Jelena Martinov Nestorov

Background/Objectives: We evaluated changes in body composition, metabolic parameters, and quality of life during liraglutide 3.0 mg treatment within a multimodal obesity-management programme and explored their association with participation in structured exercise. Methods: This prospective, non-randomised, real-world cohort included 70 adults with overweight or obesity receiving liraglutide and medical nutrition therapy 23 participated in the structured exercise group (SEG) and 47 in the non-structured exercise group (NSEG). Results: Sex-adjusted models showed significant changes over time in body weight, BMI, waist circumference, fat mass (FM), skeletal muscle mass (SMM) and several metabolic parameters, without significant time × group interactions for the main body-composition outcomes. Exploratory analyses showed different FM, FFM and SMM loss patterns per kilogram of total body-weight loss between groups (interaction p = 0.001, 0.004, and 0.014, respectively). Quality of life improved in several domains at 6 months. Conclusions: During liraglutide-based multimodal treatment, participants showed reductions in body weight and FM, together with favourable changes in several metabolic and quality-of-life measures. Absolute body composition trajectories were similar between groups, but exploratory analyses showed a different pattern in the composition of weight loss in SEG.

Background/Objectives: Acute-on-chronic liver failure (ACLF) is characterized by multiple organ failure and short-term mortality, and hepatic encephalopathy (HE) is its frequent complication. We investigated whether the severity of HE upon admission in patients with alcohol-related ACLF at the intensive care unit (ICU) was associated with short-term mortality. Methods: In total, 100 patients with alcohol-related ACLF and HE admitted in ICU were enrolled in the study. Laboratory biomarkers, total hospital length of stay (LOS), ICU length of stay, acute kidney injury (AKI), Acute Physiology and Chronic Health Evaluation II score, CLIF-C organ failure and Sequential Organ Failure Assessment score were tested in relation to the mortality risk. HE was assessed and divided into groups using the West Haven criteria. Results: Total hospital LOS, 7-day and 28-day mortality were significantly higher in the higher-grade HE group (p = 0.035, p = 0.031, p = 0.002, respectively). CLIF-C OF, SOFA, and APACHE II scores were significantly higher in the higher-grade HE group (p < 0.001). Kaplan–Meier survival analysis demonstrated reduced survival in patients with higher-grade HE (log-rank p < 0.001). In Cox regression analyses, AKI was associated with short-term mortality in both HE groups. Total hospital LOS and ICU length of stay were also associated with mortality, but were interpreted as post-baseline markers of clinical trajectory rather than baseline prognostic predictors. Conclusions: In patients with alcohol-related ACLF and HE, higher-grade HE was associated with poorer short-term survival. AKI and higher CLIF-C OF, SOFA and APACHE II scores were associated with poor outcomes, supporting their clinical relevance for mortality risk stratification in this population. LOS-related findings should be interpreted as markers of clinical trajectory rather than baseline prognostic predictors.

Background/Objectives: Cirrhosis is an irreversible state of chronic liver disease. Systemic inflammatory response syndrome (SIRS) is a severe complication and significantly contributes to lethal outcomes in cirrhotic patients. We studied a group of cirrhotic patients with SIRS admitted to our centre, assessing the relationship with in-hospital outcomes. Methods: The study population included 102 patients with alcoholic cirrhosis and SIRS. Laboratory biomarkers, the model for end-stage liver disease, the model for end-stage liver disease—natrium, the Acute Physiology and Chronic Health Evaluation II score, CLIF-C organ failure, the systemic immune-inflammation index score (S II), and the Cirrhosis Acute Gastrointestinal Bleeding (CAGIB) score were tested in relation to the mortality risk using receiver operating characteristic (ROC) curves. Results: Our results demonstrated that values of sodium, chlorides, and albumin significantly correlated with 7-day survival. The area under the curve’s (AUCs) values for sodium, chlorides, and albumin were 0.542, 0.627, and 0.610, respectively, for 7-day mortality prediction. The CAGIB score significantly correlated with 7-day mortality, with the cut-off value of −7.86 (AUC: 0.674, 95% CI (0.555–0.794)). For the assessment of 28-day mortality, the AUC values for sodium, chlorides, and albumin were 0.630, 0.654, and 0.661, respectively. Additionally, the cut-off value of the CAGIB score was found to be −7.84 (AUC: 0.625, 95% CI (0.509–0.740)) in 28-day mortality prediction. Conclusions: Sodium, chlorides, albumin, and the CAGIB score are reliable predictors of 7-day and 28-day in-hospital mortality in patients with advanced alcoholic liver disease and SIRS.

