Robert Huang

All Publications

• The Association between Antibiotic Consumption and Antimicrobial Resistance-Related Mortality and Costs: an Analysis of European Country-level Data. International journal of antimicrobial agents Mülder, D., van de Schootbrugge-Vandermeer, H. J., Sun, D., van Duuren, L. A., Spaander, M. C., Huang, R. J., Ladabaum, U., Hontelez, J. A., O'Mahony, J. F., Lansdorp-Vogelaar, I. 2026: 107903

  Abstract

  While antibiotic use is recognized to contribute to antimicrobial resistance (AMR), the magnitude of its impact on AMR-related harms is not well understood. This study quantifies the association between antibiotic consumption and AMR-related mortality and costs.Antibiotic consumption expressed in defined daily dose per 1,000 inhabitants per day (DID) was sourced from pharmaceutical sales data from 30 European countries. Linear regression models were fitted to assess the association between antibiotic consumption and (a) AMR-related mortality in 2023 and (b) AMR-related healthcare costs in 2021. Estimates were adjusted for key confounders, including median age, gross domestic product (GDP) and hospital bed density. Leave-one-out and time-lag sensitivity analysis were performed to test robustness.Each unit increase in DID of average antibiotic consumption was associated with 0.3 (95% Confidence Interval [CI]:0.2-0.5) additional AMR-related deaths per 100,000, and an increase in AMR-related costs of 5.6% (95% CI: 1.8%-9.3%), holding all other variables constant. Mortality estimates were robust across sensitivity analyses, while cost-estimates were sensitive to excluding outliers. Using antibiotic consumption from earlier years did not significantly affect the results.This ecological study demonstrated that antibiotic consumption is positively associated with AMR-related mortality and costs across European countries. Despite the ecological nature of this study, the presented quantitative estimates can be used to inform health policy analyses of antibiotic interventions. Although missing data and context-specific factors may have limited the robustness of the cost association, these findings suggest that reducing unnecessary antibiotic consumption could help lower AMR-related mortality and healthcare costs.

  View details for DOI 10.1016/j.ijantimicag.2026.107903

  View details for PubMedID 42409125

• Intentional self-harm mortality among 15-24 year olds in Asian American subgroups, 2005-2022: a population-based incidence study. Lancet regional health. Americas Uy, L. A., Chang, E., Desai, S., Villarreal Rodriguez, M. E., Hung, G. A., Kikuta, N., Jamal, A., Bacong, A. M., Huang, R. J., Kim, G. S., Palaniappan, L. P., Srinivasan, M., Rajeshuni, N., Sust, S. 2026; 59: 101484

  Abstract

  Among U.S. youth aged 15-24 years, suicide is the leading cause of death for Asian American youth, yet surveillance data are rarely disaggregated by racial subgroup. We examined whether suicide mortality differs across six Asian American subgroups.We analyzed National Center for Health Statistics mortality data for 2005 through 2022, linked with American Community Survey population denominators. Deaths from intentional self-harm (ICD-10 codes X60-X84, Y87.0) were identified among Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese youth, with non-Hispanic White and Asian Youth as comparison groups. We calculated annualized mortality rates (AMR), rate ratios (RR), proportional mortality, proportional mortality ratios, crude mortality rate (CMR) trends, and annual percentage changes (APC) using Joinpoint regression with heteroscedastic error models.Between 2005 and 2022, 2519 Asian American youth died by intentional self-harm. The AMR for Asian Youth was 8.37 per 100,000 (95% CI, 8.04-8.69), compared with 14.34 (14.23-14.46) for non-Hispanic White youth. Korean youth had the highest AMR (9.92; 8.87-10.97) and mortality (33.8%; 30.9-36.7); Chinese youth had the lowest AMR (6.38; 5.87-6.90). Among Asian Youth, Korean (RR, 1.19; 1.06-1.33), Vietnamese (1.14; 1.03-1.27), and Filipino (1.13; 1.03-1.24) youth had significantly elevated mortality. Four subgroups showed sustained CMR increases (APC, 4.9-9.1%), while Asian Indian youth rose significantly before declining. These trends contrast with a post-2018 decline among non-Hispanic White youth. State-level analysis demonstrated substantial inter-subgroup heterogeneity.Disaggregation reveals clinically meaningful variation in mortality that aggregated surveillance conceals. Race-specific, culturally grounded prevention strategies are needed, particularly for Korean, Vietnamese, and Filipino youth who bear a disproportionate and growing burden.This study received no external funding. The Stanford Center for Asian Health Research and Education provided institutional support; the Chi-Li Pao Foundation USA supported conference dissemination.

  View details for DOI 10.1016/j.lana.2026.101484

  View details for PubMedID 42099552

  View details for PubMedCentralID PMC13146612

• Cross-country comparison of perinatal outcomes between japanese mothers in the united states and japan: a cross-sectional study. BMJ public health Mito, A., Tomita, H., Iwama, N., Kawai, S., Helkey, D., Obara, T., Huang, R. J., Hamada, H., Noda, A., Ishikuro, M., Kuriyama, S., Ikeno, F., Arata, N., Saito, M., Palaniappan, L., Bacong, A. M. 2026; 4 (2): e003729

  Abstract

  In the USA, studies often show that immigrants exhibit relatively favourable perinatal outcomes compared with their US-born counterparts of the same race/ethnicity, despite socioeconomic and language barriers in healthcare. However, studies with individuals in their home country are limited.We analysed 32 028 Japanese who gave singleton births from two data sources: the US vital statistics records (N=19 462) and the Birth and Three-Generation Cohort Study conducted by the Tohoku Medical Megabank Organization (N=12 566) between 2015 and 2017. The US data were divided into two groups based on nativity: the first generation and the second generation and later. Using Japanese women who delivered in Japan as the reference, associations between nativity and perinatal outcomes were evaluated using regression models, with analyses stratified by pre-pregnancy body mass index category. The ORs (95% CI) of preterm birth were higher among Japanese women in the USA (the first generation: 1.20 (1.15 to 1.33); the second generation and later: 1.40 (1.28 to 1.54)), as were the ORs of macrosomia (1.71 (1.48 to 1.98) and 1.98 (1.68 to 2.32), respectively). In contrast, the ORs of term or post-term low birth weight were lower among Japanese women in the USA (0.77 (0.71 to 0.84) and 0.81 (0.71 to 0.91), respectively). The association of nativity on the ORs of low birth weight differed depending on the term of birth.Japanese immigrants to the USA have heterogenous risk of perinatal outcomes compared with Japanese who remain in Japan. Including home country data in immigration studies may provide a more detailed understanding of the impact of immigration on their perinatal outcomes.

  View details for DOI 10.1136/bmjph-2025-003729

  View details for PubMedID 42344031

  View details for PubMedCentralID PMC13289327

• Personal and Family History of Cancer and Primary Lung Cancer Prevalence Among Never Smoking Disaggregated Asian American Women. Cancers Kaur, B., Biswas, A., Chervo, T., Ahn, W. J., Gao, S., Nguyen, D., Villanueva, C. A., Tivakaran, S. J., Srinivasan, M., Panyanouvong, N. L., Uy, L. A., Rajeshuni, N., Huang, R. J., Kamdar, N., Yasui, O., Kim, G. S., Palaniappan, L., Velotta, J. B. 2026; 18 (12)

  Abstract

  Despite a decline in lung cancer in the U.S., lung cancer among never-smoking Asian American (AsA) women is rising, and subgroup aggregation obscures heterogeneity. We compared primary lung cancer prevalence across disaggregated AsA subgroups and examined factors associated with prevalence such as personal- and family-cancer histories versus Non-Hispanic Whites (NHWs).This cross-sectional study analyzed electronic health records of AsA women (≥18) in a large Northern California health system (2010-2022). Lung cancer cases were obtained from the hospital registry and categorized by smoking status and self-reported ethnicity. Adjusted prevalence ratios (aPRs) were estimated using targeted maximum likelihood estimation, accounting for sociodemographic, smoking, and clinical covariates.Among 1,843,119 women, 8651 had primary lung cancer; 2429 were never-smokers. In AsA never-smokers, aPRs and 95% confidence intervals versus age-matched NHW were: Chinese (3.36, [3.20-3.53]), Filipino (2.68, [2.55-2.82]), Vietnamese (2.07, [1.96-2.18]), Japanese (1.99, [1.89-2.10]), Korean (1.90, [1.80-2.00]), and Other Asian (0.35, [0.33-0.37]). Personal cancer-history reflected an increase in prevalence among Korean patients (2.91, [2.76-3.06]) while family cancer-history demonstrated increased prevalence among Chinese patients (1.51, [1.42-1.60]). Among women with uterine cancer, Chinese patients had higher lung-cancer prevalence than NHW (1.91, [1.58-2.31]).Never-smoking disaggregated AsA women show heterogeneous lung cancer prevalence, with higher prevalence in Korean women with personal cancer-history and in Chinese women with family cancer-history compared with NHW, supporting history-informed and ethnic-specific lung cancer screenings.

  View details for DOI 10.3390/cancers18121862

  View details for PubMedID 42352397

• Two decades of change: Trends and disparities in breast cancer surgical outcomes. Nair, S., Rajinikanth, N., Ahmed, A., Suh, M., Huang, C., Tivakaran, S., Srinivasan, M., Panyanouvong, N., Rajeshuni, N., Huang, R. J., Kamdar, N., Yasui, O., Kim, G., Palaniappan, L., Thompson, C. LIPPINCOTT WILLIAMS & WILKINS. 2026: e12742

  View details for DOI 10.1200/JCO.2026.44.16_suppl.e12742

  View details for Web of Science ID 001780554000018

• Basal gland localization and focal distribution of OLFM4-expressing cells in increasing severity of gastric intestinal metaplasia. bioRxiv : the preprint server for biology Sathe, A., Meka, R., Geier, B., Long, R., Wong, C., Wichmann, I. A., Han, S., Shen, J., Amieva, M. R., Ji, H. P., Huang, R. J. 2026

  Abstract

  Patients with gastric intestinal metaplasia (GIM), a precancerous lesion, are at high risk for progressing to gastric cancer. Identifying these patients is critical to enable gastric cancer interception. Current approaches rely primarily on histologic evaluation of GIM severity and extent, which may be improved by incorporating molecular features that distinguish high-risk lesions. Our prior single-cell and spatial transcriptomics study identified differentially expressed genes associated with the highest-risk category of GIM. They included ANPEP expressed in enterocytes and CPS1 and OLFM4 expressed in intestinal stem-like or progenitor cells. We evaluated the protein expression and localization of these three markers to understand the cellular features associated with GIM risk and their spatial distribution within metaplastic tissues. Using multiplex immunofluorescence, whole slide image analysis and confocal microscopy, we examined protein expression from 100 tissue biopsies annotated for metaplasia severity using the Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM) system. Tissue samples included control gastric tissue, GIM, dysplasia and adenocarcinoma. Quantitative whole slide image analysis demonstrated that CPS1 expression had a modest association with disease severity. Although ANPEP was strongly associated with GIM severity, it was also frequently expressed in stromal regions outside epithelial glands. In contrast, OLFM4 expression was largely restricted to epithelial glands and showed a strong association with increased OLGIM severity. These OLFM4-positive epithelial cells were present in discrete glandular foci that expanded with increasing severity of metaplasia. Within individual metaplastic glands, OLFM4 expression was highest at the gland base with decreased expression toward the gland surface. Overall, these findings identified OLFM4 as a protein marker associated with high-risk GIM. The spatial organization of OLFM4-expressing cells at the base of metaplastic glands and their focal expansion within tissues suggest the presence of a stem cell-like epithelial compartment that may contribute to the progression of GIM towards gastric cancer.

