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Mateescu RB, Gheorghe C, Trifan AV, Saftoiu A, Seicean A, Diculescu MM, Banciu C, Gheorghe LS, Busuioc B, Goldis A, Dobru D, Fratila O, Eugen D, Bataga S, Constantinescu G, Gheonea D, Tantau A, Jinga M, Brisc C, Cijevschi Prelipcean C, Chira R, Fierbințeanu-Braticevici C, Dumitrascu D, State M, Voiosu T, Negreanu L. Safety, Efficacy and Persistence of Advanced Therapies in Inflammatory Bowel Disease: Results from ORIGINS. A Retrospective Observational Study. J Gastrointestin Liver Dis 2023; 32:444-451. [PMID: 38147607 DOI: 10.15403/jgld-5128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/21/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND AND AIMS Real-world assessments of efficacy and safety of advanced therapies used for inflammatory bowel disease (IBD) patients are limited. We aimed to report safety, efficacy and treatment persistence of new molecules (infliximab, adalimumab, vedolizumab, tofacitinib, ustekinumab) in a retrospective multicentric national Romanian analysis. METHODS We conducted a nationwide, retrospective observational multicentric study. Data were collected retrospectively from electronic and paper files. Patients who started on one of the five investigated molecules during December 2019-December 2021 were included. The main outcome measures were clinical remission, endoscopic healing, persistence on treatment and safety data. RESULTS A total of 678 adult patients from 24 Romanian IBD centers with a diagnosis of ulcerative colitis or Crohn's disease were included. Participants had previously failure to one (268, 39.5%), two (108, 15%) or more treatment lines and only 38% (259) were biologic naïve. In the 24 months study period, most patients were started on vedolizumab (192, 28%), followed by adalimumab, infliximab, ustekinumab and tofacitinib. In biologic-naïve patients, most physicians (72%) preferred anti-TNF treatment as first line biologic (93 patients started on infliximab, 92 on adalimumab), followed by vedolizumab, ustekinumab and tofacitinib. During follow-up, 71% (470, p=0.05) of patients achieved clinical remission and 36% (134, p=0.03) achieved mucosal healing. The 6 months milestone for persistence was reached in 78% (530) of cases. Almost half of patients (47%, 316 patients) persisted on their current treatment for over 12 months. Overall, an adverse reaction was reported for 67 (10.4%) patients, with no lethal events. CONCLUSIONS Population of biologic-experienced IBD patients in Romania is increasing and is becoming more difficult to achieve long-term disease control. Discontinuation rates for advanced therapies are high.
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Affiliation(s)
| | - Cristian Gheorghe
- Gastroenterology and Hepatology Center, Fundeni Clinical Institute,Bucharest, Romania.
| | - Anca Victorita Trifan
- Gastroenterology Department, St. Spiridon Emergency Clinical County Hospital, Iasi, Romania.
| | - Adrian Saftoiu
- Gastroenterology Department, Elias Emergency Hospital, Bucharest, Romania.
| | - Andrada Seicean
- Gastroenterology Department, Prof. Dr. Octavian Fodor Gastroenterology Institute, Cluj-Napoca, Romania.
| | | | - Christian Banciu
- Gastroenterology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
| | | | - Bogdan Busuioc
- Gastroenterology Department, Ion Cantacuzino Clinical Hospital, Bucharest, Romania.
| | - Adrian Goldis
- Gastroenterology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
| | - Daniela Dobru
- Gastroenterology Department , University of Medicine , Science and Tehnology G.E.Palade Targu-Mures.
| | - Ovidiu Fratila
- Third Internal Medicine Department, University of Oradea, Romania.
| | - Dumitru Eugen
- Gastroenterology Department, Emergency Clinical County Hospital, Constanta, Romania.
| | - Simona Bataga
- Gastroenterology Department, Emergency Clinical County Hospital, Targu-Mures, Romania.
