Vanya Gerova | Medical University of Sofia (original) (raw)

Papers by Vanya Gerova

Research paper thumbnail of Evaluation of Bowel Motility in Patients with Irritable Bowel Syndrome (IBS) by Means of a Hydrogen Breath Test

Comptes Rendus De L Academie Bulgare Des Sciences, 2000

Research paper thumbnail of Gastrointestinal metastases from lobular breast cancer

Research paper thumbnail of The role of the intestinal barrier function in the pathogenesis of Crohn's disease

Despite of scientific efforts during the last decades, etiology and pathogenesis of the Crohn&#39... more Despite of scientific efforts during the last decades, etiology and pathogenesis of the Crohn's disease (CD) remain unclear. Currently, it is widely accepted that the chronic intestinal inflammation in CD results from an inappropriate immune response that occurs in genetically susceptible individuals as the result of a complex interaction among environmental, genetic and immunological factors. A multifunctional cellular and secretory barrier separates the microbial flora from host tissues. Altered function of this barrier remains a major largely unexplored area in CD. Although there is evidence of barrier dysfunction in CD, it remains unclear whether this is a primary contributor to disease or a consequence of mucosal inflammation. The aim of this review is to summarize the recent advances in the intestinal barrier dysfunction in CD and its role in the disease pathogenesis.

Research paper thumbnail of Endorectal power Doppler ultrasonography is a reliable method for evaluation of rectal cancer angiogenesis

European review for medical and pharmacological sciences, 2019

OBJECTIVE We aimed to assess the preoperative rectal cancer angiogenesis with Endorectal Power Do... more OBJECTIVE We aimed to assess the preoperative rectal cancer angiogenesis with Endorectal Power Doppler Ultrasonography by using the Power Doppler Vascularity Index (PDVI) calculated by imaging analysis software, and to compare it with the microvessel density (MVD) in surgical specimens PATIENTS AND METHODS: This study included 110 patients (39 females; mean age 61.5 years) with rectal cancer. Immunohistochemical staining of surgical specimens with anti-CD-31 antibody was used for MVD evaluation. The PDVI of each tumor was calculated using Endorectal Power Doppler with computer-assisted quantification of colour pixels. RESULTS Mean MVD - 163 ± 69 microvessels/mm2 (50-328) was used as a cutoff point, differentiating two groups of tumors with high (> 160 mm2) and low (≤ 160 mm2) angiogenic activity. Mean PDVI of 8.9 ± 6.0% (0-27.3) was used as a cutoff point, dividing two groups of tumors with high (> 8%) and low (≤ 8%) PDVI. The MVD and the PDVI showed a good positive correlatio...

Research paper thumbnail of Increased intestinal permeability in inflammatory bowel diseases assessed by iohexol test

World Journal of Gastroenterology, 2011

Author contributions: Gerova VA designed the study, enrolled and followed up the patients, provid... more Author contributions: Gerova VA designed the study, enrolled and followed up the patients, provided the requested patient materials and other clinical data, collected and analyzed the data and wrote the manuscript; Katsarov DS performed the research; Stoynov SG and Svinarov DA supervised and participated in the designing of the study, the data interpretation and in the writing and editing of the manuscript; all authors approved the final version of the paper.

Research paper thumbnail of P240. Correlation between the Ulcerative Colitis Endoscopic Index of severity (UCEIS) and intestinal mucosal calprotectin (IMC) in acute severe ulcerative colitis

