Background: The pathophysiological mechanism(s) of gastroesophageal reflux disease (GERD)‐related chronic cough (CC) is unclear. We aimed to determine the mechanism of reflux‐induced cough by synchronous monitoring of reflux episodes, esophageal motility, and cough.Methods: Patients with GERD were prospectively enrolled and classified into GERD with CC (GERD‐CC) and without CC (GERD) groups. Twenty‐four‐hour ambulatory pH‐impedance‐pressure monitoring was performed; the reflux patterns, esophageal motility during prolonged exposure to acid and characteristics of reflux episodes that induced coughing paroxysms were analyzed.Key Results: Thirty‐one patients with GERD‐CC and 47 with GERD were enrolled; all of whose monitoring results fulfilled the criteria for diagnosis of GERD. Patients with GERD‐CC had higher reflux symptom scores, longer exposure to acid, higher DeMeester scores, and more frequent reflux episodes, proximal extent reflux detected by impedance, and higher percentage of strongly acidic reflux than patients in the GERD group (all P < .05). Of 63 reflux‐cough episodes identified in the GERD‐CC group, 74.6% of distal reflux and 67.0% of proximal reflux episodes were acidic. More patients had low pan‐esophageal pressure in primary peristalsis (48.5% vs 11.8%, P = .000) and synchronous contraction in secondary peristalsis during prolonged exposure to acid in the GERD‐CC than in the GERD group (63.9% vs 9.1%, P = .000).Conclusions & Inferences: Proximal acidic reflux and distal reflux‐reflex are jointly associated with reflux‐induced cough in patients with GERD. Low pan‐esophageal pressure in primary peristalsis and synchronous contraction in secondary peristalsis may play important roles in GERD‐associated chronic cough.

To evaluate the risk factors and treatment status of Chinese stroke patients aged 35-45 years old. We collected data from 1988 in-hospital stroke patients aged 35-45 years old from 36 hospitals in mainland China and compared it to 12,260 health controls with the same age. Information about stroke risk factors was obtained through a questionnaire. Multiple logistic regression and chi-square test were performed to explore the association between risk factors and stroke in young patients. Of the stroke patients, 94.3% had an ischemic stroke and 73.0% were male. Frequencies of stroke risk factors were significantly higher in patients than those in controls, including history of hypertension (41.0% versus 9.0%, p<0.05), diabetes (5.2% versus 1.7%, p<0.05), hypercholesterolemia (4.2% versus 2.9%, p<0.05), heart diseases (7.2% versus 1.6%, p<0.05), stroke (14.9% versus 1.3%, p<0.05), smoking (38.8% versus 33.3%, p<0.05) and drinking (38.0% versus 24.9%, p<0.05). Furthermore, only 12.8% of patients with hypertension took antihypertensive drugs regularly, and 27.9% of diabetic patients took hypoglycemic drugs regularly. Risk factors when compared between male and female patients were as follows: history of heart diseases (5.9 versus 10.8, p<0.05), smoking (50.9 versus 6.5, p<0.05) and drinking (50.4 versus 5.8, p<0.05). Majority of the Chinese stroke patients aged 35-45 years were male and had suffered an ischemic stroke. The history of stroke, heart disease and hypercholesterolemia could increase the risk of stroke in young adults, and the risk factors in the order of importance were hypertension, smoking, alcohol drinking, previous stroke, heart disease, diabetes mellitus and hyperlipidemia. Hypertension, smoking and alcohol drinking were found to be the main risk factors; treatment state and lifestyle should be improved for young stroke patients.

