ABSTRACT Gastrointestinal (GI) cancers constitute over one‐fourth of global cancer morbidity and one‐third of mortality. Although lifetime risk estimates guide cancer surveillance, the risk during working age (15–64 years) remains poorly quantified despite its significant socioeconomic implications. Therefore, we aimed to evaluate global incidence and mortality risks of GI cancers during working age (15–64 years) from 1990 to 2021. We employed the adjusted for multiple primaries method to estimate working‐age risks of six major GI cancers based on data from the Global Burden of Disease 2021 study. Analyses of risk patterns were stratified by sex, sociodemographic index quintiles, geographic regions, nations, and age intervals. Temporal trends were assessed through joinpoint regression analyses spanning 1990–2021. Our analysis revealed that the 2021 global working‐age incidence and mortality risks of GI cancers were 2.19% (95% CI: 2.18–2.20) and 1.37% (95% CI: 1.36–1.37), respectively. Colorectal cancer exhibited the highest incidence risk (0.91%), whereas stomach cancer demonstrated the highest mortality risk (0.35%). Males demonstrated approximately twofold higher risks than females. High‐middle SDI countries exhibited the highest risks, with East Asia and Mongolia showing the highest regional and national risks. Age‐stratified analysis revealed ages 40–64 representing the high‐risk period during working years. Despite an encouraging decline in overall GI cancer risks, the persistent increase in CRC incidence risk emerged as a concerning pattern. In conclusion, the global working‐age risk corresponds to one in 46 people developing and one in 73 dying from GI cancers, with marked disparities across demographic, socioeconomic, and geographic dimensions necessitating targeted surveillance strategies.

Background and Objectives:EUS has emerged as an essential instrument in the field of gastroenterology, significantly enhancing both diagnostic evaluations and therapeutic procedures. By delivering high-resolution imaging and precise guidance, EUS facilitates a range of interventional techniques. This study sought to examine the adverse events linked to EUS devices following their approval by the US Food and Drug Administration. Methods:We performed a retrospective analysis utilizing postmarketing surveillance data sourced from the Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database. This analysis encompasses data from January 1, 2000, to August 31, 2025. Results:A total of 7608 reports detailing 8778 device-related issues and 7875 patient complications were analyzed. The most commonly reported device-related problems included peeling or delamination, with 1251 reports, followed by device breakage at 837 reports, microbial contamination at 781 reports, and inadequate cleaning at 704 reports. In terms of patient-related complications, the most frequently reported adverse events were blood loss (73 reports), tissue perforation (44 reports), and pancreatitis (32 reports). Furthermore, there were 743 documented instances of microbial contamination in EUS devices, with Coagulase-negative staphylococci being identified as the predominant pathogen, appearing in 151 reports. Conclusions:The examination of the MAUDE database reveals significant device and patient-related adverse events that endoscopists must consider during EUS procedures. Continuous postmarketing surveillance and the evaluation of real-world data are crucial for determining the safety and effectiveness of endoscopic devices, which in turn enhances patient outcomes.

ABSTRACT The Global Burden of Disease (GBD) database provides essential primary data for public health research. However, its complexity and diversity pose challenges for conducting advanced secondary analyses. To address these challenges, we developed easyGBDR , an innovative integrated R toolkit designed to facilitate the secondary analysis of GBD data. This package offers a comprehensive analytical workflow that encompasses data acquisition and preprocessing through to advanced statistical modeling and visualization. easyGBDR supports various epidemiological methods, including trend analysis, age‐period‐cohort (APC) modeling, future disease burden projection, decomposition analysis, frontier analysis, and health inequality assessment. By automating data handling processes and standardizing procedures while generating publication‐ready tables and figures, easyGBDR significantly reduces the technical barriers associated with robust GBD‐based research. This toolkit enhances reproducibility, accelerates evidence generation, and empowers researchers across all levels of expertise to extract meaningful public health insights from one of the world's most comprehensive health databases. Consequently, easyGBDR serves as a vital resource for advancing evidence‐informed policy and practice in global health.

Background: Artificial intelligence (AI) is increasingly integrated into clinical medicine, yet a global, registry-based characterization of AI clinical trials remains lacking. We aimed to characterize the global landscape of AI clinical trials for disease diagnosis and treatment. Methods: In this cross-sectional study, we searched ClinicalTrials.gov and the WHO ICTRP from inception to September 1, 2025, for interventional trials using AI for disease-related care. Two reviewers independently screened records and extracted data. The primary outcomes were trial registration counts, sponsorship patterns, trial completion time, and publication rates within 3 years of completion. Findings: A total of 1,305 eligible trials from 70 countries were included. Annual registrations grew from fewer than 10 before 2017 to 299 in 2024 (44.3% CAGR). China (32.3%) and the US (15.1%) contributed 47.4% of trials. Digestive diseases (27.0%) and oncology (26.2%) predominated. Academic institutions sponsored 81.8% of trials; industry sponsorship was higher in the US than China (22.8% vs 1.2%; P < 0.001). Industry-sponsored trials had faster completion (adjusted HR, 1.58; 95% CI, 1.27–1.95). Only 18.1% of completed trials published results within 3 years. Interpretation: AI clinical trials are expanding rapidly, but evidence dissemination remains poor, with geographic and disease-domain disparities. Strategies to promote result disclosure and broader clinical applications are urgently needed.

