Serdar Akca

Giriş ve Amaç: Kolonoskopi başarısı, işlem öncesi kolon temizliğinin kalitesiyle yakından ilişkilidir. Yetersiz kolon temizliği mukozal görünürlüğü azaltarak tanısal doğruluğu olumsuz etkileyebilir. Bu çalışmada, başta ileri yaş olmak üzere klinik değişkenlerin Boston Barsak Hazırlığı Skalası ile değerlendirilen kolon temizliği kalitesiyle ilişkisini araştırmayı amaçladık. Gereç ve Yöntem: Bu tek merkezli, retrospektif çalışmaya 01.01.2025–30.06.2025 tarihleri arasında kolonoskopi yapılan erişkin hastalar dahil edildi. Kolon temizliği toplam Boston Barsak Hazırlığı Skalası skoru ile değerlendirildi. Boston Barsak Hazırlığı Skalası < 6 yetersiz kolon temizliği, Boston Barsak Hazırlığı Skalası ≥ 6 yeterli kolon temizliği olarak tanımlandı. Yaş, cinsiyet, vücut kitle indeksi, diyabetes mellitus varlığı ve Amerikan Anesteziyologlar Derneği Fiziksel Durum Sınıflaması > 1 değişkenleri değerlendirildi. Gruplar karşılaştırıldı; işlem karakteristiği eğrisi, korelasyon ve ikili lojistik regresyon analizleri yapıldı. Bulgular: Çalışmaya 2350 hasta dahil edildi. Hastaların 224’ünde (%9,5) yetersiz kolon temizliği saptandı. Yetersiz kolon temizliği grubunda yaş medyanı daha yüksekti (64 yıl vs. 59 yıl; p < 0,001). Diyabetes mellitus ve Amerikan Anesteziyologlar Derneği Fiziksel Durum Sınıflaması > 1 oranları da bu grupta anlamlı olarak daha fazlaydı. Yaş ile Boston Barsak Hazırlığı Skalası skoru arasında negatif korelasyon saptandı (r = -0,210; p < 0,001). İşlem karakteristiği eğrisi analizinde yaşın yetersiz kolon temizliğini ayırt etme performansı sınırlıydı (Eğri altında kalan alan: 0,606; p < 0,001). Çok değişkenli analizde ileri yaş, diyabetes mellitus varlığı ve Amerikan Anesteziyologlar Derneği Fiziksel Durum Sınıflaması > 1 yeterli kolon temizliği olasılığında azalma ile bağımsız olarak ilişkiliydi. Sonuç: İleri yaş, diyabetes mellitus varlığı ve artmış sistemik hastalık yükü, kolonoskopi öncesi yetersiz kolon temizliği ile ilişkili bulunmuştur. Bu değişkenler, riskli hastaların işlem öncesi belirlenmesinde pratik göstergeler olarak kullanılabilir.

Background/Aims: Pancreatic steatosis (PS) is characterized by fat accumulation within the pancreas and is associated with chronic low-grade inflammation. Migraine, the third most commonly seen disease worldwide, is an established risk factor for white matter lesions (WMLs). Given the shared inflammatory background of these conditions, it was hypothesized that the presence of PS in patients with migraine may contribute to the development of WMLs. Materials and Methods: This cross-sectional study included patients with migraine who attended the outpatient clinic and had undergone cranial magnetic resonance imaging (MRI) scan for any indication within the last 6 months. Following MRI, patients were referred to the radiology department for transabdominal ultrasonography to assess the presence of PS and hepatosteatosis. Results: Among the 78 patients with migraine included in the study, 35 (44.9%) had cranial WMLs. PS was significantly more prevalent among patients with WMLs than among those without WMLs (57.4% vs. 16.7%, P < .001). In multivariable logistic regression analysis adjusted for age, body mass index, and low-density lipoprotein/high-density lipoprotein ratio, PS remained independently associated with cranial WMLs (odds ratio (OR) 5.79, 95% CI 1.004-33.41; P = .049). Increasing age was also independently associated with WMLs (OR 1.095 per year, 95% CI 1.018-1.179; P = .015). Conclusion: This study demonstrated that the presence of PS may contribute to disease burden in patients with migraine. Evaluation of PS in this population may help identify a potentially modifiable metabolic condition and provide additional insight into the management of this common and debilitating disorder. Cite this article as: Alparslan AS, Ocal R, Buldukoglu OC, et al. Pancreatic steatosis: Innocent bystander or silent culprit? Turk J Gastroenterol. Published online July 20, 2026. doi:10.5152/tjg.2026.26091.

