Background and Aim: The histological diagnosis of autoimmune hepatitis (AIH) is challenging. A new consensus recommendation was provided by the International AIH Pathology Group to address the problems in the histological diagnosis. The purpose of this study is to compare the 2008 ‘simplified’ criteria for AIH with the ‘consensus recommendation’ of 2022 in terms of diagnostic sensitivity. Materials and Methods: A retrospective analysis was conducted on pathological specimens of patients diagnosed with Autoimmune Hepatitis (AIH) between 2010 and 2022. Out of 188 patients enlisted, 88 were selected based on exclusion criteria. The specimens were examined by two experienced hepatopathologists and a resident pathologist. All specimens were analyzed using both the “simplified” criteria and the new consensus recommendations. Results: Out of a total of 78 patients, the 2022 consensus recommendations raised the diagnostic category of 16 patients (20.5%) to a higher level. Six patients who were previously diagnosed as “atypical” were now considered “possible AIH”, while 10 patients with a “compatible” diagnosis were elevated to “likely AIH” category. No patients were found to fall into a lower diagnostic category according to the new recommendations. A significant difference in diagnostic sensitivity was observed between the 2008 criteria and the 2022 consensus report (p

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are now foundational therapy for diabetic chronic kidney disease (CKD), yet their ketogenic metabolic effects in this population remain incompletely characterised. While euglycaemic diabetic ketoacidosis is a recognised complication, the prevalence and clinical determinants of subclinical asymptomatic ketonemia in patients with diabetic CKD receiving SGLT-2 inhibitors have not been systematically evaluated. We aimed to determine the prevalence of asymptomatic ketonemia, defined by point-of-care capillary β-hydroxybutyrate (β-HB) positivity, and to identify its independent clinical predictors in this population. This cross-sectional study enrolled 211 consecutive adult outpatients with diabetic CKD receiving SGLT-2 inhibitor therapy (empagliflozin or dapagliflozin). Capillary β-HB was measured under standardised fasting conditions using a point-of-care ketone meter; positivity was defined as β-HB ≥ 0.6 mmol/L. Univariate comparisons were performed using the Mann-Whitney U test, independent-samples t-test, χ² test, or Fisher's exact test as appropriate. Given the low number of outcome events (n = 16), Firth's penalised logistic regression was employed as the primary multivariable analysis to mitigate small-sample bias. Asymptomatic ketonemia was detected in 16 of 211 patients (7.6%), all of whom were clinically asymptomatic at measurement. In Firth's penalised logistic regression, heart failure (OR 4.46; 95% CI 1.48-13.51; p = 0.008), absence of statin use (OR 4.94; 95% CI 1.54-15.86; p = 0.007), and higher HbA1c per 1% increment (OR 1.35; 95% CI 1.01-1.81; p = 0.041) were independent predictors of ketone positivity. Systolic blood pressure showed a borderline inverse association (OR 0.97 per mmHg; 95% CI 0.93-1.00; p = 0.063). No ketone-positive patient was receiving thiazide diuretics (0% vs. 30.3%; p = 0.007). SGLT-2 inhibitor type was not independently associated with ketonemia. Findings were robust on sensitivity analysis with standard logistic regression (Hosmer-Lemeshow p = 0.217; Nagelkerke R²=0.234). Asymptomatic ketonemia is present in approximately one in thirteen outpatients with diabetic CKD receiving SGLT-2 inhibitors. Heart failure, absence of statin therapy, and suboptimal glycemic control independently identify a higher-risk metabolic phenotype, while ketonemia appears unrelated to CKD stage. Although these findings are exploratory and require confirmation in larger prospective studies, they suggest that targeted ketone monitoring may be warranted in selected higher-risk patients.

Background/Objectives: Peritoneal membrane failure remains a major limitation of peritoneal dialysis (PD). Systemic inflammation contributes to membrane dysfunction, yet simple predictive biomarkers are lacking. The uric acid-to-HDL cholesterol ratio (UHR) represents a novel integrative marker of metabolic-inflammatory burden, but its association with membrane failure has not been investigated. Methods: This retrospective cohort study included adult patients who initiated PD between 1997 and 2023. Baseline UHR was calculated from laboratory measurements obtained within the first three months after PD initiation. The primary outcome was peritoneal membrane failure, defined as permanent transfer to hemodialysis due to ultrafiltration failure, inadequate solute clearance, or progressive membrane dysfunction. Receiver operating characteristic, Kaplan–Meier, and Cox regression analyses were used to evaluate the association between UHR and membrane failure. Results: Among 214 patients, 62 (29%) developed membrane failure during follow-up. Baseline UHR was significantly higher in patients with membrane failure. A UHR cut-off value of 14 was identified for risk stratification. In multivariable Cox regression analysis, UHR >14 was independently associated with an increased risk of membrane failure (hazard ratio 1.836, 95% CI 1.040–3.241). A history of kidney transplantation prior to PD initiation also emerged as a strong independent predictor of membrane failure. Conclusions: Elevated baseline UHR is independently associated with peritoneal membrane failure in PD patients. As a simple and readily available biomarker, UHR may support early risk stratification and individualized management. Prospective multicenter studies are warranted to validate these findings.

