Turkish Journal of Gastroenterology最新文献

{"title":"Association of the Modified Endothelial Activation and Stress Index with MASLD and Liver Fibrosis: Effect Modification by Magnesium Intake.","authors":"Xin Li, Zizheng Huang","doi":"10.5152/tjg.2026.25591","DOIUrl":"10.5152/tjg.2026.25591","url":null,"abstract":"<p><strong>Background/aims: </strong>Few studies have reported the effect of magnesium status on the endothelial dysfunction-related risk for the development of MASLD and liver fibrosis. The current study aimed to explore the association of modified endothelial activation and stress index (mEASIX) with metabolic dysfunction-associated steatotic liver disease (MASLD) and liver fibrosis and to examine the effect of magnesium intake on this association.</p><p><strong>Materials and methods: </strong>A cross-sectional study was conducted using data from 5960 participants in the National Health and Nutrition Examination Survey 2017-2020. The mEASIX was calculated based on lactate dehydrogenase levels, high-sensitivity C-reactive protein levels, and platelet counts. Metabolic dysfunction-associated steatotic liver disease was defined as the presence of hepatic steatosis along with at least one of the 5 cardiometabolic risk factors. Liver fibrosis was defined as a liver stiffness measurement ≥ 8.0 kPa. Magnesium (Mg) intake was assessed using the 24-hour dietary recall data. Multivariate logistic regression analyses were performed to examine the associations of mEASIX with MASLD and liver fibrosis.</p><p><strong>Results: </strong>The mEASIX was positively associated with MASLD and liver fibrosis (MASLD: odds ratio [OR] in Q2 = 1.62, Q3 = 2.38, and Q4 = 2.70; liver fibrosis: OR in Q3 = 1.84 and Q4 = 2.73; all P < .05). The mEASIX revealed nonlinear relationships with MASLD and liver fibrosis. A significant interaction between magnesium intake and mEASIX was observed in relation to MASLD. Stratified analyses further demonstrated that the association between high mEASIX (≥1.2) and the risk of MASLD and liver fibrosis was more pronounced among participants with low magnesium intake compared to those with high magnesium intake.</p><p><strong>Conclusion: </strong>The current study demonstrated positive nonlinear associations of mEASIX with MASLD and liver fibrosis. Low magnesium intake may exacerbate this endothelial dysfunction-related risk for MASLD and liver fibrosis.</p>","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823286","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":"Clinical Practice Update on the Evaluation, Diagnosis, and Management of Pancreatic Exocrine Insufficiency: Expert Review.","authors":"Orhan Sezgin, Dilek Oğuz, Müjde Soytürk, İsmail Hakkı Kalkan, Göksel Bengi, Özlem Gül","doi":"10.5152/tjg.2026.25679","DOIUrl":"10.5152/tjg.2026.25679","url":null,"abstract":"<p><p>Pancreatic exocrine insufficiency (PEI) is characterized by inadequate synthesis, secretion, and/or activation of exocrine pancreatic secretions. This guideline has been developed to assist clinicians and researchers in understanding the definition, etiopathogenesis, epidemiology, diagnosis, treatment, and follow-up of PEI based on the current literature. All statements within this review were developed through consensus among the authors based on a comprehensive literature review.</p>","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":"534-554"},"PeriodicalIF":2.3,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13182929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876591","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":"Gastrointestinal Bleeding as an Unusual Presentation of Groove Pancreatitis Complicated by Intramural Duodenal Hematoma.","authors":"Tugba Tolu, Yasemin Kaldirim Armutcuoglu, Tuba Yilmaz Yildirim, Muhsinem Yılmaz Duz, Hale Nur Tiras, Yesim Ozen Alahdab, Osman Cavit Ozdogan, Coskun Ozer Demirtas","doi":"10.5152/tjg.2026.26084","DOIUrl":"10.5152/tjg.2026.26084","url":null,"abstract":"","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13382234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788650","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":"Efficacy and Safety of Direct-Acting Antivirals in Patients with Hepatitis C