Annals of Gastroenterology最新文献

{"title":"Early-onset colorectal cancer in patients younger than 50 years: a systematic review of the literature.","authors":"Ilektra D Kyrochristou, Georgios D Lianos, Gerasimia D Kyrochristou, Vaia Georvasili, Vasileios Tatsis, Michail Mitsis, Dimitrios Schizas, Konstantinos Vlachos","doi":"10.20524/aog.2025.0977","DOIUrl":"10.20524/aog.2025.0977","url":null,"abstract":"<p><p>Early-onset colorectal cancer (EO-CRC) refers to CRC diagnosed before the age of 50. Its incidence has risen in recent years, turning researchers' attention to its oncologic behavior and potentially modifiable risk factors. In this review, PubMed/MEDLINE database was searched for all original research articles concerning EO-CRC. The inclusion criteria were CRC patients under 50, without a known predisposing factor for malignancy or an inherited CRC syndrome, presenting oncological characteristics and outcomes. All studies were assessed for bias, based on the ROBINS-E 2022 tool, and were synthesized in a qualitative analysis. Twenty-nine articles, reporting on 64,376 EO-CRC patients, were included in the qualitative synthesis. Results were classified into 3 categories: a) demographics; b) histopathologic characteristics; and c) treatment outcomes. Of these publications, 21 studies agreed that rectum (45%) and left-sided (47.1%) cancers are most common in younger patients, and 5 indicated that the highest prevalence of CRC concerns the 40-49 years age group. Seventeen of 29 studies reported a higher stage (III and IV) on diagnosis, with lymphovascular and perineural invasion. Our review has some limitations: as it was based on a single database, not all studies provided information on the variables; and patients were not categorized in all studies in the same age groups, although all were under 50 years. As EO-CRC is on the rise, the need for closer monitoring and possibly earlier screening becomes apparent. Further research should focus on finding novel screening biomarkers and modifiable risk factors that would decrease mortality and improve patient outcomes.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 4","pages":"364-379"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12277510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688718","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}

{"title":"Characteristics of early- versus late-onset esophageal adenocarcinoma: insights from the National Inpatient Sample 2016-2020.","authors":"Sana Rabeeah, Ahmad Mahdi, Vikash Kumar, Jayalekshmi Jayakumar, Bisher Sawaf, Shahem Abbarh, Ali Wakil, Hasan Al-Obaidi, Ahmed El Rahyel, Muhammed Elhadi, Yaseen Alastal","doi":"10.20524/aog.2025.0976","DOIUrl":"10.20524/aog.2025.0976","url":null,"abstract":"<p><strong>Background: </strong>The incidence of early-onset esophageal adenocarcinoma (EAC) in adults aged <50 years is rising, yet remains under-investigated. This study compared demographic, clinical and socioeconomic predictors of early- vs. late-onset EAC using national hospitalization data.</p><p><strong>Methods: </strong>We analyzed adult patients diagnosed with EAC from the National Inpatient Sample (2016-2020). Cases were stratified into early-onset (age <50 years) and late-onset (≥50 years), and further categorized by tumor location (upper, middle, lower esophagus). ICD-10-CM codes were used to identify diagnoses. Demographics, comorbidities and socioeconomic variables were compared using Rao-Scott chi-square tests.</p><p><strong>Results: </strong>Among 105,228 EAC admissions, early-onset cases comprised 5.89%. Lower esophagus involvement was most common (74.6%). Compared to late-onset patients, early-onset cases had a lower proportion of Caucasians (71.5% vs. 79.8%, P<0.001) and higher proportions of Black (13.9% vs. 9.6%) and Hispanic individuals (7.0% vs. 5.4%). Smoking (25.1% vs. 17.9%), obesity (11.4% vs. 8.4%), and drug use (28.9% vs. 19.7%) were more prevalent in early-onset patients (P<0.001). In contrast, late-onset patients had higher rates of hypertension (47.1% vs. 26.7%), diabetes, chronic obstructive pulmonary disease and gastroesophageal reflex disease (P<0.001). Early-onset patients were less likely to be insured with Medicare (6.8% vs. 57.9%), and more likely with Medicaid (35.0% vs. 10.6%) or to be self-payers (3.9% vs. 1.8%).</p><p><strong>Conclusions: </strong>Early-onset EAC presents with distinct racial, socioeconomic and clinical profiles compared to late-onset disease. These findings underscore the need for tailored screening strategies and further research to address disparities and risk factors in younger populations.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 4","pages":"392-400"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12277520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688717","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}

