Abstract Background Managing Inflammatory Bowel Disease (IBD) can be challenging, requiring a careful balance of medication adherence, symptom tracking, and lifestyle adjustments. Mobile applications offer a promising avenue to support individuals with IBD in navigating these complexities. This study investigates the impact of the “My IBD Under Control” mobile application on patient education and self-management. Methods The “My IBD Under Control” app provides a comprehensive suite of features designed to improve patient outcomes. Users can record and monitor symptoms such as abdominal pain, diarrhea, and constipation, enabling early detection of potential flares and timely intervention. Timely notifications help ensure adherence to prescribed treatment plans, improving disease control and reducing the risk of complications. Access to reliable information about IBD, its causes, and management strategies empowers patients to make informed decisions about their health and take an active role in their care. The nearby restroom locator is a valuable tool, especially during flare-ups, providing peace of mind and reducing anxiety. Data on user demographics, app usage patterns, and symptom tracking were collected through the app’s built-in analytics tools. Descriptive statistics were used to analyze user demographics and app usage patterns. Data privacy was ensured through secure data storage and anonymization techniques. Results Since its launch in February 2022, the “My IBD Under Control” app has attracted a significant user base of over 5900 individuals with IBD in Turkey. The user base is predominantly male (58%) with a mean age of 38, while female users (42%) have a mean age of 33. The app’s high interaction rate of 63.4% indicates strong user engagement. Although only 7% of users have specified their IBD type, of those who did, ulcerative colitis was more prevalent (60%) than Crohn’s disease (40%). The higher engagement rate among younger users suggests that this demographic may be more receptive to digital health tools. Figure 1 illustrates the growth of the app’s user base since its launch in February 2022. The figure shows a significant increase in the total active user count and new users. Conclusion Mobile applications have the potential to revolutionize IBD care by empowering patients to take an active role in their health. The “My IBD Under Control” app offers a comprehensive suite of features to improve patient outcomes. Further research is needed to explore such apps’ long-term impact and identify strategies to optimize their use. By incorporating innovative technologies such as artificial intelligence and machine learning, future mobile health applications can enhance patient care and improve the quality of life for individuals with IBD. References Wang R, Li Z, Liu S, Zhang D. Global, regional and national burden of inflammatory bowel disease in 204 countries and territories from 1990 to 2019: a systematic analysis based on the Global Burden of Disease Study 2019. BMJ open. 2023;13(3):e065186.

Background/aim:This study aims to investigate the prevalence of malignancy in patients with inflammatory bowel disease (IBD) followed up in a tertiary reference center. Materials and methods:IBD patients with at least 6 months of follow-up from the gastroenterology clinic between 2000 and 2022 were evaluated retrospectively in a tertiary center. Patient information was obtained from the patient registration system. Results:There were 697 patients in the study, 320 (45.9%) of these were female. The mean age of the patients at IBD diagnosis was 33.4 ± 13.1 years. The mean follow-up time was 93.1 ± 64.8 (median 84, IQR (25-75) (36-144)) months. IBD types were as; 315 (45.2%) had ulcerative colitis, and 382 (54.8%) had Crohn's disease. Before the diagnosis of IBD, 10 patients (1.4%) had a history of malignancy. The prevalence of malignancy after the diagnosis of IBD was 13 (1.9%). There was a relationship between malignancy and older age, higher BMI, and female sex in survival analysis (p < 0.05). There was no correlation with disease type and malignancy (p = 0.820). When the patients who developed malignancy in IBD were compared in terms of the immunomodulators and biological agents used by the patients who did not develop malignancy, there was no statistical difference between the two groups (p > 0.05). Conclusion:Older age, higher BMI, and female sex were found to be at risk for the development of malignancy in IBD, although no relationship was found with the use of immunomodulators, biological agents, or disease type.

