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Introduction: Upper gastrointestinal bleeding can be a life-threatening condition and requires careful evaluation from the very first episode in order to reduce the risk of rebleeding, haemorrhagic shock and death. The outcome of a patient with upper gastrointestinal bleeding depends on resuscitation measures taken during admission to the hospital and an adequate assessment of the patient’s risk level. Aim: The aim of the study is to compare Glasgow Blatchford score and Rockall score and to identify the most accurate score used in predicting unfavorable outcomes and the need for intervention. Methods: This study involves 237 patients with upper gastrointestinal bleeding. The accuracy of the scoring systems was assessed by plotting receiver-operating characteristic curves (ROC curves) and was calculated for GBS and RS with 95% confidence interval (CI). Results: As for mortality prediction, RS was superior to GBS (AUC 0.806 vs. 0.750). The GBS had a higher accuracy in detecting patients who needed transfusion units and was superior to the RS (AUC 0.810 vs.0.675). In predicting the need for intervention, RS was superior to GBS (AUC 0.707 vs. 0.636. Conclusion: GBS and RS are developed to help clinicians to triage patients appropriately in order to assess endoscopic therapy within a suitable time frame, as well as identify low risk patients for possible outpatient management. High accuracy of the GBS in predicting a need for transfusion represents an important endpoint to assess. RS was superior to GBS in predicting a need for intervention as well as mortality. Currently, a combination of these scoring systems is the best way for proper assessment.

Background: Deep Acute pancreatitis (AP) is an urging cause of hospitalization in the gastroenterology due to different causes and an unpredictable outcome. Known causes are grouped into four main groups: metabolic, mechanical, vascular and infectious. Objective: To determine the role of certain biochemical or radiological parameters as predictors of an involvement of other organs in AP different pathological staging and the surgical outcome in the treatment of AP. Methods: Ninety-seven AP patients hospitalized in General Hospital “Prim.dr Abdulah Nakaš” Sarajevo, in a period between 2016 and 2021 for both sexes, were divided according to the etiological factors of AP into four groups: nutritional factors, biliary concernments, alcohol and morphological changes of the pancreas. Beside laboratory tests, the imaging methods of abdomen (transabdominal ultrasound, abdominal computed tomography) used in determining morphological changes in the pancreas and other organs were analyzed in relation to parameters that predict the need for surgical outcomes.Results: AP etiological factors of patients differ significantly by gender and showed the dominance of dietary factors in female subjects (51%), followed by the presence of concernments in the biliary tract in 36% of cases, and alcohol consumption in male subjects in 28% of cases. The only variable correlated with the indicator of necessity for surgery is the existence of pleural effusion (coefficient of correlation was 0.38; risk ratio was 5.5) resulting that patients with pleural effusion have a 5.5 times higher chance of surgery indication than other patients. Conclusion: The application of simple parameters such as creatinine value with the values of amylases in serum and urine and the presence of pleural effusion confirmed by radiological imaging of the lungs opens the possibility of a simple and effective selection of patients for surgical treatment with a more severe form of AP.

Background: Acute gastroenteritis remains an extremely common problem among the general population. In Western countries, an average person will probably face one or two episodes of gastrointestinal infections every year. Objective: The aim of this study was to compare the efficacy of nifuroxazide and probiotic preparation containing lactic acid bacteria in the treatment of acute diarrheal syndrome. Methods: The study was prospective, comparative study. Patients who suffered from acute infective diarrhoea for ≤72 hours and had ≥3 unformed stools per day, with no administration of antibiotics during 10 days before enrolment were divided into two groups: nifuroxazide group and the lactic acid probiotic group. All patients received therapies four times a day for three days. Data was collected at the baseline visit (before the initiation of the treatment) and two follow-up examinations on the third and seventh day from the treatment start. Results: The study included 61 patients, 36 in nifuroxazide group and 25 in probiotic group. Nifuroxazide group compared to probiotic group showed faster improvement of patients’ condition with lower number of stools three and seven days after therapy start (p=0.001 and p<0.001 respectively) and faster stool consistency normalization. On the seventh day from therapy start medium mushy stool consistency was observed in the majority of patients in nifuroxazide group (n=31, 86%) and only in small number of patients in probiotic group (n=5, 20%). Patients were feeling better and there was a trend of reporting better therapy efficacy in nifuroxazide group. Subjective assessment of therapy tolerability was also better in nifuroxazide group. Compliance to therapy and recommended dietary regime was similar between groups and there were no significant differences between groups regarding age, gender, elevated body temperature, abdominal pain, cramps, nausea and vomiting. Conclusion: Although probiotics are sometimes used in the treatment of acute diarrheal syndrome, nifuroxazide has better efficacy and greater patients’ satisfaction. Nifuroxazide can be recommended as the first choice empirical treatment in adult patients with the acute diarrheal syndrome.

