Serkan Yaraş

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/Objectives: Ustekinumab (UST) and upadacitinib (UPA) are molecules that have been used in patients with ulcerative colitis (UC) since 2019 and 2022, respectively. Both agents are generally preferred for biologically experienced UC patients. However, the number of head-to-head studies comparing the efficacy and adverse events of UST and UPA in this patient group is limited. Methods: This was a retrospective cohort study evaluating the efficacy and safety of UST (n = 57) and UPA (n = 32) in biologically experienced UC patients during the induction and 24-week maintenance treatment periods. Most patients in both groups had received prior anti-TNF treatment (98.2% and 96.9%, respectively). Clinical response and remission rates were determined based on the partial Mayo score (PMS). Additionally, patients’ pre-treatment laboratory parameters were compared with their results at week 24. Results: During the induction phase, clinical response and remission were achieved in 84.2% and 43.9% of the UST group and 93.8% and 50% of the UPA group, respectively (OR [95% CI] = 2.81 [0.57–6.87] and 1.28 [0.54–3.05]). At week 24, the clinical response and remission rates in the UST and UPA groups were similar (77.1% vs. 80% and 58.3% vs. 63.3%, respectively). No statistically significant difference was found between the groups (p > 0.05). Both UST and UPA provided a marked reduction in fecal calprotectin and CRP levels. Regarding safety, UPA treatment led to increased total, LDL, and HDL cholesterol levels, whereas UST did not. In both groups, glucose; HbA1c; and thyroid, renal, and liver functions remained stable. No serious adverse events were observed in either group. At week 24, treatment continuation rates were 68.4% (n = 39) for UST and 78.2% (n = 25) for UPA (OR = 0.61 [0.22–1.66]). Conclusions: In biologically experienced ulcerative colitis, both UST and UPA are effective and safe treatment options. This study did not statistically demonstrate the superiority of UPA over UST. Given the preliminary nature and limited patient numbers of this investigation, our findings require confirmation through future multicenter, large-scale, and long-term prospective studies.

Background and Objectives: Upadacitinib is a recently approved Janus kinase (JAK) inhibitor for the treatment of inflammatory bowel disease (IBD). Although it has been adopted for clinical use, there are limited real-world data regarding its efficacy and safety, as well as its effects on laboratory parameters. In our study, we aimed to evaluate these outcomes in patients with moderate-to-severe Crohn’s disease (CD) and ulcerative colitis (UC) who had previously failed biologic agents. Materials and Methods: This retrospective cohort study included 22 UC and 19 CD patients who received Upadacitinib for at least six months, where efficacy was assessed at pretreatment and at 3 and 6 months. We used the Harvey–Bradshaw Index (HBI) for CD and the partial Mayo score (PMS) for UC to define clinical response and remission. Results: All patients were biologic-experienced, with a substantial portion (47%) having previously failed at least two different agents. At six months, the persistence rates were 78.3% for CD and 88% for UC. The clinical response rates were 72.7% for CD and 83.3% for UC, while the clinical remission rates were 50% and 58.3%, respectively. Fecal calprotectin and C-reactive protein levels significantly improved (p < 0.001). Total, LDL, and HDL cholesterol levels increased, but triglyceride levels and the LDL/HDL ratio remained unchanged. Biochemical parameters, including glucose, HbA1c, and thyroid, kidney, and liver function tests, remained within normal limits. No clinically significant changes were observed in hemogram parameters, and no serious adverse events, embolisms, major cardiovascular events (MACEs), or deaths occurred. Conclusions: Upadacitinib is effective in biologic-unresponsive IBD patients. While it increases cholesterol levels, it does not alter the LDL/HDL ratio and does not demonstrate a negative effect on glucose metabolism. Further multicenter, longer-term studies are needed on this topic.

