Turkiye Klinikleri Journal of Health Sciences

.: REVIEW
Crohn Hastalığı ve Beslenme Tedavisi
Crohn's Disease and Nutrition Therapy
Burcu ATEŞ ÖZCANa, Burcu YEŞİLKAYAa
aİstanbul Okan Üniversitesi Beslenme ve Diyetetik Bölümü, İstanbul, TÜRKİYE
Turkiye Klinikleri J Health Sci. 2020;5(2):306-12
doi: 10.5336/healthsci.2019-71838
Article Language: TR
Full Text
ÖZET
 İnflamatuar bağırsak hastalıklarından biri olan Crohn, remisyon ve alevlenme evreleri ile seyreden, etiyolojisinde çeşitli faktörlerin rol oynadığı otoimmün bir hastalıklıktır. Çevresel etmenler ile ortaya çıkan bu hastalıkta, beslenme alışkanlıklarının etkisinin önemli olduğu düşünülmektedir. Crohn hastalığında, beslenme önerilerine ait kanıt düzeyinde net sonuçlar olmasa da beslenme şekli ve alışkanlıklarının, hastalığın relapslarında etkili olduğunu gösteren çalışmalar mevcuttur. Özellikle malnütrisyon açısından risk altında olan Crohn hastalarında, tanı aldıktan sonra malnütrisyon taraması yapılmalıdır. Bu taramada, beslenme durumunun değerlendirilmesinde kalsiyum, demir, B12 vitamini, folat, çinko, magnezyum, A vitamini, albümin, prealbümin ve D vitamininin kontrol edilmesi önerilmektedir. Şiddetli ishal durumunda çinko, selenyum ve potasyumda kayıplar daha da artabilmektedir. Özellikle protein enerji malnütrisyonunun gelişmesi ve inflamasyona bağlı hipermetabolizmanın varlığı, hastaların nütrisyonel destek tedavisi almasını gerektirebilir. Enteral ya da parenteral beslenme ile sağlanacak nütrisyonel destek tedavisi malnütrisyonun tedavi edilmesi ve önlenmesinde, remisyonun sağlanmasında, akut atakların önlenmesi ve azaltılmasında etkilidir. Ayrıca yaşam kalitesinin artırılmasını destekleyici olabilmektedir. Protein ve enerji yetersizliği olan Crohn hastalarında, nütrisyonel destek tedavisine başlanılması önerilir. Remisyon dönemine geçildiğinde hasta normal diyet ile beslenebilir. Ancak bu diyet tedavisi hastaya özgü olmalıdır. Crohn hastalarının iyi bilgilendirilip eğitilmesinin, hem remisyon sürecinin uzatılmasında hem de akut atakların önlenmesi ve süresinin azaltılmasında etkili ve önemli olduğu düşünülmektedir.

Anahtar Kelimeler: Crohn hastalığı; inflamatuar bağırsak hastalığı; beslenme tedavisi
ABSTRACT
 One of the inflammatory bowel diseases, Crohn is an autoimmune disease with remission and exacerbation stages and various factors play a role in its etiology. For this disease that is caused by environmental factors, the effect of nutritional habits is thought to be important. Although there is no clear evidence for nutritional recommendations in Crohn's disease, there are studies that show the effect of nutritional patterns and habits in relapses of the disease. Especially for Crohn's patients who are at risk for malnutrition, a malnutrition screening should be taken after diagnosis. During this screening, it is recommended to check calcium, iron, vitamin B12, folate, zinc, magnesium, vitamin A, albumin, prealbumin and vitamin D in determination of nutritional status. In case of severe diarrhea, the losses of zinc, selenium and potassium may increase even further. In particular, the development of protein energy malnutrition and the presence of inflammation-induced hypermetabolism may require patients to receive nutritional support. Nutritional support treatment that is provided by enteral or parenteral nutrition is effective in the treatment, and prevention of malnutrition, achieving remission, and shortening of acute attacks. It may also support the improvement of the quality of life. Nutritional support is recommended for Crohn's patients with protein and energy deficiency. When the remission period is started, the patient can be fed with a normal diet. However, this dietary treatment should be patient-specific. Well informed and educated Crohn's patients are effective and important in both prolonging the remission process and preventing and reducing the duration of acute attacks.

Keywords: Crohn's disease; inflammatory bowel disease; nutrition therapy
REFERENCES:
  1. Sandefur K, Kahleova H, Desmond AN, Elfrink E, Barnard ND. Crohn's disease remission with a plant-based diet: a case report. Nutrients. 2019;11(6):1385. [Crossref]  [PubMed]  [PMC] 
  2. Uchiyama K, Kishi H, Komatsu W, Nagao M, Ohhira S, Kobashi G. Lipid and bile acid dysmetabolism in Crohn's disease. J Immunol Res. 2018;2018:7270486. [Crossref]  [PubMed]  [PMC] 
  3. Bozkurt N, Yıldız E. [Nutrition in digestive sys­tem diseases]. Baysal A, editör. Diyet El Kitabı. 8. Baskı. Ankara: Hatipoğlu Yayınevi; 2014. p.143-78.
