Jin-Yan Zhang

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global health burden. Identifying robust prognostic biomarkers is crucial for

Background: Vonoprazan (VPZ), a potassium‐competitive acid blocker, has shown promising efficacy in Helicobacter pylori ( H. pylori ) eradication. However, direct comparisons of VPZ‐based dual therapy (V‐DT), triple therapy (V‐TT), and bismuth quadruple therapy (V‐BQT) remain limited. This study aimed to evaluate and compare the efficacy, safety, and compliance of these three regimens as first‐line treatments for H. pylori infection. Methods: 375 adults were randomized (1:1:1) to receive V‐DT (VPZ 20 mg bid + amoxicillin 1 g tid for 10 days), V‐TT (VPZ 20 mg bid + amoxicillin 1 g bid + clarithromycin 500 mg bid for 14 days), or V‐BQT (VPZ 20 mg bid + amoxicillin 1 g bid + clarithromycin 500 mg bid + bismuth 240 mg bid for 10 days). The primary outcome was H. pylori eradication rate by intention‐to‐treat (ITT), modified ITT (mITT), and per‐protocol (PP) analyses. Secondary outcomes included adverse events and compliance. Results: Eradication rates were 92.0% (95% confidence interval [CI]: 85.8%–96.1%), 89.6% (95% CI: 82.9%–94.3%), and 88.8% (95% CI: 81.9%–93.7%) in ITT; 94.3% (95% CI: 88.5%–97.7%), 94.9% (95% CI: 89.3%–98.1%), and 94.1% (95% CI: 88.2%–97.6%) in mITT; and 94.2% (95% CI: 88.4%–97.6%), 95.6% (95% CI: 90.0%–98.5%), and 94.8% (95% CI: 89.0%–98.1%) in PP analyses for V‐DT, V‐TT, and V‐BQT, respectively. The efficacy of V‐DT and V‐TT was noninferior to that of V‐BQT. Adverse events were significantly lower with V‐DT (6.4%) than with V‐TT (36.0%) and V‐BQT (49.6%) ( p < 0.001). Compliance exceeded 93% in all groups, with no significant differences ( p = 0.250). Conclusions: All three regimens achieved high eradication rates, with V‐DT and V‐TT being statistically noninferior to V‐BQT. The 10‐day V‐DT regimen achieved eradication rates comparable to V‐BQT with substantially fewer adverse events and reduced antibiotic use, supporting its potential as a simplified first‐line option for H. pylori eradication. Trial Registration: Chinese Clinical Trial Registration Number: ChiCTR2300072857

Hypertension affects over one billion adults worldwide, including approximately 116 million in the USA, and remains a leading contributor to global morbidity and mortality [1]. As a major risk factor for cardiovascular disease (CVD) events such as coronary heart disease, heart failure, and stroke, it is responsible for nearly 10 million deaths annually and accounts […]

Elevated albumin-corrected anion gap (ACAG) has been linked to increased mortality across various patient populations, but its prognostic value in the general population remains unclear. This study examined the association between ACAG and all-cause, cardiovascular disease (CVD), and cancer mortality among US adults. Data from 40,702 adults aged ≥ 20 years were analyzed from the National Health and Nutrition Examination Survey 1999–2018. ACAG was calculated as: anion gap + (4.4 − serum albumin [g/dL]) × 2.5. Cox proportional hazards models, restricted cubic splines, and Kaplan–Meier curves were used to assess associations. Subgroup and sensitivity analyses were conducted. Over a median 113 month follow-up, 6,087 deaths occurred, including 1,601 from CVD and 1,372 from cancer. Each 1-unit increase in ACAG was associated with higher risk of all-cause (HR = 1.08, 95% CI: 1.06–1.10), CVD (HR = 1.08, 95% CI: 1.05–1.12), and cancer mortality (HR = 1.06, 95% CI: 1.03–1.09). Participants in the highest ACAG quartile had significantly higher mortality risks compared to the lowest quartile. No evident nonlinear associations were observed for all-cause, CVD, and cancer mortality. The positive association with all-cause mortality was more pronounced among participants aged < 60 years, males, current smokers, and those with hyperlipidemia or diabetes. Sensitivity analyses confirmed robustness. Elevated ACAG is independently associated with increased risks of all-cause, CVD, and cancer mortality in US adults. ACAG has potential value in stratifying mortality risk in public health contexts.

Gastrointestinal cancers account for 39.0% of global cancer-related deaths. The rising incidence of early-onset gastrointestinal cancers poses a substantial public health challenge due to their aggressive nature and poor prognosis. Using the Global Burden of Disease (GBD) 2021 database, we analyzed temporal trends (1990-2021) in age-standardized incidence (ASIR), mortality (ASMR), and disability-adjusted life years (ASDR) rates for early-onset gastrointestinal cancers among individuals aged 15-49 years. Analyses included burden by age, sex, region, and socio-demographic index (SDI). Joinpoint regression estimated average annual percentage changes (AAPC), and future trends (2022-2036) were projected using the Bayesian Age-Period-Cohort model. In 2021, there were 499,800 new cases of early-onset gastrointestinal cancers globally. Colorectal and stomach cancers were most prevalent. From 1990-2021, ASIR increased only for colorectal cancer (AAPC: 0.37, 95%CI: 0.24-0.50), while declines occurred in esophageal, stomach, liver, pancreatic, and gallbladder/biliary tract cancers. Males bore a higher burden except for gallbladder/biliary tract cancer. Significant disparities existed across regions, genders, and SDI levels. Smoking and high body-mass index were leading risk factors. Projections indicate rising ASIRs for early-onset colorectal and esophageal cancers, stable liver cancer incidence, and diminishing incidence, mortality, and DALYs rates for stomach, pancreatic, and gallbladder and biliary tract cancers. Early-onset gastrointestinal cancers represent a substantial and evolving global burden, with notable variations by cancer type, age, sex, region, and SDI. Targeted prevention and healthcare strategies are urgently needed to address modifiable risk factors and reduce disparities.

