AIM:Metabolic dysfunction-associated steatotic liver disease (MASLD) and liver fibrosis are emerging extraintestinal manifestations of inflammatory bowel disease (IBD), but their true burden and the impact of therapies on liver health have not been fully elucidated. We aimed to assess the prevalence of hepatic steatosis and fibrosis in IBD versus matched controls and examine associations with therapies, particularly anti-TNF agents and corticosteroids. METHODS:In this cross-sectional study, 358 adults with IBD and 358 controls individually matched for age, sex, BMI, and diabetes underwent vibration-controlled transient elastography (VCTE; FibroScan). These are the baseline findings of the ongoing ELASTIBD cohort. RESULTS:Patients with IBD had higher rates of significant fibrosis (12.3% vs. 4.2%; adjusted odds ratio [aOR] 3.31 and 95% CI 1.75-6.26), advanced fibrosis (6.7% vs. 0.6%; OR 8.50 and 95% CI 1.98-36.52), and steatosis (41.4% vs. 28.3%; aOR 2.51 and 95% CI 1.66-3.79) than controls. Among patients with IBD, anti-TNF therapy was less frequent in those with fibrosis (44.4% vs. 68.5% and p = 0.004) and independently associated with lower odds of fibrosis (aOR 0.39 and 95% CI 0.16-0.95), whereas each steroid course was associated with 41% higher odds (aOR 1.41 and 95% CI 1.04-1.92). Older age and higher BMI were additional predictors. CONCLUSIONS:Patients with IBD demonstrated threefold higher fibrosis and twofold higher steatosis than matched controls, emphasizing the importance of liver assessment in clinical practice. The inverse association between anti-TNF exposure and fibrosis suggests inflammation control may reduce hepatic fibrogenesis and supports follow-up of the ELASTIBD cohort to clarify progression, treatment effects, and liver outcomes.

Objectives:This study aimed to investigate the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) and clinically significant fibrosis (CSF) in patients with type 1 diabetes mellitus (T1DM), as well as the factors affecting them, using non-invasive tests based on blood and imaging methods. Methods:Adult T1DM patients who were followed up in the diabetes mellitus outpatient clinic at a tertiary university hospital and who did not have other causes of liver disease were prospectively investigated. MASLD and CSF were evaluated using non-invasive scores based on biochemical tests and FibroScan®. MASLD was defined as a FibroScan® CAP score ≥275 dB/m, and CSF was defined as F≥8 kPa in the absence of any other chronic liver disease or secondary cause of hepatic steatosis in T1DM patients. Results:The prevalence of MASLD and CSF was 12.9% and 5%, respectively. BMI, fasting blood glucose, and waist and hip circumference were significantly higher in patients with MASLD (p<0.05). The rates of hypertension and dyslipidemia were also higher in patients with MASLD (p=0.026 and p=0.012, respectively). According to Pearson's correlation test, LSM was most strongly correlated with Agile 4 (p<0.001, r=0.922) and Agile 3+ scores (p<0.001, r=0.685). CAP was most strongly correlated with the fatty liver index (p<0.001, r=0.514) and the hepatic steatosis index (p<0.001, r=0.404). Conclusion:Components of metabolic syndrome are important risk factors for MASLD in patients with T1DM. There is currently no consensus on screening and diagnostic pathways for MASLD in T1DM, and further research is needed in this area.

