Tugce Eskazan

Background: Colorectal neoplasia in adults younger than 50 years has attracted increasing clinical attention because of the rising incidence of early-onset colorectal cancer. However, the clinicopathological characteristics of colorectal lesions detected in younger adults remain incompletely described. This study aimed to characterize the clinical, anatomical, and histopathological features of colorectal neoplasia in adults younger than 50 years undergoing colonoscopy. Methods: This retrospective single-center study included adults aged 18–49 years who underwent complete colonoscopy between January 2018 and December 2023. After exclusion of individuals with normal colonoscopy findings, 152 patients with at least one colorectal lesion were included. Lesions were classified as benign, advanced, or malignant according to established histopathological criteria. Demographic, endoscopic, and pathological characteristics were analyzed and compared across lesion categories. Results: Among 152 patients, 83 (54.6%) had benign lesions, 64 (42.1%) had advanced neoplasia, and 5 (3.3%) had malignant lesions. Advanced lesions were observed predominantly in individuals aged 40–49 years. Most lesions were detected in symptomatic patients undergoing clinically indicated colonoscopy. Histopathological evaluation demonstrated a higher frequency of villous/tubulovillous adenomas, sessile serrated lesions, and high-grade dysplasia among advanced lesions. Larger lesion size was strongly associated with advanced pathological features (p < 0.001). In multivariable analysis, patients aged 30–39 years had significantly lower odds of advanced or malignant neoplasia than those aged 40–49 years, whereas no independent associations were observed for sex, smoking status, alcohol use, family history of colorectal cancer, or lesion location. Conclusions: In this selected cohort of adults younger than 50 years with detected colorectal lesions undergoing clinically indicated colonoscopy, advanced neoplasia represented a substantial proportion of cases. These findings should not be extrapolated to the general population of adults younger than 50 years or to screening cohorts.

Background and Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with substantial morbidity, and hepatic fibrosis stage is the strongest predictor of long-term outcomes. Although liver biopsy remains the reference standard for fibrosis assessment, its invasiveness has driven the development of noninvasive diagnostic tools, including transient elastography (TE) and serum-based fibrosis scores. To evaluate and compare the diagnostic performance of TE and commonly used serum-based fibrosis scores for detecting clinically significant fibrosis (≥F2) in patients with biopsy-proven MASLD. Materials and Methods: This retrospective cross-sectional exploratory diagnostic accuracy study included 30 adults with biopsy-confirmed MASLD. Patients were classified into clinically significant fibrosis (CSF, ≥F2; n = 9) and no/mild fibrosis (NMF, F0–F1; n = 21) groups. Among the nine patients with CSF, six had stage F2 fibrosis and three had stage F3 fibrosis. TE, FIB-4, APRI, NAFLD Fibrosis Score (NFS), BARD score, and HOMA-IR were evaluated. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis, optimal cutoff values, dual-cutoff strategies, and confusion matrix analysis. Results: TE, FIB-4, and APRI demonstrated the highest diagnostic performance (AUROC: 0.93 for each). TE showed the most balanced diagnostic accuracy (sensitivity 88.9%, specificity 90.5%), whereas APRI provided the highest specificity (95.2%) and the strongest positive likelihood ratio (+LR: 18.67). FIB-4 achieved 100% sensitivity with lower specificity (76.2%). NFS demonstrated moderate diagnostic performance (AUROC: 0.83) with a relatively wide gray zone (56.7%), whereas BARD and HOMA-IR showed limited discriminative ability. When fibrosis categories automatically assigned by the TE device were evaluated, the overall diagnostic accuracy was 93.3%. Conclusions: TE, FIB-4, and APRI demonstrated promising diagnostic performance as noninvasive tools for identifying clinically significant fibrosis in biopsy-proven MASLD. These findings generate the hypothesis that a sequential diagnostic strategy using serum-based fibrosis scores for initial risk stratification followed by TE for confirmation may reduce the need for liver biopsy. However, this hypothesis requires confirmation in larger prospective validation studies.

