Zhong Xu

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.

Background: Potassium-competitive acid blockers (P-CABs) have shown potential in Helicobacter pylori ( H. pylori ) eradication, but the efficacy of dual therapy with P-CABs and amoxicillin remains underexplored. Objectives: This study evaluated the efficacy, safety, and compliance of a 14-day vonoprazan-amoxicillin (VA) dual therapy compared to a bismuth-based quadruple therapy (BQT) in treatment-naive patients. Design: A randomized clinical trial. Methods: This single-center, prospective, randomized controlled trial enrolled 250 H. pylori -positive patients from November 2022 to April 2024. Participants were randomly assigned (1:1) to receive 14-day VA dual therapy or BQT (lansoprazole, bismuth, amoxicillin, and clarithromycin). The primary outcomes were eradication rates in intention-to-treat (ITT) and per-protocol (PP) analyses. Secondary outcomes included adverse events and treatment compliance. Results: Eradication rates in the ITT analysis were 92.0% for the VA dual group and 88.0% for the BQT group ( p = 0.292). In the PP analysis, eradication rates were 95.8% and 91.7%, respectively ( p = 0.188). The VA dual group demonstrated statistically significant non-inferiority to the BQT group in both the ITT and PP analyses (both p < 0.001). The incidence of adverse events was significantly lower in the VA dual group compared to the BQT group (11.2% vs 20.8%, p = 0.038), with no severe adverse events reported. The compliance rates of both groups were 97.6%. Conclusion: The 14-day VA dual therapy is highly effective and well-tolerated, demonstrating non-inferiority to BQT. Given its reduced antibiotic usage and lower adverse events, it may be a viable first-line alternative for H. pylori in southern China. Trial registration: This trial was registered on the Chinese Clinical Trial Registry with the registration number ChiCTR2200055752.

Background: While Internet hospitals have rapidly developed as China's dominant digital healthcare model, critical evidence gaps persist regarding operational status and challenges of their core online consultation services. This study aimed to evaluate the current status and challenges of online consultation in Internet hospitals services through large-scale multi-center business data analysis. Methods: Retrospective analysis of 594,695 online consultations (2020-2021) from 30 Internet hospitals across 11 Chinese provinces.Descriptive analyses were conducted on counselee demographics, consultant qualifications, and order informations. A novel five-category consultation classification was applied. Multivariate logistic regression identified the inflencing factors for order, while locally weighted regression (LOESS) modeled workload-response relationships. Results: There were 244,678 counselees (median age 29) and 5,781 providers (91.89% doctors) involved. Service are concentrated in pediatrics, obstetrics and gynecology (48.25%). Senior-title providers handled 43.79% consultations but showed reduced completion probability (OR=0.77). The main types of consultations were re-visit (44.89%) and first visit (34.57%). Temporal patterns revealed peak consultation hours at 10:00 (8.11%) and 16:00 (7.29%), with provider response peaks at 12:00 (5.38%), 16:00 (6.61%), and 21:00 (6.63%), averaging 3.64-hour response delays. Provided medical history (OR=2.13) could independently increase the response probability, whereas senior title (OR=0.77) could reduce such probability. Workload-response efficiency transitioned from positive (1,700 orders), with 27.69% uncompleted orders attributed to consultant factors (75.87%). Conclusions: Even with the increased momentum, the online consultation service still faces many challenges mainly including the relative absence of elderly patients with chronic diseases, personnel qualification issues, the imbalance of service supply and demand, the unfitness of order contents with official regulations, and the insufficient quality control of response rate and timeliness. Comprehensive measures should be carried out to promote the effectiveness of online consultation for better disease prevention and control.

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.

IgA vasculitis (IgAV), previously known as Henoch-Schönlein purpura, is an IgA-mediated systemic small vessel vasculitis that tends to be more severe in adults than in children. Early diagnosis of IgAV involving the gastrointestinal tract remains difficult, especially in patients who present with gastrointestinal symptoms before purpura. This study aims to systematically analyze the abdominal imaging and endoscopic features of adult patients with abdominal IgAV, providing assistance to clinicians in the early recognition of this condition. This multicenter retrospective study was conducted in three large tertiary hospitals in China from January 2017 to January 2024. A total of 108 adult patients with abdominal IgAV, who had complete abdominal imaging and/or endoscopy results, were enrolled. The clinical manifestations, abdominal imaging findings, endoscopic characteristics, and serological indicators of the patients were analyzed. The median age of the patients was 40 years (IQR: 26-55), with a male-to-female ratio of 2:1. Acute abdominal pain was the most common presenting symptom (100 patients, 92.59%). Bowel wall thickening was the most frequent finding on abdominal imaging (50/86 patients, 58.14%). Gastrointestinal endoscopy showed findings of congestion and erosion (32/67 patients, 47.76%), and erosion with ulcers (21/67 patients, 31.34%). Among patients with both imaging and endoscopic results, the duodenum (28/51 patients, 54.90%) and ileum (28/51 patients, 54.90%) were the most commonly affected sites. Laboratory findings revealed elevated white blood cell count (WBC), neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), D-dimer and fibrinogen levels, along with decreased albumin level. Comparing patients with gastrointestinal symptoms versus purpura as the initial symptom, those with gastrointestinal symptoms had higher levels of WBC (p < 0.05) and NLR (p < 0.01). The most common symptom in adult abdominal IgAV patients is acute abdominal pain. In the early stage of the disease, most patients exhibit elevated levels of WBC, NLR, CRP, D-dimer, and fibrinogen, along with decreased albumin level. The duodenum and ileum are the most commonly affected sites. By integrating these findings, clinicians can identify abdominal IgAV patients earlier and more accurately.

Background and Aim The incidence of rectal neuroendocrine tumors (R-NETs) has increased in recent years. However, the predictors of lymph node (LN) metastasis and clinical outcomes, particularly following endoscopic treatment, remain unclear. Our study aims to elucidate the potential risk factors for LN metastasis and the clinical outcomes of patients undergoing endoscopic resection in R-NETs. Methods A total of 128 patients with R-NETs were retrospectively identified from a single center between June 2012 and December 2021. Risk factors for LN metastasis in R-NETs were analyzed using multivariate analysis. Additionally, the clinical outcomes of endoscopic resections in patients with R-NETs were assessed. Results In our study, 128 patients with R-NETs were retrospectively analyzed. The risk factors for LN metastasis determined by multivariate analysis were tumor size and patient age at diagnosis. Among the 111 patients treated with endoscopic resection and with tumor margin records available, 92 underwent endoscopic submucosal dissection (ESD) and 19 underwent conventional endoscopic mucosal resection (EMR). There was no significant difference between the two groups regarding the positive rates of basal tumor margin and lateral tumor margin. Furthermore, 64 patients who underwent endoscopic resection for R-NETs were successfully followed up (range, 1.64–76.71 months), during which only one patient developed local recurrence. Conclusion Tumor size and age at diagnosis were predictors for LN metastasis of R-NETs. Both ESD and EMR are alternative techniques with a favorable prognosis for R-NETs, even in cases with positive resection margins. However, due to the relatively small number of patients undergoing EMR and missing data in follow-up protocols, definitive conclusions require further large-scale studies.

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