The epidemiology of inflammatory bowel disease [IBD] in Eastern Europe is poorly understood, part... more The epidemiology of inflammatory bowel disease [IBD] in Eastern Europe is poorly understood, particularly with regard to diagnostic delay. Here we investigated the factors leading to delayed diagnosis and the effect of the delay on several disease progression and outcome measures. A total of 1196 IBD cases [682 ulcerative colitis [UC], 478 Crohn's disease [CD], 36 indeterminate colitis] from the Romanian national registry IBDPROSPECT were reviewed. Standard clinical and demographic factors were evaluated as predictors of a long diagnostic delay in both CD and UC. Diagnostic delay was subsequently evaluated as a potential risk factor for bowel stenoses, bowel fistulas, perianal fistulas, perianal surgery, and intestinal surgery in CD patients. The median diagnostic delay was significantly longer in CD [5 months] than in UC [1 month] patients [p < 0.001]. Compared with 5 months for UC patients, 75% of CD patients were diagnosed within 18 months of symptom onset. In CD patients, extra-ileal location was a protective factor (odds ratio [OR], 0.5; p = 0.03), whereas being an active smoker [OR, 2.09; p = 0.01] and symptom onset during summer [OR, 3.35; p < 0.001] were independent risk factors for a long diagnostic delay [> 18 months]. In UC patients, an age > 40 years was a protective factor [OR, 0.68; p = 0.04] for a long delay. Regarding outcomes, a long diagnostic delay in CD patients positively correlated with bowel stenoses [OR, 3.38; p < 0.01] and any IBD-related surgery [OR, 1.95; p = 0.03] and had a positive trend for intestinal fistulas [OR, 2.64; p = 0.08] and perianal fistulas [OR, 2.9; p = 0.07]. Disease duration since diagnosis positively correlated with bowel stenoses [OR, 1.04; p = 0.04], any IBD-related surgery [OR, 1.04; p = 0.02], and intestinal surgery [OR, 1.07; p < 0.01]. A long diagnostic delay in IBD correlates with an increased frequency of bowel stenoses and need for IBD-related surgery.
The incidence and prevalence of coeliac disease vary internationally. In Eastern Europe little is... more The incidence and prevalence of coeliac disease vary internationally. In Eastern Europe little is known about the prevalence of coeliac disease. of this study was to evaluate the prevalence and the clinical features of coeliac disease in adults biopsied during upper endoscopy in Romania. This is the first incidence study of the coeliac disease in Romania. The study was initiated by the Romanian Society of Digestive Endoscopy for the period 1 January 2002 - 31 May 2002. It was carried out in 9 Academic Centres in Romania, which ensured an even geographical distribution and therefore significant statistical results at a national level. The study included 2436 patients according to following criteria: age over 16 years, with no known history of coeliac disease, visiting the participating upper endoscopy units or patients with documented coeliac disease presenting for follow-up check or recurrence of clinical symptoms. At least two bioptic samples were obtained from the distal duodenum,...
Journal of gastrointestinal and liver diseases : JGLD, 2015
Anemia is the most frequent systemic complication in inflammatory bowel diseases. It affects the ... more Anemia is the most frequent systemic complication in inflammatory bowel diseases. It affects the quality of life and can interact with working capacity. Our objectives were to identify the prevalence of anemia, its main causes and its management in patients with inflammatory bowel disease from Romania. We conducted a multicenter prospective study from March 2013 to August 2014. We enrolled 291 patients from three referral centers: 115 (39.52%) with Crohn's disease (CD) and 176 (60.48%) with ulcerative colitis (UC). We defined anemia according to the WHO criteria. Median age of the patients was 41 years and the median time period since diagnosis was 3 years (0.75-7). The median activity index for UC (UCAI) was 4 and the median CD activity index (CDAI) was 96. More patients with CD were on antiTNFα therapy (p < 0.01), corticosteroids (p =0.18) or azathioprine (p=0.05) and required surgery for their underlying disease at study enrollment (p < 0.01). Anemia was present in 31.2...