Abstract Background Despite being in clinical remission, ulcerative colitis (UC) patients continue to have a risk of disease flare-ups. Although endoscopic and histological evaluations are considered the gold standard for follow-up, the value of histological inflammation in predicting disease flare-ups in clinically remitted patients is not clearly known. This study aimed to investigate the relationship between histological inflammation and disease flare-ups in UC patients in clinical remission. Methods Adult patients with UC, no history of colectomy, followed up in our outpatient clinic, and in clinical remission were included in the study (total Mayo score < 2). Biopsy reports from colonoscopies performed during clinical remission were examined for histological activity. The follow-up period was defined as 10 years, based on the last clinical remission recorded in the outpatient clinic records. The Nancy histological index (NHI) was used as the histological activity score. Patients with NHI < 2 were considered to be in histological remission. The temporal relationship between histological inflammation and the first clinical flare-up was evaluated using Spearman correlation analysis. Results A total of 53 patients, including 26 women and 27 men, with a diagnosis of UC in clinical remission were included in the study. The mean age of the patients was 51.5 years. While 28 patients were in endoscopic remission, 25 were followed up as endoscopically active. Among the 28 patients in endoscopic remission, 15 were in histological remission, and 13 were histologically active. Flare-ups were observed after a median of 18.0 months in patients with endoscopic remission and 10.0 months in those with endoscopic activity (p=0.07). Flare-ups were observed after a median of 96.0 months in patients with histological remission and 10.5 months in those with histological activity (p<0.05). A negative correlation was found between histological inflammation and disease flare-up (r=-0.381, p<0.05). Conclusion The risk of disease flare-ups is higher in patients who do not achieve disease clearance (i.e., those who are histologically active even in endoscopic remission). References 1.Marchal-Bressenot A, Scherl A, Salleron J, Peyrin-Biroulet L. A practical guide to assess the Nancy histological index for UC. Gut. 2016;65(11):1919-1920. 2.Wang H, Fewings I, Bornman L, Shadbolt B, Fadia M, Subramaniam K. Histologic remission (NANCY Index) is superior to endoscopic mucosal healing in predicting relapse free survival in patients with ulcerative colitis in clinical and endoscopic remission. Journal of Clinical Gastroenterology. 2023;57(5):494-500.

Abstract Background In patients with ulcerative colitis, histological healing is associated with better clinical outcomes1. Therefore,histological remission as the treatment target is advocated. observational studies2,3 have shown that patients in endoscopic, histological remission have longer relapse-free survival, reduced hospitalization rates, corticosteroid use rates. Methods Demographic information, laboratory findings, clinical courses of patients with ulcerative colitis who had disease clearance, were evaluated retrospectively for 5 years. The files of 529 patients with ulcerative colitis were scanned, patients who had not achieved disease clearance, had a history of surgery, were not followed regularly, were <5 years old were excluded. 87 patients were included in this study. The validated Nancy histological index was used to assess histological disease activity. Results A total of 87 patients with Ulcerative Colitis, 51 of whom were male. The mean age was 54.1±13.5 years. The mean age of the patients at diagnosis was 38.9±13.6 years. The mean follow-up period was 14.5±7.7 years. The mean disease age was 15.6±7.8 years. Only 1 patient had a family history. 5 (5.7%) patients had pANCA positivity. 14 (16%) patients had extraintestinal involvement (ankylosing spondylitis, erythema nodosum, sacroiliitis, arthritis, uveitis). Current disease involvement was E1 in 11 (12.6%) patients, E2 in 45 (51.7%) patients, and E3 in 31 (35.7%) patients. Mayo endoscopic subscore was 0 in 45 (51.7%) patients; Mayo endoscopic subscore was 1 in 42 (48.3%) patients. In maintenance treatment, 50 (57.5%) were receiving only oral/topical 5-ASA, 37 (42.5%) were receiving azathioprine and 5-ASA combination. Remission was achieved in 72 (82.8%) patients with conventional treatment, and only 15 (17.2%) were receiving biological treatment. During the course of the disease, 29 (33.3%) patients required ≥1 steroid. No attacks were observed in 69 (79.3%) patients in the last 5 years. The rate of achieving remission was found to be 16% in 529 patients. Conclusion Although the rate of achieving deep remission in ulcerative colitis is low, remission rates are high in patients with rectal or left colon involvement at the time of diagnosis. References 1.Turner D, Ricciuto A, Lewis A, D’Amico F, Dhaliwal J, Griffiths AM, Bettenworth D, Sandborn WJ, Sands BE, Reinisch W, Schölmerich J, Bemelman W, Danese S, Mary JY, Rubin D, Colombel JF, Peyrin-Biroulet L, Dotan I, Abreu MT, Dignass A; International Organization for the Study of IBD. STRIDE-II: An Update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) Initiative of the International Organization for the Study of IBD (IOIBD): Determining Therapeutic Goals for Treat-to-Target strategies in IBD. Gastroenterology. 2021 Apr;160(5):1570-1583. doi: 10.1053/j.gastro.2020.12.031. Epub 2021 Feb 19. PMID: 33359090. 2.Azad S, Sood N, Sood A. Biological and histological parameters as predictors of relapse in ulcerative colitis: a prospective study. Saudi J Gastroenterol. 2011 May-Jun;17(3):194-8. doi: 10.4103/1319-3767.80383. PMID: 21546723; PMCID: PMC3122090. 3.Bessissow T, Lemmens B, Ferrante M, Bisschops R, Van Steen K, Geboes K, Van Assche G, Vermeire S, Rutgeerts P, De Hertogh G. Prognostic value of serologic and histologic markers on clinical relapse in ulcerative colitis patients with mucosal healing. Am J Gastroenterol. 2012 Nov;107(11):1684-92. doi: 10.1038/ajg.2012.301. Epub 2012 Nov 13. PMID: 23147523.