| | | | - Dan Gheonea
- Gastroenterology Department, University of Medicine and Pharmacy of Craiova.
| | - Alina Tantau
- Internal Medicine and Gastroenterology Department, Iuliu-Hatieganu University of Medicine and Pharmacy, Cluj- Napoca, Romania.
| | - Mariana Jinga
- Internal Medicine and Gastroenterology Department, Dr Carol Davila Central University Emergency Military Hospital, Bucharest, Romania.
| | - Ciprian Brisc
- Gastroenterology Department, Emergency Clinical County Hospital, Oradea, Romania.
| | | | - Romeo Chira
- Gastroenterology Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania.
| | | | - Dan Dumitrascu
- Second Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania.
| | - Monica State
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania.
| | - Theodor Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania.
| | - Lucian Negreanu
- Gastroenterology Department, Emergency University Hospital Bucharest, Romania.
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Rada C, Gheonea D, Ţieranu CG, Popa DE. Diagnosis and Psychotherapeutic Needs by Early Maladaptive Schemas in Patients With Inflammatory Bowel Disease. Front Psychol 2022; 12:807107. [PMID: 35222160 PMCID: PMC8864133 DOI: 10.3389/fpsyg.2021.807107] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
Inflammatory bowel disease (IBD) is chronic and incurable. Imperious diarrhea, rectal bleeding, fatigue, and weight loss, the main manifestations, cause a decrease in the quality of the patient's personal and professional life. The objectives of this study were to identify a possible relationship between early maladaptive schemas and disease activity status using logistic regression, to identify the prevalence of early maladaptive schemes in patients and to propose a psychotherapeutic intervention plan. The following were found in a sample of 46 patients aged 16-76 years. An increase in the domain overvigilance and inhibition score had a significant effect (Wald = 6.583, p = 0.010), with an increase of 1.137 CI95% [1.031, 1.254] of the risk of the disease being diagnosed as active. High and very high scores were observed for the emotional deprivation scheme (nearly three-quarters) and dependence/incompetence, vulnerability to harm and illness and subjugation schemas (over 80%). The results show that the proposed model could predict and reconfirm the diagnosis; patients have specific psychotherapeutic needs. The therapeutic goal would be to offer care, empathy and protection, to strengthen self-confidence, to make patients realize that they have the ability to cope, to provide permission, encourage the patient to experiment, and guide the patient to express their anger healthily. The therapy scheme's intervention could lead to increased long-term disease management capacity and, consequently, reduce costs directly and indirectly caused by this condition.
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Affiliation(s)
- Cornelia Rada
- Biomedical Department, “Francisc I. Rainer” Anthropology Institute of the Romanian Academy, Bucharest, Romania
| | - Dan Gheonea
- Gastroenterology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Cristian George Ţieranu
- Gastroenterology Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Gastroenterology Department, “Elias” Emergency University Hospital, Bucharest, Romania
| | - Denisa Elena Popa
- Gastroenterology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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Pădureanu V, Florescu D, Pădureanu R, Ghenea A, Gheonea D, Oancea C. Role of antioxidants and oxidative stress in the evolution of acute pancreatitis (Review). Exp Ther Med 2022; 23:197. [PMID: 35126700 PMCID: PMC8794551 DOI: 10.3892/etm.2022.11120] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/29/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Vlad Pădureanu
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Dan Florescu
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Rodica Pădureanu
- Department of Internal Medicine, Emergency Clinical County Hospital of Craiova, 200642 Craiova, Romania
| | - Alice Ghenea
- Department of Bacteriology‑Virology‑Parasitology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Dan Gheonea
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Carmen Oancea