Background Chemokines and their receptors, which regulate lymphoid organ development and immune cell trafficking, are integral to the mechanisms underlying viral control, hepatic inflammation, and liver damage in chronic hepatitis C (CHC) infection. This study explores the potential relationship between serum chemokine levels/polymorphisms and hepatitis C infection in affected individuals, with a particular focus on their utility as biomarkers across different stages of fibrosis. Methods and results Serum levels of the chemokines CXCL11, CXCL12, and CXCL16 were measured in patients with mild/moderate and advanced fibrosis due to CHC, as well as in healthy controls, using the ELISA method. The CXCL12 rs1801157 and CXCL16 rs2277680 polymorphisms were analyzed in blood samples from patients and healthy controls through RT-qPCR. Serum levels of CXCL11, CXCL12, and CXCL16 were significantly elevated in patients with advanced fibrosis compared to healthy controls. Furthermore, CXCL11 levels were markedly higher in patients with advanced fibrosis than in those with mild/moderate fibrosis. The frequency of the CXCL12 rs1801157 AA genotype was significantly higher in the advanced fibrosis group compared to the healthy control group. Similarly, the CXCL16 rs2277680 GA genotype was significantly more prevalent in the advanced fibrosis group than in the mild/moderate fibrosis group. Conclusions The current study highlights that, in addition to the potential association between chemokine levels/polymorphisms and an increased risk of disease complications and pathological progression in CHC infection, serum CXCL11 levels and the CXCL16 rs2277680 allel polymorphism may be important factors in determining the fibrosis stage of hepatitis C infection.

Acute pancreatitis (AP) is a clinical condition that arises acutely in the pancreas through various inflammatory pathways due to multiple causes. Turkish Society of Gastroenterology Pancreas Working Group developed comprehensive guidance statements regarding the management of AP that include its epidemiology, etiology, clinical presentation, diagnostic criteria, disease severity, treatment, prognosis, local and systemic complications. The statements were developed through literature review, deliberation, and consensus opinion. These statements were ultimately used to develop a conceptual framework for the multidisciplinary management of AP. Cite this article as: Öğütmen Koç D, Bengi G, Gül Ö, et al. Turkish society of gastroenterology: Pancreas working group, acute pancreatitis committee consensus report. Turk J Gastroenterol. 2024;35(S1):S1-S44.

Background/Aims: Pancreatic steatosis (PS) is a pathology associated with metabolic syndrome (MS), endocrin and exocrine disfunctions of the pancreas, and fatty liver. The data on the frequency of PS are very limited. We aimed to evaluate the frequency of PS detected by transabdominal ultrasonography (TAU) in gastroenterology clinics located in different geographical regions of Turkey and the factors associated with it. Materials and Methods: Volunteers were evaluated by TAU for PS and hepatosteatosis (HS), and its degree. Pancreatic stiffness was evaluated by ultrasonographic shear wave elastography (SWE). All demographic, physical, and biochemical parametres were measured. Results: A total of 1700 volunteers from 14 centers throughout Turkey were included in the study. Mean age was 48.03 +- 20.86 years (56.9% female). Prevalance of PS was detected in 68.9%. In the PS group, age, body mass index (BMI), waist circumference, systolic blood pressure, fasting blood glucose (FBG), lipid levels, insulin resistance, diabetes mellitus, hypertension, MS frequency, and pancreatic SWE score were increasing, and fecal elastase level was decreasing in correlation with the degree of PS. The frequency of HS was 55.5%. Hepatosteatosis [odds ratio (OR): 9.472], increased age (OR: 1.02), and BMI (OR: 1.089) were independent risk factors for the occurrence of PS. Lean-PS rate was 11.8%. The lean-PS group was predominantly female and younger than non-lean PS. Also it has lower blood pressure, FBG, liver enzymes, lipid levels, and HS rates. Conclusion: The frequency of PS was found 68.9% in Turkey. Its relationship was determined with age, BMI, HS, MS (and its components), pancreatic stiffness, and fecal elastase level. Keywords: Elastography, exocrine pancreatic insufficiency, lean steatosis, pancreas stiffness, pancreatic steatosis, ultrasonography Cite this article as: Sezgin O, Yaraş S, Cindoruk M, et al. Prevalence of pancreatic steatosis and its associated factors in Turkey: A nation-wide multicenter study. Turk J Gastroenterol. 2024;35(3):239-254.

