Hepatitis B virus reactivation (HBVr) is a well-described result of immunosuppressive therapy initiation in various diseases, with the dose and duration of treatment being the main factors determining the probability for reactivation. Such cases have also been described in COVID-19 patients treated with immunosuppressive therapies. Nevertheless, cases of COVID-19 infection that led to HBVr with no concurrent immunosuppressive treatment or any other related cause have also been reported. By that observation, we present a patient followed for a period spanning 20 years with HBeAg negative chronic HBV infection and non-detectable HBV DNA who, after a mild COVID-19 infection treated only with low-dose and short-duration-inhaled corticosteroids (ICS), developed elevated AST and ALT as well as elevated HBV DNA levels. Other etiologies of abnormal liver biochemistries during the diagnostic workout were excluded; thus, the diagnosis of HBV reactivation was established. Treatment with entecavir was initiated, leading to the normalization of AST and ALT levels and a decreasing trend of HBV DNA levels. Since other causes of reactivation were excluded, and the ICS dose and duration were found baring only a very low risk (<1%) for HBVr, COVID-19 infection could be considered the most probable cause of reactivation, hence underlining the need for the close monitoring of those patients.

Hepatitis D virus (HDV) globally affects nearly 5% of people with chronic hepatitis B virus (HBV) infection. Bulevirtide (BLV) is an HDV/HBV entry inhibitor recently approved for adult patients with chronic hepatitis delta (CHD). In this real-life case report, we describe the virological efficacy, the safety, and the liver function amelioration of one patient with liver compensated cirrhosis with esophageal varices after one-year combo treatment with BLV (2 mg/day in sub-cutaneous injection) and tenofovir disoproxil fumarate (TDF) (245 mg/day). The patient had HDV RNA levels of 9300 IU/mL, 1100 IU/mL, and undetectable at baseline, after three months, and after six months of treatment, respectively. In addition, the model for end-stage liver disease (MELD) score has declined from 11 at baseline to 8 after twelve months of treatment accompanied by alanine aminotransferase (ALT) normalization. Moreover, the treatment significantly improved the liver stiffness measurement (LSM) since a reduction from 34.3 kPa to 24.5 kPa was observed after twelve months of treatment. Furthermore, the treatment was well tolerated, and no dose reduction was needed.

Hepatitis B virus reactivation (HBVr) is a well described result of immunosuppressive therapy initiation in a variety of diseases with dose and duration of treatment being the main factors determining the probability for reactivation. Such cases have been described also in Covid-19 patients treated with immunosuppressive therapies. Nevertheless, there have also been reported cases of Covid-19 infection that led to HBVr with no concurrent immunosuppressive therapy or any other described cause. In accordance with that observation, we present a patient followed for a period spanning 20 years with HBeAg negative chronic HBV infection and non-detectable HBV DNA who after a mild Covid-19 infection treated only with low dose and short duration inhaled corticosteroids (ICS), developed elevated AST and ALT as well as elevated HBV DNA levels. During the diagnostic workout other etiologies of abnormal liver biochemistries were excluded and thus the diagnosis of HBV reactivation was established and treated with entecavir. Since other causes of reactivation were excluded, and ICS dose and duration was found baring only a very low risk (<1%) for HBVr, Covid-19 infection could be considered the most probable cause of reactivation.

Aims Retrospective study of the effectiveness of endoscopic treatment of SB AEs with the application of APC through DBE. Methods From March 2018 to June 2019, seventeen (17) patients underwent DBE due to SB AEs in our Institution. We compared their haemoglobin (Hb) levels and transfusion requirements before and after the application of endotherapy, as well as the rate of relapse of bleeding. Results We performed 19 procedures on 17 patients: 9 men/8 women; age range: 57- 85 years (mean age 75.4 years). Four patients underwent retrograde DBE, 11 anterograde DBE and 2 patients had panenteroscopy performed through combined anterograde and retrograde routes. Prior to DBE, all patients undertook a small bowel capsule endoscopy (SBCE). The mean time of follow up was 8.7 months (range: 1-18 months). Hb levels increased from 8.1±0.96 g/dl pre-endotherapy to 10.9±1.58g/dl post-endotherapy (p< 0.001) and remained stable throughout the follow-up period. Transfusion requirements also decreased from 4.6±4.4units/month pre-endotherapy to 0.7±1.06 units/month post-endotherapy (p=0.002). Post-endotherapy, transfusions requirements abated completely in 8 patients, whereas rebleeding occured in 2 patients. Conclusions SB bleeding secondary to AEs can be effectively treated with the application of APC through DBE. In our experience, endotherapy can lead to significant improvements in Hb levels and a reduction in transfusion requirements in most patients.

Background/Objectives: Colonoscopy, as the modality of choice for Colorectal cancer (CRC) screening, has a well-documented impact on decreasing CRC incidence. Although starting CRC screening at the age of 50 for average-risk individuals is widely recommended, several studies suggest the need for an earlier onset. Methods: Study of 353 average-risk individuals aged 40-54 years old who underwent colonoscopy investigation. Out of the study population, 3 age groups (40-44, 45-49, and 50-54 years old) were formed. Adenoma detection rate (ADR), polyp detection rate (PDR), sessile serrated lesions detection rate (SDR), and rate of advanced colorectal neoplasia (ACRN) and colorectal cancer (CRC) were compared between the groups. Results: Comparing age groups 40-44 vs. 50-54 years old we found a statistically significant difference in terms of PDR and ADR (p-value= 0.038 and 0.045 respectively). On the contrary, no statistically significant difference was found between the age groups 45-49 and 50-54 years old, in terms of PDR, ADR, SDR, and CRC detection rate (p-value= 0.063 for PDR, 0.2 for ADR, 0.3 for SDR, >0.9 for CRC). ACRN rates were comparable between the age groups 45-49 and 50-54 years old. As for patients’ gender, males 50-54 had increased ADR and PDR in comparison with groups 40-44 and 45-49. In contrast, females bared no statistically significant difference in terms of ADR and PDR in all groups. Conclusions: Age group 45-49, sharing comparable detection rates with group 50-54, could also be considered for colorectal cancer screening.