  View details for DOI 10.64898/2026.05.14.725297

  View details for PubMedID 42239144

  View details for PubMedCentralID PMC13228221

• Cross-country comparison of perinatal outcomes between japanese mothers in the united states and japan: a cross-sectional study BMJ PUBLIC HEALTH Mito, A., Tomita, H., Iwama, N., Kawai, S., Helkey, D., Obara, T., Huang, R. J., Hamada, H., Noda, A., Ishikuro, M., Kuriyama, S., Ikeno, F., Arata, N., Saito, M., Palaniappan, L., Bacong, A. M. 2026; 4 (2)

  View details for DOI 10.1136/bmjph-2025-003729

  View details for Web of Science ID 001792430500001

• Racial and geographic differences of opioid overdose deaths involving additional drugs of abuse: analysis of US mortality database. British journal of anaesthesia Calumpit, M. M., Hin, C. C., Rachapudi, M., Kwan, C. Y., Choi, J., Sumerlin, T., Shang, L., Zhang, B., Yeung, D., Uy, L. A., Jamal, A., Huang, R. J., Kim, G., Palaniappan, L., Srinivasan, M., Rajeshuni, N., Gross, E. R. 2026

  View details for DOI 10.1016/j.bja.2026.03.063

  View details for PubMedID 42103500

• Sleep Duration and Psychological Distress: Mental Health Disparities Among Asian American Adults, National Health Interview Survey 2006-2018 Gunda, S., Xie, W., Parhar, S., Rodriguez, M. E., Jamal, A., Hung, G., Kikuta, N., Huang, R., Kim, G., Palaniappan, L., Rajeshuni, N., Srinivasan, M., Eggart, L. OXFORD UNIV PRESS INC. 2026: A482-A483

  View details for DOI 10.1093/sleep/zsag091.1081

  View details for Web of Science ID 001760849300035

• Single-cell multi-omic characterization of gastric intestinal metaplasia reveals potential genetic, epigenetic and isoform signatures of lesions at high risk for GC progression Lee, D., Bai, X., Grimes, S., Lee, K., Wang, Y., Wong, C., Sathe, A., Wichmann, I., Kim, Y., Meka, R., Long, R., Im, A., Lau, B., Huang, R., Ji, H. P. AMER ASSOC CANCER RESEARCH. 2026: 4130

  View details for DOI 10.1158/1538-7445.AM2026-4130

  View details for Web of Science ID 001734115300035

• Machine Learning-Based Analysis of Behavioral and Social Determinants of Cardiovascular Mortality in Adults With Diabetes Ahn, W., Gao, S., Kaur, B., Biswas, A., Nguyen, D., Tivakaran, S., Srinivasan, M., Panyanouvong, N., Uy, L., Rajeshuni, N., Huang, R., Kamdar, N., Yasui, O., Kim, G., Palaniappan, L., Le, M., Sun, L. LIPPINCOTT WILLIAMS & WILKINS. 2026: ATH842

  View details for DOI 10.1161/cir.153.suppl_1.TH842

  View details for Web of Science ID 001756041200006

• The impact of an organized screening program on gastric cancer incidence: a quasi-experimental study. International journal of epidemiology Sun, D., Mülder, D. T., Jung, K. W., Park, J. Y., Suh, M., Li, Y., Nieboer, D., Hamashima, C., Han, W., Spaander, M. C., Ladabaum, U., Huang, R. J., O'Mahony, J. F., Lansdorp-Vogelaar, I. 2026; 55 (2)

  Abstract

  Evidence of gastric cancer (GC) screening's impact on GC incidence remains limited. In 2002, South Korea started a nationwide GC screening program. This study uses a quasi-experimental design to evaluate the effect of the program on GC incidence in Seoul.Using a flexible synthetic control method (SCM), we estimated the impact of GC screening on age-standardized GC incidence in Seoul. Annual age-specific GC incidence data were obtained from the Seoul Cancer Registry and Cancer Incidence in Five Continents Plus database. Post-intervention trends in GC incidence between Seoul and the synthetic control were compared to estimate average rate ratios (RRs) with 95% confidence intervals (CIs). Several sensitivity and alternative analyses were performed, including a modified age-period-cohort (APC) analysis.The screening program was associated with a higher GC incidence in Seoul compared to the synthetic control, with an average post-intervention RR of 1.11 (95% CI: 0.99-1.24). After 2002, the start of the screening program, there was a noticeable increase in the post-intervention differences between Seoul and the synthetic control, which peaked in 2011 (RR 1.26), and then began to fall. The results were robust across sensitivity analyses and alternative analyses. The modified APC analysis indicated that after initially expanding and then diminishing, the effect eventually reversed, resulting in a reduction in incidence.These findings suggest that healthcare sectors should anticipate an immediate increase in care demands following GC screening implementation. While a subsequent reduction in GC incidence is expected, the potential preventive impact remains inconclusive.

  View details for DOI 10.1093/ije/dyag018

  View details for PubMedID 41709678

• AGA Clinical Practice Update on Management of Gastric Polyps: Expert Review. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association Buchner, A. M., Huang, R. J., Lauwers, G. Y., El-Serag, H. B. 2026

  Abstract

  This Clinical Practice Update (CPU) expert review will advise clinicians on the diagnosis and management of gastric mucosal polyps. Gastric polyps are raised epithelial lesions of the gastric mucosa that can arise from various mucosal alterations and perturbations, including mucosal hyperplasia, adenoma, fundic gland proliferation, and enterochromaffin-like cell proliferation. Current guidance on the management of gastric polyps remains limited. This CPU provides a framework for understanding the natural history and epidemiology of gastric polyps and advises on best practices for the endoscopic detection and classification of gastric polyps, the endoscopic resection of gastric polyps, and endoscopic surveillance following resection. Because gastric polyps often occur within a field of altered gastric mucosa (eg, mucosal atrophy, pseudo-pyloric and intestinal metaplasia), we will advise on best practices for the sampling and surveillance of mucosal pathology giving rise to gastric polyps. This CPU is intended to complement other documents issued by the American Gastroenterological Association (AGA) Institute on gastric neoplastic and pre-neoplastic lesions, including the clinical practice guidelines on management of gastric intestinal metaplasia, as well as AGA CPUs on atrophic gastritis, high-quality upper endoscopy, and screening and surveillance of individuals at increased risk for gastric cancer.This expert review was commissioned and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the CPUC and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. These Best Practice Advice (BPA) statements were drawn from a review of the published literature and from expert opinion. Because systematic reviews were not performed, these BPA statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations. BEST PRACTICE ADVICE STATEMENTS BPA 1: Gastric polyps are frequently identified during upper endoscopy exams and include different histologic subtypes, such as fundic gland polyps (FGPs), gastric hyperplastic polyps (GHPs), hamartomatous polyps, gastric adenomas (GAs), pyloric gland adenomas, oxyntic gland adenomas, and gastric neuroendocrine tumors (G-NETs). BPA 2: Clinicians should be aware that different types of gastric polyps may coexist in the same person. BPA 3: Clinicians should be aware that different types of gastric polyps are associated with varying spectra of histopathologic abnormalities in the surrounding gastric mucosa, which may aid in their identification and diagnosis. BPA 4: Systematic endoscopic examination of the polyps and the surrounding gastric mucosa is essential in assessing the underlying gastric mucosa pathology (eg, Helicobacter pylori gastritis, autoimmune gastritis, gastric intestinal metaplasia [GIM]) and determining subsequent management: biopsies of the polyps, biopsies of the surrounding mucosa, and resection of the polyps. BPA 5: All patients with adenomatous or hyperplastic gastric polyps should be tested and treated if positive for H pylori infection. BPA 6: Patients who are using proton pump inhibitors (PPIs) for valid reasons do not need to discontinue these medications in the presence of documented fundic gland hyperplasia-related gastric polyps. BPA 7: Clinicians should be aware that different histological types of gastric polyps have unique/characteristic topographical features, endoscopic features, and size. BPA 8: Endoscopic evaluation of patients with gastric polyps should include complete inspection with high-definition white-light and enhanced imaging, such as virtual chromoendoscopy. Endoscopists should recognize and photo-document the endoscopic features of gastric polyps as well as the surrounding gastric mucosal abnormalities. BPA 9: Clinicians should be aware that endoscopic resection of the polyps includes traditional techniques (snare and biopsy forceps, mucosal resection) or endoscopic submucosal dissection. BPA 10: In the presence of numerous gastric polyps of varied sizes, the largest polyps should be resected when possible, and the smaller polyps sampled or resected. BPA 11: Suspected abnormalities in the surrounding mucosa, such as GIM or atrophic gastritis, should undergo targeted biopsies according to the existing protocols. BPA 12: Surveillance plans in patients with gastric polyps should be formulated based on the histopathological type of the polyps and the surrounding gastric mucosa. BPA 13: When a dysplastic lesion in the polyp is confirmed and resected completely, a follow-up surveillance endoscopy should be completed in 1 year for patients with low-grade dysplasia polyps and 6 months for patients with high-grade dysplasia polyps. If the polyp is biopsied or resection is incomplete, follow-up endoscopy is advised within 3 months for high-grade dysplasia and 6 months for low-grade dysplasia. BPA 14: Endoscopic surveillance is advised in patients with gastric polyps when the histopathology of adjacent mucosa confirms GIM and/or atrophic gastritis.