{"title":"Patients with cystic fibrosis do not have an increased risk of adverse events after endoscopic retrograde cholangiopancreatography: a propensity-matched analysis.","authors":"Mahmoud Y Madi, Saqr Alsakarneh, Yassine Kilani, Ryan Plunkett, Razan Aburumman, Farah Heis, Christopher Nguyen, Christine Hachem, Wissam Kiwan","doi":"10.20524/aog.2025.0983","DOIUrl":"10.20524/aog.2025.0983","url":null,"abstract":"<p><strong>Background: </strong>Cystic fibrosis (CF) is a common life-limiting genetic disease often associated with hepatobiliary complications. Endoscopic retrograde cholangiopancreatography (ERCP), though valuable, carries procedural risks. We assessed the safety of ERCP in CF patients using real-world data.</p><p><strong>Methods: </strong>A retrospective cohort study using the TriNetX database (2010-2024) identified adults (≥18 years) with CF who underwent ERCP. Propensity-score matching adjusted for confounders, including age, sex, race, and hospitalization history. The primary outcome was post-ERCP pancreatitis (PEP); secondary outcomes included bleeding and infection. Subgroup analysis evaluated outcomes in patients with choledocholithiasis.</p><p><strong>Results: </strong>Among 534 matched CF patients (mean age 44.6 years; 48.3% female), rates of PEP (8.3% vs. 4.9%, adjusted odds ratio [aOR] 1.76, 95% confidence interval [CI] 0.937-3.315; P=0.075), bleeding (3.1% vs. 2.1%, aOR 1.52, 95%CI 0.674-3.409; P=0.31), and infection (3.7% vs. 2.4%, aOR 1.55, 95%CI 0.638-3.785; P=0.33) were not significantly different compared to non-CF controls. Subgroup analysis of choledocholithiasis patients similarly showed no significant differences.</p><p><strong>Conclusions: </strong>ERCP in CF patients demonstrated comparable adverse event rates to non-CF controls. These findings support the procedural safety of ERCP in this population, though further prospective studies are needed to validate these results and clarify risk by indication.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 4","pages":"446-452"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12277522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688725","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}

{"title":"Increased capture of post-endoscopic retrograde cholangiopancreatography adverse events by delayed (day 7) follow-up calls: a prospective comparison of physician- and nurse-initiated calls.","authors":"Monique T Barakat, Subhas Banerjee","doi":"10.20524/aog.2025.0970","DOIUrl":"10.20524/aog.2025.0970","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic retrograde cholangiopancreatography (ERCP) is a high-risk endoscopic procedure. We recently found that physician-initiated post-ERCP follow-up calls on day 7 post-ERCP increased adverse event capture. Subsequently, we prospectively evaluated the utility of nurse-initiated follow-up calls, comparing these with physician-initiated calls to assess the impact of transitioning this responsibility to a nurse.</p><p><strong>Methods: </strong>This prospective study was conducted on consecutive patients undergoing ERCP at our academic tertiary care medical center. Patients received phone calls on days 1 and 7 post-ERCP, from either an endoscopist or a nurse coordinator, using a standardized script to assess delayed complications (pancreatitis, non-pancreatitis abdominal pain, bleeding, infection, perforation), and unplanned health encounters.</p><p><strong>Results: </strong>A total of 448 ERCP patients (239 physician calls, 209 nursing calls) were included. Physician calls were more successful than nursing calls in reaching patients on both day 1 (96% vs. 74%, P<0.001) and day 7 (91% vs. 63%, P<0.001). Nursing calls were significantly longer than physician calls on both days. A higher adverse event capture rate by physician calls compared to nursing calls was evident on day 1 (3.5% vs. 2.4%, P=0.04) and day 7 (10.6% vs. 6.3%, P=0.004). Physician follow-up calls on day 7 resulted in substantially more patients triaged to the Emergency Department, primary care and oncology clinics (P<0.001).</p><p><strong>Conclusions: </strong>Physician calls were significantly more effective than nurse calls in reaching patients, capturing adverse events, and triaging patients to appropriate care. These data support the value of physician-initiated calls, at least following the most complex procedures.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 4","pages":"440-445"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12277518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688721","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}

{"title":"Replication and extension of a meta-analysis of antidepressants for irritable bowel syndrome: a comparison of odds ratios and risk ratios using artificial intelligence-powered tools.","authors":"Lefteris Teperikidis, Christos Mademlis, Georgios Hatzinakos, Nikolaos Lazaridis","doi":"10.20524/aog.2025.0975","DOIUrl":"10.20524/aog.2025.0975","url":null,"abstract":"","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 4","pages":"462-463"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12277517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688738","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}