Journal of Crohn's & colitis, 2015

Background: Stricturing or penetrating lesions develop over time in most patients with CD leading... more Background: Stricturing or penetrating lesions develop over time in most patients with CD leading eventually to surgical resection. The Lémann Index (LI) measures the digestive damage at a given time. The aim of this study was to describe the evolution of LI in an incipient cohort of CD patients and to search for predictors of digestive damage. Methods: We studied 221 patients (114 M, 107 F, median age 24 yr [19-33]) diagnosed with CD between 2004 and 2011, followed up prospectively in our center, and who had 2 or 3 serial morphological determinations of LI. Abdominal CT scan (n=204), abdominal MRI (n=332), and pelvic MRI (n=56) were re-read by a couple gastroenterologist and radiologist. LI was then calculated taking into account clinical and endoscopic data and radiological re-assessment. The cutoff of LI >2.0, corresponding to the 75th percentile value of pre-operative LI in patients led to surgery, was assigned to identify patients with a substantial damage. In addition we analyzed intervals between 2 evaluations. Factors associated with damage and progression of LI during one interval were searched for using univariate analysis and logistic regression. Results: Median LI was 2.3 (1.2-3.9) at first evaluation, 3.9 (1.6-9.8) 2-5 yr after diagnosis, and 8.3 (1-12.3) at 5-10 yr. LI increased significantly (p< 0.0001) at 2-5 yr and 5-10 yr compared to its initial value and from 2-5 yr to 5-10 yr. Last value of LI after 73 months (51-96) was >2.0 in 138 patients (63%). These patients did not differ from those without digestive damage regarding demographic data and characteristics of CD collected at diagnosis, however their earliest LI was significantly increased. 90 patients eventually required intestinal resection. Among 313 intervals between 2 morphological evaluations, LI increased (>0.1) during 161 intervals (51%), remained unchanged (± 0.1) during 59 intervals (19%), and decreased (>0.1) during 93 intervals (30%). In addition to intestinal resection, the percentage of time with clinically active disease was associated with increase of LI (p<0.001). Elevated CRP and treatment with immunomodulators or anti-TNF had no significant effect. However the increase of LI was mild in the 57 patients who received anti-TNF more than 80% of time (from 3.

Research paper thumbnail of Probiotics and Synbiotics in Gastroenterology - Our Experience Withl He New Bulgarian Synbiotic Product Entericecol

Summary: During the last years probiotics have become more widely used in medicine, especially in... more Summary: During the last years probiotics have become more widely used in medicine, especially in gastroenterology. This study examines the clinical effect of the Bulgarian synbiotic EntericEcol on two groups of patients (o rst one with chronic enterocolitis and the second with small intestinal bacterial overgrowth - SIBO). In the o rst group fecal calprotectin was examined, before and after the treatment, as an objective marker for assessing the effect of the treatment. In the second group SIBO was proved by hydrogen breath test and the effect of the treatment was demonstrated by a control test after the end of the therapy. As a result of the conducted treatment, signio cant reduction in the clinical symptoms (diarrhea, abdominal pain, dyspepsia) was observed in both groups. Moreover, there was a signio cant decrease both in fecal calprotectin values in chronic enterocolitis patients and amount of exhaled hydrogen in SIBO patients after the therapeutic course. The sinbiotic product...

Research paper thumbnail of Intestinal permeability in patents with ulcerative colitis and its association with the disease characteristics

Research paper thumbnail of Altrations in Intestinal Permeability in Patients with Liver Cirrhosis and Portal Hypertensive Gastropathy

Studied is the relationship between intestinal barrier function and portal hypertensive gastropat... more Studied is the relationship between intestinal barrier function and portal hypertensive gastropathy (PHG) in patients with liver cirrhosis (LC) by assessment of intestinal permeability (IP). The study included 31 patients with LC and 25 healthy controls. The diagnosis was made on the basis of commonly accepted criteria. IP was assessed using a contrast medium iohexol (Omnipaque), which was administered orally (25 ml, 350 mg/ml) 2 hours after breakfast. Three and six hours later serum iohexol concentrations (SIC) were determined by a validated high-performance liquid chromatography technique. In the sub-group of patients with PHG (n = 18), the median SIC at 3 (2,67 ± 1.90 mg/l) and at 6 h (2,54 ± 2,02 mg/l) after its ingestion were significantly higher in comparison to the patients without PHG (1.15 ± 0.71 mg/l, respectively 1.24 ± 0.79 mg/l) and to the controls (1.25 ± 1.40 mg/l and respectively 1,11 ± 1,10mg/l) (p < 0,05). Abnormal IP was found in 33.3% of pt with PHG, 7.7% in c...

