Turkish Journal of Gastroenterology最新文献

{"title":"Associations Between Urinary Metabolic Indicators and Metabolic Dysfunction-Associated Steatotic Liver Disease and Liver Fibrosis: Evidence from National Health and Nutrition Examination Survey 2017-2020.","authors":"Jiacheng Cai, Hong Wang, Leilei Wang, Lei Zhang","doi":"10.5152/tjg.2026.26228","DOIUrl":"https://doi.org/10.5152/tjg.2026.26228","url":null,"abstract":"<p><strong>Background/aims: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) reflects the central role of systemic metabolic disturbances in the pathogenesis of fatty liver. Urinary metabolic indicators may capture integrated renal, inflammatory, and metabolic alterations associated with MASLD and liver fibrosis.</p><p><strong>Materials and methods: </strong>The authors analyzed 3496 adults from the 2017-2020 National Health and Nutrition Examination Survey cycles. Urinary metabolic indicators-including serum uric acid-to-creatinine ratio (SUACR), urinary albumin-to-creatinine ratio (UACR), uric acid-to-high-density lipoprotein cholesterol ratio (UHR), uric acid-to-albumin ratio (UAR), and blood urea nitrogen-to-creatinine ratio (BUN/Cr)-were assessed. MASLD and liver fibrosis were defined using controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), respectively. Associations were evaluated using multivariable regression models adjusted for demographic, lifestyle, and cardiometabolic factors.</p><p><strong>Results: </strong>Higher SUACR, UACR, UHR, and UAR were positively associated with CAP and MASLD (all P < .05), whereas BUN/Cr was not significantly associated with either outcome. For liver fibrosis, SUACR, UHR, and UAR remained independently associated after multivariable adjustment. Nonlinear, threshold-dependent patterns were observed for SUACR, UHR, and UAR with MASLD and for UHR with fibrosis. Among the urinary metabolic indicators, UHR demonstrated the strongest predictive performance for MASLD, whereas UACR demonstrated the best predictive performance for fibrosis.</p><p><strong>Conclusion: </strong>Urinary metabolic indicators, particularly uric acid-related indicators, were associated with MASLD and liver fibrosis, suggesting that they may reflect systemic metabolic and renal dysregulation. These findings support their potential utility for noninvasive risk assessment and warrant further investigation into their mechanistic role in the progression of fatty liver disease.</p>","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013239","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":"Iron Status, Comparators, and the Interpretation of Red Cell Distribution Width in Inflammatory Bowel Disease.","authors":"Remzi Ekici","doi":"10.5152/tjg.2026.26515","DOIUrl":"https://doi.org/10.5152/tjg.2026.26515","url":null,"abstract":"","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012368","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":"Type 2 Diabetes Increases Severity but Not Mortality in Acute Pancreatitis: A Large Multicenter Analysis.","authors":"Bo Wu, Honglei Ju, Chiyi He, Wei Wang, Guixiang Wang","doi":"10.5152/tjg.2026.26159","DOIUrl":"https://doi.org/10.5152/tjg.2026.26159","url":null,"abstract":"<p><strong>Background/aims: </strong>Type 2 diabetes mellitus (T2DM) is increasingly recognized as a factor that may influence the course of acute pancreatitis (AP), but its independent associations with severity and mortality remain uncertain. The study investigated the independent association of preexisting T2DM with disease severity and in-hospital mortality in individuals with AP.</p><p><strong>Materials and methods: </strong>This multicenter retrospective cohort study included 4458 patients with AP from 3 medical centers. Patients were categorized into T2DM (n = 711) and non-T2DM groups (n = 3747). Demographic and clinical data were collected. Multivariable logistic regression analysis was used to evaluate the associations of T2DM with disease severity and in-hospital mortality after adjustment for potential confounders. Stabilized inverse probability of treatment weighting (sIPTW) analyses were performed to assess the robustness of the results.</p><p><strong>Results: </strong>Compared with the non-T2DM group, the T2DM group was older and had a significantly higher proportion of males, and higher prevalences of hypertension and chronic kidney disease. In multivariable analysis, T2DM was independently associated with increased disease severity (OR = 1.42, 95% CI: 1.19-1.69) but not with in-hospital mortality (OR = 1.14, 95% CI: 0.61-2.02). The sIPTW analysis yielded consistent findings, with T2DM remaining independently associated with increased disease severity but not with in-hospital mortality.