{"title":"Office-based flexible sigmoidoscopy allows rapid assessment and management of suspected immune checkpoint inhibitor-related colitis.","authors":"Alana Siev, Pamela Livingstone, Erika Tom, Tara Corso, Isabel Preeshagul, Michael Postow, Neil J Shah, Rachel Niec, Mark Schattner, David M Faleck","doi":"10.20524/aog.2025.0979","DOIUrl":"10.20524/aog.2025.0979","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors (ICIs) have transformed cancer treatment but are frequently complicated by immune-related adverse events, including immunotherapy-related colitis (irColitis). Early and accurate diagnosis, including endoscopy, is essential for appropriate management, yet the real-world feasibility and clinical impact of early endoscopic evaluation remain unclear.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of patients who underwent office-based, unsedated flexible sigmoidoscopy between February 2019 and April 2022 as part of the RAPID-GI program at Memorial Sloan Kettering Cancer Center. The program was designed to expedite evaluation of suspected irColitis in ICI-treated patients via rapid GI consultation including sigmoidoscopy. A diagnosis of irColitis was confirmed based on histology review by expert GI pathologists.</p><p><strong>Results: </strong>irColitis was confirmed in 70% (66/94) of patients. Median time from referral to consultation including sigmoidoscopy was 8 days. Visible inflammation was present in 80% of patients with confirmed irColitis vs. 11% without (P<0.001); all irColitis cases showed histologic inflammation. All procedures were completed without sedation using enemas alone for bowel preparation, and no complications occurred. Findings led to management changes in 89% of irColitis cases, including initiation or adjustment of immunosuppressive therapies. Among patients without irColitis, 79% avoided unnecessary immunosuppression and 57% continued or resumed ICI therapy.</p><p><strong>Conclusions: </strong>Office-based flexible sigmoidoscopy is a safe, feasible, and high-yield diagnostic tool for suspected irColitis. A rapid access program enables timely diagnosis, guides therapy, minimizes unnecessary immunosuppression, and facilitates ICI continuation. This model may improve outcomes and should be considered for broader adoption among integrated oncology and gastroenterology care teams.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 4","pages":"415-419"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12277519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688723","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}

{"title":"Patterns of prescription and discontinuation of glucagon-like peptide-1 receptor agonists among patients with irritable bowel syndrome.","authors":"Misha Gautam, Utkarsh Goel, Abbas Bader, Samiya Azim, Noor Hassan, Esmat Sadeddin, Wendell Clarkston, Hassan Ghoz","doi":"10.20524/aog.2025.0971","DOIUrl":"10.20524/aog.2025.0971","url":null,"abstract":"<p><strong>Background: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are associated with gastrointestinal (GI) adverse effects, but real-world evidence about their incidence in patients with functional GI disorders is limited. We examined their prescription and discontinuation patterns in irritable bowel syndrome (IBS) patients.</p><p><strong>Methods: </strong>In this retrospective analysis of GLP-1RAs prescribed to patients with IBS at our institution from 2013-2023, we assessed the association of IBS subtype- and patient-related (age, race, body mass index, insurance, diabetes, gastroesophageal reflux disease) factors on the number and reasons for agent switches throughout the treatment course.</p><p><strong>Results: </strong>Of the 256 patients with IBS prescribed >1 GLP-1RAs, 227 (88.7%) patients trialed 2-3 GLP-1RAs, while 29 (11.3%) trialed ≥4 agents. Mixed-type IBS patients showed the highest rates of switching, followed by constipation- and diarrhea-predominant type IBS (21.7%, 11.7% and 2.2%, respectively; P=0.02). Semaglutide had more discontinuations within 6 months of starting the first GLP-1RA, compared to liraglutide (63.4% vs. 43%; P=0.012). Patients aged ≥65 years were more likely to continue the first agent for >6 months compared to those <65 years (65.8% vs. 44%, P=0.014). In successive lines of therapy, treatment-related discontinuations (injection burden, non-response) remained fairly constant (17%, 14%, 14%) but symptom-related (nausea, vomiting, diarrhea, constipation) discontinuations increased steadily from first to third agent (28%, 30%, 48%, respectively). Patients with Medicare/Medicaid were more likely to switch ≥3 therapies, than those with private/self-pay coverage (23% vs. 7.3%; P=0.006).</p><p><strong>Conclusion: </strong>Our findings highlight the importance of tailoring therapy based on drug-specific and patient-related factors to optimize GLP-1RA use in IBS.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 4","pages":"420-427"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12277515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688737","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}