Objective: This study aimed to evaluate the intestinal ultrasound (IUS) findings in Crohn’s disease (CD) patients who achieved endoscopic remission (ER) and to compare the clinical and treatment-related features between patients with and without ultrasound remission (UR). Methods: Endoscopic remission was defined as a Simple Endoscopic Score for CD ≤2 in each intestinal segment. Bowel wall thickness (BWT), color Doppler signal (CDS), bowel wall stratification, and mesenteric fat inflammation were assessed. International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) and Bowel Ultrasound Score (BUSS) scores were calculated. Ultrasound remission was defined as IBUS-SAS score below 25 or as BUSS score below 3.52 in each segment. Transmural activity was defined as the absence of ultrasound remission, i.e., the presence of at least 2 intestinal segment exceeding the aforementioned thresholds. Results: Among 24 patients in ER, transmural activity was detected in 7 patients (29.2%) using IBUS-SAS, while only 1 patient (4.2%) was positive according to BUSS. When BWT alone was used as the marker of transmural activity, 4 patients (16.7%) were classified as not achieving TR, including 1 patient with an IBUS-SAS score below the activity threshold. When transmural activity was defined as the combination of BWT ≥3 mm and CDS ≥1, only 1 patient (4.1%) met the criteria. Perianal disease was observed more frequently in patients without UR compared to those achieving UR (42.9% vs. 5.9%), although this difference did not reach statistical significance. Similarly, the rate of biologic treatment and the duration of therapy were higher among patients without UR again without attaining statistical significance. Conclusion: Nearly one-third of CD patients in ER may have residual transmural activity detectable by IUS. Persistent inflammatory burden, such as perianal disease, may delay transmural healing despite mucosal remission. Cite this article as: Eşkazan T, Ceylan G, Alasgarlı S, et al. Transmural remission rate assessed by intestinal ultrasound in Crohn’s disease patients with endoscopic remission. Cerrahpaşa Med J. 2026, 50, 0034, doi: 10.5152/cjm.2026.26034.

Objective: Chronic hepatitis B virus (HBV) infection poses a risk of viral reactivation in patients receiving immunosuppressive therapies, including anti-tumor necrosis factor (TNF) agents. This study aimed to evaluate HBV screening practices, antiviral prophylaxis, and reactivation outcomes in patients with inflammatory bowel disease (IBD) undergoing biologic therapy at a tertiary referral center in Turkey. Methods: Patients diagnosed with IBD who initiated biologic therapy between 2009 and 2025 were retrospectively reviewed. Demographic and clinical characteristics, HBV serologic status, antiviral prophylaxis, vaccination history, and HBV reactivation events were recorded. Chronic HBV infection was defined as persistent hepatitis B surface antigen (HBsAg) positivity for more than 6 months. Occult HBV infection was defined as HBsAg negativity with anti–HBc positivity and detectable HBV DNA. HBV reactivation was defined as the reappearance of HBV DNA or HBsAg in patients with previously undetectable levels, or a greater than 10-fold increase in HBV DNA, in accordance with EASL 2025 criteria. Results: A total of 437 patients were included (59% male; mean age 33.2±12.8 years), of whom 72% had Crohn’s disease. Anti-HBc positivity was detected in 70 patients (16%). Five patients (1.1%) were HBsAg positive, and 1 patient had occult HBV infection; all 6 received antiviral therapy. Overall, 12 patients (2.7%) received antiviral prophylaxis. During a mean biologic exposure of 33.5±28.6 months, no HBV reactivation occurred in patients receiving or not receiving antiviral therapy. HBV vaccination was documented in 25.8% of patients, with loss of vaccine-acquired immunity observed in 18.5%. Among patients with natural immunity, 15.1% experienced anti-HBs seroreversion. Conclusion: Real-life data from this tertiary IBD center demonstrate appropriate HBV screening and antiviral prophylaxis in high-risk patients. The absence of HBV reactivation supports close monitoring rather than routine prophylaxis in intermediate-risk groups. Periodic reassessment of HBV serology is recommended due to antibody loss during immunosuppressive therapy. Cite this article as: Eşkazan T, Sonsuz A. Hepatitis B virus screening, prophylaxis, and reactivation in inflammatory bowel disease patients undergoing biologic therapy: real-life data from a tertiary center in Türkiye. Cerrahpaşa Med J. 2026, 50, 0013, doi: 10.5152/cjm.2026.26013.

