Helicobacter pylori infection remains a major health issue in Asia due to its strong association with gastric ulcers and cancer. Rising antibiotic resistance has reduced the success of standard triple therapy, leading to broader use of bismuth-based quadruple regimens. However, the relative effectiveness of these regimens in Asian populations remains uncertain. To evaluate which treatment is more effective in Asian populations, this systematic review and meta-analysis assessed randomized controlled trials comparing these two regimens. A comprehensive search across four major databases (PubMed, Web of Science, The Cochrane Library, and Scopus) up to May 2024 retrieved 16,398 studies. After thorough title and abstract (TIAB) and full-text screening, nine eligible studies involving 2266 adult patients from six Asian countries were included for this analysis. The analysis showed that quadruple therapy achieved higher eradication rates than triple therapy within all nine studies, with a pooled risk ratio of 1.21 (95% CI: 1.09–1.35; p = 0.0003), indicating a 21% greater likelihood of treatment success. Although adverse effects were somewhat more frequent with quadruple therapy, adherence remained high in most trials. The overall risk of bias was low to moderate. These findings support the use of quadruple therapy as a more effective first-line option for H. pylori eradication in Asia, especially in regions where clarithromycin resistance is common. Further research should focus on optimizing regimen tolerability and incorporating local antibiotic resistance patterns to guide treatment.
幽门螺杆菌感染在亚洲仍然是一个主要的健康问题，因为它与胃溃疡和癌症密切相关。不断增加的抗生素耐药性降低了标准三联疗法的成功率，导致以铋为基础的四联疗法得到更广泛的应用。然而，这些方案在亚洲人群中的相对有效性仍不确定。为了评估哪种治疗在亚洲人群中更有效，本系统综述和荟萃分析评估了比较这两种治疗方案的随机对照试验。在四个主要数据库（PubMed, Web of Science， The Cochrane Library和Scopus）中进行全面搜索，直到2024年5月检索到16,398项研究。经过全面的标题和摘要（TIAB）和全文筛选，9项符合条件的研究纳入了来自6个亚洲国家的2266名成年患者。分析显示，在所有9项研究中，四联疗法的根除率高于三联疗法，合并风险比为1.21 (95% CI: 1.09-1.35; p = 0.0003)，表明治疗成功的可能性高出21%。虽然四联疗法的副作用更频繁，但大多数试验的依从性仍然很高。总体偏倚风险为低至中等。这些发现支持将四联疗法作为根除亚洲幽门螺杆菌的更有效的一线选择，特别是在克拉霉素耐药性普遍存在的地区。进一步的研究应侧重于优化方案耐受性，并结合局部抗生素耐药模式来指导治疗。
{"title":"Comparative Efficacy of Triple Versus Quadruple Therapy for the Eradication of Helicobacter pylori Infection in Asian Adults—A Systematic Review and Meta-Analysis","authors":"Abdur Razzak, Nymur Rahman, Nikkon Sarker, Monira Swapna Nil, Md. Arifur Rahman, Md. Toslim Mahmud","doi":"10.1002/jgh3.70292","DOIUrl":"10.1002/jgh3.70292","url":null,"abstract":"<p><i>Helicobacter pylori</i> infection remains a major health issue in Asia due to its strong association with gastric ulcers and cancer. Rising antibiotic resistance has reduced the success of standard triple therapy, leading to broader use of bismuth-based quadruple regimens. However, the relative effectiveness of these regimens in Asian populations remains uncertain. To evaluate which treatment is more effective in Asian populations, this systematic review and meta-analysis assessed randomized controlled trials comparing these two regimens. A comprehensive search across four major databases (PubMed, Web of Science, The Cochrane Library, and Scopus) up to May 2024 retrieved 16,398 studies. After thorough title and abstract (TIAB) and full-text screening, nine eligible studies involving 2266 adult patients from six Asian countries were included for this analysis. The analysis showed that quadruple therapy achieved higher eradication rates than triple therapy within all nine studies, with a pooled risk ratio of 1.21 (95% CI: 1.09–1.35; <i>p</i> = 0.0003), indicating a 21% greater likelihood of treatment success. Although adverse effects were somewhat more frequent with quadruple therapy, adherence remained high in most trials. The overall risk of bias was low to moderate. These findings support the use of quadruple therapy as a more effective first-line option for <i>H. pylori</i> eradication in Asia, especially in regions where clarithromycin resistance is common. Further research should focus on optimizing regimen tolerability and incorporating local antibiotic resistance patterns to guide treatment.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 10","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12483952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jeyamani Ramachandran, Kylie Bragg, Sumudu Narayana, Jodi Altschwager, Lindsey Moore, Ramon Pathi, Adam Koukourou, Kate Muller, Alan Wigg
The prevalence of decompensated liver cirrhosis (DC) is increasing worldwide [1]. Ascites-related readmissions are the predominant cause of hospitalizations in DC [1, 2]. Refractory ascites (RA), characterized by diuretic non-responsiveness or intolerance, is encountered in 10% of patients with cirrhosis and is associated with reduced survival without liver transplantation (LT) or trans-jugular intrahepatic portosystemic shunts (TIPSS) [3]. Large volume paracentesis (LVP) and albumin infusions are the only therapeutic options in those with RA who cannot undergo LT or TIPSS. LVPs are often required weekly or fortnightly, placing significant burden on hospital systems and often leading to unplanned hospitalizations. These recurrent admissions, with adverse impacts on patients' quality of life (QoL) and health expenditure, are potentially avoidable if ascites drainage can be regularly performed in patients' homes. Since ascites drainage in patients unsuitable for LT is a palliative procedure, it is best approached along principles of palliative care. Drainage using indwelling catheters is a well-accepted model of care in patients with malignant ascites and hydrothorax [4]. There is limited evidence supporting this procedure in cirrhotic patients with RA [5]. The aim of this study was therefore to explore the feasibility, effectiveness, safety, and acceptability of home drainage of ascites with long-term abdominal drains (LTAD) in an Australian health care setting as a management pathway for RA. The complete study protocol is included as Supporting Information, Section 1.