  View details for DOI 10.1016/j.cgh.2026.01.007

  View details for PubMedID 41711625

• Mutational Signatures and Clonal Hematopoiesis in Intestinal Metaplasia across Countries with Varying Stomach Cancer Incidence. Cancer discovery Huang, K. K., Hagihara, T., Lian, B. S., Ong, Z. X., Lim, S. K., Chong, R. H., Srivastava, S., Kang, J. X., Lee, M. Y., Tan, A. L., Lee, M., Ho, S. W., Binte Abdul Ghani, S. A., Ng, C. S., Liang, R., Liu, L., Tay, S. T., Ong, X., Zhu, F., Chen, H., Li, Z., Ang, T. L., Gotoda, T., Huang, R. J., Khor, C. J., Kim, H. S., Lau, L. H., Lee, Y. C., Takasu, A., Teh, M., Thian, M. Y., Tam, W. L., Lu, X., Wong, S. H., So, J. B., Chung, H., Lee, J., Yeoh, K. G., Tan, P. 2026: OF1-OF24

  Abstract

  Intestinal metaplasia (IM) is a premalignant condition associated with increased risk of gastric cancer-a deadly malignancy with varying geographic incidence. High-depth targeted sequencing of more than 1,500 IM samples from six countries identified 47 significantly mutated genes, including driver genes associated with high-risk populations and worse prognosis (ARID1A), KRAS/MAPK signaling (KRAS, BRAF, MAP2K1, MAP3K1, and MAP2K4), and altered mucosal immunity (PIGR). IM whole-genome sequencing and DNA methylation analysis revealed SBS17 as a specific mutational signature separating IMs from normal gastric tissues, associated with late DNA replication, genomic hypomethylation, and tobacco exposure. Beyond epithelial-derived somatic mutations, we observed elevated clonal hematopoiesis (CH) in patients with IM associated with age, smoking, and enhanced risk of progressing to gastric cancer. Patients with CH expansions exhibited co-occurring IM PIGR truncating mutations and greater colonization of the IM microenvironment by orally derived bacteria, suggesting that CH may promote IM progression by modulating host-microbe mucosal immunity.This international study identifies recurrent IM driver genes, IM-specific mutational signatures, and alterations in IM-associated immune landscapes and microbiomes. Our results highlight a role for nonepithelial somatic alterations (CH) in IM progression to gastric cancer, offering new translational opportunities for early cancer detection and interception.

  View details for DOI 10.1158/2159-8290.CD-25-0778

  View details for PubMedID 41532847

• Comparison between optimized bismuth quadruple therapy and standard clarithromycin-based triple therapy for first-line Helicobacter pylori eradication: a double-blind randomized controlled trial. Lancet regional health. Americas Medel-Jara, P. A., Latorre, G., Fuentes-Lopez, E., Pizarro, M., Viviani, P., Chahuán, J., Maquilón, S., Corsi, O., Reyes, D., Espino, A., Vargas, J. I., Wichmann, I. A., Harris, P., Serrano, C., Buruato, I., Sandoval, C., Varela, N. M., Cerpa, L., Quiñones, L., Megraud, F., Huang, R. J., Shah, S. C., Perez, A. R. 2026; 53: 101312

  Abstract

  Helicobacter pylori eradication reduces the risk of peptic ulcer disease and gastric cancer. In Chile, the effectiveness of standard triple therapy has dropped below 80%. We compared optimized bismuth quadruple therapy: esomeprazole 40 mg three times a day, amoxicillin 1 gr three times a day, metronidazole 500 mg three times a day, and bismuth subsalicylate 369 mg three times a day for 14 days, and standard triple therapy omeprazole 20 mg twice a day, amoxicillin 1 gr twice a day, and clarithromycin 500 mg twice a day for 14 days in a Chilean population.Randomized double-blind clinical trial. 127 treatment-naïve individuals with confirmed active H. pylori were recruited. The primary outcome was successful H. pylori eradication, at least 4 weeks post-treatment. We assessed H. pylori resistance to clarithromycin and participants' CYP2C19 genotype/phenotype. We compared eradication success between the groups using intention-to-treat and per-protocol analyses. The trial adhered to CONSORT guidelines. NTC-Number: NCT05664685 (trial completed).127 participants were recruited and randomized (64 standard triple therapy, 63 optimized bismuth quadruple therapy). Men were 44% (56/127), and the mean age was 48 (standard deviation: 14.2) in the sample. Baseline characteristics between the two groups were similar. In intention-to-treat analysis, optimized bismuth quadruple therapy had a significantly higher eradication rate versus standard triple therapy: 95% (60/63) [95% CI 86%-99%] vs. 81% (52/64) [70%-89%], p = 0.033. Adverse events were comparable: optimized bismuth quadruple therapy 67% (42/63) [54%-77%] vs. standard triple therapy 66% (42/64) [53%-76%], p = 1.00. There was no difference in baseline clarithromycin resistance or CYP2C19 polymorphisms.Optimized bismuth quadruple therapy eradication is higher than standard triple therapy in treatment-naïve individuals with active H. pylori, without difference in adverse events or adherence. Optimized bismuth quadruple therapy is a reliable and safe empiric eradication therapy, especially in areas with high clarithromycin resistance.FONDECYT (1230504 AR); ANID-FONDAP (152220002 AR); Horizon 2020 program of European Union (825832 AR); ANID-FONDAP (15130011).

  View details for DOI 10.1016/j.lana.2025.101312

  View details for PubMedID 41362749

  View details for PubMedCentralID PMC12681926

• Comparison between optimized bismuth quadruple therapy and standard clarithromycin-based triple therapy for first-line<i> Helicobacter</i><i> pylori</i> eradication: a double-blind randomized controlled trial LANCET REGIONAL HEALTH-AMERICAS Medel-Jara, P., Latorre, G., Fuentes-Lopez, E., Pizarro, M., Viviani, P., Chahuan, J., Maquilon, S., Corsi, O., Reyes, D., Espino, A., Vargas, J., Wichmann, I. A., Harris, P., Serrano, C., Buruato, I., Sandoval, C., Varela, N. M., Cerpa, L., Quinones, L., Megraud, F., Huang, R. J., Shah, S. C., Perez, A. 2026; 53

  View details for DOI 10.1016/j.lana.2025.101312

  View details for Web of Science ID 001629117000001

• Health Inequity of Stage and Survival of Gastric Cancer in California. Cancers Ituarte, P. H., Sullivan, K., Jankowska, M. M., Nelson, R., Huang, R., Hernandez, M. C., Wong, C. W., Deshpande, S., Paz, I. B., Melstrom, L., Kim, E. S., Fong, Y., Woo, Y., 2025; 17 (22)

  Abstract

  Background: Gastric cancer (GC) remains a significant health burden in the U.S, particularly among ethnic minorities. We identified patient-level risk factors contributing to advanced-stage (AS) diagnosis and poor survival to guide strategies to address GC-related health disparities. Methods: We conducted a retrospective cohort analysis of 18,396 histologically confirmed GC cases (4102 early-stage (ES) and 14,294 AS) diagnosed between 2000 and 2019, using data from the California Cancer Registry linked to the California Office of Statewide Health Planning and Development. Eligible cases were adults age ≥ 18 with complete diagnostic and follow-up data. Multivariable logistic and Cox regression models were used to identify predictors of AS-GC and five-year disease-specific (DSS) and overall-survival (OS) outcomes. Analyses were further stratified by Asian and Hispanic subgroups. Results: Korean heritage was the strongest predictor of ES-GC [OR 0.58 (95% CI, 0.47-0.71), p < 0.001] and was independently associated with the lowest GC-specific mortality risk [HR 0.73 (95% CI: 0.67-0.80), p < 0.0001]. The youngest age group (18-44 years) had the highest AS-GC rate (91.4%). Asian ethnicity, receipt of care at NCI-designated cancer centers, and prior upper endoscopy were associated with improved OS and DSS. In contrast, comorbidities such as GERD, diabetes, liver disease, smoking and alcohol abuse, and older age ≥ 75, U.S.-birth, and rural residence were linked to worse outcomes. Conclusions: Distinct demographic, clinical, and healthcare access factors contribute to disparities in GC outcomes. These findings support the development of culturally tailored early-detection programs, and risk-based screening for GC care, particularly in vulnerable populations.

  View details for DOI 10.3390/cancers17223596

  View details for PubMedID 41300963

  View details for PubMedCentralID PMC12651519

• ACCULTURATION AND MENTAL HEALTH CHALLENGES IN ASIAN AMERICAN YOUTH Ahn, S., Valencia, F. M., Wang, K., Gowrikanthan, T., Choi, J., Uy, L., Huang, R., Kim, G., Palaniappan, L., Rajeshuni, N., Srinivasan, M., Sust, S. ELSEVIER SCIENCE INC. 2025

  View details for DOI 10.1016/j.jaac.2025.08.034

  View details for Web of Science ID 001642068800141

• Disaggregation of Hepatobiliary Cancer Mortality Among Asian Americans: Analysis of NVSS Mortality Data. Cancer medicine Park, A., Vodinh-Ho, A., Rok, I., Qi, X., Hung, G. A., Kikuta, N., Jamal, A., Kim, G. S., Palaniappan, L. P., Srinivasan, M., Huang, R. J., Bacong, A. M. 2025; 14 (19): e71259

  Abstract

  Asian Americans (AAs) are a diverse population, and aggregation of AA health data in national reports conceals significant differences between AA subgroups. As hepatobiliary cancer rates increase globally, a greater understanding of hepatobiliary mortality among AA subgroups could motivate precision intervention and screening programs.Using national mortality data from 2005 to 2020, we report age-adjusted mortality rates, standardized mortality ratios, and annual percent change for hepatocellular carcinoma (HCC), nonspecified liver cancer (NOS), intrahepatic cholangiocarcinoma (ICC), extrahepatic cholangiocarcinoma (ECC), and gallbladder cancer (GBC) using national mortality data for the six largest AA subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) compared to non-Hispanic White people (NHW).All AA subgroups (except Asian Indians) had significantly higher hepatobiliary cancer mortality than NHW people. Vietnamese people demonstrated the highest mortality from HCC (7.65 per 100,000) and nonspecified liver cancer (5.57 per 100,000), while Korean people had the highest mortality from the biliary tract cancers: ICC (3.10 per 100,000), GBC (0.72 per 100,000), and ECC (0.97 per 100,000). Notably, ICC mortality increased across the study period. Across all subgroups, male individuals had significantly higher hepatobiliary cancer mortality than female individuals, with differences being largest for HCC and nonspecified liver cancer.Differences in mortality across hepatobiliary cancer types demonstrate the importance of analyzing subtypes separately. These differences also highlight the importance of developing ethnically targeted screening, prevention strategies, and treatment.