Background/Aims: This study aims to assess the frequency of latent tuberculosis (TB) and the incidence of active TB infection in patients with inflammatory bowel disease (IBD) and Behçet’s syndrome with gastrointestinal involvement who received either tumor necrosis factor–alpha (TNF-α) antagonist therapy or vedolizumab as a second-line biologic treatment following TNF-α antagonist therapy. Materials and Methods: A total of 349 patients were included in the study. Demographic data, disease characteristics, TB screening results, prophylactic treatment regimens and the duration, as well as side effects were collected from patient records. Results: Among the patients, 196 (56.1%) were male, with a mean age of 42 years and a mean disease duration of 10 Å} 6 years. A total of 267 (76.5%) had Crohn’s disease, 76 (21.8%) had ulcerative colitis, 3 had indeterminate colitis (0.8%), and 3 had Behçet’s syndrome with gastrointestinal involvement (0.8%). Latent TB was diagnosed in 176 (50.4%) patients, and 162 (92%) of them received isoniazid prophylaxis. Six (1.7%) patients developed active TB infection during the treatment period, occurring between 2 and 48 months after initiating TNF-α antagonist therapy. No cases of tuberculosis were observed in patients who had vedolizumab treatment. Among those who developed TB, 3 patients had pulmonary TB, and 3 had both pulmonary and extrapulmonary TB. No significant association was found between TB development and IBD phenotype or isoniazid use. Conclusion: Despite latent TB screening and prophylactic treatment, patients receiving TNF-α antagonists remain at risk of developing active TB, with a latent TB prevalence of 50.4% and an active TB incidence of 1.7%. These findings underscore the continued need for vigilance and robust TB monitoring strategies in this patient population. Cite this article as: Dashdamirova S, Eskazan T, Erzin YZ, et al. Prevalence of latent and active tuberculosis infection in inflammatory bowel disease patients who received biological treatment. Turk J Gastroenterol.Published online February 13, 2026. doi: 10.5152/tjg.2026.25072.

Background: Azathioprine (AZA)-associated acute pancreatitis (AP) and gastrointestinal intolerance (GI-INT) are major causes of drug discontinuation in inflammatory bowel disease (IBD). This study compared HLA alleles, demographics, and clinical variables between AZA-AP and AZA-GI-INT. Methods: Data from five IBD centers included control (n = 88), AZA-AP (n = 44), and GI-INT (n = 44) groups. AP was defined by the Atlanta criteria, and GI-INT as acute dyspeptic symptoms related to AZA that resolved after withdrawal. Demographics, disease features, and HLA-DQA1/DRB1 alleles were assessed for associations. Results: Among 176 patients, female sex was more frequent in AZA-AP and GI-INT than controls (p = 0.018, p < 0.001). AZA-AP patients were older at diagnosis vs. controls (p = 0.016) but not vs. GI-INT (p = 0.15). Smoking and alcohol were more common in AZA-AP. The median onset of AP was four weeks, with 91% occurring within three months. GI-INT occurred rapidly, with a median of one day and a maximum of three days after the first dose. HLA-DQA1/DRB1 positivity was comparable in GI-INT and controls (9.2% vs. 14.8%, p = 0.42) but higher in AZA-AP (27.3% vs. 14.8%, p = 0.08). Regression identified female sex, smoking, alcohol, budesonide, and HLA-DQA1/DRB1 positivity (OR 3.01, 95% CI 1.004–9.058; p = 0.049) as independent risk factors for AZA-AP. Conclusions: AZA-AP, but not GI-INT, appears genetically influenced, with HLA-DQA1/DRB1 association extending across populations. In IBD, AZA-AP usually emerges within three months and is linked to female sex, smoking, alcohol, and budesonide. GI-INT typically develops within hours to three days of initiation. These findings support AZA-AP and GI-INT as distinct idiosyncratic entities shaped by genetic, metabolic, and sensitivity factors.

Crohn hastalığı (CH), gastrointestinal traktusta transmural tutulum yapan, kronik ve tekrarlayıcı bir hastalıktır. Patogenezi tam olarak aydınlatılamamış olmakla birlikte, genetik yatkınlık, çevresel faktörler ve bağırsak mikrobiyotası ile immün sistem arasındaki kompleks etkileşimler hastalığın gelişiminde rol oynamaktadır. Transmural inflamasyon, bağırsak duvarında fibrozis, striktür ve fistül oluşumu gibi komplikasyonlara yol açabilir. Klinik olarak karın ağrısı, ishal, kilo kaybı ve perianal hastalık gibi semptomlarla ortaya çıkarken, ekstraintestinal tutulum da sık görülmektedir. Tanı, endoskopik bulgular, histopatolojik inceleme, kesitsel görüntüleme yöntemleri ve biyokimyasal belirteçlerin kombinasyonu ile konulur. Endoskopik olarak atlamalı tutulum, lineer ülserler ve mukozal granülasyon tipik bulgular arasındadır. Hastalığın yönetiminde hedef, mukozal iyileşmenin sağlanması ve komplikasyonların önlenmesidir. Tedavi seçenekleri; kortikosteroidler, immünmodülatörler ve anti-TNF ajanları, integrin ve IL-23 inhibitörleri gibi biyolojik ajanları içermektedir. Striktür ve fistül gibi komplikasyonların geliştiği vakalarda cerrahi tedavi kaçınılmaz olabilir. Postoperatif dönemde nüksü önlemek için endoskopik takip ve bireyselleştirilmiş farmakolojik tedaviler önerilmektedir. Günümüzde CH’nin doğal seyrini değiştirmeye yönelik çabalar sürmekte olup, kişiye özgü tedavi yaklaşımlarının optimize edilmesi ve hastalık mekanizmalarına yönelik yeni hedeflerin belirlenmesi, gelecekte daha etkin tedavi seçeneklerinin geliştirilmesine katkı sağlayacaktır.

