Background/Aims: 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. Materials and Methods: 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. Results: 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. Conclusion: Preexisting T2DM is independently associated with increased disease severity in patients with AP but not with in-hospital mortality. Cite this article as: Wu B, Ju H, He C, Wang W, Wang G. Type 2 diabetes increases severity but not mortality in acute pancreatitis: A large multicenter analysis. Turk J Gastroenterol. Published online September 07, 2026. doi: 10.5152/tjg.2026.26159.
Cite this article as: Ekici R. Iron status, comparators, and the interpretation of red cell distribution width in inflammatory bowel disease. Turk J Gastroenterol. Published online September 07, 2026. doi: 10.5152/tjg.2026.26515.
Cite this article as: Yilmaz E, Ergul M, Ozturk O, et al. Lumen-apposing metal stent in the treatment of persistent dysphagia due to cervical radiation therapy. Turk J Gastroenterol. Published online September 3, 2026. doi: 10.5152/tjg.2026.26290.
Background/Aims: 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. Materials and Methods: 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. Results: 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). Conclusion: 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. Cite this article as: Li X, Fan H, Yao Q, Gu X. Social risk profile, planetary health diet, and mortality risk in individuals with metabolic dysfunction–associated steatotic liver disease: A population-based study. Turk J Gastroenterol. Published online August 25, 2026. doi: 10.5152/tjg.2026.26301.
Background/Aims: 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. Materials and Methods: 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. Results: 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). Conclusion: 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. Cite this article as: İnce YE, Sezgin O, Yaraş S, Özdoğan O, Gen. Pancreatic stiffness in patients with type 2 diabetes mellitus assessed by 2-dimensional shear wave elastography: A pilot case–control study. Turk J Gastroenterol. Published online August 17, 2026. doi: 10.5152/tjg.2026.25617
Background/Aims: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. Materials and Methods: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. Results: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. Conclusion: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.
Background/Aims: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. Materials and Methods: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. Results: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. Conclusion: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.
Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape across multiple malignancies. However, their expanding use has been accompanied by an increasing spectrum of immune-related adverse events (irAEs), particularly those affecting the gastrointestinal (GI) tract. GI toxicities may involve both the upper and lower GI tract and range from mild, nonspecific symptoms to severe inflammatory complications requiring treatment interruption, hospitalization, or selective immunosuppressive therapy. This review summarizes the current evidence regarding the pathogenesis, clinical presentation, endoscopic and histopathologic findings, and management of GI irAEs associated with ICIs. Upper GI involvement, including esophagitis, gastritis, and duodenitis, is relatively uncommon and typically presents with nonspecific symptoms and heterogeneous endoscopic findings, which may occur despite a macroscopically normal-appearing mucosa. Lower GI toxicity, particularly diarrhea and colitis, is more common and clinically significant, especially in patients receiving anti-CTLA-4–based and combination regimens. Endoscopic evaluation with mucosal biopsy remains central to diagnosis because clinical severity does not always correlate with endoscopic or histopathologic activity. Histopathologic patterns are heterogeneous and may overlap with those of other inflammatory or infectious GI disorders, making clinicopathologic correlation essential. Current management is largely guided by expert consensus and includes supportive care, corticosteroids, and biologic rescue therapy with agents such as infliximab or vedolizumab for steroid-refractory disease. Early recognition, appropriate grading, exclusion of alternative etiologies, and multidisciplinary collaboration among oncologists and gastroenterologists are critical to optimize outcomes while preserving the benefits of cancer immunotherapy. Cite this article as: Cankurtaran RE, Karpuzcu HC, Yurekli OT. Immune checkpoint inhibitor–related gastrointestinal toxicity: Pathogenesis, diagnosis, and management. Turk J Gastroenterol. Published online August 11, 2026. doi: 10.5152/tjg.2026.26304.