After obtaining informed consent, Rocket LTAD catheters (Rocket Medical, Watford, UK) were inserted by interventional radiologists. Participants underwent complete drainage with albumin replacement. They were discharged the next day with sufficient drainage kits for 4 weeks of drainage. The local community nurses' pathway was utilized for ongoing LTAD drains. Nurses were provided with instructions and a referral form regarding the frequency and amount of drainage to be done for each participant. Participants underwent drainage two to three times per week at home as guided by their abdominal discomfort. During each visit, one to two liters of ascites was drained, as per the previously published experience [5]. Antibiotic prophylaxis with norfloxacin or equivalent was given throughout the duration of LTAD being in situ. No albumin replacement was given. Whenever bacterial peritonitis (BP) was suspected, ascitic fluid was sampled via LTAD and from the abdominal wall. Emergency contact numbers for reporting any adverse events were provided.
Management of RA in DC patients without definitive options should be in line with the principles of palliative care by prioritizing symptomatic management and preserving QoL. This pilot study explored the option of LTAD in an Australian health care setting an
{"title":"Home Management of Refractory Ascites in Decompensated Cirrhosis With Long-Term Abdominal Drains, a Pilot Study","authors":"Jeyamani Ramachandran, Kylie Bragg, Sumudu Narayana, Jodi Altschwager, Lindsey Moore, Ramon Pathi, Adam Koukourou, Kate Muller, Alan Wigg","doi":"10.1002/jgh3.70228","DOIUrl":"10.1002/jgh3.70228","url":null,"abstract":"<p>The prevalence of decompensated liver cirrhosis (DC) is increasing worldwide [<span>1</span>]. Ascites-related readmissions are the predominant cause of hospitalizations in DC [<span>1, 2</span>]. Refractory ascites (RA), characterized by diuretic non-responsiveness or intolerance, is encountered in 10% of patients with cirrhosis and is associated with reduced survival without liver transplantation (LT) or trans-jugular intrahepatic portosystemic shunts (TIPSS) [<span>3</span>]. Large volume paracentesis (LVP) and albumin infusions are the only therapeutic options in those with RA who cannot undergo LT or TIPSS. LVPs are often required weekly or fortnightly, placing significant burden on hospital systems and often leading to unplanned hospitalizations. These recurrent admissions, with adverse impacts on patients' quality of life (QoL) and health expenditure, are potentially avoidable if ascites drainage can be regularly performed in patients' homes. Since ascites drainage in patients unsuitable for LT is a palliative procedure, it is best approached along principles of palliative care. Drainage using indwelling catheters is a well-accepted model of care in patients with malignant ascites and hydrothorax [<span>4</span>]. There is limited evidence supporting this procedure in cirrhotic patients with RA [<span>5</span>]. The aim of this study was therefore to explore the feasibility, effectiveness, safety, and acceptability of home drainage of ascites with long-term abdominal drains (LTAD) in an Australian health care setting as a management pathway for RA. The complete study protocol is included as Supporting Information, Section 1.</p><p>After obtaining informed consent, Rocket LTAD catheters (Rocket Medical, Watford, UK) were inserted by interventional radiologists. Participants underwent complete drainage with albumin replacement. They were discharged the next day with sufficient drainage kits for 4 weeks of drainage. The local community nurses' pathway was utilized for ongoing LTAD drains. Nurses were provided with instructions and a referral form regarding the frequency and amount of drainage to be done for each participant. Participants underwent drainage two to three times per week at home as guided by their abdominal discomfort. During each visit, one to two liters of ascites was drained, as per the previously published experience [<span>5</span>]. Antibiotic prophylaxis with norfloxacin or equivalent was given throughout the duration of LTAD being in situ. No albumin replacement was given. Whenever bacterial peritonitis (BP) was suspected, ascitic fluid was sampled via LTAD and from the abdominal wall. Emergency contact numbers for reporting any adverse events were provided.</p><p>Management of RA in DC patients without definitive options should be in line with the principles of palliative care by prioritizing symptomatic management and preserving QoL. This pilot study explored the option of LTAD in an Australian health care setting an","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 10","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12480433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Richard Lo, Ziang Ma, Lynna Chen, Abhinav Vasudevan, Ashish Srinivasan
Background
Effective communication between radiologists and clinicians is essential for optimal inflammatory bowel disease (IBD) management. Structured reporting (SR) of imaging reports may enhance interdisciplinary communication and clinical decision-making; however, its utility compared to non-structured reporting (NSR) in IBD remains unclear. This systematic review evaluated IBD clinician perceptions of SR versus NSR in IBD-related imaging.