  4. Cresci G, Escuro A. Medical nutrition therapy for lower gastrointestinal tract disorders. In: Mahan LK, Raymond JL, eds. Krause's Food & the Nutrition Care Process. 14th ed. Krause's food & the nutrition care process series. St. Louis, Missouri: Elsevier; 2017; p.525-59.
  5. Seven G, Savaş B, Erden A, Özden A. [Crohn's disease of the esophagus]. Akademik Gastroenteroloji Dergisi. 2009;8(1):45-8.
  6. Hovde Ø, Moum BA. Epidemiology and clinical course of Crohn's disease: results from observational studies. World J Gastroenterol. 2012;18(15):1723-31. [Crossref]  [PubMed]  [PMC] 
  7. Feuerstein JD, Cheifetz AS. Crohn diseases: epidemiology, diagnosis and management. Mayo Clin Proc. 2017;92(7):1088-103. [Crossref]  [PubMed] 
  8. Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142(1):46-54.e42; quiz e30. [Crossref]  [PubMed] 
  9. Ye Y, Pang Z, Chen W, Ju S, Zhou C. The epidemiology and risk factors of inflammatory bowel disease. Int J Clin Exp Med. 2015;8(12):22529-42. [PubMed] 
  10. Tomasello G, Mazzola M, Leone A, Sinagra E, Zummo G, Farina F, et al. Nutrition, oxidative stress and intestinal dysbiosis: influence of diet on gut microbiota in inflammatory bowel diseases. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2016;160(4):461-6. [Crossref]  [PubMed] 
  11. Kane SV, Flicker M, Katz-Nelson F. Tobacco use is associated with accelerated clinical recurrence of Crohn's disease after surgically induced remission. J Clin Gastroenterol. 2005;39(1):32-5. [PubMed] 
  12. Burisch J, Pedersen N, Cukovic-Cavka S, Turk N, Kaimakliotis I, Duricova D, et al. Environmental factors in a population-based inception cohort of inflammatory bowel disease patients in Europe--an ECCO-EpiCom study. J Crohns Colitis. 2014;8(7):607-16. [PubMed] 
  13. Geerling BJ, Dagnelie PC, Badart-Smook A, Russel MG, Stockbrügger RW, Brummer RJ. Diet as a risk factor for the development of ulcerative colitis. Am J Gastroenterol. 2000;95(4):1008-13. [Crossref]  [PubMed] 
  14. Lee JY, Zhao L, Youn HS, Weatherill AR, Tapping R, Feng L, et al. Saturated fatty acid activates but polyunsaturated fatty acid inhibits Toll-like receptor 2 dimerized with Toll-like receptor 6 or 1. J Biol Chem. 2004;279(17):16971-9. [Crossref]  [PubMed] 
  15. Devkota S, Chang EB. Interactions between diet, bile acid metabolism, gut microbiota, and inflammatory bowel diseases. Dig Dis. 2015;33(3):351-6. [Crossref]  [PubMed]  [PMC] 
  16. Bernstein CN, Shanahan F. Disorders of a modern lifestyle: reconciling the epidemiology of inflammatory bowel diseases. Gut. 2008;57(9):1185-91. [Crossref]  [PubMed] 
  17. Chiba M, Abe T, Tsuda H, Sugawara T, Tsuda S, Tozawa H, et al. Lifestyle-related disease in Crohn's disease: relapse prevention by a semi-vegetarian diet. World J Gastroenterol. 2010;16(20):2484-95. [Crossref]  [PubMed]  [PMC] 
  18. Kamada N, Seo SU, Chen GY, Nú-ez G. Role of the gut microbiota in immunity and inflammatory disease. Nat Rev Immunol. 2013;13(5):321-35. [Crossref]  [PubMed] 
  19. Ananthakrishnan AN. Epidemiology and risk factors for IBD. Nat Rev Gastroenterol Hepatol. 2015;12(4):205-17. [Crossref]  [PubMed] 
  20. Nişancı F. [Nutrition in bowel diseases]. Mercanlıgil S, Dağ A, editör. Hastalıklarda Diyet Tedavisi. 1. Baskı. İstanbul: Yelken Basım; 2013. p.130-69.