- Department of Analytical Chemistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Singeap AM, Girleanu I, Diculescu M, Gheorghe L, Ciocîrlan M, Gheorghe C, Costache A, Tanțău A, Zaharie R, Goldis A, Gheonea D, Dobru D, Dumitru E, Prelipcean CC, Gîlcă-Blanariu GE, Moscalu M, Stanciu C, Trifan A. Risk Factors for Extraintestinal Manifestations in Inflammatory Bowel Diseases - Data from the Romanian National Registry. J Gastrointestin Liver Dis 2021; 30:346-357. [PMID: 34375380 DOI: 10.15403/jgld-3818] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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 Identifying the risk factors for extraintestinal manifestations (EIMs) in inflammatory bowel diseases (IBD) may optimize the therapeutic decision. We aimed to assess the prevalence of EIMs in IBD patients in Romania and to determine the risk factors. METHODS We analyzed 2,626 patients registered in the Romanian IBD Prospect National Registry. We performed a descriptive cross-sectional study to assess the point prevalence of EIMs, calculating global prevalence and analyzing the different types of EIMs and their respective frequencies were carried out. Demographic and clinical risk factors were researched as possible predictors for EIMs development, based on the results of the univariate and multivariate logistic regression analysis. RESULTS The overall point prevalence of EIMs was 16.3%. A significantly higher frequency of EIMs in Crohn's disease (CD) was noted in comparison to ulcerative colitis (UC) and IBD unclassified (IBDU) (23.2% vs 11.3% and 16.3%, respectively, p<0.001). The most frequent type of EIM was peripheral arthropathy (8.3%), significantly associated with CD (p<0.001). Univariate analysis highlighted the significant independent common predictive risk factors for EIMs, in both CD and UC patients: female gender, patient's urban area of origin, anemia, hypoalbuminemia, and high level of C-reactive protein (CRP), while significant independent IBD phenotype-related risk factors were ileocolonic location and concomitant involvement of upper gastrointestinal tract for CD, non-smoker status and both moderate and severe disease activity for UC (p<0.05). Multivariate analysis determined that female CD patients with moderate or severe disease activity, with other than isolated ileal disease, and female UC patients with moderate or severe extensive colitis are the most likely to develop EIMs. CONCLUSIONS IBD patients are experiencing EIMs in a large proportion, with higher rates for CD. As EIMs negatively affect patient outcomes, foreseeing the risk by identifying independent and associated predictive factors could be a first step to optimal work-up and treatment.
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Affiliation(s)
- Ana-Maria Singeap
- Grigore T. Popa UMF, Inst. of Gastroenterol. and Hepatol., Emergency County Hospital Saint Spiridon, Iasi, Romania. .
| | - Irina Girleanu
- Grigore T. Popa UMF, Inst. of Gastroenterol. and Hepatol., Emergency County Hospital Saint Spiridon, Iasi, Romania.
| | - Mircea Diculescu
- Carol Davila UMF, Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Inst., Bucharest, Romania.
| | - Liana Gheorghe
- Carol Davila UMF, Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Inst., Bucharest, Romania.
| | - Maria Ciocîrlan
- Carol Davila UMF, Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Inst., Bucharest, Romania.
| | - Cristian Gheorghe
- Carol Davila UMF, Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Inst., Bucharest, Romania.
| | - Adrian Costache
- Carol Davila UMF, Dr. I. Cantacuzino Clinical Hospital, Bucharest.
| | - Alina Tanțău
- Iuliu Hațieganu University of Medicine and Pharmacy, 4th Medical Clinic, Cluj- Napoca, Romania.
| | - Roxana Zaharie
- Iuliu Hatieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Adrian Goldis
- Victor Babeș University of Medicine and Pharmacy, Municipal Emergency Hospital, Department of Gastroenterology and Hepatology, Timișoara, Romania.
| | - Dan Gheonea
- University of Medicine and Pharmacy, Craiova, Research Center of Gastroenterology and Hepatology, Craiova, Romania.
| | - Daniela Dobru
- University of Medicine and Pharmacy, Tg Mures, Emergency County Hospital, Department of Gastroenterology, Târgu-Mureș, Romania.
