Gastroesophageal reflux disease(GERD)is a chronic recurrent disorder characterized by typical symptoms such as acid regurgitation and heartburn.Its high recurrence rate and long-term complications not only significantly impact patients' quality of life but also impose a heavy healthcare burden.Traditional proton pump inhibitors(PPIs),as first-line therapeutic agents,are often inadequate for long-term maintenance therapy of GERD due to shortcomings such as short half-life,susceptible to genetic polymorphisms,and nocturnal acid breakthrough.Recently,the potassium-competitive acid blocker(P-CAB)vonoprazan has demonstrated advantages increasingly in the maintenance therapy of GERD.This article reviewed the research progress on vonoprazan in the maintenance therapy of GERD,aiming to provide a reference for optimizing the long-term management of GERD.

Gastric cancer is one of the most common malignant tumors of the digestive tract worldwide,and its early diagnosis and treatment have always been the focus of clinical research.In recent years,the rapid progress and wide application of proteomics technology have opened up a new perspective for the early screening,diagnosis,prognosis assessment,and mechanism exploration of gastric cancer.With the rapid development of bioinformatics,a series of innovative methods and cutting-edge results based on proteomics related to gastric cancer have emerged.This article reviewed the application progress of proteomics in gastric cancer from three dimensions:experimental techniques,analysis strategies,and major achievements,and discussed the challenges and opportunities in this field.In the future,with the integration of technologies and the deepening of interdisciplinary research,proteomics of gastric cancer is expected to make more breakthroughs,achieve clinical transformation,and provide more precise diagnosis and treatment plans for patients.

The risk and incidence of malnutrition among patients with inflammatory bowel disease(IBD)are significantly higher than those in the general population,which affect the therapeutic efficacy and prognosis of patients.Clinical nutrition plays an important role in the treatment of IBD,and with the fact that there have been many studies on the clinical practice of nutrition therapy in IBD both domestically and abroad in recent years,it is necessary to update the expert consensus on nutrition therapy for IBD and provide the latest guidance for clinical practice.This consensus is drafted and revised by experts from Inflammatory Bowel Disease Group of Chinese Society of Gastroenterology,Gastroenterology and Nutrition Cooperative Group of Chinese Society of Parenteral and Enteral Nutrition,and Nutrition Support and Treatment Collaboration Group of Chinese Society of Gastroenterology,Chinese Medical Association.It combines both expert consensus abroad and Chinese expert consensus on nutrition support therapy in inflammatory bowel disease(the second edition),aiming to reflect the latest concepts and research progress,and provide standardized guidance for nutrition therapy of IBD.In order to be consistent with the professional terminology adopted by international authoritative nutrition academic organizations,especially considering the unique role of clinical nutrition in the treatment of IBD,this consensus is hereby renamed as Expert consensus on nutrition therapy for inflammatory bowel disease.

Refractory celiac disease(RCD)is a rare yet life-threatening form of celiac disease(CeD)that severely impacts patients' quality of life and poses significant therapeutic challenges.Based on the clonality of intraepithelial lymphocytes(IELs),RCD is classified into two subtypes:typeⅠRCD(RCDⅠ),characterized by polyclonal IELs infiltration,and type Ⅱ RCD(RCDⅡ),defined by monoclonal T-cell proliferation.RCDⅡ demonstrates significantly worse prognosis than RCDⅠ due to its association with monoclonal T-cell proliferation and high incidence of enteropathy-associated T-cell lymphoma(EATL).For RCD patients,gluten-free diet alone is often insufficient to achieve satisfactory therapeutic outcomes.This article reviewed recent advances in the treatment of RCD,including the optimization of conventional therapies and the roles of emerging therapies such as elemental diet,cladribine,mesalazine,biological agents,and autologous stem cell transplantation,aiming to provide insights and directions for clinical management of RCD.