Objective: This study aimed to investigate the features of eight patients diagnosed with primary gastrointestinal system lymphoma. Materials and Methods: The features of patients diagnosed with primary gastrointestinal system lymphoma between 2021 and 2024 at the & Idot;stanbul Faculty of Medicine, Department of Internal Medicine, Division of Gastroenterohepatology, were retrospectively investigated. Results: Of the eight patients, 5 (62.5%) were male. The mean age was 55.1 +/- 18.8 (28-70) years. 4 (50%) patients had diabetes mellitus, one had Crohn's disease, one had decompensated cirrhosis, and one had compensated cirrhosis. The most common complaint of patients was stomachache. One of the patients who presented with stomachache had volvulus, one had ascites infection, and one had acute pancreatitis. Intestinal T-cell lymphoma was diagnosed in two, Burkitt lymphoma (BL) in two, Hodgkin lymphoma in one, mantle cell lymphoma (MCL) in one, follicular lymphoma in one and B-cell non-Hodgkin's lymphoma in one patients. The diagnosis of 4 (50%) patients was made by surgical resection, 3 (37.5%) patients were diagnosed by endoscopic biopsy and 1 (12.5%) patient was computerized by ascites fluid cytological examination and endoscopic biopsy. Four patients had lymphoma involvement in the small intestine, one patient had stomach, one patient had stomach and small intestine, one patient had spleen, and one patient had stomach, small intestine, and pancreas involvement. Conclusion: Primary gastrointestinal system lymphomas are rare diseases that can present in a wide age range and very different clinical presentations, and the small intestine was the most common involvement site in our cohort.

Variants in the hepatitis B virus (HBV) PreS/S gene have been suggested to contribute to the development of progressive liver disease. This study aimed to evaluate the association between HBV PreS/S variations and liver histopathology in patients with chronic hepatitis B. A total of 109 patients under clinical follow-up for chronic hepatitis B were included. The HBV PreS/S gene was amplified by PCR and sequenced using the Sanger method. Amino acid substitutions, nonsense mutations, and deletions were analyzed in relation to liver fibrosis stage. Overall, 58 of 389 amino acid sites (14.9

Background/Objectives: Exocrine pancreatic insufficiency (EPI) is increasingly recognized in patients with diabetes; however, its clinical correlates remain poorly defined. This study aimed to determine the prevalence and clinical characteristics of EPI in patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM) and to evaluate its associations with diabetes-related complications and insulin therapy. Methods: A total of 200 patients with diabetes were screened, and 182 who met the inclusion criteria were included in the final analysis. EPI was diagnosed using fecal elastase-1 (FE-1). Clinical, biochemical, and complication-related data were collected. Factors associated with EPI were evaluated using univariate and multivariate logistic regression analyses. Among patients with T2DM, an inverse probability of treatment weighting-average treatment effect on the treated (IPTW-ATT) model was constructed to evaluate the association between insulin therapy and EPI. Propensity scores were estimated using baseline demographic and clinical covariates, and covariate balance after weighting was assessed using standardized mean differences (SMDs). Results: Exocrine pancreatic insufficiency was detected in 18.1% of patients, with prevalences of 21.2% in T1DM and 17.4% in T2DM. Cardiovascular disease was the only variable independently associated with EPI in multivariate analysis (OR = 3.25; 95% CI: 1.12-6.75; p = 0.028. Among patients with T2DM, insulin therapy was significantly associated with EPI in both unadjusted and IPTW-ATT analyses (weighted OR = 10.76; 95% CI: 1.85-62.76; p = 0.008) with a wide confidence interval reflecting sparse data. Cardiovascular disease also remained significantly associated with EPI in the weighted model (OR = 3.52; 95% CI: 1.22-10.15; p = 0.020). Conclusions: Exocrine pancreatic insufficiency is a clinically relevant condition in diabetes and shows a significant cross-sectional association with cardiovascular disease. In T2DM, insulin therapy was associated with a higher prevalence of EPI, although confounding by indication cannot be excluded. These findings suggest that evaluation of exocrine pancreatic function may be considered in high-risk diabetic subgroups, pending confirmation in prospective longitudinal studies.

