complex composite inflammatory formulas unexpectedly underperformed.</p><p><strong>Conclusions: </strong>FC remains the most robust non-invasive marker for localized mucosal inflammation. Albumin-integrating scores and simple hemogram-derived ratios better reflect the systemic inflammatory burden than pure hepatic fibrosis indices, but their moderate diagnostic accuracies preclude independent clinical application. Effective IBD management requires integrating these non-invasive adjunctive tools with standard endoscopic assessments within a personalized, multiparametric framework.</p>","PeriodicalId":94081,"journal":{"name":"Journal of gastrointestinal and liver diseases : JGLD","volume":" ","pages":"355-362"},"PeriodicalIF":2.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}