Methods
Embase, MEDLINE, and CENTRAL were searched to January 2025 for studies comparing SR and NSR in abdominal and pelvic imaging for IBD, including magnetic resonance imaging (MRI), computed tomography (CT), and intestinal ultrasound (IUS). The primary outcome was perceived clarity and clinical utility by the referring clinician, with report completeness evaluated as a secondary outcome.
Results
Six studies met inclusion criteria, comprising 199 IBD patients and 224 scans (105 MRI, 119 CT), with a total of 550 SR/NSR report pairs evaluated by 19 clinicians. No eligible studies assessed pelvic MRI or IUS. In four of five studies, clinicians perceived SR as clearer than NSR. Similarly, SR were viewed as having greater clinical utility for assessing disease activity, identifying disease phenotype, and influencing management decisions in four studies. SR were also associated with more complete reporting based on predefined radiological criteria in three studies.
Conclusion
Clinicians generally perceived SR to provide greater clarity and clinical utility than NSR in IBD-related imaging, potentially enhancing interdisciplinary communication and clinical decision-making. Further research is needed to validate these findings and evaluate their impact on patient outcomes in routine IBD practice.
{"title":"Structured Versus Non-Structured Reporting of Inflammatory Bowel Disease Imaging: A Systematic Review","authors":"Richard Lo, Ziang Ma, Lynna Chen, Abhinav Vasudevan, Ashish Srinivasan","doi":"10.1002/jgh3.70288","DOIUrl":"10.1002/jgh3.70288","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Effective communication between radiologists and clinicians is essential for optimal inflammatory bowel disease (IBD) management. Structured reporting (SR) of imaging reports may enhance interdisciplinary communication and clinical decision-making; however, its utility compared to non-structured reporting (NSR) in IBD remains unclear. This systematic review evaluated IBD clinician perceptions of SR versus NSR in IBD-related imaging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Embase, MEDLINE, and CENTRAL were searched to January 2025 for studies comparing SR and NSR in abdominal and pelvic imaging for IBD, including magnetic resonance imaging (MRI), computed tomography (CT), and intestinal ultrasound (IUS). The primary outcome was perceived clarity and clinical utility by the referring clinician, with report completeness evaluated as a secondary outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six studies met inclusion criteria, comprising 199 IBD patients and 224 scans (105 MRI, 119 CT), with a total of 550 SR/NSR report pairs evaluated by 19 clinicians. No eligible studies assessed pelvic MRI or IUS. In four of five studies, clinicians perceived SR as clearer than NSR. Similarly, SR were viewed as having greater clinical utility for assessing disease activity, identifying disease phenotype, and influencing management decisions in four studies. SR were also associated with more complete reporting based on predefined radiological criteria in three studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Clinicians generally perceived SR to provide greater clarity and clinical utility than NSR in IBD-related imaging, potentially enhancing interdisciplinary communication and clinical decision-making. Further research is needed to validate these findings and evaluate their impact on patient outcomes in routine IBD practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 10","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thamir Alshamari, Priscilla Chong, Lau Min Yi, Diviya Pergassam, Dhanushan Gnanendran
Purpose
Primary gastrointestinal lymphoma (PGIL) is a rare cancer, with diffuse large B-cell lymphoma (DLBCL) as the most common subtype. PGIL can be acute, requiring emergency surgery, or non-acute, allowing elective management. This article evaluates the clinical presentation, treatments, and survival outcomes of PGIL by comparing emergency and elective cases.
Methods
A retrospective cohort study from January 2013 to December 2019 included patients with histologically confirmed PGIL, excluding secondary GI involvement. Survival distributions were performed using SPSS v.20 and Kaplan–Meier analysis.
Results
Among 33 patients, 54.5% were male, with a mean age of 69. The most common site of lymphoma was the small bowel (54.5%), with DLBCL being the predominant subtype (66.7%). Emergency cases comprised 57.6% of the cohort. Poorer survival was noted in emergency cases, with significant differences in survival by age (p = 0.036) and lymphoma site (p = 0.038). Surgical excision was the main diagnostic method in emergency cases (54.5%), while endoscopic biopsy was more common in elective cases (39.4%) (p < 0.001). Chemotherapy was given to 69.7%, with R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisone) (65.2%) being the most used regimen. Median survival was 17 months (interquartile range, IQR: 10–44.5). Survival differences were significant by age (p = 0.036) and lymphoma site (p = 0.038).
Conclusion
Emergency surgery is often needed for PGIL, especially with small bowel lymphomas, which have poorer outcomes. Early diagnosis and elective care may improve prognosis. Further research should explore prognostic markers and standardize treatment.