OBJECTIVES:It was aimed to investigate the characteristics of cirrhosis etiology, stage at diagnosis, diagnostic methods, and complications with a 1-decade interval. METHODS:The clinical and demographic characteristics of patients with cirrhosis at the time of diagnosis at a tertiary university hospital between 2005-2009 (first period) and 2019-2023 (second period) were retrospectively investigated. RESULTS:In total, 1311 patients were diagnosed with cirrhosis, of which 857 (65.4%) were men. Seven hundred and ninety-eight (60.9%) were diagnosed in the first period. Six hundred and ninety (52.6%) patients were decompensated at diagnosis. Child Turcotte Pugh score was more common in the second period. MELD-Na score was higher in the first period (p = 0.026). The presentation rate with decompensation was higher in the first period (p = 0.009). In the first period, 211 (26.4%), and in the second period, 134 (26.1%) patients were diagnosed in the emergency department. The others were diagnosed in the outpatient clinic. There was no difference in the conditions for diagnosing between periods (p = 0.898). The causes of cirrhosis were, in order, 22.6% HBV, 19.7% MASLD, 18.9% cryptogenic, 13.1% ALD, 10.1% HCV, 7.7% autoimmune liver diseases, 4% HDV, 2.1% other causes, and 1.8% genetic diseases. In the second period, the frequency of cirrhosis caused by viral etiologies decreased (p < 0.05), and the frequency of MASLD and ALD increased (p < 0.05). CONCLUSION:Over the past decade, viral factors in the etiology of cirrhosis have gradually decreased, MASLD and ALD have progressively increased. While patients were detected more in compensated states, a significant portion of patients are still diagnosed in the decompensated stage and in emergency clinics.

Chronic exogenous exposures related to perianal fistula care may lead to systemic effects in patients with Crohn’s disease and require a multisystemic evaluation. In this case, we aimed to raise awareness by presenting a rarely encountered treatment-related complication in a patient with Crohn’s disease A 22year-old female with history of ileocolonic, fistulizing Crohn’s disease had previously undergone right hemicolectomy and enterovesical fistula repair. The patient, who had prior exposure to adalimumab and ustekinumab, was most recently on upadacitinib, which had been discontinued 2 months earlier due to the development of a perianal fistula under treatment. Because of recurrent perianal fistulas, she had been under follow-up by general surgery. She was admitted to the gastroenterology clinic for further evaluation due to anal pain and elevated acute phase reactants. On admission, physical examination revealed complaints of hot flashes, sweating, and hand tremors. Tenderness in the perianal region and an active fistula tract were observed. Laboratory tests showed CRP 124 mg/L, TSH <0.01 mIU/L, fT3 >30.80 pmol/L, and fT4 >154.80 pmol/L. Thyroid ultrasonography(USG) was normal, while Tc-99m pertechnetate uptake was measured at 0.15% with a scintigraphic pattern reported as “compatible with exogenous iodine exposure/thyroiditis.” Thyroid antibody profile was negative. Spot urine iodine was 57 µg/L. Upon re-evaluating the history, it was learned that the fistula tract had been irrigated regularly with povidone-iodine for the past three months. With elevated urinary iodine levels and regular povidone-iodine exposure, the patient was diagnosed with iodine-induced thyrotoxicosis. Endocrinology consultation recommended initiation of methimazole 30 mg/day and propranolol 20 mg twice daily, with beta-blocker dose titrated according to symptoms. The patient was monitored daily for thyroid storm.Corticosteroid therapy was not initiated due to the presence of active perianal fistula and abscess. During this period, infection control was achieved with parenteral antibiotics, surgical drainage and seton placement, as well as initiation of infliximab therapy. The patient achieved control of the perianal infection, and Infliximab treatment was given for Crohn's. With antithyroid and symptomatic treatment, thyrotoxic manifestations were stabilized. This case demonstrates that chronic exogenous iodine exposure during perianal fistula care in Crohn’s disease may lead to systemic thyroid dysfunction. In the literature, iodine toxicity has been reported to cause various thyroid disorders. For the diagnosis; thyroid function tests, spot urinary iodine measurement, and thyroid scintigraphy are of particular importance. In conclusion, systemic effects of iodine-containing antiseptics used during perianal fistula care in Crohn’s patients should be carefully considered, and thyroid functions should be monitored regularlyTable 1:Follow-up of the patient's thyroid function test results

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.

