Kotarou Sunago, M. Abe, O. Yoshida, Takao Watanabe, Yoshiko Nakamura, Yusuke Imai, Y. Koizumi, M. Hirooka, Yoshio Tokumoto, Y. Hiasa
Background and Aims: Immune checkpoint inhibitors may cause various types of organ damage as immune-related adverse events, of which, liver damage is the most common. Herein, we evaluated the clinicopathological features of immune checkpoint inhibitor-related liver injury and investigated the differences between immune checkpoint inhibitor-related liver injury and drug-induced liver injury or autoimmune hepatitis. Methods: We selected patients with ≥ grade 3 liver injury who were diagnosed with immune checkpoint inhibitor-related liver injury (n=15). Liver biopsies were performed in 10 of the 15 cases. We also selected cases in which a liver biopsy was performed and drug-induced liver injury (n=7) or autoimmune hepatitis [n=21: acute exacerbation (n=13) was diagnosed and cases of acute onset (n=8), in which liver function test results corresponded to ≥ grade 3]. Results: Portal fibrosis and periportal activity scores were significantly higher in the acute exacerbation autoimmune hepatitis group than in the other groups. Portal and lobular activity were not different between the groups. Plasma cell infiltration showed a higher trend in the autoimmune hepatitis group than in the other groups. Granuloma formations were seen in 90% of immune checkpoint inhibitor-related liver injury cases. The CD4/8 ratio was significantly lower in the immune checkpoint inhibitor-related liver injury group than in the other groups. Patients with bile duct injury had poorer response to corticosteroid therapy than those without. Conclusions: There are some obvious differences among immune checkpoint inhibitor-related liver injury, drug-induced liver injury, and autoimmune hepatitis in liver histology. Liver biopsy is helpful for the diagnosis and severity evaluation of liver injury.
{"title":"Clinical and Pathological Features of Immune Checkpoint Inhibitor-induced Liver Injury in Comparison with Drug-induced Liver Injury and Autoimmune Hepatitis","authors":"Kotarou Sunago, M. Abe, O. Yoshida, Takao Watanabe, Yoshiko Nakamura, Yusuke Imai, Y. Koizumi, M. Hirooka, Yoshio Tokumoto, Y. Hiasa","doi":"10.15403/jgld-5045","DOIUrl":"https://doi.org/10.15403/jgld-5045","url":null,"abstract":"Background and Aims: Immune checkpoint inhibitors may cause various types of organ damage as immune-related adverse events, of which, liver damage is the most common. Herein, we evaluated the clinicopathological features of immune checkpoint inhibitor-related liver injury and investigated the differences between immune checkpoint inhibitor-related liver injury and drug-induced liver injury or autoimmune hepatitis. \u0000Methods: We selected patients with ≥ grade 3 liver injury who were diagnosed with immune checkpoint inhibitor-related liver injury (n=15). Liver biopsies were performed in 10 of the 15 cases. We also selected cases in which a liver biopsy was performed and drug-induced liver injury (n=7) or autoimmune hepatitis [n=21: acute exacerbation (n=13) was diagnosed and cases of acute onset (n=8), in which liver function test results corresponded to ≥ grade 3]. \u0000Results: Portal fibrosis and periportal activity scores were significantly higher in the acute exacerbation autoimmune hepatitis group than in the other groups. Portal and lobular activity were not different between the groups. Plasma cell infiltration showed a higher trend in the autoimmune hepatitis group than in the other groups. Granuloma formations were seen in 90% of immune checkpoint inhibitor-related liver injury cases. The CD4/8 ratio was significantly lower in the immune checkpoint inhibitor-related liver injury group than in the other groups. Patients with bile duct injury had poorer response to corticosteroid therapy than those without. \u0000Conclusions: There are some obvious differences among immune checkpoint inhibitor-related liver injury, drug-induced liver injury, and autoimmune hepatitis in liver histology. Liver biopsy is helpful for the diagnosis and severity evaluation of liver injury.","PeriodicalId":50189,"journal":{"name":"Journal of Gastrointestinal and Liver Diseases","volume":"54 36","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138946346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Mateescu, Cristian Gheorghe, A. Trifan, Adrian Săftoiu, A. Seicean, M. Diculescu, Christian Banciu, Liliana Simona Gheorghe, Bogdan Busuioc, A. Goldiş, D. Dobru, O. Frățilă, Dumitru Eugen, Simona Bataga, Gabriel Constantinescu, Dan Gheonea, A. Tanțău, M. Jinga, C. Brisc, C. Cijevschi Prelipcean, Romeo Chira, C. Fierbinţeanu-Braticevici, D. Dumitrascu, M. State, T. Voiosu, L. Negreanu
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.