Digestive tract diseases and neoplasms (DTDNs) constitute a major global health burden with poorly quantified economic impact. Here, using health-augmented macroeconomic modelling across 190 countries (2020–2050), we estimated DTDNs’ economic burden by comparing scenarios with and without complete disease eradication, incorporating educational heterogeneity, workforce participation variations and treatment cost impacts on capital accumulation. DTDNs will impose a US$26.1 trillion global economic burden, equivalent to 0.65% annual Gross Domestic Product tax. Cirrhosis and chronic liver diseases contribute the largest share (30.2%), followed by colorectal cancer (11.6%), gallbladder diseases (8.8%), stomach cancer (7.3%) and hernias (6.7%). China (US$8.6 trillion) and the USA (US$4.0 trillion) experience the largest absolute impacts. Upper-middle-income countries bear 46.2% of economic consequences. Disease patterns shift from infection-related to lifestyle-related conditions as income levels rise. Physical capital losses constitute 76% of burden in high-income countries versus 1% in low-income countries. The substantial and unevenly distributed global economic burden of DTDNs, particularly liver diseases, warrants targeted prevention strategies that could yield significant economic returns globally. Integrating several data sources and investigating several different scenarios related to health and economic conditions, this study presents projections of future burden for 16 digestive tract diseases at a global scale, outlining priorities for disease prevention and eradication.

Purpose Diet heavily influences global non-communicable disease burden, yet research on working-age population (WAP) dietary patterns and mortality across socioeconomic contexts remains sparse. This study assessed global, regional, and national trends in dietary risks and associated mortality over three decades in WAP. Methods Using the Global Burden of Disease 2021 database, we estimated mortality attributable to 15 dietary risk factors in 204 countries and territories. We analyzed deaths and age-standardized mortality rates (ASMR) across sociodemographic index (SDI) quintiles, examining temporal trends and health disparities. Results Dietary consumption patterns among WAP were suboptimal worldwide. In 2021, the global diet-related mortality rate in this population increased by 28.85%, whereas ASMRs fell by 35.1%. Six countries (India, China, Indonesia, USA, Pakistan, and Russian Federation) accounted for 57.91% of total mortality. The leading dietary risks associated with highest mortality were low intake of whole grains, fruits, vegetables, and high sodium consumption. Adverse trends in mortality linked to high intake of sugar-sweetened beverages were observed, particularly in middle and low-middle SDI regions. Mortality related to high consumption of red and processed meats showed an upward trend in lower SDI regions. The COVID-19 era witnessed a moderate rise in diet-related mortality among WAP, with significantly higher ASMRs observed in wealthier regions. Conclusions Dietary factors significantly contribute to health burden on WAP. Our findings have critical implications for addressing unhealthy dietary practices and reducing diet-related mortality within this population.

Background GI cancers pose an increasing global health burden, with their impact on the working-age population (WAP) aged 15-64 years remaining largely unexplored despite the crucial role of this group in societal and economic well-being.Objective To assess trends and cross-country inequality in the global burden of six GI cancers from 1990 to 2021 among individuals in the WAP.Design The 2021 Global Burden of Disease study dataset was used to obtain estimates of GI cancer incidence and 95% uncertainty intervals, including the number of cases, crude incidence rate and age-standardised incidence rate (ASIR). WAP GI cancer epidemiology was assessed at the national, regional and global levels, evaluating trends from 1990 to 2021 from overall, local and Sociodemographic Index (SDI) perspectives and using standard health equity methods to quantify cross-country inequality.Results Colorectal cancer exhibited the greatest burden of GI cancer among the WAP in 2021. From 1990 to 2021, the number of GI cancer cases rose by 51.9%, although the ASIR declined by 23.4%. These rates exhibit geographic variation, with the most cases and the highest ASIR in China and Mongolia, respectively. Incidence was disproportionately concentrated in higher SDI countries, and worsening inequality was evident over time.Conclusions While the ASIR of GI cancer is trending downwards among the WAP, high incidence rates, regional variability and an unequal burden of disease emphasise the need for flexible, targeted medical interventions to support policymaking and medical resource allocation.

Colorectal cancer often arises from precancerous polyps, where accurate size assessment is vital for clinical decisions but challenged by subjective methods. While artificial intelligence (AI) has shown promise in improving the accuracy of polyp size estimation, its development depends on large, meticulously annotated datasets. We present Polyp-Size, a dataset of 42 high-resolution white-light colonoscopy videos with polyp sizes precisely measured post-resection using vernier calipers to submillimeter precision. Unlike existing datasets primarily focused on polyp detection or segmentation, Polyp-Size offers validated size annotations, diverse polyp features (Paris classification, anatomical location and histological type), and standardized video formats, enabling robust AI models for size estimation. By making this resource publicly available, we aim to foster research collaboration and innovation in automated polyp measurement to ultimately improve clinical practice.

