Background: Hepatitis B Virus (HBV) screening rates before starting immunosuppressive treatments are suboptimal. The aim of the study was to evaluate the efficacy of a new electronic alert system in increasing HBV screening rates. Methods: The electronic alert system, HBVision2, identifies patients at risk of HBV reactivation when a pre-determined International Classification of Diseases (ICD)-10 code is entered into the hospital’s database or immunosuppressive treatment is prescribed. The system evaluates the prior Hepatitis B Surfage Antigen (HBsAg) and anti-Hepatitis B Core Immunglobulin G (HBc IgG) results and sends an alert code to the clinician for screening if serology is not completely available or consult a specialist in case of positive serology. The HBV screening and consultation rates of patients before (control group) and after HBVision2 were retrospectively compared. The clinical course of unscreened and/or unconsulted patients was determined, and the clinical efficacy of HBVision2 in preventing HBVr was predicted. Results: Control group included 815 patients (52.6% male, mean age: 60 ± 12, 82.5% with oncologic malignancy) and study group included 504 patients (56% male, mean age: 60 ± 13, 91.4% with oncologic malignancy). Groups were similar with respect to gender, mean age, and HBVr risk profile of the immunosuppressive treatment protocols. Overall, both HBsAg (from 55.1% to 93.1%) and anti- HBc IgG screening rates significantly increased (from 4.3% to 79.4%) after the electronic alert system (P < .001, for both). Consultation rates of anti-HBc IgG-positive patients significantly increased from 40% to 72.7% (P = .012). HBVr developed in 2 patients (2.6%) who were not screened and/or consulted after the alert system. Alert program prevented the development of HBVr in 10 patients (1.9%) of the study group and decreased the development of HBVr by 80%. Conclusion: Electronic alert system significantly improved HBsAg and anti-HBc IgG screening rates before starting immunosuppressive treatment and prevented the development of HBVr to a great extent. However, screening rates are still below optimal and need to be improved.

Background/Aim: Melatonin is a cytoprotective hormone with antioxidant activity and also mediates regulatory effects that inhibit tumor proliferation and angiogenesis. This study aimed to evaluate serum melatonin levels and sleep quality in patients with newly diagnosed colorectal cancer (CRC) compared with controls and to investigate whether melatonin could serve as a potential biomarker. Materials and Methods: A total of 71 participants (36 CRC, 35 controls) were included. Blood samples were obtained between 01:00- 02:00 am and serum melatonin was measured using a high-sensitivity (ELISA) Enzyme-Linked Immunosorbent Assay kit. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and sleep apnea risk was determined by the STOP-Bang questionnaire. Group comparisons were performed, followed by multivariable logistic regression and receiver-operating characteristic analysis. Results: Colorectal cancer patients had significantly lower nocturnal serum melatonin concentrations (131.1 Å} 35.5 vs. 194.8 Å} 50.8 pg/ mL, P < .001) and higher PSQI scores (5.6 Å} 3.1 vs. 5.1 Å} 3.0, P = .028). In multivariable analysis, melatonin remained the only independent predictor of CRC (OR = 0.952, 95% CI: 0.929-0.976, P < .001). Receiver-operating characteristic analysis identified a melatonin threshold of ~150 pg/mL, discriminating CRC patients from controls with 75% sensitivity and 91.4% specificity (AUC = 0.877). Conclusion: Although cancer patients and the control group showed comparable obstructive sleep apnea risk, sleep quality was poorer, and melatonin levels were significantly lower in the cancer group. Melatonin assessment can complement traditional risk stratification and may provide new insights into the interplay between circadian biology, sleep, and colorectal carcinogenesis. Cite this article as: Durak I, Durak B, Duzenli T, et al. Nocturnal melatonin deficiency in colorectal cancer: independent predictive value beyond sleep quality. Turk J Gastroenterol. Published online February 23, 2026. doi: 10.5152/tjg.2026.25808.

