Background and Aims: Recent studies have evaluated the relationship associating non-alcoholic fatty liver disease (NAFLD) with several electrocardiogram (ECG) findings, but the results have been inconsistent. The aim of this systematic review is to assess the association between NAFLD with ECG modifications. Methods: We conducted a systematic search on PubMed with predefined keywords identifying observational studies published till 22 February 2019 with NAFLD diagnosed either by biopsy, imaging, surrogate markers or ICD code and ECG findings by either a standard ECG, 24-hour Holter ECG or ICD code. Quality assessment was performed using the quality assessment tools from the National Heart, Lung, and Blood Institute. Results: A total of 20 observational studies (1 case-control, 4 cohort, 15 cross-sectional studies, 401,745 individuals) were included. Twelve studies evaluated cardiac arrhythmias in NAFLD subjects, out of which 10 evaluated atrial fibrillation (AF). Although results were inconsistent, most studies rated as “good” demonstrated that hepatic steatosis was independently associated with an increased risk for prevalent AF in NAFLD patients. Diabetic patients with NAFLD were associated with an increased risk of ventricular arrhythmias in only one study rated as “good”. Two studies rated as “good” demonstrated that hepatic steatosis was associated with a prolonged QTc interval. Four studies supported the association between cardiac conduction abnormalities and NAFLD, out of which two were rated as “good”. Two studies assessed ECG modifications of ischemic heart disease (IHD), but only one having a “good” rating confirmed this independent association. Conclusions: Studies of high quality and with low risk of bias demonstrated that NAFLD is independently associated with AF, a prolonged QTc interval, bundle branch and atrioventricular blocks. Diabetic patients with NAFLD present an increased risk for developing ventricular arrhythmias.

Background and aimThe irritable bowel syndrome (IBS) is a functional gastrointestinal disorder frequently encountered in clinical practice in Eastern Europe. Epidemiological data are diverging on this condition. Our objective was to assess the prevalence of IBS in the former communist countries from Eastern Europe (EE).MethodsWe performed a systematic review study using data from PubMed. Many languages, some having only local spreading, are spoken in EE, so we decided to look only for papers indexed in PubMed, which have at least an English summary or title. We searched PubMed using the following keywords: irritable bowel syndrome, functional digestive disorders, prevalence, EE. Only relevant studies were selected for analysis.ResultsFrom more than 4000 papers retrieved by this search, we identified a few papers appropriate to this survey. The spectrum of prevalence values is wide in IBS. Prevalence of IBS varies in different studies from 28% in a Croatian study, to 14% in Romania. Most studies report a higher prevalence in females. Stressful events are linked to the impairment of symptoms. Anxiety and depression are common in IBS patients, showing similar expression of functional symptoms. Quality of life is impaired. The role of abuse (physical, sexual) is not commonly investigated and when it was, the importance of this factor was revealed to be much less important than in Western Europe or North America. General practitioners seem to be well trained to recognize IBS, to make correct interpretations of the disease and to use the correct therapy. It seems that the Rome criteria are known and applied by general practitioners. Several epidemiological studies on IBS exist in most EE countries. Usually they look for self-reporting symptoms, or reports from endoscopy units. Psychosomatic approach of IBS was taken into consideration in several countries (Poland, Hungary, Romania), mainly by psychologists and psychotherapists rather than by gastroenterologists.ConclusionsThere are few epidemiological studies on the epidemiology of IBS in EE. The majority of studies used Rome criteria. Several studies used small groups of patients. Some of the smaller studies have methodological flaws. The effect of stress and psychological factors are often investigated and analyzed with different methods of different accuracy. Some doctors used knowledge gained in EE in order to disseminate or to investigate further in more economically developed countries with a higher level of health.

There is little data on the long term evolution of patients with irritable bowel syndrome (IBS) and of associated conditions. We therefore studied the evolution of IBS patients in a single tertiary center during a long interval of time.Methods. We carried out a retrospective study based on the survey of patients records. We analyzed the records of symptoms, therapy, associated diseases, as consigned at follow-up visits for an interval of 4 years in average (2008)(2009)(2010)(2011).Results. A cohort of 114 patients with IBS diagnosed based on Rome III criteria were included (29 men and 85 women), age 19-85 years (mean age: 43.45 years). Urban patients were predominant. The main three symptoms were: abdominal pain, bowel disorders (constipation, diarrhea) and bloating. IBS -constipation (IBS -C) is associated with a favorable course of symptoms (increasing the number of stools, decrease intensity of abdominal pain and bloating) after treatment and IBSdiarrhea (IBS -D) is associated with variable symptoms after treatment (p = 0.031). Using trimebutin or mebeverin in association with other drugs for one month correlates with a favorable evolution of symptoms after treatment and monotherapy is associated with fluctuating symptoms ( p< 0.001). Favorable symptoms are associated with the use of probiotics in combination, but not in monotherapy (p< 0.001). Favorable evolution of symptoms is also associated with the use of anxiolytics in combination. Persistence of symptoms after treatment was correlated with the presence or absence of depression. The absence of depression was correlated with a favorable evolution of symptoms (p = 0.005). IBS-C is associated at limit (marginal significance) with hemorrhoidal disease (p = 0.56). 33 patients (29%) -received monotherapy (trimebutin or mebeverin or probiotics); 81 patients (71%) -received combined therapy: (trimebutin or mebeverin or probiotics) + anxiolytics or proton pump inhibitors (PPI) or nonsteroidal anti-inflammatory (NSAI) or spasmolitics. The most common associated diseases observed in patients with IBS were: depression (27.19%), dyslipidemia (25.43%), hemorrhoidal disease (22.80%) and fibromyalgia (21%).Conclusions. The highest response rate was obtained with trimebutin or mebeverin + anxiolitics + probiotics. The most frequent disease associated with IBS was depression. Other diseases with a high incidence: dyslipidemia, hemorrhoidal disease and fibromyalgia. Further studies are needed to analyze the link between IBS and some associated diseases.

Background and Aims: The nonpharmacological therapy in irritable bowel syndrome (IBS) is expanding rapidly. Practitioners and medical educators need to be aware of progress and changes in knowledge of this topic. The Romanian Society of Neurogastroenterology aimed to create guidelines based on best evidence on the use of nonpharmacological therapy in IBS. Methods: A group of experts was constituted. This was divided in eleven subgroups dedicated to eleven categories of nonpharmacological therapy. The subgroups searched the literature and formulated statements and recommendations. These were submitted to vote in order to obtain consensus. Results: The outcome of this activity is represented by the guidelines of the Romanian Society of Neurogastroenterology, presented in this paper. The recommendations are seen as complementary to the pharmacological therapy and are not intended to recommend avoiding pharmacological drugs. Conclusions: These guidelines were elaborated by a Delphi process and represent a useful tool for physicians managing patients with IBS.