Gupse Adali

Background and aim: This study assessed depressive symptoms, sleep quality, and anhedonia in patients with primary biliary cholangitis (PBC), compared them with healthy controls (HCs), and explored their associations with UDCA treatment response, established prognostic scores, and liver stiffness measurement (LSM) in patients with PBC. Methods: In this single-center cross-sectional study, 103 patients with PBC and 50 HCs were evaluated using three validated patient-reported outcome (PRO) instruments: the Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), and Snaith–Hamilton Pleasure Scale (SHAPS). PRO measures were compared between patients with PBC and HCs, and associations between PROs and UDCA treatment response, prognostic scores, and LSM were explored in the PBC group. Results: Moderate-to-severe depressive symptoms, poor sleep quality, and anhedonia were observed in 45%, 62%, and 36% of patients with PBC, respectively, compared with 18%, 38%, and 18% of HCs. The age- and sex-adjusted odds ratios (ORs) for PBCvs. HC were 3.889 (95% CI 1.695–8.926), 3.442 (95% CI 1.636–7.238), and 2.678 (95% CI 1.158–6.193), respectively. Younger age was independently associated with poor sleep quality (OR per year 0.946, 95% CI 0.898–0.997; p = 0.039). No statistically significant associations were identified between PROs and UDCA response, prognostic scores, and LSM in patients with PBC. Conclusions: Patients with PBC reported a substantial and interrelated burden of depressive symptoms, poor sleep quality, and anhedonia compared with HCs.

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.

The Model for End-stage Liver Disease Sodium (MELD-Na) score predicts mortality in liver transplant candidates. MELD 3.0 has been proposed as an improved model for estimating mortality risk. This study evaluated MELD 3.0’s predictive accuracy for short-term mortality among Turkish liver transplant candidates and compared its performance with MELD and MELD-Na scores. Patients listed both for deceased donor transplants and living donor transplants were analyzed in the study. The discriminative abilities of MELD, MELD-Na, and MELD 3.0 scores were assessed using the area under the receiver operating characteristic curve (AUROC). Comparisons between AUROC values used the DeLong test. The most predictive cutoff for MELD 3.0 was determined using the Youden index. Transplant-free survival was analyzed using the Kaplan–Meier method, with survival curves compared using the log-rank test. A total of 1689 patients were included in this nationwide, multicenter study. Hepatitis B was the leading cause of cirrhosis (29%, n=491), followed by metabolic dysfunction–associated steatohepatitis (20%, n=335). For 3-month mortality, MELD 3.0 had the highest AUROC (0.753), followed by MELD-Na (0.747) and MELD (0.725). The most predictive cutoff values were 18 for MELD and 21 for MELD-Na and MELD 3.0. Both MELD-Na and MELD 3.0 outperformed MELD ( p p =0.17). MELD 3.0 and MELD-Na demonstrated superior performance to MELD in predicting 3-month mortality among Turkish liver transplant candidates, though their predictive accuracy was comparable. Further refinements are needed to enhance MELD 3.0’s clinical utility.