  View details for DOI 10.1002/cam4.71259

  View details for PubMedID 41020616

• Underreporting of Gastric Intestinal Metaplasia Due to Underutilization of Diagnostic Codes. Gastro hep advances Yang, J. Y., Park, J., Pang, C., Huang, R. J., Camargo, M. C., Hur, C. 2025; 4 (10): 100789

  View details for DOI 10.1016/j.gastha.2025.100789

  View details for PubMedID 41142517

  View details for PubMedCentralID PMC12547224

• Disparities in adult asthma outcomes among disaggregated data among Asian Americans in the National Health Interview Survey. The journal of allergy and clinical immunology. Global Zhang, A., Soogoor, N., Crowther, T., Vohra, S., Jamal, A., Srinivasan, M., Kim, G., Kim, K., Palaniappan, L., Huang, R., Eggert, L. E. 2025; 4 (3): 100458

  Abstract

  Asthma is a chronic lung disease affecting 8% of US adults, with significant disparities among racial and ethnic groups. The Asian American population is diverse, yet asthma research often aggregates data, potentially obscuring group-specific differences. Disaggregated data reveal that although Asian Americans overall appear to have lower asthma prevalence than non-Hispanic Whites, certain subgroups, like Filipino adults, have higher rates. Asthma outcomes are influenced by genetics, environmental exposures, and social determinants, although the specific impact of these factors remains unclear.The objective was to better describe asthma outcomes among disaggregated Asian American groups.We analyzed 2006-18 National Health Interview Survey data on asthma prevalence among non-Hispanic White and disaggregated Asian American adults. Logistic regression was used to calculate adjusted odds ratios (ORs) for Asian American asthma outcomes compared to non-Hispanic Whites, accounting for demographic, health, and socioeconomic factors.Asthma prevalence varied among adults: non-Hispanic White (n = 33,764), Chinese (n = 310, OR = 0.54), Filipino (n = 603, OR = 1.03), Asian Indian (n = 236, OR = 0.43), and other Asians (n = 601, OR = 0.61). Over half had poor asthma control: 62% non-Hispanic White, 53.5% Chinese (OR = 0.72), 50.2% Filipino (OR = 0.64), 54.8% Asian Indian (OR = 0.75), and 59.2% other Asian (OR = 0.82). Filipino adults showed higher asthma prevalence (OR = 1.37) but better control (OR = 0.74). Chinese (OR = 0.39) and Asian Indian (OR = 0.48) adults had fewer emergency department visits. Sociodemographic and health factors significantly affected symptoms, attacks, and emergency department visits.Asthma prevalence and control varied widely among Asian American populations. Sociodemographic and health factors influenced poor asthma control more than racial group.

  View details for DOI 10.1016/j.jacig.2025.100458

  View details for PubMedID 40343011

  View details for PubMedCentralID PMC12060444

• Disparities in Adult Asthma Outcomes Among Disaggregated Data Among Asian Americans in the National Health Interview Survey Journal of Allergy and Clinical Immunology: Global Alan, Z. 2025: 100458

  Abstract

  Asthma is a chronic lung disease affecting 8% of US adults, with significant disparities among racial and ethnic groups. The Asian American population is diverse, yet asthma research often aggregates data, potentially obscuring group-specific differences. Disaggregated data reveal that although Asian Americans overall appear to have lower asthma prevalence than non-Hispanic Whites, certain subgroups, like Filipino adults, have higher rates. Asthma outcomes are influenced by genetics, environmental exposures, and social determinants, although the specific impact of these factors remains unclear.The objective was to better describe asthma outcomes among disaggregated Asian American groups.We analyzed 2006-18 National Health Interview Survey data on asthma prevalence among non-Hispanic White and disaggregated Asian American adults. Logistic regression was used to calculate adjusted odds ratios (ORs) for Asian American asthma outcomes compared to non-Hispanic Whites, accounting for demographic, health, and socioeconomic factors.Asthma prevalence varied among adults: non-Hispanic White (n = 33,764), Chinese (n = 310, OR = 0.54), Filipino (n = 603, OR = 1.03), Asian Indian (n = 236, OR = 0.43), and other Asians (n = 601, OR = 0.61). Over half had poor asthma control: 62% non-Hispanic White, 53.5% Chinese (OR = 0.72), 50.2% Filipino (OR = 0.64), 54.8% Asian Indian (OR = 0.75), and 59.2% other Asian (OR = 0.82). Filipino adults showed higher asthma prevalence (OR = 1.37) but better control (OR = 0.74). Chinese (OR = 0.39) and Asian Indian (OR = 0.48) adults had fewer emergency department visits. Sociodemographic and health factors significantly affected symptoms, attacks, and emergency department visits.Asthma prevalence and control varied widely among Asian American populations. Sociodemographic and health factors influenced poor asthma control more than racial group.

  View details for DOI 10.1016/j.jacig.2025.100458

  View details for PubMedCentralID PMC12060444

• Response to Dell'Unto et al. The American journal of gastroenterology Jove, A., Huang, R. J. 2025

  View details for DOI 10.14309/ajg.0000000000003578

  View details for PubMedID 40576651

• Lung Cancer Screening Disparities in Asian American Subgroups in a Large Integrated Health System. The American surgeon Tivakaran, S. J., Raghu, J. L., Leung, J. C., Tong, K. S., Panyanouvong, N. L., Javier, C., Jiang, S. F., Uy, L. A., Jamal, A., Srinivasan, M., Rajeshuni, N., Kim, G. S., Huang, R. J., Palaniappan, L., Velotta, J. B. 2025: 31348251353073

  Abstract

  BackgroundLung cancer is the leading cause of cancer-related deaths worldwide in Asian Americans (AsA), yet AsA lung cancer screening (LCS) rates are unknown. We examined LCS rates in AsA within Kaiser Permanente Northern California (KPNC), a large integrated healthcare system where LCS is a member benefit. The California LCS rate is 0.7%.MethodsThis cohort study analyzed KPNC 2015-2022 electronic health records. Lung cancer screening rates were compared among AsA subgroups, controlling for sociodemographics, considering both more restrictive 2013 (n = 2,273) and more inclusive 2021 (n = 5,823) United States Preventive Services Task Force (USPSTF) LCS guidelines, which differ by age range and years post-smoking cessation.ResultsOverall KPNC LCS rates for eligible AsA patients were 4.3% and 2.7% using USPSTF 2013 and 2021 guidelines, respectively. Lung cancer screening rates varied by AsA subgroup. Under 2021 guidelines, Chinese (4.0%) were screened more than Korean (3.57%), Southeast Asian (3.52%), Japanese (3.19%), Asian (Other) (2.28%), Pacific Islander (1.91%), and Filipino (1.55%). Under 2013 guidelines, Southeast Asian (6.54%) were screened more than Chinese (6.51%), Japanese (5.36%), Asian (Other) (3.95%), and Filipino (1.93%).DiscussionThis is the first study to demonstrate significant heterogeneity in LCS rates for disaggregated AsA subgroups. Kaiser Permanente Northern California LCS rates were 4× California rates. When payment alone is not a care barrier, systemic and culturally sensitive interventions are necessary to increase overall LCS screening rates and address population-specific disparities.

  View details for DOI 10.1177/00031348251353073

  View details for PubMedID 40551614

• Incidence of non-cardia gastric cancer among commercially-insured individuals aged 18-64 with chronic atrophic gastritis. PloS one Huang, R. J., Balasubramanian, V., Shum, M. V., Ji, H. P., Hwang, J. H. 2025; 20 (6): e0315833

  Abstract

  Chronic atrophic gastritis (CAG) is a precancerous condition of the gastric mucosa which predisposes to non-cardia gastric cancer (NCGC). The risk for NCGC following diagnosis with CAG has not been described robustly in the United States.We used a commercial claims database (Marketscan, Merative LP) covering over 150 million privately-insured Americans aged 18-64 to create a cohort of individuals diagnosed with CAG. We then followed these individuals for the development of NCGC or to the time of their last clinical encounter. Demographic and clinical characteristics were captured through administrative coding schema, and linked to metropolitan statistical area measures of socioeconomic status. Individual race and ethnicity were not available for this analysis.We analyzed data on 107,835 individuals and recorded 355,591 person-years (p-y) of follow-up. The crude overall incidence of NCGC was 98 per 100,000 p-y. In the fully-adjusted multivariable proportional hazards model, age ≥ 50 (HR 2.20, 95% CI 1.44-3.36), anemia (HR 5.09, 95% CI 3.46-7.50), former or current smoking (HR 1.42, 95% CI 1.11-1.81) and family history (HR 1.44, 95% CI 1.05-1.99) were individual-level factors associated with increased risk.We present one of the first estimates of NCGC risk following CAG diagnosis in an American population, and highlight risk factors for cancer progression. These data may help to guide future risk prevention strategies, such as endoscopic surveillance, in the United States.

