Turkish Journal of Gastroenterology最新文献

Background/aims: The International Autoimmune Hepatitis (AIH) Group recommends the new histological criteria (HC) (2022) and modified immunoserological testing for diagnosing AIH. The diagnostic utility of the 2022 HC was evaluated. The simplified criteria were also updated with the 2022 HC and immunoserological testing and assessed the diagnostic performance.

Materials and methods: The data of 207 patients (111 AIH, 33 primary biliary cholangitis, 35 drug-induced liver injury, and 28 metabolic dysfunction-associated fatty liver disease) were evaluated.

Results: The 2022 HC and the 2008 simplified HC showed 95% vs. 88% sensitivity and 82% vs. 49% specificity for possible/compatible AIH. For likely/typical AIH, sensitivity was 60% vs. 42% and specificity was 98% vs. 95% for the 2022 HC and the 2008 HC, respectively. The area under the curve (AUC) was better for the 2022 HC than for the 2008 simplified HC (0.932 vs. 0.771, P < .001). The updated simplified criteria had a sensitivity comparable with the simplified criteria (88% vs. 87%) but a better specificity (94% vs. 80%) for prob able AIH. The sensitivity was slightly lower (57% vs. 63%), but the specificity was greater (97% vs. 89%) for definitive AIH. The AUC was higher in the updated simplified criteria than in the simplified criteria (0.959 vs. 0.894, P = .016).

Conclusion: The 2022 HC showed better sensitivity and specificity than the 2008 simplified HC for AIH. The updated simplified criteria worked well with improved accuracy of AIH diagnosis. Our results suggest that the diagnostic algorithm of AIH should be modified based on recent recommendations.   Cite this article as: Moral K, Efe C, Sert A, et al. Evaluation of histological criteria and immunoserological testing of simplified criteria for the diagnosis of autoimmune hepatitis. Turk J Gastroenterol. 2026;37(2):223-232.

Cite this article as: Yıldırım TY, Çiftçi U, Huseynov J, Demirtaş CÖ, Özdoğan OC. Rare presentation of Immunoglobulin G4-related disease: hepatic mass lesions mimicking metastasis. Turk J Gastroenterol. 2026;37(2):273-275.

Background/Aims: Preoperative anxiety is a common and significant issue in pediatric patients undergoing endoscopic interventions. The evaluation aimed to determine whether age-appropriate educational brochures could reduce anxiety in pediatric patients and their caregivers undergoing outpatient endoscopic procedures with sedation. Materials and Methods: Pediatric patients and their caregivers were randomly assigned to either a control group (standard verbal information only) or an intervention group (standard verbal information plus an age-appropriate educational brochure). On the day of the procedure, pediatric anxiety was assessed using the Modified Yale Preoperative Anxiety Scale (m-YPAS), whereas caregiver anxiety was measured using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Results: A total of 252 pediatric patients (age, 3-17 years; American Society of Anesthesiologists score, I-II) and their caregivers were recruited. Of these, 174 formed the control group and 78 received an educational brochure intervention. The demographic characteristics were similar across the groups, except for caregiver age. While there were no significant between-group differences in caregiver APAIS scores, pediatric patients in the brochure group exhibited significantly lower m-YPAS scores (P < .05) than those in the control group. Conclusion: Providing children with age-appropriate educational brochures prior to sedation for endoscopic procedures significantly reduced their preoperative anxiety. This low-cost, easily implemented intervention may help improve procedural experience in pediatric patients and potentially enhance overall clinical outcomes.

Background/Aims: The effectiveness of nafamostat for treating acute pancreatitis (AP) remains questionable. It was hypothesized that the administration of lidocaine would increase the penetration of nafamostat into the pancreas and improve its efficacy. This study evaluated the efficacy of combined management with nafamostat and lidocaine in the treatment of AP. Materials and Methods: Mild edematous AP was induced with cerulein in Wistar rats, which were distributed among 3 interventional cohorts: (1) a lidocaine cohort, with a regional intraarterial infusion of 1% lidocaine solution, (2) a lidocaine-nafamostat group, with a regional intraarterial infusion of 1% lidocaine solution followed by the infusion of nafamostat mesylate, and (3) an NaCl group, with a regional intraarterial infusion of 0.9% sodium chloride solution. Following 4, 8, and 12 hours after drug administration, serum amylase and lipase levels were tested. Rats were euthanized, and the pancreas was removed for histopathological examination. Results: A total of 16 rats were analyzed: 6 in the lidocaine group, 5 in the lidocaine-nafamostat group, and 5 in the NaCl group. Post-treatment amylase and lipase levels were comparable between the groups. The NaCl group had more prevalent signs of chronic inflammation in the pancreatic tissue and adipose tissue than both the lidocaine and lidocaine-nafamostat groups. Conclusion: The addition of nafamostat mesylate did not show superiority over lidocaine alone in the treatment of AP. Considering the prolonged observation period and self-healing tendency of mild edematous AP, both lidocaine and nafamostat do not impact treatment outcomes. However, both drugs may reduce the inflammatory and necrotic processes triggered by AP.