Aims Hereditary hemorrhagic telangiectasia (HHT) also known as Osler-Weber-Rendu syndrome (OWRS), is a rare hereditary disease. HHT is characterized by arteriovenous malformations (telangiectasia). The most important and the most common manifestation is epistaxis. In this study, we aimed to examine the clinical characteristics and disease course of patients diagnosed with HHT.

Abstract Background With its increasing incidence, IBD varies epidemiologically both over the years and geographically. The increase in treatment alternatives over the years has led to differences in the management of patients. Revealing the impact of years on IBD from past to present and realizing the paths we have gone through will make us more conscious of future paths. Therefore, we aimed to reveal the epidemiological findings in our IBD patients over three decades. Methods IBD patients followed up at our university hospital, a tertiary center, were included in our study. The demographic, epidemiological and medical data of the patients were recorded retrospectively from the patient files. Descriptive statistics for continuous variables in the study; expressed as mean, standard deviation (SD), number (n) and percentage (%). "Independent T-test" and "One-Way Analysis of Variance (ANOVA)" were calculated to compare continuous measurements according to categorical groups. In the calculations, the statistical significance level was taken as p<0.05 and SPSS (IBM SPSS for Windows, ver.26) statistical package program was used for analyses. Results A total of 346 IBD patients, 198 of whom (57.2%) had Crohn's disease and were followed up from the gastroenterology outpatient clinic, were included in the study. The mean age of the patients was 49.07±13.82 years and the mean BMI was 23.02±4.58 kg/m2. 182 (52.6%) of the patients were male. The disease duration was 34.46±12.74 years. The patients were divided into three-decade groups according to their diagnosis dates as years: a total of 84 patients was diagnosed in 1985-2003, 192 patients in 2004-2013, and 70 patients in 2014-2023. The patients were compared within these date groups in terms of age at diagnosis, gender, first biological agent preference, and the time when the first biological agent was started (Fig.1). From the first decade to the third decade, the proportion of patients diagnosed with Crohn's disease was 50%, 57.3%, 65.7%, respectively, and the proportion of patients diagnosed with UC was 50%, 42.7% and 34.3%, respectively (p<0.05). The rates of requiring hospitalization at initial diagnosis were 48%, 42.2%, and 40%, respectively, from the first decade to the third decade (p<0.05). The need for bowel surgery at diagnosis (for Crohn's disease patients) was 33.3%, 26.36% and 13.04% within 3 decades, respectively (p<0.05). Conclusion While the rate of patients diagnosed with Crohn's disease has increased compared to 30 years ago, the rate of patients diagnosed with UC was decreased. While the need for hospitalization at diagnosis and the need for surgery in CD have decreased in the last decade compared, biological agents have been started earlier in IBD patients in the last decade.