  View details for DOI 10.1371/journal.pone.0315833

  View details for PubMedID 40549789

  View details for PubMedCentralID PMC12185002

• Gastric Cancer Prevention in the United States: A Work in Progress. Gastroenterology Huang, R. J., Moayyedi, P., Shah, S. C., Woo, Y., Wang, A. Y., Hwang, J. H. 2025

  View details for DOI 10.1053/j.gastro.2025.05.009

  View details for PubMedID 40409604

• Disaggregated colorectal cancer mortality among Asian American subgroups between 2005-2020. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology Thakkar, Z., Khan, M. A., Wu, Y., Qi, X., Hung, G. A., Kikuta, N., Jamal, A., Bacong, A. M., Kim, K. M., Kim, G. S., Palaniappan, L. P., Srinivasan, M., Huang, R. J. 2025

  Abstract

  Colorectal cancer (CRC) is the second-leading cause of cancer death in Asian Americans. Asian Americans are a diverse, heterogenous population composed of groups with differing cancer risk factors. Few prior studies have analyzed CRC mortality by disaggregated Asian racial subgroup.Using 2005-2020 US national mortality records linked to American Community Survey one-year population estimates, we report age-standardized mortality rates per 100,000 person-years, standardized mortality ratios (SMR), and average annual percent change trends for the six largest Asian subgroups in a serial, cross-sectional study design. We compared these rates with Non-Hispanic Whites (NHWs). We stratified rates by sex, nativity, and CRC location (colon vs. rectum).Asian subgroups demonstrated substantial heterogeneity in CRC mortality. Relative to the NHW group, Asian Indian Americans had the lowest rate (female SMR 0.3, 95% CI 0.3-0.3; male SMR 0.3, 95% CI 0.3-0.3) and Japanese Americans the highest rate (female SMR 0.9, 95% CI 0.8-0.9; male SMR 0.9, 95% CI 0.9-1.0). Chinese, Filipino, Korean, and Vietnamese Americans demonstrated mortality between Asian Indian and Japanese. Over the study period, most Asian subgroups had stable or decreasing mortality. However, both Korean and Vietnamese CRC mortality increased over the period. By the end of the study period Korean Americans had the highest CRC mortality of any Asian subgroup.Asian subgroups demonstrate heterogeneity in patterns of CRC mortality, emphasizing the necessity of disaggregation in cancer research.Our study provides disaggregated Asian subgroup CRC mortality data, which may allow for targeted risk attenuation efforts.

  View details for DOI 10.1158/1055-9965.EPI-24-1688

  View details for PubMedID 40259799

• The Optimal Age of Helicobacter pylori Screen-and-Treat for Gastric Cancer Prevention in the United States. Helicobacter Mülder, D. T., O'Mahony, J. F., Sun, D., van Duuren, L. A., van den Puttelaar, R., Harlass, M., Han, W., Huang, R. J., Spaander, M. C., Ladabaum, U., Lansdorp-Vogelaar, I. 2025; 30 (3): e70039

  Abstract

  Recent American College of Gastroenterology (ACG) guidelines recommend screening and eradicating Helicobacter pylori (H. pylori) in high-risk racial groups to prevent gastric cancer (GC), but do not provide guidance on the age to screen. We aimed to determine the optimal age for H. pylori screen-and-treat.We developed a new microsimulation model, MISCAN-gastric, which was calibrated to SEER incidence and clinical studies on the natural history of GC. One-time screen-and-treat at ages 20-65 was compared to a no-screening scenario in terms of cumulative incidence reduction, number needed-to-screen (NNS) and number needed-to-treat (NNT) to prevent one GC case. The NNS represents the number of individuals that require testing to prevent one GC case, while the NNT reflects the number requiring treatment. The optimal age was investigated for a high-risk population subgroup (non-Hispanic [NH] Black males) and compared to other subgroups.Without screening, 332 noncardia GC cases occurred in a population of 100,000 NH Black males. H. pylori screen-and-treat reduced cumulative incidence by 43% when performed at age 20, but only by 5% when performed at age 65. The NNS was lowest at age 30 and increased markedly at older ages. The estimated NNS for test-ages 20, 30, 40, and 65 were 645, 563, 769, and 5487, respectively. The NNT was lowest at the youngest age (261) and increased with age to 448 at age 40 and 3681 at age 65. The NNT and NNS were substantially higher in groups with lower GC risk: the optimal NNT was four times higher in NH White females compared to non-Hispanic Black males.H. pylori screen-and-treat maximized population benefits when performed before age 40, emphasizing the need for early interventions. When performed at the optimal age, the benefits of H. pylori screen-and-treat may outweigh the harms for high-risk racial groups.

  View details for DOI 10.1111/hel.70039

  View details for PubMedID 40329483

  View details for PubMedCentralID PMC12056297

• Evaluating the Reliability and Robustness of Racial and Ethnic Health Disparities in Cardiometabolic Disease in NHANES, NHIS, and BRFSS (2015-2021). Journal of the American Heart Association Thakkar, Z., Wu, Y., Khan, M., Qi, X., Hung, G. A., Kikuta, N., Jamal, A., Srinivasan, M., Huang, R. J., Kim, K., Kim, G., Palaniappan, L., Bacong, A. M. 2025: e040029

  Abstract

  The United States uses the National Health Interview Survey (NHIS), Behavioral Risk Factor Surveillance System (BRFSS), and National Health and Nutrition Examination Survey to monitor disease trends and inform clinical care/prevention research. These 3 surveys share similar national estimates. However, the consistency of each survey's estimates by race has not been examined. Here, we compare prevalence estimates and disparities in cardiometabolic diseases across 5 aggregated racial and ethnic groups.We examined the age- and fully-adjusted prevalence of cardiovascular disease and diabetes among non-Hispanic White, non-Hispanic Black, Hispanic, non-Hispanic Asian, and "Other" race respondents aged 30 years or older. Cardiovascular disease included self-reported physician diagnosis of heart attack, stroke, and coronary heart disease.Although overall national population estimates were similar, there was heterogeneity in estimates by survey. For heart attack and diabetes, each racial group had a higher prevalence in BRFSS than NHIS (eg, Heart Attack: Hispanic BRFSS: 3.4% [95% CI, 3.2-3.6], NHIS: 2.0% [95% CI, 1.8, 2.2]; non-Hispanic Black BRFSS: 3.8% [95% CI, 3.6, 3.9]; NHIS: 3.0% [95% CI, 2.7, 3.2]). Non-Hispanic Asian people had the lowest general cardiovascular disease prevalence across all 3 data sets (NHIS: 5.9%, National Health and Nutrition Examination Survey: 5.3%, BRFSS: 6.9%), while Other/multi-racial respondents had the highest prevalence (NHIS: 9.9%, National Health and Nutrition Examination Survey: 13.1%, BRFSS: 10.7%). However, the magnitude of these differences across data sets was small.Prevalence estimates for heart attack and diabetes were heterogeneous by race across surveys. These results highlight the importance of improving the representation of racially minoritized groups within national surveys to produce more precise estimates.

  View details for DOI 10.1161/JAHA.124.040029

  View details for PubMedID 40008548

• A spatial transcriptomic signature of 26 genes resolved at single-cell resolution characterizes high-risk gastric cancer precursors. NPJ precision oncology Huang, R. J., Wichmann, I. A., Su, A., Sathe, A., Shum, M. V., Grimes, S. M., Meka, R., Almeda, A., Bai, X., Shen, J., Nguyen, Q., Luo, I., Han, S. S., Amieva, M. R., Hwang, J. H., Ji, H. P. 2025; 9 (1): 52

  Abstract

  Gastric cancer precursors demonstrate highly-variable rates of progression toward neoplasia. Certain high-risk precursors, such as gastric intestinal metaplasia with advanced histologic features, may be at up to 30-fold increased risk for progression compared to lower-risk intestinal metaplasia. The biological differences between high- and low-risk lesions have been incompletely explored. In this study, we use several clinical cohorts to characterize the microenvironment of advanced gastric cancer precursors relative to low-risk lesions using bulk, spatial, and single-cell gene expression assays. We identified a 26-gene panel which is associated with advanced lesions, localizes to metaplastic glands on histopathology, and is expressed in aberrant mature and immature intestinal cells not normally present in the healthy stomach. This gene expression signature suggests an important role of the immature intestinal lineages in promoting carcinogenesis in the metaplastic microenvironment. These findings may help to inform future biomarker development and strategies of gastric cancer prevention.

  View details for DOI 10.1038/s41698-025-00816-w

  View details for PubMedID 40000871

  View details for PubMedCentralID 5879496

• Association Between Sleep Duration and Cardiovascular Disease Among Asian Americans. Journal of the American Heart Association Nadarajah, S., Akiba, R., Maricar, I., Vohra, S., Jamal, A., Yano, Y., Srinivasan, M., Kim, G., Huang, R. J., Palaniappan, L., Kim, K., Elfassy, T., Yang, E. 2024: e034587

  Abstract

  Cardiovascular disease (CVD) prevalence varies widely among Asian American adults. The American Heart Association added healthy sleep to its metrics to define ideal cardiovascular health. Little is known about the association between sleep and CVD prevalence among Asian subgroups. We aim to examine the association between suboptimal sleep duration and CVD risk prevalence among Asian American subgroups.We used 2012 to 2018 National Health Interview Survey data to examine the association between suboptimal sleep duration and CVD prevalence. We included 6868 self-identifying Asian adults age >40 years (Asian Indian [n=1053], Chinese [n=1415], Filipino [n=1734], and Other Asian [n=2666] adults). Suboptimal sleep was defined as <7 or >9 hours per night. CVD was defined as self-reported stroke, heart attack, coronary artery disease, or angina. Logistic regression was used to calculate odds ratios and 95% CI to estimate the association between suboptimal sleep duration and CVD prevalence. Filipino and Other Asian participants with suboptimal sleep had the highest prevalence of CVD. Aggregated Asian American participants with suboptimal sleep duration had a higher prevalence of CVD (odds ratio [95% CI, 1.35 [1.09-1.68]) compared with those with optimal sleep duration. After stratification by race or ethnicity or both, a significant association persisted for Other Asian participants (1.77 [95% CI, 1.27-2.46]) but not among all other Asian American subgroups.Our study highlights the heterogeneity of CVD prevalence associated with suboptimal sleep duration among Asian American adults. Future studies should consider how different measures of sleep duration and quality affect CVD outcomes among disaggregated Asian American subgroups.