{"title":"Primary Gastrointestinal Lymphoma: A Retrospective Cohort Study on Clinical Presentation, Treatment Outcomes, and Survival Trends With a Focus on Emergency Versus Elective Management","authors":"Thamir Alshamari, Priscilla Chong, Lau Min Yi, Diviya Pergassam, Dhanushan Gnanendran","doi":"10.1002/jgh3.70283","DOIUrl":"https://doi.org/10.1002/jgh3.70283","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Primary gastrointestinal lymphoma (PGIL) is a rare cancer, with diffuse large B-cell lymphoma (DLBCL) as the most common subtype. PGIL can be acute, requiring emergency surgery, or non-acute, allowing elective management. This article evaluates the clinical presentation, treatments, and survival outcomes of PGIL by comparing emergency and elective cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study from January 2013 to December 2019 included patients with histologically confirmed PGIL, excluding secondary GI involvement. Survival distributions were performed using SPSS v.20 and Kaplan–Meier analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 33 patients, 54.5% were male, with a mean age of 69. The most common site of lymphoma was the small bowel (54.5%), with DLBCL being the predominant subtype (66.7%). Emergency cases comprised 57.6% of the cohort. Poorer survival was noted in emergency cases, with significant differences in survival by age (<i>p</i> = 0.036) and lymphoma site (<i>p</i> = 0.038). Surgical excision was the main diagnostic method in emergency cases (54.5%), while endoscopic biopsy was more common in elective cases (39.4%) (<i>p</i> < 0.001). Chemotherapy was given to 69.7%, with R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisone) (65.2%) being the most used regimen. Median survival was 17 months (interquartile range, IQR: 10–44.5). Survival differences were significant by age (<i>p</i> = 0.036) and lymphoma site (<i>p</i> = 0.038).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Emergency surgery is often needed for PGIL, especially with small bowel lymphomas, which have poorer outcomes. Early diagnosis and elective care may improve prognosis. Further research should explore prognostic markers and standardize treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 10","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70283","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145135747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muhammad Shahzad, Syeda Sundus Shah Bokhari, Fnu Rabia, Amna Zaman Khan, Muhammad Abdullah Ali, Ali Hashim, Farah Shahzad, Maryam Tariq, Zarhaish Barkat-Ullah, Malaika Rasheed, Muhammad Uzair Khan Niazi, Ali Hassan, Asfand Yar Khan, Taha Mazhar Awan, Saad Ahmed Waqas, Raheel Ahmed
Introduction
Liver cirrhosis, the fifth leading cause of adult mortality, involves progressive, irreversible liver fibrosis and loss of function. Its rising prevalence necessitates studying trends, identifying high-risk groups, and enhancing preventive strategies. This study aims to assess temporal trends and demographic disparities in liver fibrosis and cirrhosis-related mortality in the United States from 1999 to 2020.
Methods
Death certificates from the CDC WONDER(Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database for 1999–2020 were analyzed for liver fibrosis and cirrhosis-associated mortality in adults > 25 years. AAMRs per 100 000 were stratified by year, sex, race/ethnicity, and region. Joinpoint Regression (v5.3.0.0) calculated annual percent change (APC) and average APC (AAPC), identifying significant trends (p < 0.05, two-tailed t test).
Results
From 1999 to 2020, 787 375 liver cirrhosis-related deaths occurred in adults > 25. AAMR increased from 16.61 (1999) to 18.93 (2020). Men had a higher AAMR (21.51; 95% CI: 21.44 to 21.57) than women (11.73; 95% CI: 11.68 to 11.77). AAMRs were highest in Non-Hispanic (NH) American Indian (26.42; 95% CI: 25.91 to 26.93) followed by Hispanics (24.93; 95% CI: 24.77 to 25.09), NH White (16.71; 95% CI: 16.67 to 16.75), NH Black (15.13; 95% CI: 15.02 to 15.24), and NH Asian/Pacific Islander (9.29; 95% CI: 9.15 to 9.42). By region, the South had the highest AAMR (18.87; 95% CI: 18.8 to 18.93), followed by the West (15.75; 95% CI: 15.67 to 15.82), Midwest (14.55; 95% CI: 14.47 to 14.62), and Northeast (14.17; 95% CI: 14.1 to 14.25). Micropolitan (Nonmetro) areas had the highest AAMR (17.62; 95% CI: 17.49 to 17.74), while Large Fringe Metro Areas had the lowest AAMR (14.2; 95% CI: 14.13 to 14.27). Texas reported the highest AAMR (25.7); Nebraska reported the lowest (9.4).
Discussion
Liver cirrhosis-related mortality has risen since 1999, especially among Hispanic adults, men, and those in Southern or nonmetropolitan regions. Targeted prevention is needed to reduce mortality in these high-risk groups.