Background and aims: There is little awareness and a lack of data on the prevalence of hospital m... more Background and aims: There is little awareness and a lack of data on the prevalence of hospital malnutrition in gastro-enterology departments. Since part of these patients are referred for surgical treatment and poor nutritional status is a known risk factor for perioperative morbidity, we conducted a prospective study aimed to screen for the nutritional risk and assess the prevalence and risk factors of malnutrition in gastro-enterology departments in Romania. Methods: We included patients consecutively admitted to 8 gastroenterology units over a period of three months in our study. Nutritional risk was evaluated using NRS 2002. Malnutrition was defined using BMI ( 20 kg m2) or and 10% weight loss in the last six months. Results: 3198 patients were evaluated, 51.6% males and 48.4% females, with the mean age of 54.5 Â+- 14.3 years. Overall percentage of patients at nutritional risk was 17.1%, with the highest risk for patients with advanced liver diseases (49.8%), oncologic (31.3%),...
No direct comparison of health care cost in patients with inflammatory bowel disease across the E... more No direct comparison of health care cost in patients with inflammatory bowel disease across the European continent exists. The aim of this study was to assess the costs of investigations and treatment for diagnostics and during the first year after diagnosis in Europe. The EpiCom cohort is a prospective population-based inception cohort of unselected inflammatory bowel disease patients from 31 Western and Eastern European centers. Patients were followed every third month from diagnosis, and clinical data regarding treatment and investigations were collected. Costs were calculated in euros (€) using the Danish Health Costs Register. One thousand three hundred sixty-seven patients were followed, 710 with ulcerative colitis, 509 with Crohn's disease, and 148 with inflammatory bowel disease unclassified. Total expenditure for the cohort was €5,408,174 (investigations: €2,042,990 [38%], surgery: €1,427,648 [26%], biologicals: €781,089 [14%], and standard treatment: €1,156,520 [22%)])...
The Romanian Society of Digestive Endoscopy proposed a multicentric study to evaluate the prevale... more The Romanian Society of Digestive Endoscopy proposed a multicentric study to evaluate the prevalence of gastric cancer in the adult population referred to gastroenterology medical services, and also the demographic features of this pathology. . The study was carried out over the period 1 January 2003 - 31 December 2003 in 11 academic centers in Romania, specialized in gastroenterology, with a uniform national distribution (all areas in the country were represented) and with adequate diagnostic and therapeutic facilities. All centers used identical definition criteria and reported the data using the same protocol and a Microsoft Excel database. During the study period, 640 cases of gastric cancer were reported. In the first stage, the prevalence in each geographical region was calculated. The national prevalence of gastric cancer in the population referred to gastro-intestinal endoscopy services was 2.9 per 100,000 inhabitants over 18 years of age. The demographic data of the studied...
Multiple variables influencing the sustained virologic response (SVR) in chronic hepatitis C have... more Multiple variables influencing the sustained virologic response (SVR) in chronic hepatitis C have been evaluated. One of them is genetic polymorphism near the IL28B gene. The aim of this study was to evaluate the influence of IL28B genotypes on SVR rates in a group of patients with chronic hepatitis C from the western part of Romania. A retrospective study was performed in 107 consecutive patients, previously treated with standard-of-care medication for chronic hepatitis C, identified from the databases of 2 centers. Patient demographics, viral load before treatment and at 12, 24, and 72 weeks from the treatment start, and IL28B genotype were evaluated. Among the 107 patents in the study group, 54 patients had SVR (50.5%), and 62 (57.9%) showed a complete early virologic response (cEVR). The SVR rates according to IL28B genotype were as follows: 73.1% in patients with genotype C/C, 40.9% in those with genotype C/T, and 57.1% in those with genotype T/T (i.e., 73.1% among patients wit...