Abstract Background In this study, we evaluated hepatobiliary involvement in inflammatory bowel disease (IBD) with FibroScan® (transient elastography) and examined drug effects on liver fibrosis and steatosis. We particularly focused on the effect of azathioprine (AZT) on spleen stiffness (SS). Methods A total of 352 subjects were included in this study, including 298 IBD patients and 54 healthy controls. LSM (liver stiffness measurement), SS, and CAP™ (controlled attenuation parameter) scores were measured by FibroScan®. In addition to disease and patient characteristics; laboratory tests, and effect of the drugs were evaluated and compared within the groups. Results The patient and control groups were similar in terms of age and gender. The characteristics of the groups are shown in Table 1. Mean LSM (5.2±3.1kPa vs 4.5±1,1kPa), mean SS (22.69±13,10kPa vs 17.96±7,44kPa), CAP™ score (hepatosteatosis) (233±56dB/m vs 224±47dB/m) were significantly higher in the patients with IBD than in the control group (p<0.05). Liver fibrosis and steatosis grades are shown in Figure 1. A positive correlation was found between CAP™ score and male gender, hypertension, diabetes, BMI, smoking, penetrating disease, GGT, triglyceride, LSM, and SS (p<0.05). LSM (5.7±3,1kPa vs 5.0±3,1kPa) was significantly higher in patients with extraintestinal involvement (p<0.05). In patients with significant liver fibrosis (F2-3-4), the frequency of anti-TNF treatment was lower (44,4% vs 69,5%; p=0,008) (Figure 2). In patients who use alcohol regularly compared to nondrinkers (25.54±14,83kPa vs 21.05±11,24kPa) SS was significantly higher (p<0.05). Additionally, in patients using AZT≥100 mg/day compared to those using AZT<100 mg/day (23.48±14,61kPa vs 19.99±11,84kPa; p<0,05) SS was significantly higher (Figure 3). AZT dose was positively correlated with SS (Spearman analysis; r=0.182 and p=0.013); however, no correlation was found with the duration or cumulative dose of AZT. The mean level of platelets was significantly higher in patients with IBD than in controls (300±104x10³/µL vs 251±52x10³/µL, p=0,001); however, there was no correlation between SS and trombosit level (p>0,05). 83% of patients were in clinical remission (Mayo score≤2/CDAI<150). No positive correlation was found between disease activity and SS in IBD patients. AZT-associated non-cirrhotic portal hypertension was detected in only one patient. Conclusion In this study, fatty liver, liver fibrosis, and SS were found to be significantly higher in IBD patients than in healthy controls. Although there is no relationship with the duration of AZT therapy, AZT dose was positively correlated with SS. We recommend that spleen stiffness should be evaluated in patients who use high doses of AZT (≥100 mg/day).

Aims The aim of this study is to determine the fibrosis and adiposity scores with Fibroscan, a noninvasive method in celiac patients,and to determine the factors affecting them.