Cite this article as: Akca S, Buldukoglu OC, Atar GE, Cekin AH. Comment on machine learning–based prediction of histopathological classification in colorectal polyps. Turk J Gastroenterol. Published online February 20, 2026. doi: 10.5152/tjg.2026.25816.

Objective: To determine the colonoscopic yield of computed tomography (CT)-detected bowel wall thickening and assess whether its location is associated with colonoscopic findings. Materials and Methods: This retrospective study screened 4,773 colonoscopy records from November 1, 2024, to August 31, 2025. Patients were included when bowel wall thickening detected on CT performed for another reason was the sole indication for colonoscopy and the colonoscopy was performed within 6 months. CT locations were classified as rectum, left colon, right colon, or terminal ileum. Diagnostic yield was defined as any abnormal colonoscopic finding. Agreement was assessed using Cohen’s kappa. Results: Seventy-seven patients were included; the median age was 60 years (IQR, 49–72), and 40 patients (51.9%) were female. Colonoscopy identified an abnormal finding in 50 patients (64.9%). Diagnostic yield was 75.0% for rectal, 69.2% for left colonic, 42.9% for right colonic, and 64.7% for terminal ileal thickening, without significant differences among locations (p=0.269). Findings differed according to CT location (p=0.042). Terminal ileal thickening was most frequently associated with inflammatory lesions, whereas rectal and left colonic thickening were more commonly associated with polyps larger than 5 mm. CT and colonoscopy identified the same region in 36 of 50 patients with abnormal findings (72.0%; κ=0.619; p

Cite this article as: Akca S. Reconsidering the role of exocrine pancreatic insufficiency in functional dyspepsia. Turk J Gastroenterol. Published online October 10, 2025. doi:10.5152/tjg.2025.25532.

Acute pancreatitis (AP) is a common and potentially severe inflammatory condition of the pancreas with a heterogeneous etiology influenced by geographic, demographic, and lifestyle factors. This study aimed to evaluate the distribution of AP etiologies and their associations with age and sex in a regional cohort from a tertiary center. This retrospective observational study included 445 adult patients hospitalized with a first episode of AP between January 2022 and October 2023. Data on demographics, etiology, severity (revised Atlanta classification), hospital course, and outcomes were extracted from medical records. Etiologies were classified as biliary, idiopathic, alcohol-related, drug-induced, hypertriglyceridemia (HTG), neoplasm-associated, or other miscellaneous causes. Age was grouped into five categories, and statistical analyses assessed the association between etiologies and demographic variables. The median age was 65 years (range: 18–97), and 52.1% were female. Biliary etiology was the most frequent (66.1%), followed by idiopathic (9.4%), alcohol-related (7.0%), drug-induced (6.5%), neoplasm-associated (4.3%), and HTG-induced (3.1%). Females were significantly older than males (median 67 vs. 60 years, p < 0.001). Alcohol-related AP (AAP) was more common in males, particularly under age 55. Notably, among biliary AP (BAP) patients, males predominated in those under 55 (p = 0.02). Etiological patterns varied significantly by age. In patients aged ≥ 75 years, BAP was markedly more common (80.4% vs. 61.8%), whereas alcohol, drug, and HTG-related etiologies were rare. Severity of AP correlated with age and length of stay but not with etiology. Biliary pancreatitis remains the predominant etiology in this region, especially among elderly patients. A novel finding of male predominance in younger BAP cases warrants further investigation. These data underscore the importance of regional age and sex specific approaches to AP prevention and management.

Background/Aims: Crohn’s disease (CD) is an inflammatory, progressive disorder requiring monitoring of treatment response and disease course. Gasdermin D (GSDMD), a protein belonging to the gasdermin protein family, plays a role in inflammatory cell death, and activation of GSDMD has been shown to be a component of the pathogenesis of inflammatory bowel disease. Considering the role that GSDMD plays in inflammation, it was hypothesized that disease activity in CD may be correlated with serum GSDMD levels. The aim of this study was to assess the strength of GSDMD in predicting clinical disease activity in patients with CD in a prompt and easy manner. Materials and Methods: This cross-sectional study was conducted over a span of 22 months from September 2022 to June 2024. A total of 61 patients with CD were included in the study. Demographic data, disease- and treatment-related data, and laboratory workups of the patients were recorded and analyzed. Results: Gasdermin D levels were statistically significant in their correlation with the Harvey–Bradshaw Index (HBI) scores of the study population (P = .019). A threshold value of 5 ng/mL for GSDMD had a sensitivity of 84.6% and a specificity of 91.7% in differentiating patients with remission or mild disease from those with moderate or severe disease, according to HBI. Conclusion: This pioneering study revealed that serum GSDMD can be used as a biomarker to assess clinical disease activity in patients with CD. Future studies incorporating colonoscopic evaluation into the equation will provide more insight into the use of this protein as a surrogate marker of disease progression in CD. Cite this article as: Buldukoglu OC, Ocal S, Atar GE, et al. Gasdermin D: A new inflammatory biomarker in assessing clinical disease activity in Crohn’s disease. Turk J Gastroenterol. 2025;36(9):556-562.