The epidemiology of inflammatory bowel disease [IBD] in Eastern Europe is poorly understood, part... more The epidemiology of inflammatory bowel disease [IBD] in Eastern Europe is poorly understood, particularly with regard to diagnostic delay. Here we investigated the factors leading to delayed diagnosis and the effect of the delay on several disease progression and outcome measures. A total of 1196 IBD cases [682 ulcerative colitis [UC], 478 Crohn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease [CD], 36 indeterminate colitis] from the Romanian national registry IBDPROSPECT were reviewed. Standard clinical and demographic factors were evaluated as predictors of a long diagnostic delay in both CD and UC. Diagnostic delay was subsequently evaluated as a potential risk factor for bowel stenoses, bowel fistulas, perianal fistulas, perianal surgery, and intestinal surgery in CD patients. The median diagnostic delay was significantly longer in CD [5 months] than in UC [1 month] patients [p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001]. Compared with 5 months for UC patients, 75% of CD patients were diagnosed within 18 months of symptom onset. In CD patients, extra-ileal location was a protective factor (odds ratio [OR], 0.5; p = 0.03), whereas being an active smoker [OR, 2.09; p = 0.01] and symptom onset during summer [OR, 3.35; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001] were independent risk factors for a long diagnostic delay [&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 18 months]. In UC patients, an age &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 40 years was a protective factor [OR, 0.68; p = 0.04] for a long delay. Regarding outcomes, a long diagnostic delay in CD patients positively correlated with bowel stenoses [OR, 3.38; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01] and any IBD-related surgery [OR, 1.95; p = 0.03] and had a positive trend for intestinal fistulas [OR, 2.64; p = 0.08] and perianal fistulas [OR, 2.9; p = 0.07]. Disease duration since diagnosis positively correlated with bowel stenoses [OR, 1.04; p = 0.04], any IBD-related surgery [OR, 1.04; p = 0.02], and intestinal surgery [OR, 1.07; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01]. A long diagnostic delay in IBD correlates with an increased frequency of bowel stenoses and need for IBD-related surgery.
The incidence and prevalence of coeliac disease vary internationally. In Eastern Europe little is... more The incidence and prevalence of coeliac disease vary internationally. In Eastern Europe little is known about the prevalence of coeliac disease. of this study was to evaluate the prevalence and the clinical features of coeliac disease in adults biopsied during upper endoscopy in Romania. This is the first incidence study of the coeliac disease in Romania. The study was initiated by the Romanian Society of Digestive Endoscopy for the period 1 January 2002 - 31 May 2002. It was carried out in 9 Academic Centres in Romania, which ensured an even geographical distribution and therefore significant statistical results at a national level. The study included 2436 patients according to following criteria: age over 16 years, with no known history of coeliac disease, visiting the participating upper endoscopy units or patients with documented coeliac disease presenting for follow-up check or recurrence of clinical symptoms. At least two bioptic samples were obtained from the distal duodenum,...
Journal of gastrointestinal and liver diseases : JGLD, 2015
Anemia is the most frequent systemic complication in inflammatory bowel diseases. It affects the ... more Anemia is the most frequent systemic complication in inflammatory bowel diseases. It affects the quality of life and can interact with working capacity. Our objectives were to identify the prevalence of anemia, its main causes and its management in patients with inflammatory bowel disease from Romania. We conducted a multicenter prospective study from March 2013 to August 2014. We enrolled 291 patients from three referral centers: 115 (39.52%) with Crohn's disease (CD) and 176 (60.48%) with ulcerative colitis (UC). We defined anemia according to the WHO criteria. Median age of the patients was 41 years and the median time period since diagnosis was 3 years (0.75-7). The median activity index for UC (UCAI) was 4 and the median CD activity index (CDAI) was 96. More patients with CD were on antiTNFα therapy (p < 0.01), corticosteroids (p =0.18) or azathioprine (p=0.05) and required surgery for their underlying disease at study enrollment (p < 0.01). Anemia was present in 31.2...