  View details for DOI 10.1161/JAHA.124.034587

  View details for PubMedID 39719431

• Feasibility and Acceptability of Universal Adult Screening for Chronic Hepatitis B in Primary Care Clinics. AJPM focus Chu, R. V., Sarnala, S., Doan, T. V., Jamal, A., Phadke, A., So, S., So, R., Pham, H., Chaudhary, J., Huang, R., Kim, G., Palaniappan, L., Kim, K., Srinivasan, M. 2024; 3 (6): 100240

  Abstract

  Two thirds of Americans infected with chronic hepatitis B are unaware of their infection. In March 2023, the Centers for Disease Control and Prevention recommended moving from risk-based to universal adult chronic hepatitis B screening. In April 2022, Stanford implemented chronic hepatitis B universal screening discussion alerts for primary care providers.After 6 months, the authors surveyed 143 primary care providers at 13 Stanford primary care clinics about universal chronic hepatitis B screening acceptability and implementation feasibility. They conducted semistructured interviews with 15 primary care providers and 5 medical assistants around alerts and chronic hepatitis B universal versus risk-based screening.Forty-five percent of surveyed primary care providers responded. A total of 63% reported that universal screening would identify more patients with chronic hepatitis B. Before implementation, 77% ordered 0-5 chronic hepatitis B screenings per month. After implementation, 71% ordered >6 screenings per month. A total of 66% shared that universal screening removed the stigma around discussing high-risk behaviors. Interview themes included (1) low clinical burden, (2) current underscreening of at-risk groups, (3) providers preferring universal screening, (4) patients accepting universal screening, and (5) ease of chronic hepatitis B alert implementation.Consistent with Centers for Disease Control and Prevention guidelines, implementing universal chronic hepatitis B screening in primary care clinics in Northern California was feasible, was acceptable to providers and patients, eased health maintenance burdens, and improved clinic workflows.

  View details for DOI 10.1016/j.focus.2024.100240

  View details for PubMedID 39582739

  View details for PubMedCentralID PMC11584556

• Serum gastrin levels are associated with prevalent neuroendocrine tumors in autoimmune metaplastic atrophic gastritis. The American journal of gastroenterology Jove, A., Lin, C., Hwang, J. H., Vidhya, B., Fernandez-Becker, N. Q., Huang, R. J. 2024

  Abstract

  Autoimmune metaplastic atrophic gastritis (AMAG) is a precancerous condition that predisposes to gastric neuroendocrine tumors (gNET). There exist no methods to stratify AMAG patients for gNET risk.We identified a cohort of patients with AMAG within a university health system using histopathologic and serologic criteria. We analyzed features predictive of prevalent gNET.We identified 181 AMAG patients, 41 (22.7%) with prevalent gNET. Gastrin levels were elevated in gNET (1859.8 versus 679.5 pg/mL, p<0.001), and gastrin titers demonstrated good discrimination (c=0.799, 95% CI 0.707-0.892) for gNET.Gastrin levels differ significantly between AMAG patients with and without gNET.

  View details for DOI 10.14309/ajg.0000000000003235

  View details for PubMedID 39588964

• Serologic Features of Autoimmune Metaplastic Atrophic Gastritis: Gastrin Level as a Predictor of Gastric Neuroendocrine Tumor Status Jove, A. G., Lin, C., Hwang, J., Balasubramanian, V., Fernandez-Becker, N., Huang, R. LIPPINCOTT WILLIAMS & WILKINS. 2024: S1643-S1644

  View details for DOI 10.14309/01.ajg.0001038532.32643.7b

  View details for Web of Science ID 001359314900015

• INTENTIONAL SELF-HARM MORTALITY AMONG 15-TO 24-YEAR-OLDS IN ASIAN AMERICAN SUBGROUPS, 2011-2020 Uy, L., Chang, E., Desai, S., Hung, G., Kikuta, N. T., Jamal, A., Bacong, A., Villarreal, M., Huang, R., Kim, G., Palaniappan, L., Srinivasan, M., Sust, S. ELSEVIER SCIENCE INC. 2024: S309-S310

  View details for DOI 10.1016/j.jaac.2024.08.497

  View details for Web of Science ID 001330511902343

• Global Progression Rates of Precursor Lesions for Gastric Cancer: A Systematic Review and Meta-Analysis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association Hahn, A. I., Mülder, D. T., Huang, R. J., Zhou, M. J., Blake, B., Omofuma, O., Murphy, J. D., Gutiérrez-Torres, D. S., Zauber, A. G., O'Mahony, J. F., Camargo, M. C., Ladabaum, U., Yeh, J. M., Hur, C., Lansdorp-Vogelaar, I., Meester, R., Laszkowska, M. 2024

  Abstract

  Whether gastric cancer (GC) precursor lesions progress to invasive cancer at similar rates globally remains unknown. We conducted a systematic review and meta-analysis to determine the progression of precursor lesions to GC in countries with low versus medium/high incidence.We searched relevant databases for studies reporting the progression of endoscopically confirmed precursor lesions to GC. Studies were stratified by low (<6 per 100,000) or medium/high (≥6 per 100,000) GC incidence countries. Random-effects models were used to estimate the progression rates of atrophic gastritis (AG), intestinal metaplasia (IM), and dysplasia to GC per 1,000 person-years.Among the 5,829 studies identified, 44 met our inclusion criteria. The global pooled estimates of the progression rate per 1,000 person-years were 2.09 (95% CI 1.46-2.99), 2.89 (2.03-4.11) and 10.09 (5.23-19.49) for AG, IM, and dysplasia respectively. The estimated progression rates per 1,000 person-years for low versus medium/high GC incidence countries, respectively, were 0.97 (0.86-1.10) vs. 2.47 (1.70-2.99) for AG (p<0.01); 2.37 (1.43-3.92) vs. 3.47 (2.13-5.65) for IM (p=0.29); and 5.51 (2.92-10.39) vs. 14.80 (5.87-37.28) for dysplasia (p=0.08). There were no differences for progression of AG between groups when high quality studies were compared.Similar progression rates of IM and dysplasia were observed among low and medium/high GC incidence countries. This suggests that the potential benefits of surveillance for these lesions in low-risk regions may be comparable to those of population-wide interventions in high-risk regions. Further prospective studies are needed to confirm these findings and inform global screening and surveillance guidelines.

  View details for DOI 10.1016/j.cgh.2024.09.003

  View details for PubMedID 39362617

• Global Prevalence of Subtypes of Gastric Intestinal Metaplasia: A Systematic Review and Meta-Analysis Grell, Y., Mulder, D., Hahn, A., Huang, R., Zhou, M., Blake, B., Omofuma, O., Murphy, J., Gutierrez-Torres, D., Zauber, A. G., O'Mahony, J., Camargo, M., Ladabaum, U., Yeh, J., Hur, C., Lansdorp-Vogelaar, I., Meester, R., Laszkowska, M. LIPPINCOTT WILLIAMS & WILKINS. 2024: S1667

  View details for DOI 10.14309/01.ajg.0001038668.97984.fd

  View details for Web of Science ID 001359444700033

• Efficacy and safety of covered self-expandable metal stent for malignant hilar biliary obstruction: A systematic review and meta-analysis. Gastrointestinal endoscopy Chung, K. H., Lee, K. J., Joseph, A. A., Huang, R. J., Li, A., Hwang, J. H., Yoon, S. B. 2024

  Abstract

  Covered self-expanding metal stents (C-SEMS) are used for malignant hilar biliary obstruction (MHBO) management. Despite increasing evidence, comprehensive evaluation of the efficacy and safety of C-SEMS in MHBO management is lacking.PubMed, EMBASE, and the Cochrane Library were screened up to March 31, 2024 for studies including MHBO treated by a C-SEMS. Studies meeting predefined inclusion criteria, including adult MHBO patients treated with C-SEMS placement, reporting technical success, clinical success, and adverse event rates, were selected. Data synthesis and statistical analysis were performed using the random effects model, with heterogeneity and publication bias assessment.From 401 articles, seven studies were included. Pooled technical and clinical success rate of C-SEMS was 96.7% (95% CI 92.6-98.6%, I2=0%) and 91.6% (95% CI 86.1-95.0%, I2=0%). Overall adverse events were reported in 16.6% (95% CI 11.2-23.9%, I2=24%) of cases which included cholangitis (7.4%), pancreatitis (5.9%), liver abscess (5.9%), and cholecystitis (2.8%). Stent migration and recurrent biliary obstruction were observed in 8.9% and 49.6% of cases, respectively, with a median time to recurrent biliary obstruction of 142 days. Reintervention was successful in 92.5% of cases (95% CI 83.1-96.9%, I2=0%) CONCLUSION: Our meta-analysis revealed high technical and clinical success rates of C-SEMS in MHBO. Adverse events, notably cholangitis, cholecystitis, and pancreatitis were <10%. RBO and stent migration was mitigated by C-SEMS removal and successful reintervention. Our findings highlight the efficacy and safety of C-SEMS in managing MHBO, warranting further research to optimize treatment strategies.

  View details for DOI 10.1016/j.gie.2024.09.037

  View details for PubMedID 39357660

• Opioid overdose deaths are prominent in urban counties within the USA: an observational cross-sectional study. British journal of anaesthesia Patankar, A. V., Octaviano, R., Gurachar, N., Chen, A. W., Guan, A., Hung, G. A., Kikuta, N., Jamal, A., Srinivasan, M., Bacong, A. M., Huang, R. J., Kim, G. S., Palaniappan, L. P., Gross, E. R. 2024

  View details for DOI 10.1016/j.bja.2024.07.020

  View details for PubMedID 39209699

• Nasopharyngeal cancer mortality in disaggregated Asian and non-Asian Americans. Head & neck Hung, G. A., Vohra, S., Kim, G., Jamal, A., Srinivasan, M., Huang, R. J., Kim, G., Palaniappan, L., Colevas, A. D. 2024

  Abstract

  Nasopharyngeal carcinoma (NPC) mortality varies based on multiple risk factors. While NPC mortality is higher in Asia, little is known about Asian subgroups in the United States (US).Using the 2005-2020 National Vital Statistics System, we examined NPC mortality by age, race (non-Hispanic black, Hispanic white (HW), non-Hispanic white (NHW), Chinese, Filipino, Asian Indian, Japanese, Korean, Vietnamese), sex, and nativity (Untied States or foreign-born).Upon disaggregation, Chinese (1.96 [CI: 1.78-2.16]), Filipino (0.68 [0.68-1.11]), and Vietnamese Americans (0.68 [0.52-1.10]) had the top age-adjusted mortality rates (AAMR per 100 000 person-years). Foreign-born Chinese, Vietnamese, Filipinos, Asian Indians, and NHW had higher AAMRs compared to US-born persons. All male groups had higher AAMR compared to females. Stratifying for race, nativity, and sex, foreign-born Chinese males (4.09 [3.79-4.40]) had the highest AAMR.These findings demonstrate the importance of disaggregating NPC mortality data by Asian subgroups, providing valuable insights for targeted public health interventions in the United States.

