(1) Background: Hypertriglyceridemia (HTG) is a well-known metabolic condition associated with an increased risk of acute pancreatitis. In this study, we tried to establish whether there are any significant disparities concerning recurrence rate, intensive care unit (ICU) admission, hospital (ICU and total) length of stay (LoS), morphology, severity and age between HTG-induced acute pancreatitis and any other known cause of pancreatitis (OAP). (2) Methods: The research was a retrospective unicentric cohort study, using information from the Bucharest Acute Pancreatitis Index (BUC-API) registry, a database of 1855 consecutive cases of acute pancreatitis. (3) Results: We found a weak association between HTG-AP and recurrence. The HTG-AP patients were younger, with a median of 44.5 years, and had a longer ICU stay than the OAP patients. In addition, we identified that the HTG-AP patients were more likely to develop acute peripancreatic fluid collection (APFC), to be admitted in ICU, to have a more severe course of disease and to be cared for in a gastroenterology ward. (4) Conclusions: Hypertriglyceridemia-induced APs have a more severe course. The typical patient with HTG-AP is a middle-aged male, with previous episodes of AP, admitted in the gastroenterology ward, with a longer ICU stay and longer length of hospitalization, more likely to evolve in a severe acute pancreatitis (SAP) and with a higher probability of developing APFC.

Background and Aims: Postoperative recurrence in Crohn’s disease remains a significant clinical challenge, with high recurrence rates despite advancements in medical therapy. This study aims to evaluate the efficacy of various treatments for managing postoperative recurrence following ileocolonic resection in Crohn’s disease. Methods: A comprehensive search of PubMed, Cochrane, and Scopus databases was performed to identify studies reporting on the therapeutic management of postoperative recurrence in Crohn’s disease. Studies encompassing patients with an endoscopic Rutgeerts score of at least I2 were included. Results: Ustekinumab showed promise, achieving significant endoscopic and clinical success in difficult-to-treat patients. Anti-TNF agents demonstrated superior endoscopic and clinical remission rates compared to mesalamine and azathioprine. Retreatment with anti-TNF therapy remained effective even after preoperative failure. Thalidomide showed efficacy in refractory Crohn’s disease, but carries significant toxicity risks, necessitating careful patient selection and monitoring. Combination therapies and non-pharmacologic strategies like enteral nutrition offer additional options, though patient compliance remains challenging. Conclusions: Personalized treatment plans based on individual risk factors and biomarkers are crucial. Infliximab is recommended as the first-line treatment, with ustekinumab and vedolizumab as alternatives in case of anti-TNF failure or intolerance. Early intervention, patient education, and ongoing evaluation are essential for optimizing long-term outcomes in managing postoperative recurrence in Crohn’s disease.

INPLASY202480042 Managing Crohn’s Disease Postoperative Recurrence Beyond Prophylaxis: A Systematic Review and Meta-analysis Keywords: postoperative recurrence; Crohn’s disease; biologic therapy; i…

Introduction: Sequencing therapy for Crohn’s disease (CD) is currently being intensively discussed due to the development of novel drugs and lack of standardized criteria for drug positioning in first- and further-line treatment. The aim of this study was to compare the efficacy of a second-line advanced therapy in Romanian patients with CD who have failed an anti-TNF agent. Methods: We performed a multicenter retrospective study that included adult patients with CD who had secondary loss of response after an initial response with an anti-TNF drug. The main outcome was clinical remission at 12 weeks of second-line treatment (CDAI < 150). The secondary outcomes included clinical response (decrease in CDAI ≥ 70 points), persistence of therapy at 1 year and rates of adverse events. Results: From 2008 to 2024, 216 patients were either switched to another anti-TNF or swapped to another therapeutic class, due to the failure of a first anti-TNF drug. Secondary lines of treatment included infliximab (IFX), adalimumab (ADA), vedolizumab (VDZ), ustekinumab (UST). The highest rate of clinical remission (81%) was obtained with the sequence ADA-IFX in 26/32 (81%) patients and ADA-UST in 62/82 (76%) patients, followed by IFX-UST in 22/33 (67%) and IFX-ADA 34/51 (67%). Persistence in therapy at 1 year was better for the sequence ADA-UST (73%) and IFX-UST (67%) and ADA-IFX (63%) compared to IFX-ADA (59%) and IFX-VDZ (44%) (p < 0.001). Conclusions: There were significant baseline differences between the treatment groups, so this study represents an unadjusted comparison between the results obtained with different biologics in second-line treatment for Crohn’s disease. In patients with CD who have failed a first anti-TNF, the highest rate of clinical remission at 12 weeks was obtained with second-line IFX and UST whilst vedolizumab showed lower efficacy. UST demonstrated the most favorable long-term treatment persistence at 1 year.

Background and Aims: Acute pancreatitis (AP) presents with variable severity, and early identification of patients at risk for poor outcomes remains challenging. Red cell distribution width (RDW) is a widely available marker with potential prognostic value. Methods: We analyzed 682 patients from the RO-API/BUC-API registry admitted with AP between 2015 and 2023. RDW measured at 24±6 hours post-admission was assessed for associations with severity (per Revised Atlanta Classification) and in-hospital mortality. ROC analysis and logistic regression were applied. Results: Median RDW was significantly higher in non-survivors and patients with severe disease. RDW ≥13.85% predicted mortality [area under the curve (AUC)=0.67], and ≥14.35% predicted severe AP (AUC=0.67). RDW remained an independent predictor after adjusting for potential confounders. Conclusions: RDW at 24 hours could be a useful early biomarker for predicting severity and mortality in AP.

Introduction: Sequencing therapy in CD is currently intensively discussed due to the development of novel drugs and lack of standardized criteria for drug positioning in first and further treatment lines. The aim of this study was to compare the efficacy of a second line advanced therapy in Romanian patients with CD who have failed an anti-TNF agent. Methods: We performed a multicenter retrospective study that included adult patients with CD who had secondary loss of response after an initial response with an an-ti-TNF drug. The main outcome was clinical remission at 12 weeks of second-line treatment (CDAI < 150). Secondary outcomes included clinical response (decrease of CDAI ≥ 25%), persistence of therapy at 1 year and rates of adverse events. Results: From 2008 to 2024, 216 patients were either switched to another anti-TNF or swapped to another therapeutic class due to failure of a first anti-TNF drug. Secondary lines of treatment in-cluded infliximab (IFX), adalimumab (ADA), vedolizumab (VDZ), ustekinumab (UST). The highest rate of clinical remission (81%) was obtained with the sequence ADA-IFX in 26/32(81%) patients and ADA-UST in 62/82(76%) patients, followed by IFX-UST in 22/33(67%) and IFX-ADA 34/51(67%). Persistence on therapy at 1 year was better for the sequence ADA-UST(73%) and IFX-UST(67%) and ADA-IFX(63%) compared to IFX-ADA(59%) and IFX-VDZ(44%)(p< 0.001). Conclusions: In patients with CD who have failed a first anti-TNF, the highest rate of clinical re-mission at 12 weeks was obtained with second line IFX and UST whilst vedolizumab showed lower efficacy. UST demonstrated the most favorable long-term treatment persistence at 1 year.