Background/Aims:Inflammatory bowel disease (IBD) is a systemic disorder that affects not only the gastrointestinal tract but also extraintestinal organs and is associated with a significantly increased risk of osteoporosis. This study aims to investigate the association between plasma proteomic profiles and the subsequent risk of osteoporosis in patients with IBD. Materials and Methods:Using data from 52 953 participants in the UK Biobank Pharma Proteomics Project, overlapping plasma proteins associated with both IBD and osteoporosis using Cox regression analysis were identified. Among these proteins, those with high predictive importance for IBD-osteoporosis multimorbidity were selected using machine learning and multistate modeling. Single-cell- type expression analysis was conducted to evaluate the cell type-specific enrichment of the candidate predictive protein-coding genes in the intestine. Results:Over a median follow-up of 13.6 years, 339 proteins were significantly associated with IBD and 183 with osteoporosis, with 104 proteins overlapping between the 2 conditions. Machine learning and multistate modeling narrowed these down to 8 candidate predictive proteins (PLAUR, TNFRSF10A, SPINK1, HLA_E, CHGA, SPP1, TNFRSF10B, and IGFBP2) for IBD-osteoporosis multimorbidity. Exploratory single-cell expression analysis of 5 available candidate genes characterized their intestinal expression patterns, providing supportive biological insights. Conclusion:The study delineates the proteomic signatures associated with IBD-osteoporosis multimorbidity, identifies specific proteins associated with both conditions, highlights key molecular players linking the diseases, and identifies both established and potentially novel candidate biomarkers.
Background/Aims:The treatment of colorectal cancer (CRC) remains a challenge in clinical research. Zeaxanthin (ZEA) has demonstrated substantial anti-inflammatory and anticancer effects. However, its preventive effects and underlying mechanisms in CRC remain elusive. Therefore, this study investigated the preventive effects and 10 molecular mechanisms of ZEA in CRC. Materials and Methods:The effects of ZEA on tumor formation, inflammatory responses, and cell proliferation were investigated in an azoxymethane (AOM)/dextran sodium sulfate (DSS)-induced mouse model of CRC. Furthermore, the anti-inflammatory and antiproliferative mechanisms of ZEA were evaluated in vitro using lipopolysaccharide (LPS)-stimulated RAW264.7 macrophages and CRC cell lines (HCT116 and SW620). Results:Treatment with 50 mg/kg ZEA significantly inhibited AOM/DSS-induced CRC progression. Furthermore, treatment with ZEA reduced tumor formation in the colonic lining, increased body weight, enhanced colorectal length, improved overall survival rate, and attenuated pathological changes in mice. Moreover, ZEA significantly reduced proinflammatory cytokines (tumor necrosis factor-α and interleukin-1β) and Ki-67 expression levels. Mechanistically, ZEA mitigated inflammation in LPS-stimulated RAW264.7 macrophages by suppressing the nucleotide-binding oligomerization domain-containing protein 1 (NOD1)/receptor-interacting protein 2 kinase (RIP2)/ nuclear factor-κB (NF-κB) signaling pathway. In addition, it suppressed proliferation of HCT116 and SW620 cells by inhibiting the signaling pathway of PI3K/AKT/MYC. Conclusion:ZEA exerted significant anti-CRC effects, including anti-inflammatory and antiproliferative actions through multitarget mechanisms, such as modulation of the NOD1/RIP2/NF-κB and PI3K/AKT/MYC signaling pathways. These findings suggest that ZEA is a promising natural chemopreventive agent for the prevention and treatment of CRC.
Sedation and anesthesia practices in gastrointestinal endoscopy units play a critical role in enhancing patient comfort, improving procedural tolerance, and ensuring procedural success. However, increasing procedural complexity and the growing burden of patient comorbidities have heightened the importance of patient safety, particularly with respect to the cardiorespiratory risks associated with deep sedation. This review provides a comprehensive overview of current sedation and anesthesia practices in endoscopy units, with a focus on patient selection, risk stratification, pharmacological agents, monitoring standards, and complication management. Emphasis is placed on patient-centered and individualized sedation strategies that account for patient age, comorbidities, American Society of Anesthesiologists physical status classification, and procedural characteristics. Propofol remains the cornerstone of endoscopic sedation because of its rapid onset and favorable recovery profile. Nevertheless, newer agents such as remimazolam, ciprofol, and esketamine have emerged as promising alternatives either as primary sedative agents or as adjuvant drugs, offering improved pharmacokinetic predictability, greater hemodynamic stability, and potentially enhanced cardiorespiratory safety. Adjunctive agents, including opioids and ketamine, may further optimize analgesia and sedation quality when used appropriately. Standard monitoring modalities, including pulse oximetry, noninvasive blood pressure, and electrocardiography, are essential, whereas capnography offers significant advantages for the early detection of respiratory compromise. Effective complication management relies on early recognition, timely intervention, and adherence to structured safety protocols. Validated recovery and discharge scoring systems further contribute to safe postprocedural care. In conclusion, safe and effective sedation in gastrointestinal endoscopy units requires a multidisciplinary, protocoldriven approach that integrates individualized pharmacological strategies, appropriate monitoring, and experienced clinical teams. Cite this article as: Sahin F, Erdem AF, Preckel B. Current approaches to sedation and anesthesia in endoscopy units: Integrating pharmacology, monitoring, and patient safety. Turk J Gastroenterol. Published online July 27, 2026. doi: 10.5152/tjg.2026.26388.