Background and aims: There is little awareness and a lack of data on the prevalence of hospital m... more Background and aims: There is little awareness and a lack of data on the prevalence of hospital malnutrition in gastro-enterology departments. Since part of these patients are referred for surgical treatment and poor nutritional status is a known risk factor for perioperative morbidity, we conducted a prospective study aimed to screen for the nutritional risk and assess the prevalence and risk factors of malnutrition in gastro-enterology departments in Romania. Methods: We included patients consecutively admitted to 8 gastroenterology units over a period of three months in our study. Nutritional risk was evaluated using NRS 2002. Malnutrition was defined using BMI ( 20 kg m2) or and 10% weight loss in the last six months. Results: 3198 patients were evaluated, 51.6% males and 48.4% females, with the mean age of 54.5 Â+- 14.3 years. Overall percentage of patients at nutritional risk was 17.1%, with the highest risk for patients with advanced liver diseases (49.8%), oncologic (31.3%),...
No direct comparison of health care cost in patients with inflammatory bowel disease across the E... more No direct comparison of health care cost in patients with inflammatory bowel disease across the European continent exists. The aim of this study was to assess the costs of investigations and treatment for diagnostics and during the first year after diagnosis in Europe. The EpiCom cohort is a prospective population-based inception cohort of unselected inflammatory bowel disease patients from 31 Western and Eastern European centers. Patients were followed every third month from diagnosis, and clinical data regarding treatment and investigations were collected. Costs were calculated in euros (€) using the Danish Health Costs Register. One thousand three hundred sixty-seven patients were followed, 710 with ulcerative colitis, 509 with Crohn's disease, and 148 with inflammatory bowel disease unclassified. Total expenditure for the cohort was €5,408,174 (investigations: €2,042,990 [38%], surgery: €1,427,648 [26%], biologicals: €781,089 [14%], and standard treatment: €1,156,520 [22%)])...
The Romanian Society of Digestive Endoscopy proposed a multicentric study to evaluate the prevale... more The Romanian Society of Digestive Endoscopy proposed a multicentric study to evaluate the prevalence of gastric cancer in the adult population referred to gastroenterology medical services, and also the demographic features of this pathology. . The study was carried out over the period 1 January 2003 - 31 December 2003 in 11 academic centers in Romania, specialized in gastroenterology, with a uniform national distribution (all areas in the country were represented) and with adequate diagnostic and therapeutic facilities. All centers used identical definition criteria and reported the data using the same protocol and a Microsoft Excel database. During the study period, 640 cases of gastric cancer were reported. In the first stage, the prevalence in each geographical region was calculated. The national prevalence of gastric cancer in the population referred to gastro-intestinal endoscopy services was 2.9 per 100,000 inhabitants over 18 years of age. The demographic data of the studied...
Multiple variables influencing the sustained virologic response (SVR) in chronic hepatitis C have... more Multiple variables influencing the sustained virologic response (SVR) in chronic hepatitis C have been evaluated. One of them is genetic polymorphism near the IL28B gene. The aim of this study was to evaluate the influence of IL28B genotypes on SVR rates in a group of patients with chronic hepatitis C from the western part of Romania. A retrospective study was performed in 107 consecutive patients, previously treated with standard-of-care medication for chronic hepatitis C, identified from the databases of 2 centers. Patient demographics, viral load before treatment and at 12, 24, and 72 weeks from the treatment start, and IL28B genotype were evaluated. Among the 107 patents in the study group, 54 patients had SVR (50.5%), and 62 (57.9%) showed a complete early virologic response (cEVR). The SVR rates according to IL28B genotype were as follows: 73.1% in patients with genotype C/C, 40.9% in those with genotype C/T, and 57.1% in those with genotype T/T (i.e., 73.1% among patients wit...
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Papers by Adrian Goldis