{"title":"Trends and Demographics of Liver Fibrosis and Cirrhosis-Related Mortality Among Adults Living in the United States From 1999 to 2020: A CDC Wonder Analysis","authors":"Muhammad Shahzad, Syeda Sundus Shah Bokhari, Fnu Rabia, Amna Zaman Khan, Muhammad Abdullah Ali, Ali Hashim, Farah Shahzad, Maryam Tariq, Zarhaish Barkat-Ullah, Malaika Rasheed, Muhammad Uzair Khan Niazi, Ali Hassan, Asfand Yar Khan, Taha Mazhar Awan, Saad Ahmed Waqas, Raheel Ahmed","doi":"10.1002/jgh3.70247","DOIUrl":"https://doi.org/10.1002/jgh3.70247","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Liver cirrhosis, the fifth leading cause of adult mortality, involves progressive, irreversible liver fibrosis and loss of function. Its rising prevalence necessitates studying trends, identifying high-risk groups, and enhancing preventive strategies. This study aims to assess temporal trends and demographic disparities in liver fibrosis and cirrhosis-related mortality in the United States from 1999 to 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Death certificates from the CDC WONDER(Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database for 1999–2020 were analyzed for liver fibrosis and cirrhosis-associated mortality in adults > 25 years. AAMRs per 100 000 were stratified by year, sex, race/ethnicity, and region. Joinpoint Regression (v5.3.0.0) calculated annual percent change (APC) and average APC (AAPC), identifying significant trends (<i>p</i> < 0.05, two-tailed <i>t</i> test).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 1999 to 2020, 787 375 liver cirrhosis-related deaths occurred in adults > 25. AAMR increased from 16.61 (1999) to 18.93 (2020). Men had a higher AAMR (21.51; 95% CI: 21.44 to 21.57) than women (11.73; 95% CI: 11.68 to 11.77). AAMRs were highest in Non-Hispanic (NH) American Indian (26.42; 95% CI: 25.91 to 26.93) followed by Hispanics (24.93; 95% CI: 24.77 to 25.09), NH White (16.71; 95% CI: 16.67 to 16.75), NH Black (15.13; 95% CI: 15.02 to 15.24), and NH Asian/Pacific Islander (9.29; 95% CI: 9.15 to 9.42). By region, the South had the highest AAMR (18.87; 95% CI: 18.8 to 18.93), followed by the West (15.75; 95% CI: 15.67 to 15.82), Midwest (14.55; 95% CI: 14.47 to 14.62), and Northeast (14.17; 95% CI: 14.1 to 14.25). Micropolitan (Nonmetro) areas had the highest AAMR (17.62; 95% CI: 17.49 to 17.74), while Large Fringe Metro Areas had the lowest AAMR (14.2; 95% CI: 14.13 to 14.27). Texas reported the highest AAMR (25.7); Nebraska reported the lowest (9.4).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Liver cirrhosis-related mortality has risen since 1999, especially among Hispanic adults, men, and those in Southern or nonmetropolitan regions. Targeted prevention is needed to reduce mortality in these high-risk groups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 10","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70247","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145146890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Esophageal carcinosarcoma is a rare type of esophageal cancer with a characteristic sausage shape that is often detected at an early stage; therefore, the depth of invasion is often submucosal. However, many cases of esophageal carcinosarcoma demonstrate lymphatic metastases, which require surgery.
Case
We describe the case of a 46-year-old female patient who underwent upper gastrointestinal endoscopy that revealed a tumor shadow in the middle thoracic esophagus. The patient did not have symptoms such as dysphagia or chest pain. Subsequent upper gastrointestinal endoscopy with ultrasound and endoscopic submucosal dissection revealed carcinoma and sarcoma components that allowed the diagnosis of esophageal carcinosarcoma. Lymph node metastases and distant metastases were not observed.
Discussion
Tumor resection of the center and base of the protruding lesion with a wide margin allows an early and correct diagnosis of typical and atypical esophageal carcinosarcoma cases. Tumor resection with a wide margin can predict metastasis.
Conclusions
This rare case was correctly diagnosed during an early and asymptomatic stage.
{"title":"Asymptomatic Esophageal Carcinosarcoma Diagnosed Based on Endoscopic Submucosal Dissection Results: A Case Report","authors":"Nobuhiro Tsukamoto, Kazuya Miyaguchi, Hisashi Matsumoto, Rie Shiomi, Yoshikazu Tsuzuki, Hiromichi Iwashita, Mei Hamada, Yoko Tateishi, Hiroyuki Imaeda","doi":"10.1002/jgh3.70238","DOIUrl":"https://doi.org/10.1002/jgh3.70238","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Esophageal carcinosarcoma is a rare type of esophageal cancer with a characteristic sausage shape that is often detected at an early stage; therefore, the depth of invasion is often submucosal. However, many cases of esophageal carcinosarcoma demonstrate lymphatic metastases, which require surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case</h3>\u0000 \u0000 <p>We describe the case of a 46-year-old female patient who underwent upper gastrointestinal endoscopy that revealed a tumor shadow in the middle thoracic esophagus. The patient did not have symptoms such as dysphagia or chest pain. Subsequent upper gastrointestinal endoscopy with ultrasound and endoscopic submucosal dissection revealed carcinoma and sarcoma components that allowed the diagnosis of esophageal carcinosarcoma. Lymph node metastases and distant metastases were not observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Tumor resection of the center and base of the protruding lesion with a wide margin allows an early and correct diagnosis of typical and atypical esophageal carcinosarcoma cases. Tumor resection with a wide margin can predict metastasis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This rare case was correctly diagnosed during an early and asymptomatic stage.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 9","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70238","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145146752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Critically ill cirrhotics (CIC) pose a management challenge due to severe metabolic and renal impairment. The ideal timing of initiation of dialysis in acute kidney injury (AKI) in CIC is not known. We aimed to compare the safety and efficacy of early (ED) versus late (LD) initiation of sustained low-efficiency dialysis (SLED) in CIC.
