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Chronic pancreatitis (CP) is an end-stage disease with no specific therapy; therefore, an early diagnosis is of crucial importance. In this study, data from 1315 and 318 patients were analysed from acute pancreatitis (AP) and CP registries, respectively. The population from the AP registry was divided into AP (n = 983), recurrent AP (RAP, n = 270) and CP (n = 62) groups. The prevalence of CP in combination with AP, RAP2, RAP3, RAP4 and RAP5 + was 0%, 1%, 16%, 50% and 47%, respectively, suggesting that three or more episodes of AP is a strong risk factor for CP. Laboratory, imaging and clinical biomarkers highlighted that patients with RAP3 + do not show a significant difference between RAPs and CP. Data from CP registries showed 98% of patients had at least one AP and the average number of episodes was four. We mimicked the human RAPs in a mouse model and found that three or more episodes of AP cause early chronic-like morphological changes in the pancreas. We concluded that three or more attacks of AP with no morphological changes to the pancreas could be considered as early CP (ECP).The new diagnostic criteria for ECP allow the majority of CP patients to be diagnosed earlier. They can be used in hospitals with no additional costs in healthcare.

Background This case report addresses the diagnostic challenge of distinguishing intestinal tuberculosis (ITB) from Crohn’s disease, with a focus on the potential role of fecal zonulin as a noninvasive biomarker. Case presentation A 43-year-old female with a history of deep vein thrombosis, asthma, and previously treated pulmonary tuberculosis presented with fatigue, chronic diarrhea, diffuse abdominal pain, significant weight loss (~ 20 kg), and anorexia. Laboratory findings included a positive fecal occult blood test and markedly elevated fecal calprotectin (3370 µg/g, normal range: < 50 μg/g). Celiac disease serologies were negative. Abdominopelvic tomography showed pathological thickening of the digestive tract wall. Fecal zonulin was normal (10.75 ng/mL, reference range < 107 ng/mL). Upper endoscopy revealed multiple gastric ulcers and an esophageal ulcer suggestive of tuberculosis. Despite clinical and biochemical features mimicking IBD, endoscopic findings and normal fecal zonulin levels prompted suspicion of gastrointestinal TB. The pulmonology department confirmed intestinal tuberculosis and reactivation of the pulmonary tuberculosis after microscopic examination of the patient’s sputum and fecal samples. Antituberculous therapy was initiated with favorable evolution. Conclusion This case highlights the diagnostic overlap between ITB and Crohn’s disease and underlines the importance of integrating clinical history, imaging, and biomarkers. Fecal zonulin may aid in differentiating ITB from Crohn’s disease by reflecting intestinal permeability patterns, potentially preventing misdiagnosis and inappropriate immunosuppressive treatment. As a biomarker reflecting intestinal barrier integrity, fecal zonulin measurement may have broader implications that warrant further investigation.

Background Inflammatory bowel diseases (IBD), Crohn’s disease and ulcerative colitis, are affecting millions of people around the world with an increasing incidence. Fatigue is an exhausting and highly relevant symptom in patients with inflammatory bowel disease. This study was aimed to investigate the influence of disease activity, paraclinical findings, and level of vitamin B1 on fatigue in patients with IBD. A cross-sectional study including questionnaires was performed on patients with IBD in Gastroenterology Clinic No. 1 in Targu Mures. Additionally, demographic data, laboratory data, IBD history, treatment, and current disease activity were recorded. The blood samples of patients were analyses for level of B1 vitamin. Fatigue severity was assessed using FACIT-F score, a fatigue scale. Results A total of 41 patients with IBD were enrolled (43.9% with Crohn’s disease and 56.1% with ulcerative colitis). Fatigue was reported by 41.5% of patients, and 21.95% declared to experience severe fatigue. Thiamine level was not associated with the presence of fatigue. Female sex was associated with the presence of fatigue ( p  =  0.005 ). Positive significant correlations were demonstrated between FACIT-F score and level of hemoglobin and ( p  =  0.006 , r  =  0.58 ), hematocrit level ( p  =  0.0031 , r  =  0.45 ), albumin ( p  =  0.01 , r  =  0.366 ), and total proteins ( p  =  0.033 , r  =  0.330 ). Conclusion Fatigue was identified at almost half of patients with IBD. The plasma level of thiamine in IBD patients was normal, regardless of the presence of fatigue. Fatigue was positively correlated with female sex, active disease, level of hemoglobin, and albumin.

. We report one elderly patient diagnosed with a rare subtype of acute myeloid leukemia (AML) and also with a very rare fusion gene involving ARHGEF12 (LARG, 11q23.3) and MAPRE1 (EB1, 20q11.21) genes. . Clinical examination and routine analysis were performed including peripheral blood smear, immunophenotyping of the peripheral blood by flow cytometry and several molecular analyses. . Peripheral blood smear showed 80% blasts with round and some with convoluted nuclei, with basophilic cytoplasm, identified as monoblast and the majority of cells as promonocytes. Peripheral blood immunophenotyping was consistent with monocytic differentiation. Molecular analysis was negative for FLT3 ITD, FLT3 D835, NPM1, and DNMT3A R882 mutations. Multiplex ligation-dependent probe amplification revealed no copy number aberration. Ligation-dependent reverse transcription polymerase chain reaction (LD-RT-PCR) analysis identified the presence of one gene fusion between ARHGEF12 (LARG, 11q23.3) and MAPRE1 (EB1, 20q11.21) genes. The patient had no significant comorbidities, the renal function was normal and Eastern Cooperative Oncology Group performance status was 2 at diagnosis and 1 after treatment. She was treated with decitabine. She became transfusion independent and a reduction of the number of blasts was obtained. . The outcome of our AML patient was favorable but other patients with fusion genes involving ARHGEF12 (LARG, 11q23.3) and MAPRE1 (EB1, 20q11.21) should be reported, contributing to a better characterization of the disease, to monitor the minimal residual disease and in the end to more targeted treatment options. LD-RT-PCR represent a valuable multiplex technique for fusion gene analysis.