{"title":"Safety, Efficacy and Persistence of Advanced Therapies in Inflammatory Bowel Disease: Results from ORIGINS. A Retrospective Observational Study","authors":"R. Mateescu, Cristian Gheorghe, A. Trifan, Adrian Săftoiu, A. Seicean, M. Diculescu, Christian Banciu, Liliana Simona Gheorghe, Bogdan Busuioc, A. Goldiş, D. Dobru, O. Frățilă, Dumitru Eugen, Simona Bataga, Gabriel Constantinescu, Dan Gheonea, A. Tanțău, M. Jinga, C. Brisc, C. Cijevschi Prelipcean, Romeo Chira, C. Fierbinţeanu-Braticevici, D. Dumitrascu, M. State, T. Voiosu, L. Negreanu","doi":"10.15403/jgld-5128","DOIUrl":"https://doi.org/10.15403/jgld-5128","url":null,"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. \u0000Methods: 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. \u0000Results: 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. \u0000Conclusions: 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.","PeriodicalId":50189,"journal":{"name":"Journal of Gastrointestinal and Liver Diseases","volume":"8 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138947766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Burning mouth syndrome needs to consider the gut-brain axis from three types of pain: nociceptive, neuropathic, and nociplastic pain","authors":"Takahiko Nagamine","doi":"10.15403/jgld-5322","DOIUrl":"https://doi.org/10.15403/jgld-5322","url":null,"abstract":"","PeriodicalId":50189,"journal":{"name":"Journal of Gastrointestinal and Liver Diseases","volume":"88 20","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138945387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Angelo Zullo, V. De Francesco, Arnaldo Amato, I. Bergna, Emanuele Bendia, Giorgia Giorgini, Elisabetta Buscarini, G. Manfredi, Sergio Cadoni, Renato Cannizzaro, Stefano Realdon, Mario Ciuffi, O. Ignomirelli, Paola Da Massa Carrara, Giovanni Finucci, Antonietta Di Somma, Chiara Frandina, Mariafrancesca Loria, F. Galeazzi, Francesco Ferrara, C. Gemme, Noemi Sara Bertetti, Federica Gentili, Antonio Lotito, B. Germanà, Nunzia Russo, Giuseppe Grande, R. Conigliaro, Federico Cravero, Giovanna Venezia, R. Marmo, Piera Senneca, A. Milano, K. Efthymakis, F. Monica, P. Montalto, Mario Lombardi, Olivia Morelli, D. Castellani, Daniela Nigro, Roberto Festa, S. Peralta, Maria Grasso, Antonello Privitera, M. E. Distefano, G. Scaccianoce, Mariangela Loiacono, S. Segato, M. Balzarini, P. Usai Satta, Mariantonia Lai, Raffaele Manta
Background and Aims: International guidelines advise improving esophagogastroduodenoscopy (EGD) quality in Western countries, where gastric cancer is still diagnosed in advanced stages. This nationwide study investigated some indicators for the quality of EGD performed in endoscopic centers in Italy. Methods: Clinical, endoscopic, and procedural data of consecutive EGDs performed in one month in the participating centers were reviewed and collected in a specific database. Some quality indicators before and during endoscopic procedures were evaluated. Results: A total of 3,219 EGDs performed by 172 endoscopists in 28 centers were reviewed. Data found that some relevant information (family history for GI cancer, smoking habit, use of proton pump inhibitors) were not collected before endoscopy in 58.5-80.7% of patients. Pre-endoscopic preparation for gastric cleaning was routinely performed in only 2 (7.1%) centers. Regarding the procedure, sedation was not performed in 17.6% of patients, and virtual chromoendoscopy was frequently (>75%) used in only one (3.6%) center. An adequate sampling of the gastric mucosa (i.e., antral and gastric body specimens) was heterogeneously performed, and it was routinely performed only by 23% of endoscopists, and in 14.3% centers. Conclusions: Our analysis showed that the quality of EGD performed in clinical practice in Italy deserves to be urgently improved in different aspects.