Background and Aims: Fecal occult blood test is frequently used as a first-line screening method for colorectal cancer. In addition to fecal occult blood test, other screening methods include fecal immunohistochemical test, sigmoidoscopy, and colonoscopy. This study aims to evaluate the colonoscopy and histopathology results of patients who underwent colonoscopy due to a positive fecal occult blood test. Materials and Methods: This study included patients who underwent colonoscopy due to a positive fecal occult blood test at Antalya Training and Research Hospital between January 2020 and December 2024. Patients with inadequate bowel preparation, a known history of colorectal cancer, or inflammatory bowel disease were excluded. The age, gender, colonoscopy findings, and histopathological results of the included patients were recorded. Results: A total of 508 patients were included in the study, of whom 260 (51.2%) were male and 248 (48.8%) were female, with a median age of 61 years (range: 20 - 95). The median hemoglobin level was 13.5 g/dL (range: 5 - 16.3). Colonoscopy findings were normal in 196 (38.6%) patients. Other findings included polyps in 107 (21.1%), inflammatory bowel disease in 70 (13.8%), perianal disease in 59 (11.6%), colorectal cancer in 31 (6.1%), diverticula in 26 (5.1%), ulcers in 15 (3%), and angiodysplasia in 4 (0.8%) patients. A total of 223 (43.8%) patients with suspected colorectal cancer or polyps underwent biopsy. Histopathological examination revealed adenomatous polyps in 77 (34.5%) patients, inflammatory bowel disease in 59 (26.5%), adenocarcinoma in 31 (13.9%), and hyperplastic polyps in 26 (11.7%) patients, while 30 (13.5%) patients had no pathological findings. Conclusion: Nearly half of the patients who underwent colonoscopy due to a positive fecal occult blood test were found to have colonic pathology. Fecal occult blood test is a simple, cost-effective, and practical test not only for detecting colorectal cancer and precancerous lesions but also for identifying other colonic pathologies such as inflammatory bowel disease, diverticula, and perianal diseases.

This study aimed to assess the prevalence of periampullary diverticulum (PAD) among endoscopic retrograde cholangiopancreatography (ERCP) patients in Southwestern Turkey and investigate the association between the new PAD classification, post-ERCP hyperamylasemia, and post-ERCP pancreatitis (PEP). We retrospectively reviewed 1,317 ERCP procedures performed between January 1, 2022, and December 31, 2023, at Antalya Training and Research Hospital. The PAD type was determined according to the He-xian Shi classification. Hyperamylasemia was defined as an increase of three times the normal level of amylase at 4 to 6 h, and PEP was defined as hyperamylasemia along with abdominal pain lasting more than 24 h. A total of 594 naive patients who underwent ERCP were analyzed. PAD was present in 137 patients (23.1%), and the success rate of choledochal cannulation in the first ERCP procedure was 94.3%. There was no difference in the choledochal cannulation rate between patients with and without PAD (95.6%-93.4%, p = 0.59). Asymptomatic hyperamylasemia was observed in 19.3% of the patients. Post-ERCP hyperamylasemia rates were similar between patients with and without PAD (17.5% and 21.2% respectively, p = 0.31). PEP was observed in 8.0% of the patients. Presence of PAD was not a risk factor for post-ERCP pancreatitis (7.3% compared to 8.8%, p = 0.82). When we checked the results according to the type of PAD, the prevalence of post-ERCP hyperamylasemia was significantly lower in patients with type 2b PAD than in those with type 1 and type 2a patients. PAD is a common finding in ERCP patients, with a prevalence of 23.1% in our cohort. The rate of choledochal cannulation, post ERCP hyperamylasemia and PEP did not differ between the patients with and without PAD. However, the type of PAD is important; post-ERCP hyperamylasemia is significantly lower in patients with type 2b than in type 1 and type 2a PAD patients. Different subtypes of PAD may have different associations on ERCP outcomes. Further investigations with refined and standardized PAD classification systems are needed.