Ahmet Uyanıkoğlu

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 and objectives: Upper gastrointestinal bleeding (UGIB) is a common cause of emergency department admissions with significant mortality risk. Risk stratification remains challenging in clinical practice. This study aimed to evaluate the associations of inflammatory biomarkers including Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Monocyte-to-Lymphocyte Ratio (MLR), Systemic Immune Inflammation Index (SII), and Systemic Inflammation Response Index (SIRI) with intensive care admission rates and 30-day mortality in patients with UGIB. Materials and Methods: A retrospective cohort study was conducted, including 307 patients with UGIB treated. Inflammatory biomarkers were calculated from admission hemogram results. The associations of these biomarkers with intensive care admission and 30-day mortality (survivors vs. non-survivors) were analyzed. ROC analysis was performed to evaluate the predictive value of inflammatory parameters for mortality. Results: The 30-day mortality rate was 14.3%. Significant differences were observed between survivors and non-survivors in terms of SII (median 1268vs. 2544, p=0.030) and SIRI values (median 3.96vs. 9.23, p=0.003). Furthermore, SIRI values exhibited substantial variances among the various Forrest bleeding classification groups (p=0.037). ROC analysis revealed that SII (AUC 61.1%, cut-off 1056.8) and SIRI (AUC 67.5%, cut-off 3.19) had limited predictive value for mortality. After adjusting for age, comorbidities, and bleeding etiology in multivariable analysis, SIRI remained independently associated with mortality. Conclusions: SII and SIRI demonstrate statistically significant associations with mortality in UGIB patients, though with limited discriminative ability. These biomarkers, which are easily calculable from routine blood tests, may serve as supplementary tools in the risk assessment of UGIB patients. Further prospective studies with larger cohorts are required to confirm these findings and investigate their potential clinical applications.

Colorectal polyps are recognized precursors of colorectal cancer. Their prevalence in Türkiye ranges from 15% to 31%, with higher rates reported in men and older individuals. Iron deficiency anemia is an important alarm finding that warrants colorectal evaluation. We present the case of a 52-year-old male patient who presented with abdominal pain and iron deficiency anemia. Colonoscopy revealed extensive colorectal polyposis and a 20-mm rectosigmoid polyp, which was removed by endoscopic mucosal resection. Histopathological examination demonstrated invasive adenocarcinoma arising within a tubulovillous adenoma (pT1NxMx). Given the extensive polyposis, adenocarcinoma, and family history suggestive of a hereditary polyposis syndrome, genetic testing was initiated; however, the results were not available at the time of manuscript preparation. Following multidisciplinary evaluation, laparoscopic total proctocolectomy with ileal pouch-anal anastomosis was performed. Histopathological examination of the surgical specimen revealed adenomatosis coli with more than 100 adenomatous polyps, focal high-grade dysplasia, a synchronous well-differentiated rectal neuroendocrine tumor (WHO Grade 1), and 37 reactive lymph nodes without metastatic involvement. This case highlights the malignant potential of extensive colorectal polyposis and the importance of early recognition and appropriate surgical management.

Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms but represent the most common subtype associated with anemia, typically arising in the stomach or small intestine. Diagnosis is generally suggested by contrast-enhanced computed tomography (CT) and endoscopic ultrasonography (EUS), while definitive confirmation requires histopathological and immunohistochemical evaluation. EUS-guided biopsy is sometimes avoided due to bleeding and tumor dissemination risks. We report a 72-year-old male who developed severe anemia five days after blunt abdominal trauma from a cow kick. EUS findings suggested GIST, which was pathologically confirmed after surgical excision, and the relevant literature is reviewed.