Background:Liver cirrhosis is characterized by chronic inflammation,progressive fibrosis,and eventual liver dysfunction,and poses a major global health challenge.Aims:To assess the global burden of liver cirrhosis and its risk factors from 1990 to 2021.Methods:Using data extracted from the Global Burden of Diseases,Injuries,and Risk Factors Study(GBD)2021,the incidence,mortality,disability-adjusted life years(DALYs),and their age-standardized rates of liver cirrhosis were analyzed.Furthermore,a stratified analysis was conducted by sex,age,region,and etiology,with projections of the trends in the next 15 years.Results:Compared to 1990,the global incidence number of liver cirrhosis in 2021 was increased by 58.2%,the death number and DALYs rose by 39.5%and 27.9%,respectively.While the global age-standardized incidence rate(ASIR)showed a slight increase,the age-standardized death rate(ASDR)and DALY rate continued to decline.Both ASIR and ASDR exhibited negative correlations with the sociodemographic index(SDI).All age-standardized rates were higher in males than in females.Since 1990,the incidence rate increased in younger populations,while the mortality and DALY rates declined in most age groups.Non-alcoholic fatty liver disease(NAFLD)emerged as the leading cause of incidence,whereas chronic hepatitis B and C remained the primary contributors to deaths and DALYs.The incidence of NAFLD was prominent in high and high-middle SDI regions,while chronic hepatitis B was concentrated in low SDI regions.Projections to 2036 indicated a continuing rise in ASIR,and declines in ASDR and DALY rate.The incidence of chronic hepatitis B was projected to decrease markedly,whereas that of NAFLD was expected to continue increasing.Conclusions:Between 1990 and 2021,the global incidence of liver cirrhosis showed a modest increase;in contrast,both mortality and DALY rates demonstrated a steady decline.Burden of liver cirrhosis poses notable regional disparities.NAFLD dominates incidence in high-income regions,while viral hepatitis remains predominant in low-income areas,highlighting the need for region-specific prevention strategies.

Background:Acute pancreatitis(AP)is a common disease of the digestive system,among which severe acute pancreatitis(SAP)has a high mortality rate.Finding more accurate and convenient methods for early recognition of SAP is one of the major challenges in clinical treatment.Aims:To explore the application value of the controlled attenuation parameter(CAP)of ultrasound elastography in predicting SAP.Methods:A retrospective cohort study was conducted involving 135 AP patients admitted to Jiading Branch of Shanghai General Hospital from February to October 2024.Patients were categorized into non-SAP and SAP groups according to the severity of the disease.Clinical data,local complications,laboratory indicators,and CAP were compared between the two groups.Univariate and multivariate Logistic regression analyses were used to identify independent risk factors for SAP.A SAP prediction model based on CAP was constructed according to the identified risk factors and the minimum Akaike information criterion(AIC).ROC curve and Bootstrap method were used to evaluate the efficacy of the prediction model and conduct internal validation,respectively.Results:There were statistically significant differences between the non-SAP group and SAP group in body mass index(BMI),incidence of hyperlipidemia,etiological composition,incidence of pleural and ascitic fluid,length of hospital stay,incidence of peripancreatic effusion,incidence of pancreatic necrosis,white blood cell count(WBC),D-dimer(D-D)level,blood glucose,triglyceride(TG),C-reactive protein(CRP),neutrophil count,procalcitonin(PCT),interleukin-6(IL-6),free triiodothyronine(FT3),and CAP(all P<0.05).Multivariate Logistic regression analysis showed that pancreatic necrosis(OR=13.39,95%CI:3.10-57.94,P<0.001)and CAP(OR=1.01,95%CI:1.01-1.02,P=0.038)were independent risk factors for SAP.The SAP prediction model based on CAP was formulated as:Logit(P)=-5.884+0.010×CAP+2.839×pancreatic necrosis+0.169×D-D+0.132×blood glucose+0.006×CRP.The model showed an area under the curve(AUC)of 0.834 for predicting SAP,which was superior to CAP alone(P<0.05).Internal validation indicated that the prediction model had high stability and accuracy(C-index=0.808).Conclusions:The prediction model constructed based on CAP has good clinical value for predicting SAP,providing a new perspective and tool for early identification and prognostic assessment of AP.