</p><p><strong>Conclusion: </strong>Preexisting T2DM is independently associated with increased disease severity in patients with AP but not with in-hospital mortality.</p>","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012946","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":"Lumen-Apposing Metal Stent in the Treatment of Persistent Dysphagia due to Cervical Radiation Therapy.","authors":"Eren Yilmaz, Mucahit Ergul, Oguz Ozturk, Kadir Can Acun, Emir Tuğrul Keskin, Orhan Coskun, Ilhami Yuksel","doi":"10.5152/tjg.2026.26290","DOIUrl":"https://doi.org/10.5152/tjg.2026.26290","url":null,"abstract":"","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012496","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":"Social Risk Profile, Planetary Health Diet, and Mortality Risk in Individuals with Metabolic Dysfunction-Associated Steatotic Liver Disease: A Population-Based Study.","authors":"Xin Li, Hui Fan, Qiuming Yao, Xinhong Gu","doi":"10.5152/tjg.2026.26301","DOIUrl":"https://doi.org/10.5152/tjg.2026.26301","url":null,"abstract":"<p><strong>Background/aims: </strong>The individual and combined associations of social vulnerability and diet quality with long-term health outcomes in metabolic dysfunction-associated steatotic liver disease (MASLD) remain unclear. The authors aimed to examine the independent and cumulative associations of diet quality and social vulnerability with all-cause and cardiovascular disease (CVD) mortality among US adults with MASLD.</p><p><strong>Materials and methods: </strong>The authors included 13 518 adults with MASLD from the 1999-2018 National Health and Nutrition Examination Survey, with mortality follow-up through 2019. Diet quality was assessed using the planetary health diet index (PHDI) based on 24-hour dietary recalls. Social vulnerability was evaluated using a composite social risk profile (SRP) score. Cox proportional hazards models were used to derive hazard ratios (HRs) with 95% CIs.</p><p><strong>Results: </strong>Over a median follow-up of 104 months, 1875 deaths, including 643 from CVD, were recorded. Lower PHDI and SRP scores were each associated with significantly higher risks of all-cause and CVD mortality (all P < .05). In the joint analysis, participants with both the lowest PHDI tertile and an SRP score of 0-2 had the highest hazards for all-cause (HR = 3.86, 95% CI: 2.86-5.20) and CVD mortality (HR = 4.94, 95% CI: 2.97-8.20) compared with those with the highest PHDI tertile and an SRP score of 6-8. Subgroup analysis revealed that the associations of SRP score and PHDI with all-cause mortality were stronger among adults younger than 65 years (P for interaction < .001).</p><p><strong>Conclusion: </strong>Poor diet quality and social disadvantage were independently and jointly associated with increased mortality risk among US adults with MASLD, particularly those younger than 65 years.</p>","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882175","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":"Gender Disparity in Academic Gastroenterology in Türkiye: A Nationwide Bibliometric Analysis.","authors":"Gülden Bilican, Stephan L Haas, Hanife Uzar, Çağdaş Kalkan","doi":"10.5152/tjg.2026.26389","DOIUrl":"https://doi.org/10.5152/tjg.2026.26389","url":null,"abstract":"<p><strong>Background/aims: </strong>Gender disparities in academic medicine are well documented; however, no study has examined this within academic gastroenterology in Türkiye. The authors evaluated the gender distribution of academic gastroenterologists and examined relationships between gender, academic rank, research productivity, and leadership positions.</p><p><strong>Materials and methods: </strong>Academic gastroenterologists were identified using the Council of Higher Education database. Of 317 academic gastroenterologists, 305 with reliable Scopus profiles were included; 12 were excluded because of ambiguous or duplicate profiles. Productivity metrics (publication count, citation count, h-index, years of active research, and m-index) were obtained from Scopus. Leadership status was assessed using institutional websites for the full cohort of 317 gastroenterologists, with leadership status determinable for 309 individuals. The history of presidencies of the Turkish Society of Gastroenterology (TSG) was also reviewed.