Autoimmune hepatitis (AIH) is a rare, immune-mediated liver disease. It has a heterogeneous nature with varied clinical presentations. The management of patients with AIH is challenging in many ways. The main difficulties are inexperience due to the rarity of the disease, diagnostic confusion in controversial areas such as variant/overlap cases, acute presentations, the presence of non-alcoholic fatty liver disease or drug-induced liver injury features, and the long and complex course of treatment. Here, we provide a clear, concise, and visualized review regarding the diagnosis and treatment of AIH, including illustrative cases.

Background and Aim: The aim of the present study was to examine the etiology of hepatocellular carcinoma (HCC) by underlying cause and determine the characteristics and clinical features of patients with HCC. Materials and Methods: The study comprised 1802 HCC patients diagnosed and followed up by Liver Diseases Outpatient Clinics in 14 tertiary centers in Turkey between 2001 and 2020. Results: The mean age was 62.3±10.7 years, and 78% of them were males. Of the patients, 82% had cirrhosis. Hepatitis B virus (HBV) infection was the most common etiology (54%), followed by hepatitis C virus (HCV) infection (19%) and nonalcoholic fatty liver disease (NAFLD) (10%). Of the patients, 56% had a single lesion. Macrovascular invasion and extrahepatic spread were present in 15% and 12% of the patients, respectively. The median serum alpha-fetoprotein level was 25.4 ng/mL. In total, 39% of the patients fulfilled the Milan Criteria. When we compared the characteristics of patients diagnosed before and after January 2016, the proportion of NAFLD-related HCC cases increased after 2016, from 6.6% to 13.4%. Conclusion: Chronic HBV and HCV infections remain the main causes of HCC in Turkey. The importance of NAFLD as a cause of HCC is increasing.

Cytomegalovirus (CMV) is an opportunistic pathogen that exacerbates inflammatory bowel disease (IBD). There are no clear diagnostic criteria for CMV infection in IBD patients. The aim of this study was to evaluate the importance of the diagnosis of CMV infection with CMV-DNA polymerase chain reaction (PCR) in the colonic mucosa and the response to antiviral treatment. We retrospectively analyzed the clinical data of 30 patients with IBD (24 men, 6 women; median age: 42 years) who were hospitalized because of IBD exacerbation and whose samples were assessed by tissue CMV-DNA PCR positivity. Most of the IBD patients had ulcerative colitis (90%). The CMV-DNA PCR median value was 8848 copies/mL of tissue (range 90–242,936 copies/mL). Blood CMV-DNA PCR was found to be positive in a small group (33.3%, 10/30) of tissue CMV-DNA PCR-positive cases. immunohistochemistry tests were positive in only 5 of the 23 patients positive for CMV-DNA PCR in the colonic mucosa, and high remission (25/30, 83.3%) was detected with antiviral therapy. Recurrence of CMV colitis infection was observed in 9 of 25 patients who had remission with antiviral therapy. The tissue CMV-DNA PCR test was found to be more useful than blood CMV-DNA PCR and immunohistochemistry tests for diagnosing CMV colitis, and the tissue CMV-DNA PCR test enabled rapid and appropriate treatment.