Yue Chen, Juan Yu, Jin-Yan Zhang, Xue-Qin Chen, Wei-Feng Huang. Gut and Liver -0001;0:. https://doi.org/10.5009/gnl250261

Although endoscopic resection (ER) is an established technique for gastric subepithelial tumours (SETs), comprehensive data on its efficacy and safety remain limited. This study aimed to evaluate the efficacy and safety of ER in patients with gastric SETs and to identify risk factors associated with procedure-related complications. This retrospective study included 483 patients who underwent ER for gastric SETs between February 2012 and May 2023. Patient demographics, tumour characteristics, and clinical outcomes were evaluated. Multivariate analysis was performed to identify risk factors for complications. The median tumour size was 1.2 cm (range: 0.5–6.0 cm). The complete resection rate was 93.8%. Complications occurred in 6.8% of cases, including perioperative bleeding (2.1%), perforation (1.7%), and both (0.4%), with 0.8% of cases requiring conversion to surgery. Larger tumours notably increased the risks of incomplete resection (odds ratio [OR] = 1.605, 95% confidence interval [CI]: 1.066–2.416, p = 0.023), perioperative bleeding (OR = 2.004, 95% CI: 1.099–3.653, p = 0.023), and perforation (OR = 3.476, 95% CI: 1.830–6.602, p < 0.001). Additionally, an irregular tumour shape significantly elevated the risk of incomplete resection (OR = 10.771, 95% CI: 3.452–33.605, p < 0.001). Conversely, tumours located in the middle third (OR = 0.068, 95% CI: 0.014–0.341, p = 0.001) and the upper third (OR = 0.211, 95% CI: 0.051–0.884, p = 0.033) of the stomach substantially reduced the risk of incomplete resection. ER is an effective and generally safe treatment modality for managing gastric SETs. However, larger tumour size and irregular shape are significant risk factors for adverse outcomes.

Autoimmune gastritis (AIG) is an immune-mediated chronic atrophic gastritis. This study aimed to investigate the clinical characteristics of AIG patients, stratified by age, sex, and the presence/absence of autoimmune thyroid disease (AITD). We reviewed the data of AIG patients treated at a large academic tertiary teaching hospital from January 2018 to October 2023. Patients were grouped according to age (≥60 years or younger), sex, and the presence/absence of AITD and the clinical characteristics of the groups were analyzed. This study included 183 AIG patients. Older patients (≥60 years) had higher rates of pernicious anemia (26.7% vs 11.8%) and intrinsic factor antibodies (36.8% vs 20.9%) than younger patients (<60 years). However, no significant differences were observed in the extent of gastric atrophy, sex ratio, or serum gastrin levels between the age groups. Female patients were more prone than males to exhibit enterochromaffin-like cell hyperplasia (69.4% vs 39.2%) and had a higher prevalence of iron deficiency anemia (IDA) (25.0% vs 0.0%, p=0.004). AIG patients with AITD were younger (50.9±12.0 years vs 58.0±11.5 years), were more likely to be females (p=0.023), and exhibited milder gastric body atrophy (p=0.009) than those without AITD. AIG patients demonstrate age- and sex-related differences in clinical characteristics. Older patients are more likely to have intrinsic factor antibody positivity and pernicious anemia, while women are more prone to IDA. There is a high comorbidity rate between AITD and AIG, and patients with AITD-associated AIG are typically younger and tend to have milder gastric body atrophy.

Evidence concerning the effect of cardiovascular health (CVH) on the risk of metabolic dysfunctional-associated steatotic liver disease (MASLD) is scarce. This study aimed to investigate the association between CVH and MASLD. 5680 adults aged ≥ 20 years from the National Health and Nutrition Examination Survey 2017-March 2020 were included. Life’s essential 8 (LE8) was applied to assess CVH. Weighted binary logistic regression was employed to calculate the odds ratio (OR) and 95% confidence interval (CI) to investigate the association of CVH with MASLD. Restricted cubic spline (RCS) was conducted to explore the dose-response association between LE8 and its subscales scores with MASLD. Among 5680 participants, 724, 3901, and 1055 had low, moderate, and high CVH levels, respectively, with a MASLD diagnosis prevalence of 36.83%. In the fully adjusted logistic regression model, ORs for MASLD were 0.50 (95% CI, 0.37–0.69) for participants with moderate CVH and 0.21 (95% CI, 0.13–0.34) for those with high CVH, when compared to those with low CVH (P < 0.001 for trend). OR for MASLD was 0.68 (95% CI, 0.61–0.77) for each 10-point increase in LE8 score. RCS model demonstrated a non-linear dose-response relationship between LE8 score and health factors score with MASLD, while a linear relationship was found between health behaviors score and MASLD. Subgroup analysis showed a consistent negative correlation between LE8 score and MASLD, and sensitivity analysis validated the reliability of these findings. Higher LE8 score was associated with a lower risk of MASLD. Encouraging adherence to optimal CVH levels may help mitigate the burden of MASLD.