Background:  Acute pancreatitis (AP) is an acute inflammatory illness of the pancreas representing a true question in diagnostic process. Laboratory markers of the hepatobiliary tract such as liver transaminases with pancreatic enzymes give a true hint of a hidden diagnosis together with urea, creatinine and creatine kinase (CK). Objective: This clinical study aims to show whether there is any correlation between alpha-amylase and CK or their ratio examining hospitalized patients with AP diagnosis. Methods: From total number of 99 patients with a clinical picture of AP, 71 patients in this retrospective analysis (including both genders) were included according to the presence of two biochemical markers in collected laboratory analysis at admission and 72 hours later on a laboratory check-up: CK and alpha-amylase. Results: The median CK value of AP cases was 92 (41.75 – 207.25) in the acute period and 73 (37 – 159) after 72h staying in the hospital without statistical significant (p=0.521; p<0.05). However, there was a statistically significant correlation between the parameters of CK at admission and creatine kinase after 72h staying in the hospital. The median value of CK/Amylase ratio in the acute period was 0.168 (0.069 – 0.532) and 0.386 (0.12 – 1.12) after 72 hours of staying in the hospital. There was a statistically significant difference between values of CK/amylase ratio in these two groups (p=0.000; p<0.01). Conclusion: In conclusion, a connection between CK and alpha-amylase needs to be elucidated in further studies and its existence must be researched both in physiological and pathophysiological conditions, and it is two-way and very complex. This study helped us obtain significant information about the perspective of AP in the potential relation to other non-standard laboratory markers for some diseases

Non-alcoholic fatty liver disease (NAFLD) is an increasingly common cause of chronic liver disease and is becoming a major public health problem. NAFLD has been recognized as a hepatic manifestation of metabolic syndrome, associated with systemic diseases such as cardiovascular disease (CVD) and chronic kidney disease (CKD). The aim of this study was to examine the role of serum LFT parameters and renal function parameters as predictors of unmanifested liver disease. In this study, the presence of possible liver disease detected by biochemical parameters and confirmed by Transient Liver Elastography (TE) in a group of patients with different stages of chronic kidney disease (CKD) was investigated. Patients with various stages of CKD were divided into five subgroups regarding aetiology: nephroangiosclerosis, diabetic nephropathy, glomerulonephritis and pyelonephritis, autoimmune kidney disease, and polycystic and another morphological kidney disease. Liver stiffness was used to quantify liver fibrosis while Controlled attenuation parameter (CAP) was used to quantify liver steatosis. Functional liver tests and biochemical parameters of kidney function were measured in all patients. Statistical analysis used in this study was a decision tree as a predictive model to map observed variables resulting in the conclusion about outcomes. The application of existing laboratory parameters, in combination with other parameters in presence of the defined etiological factors of kidneys diseases, indicate development of hepatic diseases. Higher values of phosphorus and low values of ferritin in patients with autoimmune kidney disease, and polycystic and another morphological kidney disease, expresses steatosis of the hepatic parenchyma. In contrary, low values of phosphorus and higher values of ferritin in patients with nephroangiosclerosis, diabetic nephropathy, glomerulonephritis and pyelonephritis, are in a favour steatosis of the hepatic parenchyma. Serum values of phosphorus and ferritin are valuable predictors of the liver disease in patients with end-stage kidney diseases of different aetiology.