Dysphagia is a prevalent symptom of the upper gastrointestinal tract causing health related consequences, impacting quality of life and is associated with global economic burden. Swallowing difficulties are classified into oropharyngeal dysphagia (OD) and esophageal dysphagia. Despite its clinical importance, dysphagia is associated with several uncertainties regarding its optimal diagnostic work-up and management, particularly, considering the progress with diagnostic modalities and technologies. A Delphi consensus was performed with experts from various disciplines who conducted a literature summary and voting process on 41 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation criteria. Consensus was reached for all the statements. The panel agreed with the definition and prevalence of esophageal and OD types. The role of endoscopy, high-resolution manometry, EndoFLIP, barium swallow and other imaging tests in evaluating esophageal dysphagia has reached overall strong agreement. Videofluoroscopic swallow study, alongside fiber-endoscopic evaluation of swallowing, as the methods of choice for the instrumental assessment of oropharyngeal dysfunction is a strong recommendation. Regarding treatment, a weak recommendation was achieved for the use of PPIs, calcium-channel blockers, nitrates, phosphodiesterase type 5 inhibitors, antidepressants or peppermint oil for the treatment of hypercontractile esophagus. A strong recommendation exists for endoscopic and surgical treatment of achalasia, while a weak recommendation is provided for other esophageal motility disorders. Regarding OD, a weak recommendation was achieved for swallow therapy, to improve swallowing mechanics, reduce symptoms, and enhance quality of life. Swallow therapy could be more effective when using validated assessment tools, consistent treatment parameters, and considering long-term follow-up. A multinational group of European experts summarized the current state of consensus on the definition, diagnosis, and management of dysphagia.

Background/Aims:Hepatocellular carcinoma (HCC) ranks as a major contributor to cancer-related deaths. Systemic inflammation plays a pivotal role in HCC development and progression. Thus, we aimed to determine the impact of inflammation- and immune-based scores in predicting the prognosis of HCC. Materials and Methods:In this retrospective study, patients with HCC were enrolled between 2010 and 2020. The purpose of this retrospective study was to evaluate the impact of various biomarkers, including baseline alpha-fetoprotein (AFP) levels, C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index, neutrophil-to-CRP (N/CRP) ratio, systemic immune-inflammation index (SII), albumin-bilirubin (ALBI) score, neutrophil-to-lymphocyte ratio (NLR), and aspartate aminotransferase (AST)-to-alanine aminotransferase (ALT) (AST/ALT) ratio (AAR), on survival, invasion of vascular tracts, metastasis, and treatment responses. Results:A total of 199 patients with complete (n = 44) and non-complete (n = 145) treatment response groups were enrolled in the study. All scores for the non-complete response group were statistically significant (P < .05). The areas under the curves for predicting a non-complete response group were 0.651, 0.649, 0.636, 0.625, 0.613, 0.609, and 0.600 for AFP, CALLY index, AAR, SII, N/CRP ratio, ALBI score, and NLR, respectively. These results are consistent with the assessment of mortality and HCC progression. Conclusion:Our results indicate that these biomarkers could serve as powerful prognostic tools for HCC.