Background and Aim: The aims of the present study were to evaluate the real-life efficacy and tolerability of glecaprevir (GLE)/pibrentasvir (PIB) in the treatment of patients with chronic hepatitis C (CHC). Materials and Methods: Between May 2019 and May 2022, 686 patients with CHC, treated with GLE/PIB combination from 21 participating centers in Turkiye, were enrolled in the study. Results: All patients were Caucasian, and their median age was 56 years. At the start of GLE/PIB treatment, the median serum Hepatitis C virus RNA and serum alanine amino transaminase (ALT) levels were 6.74 log10 IU/mL and 47 U/L, respectively. Fifty-three percent of the patients were infected with genotype 1b, followed by genotype 3 (17%). Diabetes was the more common concomitant disease. The sustained virological response (SVR12) was 91.4% with intent-to-treat analysis and 98.5% with per proto-col analysis. The SVR12 rates were statistically significant differences be-tween the patients who were i.v. drug users and non-user (88.0% vs. 98.8%,p=0.025). From the baseline to SVR12, the serum ALT levels and Model for End-Stage Liver Disease score were significantly improved (p

Objective: Pancreatitis is the most frequently observed complication after endoscopic retrograde chola ngiop ancre atogr aphy. Several preventive methods for post-endoscopic retrograde chola ngiop ancre atogr aphy pancreatitis have been developed. A pilot study was conducted to determine whether aggressive peripro-cedural hydration with lactated Ringer’s solution reduces the incidence of post-endoscopic retrograde chola ngiop ancre atogr aphy pancreatitis. Methods: The study included 32 patients who required endoscopic retrograde chola ngiop ancre atogr aphy for diagnostic or therapeutic purposes. Patients were randomized (1 : 1) to receive either aggressive hydration with lactated Ringer’s solution (n = 16) or standard hydration with the same solution (n = 16). Oral intake was stopped after midnight and endoscopic retrograde chola ngiop ancre atogr aphy began at 10:00 AM. Hourly fluid requirements of patients in the aggres-sive hydration group were calculated based on the 4-2-1 formula (4 mL/kg/h for the first 10 kg, 2 mL/kg/h for the next 10 kg, and 1 mL/kg/h thereafter) and fluid requirements of 10 hours were met in 2 hours from 08:00 to 10:00 AM before endoscopic retrograde chola ngiop ancre atogr aphy. At the 4th and 24th hours following endoscopic retrograde chola ngiop ancre atogr aphy, serum amylase and lipase levels, volume overload, and other complications were assessed. Acute pancreatitis was defined and ranked in accordance with the 2012 Atlanta Classification criteria. Results: Of all patients, 34% (11/32) developed pancreatitis after endoscopic retrograde chola ngiop ancre atogr aphy, compared with 12.5% (2/16) in the aggres-sive hydration group and 56.3% (9/16) in the standard hydration group. Pancreatitis was significantly less prevalent in the aggressive hydration group (P = .009). All observed cases of pancreatitis were mild. Conclusion: According to this pilot study, aggressive hydration with lactated Ringer's solution reduces the risk of post-endoscopic retrograde chola ngiop ancre atogr aphy pancreatitis.

Background and Objectives: It has been demonstrated that parameters such as the Controlled Nutrition Status (CONUT) score and Prognostic Nutrition Index (PNI) are beneficial for the assessment of patients’ nutrition. In this study, our objective was to investigate the potential benefits of CONUT and, as a prognostic marker of acute pancreatitis, the PNI. Materials and Methods: The data of 361 patients were analysed retrospectively. The PNI and CONUT scores of these patients were retrospectively calculated. They were categorised as CONUT-high (≥3) and CONUT-low (≤2). A PNI ≥ 45 was considered high and a PNI < 45 low. The AP severity and organ failure due to disease were evaluated based on Atlanta 2012. Results: According to the CONUT score, it was found that 209 patients had normal to mild, whereas 152 patients had severe malnutrition. A total of 293 patients had mild AP and 68 thereof had severe AP. The patients with a high CONUT score used more antibiotics, were hospitalised more in intensive care units and experienced organ failure more frequently. There were no intensive care hospitalisations, mortalities, surgical needs and local complications among the patients with a higher PNI score. Conclusions: CONUT and the PNI have proven to be useful prognostic markers not only for predicting nutritional status but also for estimating the severity and results of AP.