Infection: Nationwide Real-life Data from Türkiye.","authors":"Alper Gunduz, Nefise Çuvalcı Öztoprak, Nagehan Didem Sarı, Behice Kurtaran, Yusuf Önlen, Ebubekir Senates, Esra Zerdali, Hasan Karsen, Ayse Batırel, Rıdvan Kara Ali, Rahmet Güner, Tansu Yamazhan, Sukran Kose, Nurettin Erben, Nevin Ince, İftihar Köksal, Figen Sarıgül Yıldırım, Gulsen Yoruk, Suheyla Komur, Tayibe Bal, Sibel Kaya, Şaban Esen, Özgür Günal, Ilknur Esen Yıldız, Dilara Inan, Şener Barut, Mustafa Namıduru, Selma Tosun, Kamuran Türker, Alper Sener, Kenan Hızel, Nurcan Baykam, Fazilet Duygu, Esragül Akıncı, Güray Can, Ulku User, Hanefi Cem Gül, Ayhan Akbulut, Güven Çelebi, Mahmut Sünnetçioğlu, Oğuz Karabay, Hayat Kumbasar Karaosmanoğlu, Fatma Sırmatel, Fehmi Tabak","doi":"10.5152/tjg.2026.25287","DOIUrl":"10.5152/tjg.2026.25287","url":null,"abstract":"<p><strong>Background/aims: </strong>Chronic hepatitis C virus (HCV) infection constitutes a substantial healthcare concern in Türkiye. The clinical application of direct-acting antiviral medications (DAAs) has transformed its management. The goal is to assess the efficacy and safety of DAAs in the real-world setting in Turkish patients with chronic HCV.</p><p><strong>Materials and methods: </strong>Thirty-seven centers from Türkiye recorded 1807 patients to the database. Patients aged >18 years were enrolled to the study. Their demographics, clinical information, DAAs used, efficacy, and safety information were evaluated. Efficacy and safety results were reported for patients with 12-week post-treatment (SVR12) data.</p><p><strong>Results: </strong>Among the patients, 919 (50.9%) were female with a mean of age 56 ± 15 years (range:18-97 years) and 238 (13%) were cirrhotic. Liver biopsy was performed in 296 patients. Mean histologic activity index score was 7.68 and fibrosis score was 2.58. Baseline mean viral load was 4.11×106 copies/mL. Patients received the following treatments: Paritaprevir+Ritonavir+Ombitasvir+Dasabuvir (PrOD):706, Ledipasvir+Sofosbuvir:490, Sofosbuvir+Ribavirin:176, PrOD+Ribavirin:175, Ledipasvir+Sofosbuvir+Ribavirin:156, PrO+Ribavirin:32, and PrO:10. Response at the end of treatment was 99.2% (1454/1465) and SVR12 was 97.8% (1289/1318). The DAAs were generally well tolerated. Ten and 13 patients discontinued therapy because of drug-related and unrelated adverse side effects, respectively.</p><p><strong>Conclusion: </strong>This real-world study demonstrated that DAA treatment for HCV is both safe and highly effective. In two-thirds of the patients, the hepatic inflammation is moderate to severe, and fibrosis is moderate to advanced in half of them. Patients' characteristics suggest that HCV infection is often not diagnosed or treated until patients present with moderate-to-severe stage, indicating that diagnostic and therapeutic approaches should be used more effectively.</p>","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788641","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":"Red Cell Distribution Width as an Independent Marker of Objective Disease Activity in Ulcerative Colitis and Crohn's Disease: A Large Real-World Cohort of 1000 Patients.","authors":"Yavuz Özden","doi":"10.5152/tjg.2026.25788","DOIUrl":"10.5152/tjg.2026.25788","url":null,"abstract":"<p><strong>Background/aims: </strong>The treat-to-target (T2T) strategy requires objective biomarkers in inflammatory bowel disease (IBD). Red cell distribution width (RDW) is of interest and routinely available; however, its incremental diagnostic value beyond anemia and inflammatory markers for detecting endoscopic activity (and histologic activity in ulcerative colitis) remains unclear.</p><p><strong>Materials and methods: </strong>This retrospective cohort included 1000 IBD patients (ulcerative colitis (UC) = 580, Crohn's disease (CD) = 420). Objective activity was defined endoscopically (UC: Mayo endoscopic subscore ≥2; CD: SES-CD ≥3), with histologic activity (Nancy Index ≥1) as a prespecified secondary endpoint in UC. Red cell distribution width was measured within a peri-endoscopic window (median 1 day; IQR 0-3). Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis, reporting observed and optimism-corrected area under the curve (AUC). Incremental value over C-reactive protein (CRP) was evaluated using the DeLong method. Multivariable logistic regression was adjusted for anemia, iron-related parameters, inflammatory markers, disease extent, and medications.</p><p><strong>Results: </strong>Active disease is present in 432 patients (43.2%). The RDW is higher in active vs. inactive disease (15.6 ± 1.8% vs 13.9 ± 1.4%; P < .001) and shows good discrimination (observed AUC 0.820; optimism-corrected AUC 0.815). A cut-off of 14.5% yield 78.9% sensitivity and 76.3% specificity. Adding RDW to CRP improve AUC from 0.845 to 0.880 (P = .002). Each 1% RDW increase independently predict active disease (adjusted OR 1.65; 95% CI, 1.30 2.09), including non-anemic patients. In UC, RDW increase with histological severity (P < .001).</p><p><strong>Conclusion: </strong>Red cell distribution width independently reflects objective inflammatory activity in IBD and provides incremental value beyond standard markers, supporting its role as a low-cost adjunct for T2T monitoring.</p>","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788587","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":"Liver Conditions Specific to Pregnancy: Optimizing Management and Outcomes.","authors":"Alexandra Frolkis, Ilkay Ergenc, Michael A Heneghan","doi":"10.5152/tjg.2026.26024","DOIUrl":"10.5152/tjg.2026.26024","url":null,"abstract":"<p><p>Pregnancy is accompanied by complex physiological adaptations that influence hepatic metabolism, bile transport, coagulation, and immune tolerance, which may precipitate the development of pregnancy-specific liver disorders. Gestational liver disease comprises a distinct group of conditions such as hyperemesis gravidarum (HG), intrahepatic cholestasis of pregnancy (ICP), acute fatty liver of pregnancy (AFLP), and the spectrum of preeclampsia that includes hepatic involvement and Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. Although heterogeneous in presentation and pathophysiology, these disorders share the potential for significant maternal and fetal morbidity and mortality. Early recognition and hepatology-guided interpretation of abnormal liver biochemistry during pregnancy are critical to differentiate gestational liver disease from underlying chronic liver disease and to identify conditions that require urgent intervention. Management of gestational liver disease requires coordinated, multidisciplinary care focused on maternal stabilization, appropriate disease-specific therapy, and carefully timed delivery according to both maternal and fetal risk. Treatment strategies range from supportive and nutritional management for HG, biochemical and symptom control with ursodeoxycholic acid for ICP, and urgent delivery and intensive supportive care for AFLP to delivery with antihypertensive and anticonvulsant therapy for hypertensive disorders and HELLP syndrome. Although each condition poses unique diagnostic and therapeutic challenges, complications associated with gestational liver disease in pregnancy may be reduced through proactive management and multidisciplinary involvement. This review summarizes current evidence on the pathophysiology, diagnostic evaluation, management strategies, and pregnancy outcomes associated with pregnancy-specific liver disorders.</p>","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788553","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":"Prognostic Significance of Cystic Biliary Dilatation in Primary Sclerosing Cholangitis.","authors":"Yavuz Emre Parlar, Bengi Öztürk, Onur Keskin, Sabir İsrafilov, Taylan Kav, Cenk Sökmensüer, Ahmet Bülent Doğrul, Erkan Parlak","doi":"10.5152/tjg.2026.26055","DOIUrl":"10.5152/tjg.2026.26055","url":null,"abstract":"<p><strong>Background/aims: </strong>Primary sclerosing cholangitis (PSC) is a chronic, progressive disease characterized by inflammatory and fibrotic strictures in the intrahepatic and/or extrahepatic bile ducts. Typical cholangiographic findings include multifocal, annular, short bile duct strictures with minimal upstream dilatation. However, in some patients, this dilatation progresses to cystic dimensions. The current study aimed to investigate whether the clinical features and prognosis of patients with cystic dilatation (CD) of the bile ducts differ from those of patients with classic cholangiographic PSC.