Background/Aims: Ineffective esophageal motility (IEM) is the most common esophageal motility disorder. Reflux is common in patients with IEM. The relationship between IEM and gastroesophageal reflux disease is not fully understood. The current study evaluated the associations between clinical, endoscopic, and manometric characteristics and acid exposure in patients with IEM. Materials and Methods: The authors prospectively enrolled patients diagnosed with IEM who underwent high-resolution manometry according to the Chicago classification, version 4.0. Patients were classified into pathological and physiological reflux groups based on multichannel intraluminal impedance-pH ( MII-pH) monitoring results. Clinical, endoscopic, manometric, and MII-pH parameters were compared between the 2 groups. Results: Of the 69 patients, 49 (71%) had pathological reflux and 20 (29%) had physiological reflux. The most frequent symptoms were heartburn, regurgitation, and dysphagia. No significant differences were observed between the 2 groups in demographic, clinical, or endoscopic characteristics. Among the manometric metrics, mean lower esophageal sphincter pressure and esophagogastric junction (EGJ) morphology differed significantly between the 2 groups (P = .017 and P = .046, respectively). All MII‑pH metrics, except weak acid reflux episodes and nonacid reflux episodes, differed significantly between the groups (P <.05). Conclusion: Acid exposure did not affect symptoms in patients with IEM. In addition to impaired esophageal body contractility, impaired esophageal clearance and EGJ barrier dysfunction may contribute to acid exposure. Cite this article as: Erdal H, Coşkun Y, Deniz DA, Birsoy B, Üstün Y. Ineffective esophageal motility with and without abnormal acid exposure: Clinical, endoscopic, and manometric features. Turk J Gastroenterol. Published online July 27, 2026. doi: 10.5152/tjg.2026.25627.
BACKGROUND/AIMS:Gut-microbiota dysbiosis has been implicated in gallstone formation through alterations in bile acid and cholesterol metabolism, but whether adherence to a microbiota-supportive diet is associated with gallstone disease at the population level remains unclear. The current study examined the cross-sectional association between the Dietary Index for Gut Microbiota (DI-GM) and the prevalence of gallstone disease. MATERIALS AND METHODS:The current study analyzed National Health and Nutrition Examination Survey (NHANES) 2017-2020 (n = 7198 adults aged ≥20 years) and the UK Biobank (n = 126 478) cross-sectionally. DI-GM was calculated using 14 food components in NHANES and 13 food components in the UK Biobank. Gallstone disease was ascertained by self-report in NHANES and by self-report supplemented with inpatient ICD-10 K80 codes in the UK Biobank. The authors used logistic regression (survey-weighted for NHANES and unweighted for the UK Biobank) and restricted cubic splines. A demographic and behavioral adjusted model estimated the total effect and a cardiometabolic adjusted model was used as a conservative sensitivity analysis. RESULTS:Higher DI-GM scores were associated with lower odds of prevalent gallstones in both cohorts. In the total-effect model, each 1-point increment in the DI-GM score was associated with 13% lower odds of gallstone disease in NHANES (odds ratio (OR) = 0.87, 95% confidence interval (CI): 0.83-0.92) and 7% lower odds in the UK Biobank (OR = 0.93, 0.91-0.95). These associations were attenuated but remained significant after cardiometabolic adjustment (NHANES 0.92, 0.87-0.98; UK Biobank 0.95, 0.93-0.97; both P ≤ .007). Compared with the lowest DI-GM category, the highest category was associated with lower odds of gallstone disease in both NHANES (OR, 0.73; 95% CI, 0.60-0.89) and the UK Biobank (OR, 0.80; 95% CI, 0.74-0.87). Restricted cubic spline analyses supported a linear association, and the subgroup and sensitivity analyses yielded consistent results. CONCLUSION:In 2 demographically distinct populations, greater adherence to a gut microbiota-supportive diet was independently associated with lower odds of prevalent gallstone disease. These cross-sectional findings require prospective confirmation before causal or preventive inferences are drawn. Cite this article as: He H, Li L, Yang X. The potential of microbiota-modulating dietary strategies in gallstone prevention: Evidence from 2 large population-based cohorts. Turk J Gastroenterol. 2026;37(8):880-894.
