Supplementary Figure S5. Calibration curve for the prediction model in the external validation set. Calibration plot showing agreement between predicted and observed advanced colorectal neoplasm risk in the validation set (n = 1,678).

Supplementary Figure S8. The receiver operating characteristic curves and calibration curves of the model/qFIT only for advanced colorectal neoplasia in symptomatic/asymptomatic patients. (A) Receiver operating characteristic curves and (B) calibration curves of the model/qFIT only for advanced colorectal neoplasia in asymptomatic patients; (C) receiver operating characteristic curves and (D) calibration curves of the model/qFIT only for advanced colorectal neoplasia in symptomatic patients.

Supplementary Figure S3. Receiver operating characteristic curves for restricted cubic spline analysis of different FIT transformation methods. Comparison of ROC curves for models using raw FIT, log-transformed FIT, winsorized FIT, and categorized FIT in predicting ACRN. AUC values are shown for each method. AUC, area under curve.

Table S1. Baseline characteristics of symptomatic and asymptomatic population

Supplementary Figure S9. Nomogram for predicting the risk of advanced colorectal neoplasia in asymptomatic patients. The nomogram integrates the same seven predictors as the main model, developed specifically for the asymptomatic screening population (n = 2,704). ACRN, advanced colorectal neoplasia; BMI, body mass index.

Supplementary Figure S10. The receiver operating characteristic curve of qFIT only in the development set. ROC curve showing the discriminative ability of quantitative FIT (categorized) without clinical variables for advanced colorectal neoplasm prediction in the development set (n = 3,209; AUROC = 0.844).

BACKGROUND:This study aimed to develop and externally validate a risk stratification model for advanced colorectal neoplasia (ACRN) based on the quantitative fecal immunochemical test (FIT) and easily available clinical data. METHODS:Data were derived from a multicenter study, comprising 3,209 individuals in the development set and 1,678 in the validation set. Significant risk factors for ACRN were identified using multivariable logistic regression. The area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test were used to evaluate model performance. After point assignments based on the regression coefficients, patients in the validation set were categorized into low-, intermediate-, high-, and very high-risk tiers. RESULTS:Age, sex, body mass index, habitual residence, alcohol intake, smoking, and fecal hemoglobin concentration were identified as significant risk factors for ACRN. The model demonstrated strong predictive performance (AUROC = 0.870) and good calibration (P = 0.929). The corresponding prevalence of ACRN in the low-, intermediate-, high-, and very high-risk tiers was 1.66%, 4.50%, 28.45%, and 60.64%, respectively. Subjects in the intermediate-, high-, and very high-risk tiers had 2.71-, 17.13-, and 36.51-fold higher risk of ACRN, respectively, compared with those in the low-risk tier. CONCLUSIONS:This model can effectively stratify the risk of ACRN. Individuals in the high-risk and very high-risk groups should undergo colonoscopy promptly. Furthermore, it may help compensate for the low detection rate of FIT for advanced adenoma. IMPACT:This model provides clinicians with a complementary approach to colorectal cancer screening strategy and may help optimize the efficiency of screening resource allocation.

Supplementary Figure S6. Comparison of our model with the “APCS + Binary FIT” model. ROC curves comparing the full risk model (AUROC = 0.87) and the APCS score combined with binary FIT result (AUROC = 0.80) in the validation set (P < 0.001, DeLong’s test).

Background::The effect of the interval between previous Helicobacter pylori (H. pylori) eradication and rescue treatment on therapeutic outcomes remains unknown. The aim of this study was to investigate the association between eradication rates and treatment interval durations in H. pylori infections. Methods::This prospective observational study was conducted from December 2021 to February 2023 at six tertiary hospitals in Shandong, China. We recruited patients who were positive for H. pylori infection and required rescue treatment. Demographic information, previous times of eradication therapy, last eradication therapy date, and history of antibiotic use data were collected. The patients were divided into four groups based on the rescue treatment interval length: Group A, ≥4 weeks and ≤3 months; Group B, >3 and ≤6 months; Group C, >6 and ≤12 months; and Group D, >12 months. The primary outcome was the eradication rate of H. pylori. Drug compliance and adverse events (AEs) were also assessed. Pearson’s χ 2 test or Fisher’s exact test was used to compare eradication rates between groups. Results::A total of 670 patients were enrolled in this study. The intention-to-treat (ITT) eradication rates were 88.3% (158/179) in Group A, 89.6% (120/134) in Group B, 89.1% (123/138) in Group C, and 87.7% (192/219) in Group D. The per-protocol (PP) eradication rates were 92.9% (156/168) in Group A, 94.5% (120/127) in Group B, 94.5% (121/128) in Group C, and 93.6% (190/203) in Group D. There was no statistically significant difference in the eradication rates between groups in either the ITT ( P = 0.949) or PP analysis ( P = 0.921). No significant differences were observed in the incidence of AEs ( P = 0.934) or drug compliance ( P = 0.849) between groups. Conclusion::The interval duration of rescue treatment had no significant effect on H. pylori eradication rates or the incidence of AEs. Registration::ClinicalTrials.gov, NCT05173493.