Background/Aims: The International Autoimmune Hepatitis (AIH) Group recommends the new histological criteria (HC) (2022) and modified immunoserological testing for diagnosing AIH. The diagnostic utility of the 2022 HC was evaluated. The simplified criteria were also updated with the 2022 HC and immunoserological testing and assessed the diagnostic performance. Materials and Methods: The data of 207 patients (111 AIH, 33 primary biliary cholangitis, 35 drug-induced liver injury, and 28 metabolic dysfunction–associated fatty liver disease) were evaluated. Results: The 2022 HC and the 2008 simplified HC showed 95% vs. 88% sensitivity and 82% vs. 49% specificity for possible/compatible AIH. For likely/typical AIH, sensitivity was 60% vs. 42% and specificity was 98% vs. 95% for the 2022 HC and the 2008 HC, respectively. The area under the curve (AUC) was better for the 2022 HC than for the 2008 simplified HC (0.932 vs. 0.771, P < .001). The updated simplified criteria had a sensitivity comparable with the simplified criteria (88% vs. 87%) but a better specificity (94% vs. 80%) for prob able AIH. The sensitivity was slightly lower (57% vs. 63%), but the specificity was greater (97% vs. 89%) for definitive AIH. The AUC was higher in the updated simplified criteria than in the simplified criteria (0.959 vs. 0.894, P = .016). Conclusion: The 2022 HC showed better sensitivity and specificity than the 2008 simplified HC for AIH. The updated simplified criteria worked well with improved accuracy of AIH diagnosis. Our results suggest that the diagnostic algorithm of AIH should be modified based on recent recommendations. Cite this article as: Moral K, Efe C, Sert A, et al. Evaluation of histological criteria and immunoserological testing of simplified criteria for the diagnosis of autoimmune hepatitis. Turk J Gastroenterol. Published online September 18, 2025. doi: 10.5152/ tjg.2025.25402.

Background/Objectives: Gastric intestinal metaplasia (GIM) is a recognized premalignant condition for gastric cancer (GC), but long-term outcomes and predictors of progression remain incompletely understood. This study aimed to evaluate the progression of GIM and identify factors associated with malignant transformation. Methods: In this retrospective single-center study, 1204 adult patients with histologically confirmed GIM and at least 12 months of follow-up after esophagogastroduodenoscopy (EGD) were analyzed. Clinical and pathological variables, including GIM extent, Helicobacter pylori status, family history of GC, demographic factors, and residence in endemic regions, were assessed. Patients were stratified into high- and low-risk groups according to established criteria, and progression to GC or other neoplasms was recorded. Results: During a mean follow-up of 38.6 months, 49.1% of patients had no detectable GIM at the end of follow-up, 48.7% remained unchanged, and 2.2% showed disease progression. Among progressed cases, adenocarcinoma accounted for 66.7%, dysplasia for 29.6%, and SCC for 3.7%. Progression was significantly more common among males, older patients, and those with antrum + corpus involvement. The overall progression rate from GIM to adenocarcinoma was 1.5% (approximately 0.45% per patient-year). No significant difference in progression or survival was observed between high- and low-risk groups. Conclusions: The long-term malignant transformation rate of GIM is low. Male sex and extensive gastric involvement were associated with higher progression rates, while H. pylori was not predictive of malignant transformation. These findings support individualized surveillance strategies for patients with GIM, while routine surveillance of antrum-limited GIM may provide minimal benefit but increase healthcare burden.

Eosinophilic cystitis (EC) is a rare, non-infectious inflammatory bladder disease that mimics malignancy and is diagnosed histopathologically. We report a 53-year-old male patient with a history of membranous nephropathy in remission, who presented with sudden onset gross hematuria and dysuria. Imaging revealed a bladder wall lesion, which was resected transurethrally. Histopathology confirmed EC. The patient was treated symptomatically and recovered without complications. No recurrence was observed during follow-up. The patient did not require corticosteroids or antibiotics and remained asymptomatic during 6 months of follow-up. This case underscores the importance of considering EC in patients with hematuria, especially those with underlying nephropathy.