Methods
CIC were randomized to ED (SLED initiated within 6–12 h) or the LD (where SLED was performed when the patient met absolute criteria) group.
Results
Fifty CIC (aged 45.2 ± 10 years), 90% males, 87% alcohol-related, 72% with pneumonia admitted to liver ICU were randomized to ED or LD group. Baseline lactate (mg/dL) (2.7 ± 1.8 vs. 3.3 ± 2.1) and SOFA scores (12.9 ± 2.1 vs. 13.7 ± 4.0) were comparable. Median time to dialysis (in hours) was 7 (IQR 6–8) in ED and 24 (18–48) in LD group. Mortality at 28 days (56% vs. 76%; p = 0.14) was similar. A significantly lower incidence of intradialytic hypotension (IDH) (12% vs. 48%; p = 0.005), and better urea reduction (75% vs. 41%, p = 0.019), reversal of shock (60% vs. 16%; p = 0.001), renal functions (68% vs. 12%; p < 0.001), and lower early deaths at Day 7 were noted in the ED (20% vs. 52%; p = 0.038).
Conclusions
Timely initiation of dialysis could avert the development or progression of metabolic complications, decrease the incidence of IDH and early deaths in CIC. A higher frequency of recovery of renal functions and reduced AKI-related mortality could be achieved by timely dialysis in CICs.
Trial Registration: NCT02937961
背景和目的危重症肝硬化（CIC）由于严重的代谢和肾脏损害，给治疗带来了挑战。CIC急性肾损伤（AKI）患者开始透析的理想时机尚不清楚。我们的目的是比较CIC患者早期（ED）和晚期（LD）开始持续低效率透析（SLED）的安全性和有效性。方法将CIC随机分为ED组（6-12 h内启动SLED）和LD组（当患者达到绝对标准时进行SLED）。结果50例CIC患者（年龄45.2±10岁），男性90%，酒精相关87%，合并肺炎72%，随机分为ED组和LD组。基线乳酸（mg/dL）（2.7±1.8 vs. 3.3±2.1）和SOFA评分（12.9±2.1 vs. 13.7±4.0）具有可比性。ED组透析的中位时间（单位小时）为7 (IQR 6-8)， LD组为24（18-48）。28天死亡率（56% vs. 76%; p = 0.14）相似。ED的发生率显著降低（12%对48%，p = 0.005），尿素减少（75%对41%，p = 0.019），休克逆转（60%对16%，p = 0.001），肾功能（68%对12%，p < 0.001），以及第7天早期死亡（20%对52%，p = 0.038）。结论及时开始透析可避免代谢并发症的发生或进展，降低CIC患者IDH的发生率和早期死亡。CICs患者通过及时透析可获得更高的肾功能恢复频率和降低aki相关死亡率。试验注册：NCT02937961
{"title":"Early Versus Late Dialysis in Cirrhosis Patients and Septic Shock (ELDICS Study): A Randomized Controlled Trial (NCT02937961)","authors":"Rakhi Maiwall, Samba Siva Rao Pasupuleti, Prashant Agarwal, Sherin Thomas, Harsh Vardhan Tevethia, Rajendra Prasad Mathur, Shiv Kumar Sarin","doi":"10.1002/jgh3.70216","DOIUrl":"https://doi.org/10.1002/jgh3.70216","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Critically ill cirrhotics (CIC) pose a management challenge due to severe metabolic and renal impairment. The ideal timing of initiation of dialysis in acute kidney injury (AKI) in CIC is not known. We aimed to compare the safety and efficacy of early (ED) versus late (LD) initiation of sustained low-efficiency dialysis (SLED) in CIC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>CIC were randomized to ED (SLED initiated within 6–12 h) or the LD (where SLED was performed when the patient met absolute criteria) group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty CIC (aged 45.2 ± 10 years), 90% males, 87% alcohol-related, 72% with pneumonia admitted to liver ICU were randomized to ED or LD group. Baseline lactate (mg/dL) (2.7 ± 1.8 vs. 3.3 ± 2.1) and SOFA scores (12.9 ± 2.1 vs. 13.7 ± 4.0) were comparable. Median time to dialysis (in hours) was 7 (IQR 6–8) in ED and 24 (18–48) in LD group. Mortality at 28 days (56% vs. 76%; <i>p</i> = 0.14) was similar. A significantly lower incidence of intradialytic hypotension (IDH) (12% vs. 48%; <i>p</i> = 0.005), and better urea reduction (75% vs. 41%, <i>p</i> = 0.019), reversal of shock (60% vs. 16%; <i>p</i> = 0.001), renal functions (68% vs. 12%; <i>p</i> < 0.001), and lower early deaths at Day 7 were noted in the ED (20% vs. 52%; <i>p</i> = 0.038).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Timely initiation of dialysis could avert the development or progression of metabolic complications, decrease the incidence of IDH and early deaths in CIC. A higher frequency of recovery of renal functions and reduced AKI-related mortality could be achieved by timely dialysis in CICs.</p>\u0000 \u0000 <p><b>Trial Registration:</b> NCT02937961</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 9","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70216","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145146366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carbon-ion radiation therapy (CIRT) is a promising technological innovation for treating hepatocellular carcinoma (HCC). This study aimed to evaluate the effectiveness and safety of CIRT for primary, solitary, potentially resectable HCC in comparison to liver resection (LR).