Drug-induced liver injury (DILI) is an important clinical condition and should be considered in the differential diagnosis of patients with elevated liver enzymes and normal hepatobiliary imaging. In previous studies of DILI, antibiotics were the most commonly implicated class of drugs. A newly recognized phenotype of cefazolin has been described in several studies. After an ultra-short duration of cefazolin, with 1 or 2 doses, a prominent cholestatic or mixed reaction develops 2-3 weeks later. This phenotype was originally described in the United States and has recently been reproduced in a study from Iceland. In a recent and important report from Türkiye, hepatocellular jaundice associated with the antibiotic ornidazole was described; 8% of affected patients required liver transplantation. In recent years, several new agents have been associated with other idiosyncratic DILI associated with prescription drugs, suggesting that the clinical landscape of DILI may be evolving. Liver injury resulting from the biological effects of drugs that modulate the immune system appears to be increasing. In a recent study from Barcelona, anticancer drugs, mainly checkpoint inhibitors, were the most frequent causes of DILI, followed by antibiotics, analgesics, and recreational drugs. Furthermore, several newly recognized hepatotoxic herbal and dietary supplements (HDSs) have been reported. These are Polygonum multiflorum, ashwagandha, green tea extract, turmeric, Tinospora cordifolia, Garcinia cambogia, and kratom. Most patients recover after discontinuation of the HDS, but acute liver failure (ALF), death from ALF, or liver transplantation has been reported in some cases. Cite this article as: Björnsson ES. Common causes of drug-induced liver injury in 2025. Turk J Gastroenterol. Published online July 21, 2026. doi: 10.5152/tjg.2026.26361.
Background/Aims:miR-143-5p functions as a tumor-suppressive microRNA across various cancer types. The current study investigated the expression, prognostic value, and role of miR-143-5p in colorectal cancer (CRC). Materials and Methods:The expression of miR-143-5p was measured by quantitative reverse transcription polymerase chain reaction. Associations between miR-143-5p expression and clinicopathological characteristics of patients with CRC were statistically analyzed. A series of in vitro cell-based assays were performed to investigate the underlying regulatory mechanisms. Results:miR-143-5p was downregulated in CRC and may serve as a promising independent prognostic biomarker. Reduced miR- 143-5p expression was associated with adverse clinicopathological characteristics and decreased 5-year overall survival. MYCBP was identified as a direct target of miR-143-5p. Overexpression of miR-143-5p suppressed the malignant behaviors of CRC cells, which were partially restored by enforced MYCBP expression. Conclusion:miR-143-5p is downregulated in CRC and may function as a potential independent prognostic biomarker. Moreover, miR- 143-5p may play a tumor-suppressive role in CRC by specifically targeting MYCBP.
Background/Aims: Hepatitis E virus (HEV)–associated acute liver failure (ALF) lacks reliable biomarkers for risk stratification at hospital admission. This study evaluated the diagnostic utility of serum glypican-3 (GPC3) and aldo-keto reductase family 1 member B10 (AKR1B10). Materials and Methods: Between May 2023 and May 2025, 231 adults with acute HEV infection were classified as HEV-ALF (n = 43) or HEV without ALF (n = 188). Serum GPC3 and AKR1B10 concentrations were measured using enzyme linked immunosorbent assay. Associations were evaluated using Pearson correlation coefficient r; diagnostic performance was assessed by receiver operating characteristic curves, and independent predictors of ALF were identified using multivariable logistic regression. Results: Patients with HEV-ALF had lower albumin, triglyceride, and cholesterol levels and higher total bilirubin, prothrombin time, and international normalized ratio values than patients without ALF (all P < .05). GPC3 and AKR1B10 concentrations were markedly elevated in the HEV-ALF group (both P < .001) and were strongly correlated (r = 0.610, P < .001). The combination of GPC3 and AKR1B10 demonstrated superior diagnostic performance for identifying ALF, with an area under the curve (AUC) of 0.931, outperforming either GPC3 alone (AUC, 0.832) or AKR1B10 alone (AUC, 0.792). In multivariable logistic regression analysis, elevated GPC3 (odds ratio [OR], 2.138; 95% CI, 1.213-3.771) and AKR1B10 (OR, 2.304; 95% CI, 1.215-4.368) remained independent risk factors for ALF. Conclusion: Serum GPC3 and AKR1B10 were independent predictors of HEV-ALF and may facilitate risk stratification at hospital admission. Cite this article as: Zhang G, Liu X, Wang Y, Lu K, Wang Y. Serum GPC3 and AKR1B10 as diagnostic biomarkers for hepatitis E virus–associated acute liver failure. Turk J Gastroenterol. Published online July 21, 2026. doi: 10.5152/tjg.2026.26017.