Research paper thumbnail of Fecal Calprotectin for Assessment of Inflammatory Bowel Disease Activity

Background: Fecal calprotectin (FCP) is frequently used for monitoring inflammatory activity and ... more Background: Fecal calprotectin (FCP) is frequently used for monitoring inflammatory activity and prediction of relapse in inflammatory bowel disease (IBD). We aimed to assess the usefulness of FCP as a marker of disease activity in patients with IBD. Methods: This prospective study enrolled 174 patients (84 with Crohn’s disease [CD] and 90 with ulcerative colitis [UC]) referred for colonoscopy to our center. FCP was analyzed in stool samples by means of a point-of-care Quantum Blue® method. Results: Mean FCP values in patients with colonic or ileocolonic CD were significantly higher than in patients with ileal CD (<0.001) and quiescent CD (<0.001). Mean FCP levels in quiescent CD were higher than those of controls (Р = 0.001). Patients with active ileal CD had significantly higher FCP values than quiescent CD patients (<0.001). A cutoff value of 315 μg/g predicted mucosal inflammation in CD patients with 94% sensitivity and 98% specificity. There was no significant differen...

Research paper thumbnail of Establishment of the first stool bank in an Eastern European country and the first series of successful fecal microbiota transplantations in Bulgaria

European review for medical and pharmacological sciences, 2021

OBJECTIVE For safe implementation and broader application of fecal microbiota transplantation (FM... more OBJECTIVE For safe implementation and broader application of fecal microbiota transplantation (FMT), quality controlled stool banking is a must. Establishing a stool bank is a complex, time-consuming, and expensive process, making it a real challenge in an Eastern European country. We aimed to establish the first stool bank in Eastern Europe - in Bulgaria. SUBJECTS AND METHODS A multidisciplinary team of gastroenterologists, microbiologists, infectionists, and geneticists was set up. We used a questionnaire based on the First European FMT Consensus in order to recruit possible stool donors. Laboratory blood and stool tests were performed on all potential donors. RESULTS Between October 2018 and April 2019, 112 donor volunteers completed a questionnaire; 70 (62.5%) were excluded, mainly because of age above 50, an unhealthy BMI, and risk behavior. Fourty-two (37.5%) donor candidates were invited for laboratory testing of blood and feces, of which 12 (28.6%) passed this screening. Of ...

Research paper thumbnail of Fecal calprotectin correlates well with endoscopic activity in ulcerative colitis patients

Journal of Gastrointestinal and Liver Diseases, 2018

Research paper thumbnail of Gerova V., L.Tankova, A.Mihova et al. Gastrointestinal metastases from breast cancer. Report of two cases. Hepato-Gastroenterol 59, 2012, 113, 178-181

Research paper thumbnail of Evaluation of Bowel Motility in Patients with Chronic Alcoholism by Means of Lactulose Hydrogen Breath Test

… Rendus de l' …, 2000

... BREATH TEST S. Stoinov, A. Mendizova, V. Nacov, P. Penchev, G. Savov, N. Tsolova, V. Gerova, ... more ... BREATH TEST S. Stoinov, A. Mendizova, V. Nacov, P. Penchev, G. Savov, N. Tsolova, V. Gerova, H. Kadiyan (Submitted by Academician V. Petkov on July ... Clinical Centre of Gastroenterology Clinic of Gastroenterology Queen Joanna State University Hospital 8, Bjalo more Str. ...

Research paper thumbnail of Simultaneously Diagnosed Autoimmune Hepatitis Type II, Grave’s Disease and Congenital Factor VII Deficiency

American Journal of Medical Case Reports, 2015

Autoimmune hepatitis (AIH) is progressive, chronic immunologically mediated inflammatory liver di... more Autoimmune hepatitis (AIH) is progressive, chronic immunologically mediated inflammatory liver disorder that occurs in children and adults of all ages, predominantly in women. AIH can be combined with other autoimmune and non-autoimmune conditions. We present a case of a 32 year-old female with three relatively uncommon diseases-two autoimmune diseases and one inherited, making their combination even more rare.

Research paper thumbnail of Serum trefoil factor 3 predicts disease activity in patients with ulcerative colitis

European review for medical and pharmacological sciences, 2019

OBJECTIVE In this study, we aimed to evaluate the role of serum trefoil factor 3 (TFF3) as a biom... more OBJECTIVE In this study, we aimed to evaluate the role of serum trefoil factor 3 (TFF3) as a biomarker of disease activity in patients with inflammatory bowel disease (IBD) and to compare TFF3 values with those of fecal calprotectin (FC). PATIENTS AND METHODS 128 patients with IBD were divided into four groups: 1) active ulcerative colitis (UC); 2) quiescent UC; 3) active Crohn's disease (CD); 4) quiescent CD. The serum levels of TFF3 and FC levels were assessed in all patients and 16 controls. RESULTS Patients with active UC had higher TFF3 levels than those with quiescent UC (p<0.001), those with active (p<0.001) or quiescent CD (p<0.001) and controls (p <0.001). We found a correlation between TFF3 and FC values in patients with active (r = 0.478, p = 0.006) and quiescent UC (r=0.528, p=0.002). TFF3 levels correlated with endoscopic activity in UC (evaluated by UC Endoscopic Index of Severity - UCEIS) (r=0.662, p<0.001). CONCLUSIONS Serum TFF3 is able to identif...