| | - Eugen Dumitru
- Faculty of Medicine, Ovidius University of Constanța, Emergency County Hospital, Department of Gastroenterology, Constanta, Romania.
| | | | | | - Mihaela Moscalu
- Department of Preventive Medicine and Interdisciplinarity, Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.
| | - Carol Stanciu
- Grigore T. Popa UMF, Inst. of Gastroenterol. and Hepatol., Emergency County Hospital Saint Spiridon, Iasi, Romania.
| | - Anca Trifan
- Grigore T. Popa UMF, Inst. of Gastroenterol. and Hepatol., Emergency County Hospital Saint Spiridon, Iasi, Romania.
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Abstract
Non-alcoholic steatohepatitis morbidity and mortality is on the rise due to the obesity pandemic. Its pathophysiology is not well understood and implies complex interactions between local hepatic cells populations, adipocytes, immune effectors that lead to hepatic lipid excess, lipotoxicity, cellular stress and inflammation, as well as programmed cell death. A better understanding of these pathogenic interactions would allow better identification of therapeutic targets in a disease that has no known pharmacological therapy until now.
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Affiliation(s)
- Silvia Sovaila
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
| | | | - Dan Gheonea
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
| | - Sanziana Ionescu
- First Surgical Clinic, Colentina University Hospital, Carol Davila Univeristy of Medicine and Pharmacy, Bucharest, Romania
| | - Tudorel Ciurea
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
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Sovaila S, Purcarea A, Gheonea D, Ciurea T. Specific Factors That Influence Adherence to Beta Blocker Treatment in Primary Prevention of Variceal Bleeding in Cirrhotic Romanian Patients. a Proof of Concept Qualitative Study. J Med Life 2019; 11:355-358. [PMID: 30894894 PMCID: PMC6418326 DOI: 10.25122/jml-2018-1006] [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] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Adherence to medical treatment in chronic patients challenging, especially in primary prevention where the benefit is not directly perceived by the patient. Through the directed interview of this qualitative study we assessed some specific factors that intervene in beta-blockers adherence in cirrhotic patients with oesophageal varices in primary prevention in Romanian. We identified that the most important modifiable extrinsic factor that influences adherence is the confidence in medicine. The intensely negative perception of the disease seemed to be another major driver of adherence.
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Affiliation(s)
- Silvia Sovaila
- Gastroenterology Department, University of Medicine and Pharmacy, Craiova, Romania.,Internal Medicine Clinic "Internist.ro", Brasov, Romania
| | | | - Dan Gheonea
- Gastroenterology Department, University of Medicine and Pharmacy, Craiova, Romania
| | - Tudorel Ciurea
- Gastroenterology Department, University of Medicine and Pharmacy, Craiova, Romania
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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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Rogoveanu I, Văcaru D, Gheonea D, Georgescu CV, Comănescu V, Ciurea T. Diagnostic particularities in primitive diffuse form hepatocellular carcinoma associated with portal vein thrombosis. Rom J Morphol Embryol 2005; 46:317-21. [PMID: 16688370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The diagnosis of primitive hepatocellular carcinoma, infiltrative form, arose on liver cirrhosis is often difficult because the imagistic investigations could not relevate the tumoral formation. We are presenting the case of a 56 years patient, diagnosed with viral B liver cirrhosis, in which the clinical symptomatology and laboratory investigations were leading to hepatocellular carcinoma, but the ultrasonography and CT scan could not confirm the malignant transformation. In these conditions we performed ultrasonographically guided biopsy from the liver parenchyma and visualized thrombus in portal vein lumen. Histopathological exam from the thrombus tissue samples confirmed hepatocellular carcinoma diagnosis.
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Affiliation(s)
- I Rogoveanu
- Department of Internal Medicine, Division of Gastroenterology, University of Medicine and Pharmacy of Craiova, and Emergency County Hospital, Department of Pathology, Romania.
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