</p><p><strong>Results: </strong>Among 305 gastroenterologists from 119 institutions across 47 cities, 77 (25.2%) were women and 228 (74.8%) were men. Female representation was lowest among professors (20.8%) compared with associate professors (32.5%) and assistant professors (33.3%) (χ2 = 5.36, P = .069). Leadership status was determined for 309 academics; among 55 department heads, only 10 (18.2%) were women (P = .247). Women had significantly fewer publications and citations, lower h index, and fewer years of active research than men (all P < .05), whereas the m-index did not differ significantly by sex (P = .066). When stratified by academic rank, no significant sex differences were observed for any metric (all P > .05). Of 20 documented terms of presidency of the TSG, only 2 (10.0%) had been held by women.</p><p><strong>Conclusion: </strong>Women are substantially underrepresented in academic gastroenterology in Türkiye, particularly at the professor rank and in leadership positions. The absence of a significant difference in m-index suggests that lower productivity among women may partly reflect differences in career duration rather than an intrinsic gap. Structural interventions targeting mentorship, promotion, and leadership opportunities are needed to reduce these disparities.</p>","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809365","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":"Lumen-Apposing Metal Stent as a Salvage Therapy for Corrosive-Induced Gastric Outlet Obstruction: A Case Report.","authors":"Mucahit Ergul, Oguz Ozturk, Mehmet Rasit Ayte, Kadir Can Acun, Emir Tugrul Keskin, Ali Atay, Yavuz Cagir, Ilhami Yuksel","doi":"10.5152/tjg.2026.25719","DOIUrl":"10.5152/tjg.2026.25719","url":null,"abstract":"","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pancreatic Stiffness in Patients with Type 2 Diabetes Mellitus Assessed by 2-Dimensional Shear Wave Elastography: A Pilot Case-Control Study.","authors":"Yahya Erdem İnce, Orhan Sezgin, Serkan Yaraş, Osman Özdoğan, Ramazan Gen","doi":"10.5152/tjg.2026.25617","DOIUrl":"10.5152/tjg.2026.25617","url":null,"abstract":"<p><strong>Background/aims: </strong>Shear wave elastography (SWE) is a noninvasive method for assessing tissue stiffness. This study evaluated pancreatic stiffness in patients with type 2 diabetes mellitus (T2DM) and examined its association with metabolic factors and microvascular complications.</p><p><strong>Materials and methods: </strong>This prospective case-control study included 45 patients with T2DM and 45 healthy controls. Pancreatic stiffness was measured using 2-dimensional SWE (2D-SWE). Clinical, anthropometric, and laboratory data were collected, and diabetic microvascular complications were assessed.</p><p><strong>Results: </strong>A total of 90 participants were included, comprising 45 patients with T2DM and 45 healthy controls. Pancreatic stiffness was significantly higher in patients with T2DM than in controls across all pancreatic regions (P < .001). However, pancreatic stiffness did not differ significantly between patients with T2DM with and without microvascular complications (P > .05). Pancreatic steatosis (PS) was more prevalent in patients with T2DM than in healthy controls (P = .001). Among patients with T2DM, pancreatic stiffness was significantly higher in those with steatosis than in those without (P = .035), and stiffness increased with the severity of steatosis (P = .021). Body mass index and waist circumference (WC) were independently associated with increased pancreatic stiffness, with WC accounting for a significant proportion of the variance (P < .001).</p><p><strong>Conclusion: </strong>Pancreatic stiffness was significantly higher in patients with T2DM than in healthy controls and was primarily associated with metabolic factors, particularly obesity and PS, rather than microvascular complications. These findings suggest that increased pancreatic stiffness may reflect metabolic associated pancreatic alterations.</p>","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809304","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":"Risk Factors for Pouchitis After Ileal Pouch-Anal Anastomosis in Ulcerative Colitis Patients.","authors":"Haipeng Du, Wanyi Xiao, Wanbin Yin, Xuliang Yang, Xingcan Fan, Baosong Li, Anqi He, Qingxiang Yu, Gang Liu","doi":"10.5152/tjg.2026.25594","DOIUrl":"10.5152/tjg.2026.25594","url":null,"abstract":"<p><strong>Background/aims: </strong>Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical gold standard for patients with ulcerative colitis (UC) who require surgery. However, the most common long-term complication, pouchitis, significantly affects postoperative quality of life and often results in recurrent or chronic inflammation. This study systematically summarizes the risk factors for pouchitis after IPAA in patients with UC over the past 2 decades and discusses reliable risk factors and existing controversies.