Research paper thumbnail of Evaluation of the Effect of the Medications Coordinax (Janssen) Imodium (Janssen) and Duspatalin (Solvay-Pharma) on Bowel Motility in Patients with Irritable …

Research paper thumbnail of Prevalence of Small Intestinal Bacterial Overgrowth in Children with Irritable Bowel Syndrome: A Case-Control Study

The Journal of Pediatrics, 2009

Objective To assess the prevalence of small intestinal bacterial overgrowth (SIBO) in children af... more Objective To assess the prevalence of small intestinal bacterial overgrowth (SIBO) in children affected by irritable bowel syndrome (IBS). Study design Consecutive children affected by IBS according to Rome II criteria (n = 43) were enrolled at the Gemelli Hospital, Catholic University of Rome. The control population (n = 56) consisted of healthy subjects without IBS symptoms, similar to patients for age, sex, and social background. All subjects underwent lactulose/methane breath test (LBT) to assess small intestinal bacterial overgrowth. Results The prevalence of abnormal LBT result was significantly higher in patients with IBS (65%, 28/43) with respect to control subjects (7%, 4/56; OR 3.9, 95% CI 7.3-80.1, P < .00001). Patients with abnormal LBT showed a trend toward a worse visual analog scale score with respect to children with IBS without SIBO, but a significant statistical difference was observed only for bloating. Conclusions Results from this study suggest a significant epidemiologic association between SIBO and IBS in childhood. Placebo-controlled interventional studies with antibiotics used to treat bacterial overgrowth are warranted to clarify the real impact of the disease on IBS symptoms.

Research paper thumbnail of Metastatic Nonfunctional Pancreatic Neuroendocrine Tumor – Case Report and Review of the Literature

American Journal of Medical Case Reports, 2015

We present a 56-year-old patient with liver metastases from nonfunctional pancreatic neuroendocri... more We present a 56-year-old patient with liver metastases from nonfunctional pancreatic neuroendocrine tumor. The disease is found incidentally in a patient with nonspecific symptoms. Conventional abdominal ultrasound establishes several liver lesions mimicking hemangiomas. On contrast enhancement ultrasonography hypervascularized secondary liver lesions are detected. Subsequent imaging methods and biochemical tests diagnose a pancreatic neuroendocrine metastatic tumor. Left-sided pancreatectomy with splenectomy is carried out. The patient is in good general condition six months after initiation of combination therapy with everolimus and sandostatin LAR depot. Tc-99m-tektrotyd single photon emission computed tomography-CT hybrid imaging shows reduced accumulation of the radiopharmaceutical in the liver parenchyma without data of pancreatic tumor.

Research paper thumbnail of Intestinal barrier dysfunction in liver cirrhosis assessed by iohexol test

OBJECTIVE To study gut barrier function in patients with liver cirrhosis (LC) by evaluating the i... more OBJECTIVE To study gut barrier function in patients with liver cirrhosis (LC) by evaluating the intestinal permeability (IP) and its relationship with the severity and etiology of the disease. PATIENTS AND METHODS The study included 31 patients with LC and 25 healthy controls. Child-Pugh score was used for evaluation of the LC severity. IP was assessed by the rise in levels of iohexol, which was administered orally (25 mL, 350 mg/mL) 2 h after breakfast. Three and six hours later serum (SIC mg/L) and urine (UIC g/mol) iohexol concentrations were determined by a validated HPLC-UV technique. RESULTS Patients with LC had significantly higher mean SIC value compared with control group at 3 h (2.05 ± 1.67 vs. 1.25 ± 1.41 mg/L, p=0.021, as well as at 6 h (2.20 ± 2.65 vs. 1.11 ± 1.06 mg/L, p=0.001) after ingestion. No significant difference was found in mean SIC value of patients at 3 and 6 h. 23% of the patients had an increased IP. The mean iohexol urine recovery of patients was similar ...