The gut microbiota plays a crucial role in maintaining gastrointestinal balance and regulating immune system activity. Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, are changes associated with significant alterations in both the composition and activity of the gut microbiota, a condition known as dysbiosis. Dysbiosis can lead to compromised mucosal barrier integrity, increased inflammation, and irregular immune system activity. Microbiota influences the development of IBD through altered short-chain fatty acid levels, lower microbial diversity, and an imbalance between protective and harmful bacterial populations. Current research continues to explore how interactions between the microbiota and immune cells contribute to the onset and persistence of inflammation. Therapies designed to adjust the gut microbiota, such as the use of probiotics, prebiotics, dietary modifications, and fecal microbiota transplantation, have shown encouraging results for symptom relief and longer remission in individuals with IBD. Enhanced knowledge of the complex microbiota role facilitates the development of tailored medical interventions and new treatment strategies for inflammatory bowel diseases.

Cirrhotic cardiomyopathy (CCM) is a diagnostic entity defined as cardiac dysfunction (diastolic and/or systolic) in patients with liver cirrhosis, in the absence of overt cardiac disorder. Pathogenically, CCM stems from a combination of systemic and local hepatic factors that, through hemodynamic and neurohormonal changes, affect the balance of cardiac function and lead to its remodeling. Vascular changes in cirrhosis, mostly driven by portal hypertension, splanchnic vasodilatation, and increased cardiac output alongside maladaptively upregulated feedback systems, lead to fluid accumulation, venostasis, and cardiac dysfunction. Autocrine and endocrine proinflammatory cytokines (TNF-alpha, IL-6), as well as systemic endotoxemia stemming from impaired intestinal permeability, contribute to myocardial remodeling and fibrosis, which further compromise the contractility and relaxation of the heart. Additionally, relative adrenal insufficiency is often present in cirrhosis, further potentiating cardiac dysfunction, ultimately leading to the development of CCM. Considering its subclinical course, CCM diagnosis remains challenging. It relies mostly on stress echocardiography or advanced imaging techniques such as speckle-tracking echocardiography. Currently, there is no specific treatment for CCM, as it vastly overlaps with the treatment of heart failure. Diuretics play a central role. The role of non-selective beta-blockers in treating portal hypertension is established; however, their role in CCM remains somewhat controversial as their effect on prognosis is unclear. However, our group still advocates them as essential tools in optimizing the neurohumoral pathologic axis that perpetuates CCM. Other targeted therapies with direct anti-inflammatory and antioxidative effects still lack sufficient evidence for wide approval. This is not only a review but also a comprehensive distillation of the insights from practicing clinical hepatologists and other specialties engaged in advanced approaches to treating liver disease and its sequelae.

A retrospective study in patients who underwent video capsule endoscopy (VCE) between 2006 and 2016 was conducted in the Clinic for gastroenterology and Hepatology, University Clinical Center of Serbia. A total of 245 patients underwent VCE. In 198 patients the indication was obscure gastrointestinal bleeding (OGIB), with 92 patients having overt and the other 106 occult bleeding. The remaining 47 patients underwent VCE due to suspected small bowel (SB) disease (i.e., Von Hippel–Lindau syndrome, familial adenomatous polyposis, Peutz Jeghers syndrome, Crohn’s disease, prolonged diarrhea, abdominal pain, congenital lymphangiectasia, protein-losing enteropathy, tumors, refractory celiac disease, etc.). VCE identified a source of bleeding in 38.9% of patients (in the obscure overt group in 48.9% of patients, and in the obscure occult group in 30.2% of patients). The most common findings were angiodysplasias, tumors, Meckel’s diverticulum and Crohn’s disease. In the smaller group of patients with an indication other than OGIB, 38.3% of patients had positive VCE findings. The most common indication is OGIB, and the best candidates are patients with overt bleeding; patients with IBD should be evaluated in this setting.