Background/Aims: The impact of dynamic Helicobacter pylori (Hp) infection status on DNA methylation and progression risk in elderly patients with gastric intestinal metaplasia (IM) remains unclear. This study evaluated the associations of Hp infection status with SEPTIN9 and SDC2 methylation levels and whether baseline methylation markers were associated with subsequent clinical outcomes. Materials and Methods: This single-center retrospective cohort study enrolled 200 older adults with IM. Hp infection status was dynamically defined over follow-up as persistent infection, successful eradication, or sustained negative infection. Baseline SEPTIN9 and SDC2 methylation levels were quantified in formalin-fixed, paraffin-embedded tissue samples using quantitative methylation-specific polymerase chain reaction (qMSP). Kaplan–Meier analysis and Cox proportional hazards regression were used to evaluate progression risk. Predictive performance was assessed using Harrell’s C-index and time-dependent receiver operating characteristic analysis. Because methylation was measured only at baseline, the analyses were designed to evaluate baseline methylation markers rather than dynamic methylation changes over time. Results: During a median follow-up of 3.86 years, 38 patients (19.0%) experienced disease progression. Persistent Hp infection was associated with higher SEPTIN9 and SDC2 methylation levels (P < .01). Combined double-positive methylation status was associated with an increased risk of IM progression (adjusted hazard ratio [HR] = 3.12, 95% CI: 1.53 6.38, P = .002), with the strongest association observed among patients with persistent Hp infection. Incorporation of the combined methylation indicator improved model discrimination (C-index 0.75 vs. 0.68) and the 5-year area under the curve (0.77 vs. 0.69). Conclusion: Baseline SEPTIN9 and SDC2 methylation levels differed according to the Hp infection status, with the highest levels observed among patients with persistent Hp infection. Baseline combined methylation status was associated with an increased risk of IM progression and may provide incremental value for risk stratification. These findings should be interpreted as baseline associations. Cite this article as: Yu Z, Ni H, Chen X, Xiao K. Impact of Helicobacter pylori infection status on SEPTIN9 and SDC2 methylation levels and their association with clinical outcomes in elderly patients with gastric mucosal intestinal metaplasia. Turk J Gastroenterol. Published online July 21, 2026. doi: 10.5152/tjg.2026.26162.
Cite this article as: Adali G, Kose M, Dertsiz B, Eser M, Kirbas I, Parlak E. Familial low-phospholipid-associated cholelithiasis syndrome presenting with recurrent intrahepatic stones after cholecystectomy with a heterozygous ABCB4 variant. Turk J Gastroenterol. Published online July 20, 2026. doi: 10.5152/tjg.2026.26254.
Background/Aims:Pancreatic steatosis (PS) is characterized by fat accumulation within the pancreas and is associated with chronic low-grade inflammation. Migraine, the third most commonly seen disease worldwide, is an established risk factor for white matter lesions (WMLs). Given the shared inflammatory background of these conditions, it was hypothesized that the presence of PS in patients with migraine may contribute to the development of WMLs. Materials and Methods:This cross-sectional study included patients with migraine who attended the outpatient clinic and had undergone cranial magnetic resonance imaging (MRI) scan for any indication within the last 6 months. Following MRI, patients were referred to the radiology department for transabdominal ultrasonography to assess the presence of PS and hepatosteatosis. Results:Among the 78 patients with migraine included in the study, 35 (44.9%) had cranial WMLs. PS was significantly more prevalent among patients with WMLs than among those without WMLs (57.4% vs. 16.7%, P < .001). In multivariable logistic regression analysis adjusted for age, body mass index, and low-density lipoprotein/high-density lipoprotein ratio, PS remained independently associated with cranial WMLs (odds ratio (OR) 5.79, 95% CI 1.004-33.41; P = .049). Increasing age was also independently associated with WMLs (OR 1.095 per year, 95% CI 1.018-1.179; P = .015). Conclusion:This study demonstrated that the presence of PS may contribute to disease burden in patients with migraine. Evaluation of PS in this population may help identify a potentially modifiable metabolic condition and provide additional insight into the management of this common and debilitating disorder.
Cite this article as: Liang H, Yin T, Liu Z. A simple and effective method for endoscopic fragmentation of gastric bezoars. Turk J Gastroenterol. 2026;37(8):912-914.