Background/Aims: De novo malignancies are an important long-term complication following liver transplantation (LT), driven bychronic immunosuppression and extended post-transplant survival. Understanding patterns by tumor type, timing, and patient characteristics is essential for optimized surveillance. This study aimed to evaluate the clinical characteristics and temporal trends of de novoneoplasms in LT recipients.Materials and Methods: A total of 6943 adult LT recipients from 16 Turkish centers were evaluated between 1999 and 2023). Two hundred eight patients with 220 histologically confirmed de novo malignancies (excluding hepatocellular carcinoma) were included. Patientswho died within 30 days or developed cancer within 90 days post-LT were excluded. Incidence and mortality rates were assessed acrosspost-transplant intervals.Results: Non-skin solid (53.2%), dermatologic (28.6%), and hematologic (18.2%) cancers were predominant. Most malignancies (76.8%)occurred within 10 years post-LT. Early-onset (<10 years) malignancies were more common in living donor recipients (62.7%, P = .001)and associated with higher mortality (39.6% vs. 11.8%, P < .001). Recipients ≤60 years exhibited a higher incidence of hematologiccancers (23.9% vs. 12.6%, P = .03) and increased mortality (39.4% vs. 27.0%, P = .05). In subgroup analysis, tacrolimus use was stronglyassociated with cutaneous squamous cell carcinoma (P = .004). Peak incidence occurred 2-10 years post-LT (≈13-14 per 1000 recipients), with non-skin solid tumors being the most frequent.Conclusion: De novo malignancies remain a significant long-term risk after LT, with outcomes influenced by tumor type, age, immunosuppression, and timing of onset. Risk-adapted surveillance and tailored oncologic management, particularly dermatologic screeningin tacrolimus-treated patients and enhanced surveillance during the 2-10 year post-transplant period are recommended to improvelong-term survival.Cite this article as: Danış N, Döngelli H, Ünek T, et al. De novo malignancies after liver transplantation: A multicenter cohort studyof incidence, timing, and outcomes. Turk J Gastroenterol. Published online February 20, 2026. doi:10.5152/tjg.2026.25748.

Background and Aims: Primary sclerosing cholangitis recurrence (rPSC) after liver transplantation (LT) is common; however, the factors contributing to rPSC are poorly understood. This study aimed to identify the risk factors for rPSC after LT and determine whether donor type affects rPSC. Methods: A multicenter retrospective cohort analysis was conducted on 174 patients with PSC who underwent LT between January 2000 and January 2024. Multivariable Cox models were used to evaluate risk factors for rPSC. The rPSC risk for living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT) recipients was compared using Kaplan‐Meier survival curves and log‐rank tests. Results: Of the 174 recipients, 144 (83%) underwent LDLT and 30 (17%) underwent DDLT. Sixty‐four (37%) had inflammatory bowel disease (IBD) prior to LT. Thirty‐three patients (19%) had rPSC after LT. The median time to rPSC was 28 months (IQR 6‐252). Patients with rPSC were younger at the time of PSC diagnosis, and had a higher prevalence of biliary complications after LT and concomitant IBD than those without recurrence. Multivariable Cox regression identified LDLT (HR 3.92, 95% CI 1.06–14.51, p = 0.041), biliary complications (HR 2.18, 95% CI 1.05–4.54, p = 0.037), IBD (HR 2.42, 95% CI 1.20–4.89, p = 0.013), and acute cellular rejection (HR 2.43, 95% CI 1.08–5.48, p = 0.032) as independent risk factors for rPSC. Conclusions: This multicenter study identified LDLT, acute cellular rejection, IBD, and biliary complications as independent risk factors for rPSC. These findings underscore the need for individualized post‐transplant surveillance and provide important considerations for graft selection and perioperative management in patients with PSC, particularly in settings where LDLT is predominant.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide and represents a major and growing public health challenge in Türkiye. This guidance provides an updated, clinically oriented overview of the definition, epidemiology, screening, diagnosis, risk stratification, and management of MASLD, with particular emphasis on evolving nomenclature, non-invasive diagnostic pathways, and current treatment strategies. The document addresses the full clinical spectrum of disease, from steatosis and metabolic dysfunction-associated steatohepatitis (MASH) to advanced fibrosis, cirrhosis, hepatocellular carcinoma, and liver transplantation. The guidance also incorporates evidence and practice considerations relevant to the Turkish population, including local epidemiology, resource availability, and implementation challenges in real-world care. Finally, areas of uncertainty and evidence gaps are highlighted to support future research and locally relevant policy development.