OBJECTIVE Esophageal motility is regulated both by coordinated stimulation and inhibition of the circular and longitudinal muscle layers of the esophagus. Although there are many diseases known to have an effect on esophageal motility, the effect of subepithelial lesions (SELs) of the esophagus on esophageal motility, which is often detected incidentally, remains still unclear. The aim of this study is to reveal the effect of SELs of the esophagus on esophageal motility evaluating it by high-resolution manometry (HRM). PATIENTS AND METHODS A total of 32 patients with SELs in the esophagus and 12 healthy individuals were included. All patients and controls included in the study underwent HRM using a Unisensor UniTip High Resolution catheter (Laborie, Amsterdam, Netherlands) and endosonographic examination. RESULTS The mean age was 52.60±15.56 years (range: 23-79) and the average body mass index (BMI) was 26.63±4.71 kg/m2. Gender, height, weight, and BMI measurements, smoking status, alcohol use, and DM status did not statistically differ significantly between the groups (p>0.05). Of 32 patients with SELs, 65.6% (n=21) had lesions originating in the muscularis propria, while 34.4% had lesions originating in the submucosa. The rate of abnormal motility both in the supine and in upright positions of patients with SELs was found to be significantly higher than in the control group (p=0.001, p<0.01, respectively). In patients with SELs, the incidence of infective motility was higher than the normal group (p=0.001, p<0.01, respectively). As the size of the lesion increases (>2 cm), the probability of abnormal HRM results increased. CONCLUSIONS SELs of the esophagus have pathological effects on esophageal motility, mainly ineffective esophageal motility disorder.

OBJECTIVE: Detection of the Kayser-Fleischer (KF) ring in the diagnostic scoring and treatment follow-up of Wilson’s Disease (WD) is important. Slit lamp (SL) biomicroscopic examination has traditionally been used in the evaluation of the KF ring. The role of Anterior Segment Optical Coherence Tomography (AS-OCT), which is used in various corneal diseases, in the detection of KF rings has attracted attention in recent years. In our study, we tried to demonstrate the effectiveness of AS-OCT in detecting the KF ring by comparing it with SL biomicroscopic examination. PATIENTS AND METHODS: 64 of 356 patients followed in our outpatient clinic due to WD were included in the study in the order of their admission to the outpatient clinic. The KF ring was evaluated in both eyes by SL-biomicroscopic examination and AS-OCT. Ophthalmic examination, and findings were performed by the same physician. RESULTS: Age range was 18-67 years, mean 33.06±10.83 years, gender was 39.1% (n: 25) female. At the time of diagnosis, the mean age was 19.48 ± 9.36 years, range was minimum 5 years and maximum 51 years. Clinical presentation was mixed type involvement n: 18 (28.1%), hepatic involvement n: 32 (50%), neurological involvement n: 14 (21.9%). The follow-up period was 2-257 months (74.6±76.16). The presence of KF ring was evaluated together with both AS-OCT and slit-lamp examination, the presence of KF could be detected in both AS-OCT and SL biomicroscopic examination in 10 patients (15.6%), in 12 (18.8%) of the cases KF ring is positive in AS-OCT but was negative in Slit-lamp biomicroscopic examination, in 65.6 (n: 42) of the cases OCT and slit-lamp biomicroscopic examination results were negative. CONCLUSIONS: The sensitivity of AS-OCT in detecting the KF ring was higher than the slit-lamp biomicroscopic examination. AS-OCT can detect early stage of KF rings in Wilson’s Disease patients, so that diagnosis and treatment accuracy can be evaluated effectively.

OBJECTIVE Patients with inflammatory bowel disease (IBD) show increased the prevalence of cytomegalovirus (CMV) infection due to the severity of the disease and the immunosuppressive treatments they receive. The aim of this study was to determine the prevalence of CMV infection in IBD patients and identify the risk factors for CMV infection with different demographic characteristics in IBD patients. PATIENTS AND METHODS We enrolled 85 patients diagnosed with IBD (43 with ulcerative colitis (UC) and 42 with Crohn's disease (CD)) in this prospective study. The clinical disease activities of UC and CD were assessed using Truelove-Witts and Crohn's disease activity index (CDAI). CMV infection was assessed by detection of DNA using real-time polymerase chain reaction (PCR) in blood samples and quantitative PCR in colonic biopsy specimens and by detection of inclusion bodies using hematoxylin-eosin staining. RESULTS Thirteen patients with IBD exhibited concomitant CMV infection. CMV infection was not detected in any of the patients in remission. Viral loads measured in the colonic mucosa of infected patients ranged from 800-7000 genome copies/mL total extracted DNA. The mean serum CMV DNA level was 1694 ± 910 copies/mL (range: 800-3800). The rate of steroid resistance in CMV-positive cases was significantly higher than that in CMV-negative cases (p = 0.001). CD with acute exacerbation was a risk factor for CMV disease (p = 0.04). All of the CMV-positive patients received immunosuppressive treatments. CONCLUSIONS CMV infection should be suspected in steroid-resistant UC and CD. Antiviral treatment improved the clinical outcome in steroid-resistant IBD cases with serum CMV DNA levels above 1000 copies/mL.