Aim: We have previously shown that CRP < 2.9 mg/L is a better predictor of endoscopic remission (ER) than CRP < 5 mg/L in ulcerative colitis (UC). Here, we prospectively evaluate CRP and FCP cut-offs and compare them in predicting ER and histological remission (HR) in UC. Method: One hundred thirty-five steroid-free UC patients were evaluated prospectively. ER was defined as Mayo endoscopic sub-score 0–1. In colonoscopy, the colon was evaluated as seven segments: rectum, sigmoid, descending, proximal-transverse, distal-transverse, ascending colon, and cecum. Two biopsies of each segment were evaluated for histological inflammation and graded using the Nancy and Geboes scores. All segment biopsies with Nancy < 1 and Geboes < 2 were defined as HR. Results: The optimum cut-off values for FCP and CRP were 120 μg/g and 2.75 mg/L for ER, respectively. AUC values of FCP and CRP were similar for ER and Mayo-0 disease in ROC analysis. CRP and FCP also had similar performances with these cut-offs regarding ER. While CRP was a predictor to assess the extensiveness of active UC, FCP was not. ROC analysis showed no difference between CRP and FCP regarding HR. Cut-off values for HR were 2.1 mg/L and 55 μg/g for CRP and FCP, respectively. CRP and FCP, in combination with the mentioned cut-off values, detected ER and HR in nearly 2/3 and ½ of the patients, respectively, with high specificity. Conclusions: Reappraised CRP (ER: 2.75 mg/L, HR: 2.1 mg/L) has as much diagnostic contribution as relevant FCP in predicting ER and HR and contributes more to revealing the proximal extension in active colitis compared to FCP. Relevant CRP and FCP combinations may improve the prediction rates.

Aims: The share of older population is increasing globally. Colonoscopy is a frequently used diagnostic/therapeutic procedure, no study to our knowledge comprehensively examines the indications and findings of colonoscopy in geriatric population. We aimed to reveal these in older adults.Methods: Colonoscopy procedures performed in older adults (≥65 years), which covered a 5-year period (2017-2022), were analyzed retrospectively. Indications and findings of colonoscopies were assessed. The relationship between the indications and the associated findings was also evaluated on an indication basis.Results: In the study, 2370 colonoscopy procedures were examined. 27.8% were performed in very old (≥75 years) patients. Colonoscopy was completed in 84.3%. Colon cleansing was not optimal in approximately one-fourth. The frequency of completion of colonoscopies and optimal cleaning were similar in the very old. Iron deficiency anemia (IDA) or fecal occult blood test (FOBT) positivity and screening colonoscopy were the common indications. Regarding indications, IDA-FOBT positivity and bleeding were more frequent, screening colonoscopy, IBD and polyp control were less frequent in the very old group. Colonoscopy was reported as normal in 42.4% of the patients, while polyps (28.3%) and diverticula (17.5%) were the common findings. Among findings tumor, diverticula and solitary rectal ulcer were higher in the very old. IDA -FOBT positivity, bleeding, and colonoscopy performed due to findings of other imaging modalities were related to diagnosis of a tumor.Conclusion: In this study, we presented the indications and results of colonoscopy in a large number of older patients. The main indications for colonoscopy can be listed as IDA-FOBT positivity, screening colonoscopy and control of previous polyp-tumor. Near one of two colonoscopies were found to be normal, polyps and diverticula were the major pathologies in the rest. It should be emphasized that IDA -FOBT positivity, bleeding, and findings of other imaging modalities were related to tumor in colonoscopy.