Background/Aims: Patients with prior exposure to hepatitis B virus (HBV) (HBsAg [Hepatitis B surface antigen]-negative/anti-HBc [Hepatitis B core] immunoglobulin G (IgG)-positive) who receive immunosuppressive therapy (IST) remain susceptible to HBV reactivation (HBVr). Current clinical guidelines generally estimate HBVr risk according to the immunosuppressive potential of individual agents. However, evidence regarding the cumulative risk associated with the concurrent use of multiple agents within the same risk category remains limited. The current study investigated the effect of frequently used moderate risk IST combinations on the development of HBVr. Materials and Methods: A total of 406 HBsAg-negative/anti-HBc IgG-positive patients treated with moderate-risk IST were retrospectively analyzed. Patients were classified according to the treatment regimen into monotherapy (n = 178) and combination therapy (n = 228). HBVr was defined as either HBsAg seroconversion or the detection of HBV DNA during follow-up. The incidence of HBVr was compared between groups. Results: No significant differences were observed between the groups in baseline demographic and clinical features, including age, sex, and IST-related risk profiles. Among patients receiving combination therapy (58.7% female; mean age 62.8 ± 10.2 years), HBVr occurred in 6 patients, including 4 cases with HBV flare, whereas no reactivation occurred in the monotherapy group (62.3% female; mean age 63.6 ± 10.1 years). All patients who developed HBVr were anti-HBs-negative at baseline. HBVr occurred significantly more frequently among patients receiving combination therapy (P < .05). Conclusion: The use of combination IST and baseline anti-HBs negativity were identified as 2 important factors associated with increased risk of HBVr in HBsAg-negative/anti-HBc IgG-positive patients. In this subgroup, a clinical approach favoring antiviral prophylaxis may be considered. Further prospective studies with larger sample sizes are needed to fully elucidate this association. Cite this article as: Sadeçolak M, Düzenli T, Durak İ, et al. Increased risk of hepatitis B virus reactivation in patients with resolved hepatitis B virus infection receiving combination immunosuppressive therapy: The role of anti-HBs status. Turk J Gastroenterol. Published online June 2, 2026. doi: 10.5152/tjg.2026.26167.

Objective: In ulcerative colitis (UC), endoscopic assessment remains central to disease monitoring, but repeated colonoscopy is invasive and resource-intensive. This study evaluated the association and discriminatory performance of the systemic immune–inflammation index (SII; platelet × neutrophil/lymphocyte) and the hemoglobin–albumin–lymphocyte–platelet (HALP; hemoglobin × albumin × lymphocyte/platelet) score for endoscopic activity in UC and explored whether azathioprine use modified these associations. Methods: Among 428 retrospectively reviewed patients with UC, 218 met the inclusion criteria. Mayo-defined activity (endoscopic score ≥ 2) and Rachmilewitz EAI-defined activity (score ≥ 4) were analyzed as separate outcomes. Laboratory parameters were compared between active disease and remission groups. Receiver operating characteristic (ROC) analyses, multivariable logistic regression, sensitivity analyses accounting for disease duration and treatment category, and azathioprine interaction analyses were performed. Results: According to the Mayo and Rachmilewitz EAI definitions, 80 (36.7%) and 150 (68.8%) patients, respectively, had active disease. For Mayo-defined activity, CRP showed the highest discrimination (AUC = 0.720), followed by SII (AUC = 0.692), whereas HALP showed limited discrimination (AUC = 0.598). In the primary multivariable Mayo model, CRP, SII, younger age, and male sex were independently associated with activity, whereas HALP and azathioprine use were not. Adding SII to CRP produced only a small numerical increase in AUC (0.720 to 0.752), and adding HALP produced essentially no further change. No significant interaction between azathioprine use and SII or HALP was identified. Conclusion: SII was associated with endoscopic activity but showed only modest discriminatory performance, while HALP had limited discriminatory and independent predictive value. CRP remained the strongest individual biomarker. SII and HALP should therefore be interpreted as adjunctive inflammatory indices rather than substitutes for established biomarkers or endoscopic assessment.