Although previous studies indicated that chronic alcohol abuse (CAA) and alcoholic liver cirrhosis (ALC) are associated with increased bone fragility, understanding bone fragility determinants is still modest in these individuals. We used a comprehensive individualized clinical fracture risk assessment approach (vertebral osteodensitometry, femoral osteodensitometry and geometry, and serum bone turnover biomarkers) to compare adult male patients with ALC who have not previously had femoral or vertebral fractures (n = 39), patients with CAA (without liver cirrhosis, n = 78) who have not previously had femoral or vertebral fractures and healthy age- and sex-matched controls (n = 43). Our data suggested that intertrochanteric bone mineral density was significantly lower in ALC and CAA patients than in controls. Also, the trabecular bone score was considerably lower in ALC patients compared with CAA and control individuals. The most significant inter-group differences in femoral geometry were noted on the femoral shaft. Patients with ALC and CAA have a higher 10-year risk of major osteoporotic fractures compared to the controls. Analysis of bone turnover biomarkers showed increased osteoprotegerin and beta-C-terminal telopeptide serum concentrations and decreased insulin growth factor-1 concentrations in patients with ALC compared to CAA and control groups. Our data revealed that bone alterations are present in patients with ALC and CAA even if they did not sustain a nontraumatic bone fracture, but it is also indicative that current bone-assessing clinical methods are not entirely reliable. Thus, future studies should focus on developing a reliable integrative clinical tool that can be used to accurately predict and prevent bone fracture occurrences in patients with ALC and CAA.

Recently, there has been a growing interest in the application of artificial intelligence (AI) in medicine, especially in specialties where visualization methods are applied. AI is defined as a computer’s ability to achieve human cognitive performance, which is accomplished through enabling computer “learning”. This can be conducted in two ways, as machine learning and deep learning. Deep learning is a complex learning system involving the application of artificial neural networks, whose algorithms imitate the human form of learning. Upper gastrointestinal endoscopy allows examination of the esophagus, stomach and duodenum. In addition to the quality of endoscopic equipment and patient preparation, the performance of upper endoscopy depends on the experience and knowledge of the endoscopist. The application of artificial intelligence in endoscopy refers to computer-aided detection and the more complex computer-aided diagnosis. The application of AI in upper endoscopy is aimed at improving the detection of premalignant and malignant lesions, with special attention on the early detection of dysplasia in Barrett’s esophagus, the early detection of esophageal and stomach cancer and the detection of H. pylori infection. Artificial intelligence reduces the workload of endoscopists, is not influenced by human factors and increases the diagnostic accuracy and quality of endoscopic methods.

Foreign body ingestion is a frequently encountered emergency in healthcare institutions. It mostly affects pediatric populations, although it can also affect adults with developmental delays, those with psychiatric diseases, drug abusers, and prisoners. Endoscopy is a diagnostic and treatment method for suspected foreign body ingestion. In this article, we discuss a 45-year-old tailor who swallowed a sewing pin while at work. The abdominal X-ray showed a needle-shaped metal shadow in the stomach region. During an upper endoscopy, it was discovered that a sewing pin with a sharp edge was stuck in the pylorus. The sewing pin was extracted endoscopically, and the patient was discharged the same day in good condition. Since the estimated risk of complications of foreign body ingestion in the adult population is about 35%, and the most common complications include impaction, laceration, bleeding, or perforation of the gastrointestinal wall, endoscopic or surgical removal is necessary. This also emphasizes the importance of a careful endoscopic evaluation of some at-risk occupations for foreign body ingestion with or without gastrointestinal complaints.

Background and Objectives: Upper endoscopy is considered the gold standard for screening and diagnosis of esophageal varices (EV). Non-invasive methods for predicting EV have become a research hotspot in recent years. The aim of this study was to assess the role of non-invasive scores in predicting the presence of EV in patients with liver cirrhosis, and to determine the value of these scores in predicting the outcome of patients with cirrhosis presenting with acute variceal bleeding. Materials and Methods: A total of 386 patients with liver cirrhosis were included. The model for end-stage liver disease (MELD), aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT), AST to platelet ratio index (APRI), fibrosis-4-index (FIB-4), fibrosis index (FI), King’s Score, albumin-bilirubin (ALBI) score, and platelet-albumin-bilirubin (PALBI) score were calculated. The discriminatory capacities of the examined scores in predicting the presence of esophageal varices were tested using receiver operating characteristic (ROC) curves. Results: The ROC curve analysis showed (area under the curve) AUC values of ALBI and PALBI of 0.603, and 0.606, respectively, for the prediction of EV. APRI, MELD, PALBI, King’s, FIB-4, and ALBI scores showed statistically significant correlation with EV bleeding (p < 0.05). AUC of APRI and MELD for predicting EV bleeding were 0.662 and 0.637, respectively. The AUC value of MELD in short-term mortality was 0.761. Conclusions: ALBI and PALBI scores had modest diagnostic accuracy of EVs in liver cirrhosis. APRI and MELD can be used as a reference index for the EV bleeding, and MELD score is best associated with short-term outcome in cirrhotic patients.