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/Objectives: Chat Generative Pretrained Transformer (ChatGPT) is a useful resource for individuals working in the healthcare field. This paper will include descriptions of several ways in which ChatGPT-4 can achieve greater accuracy in its diagnosis and treatment plans for ulcerative colitis (UC) and Crohn’s disease (CD) by following the guidelines set out by the European Crohn’s and Colitis Organization (ECCO). Methods: The survey, which comprised 102 questions, was developed to assess the precision and consistency of respondents’ responses regarding the UC and CD. The questionnaire incorporated true/false and multiple-choice questions, with the objective of simulating real-life scenarios and adhering to the ECCO guidelines. We employed Likert scales to assess the responses. The inquiries were put to ChatGPT-4 on the initial day, the 15th day, and the 180th day. Results: The 51 true or false items demonstrated stability over a six-month period, with an initial accuracy of 92.8% at baseline, 92.8% on the 15th day, and peaked to 98.0% on the 180th day. This finding suggests a negligible effect size. The accuracy of the multiple-choice questions was initially 90.2% on Day 1, reached its highest point at 92.2% on Day 15, and then decreased to 84.3% on Day 180. However, the reliability of the data was found to be suboptimal, and the impact was deemed negligible. A modest, transient increase in performance was observed at 15 days, which subsequently diminished by 180 days, resulting in negligible effect sizes. Conclusions: ChatGPT-4 demonstrates potential as a clinical decision support system for UC and CD, but its assessment is marked by temporal variability and the inconsistent execution of various tasks. Essential initiatives that should be carried out before involving artificial intelligence (AI) technology in IBD trials are routine revalidation, multi-rater comparisons, prompt standardization, and the cultivation of a comprehensive understanding of the model’s limitations.

Background: Autoimmune liver diseases (ALDs) are a diverse group of chronic inflammatory disorders. Individuals with a history of one autoimmune disease (AD) are at a substantially increased risk of developing additional autoimmune conditions. Polyautoimmunity has increasingly been recognized as a factor associated with a more complex disease course and poorer long-term outcomes. Methods: This retrospective, cross-sectional observational study reviewed medical records of patients diagnosed with ALDs who had been admitted to the gastroenterology clinic. Results: A total of 457 patients with ALDs were included. Polyautoimmunity was present in 194 patients (42.5%), and multiple autoimmune syndrome (MAS) was diagnosed in 26 of these patients (5.7%). Serological comparisons revealed that antinuclear antibody (ANA) positivity was significantly more common in the polyautoimmunity group. Only 22.2% of the patients with polyautoimmunity were ANA-negative, compared with 52.9% in those without. An ROC curve analysis was conducted to assess the predictive value of clinical and laboratory variables for polyautoimmunity. Among all the tested parameters, ANA positivity (>+2) had the strongest predictive value (AUC: 0.724). A disease duration longer than 6.5 years followed, with a moderate discriminative capacity (AUC: 0.677). Additionally, lower albumin levels (29.5 mm/h) were significantly associated with polyautoimmunity. Conclusions: In our cohort, 42.5% of patients had at least one additional autoimmune disorder, highlighting the need for a systemic and comprehensive approach to patient care. Simple and accessible markers—such as ANA titers, disease duration, albumin levels, and ESRs—may help to identify patients at greater risk.

Inflammatory bowel diseases (IBD), including ulcerative colitis and Crohn’s disease (CD), exhibit clinical heterogeneity, with sex-related differences potentially influencing disease course and prognosis. This study investigates the impact of sex on IBD prognosis in a large cohort. Data were collected from patients diagnosed with IBD at our clinics between July 1993 and April 2025. Demographic, clinical, and treatment variables were analyzed, focusing on sex-based differences in disease onset, disease activity, extraintestinal manifestations (EIMs), treatment escalation, hospitalizations, and surgical interventions. A total of 1774 patients diagnosed with IBD were included in the study. A male predominance (61%) was observed in IBD, with higher male-to-female ratios in both ulcerative colitis (1.6:1) and CD (1.47:1). Female patients presented earlier with IBD (mean age 34.7 vs 37.0 years; P = .001) and had a higher frequency of EIMs, particularly peripheral arthritis and erythema nodosum ( P < .001). No significant sex differences were observed in disease severity, hospitalizations, or need for treatment escalation. However, female patients with CD demonstrated higher disease activity at baseline, as measured by the Crohn’s disease activity index. Both sexes exhibited similar rates of biologic therapy use, the number of biologic therapies, hospitalizations, and major surgeries. Despite the male predominance in IBD prevalence, sex-related differences in clinical outcomes were minimal, with both sexes experiencing comparable disease activity, treatment escalation, and need for surgery. However, female patients exhibited a higher frequency of EIMs, highlighting the importance of a sex-based approach in clinical management.