  21. Hébuterne X, Filippi J, Al-Jaouni R, Schneider S. Nutritional consequences and nutrition therapy in Crohn's disease. Gastroenterol Clin Biol. 2009;33 Suppl 3:s235-44. [Crossref]  [PubMed] 
  22. Wilkins T, Jarvis K, Patel J. Diagnosis and management of Crohn's disease. Am Fam Physician. 2011;84(12):1365-75. [PubMed] 
  23. Fatahi DA, Asmari ASA, Bukhari GA, Alshamrani HA, Hunaydi KA, Sharahili AM, et al. Crohn's disease: pathophysiology, and management. Egypt J Hosp Med. 2018;70(11):2004-7. [Crossref] 
  24. DeClercq V, Langille MGI, Limbergen JV. Differences in adiposity and diet quality among individuals with inflammatory bowel disease in Eastern Canada. Plos One. 2018;13(7):e0200580. [Crossref]  [PubMed]  [PMC] 
  25. Halling ML, Kjeldsen J, Knudsen T, Nielsen J, Hansen LK. Patients with inflammatory bowel disease have increased risk of autoimmune and inflammatory diseases. World J Gastroenterol. 2017;23(33):6137-46. [Crossref]  [PubMed]  [PMC] 
  26. Bähler C, Schoepfer AM, Vavricka SR, Brüngger B, Reich O. Chronic comorbidities associated with inflammatory bowel disease: prevalence and impact on healthcare costs in Switzerland. Eur J Gastroenterol Hepatol. 2017;29(8):916-25. [Crossref]  [PubMed] 
  27. Kostic AD, Xavier RJ, Gevers D. The microbiome in inflammatory bowel disease: current status and the future ahead. Gastroenterology. 2014;146(6):1489-99. [Crossref]  [PubMed]  [PMC] 
  28. Agus A, Denizot J, Thévenot J, Martinez-Medina M, Massier S, Sauvanet P, et al. Western diet induces a shift in microbiota composition enhancing susceptibility to adherent-invasive E. coli infection and intestinal inflammation. Sci Rep. 2016;6:19032. [Crossref]  [PubMed]  [PMC] 
  29. Crohn's & Colitis Foundation of America. Diet, nutrition, and inflammatory bowel disease. New York 2013. Available at: 26.08.2019. https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/diet-nutrition-2013.pdf
  30. Owczarek D, Rodacki T, Domagala-Rodacka R, Cibor D, Mach T. Diet and nutritional factors in inflammatory bowel diseases. World J Gastroenterol. 2016;22(3):895-905. [Crossref]  [PubMed]  [PMC] 
  31. Forbes A, Escher J, Hébuterne X, Kłek S, Krznaric Z, Schneider S, et al. ESPEN guideline: clinical nutrition in inflammatory bowel disease. Clin Nutr. 2017;36(2):321-47. [Crossref]  [PubMed] 
  32. Farrukh A, Mayberry JF. Is there a role for fish oil in inflammatory bowel disease? World J Clin Cases. 2014;2(7):250-2. [Crossref]  [PubMed]  [PMC] 
  33. Brown AC, Rampertab SD, Mullin GE. Existing dietary guidelines for Crohn's disease and ulcerative colitis. Expert Rev Gastroenterol Hepatol. 2011;5(3):411-25. [Crossref]  [PubMed] 
  34. Garcia Vilela E, De Lourdes De Abreu Ferrari M, Oswaldo Da Gama Torres H, Guerra Pinto A, Carolina Carneiro Aguirre A, Paiva Martins F, et al. Influence of Saccharomyces boulardii on the intestinal permeability of patients with Crohn's disease in remission. Scand J Gastroenterol. 2008;43(7):842-8. [Crossref]  [PubMed] 
  35. Guslandi M, Giollo P, Testoni PA. A pilot trial of Saccharomyces boulardii in ulcerative colitis. Eur J Gastroenterol Hepatol. 2003;15(6):697-8. [Crossref]  [PubMed] 
  36. Elhusseiny MH, Amine AK, Salem OE, Tayel DI, Elsayed EA. Low FODMAP diet in Egyptian patients with Crohn's disease in remission phase with functional gastrointestinal symptoms. JGH Open. 2018;2(1):15-20. [Crossref]  [PubMed]  [PMC] 
  37. Gearry RB, Irving PM, Barrett JS, Nathan DM, Shepherd SJ, Gibson PR. Reduction of dietary poorly absorbed short-chain carbohydrates (FODMAPs) improves abdominal symptoms in patients with inflammatory bowel disease-a pilot study. J Crohns Colitis. 2009;3(1):8-14. [Crossref]  [PubMed] 
  38. Halmos EP. A low FODMAP diet in patients with Crohn's disease. J Gastroenterol Hepatol. 2016;31 Suppl 1:14-5. [Crossref]  [PubMed] 
  39. Cohen AB, Lee D, Long MD, Kappelman MD, Martin CF, Sandler RS, et al. Dietary patterns and self-reported associations of diet with symptoms of inflammatory bowel disease. Dig Dis Sci. 2013;58(5):1322-8. [Crossref]  [PubMed]  [PMC] 
  40. Triggs CM, Munday K, Hu R, Fraser AG, Gearry RB, Barclay ML, et al. Dietary factors in chronic inflammation: food tolerances and intolerances of a New Zealand caucasian Crohn's disease population. Mutat Res. 2010;690(1-2):123-38. [Crossref]  [PubMed] 
  41. Donnellan CF, Yann LH, Lal S. Nutritional management of Crohn's disease. Therap Adv Gastroenterol. 2013;6(3):231-42. [Crossref]  [PubMed]  [PMC] 
  42. Charlebois A, Rosenfeld G, Bressler B. The impact of dietary interventions on the symptoms of inflammatory bowel disease: a systematic review. Crit Rev Food Sci Nutr. 2016;56(8):1370-8. [Crossref]  [PubMed] 
  43. Richman E, Rhodes JM. Review article: evidence-based dietary advice for patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2013;38(10):1156-71. [Crossref]  [PubMed] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com