Hepatocellular carcinoma (HCC) is the commonest primary malignant cancer of the liver in the world. This study was conducted to investigate the serum levels of hepatocyte growth factor (HGF)in HCC patients and the relationship with tumor progression and known prognostic parameters. Fifty-four patients with HCC were investigated. Pretreatment HGF levels were employed the quantitative sandwich enzyme immunoassay technique (ELISA). Age and sex matched 20 healthy controls were included in the analysis. The median age of the patients was 60 years (range 36-77 years); where males consistituted of majority of the group (88.8%). All of patients had cirrhotic history. Fourty-six percent (n = 25) of patients had Child-Pugh Score A, 30% (n = 16) had Score B or C. All of the patients were treated with local therapies but none of them received sorafenib. The baseline serum HGF levels were significantly higher in patients with HCC than in the control group (p < 0.001). Male patients had higher serum HGF levels compared with female patients (p = 0.01). Serum HGF levels were significantly higher in the patients with elevated serum ALT levels than others with normal serum ALT levels (p = 0.05). Poor performance status (p < 0.001), viral etiology of cirrhosis (p = 0.03), larger tumor size (p = 0.01), lower serum hemogloblin levels (p = 0.03), and not be treated for HCC (p = 0.001) related to worse survival. However, serum HGF did not have significantly adverse effect on survival (p = 0.58). Despite serum HGF levels were found diagnostic value, serum HGF levels had no prognostic value in patients with HCC.

SummaryChronic hepatitis C (CHC) patients with treatment failure (TF) remain at risk of continuing fibrosis progression. However, it has not been investigated whether there is an increased risk of accelerated fibrosis progression after failed interferon‐based therapy. We aimed to investigate long‐term influence of TF on fibrosis progression compared with untreated patients with CHC. We studied 125 patients with CHC who underwent paired liver biopsies from 1994 to 2012. Patients with advanced fibrosis were excluded from the analysis. Sixty‐three patients had TF, and 62 patients were treatment‐naïve (TN). Annual fibrosis progression rate (FPR) was calculated, and significant fibrosis progression (SFP) was defined as ≥2 stage increase in fibrosis during follow‐up. Multiple regression analyses were performed to find out independent predictors of FPR and SFP. Demographic characteristics and duration between paired liver biopsies were similar in TF and TN groups. Baseline alanine aminotransferase and gamma‐glutamyl transferase (GGT) levels (71 ± 31 vs 47 ± 22, P < 0.001 and 49 ± 39 vs 36 ± 28, P = 0.027, respectively), baseline mean fibrosis stage (2.2 ± 0.7 vs 1.9 ± 0.7, P = 0.018) and histologic activity index (6.3 ± 1.9 vs 4.3 ± 1.6, P < 0.001) were higher in the TF group compared with the TN group. In regression analyses, the strongest independent predictor of fibrosis progression was the GGT level (OR: 1.03, 95%CI 1.01–1.5, P < 0.001). Treatment experience (OR: 5.97, 95%CI 1.81–19.7, P = 0.003) also appeared as an independent predictor of both FPR and SFP. Failed interferon‐based CHC treatment may lead to accelerated FPR in the long‐term compared with the natural course.