Background and Aims The detection of gastric intestinal metaplasia (GIM), gastric intraepithelial neoplasia (GIN), and early gastric cancer (EGC) using white-light endoscopy (WLE) is unsatisfactory. This study assessed the value of optical enhancement combined with magnification endoscopy (ME-OE) versus WLE for detecting GIM, GIN, and EGC. Methods Patients at high risk for gastric cancer were randomly assigned to the ME-OE group or WLE group at a 1:1 ratio. Suspicious GIM, GIN, and EGC lesions underwent targeted biopsy sampling in both groups. The diagnostic yield, diagnostic efficacy, and agreement of suspicious lesions were compared between the 2 groups. Results Two hundred eighty-five patients were finally analyzed. The per-patient diagnostic yields of GIM, GIN, and EGC were 36.6% in the ME-OE group and 23.8% in the WLE group (P = .018). The per-lesion diagnostic yield of GIM, GIN, and EGC in the ME-OE group was higher than that in the WLE group (66.7% vs 48.7%, P = .017). Sensitivity (82.8% vs 54.3%, P = .003), specificity (84.2% vs 81.4%, P = .738), positive predictive value (88.9% vs 70.4%, P = .038), negative predictive value (76.2% vs 68.6%, P = .419), and accuracy (83.3% vs 69.2%, P = .028) for GIM were compared between the 2 groups. The intraobserver agreements of experienced endoscopists were excellent for ME-OE (κ = 0.81 and κ = 0.83) and good for WLE (κ = 0.63 and κ = 0.62). The interobserver agreements of experienced endoscopists were good for both groups (κ = 0.75 and κ = 0.61, respectively). Conclusions ME-OE showed better performance for detecting GIM than WLE in high-risk populations. (Clinical trial registration number: NCT04411589.)

The prospective relationship between proteomics and inflammatory bowel disease (IBD) remains largely underexplored, presenting potential of therapeutic interventions. Using data from 48,800 IBD-free participants in the UK Biobank Pharma Proteomics Project (UKB-PPP), we assessed associations between 2923 plasma proteins and incident IBD risk using Cox analysis. Mendelian randomization (MR) meta-analysis, integrating cis-protein quantitative trait loci data from the UKB-PPP with IBD genome-wide association study data from the International Inflammatory Bowel Disease Genetics Consortium and FinnGen studies, identified causal proteins. Colocalization analysis strengthened evidence of shared common causal variants. Cohort study revealed associations of 673, 295, and 125 proteins with the risk of IBD, Crohn's disease (CD), and ulcerative colitis (UC), respectively. MR and colocalization analyses prioritized IL12B, CD6, MXRA8, CXCL9, IFNG, CCN3, RSPO3, and IL18 as having causal and high colocalization evidence with IBD or its subtypes. Our findings advance understanding of IBD's molecular etiology and highlight potential therapeutic targets.

Bismuth-containing quadruple therapy is the first-line treatment for eradicating Helicobacter pylori (H. pylori). The optimal duration for H. pylori eradication using bismuth-containing quadruple therapy remains controversial. Therefore, we aimed to compare the clinical effects of the 10- and 14-day bismuth-containing quadruple treatment regimen to eradicate H. pylori. Treatment-naïve patients with H. pylori infection (n = 1300) were enrolled in this multicenter randomized controlled study across five hospitals in China. They were randomized into 10- or 14-day treatment groups to receive bismuth-containing quadruple therapy as follows: vonoprazan 20 mg twice daily; bismuth 220 mg twice daily; amoxicillin 1000 mg twice daily; and either clarithromycin 500 mg twice daily or tetracycline 500 mg four times daily. At least 6 weeks after treatment, we performed a 13C-urea breath test to evaluate H. pylori eradication. The per-protocol eradication rates were 93.22