Background: The Brixia scoring system interpreted chest X-ray changes, serves as an indicator of the extent of changes in the lung parenchyma. Objective: To indicate the effect of D-dimer and C-reactive protein (CRP) on Brixia score in patients with positive polymerase chain reaction (PCR) test for severe acute respiratory syndrome rus 2 Methods: The research had prospective, descriptive and analytical character, and included patients (n=104) with Coronavirus disease 2019 (COVID-19) diagnosis. Chest X-ray, as well as calculation of Brixia score was done on admission, in the first week of hospitalization, on discharge, and 10 days after discharge (the patient was considered a post-COVID patient. Maximum CRP and D-dimer values were taken into account, along with data about dependence of mechanical ventilation and oxygen therapy. Results: Initial Brixia score was significantly associated with the values of CRP (r = .23, p <.05). Higher level of CRP affected the higher result on the Brixia score after the initial X-ray. High CRP and D-dimer were significantly associated with oxygen use in patients, while high D-dimer was also statistically significantly associated with comorbidity. The mean value of Brixia score (during four time points) was significantly related to the values of CRP, D-dimer, the use of mechanical ventilation and oxygen therapy, but also with the existence of comorbidities. The largest statistically significant positive correlaton of Brixia scora is with the values of D-dimer (r = .45, p <.000), but also with the values of CRP (r = .36, p <.000). Conclusion: Values of CRP have an impact on Brixia score. Investigation of clinical characteristics and outcomes of severe clinical presentation of COVID-19 along with CXR scoring system will contribute to early prediction, accurate diagnosis and treatment as well as to improve the prognosis of patients with severe illness.

Despite ongoing findings on the relationship between liver fibrosis in nonalcoholic fatty liver disease (NAFLD) and metabolic syndrome (MetS), this association in diabetic patients remains unclear. Early diagnosis of liver fibrosis is important due to the easily available diagnostic tools, such as noninvasive indices that combine clinical and laboratory variables, and the possibility of preventing its complications in type 2 diabetes mellitus (T2DM) patients with MetS. This study examines the potential predictive values of non-invasive liver fibrosis indices for MetS in T2DM patients. Over the course of a two-year prospective, observational, clinical study, 80 individuals with T2DM randomly selected from the Diabetes Counseling Centers of the Public Institution Health Center of Sarajevo Canton were divided into two groups: T2DM-MetS and T2DM-non-MetS, based on the development of MetS. The study included individuals with T2DM aged 30 to 60 who were clinically diagnosed without MetS, voluntarily agreed to participate, and provided complete data in the collection forms. Serum samples from the patients were assessed for levels of liver enzymes, platelet counts, total cholesterol, high-density lipoprotein cholesterol, fasting glucose, and triglycerides. Various equations were utilized to calculate liver fibrosis indices, including the Aspartate Aminotransferase to Platelet Ratio Index (APRI), Aspartate Aminotransferase to Gamma-Glutamyl Transferase to Platelet Ratio (AGPR), Aspartate Aminotransferase to Alanine Aminotransferase Ratio to Platelet Ratio Index (AARPRI), Fibrosis-4 (FIB-4) Index, Forns Index, and Gamma-Glutamyl Transpeptidase to Platelet Ratio (GPR). Receiver operating characteristic (ROC) analysis was utilized to determine the usefulness of noninvasive liver fibrosis indices for diagnosing MetS in individuals with T2DM. Logistic regression analysis was used to predict the onset of MetS in T2DM patients. Significant differences in the values of APRI (p<0.001), AGPR (p<0.05), AARPRI (p<0.001), and the FIB-4 index (p=0.001) were observed in T2DM-MetS individuals compared to T2DM-non-MetS. According to ROC analysis, the area under the curve (AUC) was found to be highest for APRI (0.84), followed by FIB-4 (0.783) and AARPRI (0.747). Logistic regression analysis identified APRI as an independent positive predictor of MetS (OR 18.179, 95% CI 6.035-24.58, p=0.015). This research highlights the effectiveness of the APRI index as a reliable predictor of MetS development in individuals with T2DM.

