Small Intestinal Bacterial Overgrowth Syndrome Prevalence in Romanian Patients with Inflammatory Bowel Disease.

BACKGROUND: small intestinal bacterial overgrowth (SIBO) is an entity commonly associated with digestive disease. Recently, its association with inflammatory bowel diseases (IBD) made the object of an increasing number of investigations. Sometimes symptoms of excessive bacterial populations may overlap or mimic flares of inflammatory disease. METHOD: patients with IBD (CD - Crohn disease and UC - ulcerative colitis) in remission underwent screening for the presence of SIBO using the hydrogen breath test. RESULTS: of the 75 patients tested, the breath test was positive for SIBO in 25.3% (30.77% of patients with CD and 19.4% of patients with UC). The risk factors associated with the presence of this syndrome were identified as: pancolonic impairment in UC, perianal and ileo-colonic involvement in CD, postoperative absence of the ileocecal valve. Patients in remission with bacterial overgrowth tend to present more frequently: a higher daily average of stools, a lower BMI (body mass index) and much more frequent complaints of persistent flatulence. CONCLUSIONS: patients with Crohn's disease suffer from small intestinal bacterial overgrowth syndrome more frequently than those with ulcerative colitis. The hydrogen breath test may be used, along with other laboratory methods, to distinguish between an inflammatory bowel disease and an overlap of small intestinal bacterial overgrowth.

Adiponectin, body mass index and hepatic steatosis are independently associated with IGF-I status in obese non-diabetic women.

OBJECTIVE: Low IGF-I levels have been associated with obesity, insulin resistance, hepatic steatosis, and were shown to predict cardiovascular mortality. Adiponectin, on the other hand, was proved to have an important protective role against metabolic and cardiovascular diseases. This study investigates the relation between hepatic steatosis, adiponectin and IGF-I levels in a group of non-diabetic obese Romanian women. DESIGN: This cross-sectional study included 201 obese non-diabetic women, with mean age of 41.1±11.9 years and mean body mass index (BMI) of 44.1±8.3 kg/m(2), consecutively admitted to the Endocrinology Department of a University Hospital to be evaluated as candidates for bariatric surgery. Main measured parameters included total adiponectin (detected by ELISA method), insulin, C reactive protein (CRP), and IGF-I (all by chemiluminescence methods). Insulin sensitivity was assessed using the Quantitative Insulin Sensitivity Check Index (QUICKI). Patients were considered IGF-deficient if IGF-I z score was ≤2 standard deviations from mean for age. Hepatic ultrasound was used to determine the presence of significant steatosis (SS+). RESULTS: Significant steatosis was observed in 60.7% of our patients and this feature was associated with reduced total adiponectin levels (p<0.001) and lower IGF-I z scores (p<0.001). IGF-I z score negatively correlated with BMI (r=-0.283, p<0.001), alanine aminotransferase (ALT) (r=-0.130, p=0.032), gamma glutamyltransferase (GGT) (r=-0.158, p=0.018) and logarithmic transformed (log) CRP (r=-0.232, p=0.001) and positively correlated with QUICKI (r=0.148, p=0.023) and log adiponectin (r=0.216, p=0.003). The relationship between IGF-I z score and log adiponectin remained significant after adjusting for age, BMI, ALT, QUICKI and log CRP (r=0.183, p=0.012). IGF-I deficiency was present in 33.3% of these obese women. In multivariate logistic analysis, BMI (p<0.001), ALT (p=0.003), log adiponectin (p<0.001) and SS (p=0.043) proved to be independently associated with IGF-I deficiency. CONCLUSIONS: Adiponectin is significantly correlated with IGF-I z scores and, along with BMI, ALT and significant steatosis, is independently associated with IGF-I deficiency in obese non-diabetic women.

[Evaluation of efficacy of mechanical bowel preparation in colorectal surgery]. / Evaluarea eficacitatii pregatirii mecanice in chirurgia colonului.

Mechanical bowel preparation (MBP) is commonly used for preparing patients before elective colorectal surgery. MBP has long been considered indispensable for the prevention of complications, especially of the infectious ones. There is little scientific evidence demonstrating the efficiency of this practice in reducing the rate of infectious complications. The purpose of this study was to evaluate the usefulness of MBP in colorectal surgery. A prospective non randomized study analyzed 99 patients divided into two groups (60 with and 39 without MBP) which underwent colonic surgery finished with anastomosis. Anastomotic fistulas rate was 5% in the group with MBP and 2.5% in the one without MBP, parietal suppuration appeared in 15% of the patients with MBP and in 15% of those without MBP. There was a single intraperitoneal abscess in the group with MBP. Recent randomised clinical studies evaluating MBP in elective colorectal surgery were unable to show its benefits or real effects when compared with the operations without preparation. Colorectal surgery without MBP can be safely performed having the same or even better results than the one with MBP.