Research paper thumbnail of Evaluation of Bowel Motility in Patients with Irritable Bowel Syndrome (IBS) by Means of a Hydrogen Breath Test

Comptes Rendus De L Academie Bulgare Des Sciences, 2000

Research paper thumbnail of Gastrointestinal metastases from lobular breast cancer

Research paper thumbnail of The role of the intestinal barrier function in the pathogenesis of Crohn's disease

Despite of scientific efforts during the last decades, etiology and pathogenesis of the Crohn&#39... more Despite of scientific efforts during the last decades, etiology and pathogenesis of the Crohn's disease (CD) remain unclear. Currently, it is widely accepted that the chronic intestinal inflammation in CD results from an inappropriate immune response that occurs in genetically susceptible individuals as the result of a complex interaction among environmental, genetic and immunological factors. A multifunctional cellular and secretory barrier separates the microbial flora from host tissues. Altered function of this barrier remains a major largely unexplored area in CD. Although there is evidence of barrier dysfunction in CD, it remains unclear whether this is a primary contributor to disease or a consequence of mucosal inflammation. The aim of this review is to summarize the recent advances in the intestinal barrier dysfunction in CD and its role in the disease pathogenesis.

Research paper thumbnail of Endorectal power Doppler ultrasonography is a reliable method for evaluation of rectal cancer angiogenesis

European review for medical and pharmacological sciences, 2019

OBJECTIVE We aimed to assess the preoperative rectal cancer angiogenesis with Endorectal Power Do... more OBJECTIVE We aimed to assess the preoperative rectal cancer angiogenesis with Endorectal Power Doppler Ultrasonography by using the Power Doppler Vascularity Index (PDVI) calculated by imaging analysis software, and to compare it with the microvessel density (MVD) in surgical specimens PATIENTS AND METHODS: This study included 110 patients (39 females; mean age 61.5 years) with rectal cancer. Immunohistochemical staining of surgical specimens with anti-CD-31 antibody was used for MVD evaluation. The PDVI of each tumor was calculated using Endorectal Power Doppler with computer-assisted quantification of colour pixels. RESULTS Mean MVD - 163 ± 69 microvessels/mm2 (50-328) was used as a cutoff point, differentiating two groups of tumors with high (> 160 mm2) and low (≤ 160 mm2) angiogenic activity. Mean PDVI of 8.9 ± 6.0% (0-27.3) was used as a cutoff point, dividing two groups of tumors with high (> 8%) and low (≤ 8%) PDVI. The MVD and the PDVI showed a good positive correlatio...

Research paper thumbnail of Increased intestinal permeability in inflammatory bowel diseases assessed by iohexol test

World Journal of Gastroenterology, 2011

Author contributions: Gerova VA designed the study, enrolled and followed up the patients, provid... more Author contributions: Gerova VA designed the study, enrolled and followed up the patients, provided the requested patient materials and other clinical data, collected and analyzed the data and wrote the manuscript; Katsarov DS performed the research; Stoynov SG and Svinarov DA supervised and participated in the designing of the study, the data interpretation and in the writing and editing of the manuscript; all authors approved the final version of the paper.

Research paper thumbnail of P240. Correlation between the Ulcerative Colitis Endoscopic Index of severity (UCEIS) and intestinal mucosal calprotectin (IMC) in acute severe ulcerative colitis