Methods and Results
We retrospectively compared treatment effectiveness and safety between patients treated with CIRT and those who underwent LR for potentially resectable HCC at our institution. The clinical data for the CIRT group were obtained from a prospective observational study carried out at our institution, and additional information was obtained from clinical records. Their data were compared with those of patients who underwent LR during the same period. Twenty-three patients were included in the CIRT group and 41 in the LR group. In the overall cohort, the respective 3-and 5-year overall survival (OS) rates were 86.5% and 65.9% for the CIRT group and 90.2% and 79.7% for the LR group. The OS rates did not significantly differ between the two groups in the propensity score-matched cohort. The 3- and 5-year local control rates after CIRT were 77.0% and 77.0%, respectively. CIRT was associated with elevated albumin-bilirubin (ALBI) scores 3 and 6 months after treatment.
Conclusion
CIRT for primary, solitary, potentially resectable HCC was associated with favorable clinical outcomes and satisfactory safety, with an acceptable elevation of the ALBI score. CIRT might achieve a favorable OS comparable to LR for potentially resectable HCC; however, further large-scale, prospective studies are needed for confirmation.
{"title":"Carbon-Ion Radiation Therapy Compared to Surgical Resection for Primary, Solitary, Potentially Resectable Hepatocellular Carcinoma","authors":"Soichiro Morinaga, Shinnosuke Kawahara, Rei Kanemoto, Naohiko Matsushita, Yuto Kamioka, Mariko Kamiya, Masaaki Murakawa, Taito Fukushima, Satoshi Kobayashi, Makoto Ueno, Hiroyuki Kato, Naoto Yamamoto","doi":"10.1002/jgh3.70256","DOIUrl":"10.1002/jgh3.70256","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Carbon-ion radiation therapy (CIRT) is a promising technological innovation for treating hepatocellular carcinoma (HCC). This study aimed to evaluate the effectiveness and safety of CIRT for primary, solitary, potentially resectable HCC in comparison to liver resection (LR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>We retrospectively compared treatment effectiveness and safety between patients treated with CIRT and those who underwent LR for potentially resectable HCC at our institution. The clinical data for the CIRT group were obtained from a prospective observational study carried out at our institution, and additional information was obtained from clinical records. Their data were compared with those of patients who underwent LR during the same period. Twenty-three patients were included in the CIRT group and 41 in the LR group. In the overall cohort, the respective 3-and 5-year overall survival (OS) rates were 86.5% and 65.9% for the CIRT group and 90.2% and 79.7% for the LR group. The OS rates did not significantly differ between the two groups in the propensity score-matched cohort. The 3- and 5-year local control rates after CIRT were 77.0% and 77.0%, respectively. CIRT was associated with elevated albumin-bilirubin (ALBI) scores 3 and 6 months after treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CIRT for primary, solitary, potentially resectable HCC was associated with favorable clinical outcomes and satisfactory safety, with an acceptable elevation of the ALBI score. CIRT might achieve a favorable OS comparable to LR for potentially resectable HCC; however, further large-scale, prospective studies are needed for confirmation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 9","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12455018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gastric neuroendocrine neoplasms are a rare type of stomach cancer, classified into well-differentiated neuroendocrine tumors (NETs) and poorly differentiated neuroendocrine carcinomas (NECs). Gastric NETs (G-NETs) originate from endocrine progenitor cells in the basal layer of the mucosa, primarily in the setting of chronic atrophic gastritis, such as autoimmune gastritis. They generally exhibit low malignancy and a favorable prognosis. By contrast, gastric NECs (G-NECs), a rare subtype of gastric cancers, arise from endocrine precursor cell clones that dedifferentiate in the deep portion of pre-existing differentiated-type adenocarcinomas. G-NECs are characterized by rapid growth, frequent lymphovascular invasion, high metastatic potential, and aggressive biological behavior. Most G-NEC cases are therefore diagnosed at advanced stages, often with lymph node or distant metastases, leading to a poorer prognosis than gastric adenocarcinomas. Furthermore, endoscopic diagnosis of G-NECs remains challenging because of the low sensitivity of biopsy-based techniques. While it is well established that G-NETs and G-NECs have distinct clinicopathological characteristics, information on their endoscopic features, particularly those observed with magnifying narrow-band imaging, remains limited. This review aims to summarize the characteristic endoscopic findings of G-NETs and G-NECs in relation to their clinicopathological findings.