Background/Objectives: This study aimed to determine the prevalence of malnutrition and sarcopenia risk among patients hospitalized in gastroenterology clinics across different geographical regions of Turkey, to identify their risk factors, and to evaluate their associations with clinical outcomes. Methods: A total of 1051 patients admitted to 36 gastroenterology clinics across six geographical regions of Turkey during the week of 14 November 2024 were evaluated in a cross-sectional design. The nutritional status of the patients was assessed using the NRS-2002 questionnaire, while the risk of sarcopenia was evaluated with the SARC-F questionnaire. Demographic data, clinical diagnoses, disease severity scores, and comorbidities were also recorded and analyzed. Results: Of the patients included in the study, 54.7% were female, and the mean age was 61.7 ± 17.2 years. The prevalence of malnutrition risk was 27.8%, while the prevalence of sarcopenia risk was 32.7%. Patients with malnutrition risk had a lower BMI (24.7 ± 5.3 vs. 27.1 ± 5.4, p < 0.001) and were older (67.6 ± 16.0 vs. 56.5 ± 17.1, p < 0.001). The risks of sarcopenia and malnutrition were significantly higher in patients with liver cirrhosis (40.7% malnutrition; 54.5% sarcopenia), gastrointestinal malignancy (50.5%; 44.2%), and diabetes mellitus. Logistic regression analysis identified older age, male sex, and presence of malignancy as independent risk factors for malnutrition, whereas older age, female sex, presence of malnutrition, liver cirrhosis, and heart failure were independent risk factors for sarcopenia. A strong correlation was also found between malnutrition and sarcopenia (r = 0.544, p < 0.001). Conclusions: Approximately one-third of patients hospitalized in gastroenterology clinics across Turkey are at risk of malnutrition and sarcopenia. These conditions are particularly associated with malignancy, cirrhosis, and metabolic comorbidities. Our findings highlight the necessity of systematic nutritional and sarcopenia screening upon hospital admission.

Amaç: Gaucher hastalığı (GH) nadir görülen, otozomal resesif (OR) geçişli, lizozomal depo hastalığıdır. En sık tip 1 GH görülmekte olup, yaklaşık %80’inde hepatomegali, %90’ında splenomegali saptanır. Bu çalışmada hepatosplenomegali saptanan ve nedeni bulunamayan hastalarda GH sıklığı araştırılmıştır. Materyal ve metod: Eylül 2016- Mayıs 2019 tarihleri arasında polikliniğine başvuran, gastroenteroloji, hematoloji ve enfeksiyon tetkikleri sonrası hepatomegali ve/veya splenomegalinin etiyolojik nedeni saptanamayan hastalar çalışmaya alındı. Hastalardan kuru kan testi için hazırlanmış hazır formlara, parmak ucundan bir damla kan alındı ve tetkik için Viyana (Avusturya)’da bulunan Archimed laboratuvarına gönderildi. Beta-glukoserebrosidaz için cut-off>2,5, asid-sfingomyelidaz için >0,9 mikromol/L alındı. Bulgular: Tarama yapılan 22 hastadan 11 tanesi (% 50) kadın, yaş ortalaması 38,86 ± 13,78 (yaş dağılımı 20-76) idi. GH düşünülen dört hastanın ikisi (%50 kadın), yaş ortalaması 43,2 ± 16,7 (yaş dağılımı 20-60) idi. Beta-glukoserebrosidaz düzeyi cut-off değerin altında altı hasta (%26) saptandı. Mutasyon saptanan, ikisinde asid-sfingomyelidaz düzeyi de düşük ve ikisinde aile hikayesi olan dört hastanın (%18,0), tip1 GH olduğu görüldü. Sonuç: Sık görülen hastalıklar ekarte edildikten sonra nedeni halen saptanamayan hepatomegali ve/veya splenomegalisi olan hastaların taramasında, hastaların dörtte birinde beta-glukoserebrosidaz enzim düşüklüğü saptanmış, 22 hastadan dört tanesine tip 1 GH tanısı konulmuştur. İyi araştırılmış bu hastalar-da tarama yapıldığında nadir görülen bir hastalık olarak bilinen GH’nın bu grup için nadir olmadığı göste-rilmiştir.