</p><p><strong>Materials and methods: </strong>A comprehensive literature search was conducted in PubMed, Embase, and Cochrane Library for studies published between January 2006 and December 2025. The search terms included \"ulcerative colitis,\" \"ileal pouch-anal anastomosis,\" \"IPAA,\" \"pouchitis,\" and \"risk factors.\" Two reviewers independently screened the literatüre according to the inclusion and exclusion criteria. Meta-analysis was performed using inverse-variance weighting with fixed- or random effects models depending on the degree of heterogeneity.</p><p><strong>Results: </strong>A total of 49 eligible citations were included. Based on the literature search, risk factors for pouchitis were classified into 6 categories: clinical, endoscopy related, histological, laboratory, genetic, and other factors. Preoperative steroid use and primary sclerosing cholangitis (PSC) were identified as reliable risk factors based on consistent findings from multivariate analysis. Pooled analyses identified 4 factors with consistent evidence: male sex (pooled odds ratio (OR) = 1.34, 95% CI = 1.00-1.79), PSC (pooled OR = 3.52, 95% CI = 2.53-4.90), preoperative steroid use (pooled OR = 1.89, 95% CI = 1.48-2.41), and preoperative antitumor necrosis factor (anti-TNF) therapy (pooled OR = 1.35, 95% CI = 1.17-1.57). Other factors such as extraintestinal manifestations, preoperative anti-TNF therapy, and short J-pouch length demonstrated significant associations in multiple studies, although the findings were inconsistent. Smoking, age, and sex remain controversial risk factors because of conflicting evidence.</p><p><strong>Conclusion: </strong>Preoperative steroid use and PSC are the most reliable risk factors for pouchitis after IPAA in patients with UC. Many proposed risk factors require further validation in large-scale prospective studies, and standardized diagnosis criteria and unified research methods are essential for evaluating the role of potential risk factors.</p>","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762817","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":"Revisiting the Gray Zone in HBeAg-Negative Chronic Hepatitis B: Insights From a Multicenter Liver Biopsy Cohort.","authors":"Özlem Gül, Hüseyin Köseoğlu, Selim Yalçın, Barış Yılmaz, Dilek Oğuz, Sema Zergeroğlu, Bilal Ergül","doi":"10.5152/tjg.2026.26367","DOIUrl":"https://doi.org/10.5152/tjg.2026.26367","url":null,"abstract":"<p><strong>Background/aims: </strong>The management of patients with HBeAg-negative chronic hepatitis B (CHB) with intermediate viremia and persistently normal alanine aminotransferase (ALT) levels remains controversial. This \"gray-zone\" (GZ) population may harbor significant histological liver injury despite not meeting conventional treatment criteria. This study characterized the histologic features of this GZ population and compared their clinical and laboratory characteristics.</p><p><strong>Materials and methods: </strong>In this multicenter retrospective study, patients with HBeAg negative CHB who had hepatitis B virus (HBV) DNA levels between 2000 and 20 000 IU/mL and persistently normal ALT levels and who underwent liver biopsy between 2014 and 2022 were included. Histological assessment was performed using the modified Ishak scoring system. Significant fibrosis was defined as Ishak stage of 2 or greater. Clinical, virological, and noninvasive fibrosis parameters were analyzed.</p><p><strong>Results: </strong>A total of 145 patients were included (mean age: 46.3 ± 12.6 years; 54.5% female). Significant fibrosis and/or moderate-tosevere necroinflammatory activity requiring antiviral therapy was identified in 109 patients (75.1%). Although ALT and aspartate aminotransferase levels remained within normal reference range, both were significantly higher in the treatment group compared than in the nontreatment group (P = .003 and P = .018, respectively). Aspartate aminotransferase-to-platelet ration index (APRI) scores were also significantly elevated among treated patients (P = .02), whereas Fibrorsis-4 (FIB-4) scores did not differ significantly. HBV DNA and quantitative Hepatitis B surface antigen (HBsAg) levels were comparable between groups.</p><p><strong>Conclusion: </strong>A substantial proportion of patients with HBeAg-negative CHB in the GZ exhibited clinically significant histologic disease despite persistently normal ALT levels. Reliance solely on conventional biochemical thresholds may underestimate the burden of fibrosis. Early histological evaluation and more proactive treatment strategies should be considered for selected patients in the GZ.</p>","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761993","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}