Background/Aims: Inflammatory bowel diseases (IBDs) are increasingly prevalent and challenging globally. Data regarding IBD frequency and severity between Europe and Asia are needed. The aim was to investigate the trend of IBD in Türkiye during the last 3 decades. Materials and Methods: The study was conducted retrospectively at 14 centers in Türkiye between June 1993 and March 2024. Results: Over 30 years, 4308 patients, of whom 2507 (58.2%) had ulcerative colitis (UC) and 1717 (39.9%) had Crohn’s Disease (CD), were included in the study. The overall median age at the onset of IBD was 34.43 (25.28-45.64) years; the age at onset of IBD was younger in CD compared to UC (32.72 vs. 35.52 years respectively, P < .001). The peak age onset range was 28-32 years in CD, whereas 23-27 years in UC. Overall, 2526 (58.6%) patients were male. The most common location was left-sided colitis in UC patients (45.1%), followed by extensive colitis (31.2%), and proctitis (23.7%), while ileal involvement in CD patients (45.2%), afterward ileocolonic (409%), and colonic (13.5%). Both illnesses are becoming increasingly prevalent. The UC/CD ratio tends to decrease over time. During the study period, 1577 (36.6%) patients received biologic treatment. During the study period, 418 (24.3%) underwent resective surgery for CD and 88 (3.5%) total colectomy for UC; the major abdominal surgery has declined over time. Conclusion: The frequency and characteristic features of IBD in Türkiye appear to be between Europe and Asia. Over time, while the usage of biologic therapy and the rate of CD have increased, the frequency of surgery has decreased. Cite this article as: Durak MB, Cagin YF, Balkan A, et al. Three-decade analysis of inflammatory bowel disease in Türkiye: A multicenter study (1993-2024). Turk J Gastroenterol. 2025;36(12):822-833.

Background/Objectives: Dose escalation has been commonly used to achieve and maintain response. We aimed to compare the outcomes of adalimumab or infliximab dose escalation in inflammatory bowel disease (IBD) patients. Methods: Treatment persistence (TP) and predictive factors for remission-free treatment discontinuation (r-fTD) were evaluated in patients treated with adalimumab or infliximab dose escalation between 2019 and 2024. Results: Dose escalation was identified in 142 patients treated with adalimumab (UC: 23.9%; CD: 76.1%) and in 126 patients treated with infliximab (UC: 23.8%; CD: 76.2%). The TP rate was significantly lower in the adalimumab group (35.2%) than the infliximab group (53.2%) (p = 0.003). The survival analysis showed that drug persistence was lower in the adalimumab group compared with the infliximab group (mean time: 74.3 vs. 99.5 months, p < 0.001). TP rates showed no significant differences between UC and CD for both adalimumab (mean time UC: 64.7 months vs. CD: 76.2 months, p = 0.403) and infliximab (mean time UC: 80.3 months and CD: 102.6 months, p = 0.151). The r-fTD rates were significantly higher in the adalimumab group (62.7%) than the infliximab group (39.7%) (p < 0.001). Primary lack of response and secondary loss of response (sLOR) rates were both higher in the adalimumab group (7.7% and 51.4%) than the infliximab group (1.6% and 28.6%). However, serious adverse events were lower in the adalimumab group (2.1%) than the infliximab group (7.9%) (p = 0.027). Conclusions: Infliximab dose escalation was more effective than adalimumab in both UC and CD patients. Regarding the side effect profile, adalimumab dose escalation was found to be safer compared with infliximab.