  View details for DOI 10.1002/hed.27857

  View details for PubMedID 39022914

• CLINICAL AND SEROLOGIC FEATURES OF AUTOIMMUNE METAPLASTIC ATROPHIC GASTRITIS: RESULTS OF AN ELECTRONIC HEALTH RECORDS COHORT Jove, A., Lin, C., Hwang, J., Fernandez-Becker, N., Huang, R. MOSBY-ELSEVIER. 2024: AB1095-AB1096

  View details for Web of Science ID 001278323004222

• Nasopharyngeal cancer mortality in disaggregated Asian and non-Asian Americans Hung, G. A., Vohra, S., Kim, G., Jamal, A., Srinivasan, M., Huang, R. J., Kim, G., Palaniappan, L., Colevas, A. LIPPINCOTT WILLIAMS & WILKINS. 2024

  View details for Web of Science ID 001275557404830

• Leading causes of death in Vietnamese Americans: An ecological study based on national death records from 2005-2020. PloS one Tran, K., Shon, H., Phan, J., Cheng, T., Kim, G. S., Jamal, A., Srinivasan, M., Palaniappan, L. P., Nguyen, L., Huang, R. J. 2024; 19 (5): e0303195

  Abstract

  Disaggregated data is a cornerstone of precision health. Vietnamese Americans (VietAms) are the fourth-largest Asian subgroup in the United States (US), and demonstrate a unique burden of disease and mortality. However, most prior studies have aggregated VietAms under the broader Asian American category for analytic purposes. This study examined the leading causes of death among VietAms compared to aggregated Asian Americans and non-Hispanic Whites (NHWs) during the period 2005-2020.Decedent data, including underlying cause of death, were obtained from the National Center for Health Statistics national mortality file from 2005 to 2020. Population denominator estimates were obtained from the American Community Survey one-year population estimates. Outcome measures included proportional mortality, age-adjusted mortality rates per 100,000 (AMR), and annual percent change (APC) in mortality over time. Data were stratified by sex and nativity status. Due to large differences in age structure, we report native- and foreign-born VietAms separately.We identified 74,524 VietAm decedents over the study period (71,305 foreign-born, 3,219 native-born). Among foreign-born VietAms, the three leading causes of death were cancer (26.6%), heart disease (18.0%), and cerebrovascular disease (9.0%). Among native-born VietAms the three leading causes were accidents (19.0%), self-harm (12.0%), and cancer (10.4%). For every leading cause of death, VietAms exhibited lower mortality compared to both aggregated Asians and NHWs. Over the course of the study period, VietAms witnessed an increase in mortality in every leading cause. This effect was mostly driven by foreign-born, male VietAms.While VietAms have lower overall mortality from leading causes of death compared to aggregated Asians and NHWs, these advantages have eroded markedly between 2005 and 2020. These data emphasize the importance of racial disaggregation in the reporting of public health measures.

  View details for DOI 10.1371/journal.pone.0303195

  View details for PubMedID 38787829

• Prevalence of Gastric Precursor Lesions in Countries with Differential Gastric Cancer Burden: A Systematic Review & Meta-Analysis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association Mülder, D. T., Hahn, A. I., Huang, R. J., Zhou, M. J., Blake, B., Omofuma, O., Murphy, J. D., Gutiérrez-Torres, D. S., Zauber, A. G., O'Mahony, J. F., Camargo, M. C., Ladabaum, U., Yeh, J. M., Hur, C., Lansdorp-Vogelaar, I., Meester, R., Laszkowska, M. 2024

  Abstract

  The prevalence of precursor lesions for gastric cancer (GC) and the differential burden between countries of varying GC risk is not well understood. We conducted a systematic review and meta-analysis to estimate the global prevalence of precursor lesions.We estimated the prevalence of atrophic gastritis (AG), gastric intestinal metaplasia (IM), and dysplasia in regions with low, medium, and high-GC incidence. Since IM is an advanced manifestation of AG, we assessed the prevalence of less advanced precursors regardless of the presence of more advanced lesions. Prevalence was sub-stratified by Helicobacter pylori (H.pylori) infection, symptomatology, and period (<2000, 2000-2010, and >2010).Among the 582 articles which underwent full-text review, 166 studies met inclusion criteria. The global prevalence estimates of AG, IM, and dysplasia were 25.4%, 16.2% and 2.0%, based on 126 studies that reported the prevalence of less advanced precursors regardless of the presence of more advanced lesions. The prevalence of all precursor lesions was higher in high- and medium- compared to low-GC incidence countries (p<0.01). Prevalence of AG and IM was significantly higher among H.pylori-infected individuals (p<0.01), but not statistically different between symptomatic and asymptomatic individuals (p>0.17). All precursors demonstrated a secular decrease in prevalence over time.Gastric precursor lesions have differences in prevalence in regions with differential GC incidence and are associated with H.pylori infection. Given the substantial prevalence of precursor lesions in both symptomatic and asymptomatic individuals, symptomatic evaluation may not be sufficient to identify individuals at risk. These estimates provide important insights for tailoring GC prevention strategies.

  View details for DOI 10.1016/j.cgh.2024.02.023

  View details for PubMedID 38438000

• An International Classification of Diseases code for gastric intestinal metaplasia: an opportunity for gastric cancer prevention. The lancet. Gastroenterology & hepatology Huang, R. J., Camargo, M. C. 2024; 9 (3): 201-202

  View details for DOI 10.1016/S2468-1253(23)00439-9

  View details for PubMedID 38340750

• Risk of Gastric Adenocarcinoma in a Multiethnic Population undergoing Routine Care: an Electronic Health Records Cohort Study. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology Huang, R. J., Huang, E. S., Mudiganti, S., Chen, T., Martinez, M. C., Ramrakhiani, S., Han, S. S., Hwang, J. H., Palaniappan, L. P., Liang, S. Y. 2024

  Abstract

  Gastric adenocarcinoma (GAC) is often diagnosed at advanced stages and portends a poor prognosis. We hypothesized that electronic health records (EHR) could be leveraged to identify individuals at highest risk for GAC from the population seeking routine care.This was a retrospective cohort study, with endpoint of GAC incidence as ascertained through linkage to an institutional tumor registry. We utilized 2010-2020 data from the Palo Alto Medical Foundation, a large multispecialty practice serving Northern California. The analytic cohort comprised individuals aged 40-75 receiving regular ambulatory care. Variables collected included demographic, medical, pharmaceutical, social, and familial data. Electronic phenotyping was based on rules-based methods.The cohort comprised 316,044 individuals and ~2 million person-years (p-y) of observation. 157 incident GACs occurred (incidence 7.9 per 100,000 p-y), of which 102 were non-cardia GACs (incidence 5.1 per 100,000 p-y). In multivariable analysis, male sex (HR 2.2, 95% CI 1.6-3.1), older age, Asian race (HR 2.5, 95% CI 1.7-3.7), Hispanic ethnicity (HR 1.9, 95% CI 1.1-3.3), atrophic gastritis (HR 4.6, 95% CI 2.2-9.3), and anemia (HR 1.9, 95% CI 1.3-2.6) were associated with GAC risk; use of non-steroidal anti-inflammatory drug was inversely associated (HR 0.3, 95% CI 0.2-0.5). Older age, Asian race, Hispanic ethnicity, atrophic gastritis, and anemia were associated with non-cardia GAC.Routine EHR data can stratify the general population for GAC risk.Such methods may help triage populations for targeted screening efforts, such as upper endoscopy.

  View details for DOI 10.1158/1055-9965.EPI-23-1200

  View details for PubMedID 38231023

• The <i>Helicobacter pylori</i> Genome Project: insights into <i>H. pylori</i> population structure from analysis of a worldwide collection of complete genomes NATURE COMMUNICATIONS Thorell, K., Munoz-Ramirez, Z. Y., Wang, D., Sandoval-Motta, S., Agostini, R., Ghirotto, S., Torres, R. C., Falush, D., Camargo, M., Rabkin, C. S., HpGP Research Network 2023; 14 (1): 8184

  Abstract

  Helicobacter pylori, a dominant member of the gastric microbiota, shares co-evolutionary history with humans. This has led to the development of genetically distinct H. pylori subpopulations associated with the geographic origin of the host and with differential gastric disease risk. Here, we provide insights into H. pylori population structure as a part of the Helicobacter pylori Genome Project (HpGP), a multi-disciplinary initiative aimed at elucidating H. pylori pathogenesis and identifying new therapeutic targets. We collected 1011 well-characterized clinical strains from 50 countries and generated high-quality genome sequences. We analysed core genome diversity and population structure of the HpGP dataset and 255 worldwide reference genomes to outline the ancestral contribution to Eurasian, African, and American populations. We found evidence of substantial contribution of population hpNorthAsia and subpopulation hspUral in Northern European H. pylori. The genomes of H. pylori isolated from northern and southern Indigenous Americans differed in that bacteria isolated in northern Indigenous communities were more similar to North Asian H. pylori while the southern had higher relatedness to hpEastAsia. Notably, we also found a highly clonal yet geographically dispersed North American subpopulation, which is negative for the cag pathogenicity island, and present in 7% of sequenced US genomes. We expect the HpGP dataset and the corresponding strains to become a major asset for H. pylori genomics.

  View details for DOI 10.1038/s41467-023-43562-y

  View details for Web of Science ID 001142897900001

  View details for PubMedID 38081806

  View details for PubMedCentralID PMC10713588

• COVID-19 pandemic impact on opioid overdose deaths among racial groups within the United States: an observational cross-sectional study. British journal of anaesthesia Chu, R., Sarnala, S., Doan, T., Cheng, T., Chen, A. W., Jamal, A., Kim, G., Huang, R., Srinivasan, M., Palaniappan, L., Gross, E. R. 2023

  View details for DOI 10.1016/j.bja.2023.10.024

  View details for PubMedID 37977954

• The association between local area immigrant fraction and prevalence of cardiovascular diseases in the United States: an observational study. Lancet regional health. Americas Shokeen, D., Wang, N., Nguyen, N. P., Bakal, E., Tripathi, O., Palaniappan, L. P., Huang, R. J. 2023; 27: 100613

  Abstract

  Local area immigrant fraction is strongly and positively correlated with local life expectancy in the United States. The aim of the study was to determine the relationship between local area immigrant fraction and local prevalence of coronary heart disease (CHD) and stroke.Cross-sectional study design, with ZIP code as the unit of observation. Demographic data was obtained from the American Community Survey, and linked to indicators of health access (e.g., insurance, annual check-ups, cholesterol screening), obesity, behavior (smoking, exercise), and cardiovascular outcomes data from the 2020 Population Level Analysis and Community Estimates. Multivariable regression and path analyses were used to assess both direct and indirect relationships among variables.CHD prevalence was lower in the second (3.9% relative difference, 95% CI: 3.1-4.5%), third (6.5%, 95% CI: 5.8-7.1%), and fourth (14.8%, 95% CI: 14.1-15.8%) quartiles of immigrant fraction compared to the lowest (p-trend <0.001). These effects remained robust in multivariable analysis following adjustment for indicators of access, obesity, and behavioral variables (p-trend <0.0001). For stroke, only the highest quartile demonstrated a significant difference in prevalence (2.1%, 95% CI: 1.2-3.0% with full adjustment). In CHD path analysis, ∼45% of the association of immigrant fraction was direct, and ∼55% was mediated through lower prevalence of deleterious behaviors (e.g., smoking). In stroke path analysis, the effect was entirely mediated through indirect effects.In the United States, ZIP codes with higher immigrant fractions have lower prevalence of cardiovascular diseases. These associations are partially mediated through differences in health behaviors at the community level.NIH (K08CA252635, P30AG0059304, K24HL150476), Stanford University, Rutgers University.