Journal of Crohn's & colitis, 2015

Background: Stricturing or penetrating lesions develop over time in most patients with CD leading... more Background: Stricturing or penetrating lesions develop over time in most patients with CD leading eventually to surgical resection. The Lémann Index (LI) measures the digestive damage at a given time. The aim of this study was to describe the evolution of LI in an incipient cohort of CD patients and to search for predictors of digestive damage. Methods: We studied 221 patients (114 M, 107 F, median age 24 yr [19-33]) diagnosed with CD between 2004 and 2011, followed up prospectively in our center, and who had 2 or 3 serial morphological determinations of LI. Abdominal CT scan (n=204), abdominal MRI (n=332), and pelvic MRI (n=56) were re-read by a couple gastroenterologist and radiologist. LI was then calculated taking into account clinical and endoscopic data and radiological re-assessment. The cutoff of LI >2.0, corresponding to the 75th percentile value of pre-operative LI in patients led to surgery, was assigned to identify patients with a substantial damage. In addition we analyzed intervals between 2 evaluations. Factors associated with damage and progression of LI during one interval were searched for using univariate analysis and logistic regression. Results: Median LI was 2.3 (1.2-3.9) at first evaluation, 3.9 (1.6-9.8) 2-5 yr after diagnosis, and 8.3 (1-12.3) at 5-10 yr. LI increased significantly (p< 0.0001) at 2-5 yr and 5-10 yr compared to its initial value and from 2-5 yr to 5-10 yr. Last value of LI after 73 months (51-96) was >2.0 in 138 patients (63%). These patients did not differ from those without digestive damage regarding demographic data and characteristics of CD collected at diagnosis, however their earliest LI was significantly increased. 90 patients eventually required intestinal resection. Among 313 intervals between 2 morphological evaluations, LI increased (>0.1) during 161 intervals (51%), remained unchanged (± 0.1) during 59 intervals (19%), and decreased (>0.1) during 93 intervals (30%). In addition to intestinal resection, the percentage of time with clinically active disease was associated with increase of LI (p<0.001). Elevated CRP and treatment with immunomodulators or anti-TNF had no significant effect. However the increase of LI was mild in the 57 patients who received anti-TNF more than 80% of time (from 3.

Research paper thumbnail of Probiotics and Synbiotics in Gastroenterology - Our Experience Withl He New Bulgarian Synbiotic Product Entericecol

Summary: During the last years probiotics have become more widely used in medicine, especially in... more Summary: During the last years probiotics have become more widely used in medicine, especially in gastroenterology. This study examines the clinical effect of the Bulgarian synbiotic EntericEcol on two groups of patients (o rst one with chronic enterocolitis and the second with small intestinal bacterial overgrowth - SIBO). In the o rst group fecal calprotectin was examined, before and after the treatment, as an objective marker for assessing the effect of the treatment. In the second group SIBO was proved by hydrogen breath test and the effect of the treatment was demonstrated by a control test after the end of the therapy. As a result of the conducted treatment, signio cant reduction in the clinical symptoms (diarrhea, abdominal pain, dyspepsia) was observed in both groups. Moreover, there was a signio cant decrease both in fecal calprotectin values in chronic enterocolitis patients and amount of exhaled hydrogen in SIBO patients after the therapeutic course. The sinbiotic product...

Research paper thumbnail of Intestinal permeability in patents with ulcerative colitis and its association with the disease characteristics

Research paper thumbnail of Altrations in Intestinal Permeability in Patients with Liver Cirrhosis and Portal Hypertensive Gastropathy

Studied is the relationship between intestinal barrier function and portal hypertensive gastropat... more Studied is the relationship between intestinal barrier function and portal hypertensive gastropathy (PHG) in patients with liver cirrhosis (LC) by assessment of intestinal permeability (IP). The study included 31 patients with LC and 25 healthy controls. The diagnosis was made on the basis of commonly accepted criteria. IP was assessed using a contrast medium iohexol (Omnipaque), which was administered orally (25 ml, 350 mg/ml) 2 hours after breakfast. Three and six hours later serum iohexol concentrations (SIC) were determined by a validated high-performance liquid chromatography technique. In the sub-group of patients with PHG (n = 18), the median SIC at 3 (2,67 ± 1.90 mg/l) and at 6 h (2,54 ± 2,02 mg/l) after its ingestion were significantly higher in comparison to the patients without PHG (1.15 ± 0.71 mg/l, respectively 1.24 ± 0.79 mg/l) and to the controls (1.25 ± 1.40 mg/l and respectively 1,11 ± 1,10mg/l) (p < 0,05). Abnormal IP was found in 33.3% of pt with PHG, 7.7% in c...

Research paper thumbnail of Fecal Calprotectin for Assessment of Inflammatory Bowel Disease Activity

Background: Fecal calprotectin (FCP) is frequently used for monitoring inflammatory activity and ... more Background: Fecal calprotectin (FCP) is frequently used for monitoring inflammatory activity and prediction of relapse in inflammatory bowel disease (IBD). We aimed to assess the usefulness of FCP as a marker of disease activity in patients with IBD. Methods: This prospective study enrolled 174 patients (84 with Crohn’s disease [CD] and 90 with ulcerative colitis [UC]) referred for colonoscopy to our center. FCP was analyzed in stool samples by means of a point-of-care Quantum Blue® method. Results: Mean FCP values in patients with colonic or ileocolonic CD were significantly higher than in patients with ileal CD (<0.001) and quiescent CD (<0.001). Mean FCP levels in quiescent CD were higher than those of controls (Р = 0.001). Patients with active ileal CD had significantly higher FCP values than quiescent CD patients (<0.001). A cutoff value of 315 μg/g predicted mucosal inflammation in CD patients with 94% sensitivity and 98% specificity. There was no significant differen...