{"title":"Upper Gastrointestinal Endoscopy Quality in Italy: A Nationwide Study","authors":"Angelo Zullo, V. De Francesco, Arnaldo Amato, I. Bergna, Emanuele Bendia, Giorgia Giorgini, Elisabetta Buscarini, G. Manfredi, Sergio Cadoni, Renato Cannizzaro, Stefano Realdon, Mario Ciuffi, O. Ignomirelli, Paola Da Massa Carrara, Giovanni Finucci, Antonietta Di Somma, Chiara Frandina, Mariafrancesca Loria, F. Galeazzi, Francesco Ferrara, C. Gemme, Noemi Sara Bertetti, Federica Gentili, Antonio Lotito, B. Germanà, Nunzia Russo, Giuseppe Grande, R. Conigliaro, Federico Cravero, Giovanna Venezia, R. Marmo, Piera Senneca, A. Milano, K. Efthymakis, F. Monica, P. Montalto, Mario Lombardi, Olivia Morelli, D. Castellani, Daniela Nigro, Roberto Festa, S. Peralta, Maria Grasso, Antonello Privitera, M. E. Distefano, G. Scaccianoce, Mariangela Loiacono, S. Segato, M. Balzarini, P. Usai Satta, Mariantonia Lai, Raffaele Manta","doi":"10.15403/jgld-5059","DOIUrl":"https://doi.org/10.15403/jgld-5059","url":null,"abstract":"Background and Aims: International guidelines advise improving esophagogastroduodenoscopy (EGD) quality in Western countries, where gastric cancer is still diagnosed in advanced stages. This nationwide study investigated some indicators for the quality of EGD performed in endoscopic centers in Italy. \u0000Methods: Clinical, endoscopic, and procedural data of consecutive EGDs performed in one month in the participating centers were reviewed and collected in a specific database. Some quality indicators before and during endoscopic procedures were evaluated. \u0000Results: A total of 3,219 EGDs performed by 172 endoscopists in 28 centers were reviewed. Data found that some relevant information (family history for GI cancer, smoking habit, use of proton pump inhibitors) were not collected before endoscopy in 58.5-80.7% of patients. Pre-endoscopic preparation for gastric cleaning was routinely performed in only 2 (7.1%) centers. Regarding the procedure, sedation was not performed in 17.6% of patients, and virtual chromoendoscopy was frequently (>75%) used in only one (3.6%) center. An adequate sampling of the gastric mucosa (i.e., antral and gastric body specimens) was heterogeneously performed, and it was routinely performed only by 23% of endoscopists, and in 14.3% centers. \u0000Conclusions: Our analysis showed that the quality of EGD performed in clinical practice in Italy deserves to be urgently improved in different aspects.","PeriodicalId":50189,"journal":{"name":"Journal of Gastrointestinal and Liver Diseases","volume":"39 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138945984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adriana Cavasi, Irina Ștoleru, Maria Buziaș, Ioana Rusu
{"title":"Challenges in the management of checkpoint inhibitor induced liver injury","authors":"Adriana Cavasi, Irina Ștoleru, Maria Buziaș, Ioana Rusu","doi":"10.15403/jgld-5401","DOIUrl":"https://doi.org/10.15403/jgld-5401","url":null,"abstract":"","PeriodicalId":50189,"journal":{"name":"Journal of Gastrointestinal and Liver Diseases","volume":"24 11","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138947404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Dimitriu, R. Saizu, Dragos Oancea, Cristian Gheorghe
Background and Aims: The primary method for assessing anorectal function is high resolution anorectal manometry (HRAM). It is a useful tool in the diagnosis of different anorectal functional disorders such as fecal incontinence or dyssynergia. The aim of the present study was to propose a new set of normal values to be used in practice for East-European individuals, as it was proven that the results are highly influenced by race and sociocultural status. Methods: We conducted a study based on anorectal manometric values of healthy volunteers analyzed at Clinic Fundeni Institute, Bucharest, Romania, between 2017 and 2022. The anorectal manometry was performed using a solid-state catheter (Diversatek, 23 pressure sensors). All anorectal measurement values were analyzed using the Bioview Software Analysys, respecting the timing and the order from the standardized IAPWG protocol. Manometric measurements were summarized using mean, median, standard deviation, minimum and maximum values. The impact of age and gender on 8 different manometric parameters was further analyzed. Normal ranges for all numeric variables were estimated using the 5th and 95th percentiles of the measurements. Results: A total of 132 subjects (97 females, 35 males) were enrolled in the study. Median age was similar between groups (54 vs. 55 years). The values for rectal propulsion, anal gradient and anal relaxation proved to be higher in females under 54 years as opposed to older women. The values for resting pressure, maximum squeeze pressure, incremental squeeze pressure were significantly higher in males younger than 54. Regardless of age, values for maximum squeeze pressure, incremental squeeze pressure, duration of squeeze and rectal propulsion were found to be significantly higher in males than in females. Normal values of HRAM in healthy volunteers are presented in a table at the end of the study. Conclusions: The data presented in the current study are of high value and have a great impact on clinical practice, being the first study offering a spectrum of the normal values for HRAM in an Eastern Europe population.