Background:Duodenal papillary adenoma is a benign tumor with relatively low incidence but significant carcinogenesis potential.Despite the minimal invasiveness and low complication rate,endoscopic papillectomy is associated with a definite risk of recurrence for duodenal papillary adenoma.Investigating the driver genes of duodenal papillary adenoma and establishing predictive models for recurrence and malignant progression could facilitate the precision medicine.Aims:To identify the key driver genes for tumor occurrence,carcinogenesis and recurrence in duodenal papillary adenoma by integrating multi-dimensional bioinformatics approaches based on transcriptomics data,and validate clinically.Methods:Expression profiles of duodenal papillary adenoma and adenocarcinoma were obtained from the GEO database(including data sets GSE189035,GSE94919,GSE111156,and GSE102208).Differentially expressed genes(DEGs)between adenomatous and normal tissues were screened.Weighted gene co-expression network analysis(WGCNA)and pseudo-time analysis were combined to identify the core genes exhibiting an"initial rise followed by decline"expression pattern during the dynamic progression from normal tissue to adenoma and adenocarcinoma.Functional annotation,immune microenvironment profiling,and protein-protein interaction network analysis were performed to explore the tumor-promoting mechanisms of these core genes.Clinical validation was conducted using immunohistochemistry to estimate the gene expression level and its relationship with tumor recurrence.Results:A total of 469 common DEGs were identified.WGCNA revealed that the blue module(including 1 051 genes)was associated with adenoma development and progression(Cor=-0.29,0.15,and 0.11 for normal tissue,adenoma,and adenocarcinoma,respectively).Intersection with DEGs pinpointed four key genes:SLC12A2,BEST4,SLC37A2,and SOAT2.Pseudo-time analysis demonstrated that only SLC12A2 maintained sustained high expression in both adenoma and adenocarcinoma tissues.KEGG enrichment analysis indicated that SLC12A2 was linked to various malignant pathways(e.g.,PD-1/PD-L1 signaling pathway),and its high expression correlated with the reduced immune cell infiltration(e.g.,γδ T cells,CD8+T cells,etc.).Clinical validation by immunohistochemistry confirmed the trend of initial upregulation and subsequent downregulation of SLC12A2 expression in normal,adenoma,and adenocarcinoma tissues.Patients with tumor recurrence showed higher SLC12A2 expression level(P=0.004);likewise,SLC12A2 high expression was associated with an elevated recurrence risk(P=0.034).Conclusions:SLC12A2 serves as a critical driver of tumorigenesis and progression for duodenal papillary adenoma,and might be a promising biomarker for recurrence prediction.

Background:Obesity has been confirmed as one of the risk factors for gastric cancer.Obesity can affect hormone levels,but studies on the impact of obesity-related hormones on gastric cancer are limited in China.Aims:To investigate the effects of obesity-related hormones on cardia gastric cancer(CGC)and non-cardia gastric cancer(NCGC).Methods:This case-control study included 316 patients diagnosed with gastric cancer at the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from July 2021 to June 2024,while 632 individuals who underwent physical examination during the same period were enrolled as the control group.According to the location of cancer,gastric cancer patients were divided into CGC and NCGC groups.General data and obesity-related hormone levels were compared among the three groups.Multivariate Logistic regression analysis was used to identify the risk factors for CGC and NCGC stratified by gender.Results:Compared with the control group,the levels of C-peptide and insulin-like growth factor-1(IGF-1)in both CGC and NCGC groups were significantly increased(all P<0.05),while the dehydroepiandrosterone(DHEA)level was significantly decreased(all P<0.05).The levels of leptin and sex hormone binding globulin(SHBG)in CGC group were significantly higher than those in the control group(all P<0.05).Compared with NCGC group,CGC group showed significantly higher levels of C-peptide,IGF-1,leptin and SHBG(all P<0.05),and significantly lower level of DHEA(P<0.05).Risk factors for male CGC included obesity,history of digestive system diseases,family history of gastric cancer,irregular meals,consumption of pickled food≥3 times/week,consumption of hot food≥3 times/week,smoking,Helicobacter pylori(Hp)infection,IGF-1≥250 ng/mL,leptin≥7 μg/L,DHEA<15 nmol/L,and SHBG≥80 mmol/L(all P<0.05),while education duration≥9 years was a protective factor(P<0.05).For female CGC,risk factors were history of digestive system diseases,family history of gastric cancer,irregular meals,consumption of pickled food≥3 times/week,smoking,Hp infection,C-peptide≥400 pmol/L,and IGF-1≥250 ng/mL(all P<0.05),while consumption of vegetables≥1 time/day and fruits≥3 times/week were protective factors(all P<0.05).For male NCGC,risk factors included history of mental illness,family history of gastric cancer,meat consumption≥3 times/week,smoking,alcohol drinking,Hp infection,and IGF-1≥250 ng/mL(all P<0.05),while education duration≥9 years and preference for light taste were protective factors(all P<0.05).For female NCGC,risk factors included family history of gastric cancer,irregular meals,consumption of fried food≥3 times/week,Hp infection,and C-peptide≥400 pmol/L(all P<0.05),while vegetables consumption≥1 time/day,fruits consumption≥3 times/week,and tea drinking were protective factors(all P<0.05).Conclusions:Some obesity-related hormones might have significant effects on the development of gastric cancer.