Research paper thumbnail of Establishment of the first stool bank in an Eastern European country and the first series of successful fecal microbiota transplantations in Bulgaria

European review for medical and pharmacological sciences, 2021

OBJECTIVE For safe implementation and broader application of fecal microbiota transplantation (FM... more OBJECTIVE For safe implementation and broader application of fecal microbiota transplantation (FMT), quality controlled stool banking is a must. Establishing a stool bank is a complex, time-consuming, and expensive process, making it a real challenge in an Eastern European country. We aimed to establish the first stool bank in Eastern Europe - in Bulgaria. SUBJECTS AND METHODS A multidisciplinary team of gastroenterologists, microbiologists, infectionists, and geneticists was set up. We used a questionnaire based on the First European FMT Consensus in order to recruit possible stool donors. Laboratory blood and stool tests were performed on all potential donors. RESULTS Between October 2018 and April 2019, 112 donor volunteers completed a questionnaire; 70 (62.5%) were excluded, mainly because of age above 50, an unhealthy BMI, and risk behavior. Fourty-two (37.5%) donor candidates were invited for laboratory testing of blood and feces, of which 12 (28.6%) passed this screening. Of ...

Research paper thumbnail of Fecal calprotectin correlates well with endoscopic activity in ulcerative colitis patients

Journal of Gastrointestinal and Liver Diseases, 2018

Research paper thumbnail of Gerova V., L.Tankova, A.Mihova et al. Gastrointestinal metastases from breast cancer. Report of two cases. Hepato-Gastroenterol 59, 2012, 113, 178-181

Research paper thumbnail of Evaluation of Bowel Motility in Patients with Chronic Alcoholism by Means of Lactulose Hydrogen Breath Test

… Rendus de l' …, 2000

... BREATH TEST S. Stoinov, A. Mendizova, V. Nacov, P. Penchev, G. Savov, N. Tsolova, V. Gerova, ... more ... BREATH TEST S. Stoinov, A. Mendizova, V. Nacov, P. Penchev, G. Savov, N. Tsolova, V. Gerova, H. Kadiyan (Submitted by Academician V. Petkov on July ... Clinical Centre of Gastroenterology Clinic of Gastroenterology Queen Joanna State University Hospital 8, Bjalo more Str. ...

Research paper thumbnail of Simultaneously Diagnosed Autoimmune Hepatitis Type II, Grave’s Disease and Congenital Factor VII Deficiency

American Journal of Medical Case Reports, 2015

Autoimmune hepatitis (AIH) is progressive, chronic immunologically mediated inflammatory liver di... more Autoimmune hepatitis (AIH) is progressive, chronic immunologically mediated inflammatory liver disorder that occurs in children and adults of all ages, predominantly in women. AIH can be combined with other autoimmune and non-autoimmune conditions. We present a case of a 32 year-old female with three relatively uncommon diseases-two autoimmune diseases and one inherited, making their combination even more rare.

Research paper thumbnail of Serum trefoil factor 3 predicts disease activity in patients with ulcerative colitis

European review for medical and pharmacological sciences, 2019

OBJECTIVE In this study, we aimed to evaluate the role of serum trefoil factor 3 (TFF3) as a biom... more OBJECTIVE In this study, we aimed to evaluate the role of serum trefoil factor 3 (TFF3) as a biomarker of disease activity in patients with inflammatory bowel disease (IBD) and to compare TFF3 values with those of fecal calprotectin (FC). PATIENTS AND METHODS 128 patients with IBD were divided into four groups: 1) active ulcerative colitis (UC); 2) quiescent UC; 3) active Crohn's disease (CD); 4) quiescent CD. The serum levels of TFF3 and FC levels were assessed in all patients and 16 controls. RESULTS Patients with active UC had higher TFF3 levels than those with quiescent UC (p<0.001), those with active (p<0.001) or quiescent CD (p<0.001) and controls (p <0.001). We found a correlation between TFF3 and FC values in patients with active (r = 0.478, p = 0.006) and quiescent UC (r=0.528, p=0.002). TFF3 levels correlated with endoscopic activity in UC (evaluated by UC Endoscopic Index of Severity - UCEIS) (r=0.662, p<0.001). CONCLUSIONS Serum TFF3 is able to identif...