Solitary fibular metastasis from lung adenocarcinoma is exceedingly rare, with only five documented cases. This report presents a 40-year-old non-smoking Asian male who initially presented with painful swelling in the right knee. Imaging revealed bony destruction of the right fibular head, and further investigations with chest CT, PET/C, pathologic biopsy and genetic testing identified a primary lung adenocarcinoma with EGFR exon 19 deletion mutation. The patient was treated with Osimertinib, resulting in significant tumor reduction. This was followed by thoracoscopic lobectomy and systematic lymph node dissection, and local radiotherapy for the fibular metastasis. The patient experienced complete pain relief and showed no recurrence or metastasis over a 26-month follow-up. This case highlights the diagnostic challenge posed by atypical presentations of metastasis and underscores the importance of comprehensive evaluation, adherence to treatment guidelines, and a multidisciplinary approach in managing oncological patients. The successful outcome in this young patient emphasizes the effectiveness of personalized treatment strategies in optimizing patient prognosis, offering valuable insights for similar clinical scenarios.

BACKGROUND:Beverage choices significantly impact the health of women of childbearing age (WCBA). Despite growing scientific interest, comprehensive global analyses of beverage consumption patterns in this population remain limited. We aimed to evaluate global beverage consumption patterns among WCBA and investigate their relationships with the Socio-demographic Index (SDI) from 1990 to 2018. METHODS:This study analyzed beverage consumption data across 185 countries using the Global Dietary Database 2018. Five beverage categories (sugar-sweetened beverages [SSBs], coffee, fruit juices, tea, and milk) were assessed among WCBA across seven global regions. Consumption metrics were calculated using weighted methodologies integrating population statistics, with 95% uncertainty intervals established through Monte Carlo simulations. Multi-level analyses examined consumption patterns at the global, regional, and national levels. Spearman correlation analysis evaluated relationships between the SDI and consumption patterns. RESULTS:In 2018, the global mean intake of SSBs was 120.47 g/d of SSBs, 0.68 cup/d of coffee, 17.16 g/d of fruit juices, 0.85 cup/d of tea, and 81.87 g/d of milk. Total beverage consumption showed global variation, with intake ranging from 1 to 2 servings in South and Southeast Asia to 3 to 4 servings in high-income countries. Between 1990 and 2018, consumption increased across most beverage types, except for fruit juices, which decreased by 13.1%. Significant regional disparities are evident in age-related intake patterns. Milk consumption demonstrated the strongest positive correlation with SDI (r = 0.73), while SSB consumption showed varied associations across development levels. CONCLUSIONS:Substantial global variations in beverage consumption among WCBA highlight the need for targeted interventions and policies considering regional socioeconomic differences.

BACKGROUND:Understanding global dietary patterns and their implications for human and planetary health has become increasingly critical. The Planetary Health Diet (PHD), introduced by the EAT-Lancet Commission in 2019, offers a framework to address nutrition-related diseases while mitigating environmental impacts. OBJECTIVES:We aimed to analyze adherence to a modified PHD (mPHD) among working-age population (WAP) across 185 countries between 1990 and 2018. METHODS:We conducted a serial cross-sectional analysis using data from the Global Dietary Database (GDD) 2018. The modified Planetary Health Diet Index (mPHDI) score was constructed based on consumption of 12 food groups. Each component was scored from 0 to 10, generating a composite score ranging from 0 to 120. Distributive inequalities were assessed using the slope index of inequality and concentration index, which are 2 standard metrics of absolute and relative gradient inequality. RESULTS:Modest overall adherence to the mPHD recommendations [global mPHDI score: 75.2; 95% uncertainty interval (UI): 74.2, 76.3] was observed, with significant regional variations. Sub-Saharan Africa showed the highest adherence (84.5; 95% UI: 83.2, 85.5), whereas Latin America and the Caribbean showed the lowest (66.0; 95% UI: 64.5, 67.7). Excessive consumption of red/processed meat and added sugar was prevalent across various populations. Over the past 28 y, global improvement was minimal (+1.3; 95% UI: -0.1, 2.4), with concerning declines in South Asia (-4.0; 95% UI: -5.7, -2.2), despite substantial improvements in high-income countries (6.5; 95% UI: 4.0, 8.5). The slope index of inequality decreased from -15.48 (95% confidence interval [CI]: -19.2, -11.76) in 1990 to -8.49 (95% CI: -12.26, -4.72) in 2018. CONCLUSIONS:Our findings reveal substantial global variations in mPHD adherence among WAP, with concerning trends in certain regions. These results provide crucial insights for developing targeted interventions that consider regional contexts while pursuing the dual objectives of promoting healthier diets and ensuring environmental sustainability.