{"title":"Differences in Endoscopic Features of Gastric Neuroendocrine Tumor and Neuroendocrine Carcinoma From a Clinicopathological Perspective","authors":"Katsunori Matsueda, Noriya Uedo, Masanori Kitamura, Seiji Kawano, Motoyuki Otsuka","doi":"10.1002/jgh3.70272","DOIUrl":"10.1002/jgh3.70272","url":null,"abstract":"<p>Gastric neuroendocrine neoplasms are a rare type of stomach cancer, classified into well-differentiated neuroendocrine tumors (NETs) and poorly differentiated neuroendocrine carcinomas (NECs). Gastric NETs (G-NETs) originate from endocrine progenitor cells in the basal layer of the mucosa, primarily in the setting of chronic atrophic gastritis, such as autoimmune gastritis. They generally exhibit low malignancy and a favorable prognosis. By contrast, gastric NECs (G-NECs), a rare subtype of gastric cancers, arise from endocrine precursor cell clones that dedifferentiate in the deep portion of pre-existing differentiated-type adenocarcinomas. G-NECs are characterized by rapid growth, frequent lymphovascular invasion, high metastatic potential, and aggressive biological behavior. Most G-NEC cases are therefore diagnosed at advanced stages, often with lymph node or distant metastases, leading to a poorer prognosis than gastric adenocarcinomas. Furthermore, endoscopic diagnosis of G-NECs remains challenging because of the low sensitivity of biopsy-based techniques. While it is well established that G-NETs and G-NECs have distinct clinicopathological characteristics, information on their endoscopic features, particularly those observed with magnifying narrow-band imaging, remains limited. This review aims to summarize the characteristic endoscopic findings of G-NETs and G-NECs in relation to their clinicopathological findings.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 9","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12455147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mitsushige Sugimoto, Takeshi Matsuhisa, Hafeza Aftab, Sirikan Limpakan, Sunil K. Sharma Dhakal, Kim Sang, Kyaw Htet, Than Than Yee, Yoshio Yamaoka
Background and Aim
Helicobacter pylori infection rates and severity and susceptibility to gastric diseases vary widely in different populations because of different H. pylori strains, lifestyles, and genetic factors. South and Southeast Asia is a region where many ethnic groups are intermingled, and H. pylori strains have been shifting from Western-type to East Asian-type strains. We aimed to investigate the different endoscopic and histopathologic features in five South and Southeast Asian countries.
Methods
We examined differences in endoscopic and histopathological gastritis and H. pylori infection status in 2426 patients from South and Southeast Asian populations in Vietnam, Thailand, Myanmar, Bangladesh, and Nepal.
Results
Among Asian patients with abdominal symptoms, such as epigastric pain, nausea, abdominal discomfort, constipation, and heartburn, the prevalence of gastric disease, H. pylori infection status (current, past, and non-infection), and severity of histopathological gastritis significantly differed between countries. Less than 10% of patients had atrophy and intestinal metaplasia, irrespective of country and H. pylori infection status; their severity when present was also mild. Although patients with gastric cancer had higher rates of atrophy and intestinal metaplasia compared with those with other diseases, half of them had no pathological atrophy or intestinal metaplasia.
Conclusions
Gastric condition and susceptibility to gastric disease differed among South and Southeast Asian populations. H. pylori infection rates remain high in Asian countries, but the frequency and severity of atrophy and gastric mucosal atrophy were low.
{"title":"Characteristics of Gastric Endoscopic and Histopathological Findings in the South and Southeast Asian Populations","authors":"Mitsushige Sugimoto, Takeshi Matsuhisa, Hafeza Aftab, Sirikan Limpakan, Sunil K. Sharma Dhakal, Kim Sang, Kyaw Htet, Than Than Yee, Yoshio Yamaoka","doi":"10.1002/jgh3.70242","DOIUrl":"https://doi.org/10.1002/jgh3.70242","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p><i>Helicobacter pylori</i> infection rates and severity and susceptibility to gastric diseases vary widely in different populations because of different <i>H. pylori</i> strains, lifestyles, and genetic factors. South and Southeast Asia is a region where many ethnic groups are intermingled, and <i>H. pylori</i> strains have been shifting from Western-type to East Asian-type strains. We aimed to investigate the different endoscopic and histopathologic features in five South and Southeast Asian countries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We examined differences in endoscopic and histopathological gastritis and <i>H. pylori</i> infection status in 2426 patients from South and Southeast Asian populations in Vietnam, Thailand, Myanmar, Bangladesh, and Nepal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among Asian patients with abdominal symptoms, such as epigastric pain, nausea, abdominal discomfort, constipation, and heartburn, the prevalence of gastric disease, <i>H. pylori</i> infection status (current, past, and non-infection), and severity of histopathological gastritis significantly differed between countries. Less than 10% of patients had atrophy and intestinal metaplasia, irrespective of country and <i>H. pylori</i> infection status; their severity when present was also mild. Although patients with gastric cancer had higher rates of atrophy and intestinal metaplasia compared with those with other diseases, half of them had no pathological atrophy or intestinal metaplasia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Gastric condition and susceptibility to gastric disease differed among South and Southeast Asian populations. <i>H. pylori</i> infection rates remain high in Asian countries, but the frequency and severity of atrophy and gastric mucosal atrophy were low.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 9","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70242","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145110961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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