BACKGROUND:Large language models (LLMs) are promising medical counseling tools, but the reliability of responses remains unclear. We aimed to assess the feasibility of three popular LLMs as counseling tools for Helicobacter pylori infection in different counseling languages. MATERIALS AND METHODS:This study was conducted between November 20 and December 1, 2023. Three large language models (ChatGPT 4.0 [LLM1], ChatGPT 3.5 [LLM2], and ERNIE Bot 4.0 [LLM3]) were input 15 H. pylori related questions each, once in English and once in Chinese. Each chat was conducted using the "New Chat" function to avoid bias from correlation interference. Responses were recorded and blindly assigned to three reviewers for scoring on three established Likert scales: accuracy (ranged 1-6 point), completeness (ranged 1-3 point), and comprehensibility (ranged 1-3 point). The acceptable thresholds for the scales were set at a minimum of 4, 2, and 2, respectively. Final various source and interlanguage comparisons were made. RESULTS:The overall mean (SD) accuracy score was 4.80 (1.02), while 1.82 (0.78) for completeness score and 2.90 (0.36) for comprehensibility score. The acceptable proportions for the accuracy, completeness, and comprehensibility of the responses were 90%, 45.6%, and 100%, respectively. The acceptable proportion of overall completeness score for English responses was better than for Chinese responses (p = 0.034). For accuracy, the English responses of LLM3 were better than the Chinese responses (p = 0.0055). As for completeness, the English responses of LLM1 was better than the Chinese responses (p = 0.0257). For comprehensibility, the English responses of LLM1 was better than the Chinese responses (p = 0.0496). No differences were found between the various LLMs. CONCLUSIONS:The LLMs responded satisfactorily to questions related to H. pylori infection. But further improving completeness and reliability, along with considering language nuances, is crucial for optimizing overall performance.

AbstractBackground and AimsThe resect‐and‐discard strategy for colorectal polyps based on accurate optical diagnosis remains challenges. Our aim was to investigate the feasibility of hyperspectral imaging (HSI) for identifying colorectal polyp properties and diagnosis of colorectal cancer in fresh tissues during colonoscopy.Methods144,900 two dimensional images generated from 161 hyperspectral images of colorectal polyp tissues were prospectively obtained from patients undergoing colonoscopy. A residual neural network model was trained with transfer learning to automatically differentiate colorectal polyps, validated by histopathologic diagnosis. The diagnostic performances of the HSI‐AI model and endoscopists were calculated respectively, and the auxiliary efficiency of the model was evaluated after a 2‐week interval.ResultsQuantitative HSI revealed histological differences in colorectal polyps. The HSI‐AI model showed considerable efficacy in differentiating nonneoplastic polyps, non‐advanced adenomas, and advanced neoplasia in vitro, with sensitivities of 96.0%, 94.0%, and 99.0% and specificities of 99.0%, 99.0%, and 96.5%, respectively. With the assistance of the model, the median negative predictive value of neoplastic polyps increased from 50.0% to 88.2% (p = 0.013) in novices.ConclusionThis study demonstrated the feasibility of using HSI as a diagnostic tool to differentiate neoplastic colorectal polyps in vitro and the potential of AI‐assisted diagnosis synchronized with colonoscopy. The tool may improve the diagnostic performance of novices and facilitate the application of resect‐and‐discard strategy to decrease the cost.

Purpose To identify and predict the epidemiological burden and trends of inflammatory bowel disease (IBD) in China and compare them globally. Methods We collected incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and the age-standardized rates (ASRs) of IBD from 1990 to 2019 in China, four developed countries and the world, from the Global Burden of Disease Study 2019. The average annual percentage change (AAPC) was calculated to evaluate the temporal trends. Results From 1990 to 2019, the numbers of incident and prevalent cases, age-standardized incidence rate (ASIR), and age-standardized prevalence rate (ASPR) of IBD increased in China, regardless of gender and age; decreased YLLs and increased YLDs caused a stable number of DALYs; the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) decreased. In 2019, the ASIR, ASPR, ASMR, and ASDR were 3.01/100,000 person-years (/100,000) (95% UI: 2.59, 3.50), 47.06/100,000 (95% UI: 40.05, 54.99), 0.30/100,000 (95% UI: 0.24, 0.35), and 13.1/100,000 (95% UI: 10.29, 16.31), respectively; almost all disease burden data were higher in males. In 2017, the ASDR in different socio-demographic index provinces ranged from 24.62/100,000 (95% UI: 16.95, 33.81) to 63.97/100,000 (95% UI: 44.61, 91.48). When compared globally, the ASIR and ASPR in China had opposite trends and the highest AAPCs. In 2019, the ASIR and ASPR in China were in the middle of the world and lower than in some developed countries. The numbers and ASRs of incidence, prevalence, and DALYs were expected to increase by 2030. Conclusion The IBD burden in China significantly increased from 1990 to 2019 and was expected to rise further by 2030. China had the world’s opposite and most dramatic trends in ASIR and ASPR from 1990 to 2019. Strategies should be adjusted to adapt to the significantly increased disease burden.