Background: Gastroesophageal reflux disease (GERD) is a common condition characterized by the reflux of stomach contents into the esophagus. Despite its widespread prevalence worldwide, the causal link between GERD and various cancer risks has not been fully established, and past medical research has often underestimated or overlooked this relationship. Methods: This study performed Mendelian randomization (MR) to investigate the causal relationship between GERD and 19 different cancers. We leveraged data from 129,080 GERD patients and 473,524 controls, along with cancer-related data, obtained from the UK Biobank and various Genome-Wide Association Studies (GWAS) consortia. Single nucleotide polymorphisms (SNPs) associated with GERD were used as instrumental variables, utilizing methods such as inverse variance weighting, weighted median, and MR-Egger to address potential pleiotropy and confounding factors. Results: GERD was significantly associated with higher risks of nine types of cancer. Even after adjusting for all known risk factors—including smoking, alcohol consumption, major depression, and body mass index (BMI)—these associations remained significant, with higher risks for most cancers. For example, the adjusted risk for overall lung cancer was (OR, 1.23; 95% CI: 1.14–1.33), for lung adenocarcinoma was (OR, 1.18; 95% CI: 1.03–1.36), for lung squamous cell carcinoma was (OR, 1.35; 95% CI: 1.19–1.53), and for oral cavity and pharyngeal cancer was (OR, 1.73; 95% CI: 1.22–2.44). Especially noteworthy, the risk for esophageal cancer increased to (OR, 2.57; 95% CI: 1.23–5.37). Mediation analyses further highlighted GERD as a significant mediator in the relationships between BMI, smoking, major depression, and cancer risks. Conclusions: This study identifies a significant causal relationship between GERD and increased cancer risk, highlighting its role in cancer development and underscoring the necessity of incorporating GERD management into cancer prevention strategies.

Ulcerative colitis (UC)-related post-colectomy enteritis is a very rare condition that is characterized by diffuse small-bowel mucosal inflammation following colectomy and could be very dangerous. In previously reported cases, corticosteroid therapy seemed to be the optimal choice for inducing remission; however, the patient studied herein presented with severe diarrhoea and hypovolemic shock and failed to achieve full remission with corticosteroid therapy. We describe the case of a patient with severe pan-enteritis presenting with life-threatening diarrhoea complicated with hypovolemic shock and acute kidney injury after colectomy and ileal pouch anal anastomosis (IPAA) for UC; this patient was successfully treated by ileostomy closure after failing to achieve full remission with corticosteroid therapy. Next, we review other cases of post-colectomy enteritis reported in the literature and propose a flow-chart for its diagnosis and initial treatment. Post-colectomy enteritis can be dangerous, and the early awareness of this condition plays a vital role. Additionally, in patients who do not respond well to corticosteroid or immunosuppressant therapy, early closure of the ileostomy and re-establishment of the natural faecal stream could be important considerations.

Background and aims: Common variable immunodeficiency disorder (CVID) patients may have gastrointestinal (GI) involvement and suffer from infections, which are poorly understood. This study aimed to evaluate the clinical, endoscopic, and histopathological features of CVID patients with GI symptoms and determine their correlation with infections. Methods: We performed a retrospective study on 21 CVID patients with GI symptoms who underwent endoscopic examination in Peking Union Medical College Hospital from 2000 to 2020. The clinical, infectious, endoscopic, and histopathological features were reassessed. Results: Chronic diarrhea was the most prevalent GI symptom, observed in 95.2% of our CVID cohort. Over 85% of patients had low body weight and malabsorption. Small bowel villous atrophy was found in 90.5% of patients under endoscopy and mostly confirmed by histopathology. GI infections were identified in 9 (42.9%) patients. Of these, 7 patients with diffuse and obvious nodular lymphoid hyperplasia (NLH) of small bowel under endoscopy had significantly higher infection rate (85.7% vs 21.4%, p < 0.05), predominantly with Giardia and bacteria. Small bowel biopsies showed 95% of patients lacked plasma cells and 60% had increased intraepithelial lymphocytes (IELs), but not significantly different between GI infection and non-infection group. Most patients improved after intravenous immunoglobulin and anti-infection therapy. Conclusions: CVID could involve GI tract, particularly small bowel. Obvious NLH under endoscopy could be a hint for GI infection in CVID patients. Comprehensive endoscopic and histopathological evaluation may be helpful in CVID diagnosis and identification of potential co-infection, leading to proper treatment.