Chanarin-Dorfman Syndrome (CDS) is a rare autosomal recessive lipid storage disorder characterized by systemic triglyceride accumulation in various tissues, including the muscle, skin, central nervous system, liver, and white blood cells. Lipid accumulation results from mutations in the abhydrolase domain-containing 5 (ABHD5) gene, located on the p arm of chromosome 3. This report describes two adult Turkish siblings diagnosed with CDS who exhibited clinical features such as ichthyosis and cirrhosis secondary to steatotic liver disease. Genetic analysis revealed a novel homozygous frameshift mutation in the ABHD5 gene, c.29_30del (p.Ser10CysfsTer26), a variant previously documented in only one pediatric case. This report underscores the necessity of considering CDS in the differential diagnosis of steatotic liver disease, particularly when associated with ichthyosis, and highlights its relevance in populations from the Mediterranean region where such cases may be underdiagnosed.

Background Acute-on-chronic liver failure (ACLF) is a rapidly progressive syndrome marked by high short-term mortality. While diabetes mellitus (DM) is known to worsen liver-related outcomes, its specific impact on alcohol-related ACLF (ALD-ACLF) remains underexplored. This study aimed to assess the prognostic impact of DM on 90-day outcomes in ALD-ACLF using data from the APASL ACLF Research Consortium (AARC) database. Methods This observational study involved data from 5612 ACLF patients with documented 90-day outcomes. We identified 2096 patients with ALD-ACLF precipitated by alcoholic hepatitis. Patients with non-ALD etiologies, mixed etiologies, or non-alcoholic precipitants were excluded. Diabetic and non-diabetic patients were compared using 1:2 propensity score matching based on key baseline covariates. Survival outcomes were assessed using Kaplan–Meier analysis and multivariable Cox regression. Results After matching, 109 diabetic patients were compared with 218 well-matched non-diabetic controls. Diabetic patients had significantly lower overall survival (32 vs. 57%) and transplant-free survival (31 vs. 50%) compared to non-diabetics (log-rank p < 0.001). On multivariable Cox regression, DM was independently associated with increased 90-day mortality (HR 1.739, 95% CI 1.262–2.395, p < 0.001), along with elevated serum lactate (HR 1.187 per mmol/L, p < 0.001) and creatinine (HR 1.267 per mg/dL, p < 0.001). Conclusion Diabetes mellitus is a significant independent predictor of mortality in patients with ALD-ACLF. These findings highlight the need for early identification and integrated management of diabetes in ACLF care pathways to improve clinical outcomes.

Cite this article as: Aykut H, Ordu B, Dertsiz B, Saruhan MA, Adalı G. Splenic artery aneurysm following endoscopic ultrasound guided fine-needle aspiration: A rare complication presenting with delayed massive gastrointestinal bleeding. Turk J Gastroenterol. Published online November 3, 2025. doi:10.5152/tjg.2025.25457

Background/Objectives: Hepatitis B virus (HBV) is a virus that can cause chronic hepatitis B (CHB) in humans, leading to cirrhosis and hepatocellular carcinoma (HCC). In this study, we aimed to investigate the relationships between early ALT normalization (at 12 months), the virologic response in CHB patients, and the risk of HCC development. Methods: Data from a retrospective cohort study involving 616 chronic hepatitis B patients were used. The effects of ALT normalization and virologic response on the risk of developing HCC at 12 months of treatment were analyzed. Results: During a median treatment duration of 70.9 months, 36 (5.8%) HCC cases were detected in the total patient population. ALT normalization was detected in 68.83% of patients at 12 months of treatment. The rate of HCC in the group with early ALT normalization was lower than that in the group without ALT normalization, but this difference was not statistically significant (5% vs. 7.8%, p = 0.161). At the end of 12 months of treatment, virologic response was detected in 80.68% of the patients. The rate of patients developing HCC was significantly lower in the virologic response group (4.8% vs. 10.1%, p = 0.028). However, the risk of developing HCC was also significantly higher in the virologically unresponsive group, according to the virologic response at 12 months (p = 0.034). Conclusions: According to the results of this study, achieving virologic response at the end of 12 months in genotype D CHB patients treated with nucleos(t)ide analogs (NAs) reduces the risk of developing HCC.