Research paper thumbnail of Evaluation of the Effect of the Medications Coordinax (Janssen) Imodium (Janssen) and Duspatalin (Solvay-Pharma) on Bowel Motility in Patients with Irritable …

Research paper thumbnail of Prevalence of Small Intestinal Bacterial Overgrowth in Children with Irritable Bowel Syndrome: A Case-Control Study

The Journal of Pediatrics, 2009

Objective To assess the prevalence of small intestinal bacterial overgrowth (SIBO) in children af... more Objective To assess the prevalence of small intestinal bacterial overgrowth (SIBO) in children affected by irritable bowel syndrome (IBS). Study design Consecutive children affected by IBS according to Rome II criteria (n = 43) were enrolled at the Gemelli Hospital, Catholic University of Rome. The control population (n = 56) consisted of healthy subjects without IBS symptoms, similar to patients for age, sex, and social background. All subjects underwent lactulose/methane breath test (LBT) to assess small intestinal bacterial overgrowth. Results The prevalence of abnormal LBT result was significantly higher in patients with IBS (65%, 28/43) with respect to control subjects (7%, 4/56; OR 3.9, 95% CI 7.3-80.1, P < .00001). Patients with abnormal LBT showed a trend toward a worse visual analog scale score with respect to children with IBS without SIBO, but a significant statistical difference was observed only for bloating. Conclusions Results from this study suggest a significant epidemiologic association between SIBO and IBS in childhood. Placebo-controlled interventional studies with antibiotics used to treat bacterial overgrowth are warranted to clarify the real impact of the disease on IBS symptoms.

Research paper thumbnail of Metastatic Nonfunctional Pancreatic Neuroendocrine Tumor – Case Report and Review of the Literature

American Journal of Medical Case Reports, 2015

We present a 56-year-old patient with liver metastases from nonfunctional pancreatic neuroendocri... more We present a 56-year-old patient with liver metastases from nonfunctional pancreatic neuroendocrine tumor. The disease is found incidentally in a patient with nonspecific symptoms. Conventional abdominal ultrasound establishes several liver lesions mimicking hemangiomas. On contrast enhancement ultrasonography hypervascularized secondary liver lesions are detected. Subsequent imaging methods and biochemical tests diagnose a pancreatic neuroendocrine metastatic tumor. Left-sided pancreatectomy with splenectomy is carried out. The patient is in good general condition six months after initiation of combination therapy with everolimus and sandostatin LAR depot. Tc-99m-tektrotyd single photon emission computed tomography-CT hybrid imaging shows reduced accumulation of the radiopharmaceutical in the liver parenchyma without data of pancreatic tumor.

Research paper thumbnail of Intestinal barrier dysfunction in liver cirrhosis assessed by iohexol test

OBJECTIVE To study gut barrier function in patients with liver cirrhosis (LC) by evaluating the i... more OBJECTIVE To study gut barrier function in patients with liver cirrhosis (LC) by evaluating the intestinal permeability (IP) and its relationship with the severity and etiology of the disease. PATIENTS AND METHODS The study included 31 patients with LC and 25 healthy controls. Child-Pugh score was used for evaluation of the LC severity. IP was assessed by the rise in levels of iohexol, which was administered orally (25 mL, 350 mg/mL) 2 h after breakfast. Three and six hours later serum (SIC mg/L) and urine (UIC g/mol) iohexol concentrations were determined by a validated HPLC-UV technique. RESULTS Patients with LC had significantly higher mean SIC value compared with control group at 3 h (2.05 ± 1.67 vs. 1.25 ± 1.41 mg/L, p=0.021, as well as at 6 h (2.20 ± 2.65 vs. 1.11 ± 1.06 mg/L, p=0.001) after ingestion. No significant difference was found in mean SIC value of patients at 3 and 6 h. 23% of the patients had an increased IP. The mean iohexol urine recovery of patients was similar ...