Background and Objectives: Functional dyspepsia (FD) is a heterogeneous disorder of gut–brain interaction with a multifactorial pathophysiology. Although Helicobacter pylori infection has been implicated in FD, its relationship with Rome IV FD subgroups and the extent to which successful eradication results in sustained symptomatic improvement remain unclear. This study aimed to evaluate the distribution of H. pylori infection across Rome IV FD subgroups and to assess long-term symptomatic response following successful eradication. Materials and Methods: This prospective, single-center observational cohort study included patients with dyspeptic symptoms who underwent evaluation according to the Rome IV criteria. Adult patients who completed the Rome IV gastroduodenal symptom questionnaire and underwent upper gastrointestinal endoscopy were evaluated. Patients fulfilling the Rome IV criteria for FD without an organic cause explaining their symptoms were classified as postprandial distress syndrome (PDS), epigastric pain syndrome (EPS), or overlapping PDS–EPS. H. pylori status was determined histopathologically using gastric antral and corpus biopsies. H. pylori-positive patients received 14-day bismuth-based quadruple therapy, and eradication was assessed using a stool antigen test 8–12 weeks after treatment. Symptomatic response was evaluated at month 2, 6, and 12 using Likert scale and clinical assessment. Results: Of 425 patients evaluated, 244 fulfilled the Rome IV criteria for FD, and 127 (52.0%) were H. pylori positive. The prevalence of H. pylori infection differed significantly among the Rome IV FD subgroups (p < 0.001) and was highest in the EPS subgroup (73.4%, 58/79), compared with the PDS (37.7%, 40/106) and overlapping (49.2%, 29/59) subgroups. H. pylori positivity was significantly higher in EPS than in both PDS and overlapping subgroups (p < 0.001 and p = 0.003, respectively). First-line eradication rates were 96.4% (106/110) per protocol and 83.5% (106/127) by intention to treat. Symptomatic response rates following successful eradication were 43.4% (46/106), 60.4% (64/106), and 70.2% (66/94) at month 2, 6, and 12, respectively, compared with 47.0% (55/117), 63.4% (71/112), and 78.4% (80/102) in H. pylori-negative patients. Between-group differences in symptomatic response were not statistically significant (p = 0.58, 0.64, and 0.18, respectively). In the conservative sensitivity analysis, month 12 response was lower in the H. pylori-positive cohort (55.1% vs. 68.4%, p = 0.03). Sustained complete symptom resolution occurred in 25.5% (24/94) of patients after successful eradication and 19.6% (20/102) of H. pylori-negative patients (p = 0.32). Conclusions: H. pylori infection was significantly more prevalent in the EPS phenotype, supporting the biological heterogeneity of Rome IV functional dyspepsia. Sustained complete symptom resolution occurred in 25.5% after successful eradication and 19.6% in the H. pylori-negative cohort. Despite successful eradication in 96.4% per protocol and 83.5% by intention to treat, no clear symptomatic advantage over the H. pylori-negative cohort was demonstrated. Differences in phenotype distribution, treatment exposure, and follow-up completeness limit direct comparisons and preclude conclusions of equivalence or attribution of symptom resolution to eradication alone.

Aim: Adequate bowel preparation is essential for high-quality colonoscopy and directly affects key quality indicators such as adenoma detection and cecal intubation. Although low-volume, nonpolyethylene glycol (PEG) regimens are widely used in clinical practice, real-world comparative data between stimulant-based preparations and sodium picosulfate-based combinations remain limited. This study aimed to compare the effectiveness and tolerability of sennoside A + B versus sodium picosulfate/magnesium oxide/citric acid (PM/Ca) using the Boston Bowel Preparation Scale (BBPS). Methods: This prospective, randomized, observer-blinded trial included adults aged 18–80 years undergoing elective outpatient colonoscopy. Participants were randomized 1:1 to receive either sennoside A + B oral solution (split-dose: 250 mL at 21:00 and 250 mL at 23:00) or PM/Ca (two sachets at 19:00 and 21:00), both administered with a low-residue diet and written instructions; rectal enemas were applied as part of the institutional protocol. Bowel cleanliness was assessed using BBPS. Adequate preparation was defined as BBPS > 6. Multivariable logistic regression was performed to identify independent predictors of adequate preparation. Results: A total of 705 patients were included in the primary analysis cohort (341 sennoside A + B; 364 PM/Ca). Adequate bowel preparation (BBPS > 6) was achieved more frequently in the sennoside A + B group than in the PM/Ca group (70.1% versus 56.3; p < 0.001), and the mean BBPS score was higher (6.64 ± 1.78 versus 5.93 ± 1.92; p < 0.001). Polyp detection rates were similar between groups (21.4% versus 26.6; p = 0.138). In multivariable analysis, higher education (OR 1.38; 95% CI 1.06–1.81; p = 0.016) and sennoside A + B (OR 1.77; 95% CI 1.29–2.43; p < 0.001) were independent predictors of adequate preparation, whereas age, BMI, sex, diabetes mellitus, and constipation were not. Preparation intolerance was more frequent in the sennoside A + B group (7.0% versus 0.7%; p < 0.001; tolerance analysis n = 824). Failure to reach the cecum did not differ significantly between regimens (9.3% versus 12.3%; p = 0.216; analyzed in the entire study population n = 791). Conclusions: In routine clinical practice, sennoside A + B provided higher cleansing efficacy than PM/Ca as reflected by higher BBPS scores and a greater probability of achieving adequate bowel preparation. However, PM/Ca demonstrated a more favorable tolerability profile. Bowel preparation selection should balance efficacy and tolerability while considering patient-related factors such as educational level. Trial registration: ClinicalTrials.gov, NCT06580366.