Objective: Acute upper gastrointestinal bleeding is a life-threatening emergency situation. Gastroscopy has an important place in the diagnosis and treatment. This study aimed to examine the etiological, clinical, and gastroscopic data of patients with upper gastrointestinal bleeding. Materials and Methods: The outcomes of patients who underwent gastroscopy for upper gastrointestinal bleeding in the endoscopy unit between January 2016 and December 2021 were retrospectively reviewed. Results: Of the 511 patients evaluated, 341 (66.7%) were male, 170 (33.3%) were female, and the mean age of the patients was 60.2 ± 19.05 years (range 16-88) years. The most common cause of the bleeding was peptic ulcer (51.2%), and its location was the duodenum (70.7%). The second most common cause was esophageal variceal bleeding (23%). Band ligation was applied to 99 (82%) of 122 patients with bleeding esophageal varices at the same session or at a later session, and sclerotherapy was applied to 120 (46%) of 262 patients with bleeding peptic ulcers at the same session. Fifteen patients (2.9%) underwent surgery due to severe bleeding and hemodynamic instability. Intravenous iron therapy was administered to 101 patients (20%). Mortality occurred in 67 of 511 patients (13.1%), including 29 of 122 patients (24%) with varicose veins and 38 of 391 patients (10%) with non-variceal bleeding during hospitalization. Conclusion: It was found that the mortality rate during hospitalization in the gastroenterology unit was 13% overall for patients hospitalized for upper gastrointestinal bleeding, one-fourth for patients hospitalized for variceal bleeding, and one-tenth for patients hospitalized for non-variceal bleeding. These data reveal that upper gastrointestinal bleeding, especially variceal bleeding, is a clinical condition with high mortality that requires urgent intensive care admission and rapid intervention.

ÖZET İnlet Patch (IP), heterotropik gastrik mukozanın konjenital olarak servikal özofagusta görülmesidir. IP, özofagogastroduodenoskopi sırasında tesadüfen tespit edilmekle birlikte sıklıkla disfaji, odinofaji, kalıcı globus hissi, midede yanma, şişkinlik, gaz ve bazen ağza acı, ekşi su gelmesi semptomları ile prezente olabilir. Bu yazıda nadir görülen servikal inlet patch olgusu literatür eşliğinde sunulmuştur. Anahtar Kelimeler: İnlet patch, özofagus, gastroskopi

Background/Aims: The aim of our study was to investigate the underlying causes behind the etiology of cirrhosis in Türkiye. Materials and Methods: The study was comprised of patients with cirrhosis located in the gastroenterology clinics of 28 centers in Türkiye between January 2000 and June 2021. Results: The study group consisted of 4953 cirrhotic patients (median age: 62.2 years, male / female: 58% / 42%). Among the patients, 39% of the patients were compensated, and 61% were decompensated. Furthermore, 47.5% had Child-Pugh class A, 38% had ChildPugh class B, and 14.5% had Child-Pugh class C. The most frequent complaints were abdominal bloating (28%). Ascites (54.2%) was the most common manifestation of decompensation. The median Child-Pugh and MELD-Na scores were 7.0 and 10.0, respectively. The most common cause of cirrhosis was chronic viral hepatitis (43%), followed by cryptogenic cirrhosis (CC) (19%), metabolic dysfunction-associated steatotic liver disease (MASLD)-related cirrhosis (13%), and alcohol-related cirrhosis (11%). Among the 950 patients with CC, 416 had metabolic abnormalities. If these 416 CC patients with metabolic abnormalities were categorized as having MASLDrelated cirrhosis, the proportion of MASLD-related cirrhosis increased to 21%. Thirteen percent of the patients were diagnosed with HCC, while 4% had extrahepatic malignancy. Female breast cancer (18%) and colorectal cancer (18%) were the most frequent extrahepatic malignancies. Conclusion: Viral hepatitis remains the main cause of cirrhosis in Türkiye. However, its prevalence seems to be declining, whereas the prevalence of steatotic liver disease-related cirrhosis is increasing. Cite this article as: Üçbilek E, Yıldırım AE, Ellik Z, et al. Changing trends in the etiology of cirrhosis in Türkiye: A multicenter nationwide study. Turk J Gastroenterol. 2024;35(10):772-777.