Background/Aims: Mushroom intoxication poses a considerable public health risk due to its potential for severe toxicity and fatality. This study aims to investigate demographic trends, diagnostic locations, and mortality rates of patients with mushroom intoxication. Materials and Methods: This retrospective cohort study utilized data from the National Electronic Database of the Turkish Ministry of Health. The study focused on patients without chronic liver disease or prior liver transplantation presenting with mushroom intoxication between 2018 and 2023. Demographic information, diagnostic locations, and mortality rates were analyzed, considering a six-year period to ensure even seasonal distribution. Results: Among 30459 individuals admitted with mushroom intoxication, 44.75% were male, with a mean age of 45.84 years. The Black Sea, Marmara, and Central Anatolia regions had the highest number of cases, with specific cities like Tokat, Bolu, Yozgat, and Kastamonu having the highest rates per 100,000 population in 2022. Mushroom intoxication predominantly occurred in May, June, October, and November. Hospitalization occurred in 8.9% of cases, with a 6.6% mortality rate within 90 days and 1.3% progressing to liver transplantation. Notably, mushroom intoxication cases increased by 130% in the first half of 2023, particularly in May and June, correlating with increased rainfall. Conclusion: Mushroom intoxication is a serious public health issue, with morbidity and mortality influenced by climate factors. The study highlights a significant increase in cases in the first half of 2023, potentially linked to heightened rainfall and climate change. Cite this article as: Turan Gökçe D, Arı D, Ata N, et al. Mushroom intoxication in Türkiye: a nationwide cohort study based on demographic trends, seasonal variations, and the impact of climate change on incidence. Turk J Gastroenterol. 2025;36(1):61-66.

Background/Aims: Primary biliary cholangitis (PBC) is a chronic liver disease influenced by environmental, genetic, and epigenetic fac tors, with varying incidence across populations. This study compared demographic, biochemical, and treatment responses in Danish and Turkish PBC patients. Materials and Methods: Four cohorts were analyzed: (1) 101 incident Turkish patients, (2) 77 incident Danish patients, (3) 103 prevalent Turkish patients, and (4) 155 prevalent Danish patients. Demographics, biochemical data, disease severity, and response to ursodeoxy cholic acid (UDCA) were assessed. Regression analysis was applied to the entire cohort to identify factors associated with the UDCA response. Results: Female dominance was noted in all cohorts (>90%) except the Danish incident group (75%). Turkish patients in the preva lent cohort were younger than Danish patients. Antimitochondrial antibody (AMA) positivity was higher in Turkish cohorts (92%-97%) compared to Danish cohorts (75%-88%). Biochemical data were similar across groups, with 15% of both populations having cirrhosis. Turkish patients showed a higher complete response to UDCA. Elevated alanine aminotransferase (ALT) levels reduced UDCA response, while Turkish ethnicity and older age improved it. Conclusion: Despite similar disease severity and age at diagnosis between Danish and Turkish PBC patients, Turkish patients had higher AMA positivity and better responses to UDCA treatment. These findings suggest potential genetic or environmental influences on treat ment efficacy. Cite this article as: Eruzun H, Bossen L, Turan Gökçe D, et al. Clinical and biochemical characteristics of a Danish and Turkish cohort of incident and prevalent patients with primary biliary cholangitis. Turk J Gastroenterol. 2025;36(4):241-246.

Background: The aim of the study was to share the effectiveness of pneumatic dilation in geriatric achalasia patients. Methods: Achalasia patients over the age of 65 and those under the age of 65 as the control group who received pneumatic dilation as the first-line treatment were evaluated in the study. Results: The average age of geriatric patients was 72.5 ± 55.92 years (65-90), with 50.3% of them being male. Follow-up was conducted for a mean of 64.52 ± 38.73 months. While pneumatic dilation was successful in 98.6% (141/143) of geriatric patients, it was also successful in 94% (141/150) of non-geriatric patients. Remission after single balloon dilatation was observed in 81.8% of geriatric patients, while it was observed in only 52.7% of non-geriatric patients (P = .000). When comparing remission after single dilatation and multiple dilatations, it was observed that geriatric patients who achieved remission after multiple balloon dilatation had higher lower esophageal sphincter pressure and Eckardt scores at the diagnosis and higher lower esophageal sphincter pressure and esophageal body resting pressures after the first balloon dilatation. Conclusions: The proportion of elders in the world population is increasing daily and this disease has been known to disproportionately afflict this group. Although surgical treatments, in particular per-oral endoscopic myotomy, have recently gained popularity as therapies for achalasia, pneumatic dilation remains the most commonly used in geriatric patients. Cite this article as: Tenlik İ, Öztürk Ö, Özin Y, et al. Pneumatic dilation in geriatric achalasia patients. Turk J Gastroenterol. 2023;34(4):332-338.