</p><p><strong>Materials and methods: </strong>Demographic data, laboratory and clinical findings, and prognostic outcomes of patients with CD of the bile ducts who underwent endoscopic retrograde cholangiopancreatography (ERCP) and/or percutaneous transhepatic biliary drainage at the hospital between 2017 and 2023 were compared with those of patients without CD.</p><p><strong>Results: </strong>Of the 37 patients, 5 (13.5%) had cystic biliary dilatation. Median follow-up was 24 months (range, 12-62) in the CD group and 20 months (range, 8-52) in the non-cystic group. Patients with CD had a higher frequency of cholangitis (median attacks per patient, 1.6 vs. 0.3; P < .001), a greater proportion of recurrent cholangitis (4/5 [80%] vs. 7/32 [21.8%]; P = .038), an increased risk of end stage liver disease (3/5 [60%] vs. 5/32 [15.6%]; P = .025), and higher mortality (1/5 [20%] vs. 2/32 [6.25%]; P = .045). Median transplant free survival was significantly shorter in the cystic group (7.1 years [95% CI, 1-9] vs. 19.5 years; P = .017).</p><p><strong>Conclusion: </strong>Cystic dilatation appears to be a clinically relevant prognostic feature in patients with primary sclerosing cholangitis, however, confirmation in larger studies is warranted.</p>","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788597","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":"Thrombotic Risk and Hemostatic Profiles in Pediatric Inflammatory Bowel Disease: Association with Disease Activity.","authors":"","doi":"10.5152/tjg.2026.25541","DOIUrl":"10.5152/tjg.2026.25541","url":null,"abstract":"<p><strong>Background/aims: </strong>Inflammatory bowel disease (IBD) increases thromboembolic risk, but pediatric evidence remains limited. The current study evaluated the associations between coagulation markers, systemic inflammation, and disease activity in pediatric IBD and assessed the prevalence of silent thrombosis.</p><p><strong>Materials and methods: </strong>A total of 46 pediatric patients with IBD were enrolled in this single center cross-sectional study. All underwent Doppler ultrasonography of the lower extremities and the portal venous system. Hemostatic and inflammatory markers were evaluated in the laboratory and were analyzed in relation to disease activity.</p><p><strong>Results: </strong>One asymptomatic thrombus was detected in a patient with Crohn's disease (CD). Factor VIII was significantly higher in ulcerative colitis (UC) compared to CD (median 109.5 vs. 74.3 IU/dL, P = .007). In UC, platelet count and D-dimer increased with increasing disease activity and extent. There was a significant relationship between platelet counts and the endoscopic extent (P = .008) and Mayo Score (P = .031). In CD, fibrinogen and factor VIII levels revealed a positive correlation with Pediatric Crohn's Disease Activity Index scores (P = .012 and P = .040, respectively) but not with the Simple Endoscopic Score. Corticosteroid use was linked to higher factor VII (P = .017).</p><p><strong>Conclusion: </strong>Asymptomatic thrombosis rare in IBD, but inflammation and procoagulant activity were closely related, especially in UC. Platelet count, D-dimer, and factor VIII might serve as biomarkers for thrombotic risk and monitoring.</p>","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788606","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":"A Critical Perspective on Helicobacter pylori Treatment Strategies: Are Levofloxacin-Based Regimens Truly Suitable as First-Line Therapy?","authors":"Ramazan Dertli, Mehmet Asil","doi":"10.5152/tjg.2026.25791","DOIUrl":"10.5152/tjg.2026.25791","url":null,"abstract":"","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788461","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":"Acute Liver Failure Due to Plasmodium falciparum: A Rare Case from a Non-Endemic Country.","authors":"Ersin Batıbay, Osman Yüksekyayla, Mahmut Polat","doi":"10.5152/tjg.2026.25669","DOIUrl":"10.5152/tjg.2026.25669","url":null,"abstract":"","PeriodicalId":51205,"journal":{"name":"Turkish Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788631","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}