Background/aims: The chronicity and recurrence of irritable bowel syndrome (IBS) pose significant burdens on patients’ lives, making it urgent to understand its underlying mechanisms. This study intends to investigate the function and regulatory mechanisms of miR- 539-5p in IBS and lay the foundation for the creation of more effective therapeutic strategies.

Materials and methods: Rat model of IBS with diarrhea (IBS-D) was established and evaluated by the abdominal withdrawal reflex. The IBS cellular model was established in vitro using lipopolysaccharide (LPS), and real-time quantitative polymerase chain reaction was used to assess the changes in the miR-539-5p expression. Cell counting kit-8 assays, flow cytometry, and enzyme-linked immunosorbent assay were used to evaluate the effects of different treatments on cell viability, paracellular permeability, apoptosis, and inflammatory responses. Bioinformatics techniques and dual-luciferase reporter gene assays were leveraged to forecast and confirm the interaction between miR-539-5p and the KDM6A gene.

Results: In IBS-D rats, miR-539-5p was conspicuously downregulated, and miR-539-5p overexpression could improve the symptoms of rats. Under exposure to LPS, the expression of miR-539-5p was evidently decreased. Upregulating miR-539 5p could significantly mitigate LPS-induced cellular damage, namely inhibiting the apoptosis of intestinal mucosal epithelial cells, promoting cell proliferation, reducing paracellular permeability, and suppressing the inflammatory response. KDM6A, as the target gene of miR-539-5p, was remarkably upregulated in IBS-D rats and cells exposed to LPS. KDM6A overexpression counteracts the protective effects mediated by the upregulation of miR-539-5p.

Conclusion: miR-539-5p may be involved in regulating the pathological processes of IBS-D by targeting KDM6A.

Background/aims: Despite the widespread use of direct-acting antivirals (DAAs), real-world data on treatment outcomes and predictors of response in hepatitis C virus (HCV) genotypes 2 and 3 remain limited, particularly in countries with heterogeneous patient populations such as Türkiye. This study evaluates the efficacy and safety of direct-acting antivirals (DAAs) in treating hepatitis C virus (HCV) genotype 2 (GT-2) and genotype 3 (GT-3) in Türkiye.

Materials and methods: This cohort is a multicenter, retrospective, and observational study. Data from 267 GT-2 or GT-3 patients treated with a DAA were analyzed. Treatment efficacy was assessed by sustained virological response at 12 weeks after the end of treatment (SVR), and baseline demographic, clinical, and laboratory parameters were evaluated to identify factors associated with treatment response.

Results: An overall sustained virological response (SVR) rate of 95.9%, with no significant difference between GTs. The SVR rates were relatively lower in patients with cirrhosis. Prior pegylated interferon and ribavirin reduced SVR rates, particularly in males and patients with cirrhosis. The most common treatments were sofosbuvir-based regimens, which demonstrated comparable efficacy. No significant drug interactions were observed. The most commonly reported adverse events were fatigue and mild anemia, particularly in cirrhotic patients; however, these did not lead to treatment discontinuation.

Conclusion: This study supports the efficacy and tolerability of DAA regimens for these HCV GTs, thereby reinforcing their role in HCV eradication.

Intolerance to wheat and gluten intake has gained public and scientific interest in recent years. Celiac disease (CD) and wheat allergy are wheat-related disorders with a well-defined etiological mechanism alongside corresponding diagnostic tests. In addition, patients also self-report intolerance toward wheat and gluten that does not meet the criteria of CD and wheat allergy. This gives rise to a third category, namely non-celiac wheat sensitivity (also referred to as non-celiac gluten sensitivity). However, this category is controversial. Unlike CD and wheat allergy, the pathophysiological mechanism is unknown. When conducting double-blinded placebo-controlled trials, only a small proportion of patients can correctly identify gluten from a placebo based on symptoms, indicating a substantial nocebo component. In fact, it has been posited that non-celiac wheat sensitivity is simply a form of irritable bowel syndrome. The aim of this review is to provide an overview of the epidemiology, etiology, clinical manifestations, diagnosis, and management of the 3 abovementioned conditions.

Background/aims: Soluble Tim-3 (sTim-3) has been implicated in primary biliary cholangitis (PBC), an autoimmune liver disease, though its clinical significance remains unclear. This study aimed to evaluate the associations between sTim-3, Galectin-9, and cytokines in PBC, as well as their potential prognostic utility.

Materials and methods: A total of 55 PBC patients were enrolled (45 without overlapping conditions) and serum levels of sTim-3, Galectin-9, and 18 cytokines/chemokines were measured. Disease severity was assessed using the model for end-stage liver disease (MELD), MELD-Na, and Mayo risk score (MRS) 1994, alongside fibrosis-4 (FIB-4) index and monocyte-lymphocyte ratio (MLR). Patients were stratified by fibrosis stage, cirrhosis status, Child-Pugh score, and treatment duration, with intergroup parameter comparisons performed. The least absolute shrinkage and selection operator regression identified potential risk factors for MRS1994, followed by multivariate linear regression analysis.