EMVI is a direct invasion of a vein by a tumor. As a predictor of hematogenous metastasis, it is a poor prognostic factor in rectal cancer and can be accurately identified on MRI prior to surgical procedure. To evaluate the role of contrast-enhanced T1-weighted magnetic resonance imaging (CET1WI) in addition to high-resolution T2-weighted imaging (HRT2WI) in assessing extramural venous invasion (EMVI) of rectal cancer. In all 195 patients with rectal cancer, HRT2WI and CET1WI sequences were produced within pre-operative MRI for the purpose of assessing for the presence of EMVI (mrEMVI). CET1WI sequences were produced following administration of Gadolinium contrast medium. mrEMVI assessment results were classified into two groups. Group A consisted of mrEMVI assessment results obtained using HRT2WI sequences only. Group B consisted of mrEMVI assessment results obtained using a combination of HRT2WI + CET1WI sequences. Results obtained for each group (A and B) were correlated with a histopathological finding (pEMVI) as a reference standard. Out of a total of 195 rectal cancer patients, mrEMVI was positive in 41 (21%) patients in group A, and in 45 (23%) patients in group B. Histopathological finding demonstrated pEMVI in 54 (27.7%) patients. A statistical analysis of group A (HRT2WI sequences) resulted in 75.9% sensitivity to mrEMVI and 96.4% specificity, Positive Predictive Value of 89.1% and Negative Predictive Value of 91.2% (95% confidence interval (CI), p< 0.05). Statistical analysis of group B (HRT2WI + CET1WI sequences) resulted in 83.3% sensitivity to mrEMVI and 98.5% specificity, Positive Predictive Value of 89.1% and Negative Predictive Value of 91.2% (CI 95%, p< 0.05). T1-weighted magnetic resonance imaging (CET1WI) in addition to high-resolution T2-weighted imaging (HRT2WI) increased evaluation of extramural venous invasion (EMVI) of rectal cancer.

Small bowel and ileocecal diseases remain a diagnostic and therapeutic challenge, despite the introduction of various modalities for deep enteroscopy. Novel Motorized Spiral Enteroscopy is an innovative technology that uses an overtube with a raised spiral at the distal end to pleat the small intestine. It consumes less time and meets both the diagnostic and therapeutic needs of small bowel diseases. The objective of this article is to highlight the possibility of using NMSE as an alternative technique when a target lesion is inaccessible during conventional colonoscopy or cecal intubation cannot be achieved. We report the case of a 61-year-old man who presented with pain in the right lower abdominal segment, diarrhea, and rapid weight loss for more than 3 months. An initial ultrasound showed a suspicious liver metastasis. Computerized tomography scans showed an extensive ileocecal tumor mass with liver metastasis. The colonoscopy was unsuccessful and incomplete due to dolichocolon and intestinal tortuosity. Later, endoscopy was performed using a Novel Motorized Spiral Enteroscope in a retrograde approach, passing the scope through the anus and colon up to the ileocecal segment, where a tumor biopsy was performed and adenocarcinoma was pathohistologically confirmed.

The aim of this article was to present a summary of the current resources available in the literature regarding the role of inflammation in anal cancer development. Anal cancer is relatively uncommon, accounting for about 2.7% of all reported gastrointestinal cancers in the United States. However, the importance of understanding the pathogenesis and risk factors for anal cancer has been recognized over the last several decades due to a noticed increase in incidence worldwide. Infections, autoimmune diseases, and inflammatory diseases of unknown etiology cause chronic inflammation that promotes tumorigenesis. The association between chronic inflammation and cancer development is widely accepted. It is based on different pathophysiological mechanisms that lead to cellular transformation and changes in immunological response, allowing tumor cells to avoid apoptosis and immune surveillance. However, there are still many molecular and cellular mechanisms that remain largely unexplored. Further studies on this topic could be of tremendous significance in elucidating anal cancer pathogenesis and developing immunotherapeutic approaches for its treatment.