Small bowel Crohn's disease(CD)is a multi-ulcerative lesion that tends to occur in the small intestine,which leads to intestinal obstruction,stricture,and bleeding easily.With the clinical application of capsule endoscopy and balloon-assisted enteroscopy,the detection rate of small bowel CD has increased significantly.However,the treatment of small bowel CD is still a difficult issue which troubles clinical practice.It is of great significance to standardize the diagnosis and treatment process,optimize the diagnosis and treatment strategy,and further improve the diagnosis and treatment efficiency.Therefore,it is necessary to formulate an expert consensus on the endoscopic diagnosis and treatment of small bowel CD.Based on the evidence-based medicine and expert experience,the consensus focus on the clinical issues including the epidemiology,endoscopic and imaging diagnosis,enteroscopy treatment,drug treatment and follow-up of small bowel CD,and formulated relevant recommendations,so as to standardize the diagnosis and treatment process of small bowel CD and improve the prognosis of patients.

Background:With the widespread use of vonoprazan-based dual therapy for Helicobacter pylori(Hp)eradication,a comparative analysis of its efficacy and safety against bismuth-containing quadruple therapy is warranted.Aims:To compare the efficacy and safety of vonoprazan and amoxicillin-based 14-day dual therapy and 10-day bismuth-containing quadruple therapy for eradication of Hp infection.Methods:This study is a single-center,prospective,randomized,controlled,open-label,non-inferiority trial.Patients with chronic gastritis,diagnosed with Hp infection and scheduled for eradication therapy at Yuancheng District People's Hospital between December 2023 and December 2025 are planned to enroll in this study and randomly assigned into two groups.Patients in the control group received bismuth-containing quadruple therapy(vonoprazan 20 mg+bismuth potassium citrate 220 mg+amoxicillin 1.0 g+furazolidone 0.1 g,all twice daily)for 10 days,and those in the treatment group received dual therapy(vonoprazan 20 mg twice daily+amoxicillin 1.0 g three times daily)for 14 days.Both groups were supplemented with compound lactobacillus capsule.Adverse events were recorded during the treatment period.Hp eradication was assessed by 13C-or 14C-urea breath test at least four weeks after the completion of therapy.Results:As of the interim analysis,a total of 160 patients have been enrolled in the study,with 80 in each group.The per-protocol(PP)Hp eradication rates were 93.6%(95%CI:85.6%-97.9%)for the treatment group and 94.7%(95%CI:86.8%-98.5%)for the control group,with an intergroup difference of-1.147%(95%CI:-8.5%-6.1%).While in intention-to-treat(ITT)analysis,the Hp eradication rates were 91.2%(95%CI:82.9%-96.4%)for the treatment group and 90.0%(95%CI:81.2%-95.6%)for the control group,with an intergroup difference of 1.25%(95%CI:-7.8%-10.4%).Non-inferiority was confirmed for both PP and ITT analyses(P=0.012,P=0.021).No significant difference in symptoms relieve was observed between the two groups(92.1%vs.91.0%,P=0.81).The incidence of adverse events was significantly lower in the treatment group(7.7%vs.18.4%,P=0.043).The symptoms were mild and required no intervention.Conclusions:The 14-day vonoprazan-amoxicillin dual therapy is non-inferior to 10-day bismuth-containing quadruple therapy in Hp eradication rate with fewer adverse events,making it a preferred option for family-based management and primary care settings for Hp eradication.