ObjectivesTo assess the region-specific relative risk of cardia/non-cardia gastric cancer (CGC/NCGC) associated with Helicobacter pylori (H. pylori) and quantify its contribution to gastric cancer burden using population attributable fraction (PAF). MethodsPubMed, EMBASE, Web of Science, and Cochrane Central databases were searched by two reviewers until April 20, 2022. The association between H. pylori infection and NCGC/CGC was assessed using pooled odds ratios (ORs) with 95% confidence intervals (CIs). PAF was calculated using the formula of H. pylori prevalence and the pooled OR. ResultsOne hundred and eight studies were included. A significant association was observed between H. pylori infection and NCGC in East Asia (OR, 4.36; 95% CI: 3.54-5.37) and the West (OR, 4.03; 95% CI: 2.59-6.27). Regarding CGC, a significant association was found only in East Asia (OR, 2.86; 95% CI: 2.26-3.63), not in the West (OR, 0.80; 95% CI: 0.61-1.05). For studies with a follow-up time of >= 10 years, pooled ORs for NCGC and CGC in East Asia were 5.58 (95% CI: 4.08-7.64) and 3.86 (95% CI: 2.69-5.55), respectively. Pooled OR for NCGC was 6.80 (95% CI: 3.78-12.25) in the West. PAFs showed that H. pylori infection accounted for 71.2% of NCGC, 60.7% of CGC in East Asia, and 73.2% of NCGC in the West. ConclusionsGastric cancer burden associated with H. pylori infection exhibits important geographical differences. Prolonged follow-up period could overcome the underestimation of the magnitude of the association between H. pylori infection and CGC/NCGC. Customized strategies for H. pylori screening and eradication should be implemented to prevent gastric cancer.

This study aimed to evaluate the efficacy and safety of vonoprazan (VPZ) versus proton pump inhibitor (PPI) in clarithromycin‐based bismuth‐containing quadruple therapy (C‐BQT) for the treatment of Helicobacter pylori (H. pylori) eradication.

This study aimed to evaluate the efficacy and safety of vonoprazan (VPZ) versus proton pump inhibitor (PPI) in clarithromycin-based bismuth-containing quadruple therapy (C-BQT) for the treatment of Helicobacter pylori ( H. pylori ) eradication. Medical records of patients in whom H. pylori was eradicated between 1 July 2018 and 31 December 2021 were retrieved retrospectively from the Outpatient Unit of Qilu Hospital. Efficacy, safety, and compliance were compared between VPZ-based and PPI-based C-BQT, containing vonoprazan 20 mg or proton pump inhibitors (lansoprazole 30 mg or esomeprazole 20 mg), bismuth 220 or 200 mg, amoxicillin 1000 mg, and clarithromycin 500 mg, twice daily for 2 weeks by 1:1 propensity score matching analysis. The trial was registed on ClinicalTrials.gov (registration no. NCT05301725). The H. pylori eradication rates of VPZ-based and PPI-based therapies were 88.8% (151/170) and 87.6% (149/170) in the intention-to-treat analysis, 94.1% (144/153) and 91.1% (144/158) in the per-protocol analysis, respectively. The noninferiority of VPZ to PPI was confirmed in all analyses ( P  < 0.001). The incidence of adverse events was 30.0% (51/170) and 27.1% (46/170) in the VPZ-based and PPI-based groups, respectively. VPZ-based and PPI-based therapies were well tolerated and showed good patient compliance without significant differences. VPZ-based therapy resulted in a satisfactory eradication rate and was well tolerated for H. pylori eradication, which are comparable to PPIs in C-BQT as a first-line treatment for H. pylori infection.

The incidence of early-onset colorectal cancer (CRC) is continuously increasing worldwide. Current guidelines in China recommend average-risk individuals starting CRC screening at age 50. To investigate the relationship between the gastric histopathology and colorectal neoplasms to identify CRC risk factors which potentially guide earlier colonoscopy in individuals aged < 50 years. A retrospective cross-sectional study was conducted on 8819 patients younger than age 50 who underwent gastroscopy and colonoscopy simultaneously between November 7, 2020 and November 14, 2022. Multivariate logistic regression was used to evaluate whether various gastric histopathology are risk factors for different types of colorectal polyps, reporting odds ratios (ORs) with corresponding 95

Helicobacter pylori (H. pylori), a gram‐negative bacterium that colonizes the stomach, can cause chronic gastritis and peptic ulcers, as well as gastric cancer as a Class I carcinogen. However, the modes of H. pylori transmission are not clear. This review aims to clarify the transmission routes and patterns of H. pylori and identify efficacious prevention measures.