{"title":"Normal Values of High Resolution Anorectal Manometry in 132 Romanian Healthy People","authors":"A. Dimitriu, R. Saizu, Dragos Oancea, Cristian Gheorghe","doi":"10.15403/jgld-4879","DOIUrl":"https://doi.org/10.15403/jgld-4879","url":null,"abstract":"Background and Aims: The primary method for assessing anorectal function is high resolution anorectal manometry (HRAM). It is a useful tool in the diagnosis of different anorectal functional disorders such as fecal incontinence or dyssynergia. The aim of the present study was to propose a new set of normal values to be used in practice for East-European individuals, as it was proven that the results are highly influenced by race and sociocultural status. \u0000Methods: We conducted a study based on anorectal manometric values of healthy volunteers analyzed at Clinic Fundeni Institute, Bucharest, Romania, between 2017 and 2022. The anorectal manometry was performed using a solid-state catheter (Diversatek, 23 pressure sensors). All anorectal measurement values were analyzed using the Bioview Software Analysys, respecting the timing and the order from the standardized IAPWG protocol. Manometric measurements were summarized using mean, median, standard deviation, minimum and maximum values. The impact of age and gender on 8 different manometric parameters was further analyzed. Normal ranges for all numeric variables were estimated using the 5th and 95th percentiles of the measurements. \u0000Results: A total of 132 subjects (97 females, 35 males) were enrolled in the study. Median age was similar between groups (54 vs. 55 years). The values for rectal propulsion, anal gradient and anal relaxation proved to be higher in females under 54 years as opposed to older women. The values for resting pressure, maximum squeeze pressure, incremental squeeze pressure were significantly higher in males younger than 54. Regardless of age, values for maximum squeeze pressure, incremental squeeze pressure, duration of squeeze and rectal propulsion were found to be significantly higher in males than in females. Normal values of HRAM in healthy volunteers are presented in a table at the end of the study. \u0000Conclusions: The data presented in the current study are of high value and have a great impact on clinical practice, being the first study offering a spectrum of the normal values for HRAM in an Eastern Europe population.","PeriodicalId":50189,"journal":{"name":"Journal of Gastrointestinal and Liver Diseases","volume":"1 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138944436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohammad Ahmad, Elizabeth Reynolds, Mahin Chowdhury, Mutwakil Abdalla, Simon Galloway
{"title":"COVID-19 as a possible cause for achalasia: a case report","authors":"Mohammad Ahmad, Elizabeth Reynolds, Mahin Chowdhury, Mutwakil Abdalla, Simon Galloway","doi":"10.15403/jgld-5062","DOIUrl":"https://doi.org/10.15403/jgld-5062","url":null,"abstract":"","PeriodicalId":50189,"journal":{"name":"Journal of Gastrointestinal and Liver Diseases","volume":"19 10","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138947523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Device-assisted Full Thickness R0 Resection of BRAF (V600E)-Mutated T3 Colorectal Cancer in the Ascending Colon","authors":"Vincent Zimmer, Jochen Schuld","doi":"10.15403/jgld-4884","DOIUrl":"https://doi.org/10.15403/jgld-4884","url":null,"abstract":"","PeriodicalId":50189,"journal":{"name":"Journal of Gastrointestinal and Liver Diseases","volume":"65 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138950471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Colorectal Cancer Screening Program in Romania - ROCCAS - is Ready for the Implementation at National Level","authors":"Cristian Gheorghe, Stefania Bunduc","doi":"10.15403/jgld-5329","DOIUrl":"https://doi.org/10.15403/jgld-5329","url":null,"abstract":"","PeriodicalId":50189,"journal":{"name":"Journal of Gastrointestinal and Liver Diseases","volume":"22 18","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138950296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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