Abstract Background Azathioprine (AZA)-associated acute pancreatitis (AP) and gastrointestinal intolerance (GI-INT) are common causes of AZA discontinuation in IBD patients1,2. This study compares HLA alleles linked to AZA-AP3,4, along with demographic and clinical data, between AP and GI-INT patients. Methods Data from five IBD centers were used to form three groups: Control (n=88), AZA-AP (n=44), and GI-INT (n=44). Patients diagnosed with AP during AZA treatment per the Atlanta criteria (radiology, elevated amylase/lipase, and typical pain) were placed in the AZA-AP group. The GI-INT group included cases with pancreatitis-like symptoms lacking objective evidence, appearing within hours of AZA use and resolving very rapidly after stopping the medication. The impact of patients’ demographic data, disease characteristics, and HLA-DQA1/HLA-DRB1 allele status on AZA-AP and GI-INT were analyzed. Factors associated with AP (p<0.1) were further evaluated using regression analysis. Results A total of 176 patients were evaluated, and their socio-demographic characteristics are summarized in Table 1. Crohn’s disease was the most common diagnosis. Female gender was more prevalent in the AZA-AP and GI-INT groups compared to controls (p=0.018 and p<0.001, respectively). The AZA-AP group had a higher age at diagnosis than controls (p=0.016), but no difference was noted for the GI-INT group (p=0.15). Alcohol use and smoking were more common in the AZA-AP group. In the AZA-AP group, AP developed at a median of 4 weeks, with 91% of cases occurring within the first 3 months (AP onset occurred in one patient after 8 years and in another after 5 years). GI-INT developed at a median of 1 day, with a maximum onset time of 3 days. HLA-DQA1/DRB1 positivity was comparable between the GI-INT and control groups (9.2% vs. 14.8%; p=0.42) but was higher in the AZA-AP group (27.3% vs. 14.8%; p=0.08) (Table 1). Regression analysis indicated that female gender, older age at diagnosis, active smoking, alcohol use, and HLA-DQA1/DRB1 positivity were independently associated with an increased AP risk (OR: 2.7, 95% CI: 1.008–7.221; p=0.048) (Table 2). To prevent one case of pancreatitis, avoiding AZA in all individuals with the risk allele would mean that testing around 6 patients (NNTest) is necessary. Conclusion In IBD patients, azathioprine-associated pancreatitis most commonly occurs within the first 3 months of treatment and is independently associated with active smoking, alcohol use, female gender, and HLA-DQA1/DRB1 positivity. In contrast, GI intolerance typically begins within hours of the first dose, up to a maximum of 3 days, shows no significant demographic differences from the AZA-AP group, and is not associated with HLA-DQA1/DRB1 positivity. References 1.Teich N, Mohl W, Bokemeyer B, et al. Azathioprine-induced Acute Pancreatitis in Patients with Inflammatory Bowel Diseases--A Prospective Study on Incidence and Severity. J Crohns Colitis. 2016;10(1):61-68. doi:10.1093/ecco-jcc/jjv188 2.Eskazan T, Bozcan S, Atay K, et al. Frequency, Predisposing Factors, and Clinical Outcome of Azathioprine-Induced Pancreatitis Among Patients With Inflammatory Bowel Disease: Results From a Tertiary Referral Center. Pancreas. 2021;50(9):1274-1280. doi:10.1097/MPA.0000000000001914 3.Wilson A, Wang Q, Choi YH, et al. Pretreatment HLADQA1-HLADRB1 Testing for the Prevention of Azathioprine-Induced Pancreatitis in Inflammatory Bowel Disease: A Prospective Cohort Study. Clin Transl Gastroenterol. 2021;12(4):e00332. Published 2021 Apr 5. doi:10.14309/ctg.0000000000000332 4.Heap GA, Weedon MN, Bewshea CM, et al. HLA-DQA1-HLA-DRB1 variants confer susceptibility to pancreatitis induced by thiopurine immunosuppressants. Nat Genet. 2014;46(10):1131-1134. doi:10.1038/ng.3093

Background/Aims: Elevated intra-abdominal pressure (IAP) can lead to intra-abdominal hypertension (IAH) and, in severe cases, abdominal compartment syndrome (ACS) in patients with cirrhosis and ascites. Paracentesis reduces IAP and improves abdominal perfusion. Intra-abdominal hypertension can also trigger acute-on-chronic liver failure (ACLF) in decompensated cirrhosis. This study evaluates the association between IAH and short-term mortality in patients with cirrhosis and ascites. Materials and Methods: This prospective, single-center cohort study included 18 patients (7 females, 11 males; median age: 59) sched uled for therapeutic paracentesis. Intra-abdominal pressure was measured using the bladder technique. Patients were grouped based on initial Chronic Liver Failure Consortium Organ Failure (CLIF-C OF) scores as ACLF or non-ACLF and followed up for 3 months. Results: The median model for end-stage liver disease score was 17 (IQR 11-19). The primary etiologies of cirrhosis were viral hepatitis and alcoholic liver disease. Independent risk factors for IAH included advanced liver disease and large-volume ascites. Pre paracentesis IAP was higher in ACLF patients (22 vs. 18 mm Hg). Post-paracentesis IAP was also higher in ACLF patients (14 vs. 8 mm Hg, P = .007). The 3-month mortality rate was 50%, with worse survival in ACLF patients (24 vs. 76.9 days, P = .002). Pre-paracentesis IAP was signifi cantly higher in patients who died (22 vs. 18 mm Hg, P = .034), and survival was worse in those with IAP #18.5 mm Hg (P = .026). Conclusion: Intra-abdominal pressure is elevated in cirrhosis patients with grade 3 ascites. Despite similar paracentesis volumes, IAP remained higher in the ACLF group. Intra-abdominal pressure #18.5 mm Hg is associated with significantly reduced survival, indicating that IAH accelerates short-term mortality in these patients. Cite this article as: Mutlu U, Genc Ulucecen S, Iliaz R, et al. Intra-abdominal hypertension and its prognostic impact on mortality in cirrhotic patients with ascites: The role of paracentesis. Turk J Gastroenterol. 2025;36(6):390-397.