{"title":"Authors' reply.","authors":"Maria José Temido, Margarida Cristiano, Carolina Gouveia, Bárbara Mesquita, Pedro Figueiredo, Francisco Portela","doi":"10.20524/aog.2025.0974","DOIUrl":"10.20524/aog.2025.0974","url":null,"abstract":"","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 4","pages":"463-464"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12277512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688716","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}

{"title":"Neoadjuvant therapy versus upfront surgery approach in resectable pancreatic cancer: a systematic review and meta-analysis.","authors":"Caroline Tanadi, Kevin Tandarto, Maureen Miracle Stella, Randy Adiwinata, Jeffry Beta Tenggara, Paulus Simadibrata, Marcellus Simadibrata","doi":"10.20524/aog.2025.0972","DOIUrl":"10.20524/aog.2025.0972","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic cancer is among the leading causes of cancer-related deaths worldwide. Resectable pancreatic cancer is typically treated with curative resection, often followed by adjuvant therapy. Despite this, recurrence rates remain high after resection. Additionally, micro-metastases may develop during the immediate postoperative period. To address this issue, neoadjuvant therapy has been proposed. This review aimed to assess the effectiveness of neoadjuvant treatment compared to surgery as first approach in resectable pancreatic cancer.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted up to October 2, 2024, in CENTRAL, PubMed, ProQuest, SAGE and JSTOR. Randomized controlled trials (RCTs) evaluating the effects of neoadjuvant treatment in patients with resectable pancreatic cancer were included.</p><p><strong>Results: </strong>A total of 5422 articles were identified after duplicate removal. Following the screening process, 8 RCTs were included. No significant difference was observed in the overall survival (OS) among those who received neoadjuvant therapy and those who underwent upfront surgery (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.72-1.18; P=0.51). Additionally, the groups' disease-free survival (DFS) was comparable (HR 0.98, 95%CI 0.80-1.20; P=0.83). Patients who received neoadjuvant treatment had noticeably higher R0 resection rates compared to the upfront surgery group (risk ratio 1.31, 95%CI 1.11-1.55; P=0.002).</p><p><strong>Conclusions: </strong>When compared to upfront surgery, neoadjuvant therapy significantly improved the R0 resection rates, but had no significant effect on OS or DFS. More research is required to confirm the potential benefits of neoadjuvant therapy in treating resectable pancreatic cancer.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 4","pages":"453-461"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12277514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688722","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}

{"title":"Trends and disparities of diverticular disease mortality in the United States before and during the COVID-19 era: estimates from the Centers for Disease Control WONDER database.","authors":"Thai Hau Koo, Venkata Sunkesula, Rishi Chowdhary, Xue Bin Leong, Ronnie Fass, Ala A Abdel Jalil","doi":"10.20524/aog.2025.0973","DOIUrl":"10.20524/aog.2025.0973","url":null,"abstract":"<p><strong>Background: </strong>Diverticular disease (DD) is a common gastrointestinal condition in the United States (US) associated with significant morbidity and mortality. The COVID-19 pandemic posed new challenges that might exacerbate DD-related outcomes. This study analyzed the trends in all-cause, digestive system (DGS), and cardiovascular system (CVS) mortality associated with DD from 1999-2020, focusing on the impact of COVID-19 on age-adjusted mortality rates (AAMRs) and disparities across demographics and geography.</p><p><strong>Methods: </strong>Data from adults aged ≥25 years were extracted from the Centers for Disease Control WONDER database. AAMRs per 100,000 people were standardized using the 2000 US census. AAMRs were assessed from 1999-2020 for context, while the primary comparative analysis focused on the pre-COVID-19 (2016-2019) and post-COVID-19 (2019-2022) periods using linear regression models. AAMRs were stratified by age, sex, race/ethnicity and geographic region. Note: 2021-2022 trends were extrapolated, as finalized mortality records were not available at the time of analysis.</p><p><strong>Results: </strong>Between 1999 and 2020, 115,009 DD-related deaths occurred (AAMR 2.4/100,000), including 70,648 DGS-related deaths (AAMR 1.5) and 17,405 CVS-related deaths (AAMR 0.4). Females (AAMR 2.6), elderly individuals (AAMR 11.1), and non-Hispanic whites (AAMR 2.5) had the highest mortality rates. Post-COVID-19, AAMRs increased from 1.8 to 2.0, with significant increases among rural populations. DGS-related deaths were most prevalent, particularly in non-metropolitan areas.</p><p><strong>Conclusions: </strong>DD-related mortality has increased in the post-COVID-19 period, especially in vulnerable populations, such as the elderly, rural residents and females. These findings highlight the need for equitable healthcare interventions and the continued monitoring of pandemic-era health disparities.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 4","pages":"428-439"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12277521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688739","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}