Results: Compared to healthy controls, PBC patients exhibited elevated sTim-3 and reduced Galectin-9, though neither biomarker cor related with clinical parameters. Advanced disease stages were associated with increased MLR, interferon-gamma (IFN-γ), interleukin (IL)-6, IL-8, C-C motif chemokine ligand 3 (CCL3), CCL20, and C-X3-C motif chemokine ligand 1 (CX3CL1). The MELD/MELD-Na scores strongly correlated with IL-6, TNF-α, IFN-γ, CCL3, and CCL20, while IL-6 and CX3CL1 linked to FIB-4 index. Multivariate analysis identi fied MLR, albumin/globulin (A/G) ratio, TNF-α, IL-6, and CX3CL1 as independent predictors of MRS1994.

Conclusion: Although sTim-3 and Galectin-9 dysregulation lacked direct clinical relevance, MLR, A/G ratio, cirrhosis status, and inflam matory markers (TNF-α, IL-6, CX3CL1) emerged as robust predictors of disease severity (MELD) and prognosis (MRS1994), highlighting their potential for non-invasive risk stratification in PBC.   Cite this article as: Xu J, Ma H, Dang F, et al. Elevated serum soluble tim-3 in primary biliary cholangitis: lack of correlation with cytokines, chemokines, and clinical parameters. Turk J Gastroenterol. 2026;37(2):196-207.

Background/aims: The aim was to determine the findings of the gastrointestinal system, which is the second most frequently affected system in the primary immunodeficiency (PID) patient population, and the frequency of these findings.

Materials and methods: Fifty patients with PID were included in this study, and the characteristics of the patients, upper gastrointesti nal endoscopy, colonoscopy, and biopsy (endoscopic and colonoscopic) results were evaluated.

Results: The median age of patients included in the study was 31 years (range 18-72 years) and 64% were male. Seventy-two percentnof the patients had common variable immunodeficiency (CVID) and 68% were diagnosed in adulthood. Chronic diarrhea was present in 48% of the patients, and body mass index was lower in this group. Switched memory B cells were lower in chronic diarrhea (P = .003). Twenty-nine patients underwent upper gastrointestinal endoscopy, and the most common macroscopic findings were gastropathy (79.3%), duodenopathy (37.9%), and esophagitis (27.6%). Of the 23 patients who underwent colonoscopy, 14 had at least 1 macro scopic finding other than internal hemorrhoids and only 1 patient had no macroscopic findings. One patient had mucosa-associated lymphoid tissue lymphoma (MALToma) on gastric biopsy, while 1 patient had poorly differentiated adenocarcinoma on antrum biopsy.

Conclusion: In conclusion, chronic diarrhea is more common in PID than in the general population, and switched memory B cells arenlower in PID patients with chronic diarrhea. Most importantly, a collaboration between immunologists, gastroenterologists, and patholo gists is required when evaluating the gastrointestinal tract in PID.   Cite this article as: Erkoç M, Erhan Ç, Çevirme L, et al. Gastrointestinal tract findings in patients with primary immunodeficiency: A single-center 6-year experience. Turk J Gastroenterol. 2026;37(1):55-61.

Background/aims: Hepatocellular carcinoma (HCC) constitutes approximately 85% of liver cancers. This study aimed to investigate the role of immune escape-related genes (IEGs) in HCC patients and analyze their relationship with prognosis and immunotherapy, thereby providing a reference for further clinical treatment.

Materials and methods: Datasets were collected from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus databases. Differential expression analysis was conducted to identify differentially expressed IEGs between normal and HCC tissues. Expression, survival, mutational, and immune profiles of a hub gene nuclear transport factor 2 like export factor 1 (NXT1) were evaluated. Validation of NXT1 expression in adjacent normal and HCC tissues was carried out using RT-qPCR and western blot assays. Next, CCK-8, wound healing, and transwell assays were conducted to evaluate the biological function of NXT1 in HCC cell lines.

Results: Analysis of the TCGA-LIHC and GSE164359 datasets revealed that NXT1 was notably elevated in HCC tissues compared to adjacent normal tissues, a finding validated through RT-qPCR and western blot assays. Meanwhile, high levels of NXT1 were associ ated with an unfavorable prognosis of HCC patients. Mutational analysis indicated a higher incidence of TP53 mutations in the NXT1 high-expression group relative to the NXT1 low-expression group. HCC patients with high NXT1 expression demonstrated an increased proportion of M0 macrophages and regulatory T cells (Tregs) and a decreased proportion of M1 macrophages. Furthermore, deficiency of NXT1 significantly suppressed HCC cell viability, migration, and invasion.

Conclusion: Collectively, NXT1 may serve as a valuable prognostic marker and a potential therapeutic target for HCC.   Cite this article as: Guo J, Tong X, Liu S, et al. Immune escape-related gene NXT1 as a potential prognostic and therapeutic target in hepatocellular carcinoma. Turk J Gastroenterol. 2026;37(1):98-112.