Objective: This study aimed to investigate the effectiveness, sustainability, and side effects of ustekinumab in patients with ulcerative colitis (UC) and Crohn's disease (CD). Material and Methods: The data of 48 inflammatory bowel disease patients who were unresponsive to previous treatment and were followed up at a tertiary centre were retrospectively investigated. Demographic features, characteristics of bowel diseases, treatment experiences, laboratory and endoscopic features, and disease scores [Crohn's Disease Activity Index (CDAI) and Simple Clinical Colitis Activity Index (SCCAI)] were analysed. Results: Of the total 48 patients, 35 (73%) were CD and 26 (54.2%) were women. The mean age of the patients was 42.1 +/- 13.3 years, and the mean age of disease was 136.8 +/- 92 months. There was previous use of biological agents in 100% of both UC and CD. The most common reason for switching to ustekinumab in patients was a lack of response to previous biologics (90%). The mean duration of use of ustekinumab was 17.1 +/- 8 months. At the end of the follow-up, 71% of the CD patients had CDAI<150 and were in complete clinical remission, and 53.8% of the UC patients had SCCAI<5 and were in complete clinical remission. Control endoscopy was performed for 13 UCs, and 6 (46.2%) had endoscopic remission. Control endoscopy was performed for 5 CDs, and 3 (60%) had endoscopic remission. Conclusion: Ustekinumab is an effective treatment method in achieving clinical remission in CD and UC resistant to previous treatments in the follow-up.

This study aims to investigate antiviral effectiveness, side effects, and disease outcomes in patients who have been using entecavir (ETV) and tenofovir disoproxil fumarate (TDF) for a long-term in chronic hepatitis B. Patients with chronic hepatitis B who had been using TDF or ETV for at least 10 years were included in this retrospective study. Co-infected patients, those receiving immunosuppressive therapy, and transplant patients were excluded. Of the study's total 173 patients (baseline mean age 43.4 +/- 11.7 years), 110 (63.6%) were men. Thirty-three (19.1%) patients were cirrhotic, and hepatitis B e-antigen was negative in 131 (75.7%) patients at the baseline. Ninety-two (53.2%) patients used TDF and 81 (46.8%) used ETV for a mean of 156.76 +/- 21.60 (120-204) months. Hepatitis B virus (HBV)-DNA negativity (<10 IU/mL) was achieved in 97.7% of all patients. Biochemical remission was achieved in 98.3% of all patients at the last visit. HBsAg became negative in only 5 (2.9%). Hepatocellular carcinoma (HCC) developed in 9 (5.2%) patients. All HCCs occurred after the 5th year of treatment. The age at HBV diagnosis was higher in HCC patients (P =.023), but the most important risk factor for the development of HCC was to have cirrhosis at baseline. Eight (4.6%) patients died in the follow-up, and 2 were due to liver disease and the remaining non-liver disease. At the end of follow-up, HBV-DNA negativity was achieved in almost all patients, and HBsAg sero-clearance was rarely achieved. Very few patients developed HCC and the long-term mortality rate was similar to the general population.