Background: Colon polyps are precursors of colorectal cancer (CRC), therefore their endoscopic detection is very important. A shift of in the localization of colorectal polyps toward the proximal colon has been recently observed in Western countries.Aim: The aim of this paper was to establish the most important clinical and endoscopic aspects of right colon polyps and to correlate them with their histopathological types, with an emphasis on sessile serrated adenomas/polyps (SSA/Ps).Material and method: We perfomed a retrospective study on a series of consecutive patients who underwent colonoscopy in the Gastroenterology and Endoscopy Unit of the County Emergency Clinical Hospital of Tîrgu Mureș between January 1, 2010 – December 31, 2014, comparing the results with those of patients who underwent colonoscopy between January 1, 2005 – December 31, 2009. In all cases with abnormal aspects at endoscopy, multiple biopsies were taken for histopathological examination. Only cases where the diagnosis of colon polyp was confirmed by the Histopathology Department were included in the study.Results: In the 2010–2014 period there were 871 patients diagnosed with colon polyps (1,038 polyps), with a mean age of 62.28 years. The most frequent histopathological form was tubular adenoma in 55.97% of cases (n = 581). SSA/Ps were found in 66 patients (75 polyps). Considering all polyps, the most frequent localization was in the sigmoid colon in 32.36% of cases (n = 336), but for SSA/Ps the most common localization was the ascending colon in 24% of cases (n = 18), followed by the sigmoid colon in 21.33% of cases (n = 16). Compared with patients investigated between 2005 and 2009, we found an increasing localization in the right colon, from 10.43% (n = 67) in 2005–2009 to 15.41% (n = 160) in 2010–2014. SSA/Ps were found in the right colon in 5.97% of cases (n = 4) in the first period compared with 11.25% of cases (n = 18) in the second period.Conclusions: In the last years we found an increasing localization of colon polyps in the right colon. These findings underscore the importance of high quality colonoscopy to maximize protection against colorectal cancer.

Chronic pancreatitis (CP) is characterised by irreversible damage to the pancreas causing endocrine and exocrine dysfunction which results in decreased quality of life and reduced life expectancy.1

Pancreatic necrosis is a consistent prognostic factor in acute pancreatitis (AP). However, the clinical scores currently in use are either too complicated or require data that are unavailable on admission or lack sufficient predictive value. We therefore aimed to develop a tool to aid in necrosis prediction. The XGBoost machine learning algorithm processed data from 2387 patients with AP. The confidence of the model was estimated by a bootstrapping method and interpreted via the 10th and the 90th percentiles of the prediction scores. Shapley Additive exPlanations (SHAP) values were calculated to quantify the contribution of each variable provided. Finally, the model was implemented as an online application using the Streamlit Python-based framework. The XGBoost classifier provided an AUC value of 0.757. Glucose, C-reactive protein, alkaline phosphatase, gender and total white blood cell count have the most impact on prediction based on the SHAP values. The relationship between the size of the training dataset and model performance shows that prediction performance can be improved. This study combines necrosis prediction and artificial intelligence. The predictive potential of this model is comparable to the current clinical scoring systems and has several advantages over them.

Objective: This study aims to determine the correlation between risk factors and erosive esophagitis development.Methods: We conducted a retrospective observational study on a consecutive series of 19.672 patients who underwent upper gastrointestinal endoscopy between 01.01.2011-31.12.2017. A total of 3005 patients, diagnosed with erosive esophagitis, were included in the present study and stratified according to Los Angeles classification.Results: During the studied period we found 3005 patients with erosive esophagitis, sex ratio male to female was 1.3/1, the most common forms of esophagitis being grade A and B: 74.54% patients with esophagitis grade A, 14.80% patients with grade B; 5.29% patients were with grade C and 5.35% patients with esophagitis grade D. In severe esophagitis the male predominance was more prevalent (249 males, 71 female), with a sex ratio 3.50/1. The correlation of male gender with severe esophagitis was highly statistically significant (p < 0.0001, OR 2.97; 95% CI 2.25-3.91). Hiatal hernia was diagnosed in 1171 patients, the presence of large hiatal hernias, being an important predictor, with statistical significance (p < 0.0001, OR 3.41; 95% CI 2.22-5.21), for severe esophagitis development. Incidence of Helicobacter pylori infection was 11.51%, in the entire study group, with no statistical significant difference between patients with mild or severe esophagitis (12.02% vs 7.18%).Conclusion: Erosive esophagitis is a frequent disease, the most common forms being grade A and B. Male gender and the presence of hiatal hernia are the most important risk factors for erosive esophagitis development, in our study group.