  View details for DOI 10.1016/j.lana.2023.100613

  View details for PubMedID 37860751

  View details for PubMedCentralID PMC10582736

• Detection and surveillance of gastric cancer precursors: evolving guidelines and technologies ANNALS OF LAPAROSCOPIC AND ENDOSCOPIC SURGERY Koh, J., Shunt, M., Hwang, J., Huang, R. J. 2023; 8

  View details for DOI 10.21037/ales-23-13

  View details for Web of Science ID 001088917900002

• A spatially mapped gene expression signature for intestinal stem-like cells identifies high-risk precursors of gastric cancer. bioRxiv : the preprint server for biology Huang, R. J., Wichmann, I. A., Su, A., Sathe, A., Shum, M. V., Grimes, S. M., Meka, R., Almeda, A., Bai, X., Shen, J., Nguyen, Q., Amieva, M. R., Hwang, J. H., Ji, H. P. 2023

  Abstract

  Gastric intestinal metaplasia (GIM) is a precancerous lesion that increases gastric cancer (GC) risk. The Operative Link on GIM (OLGIM) is a combined clinical-histopathologic system to risk-stratify patients with GIM. The identification of molecular biomarkers that are indicators for advanced OLGIM lesions may improve cancer prevention efforts.This study was based on clinical and genomic data from four cohorts: 1) GAPS, a GIM cohort with detailed OLGIM severity scoring (N=303 samples); 2) the Cancer Genome Atlas (N=198); 3) a collation of in-house and publicly available scRNA-seq data (N=40), and 4) a spatial validation cohort (N=5) consisting of annotated histology slides of patients with either GC or advanced GIM. We used a multi-omics pipeline to identify, validate and sequentially parse a highly-refined signature of 26 genes which characterize high-risk GIM.Using standard RNA-seq, we analyzed two separate, non-overlapping discovery (N=88) and validation (N=215) sets of GIM. In the discovery phase, we identified 105 upregulated genes specific for high-risk GIM (defined as OLGIM III-IV), of which 100 genes were independently confirmed in the validation set. Spatial transcriptomic profiling revealed 36 of these 100 genes to be expressed in metaplastic foci in GIM. Comparison with bulk GC sequencing data revealed 26 of these genes to be expressed in intestinal-type GC. Single-cell profiling resolved the 26-gene signature to both mature intestinal lineages (goblet cells, enterocytes) and immature intestinal lineages (stem-like cells). A subset of these genes was further validated using single-molecule multiplex fluorescence in situ hybridization. We found certain genes (TFF3 and ANPEP) to mark differentiated intestinal lineages, whereas others (OLFM4 and CPS1) localized to immature cells in the isthmic/crypt region of metaplastic glands, consistent with the findings from scRNAseq analysis.using an integrated multi-omics approach, we identified a novel 26-gene expression signature for high-OLGIM precursors at increased risk for GC. We found this signature localizes to aberrant intestinal stem-like cells within the metaplastic microenvironment. These findings hold important translational significance for future prevention and early detection efforts.

  View details for DOI 10.1101/2023.09.20.558462

  View details for PubMedID 37786704

  View details for PubMedCentralID PMC10541579

• Software Application Profile: dynamicLM-a tool for performing dynamic risk prediction using a landmark supermodel for survival data under competing risks. International journal of epidemiology Fries, A. H., Choi, E., Wu, J. T., Lee, J. H., Ding, V. Y., Huang, R. J., Liang, S., Wakelee, H. A., Wilkens, L. R., Cheng, I., Han, S. S. 2023

  Abstract

  MOTIVATION: Providing a dynamic assessment of prognosis is essential for improved personalized medicine. The landmark model for survival data provides a potentially powerful solution to the dynamic prediction of disease progression. However, a general framework and a flexible implementation of the model that incorporates various outcomes, such as competing events, have been lacking. We present an R package, dynamicLM, a user-friendly tool for the landmark model for the dynamic prediction of survival data under competing risks, which includes various functions for data preparation, model development, prediction and evaluation of predictive performance.IMPLEMENTATION: dynamicLM as an R package.GENERAL FEATURES: The package includes options for incorporating time-varying covariates, capturing time-dependent effects of predictors and fitting a cause-specific landmark model for time-to-event data with or without competing risks. Tools for evaluating the prediction performance include time-dependent area under the ROC curve, Brier Score and calibration.AVAILABILITY: Available on GitHub [https://github.com/thehanlab/dynamicLM].

  View details for DOI 10.1093/ije/dyad122

  View details for PubMedID 37670428

• A QUALITATIVE EVALUATION OF A UNIVERSAL HEPATITIS B SCREENING ELECTRONIC MEDICAL RECORD REMINDER TOOL AT AN ACADEMIC PRIMARY CARE NETWORK Sarnala, S., Chu, R. V., Doan, T. V., Jamal, A., Phadke, A., Hang Pham, So, R., Huang, R., Kim, G. S., Palaniappan, L., Kim, K., Srinivasan, M. SPRINGER. 2023: S329

  View details for Web of Science ID 001043057201121

• Why Are We Going Backward? Barriers to Disaggregated Racial Information in Federal Data Sets. American journal of public health Jamal, A., Srinivasan, M., Kim, G., Huang, R. J., Palaniappan, L. 2023: e1-e4

  View details for DOI 10.2105/AJPH.2023.307339

  View details for PubMedID 37319392

• ASGE Upper GI Tract: A Potpourri of AI, Imaging, Resection and Myotomy AN ANALYSIS OF RISK FACTORS FOR GASTRIC INTESTINAL METAPLASIAdTHE STANFORD GAPS STUDY Shum, M., Huang, R., Kim, J., Hwang, J. MOSBY-ELSEVIER. 2023: AB1234-AB1235

  View details for Web of Science ID 001038022803057

• Controlling Gastric Cancer in a World of Heterogeneous Risk. Gastroenterology Huang, R. J., Laszkowska, M., In, H., Hwang, J. H., Epplein, M. 2023

  Abstract

  Gastric cancer (GC) is a leading cause of global mortality, but also a cancer whose footprint is highly unequal. This review aims to define global disease epidemiology, critically appraise strategies of prevention and disease attenuation, and assess how these strategies could be applied to improve outcomes from GC in a world of variable risk and disease burden. Strategies of primary prevention focus on improving the detection and eradication of the main environmental risk factor, Helicobacter pylori. In certain countries of high incidence, endoscopic or radiographic screening of the asymptomatic general population has been adopted as a means of secondary prevention. By contrast, identification and targeted surveillance of individuals with precancerous lesions (such as intestinal metaplasia) is being increasingly embraced in nations of low incidence. This review will also highlight existing knowledge gaps in GC prevention, as well as the role of emerging technologies for early detection and risk stratification.

  View details for DOI 10.1053/j.gastro.2023.01.018

  View details for PubMedID 36706842

• Low rates of structured advance care planning documentation in electronic health records: results of a single-center observational study. BMC palliative care Wu, A., Huang, R. J., Colon, G. R., Zembrzuski, C., Patel, C. B. 2022; 21 (1): 203

  Abstract

  BACKGROUND: Proper advance care planning (ACP) documentation both improves patient care and is increasingly seen as a marker of high quality by governmental payers. The transition of most medical documentation to electronic health records (EHR) allows for ACP documents to be rapidly disseminated across diverse ambulatory practice settings. At the same time, the complexity and heterogeneity of the EHR, as well as the multiple potential storage locations for documentation, may lead to confusion and inaccessibility. There has been movement to promote structured ACP (S-ACP) documentation within the EHR.METHODS: We performed a retrospective cohort study at a single, large university medical center in California to analyze rates of S-ACP documentation. S-ACP was defined as ACP documentation contained in standardized locations, auditable, and not in free-text format. The analytic cohort composed of all patients 65 and older with at least one ambulatory encounter at Stanford Health Care between 2012 and 2020, and without concurrent hospice care. We then analyzed clinic-level, provider-level, insurance, and temporal factors associated with S-ACP documentation rate.RESULTS: Of 187,316unique outpatient encounters between 2012 and 2020, only 7,902 (4.2%) contained S-ACP documentation in the EHR. The most common methods of S-ACP documentation were through problem list diagnoses (3,802; 40.3%) and scanned documents (3,791; 40.0%). At the clinic level, marked variability in S-ACP documentation was observed, with Senior Care (46.6%) and Palliative Care (25.0%) demonstrating highest rates. There was a temporal trend toward increased S-ACP documentation rate (p<0.001).CONCLUSION: This retrospective, single-center study reveals a low rate of S-ACP documentation irrespective of clinic and specialty. While S-ACP documentation rate should not be construed as a proxy for ACP documentation rate, it nonetheless serves as an important quality metric which may be reported to payers. This study highlights the need to both centralize and standardize reporting of ACP documentation in complex EHR systems.

  View details for DOI 10.1186/s12904-022-01099-9

  View details for PubMedID 36419072

• Catching Up with the World: Pepsinogen Screening for Gastric Cancer in the United States. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology Zhou, M. J., Huang, R. J. 2022; 31 (7): 1257-1258

  Abstract

  Gastric cancer remains a deadly cancer with poor outcomes in the United States. There is a need for screening strategies for gastric cancer in the U.S. population. With progressive Helicobacter pylori-mediated inflammation of the gastric mucosa, pepsinogen I levels decrease and the pepsinogen I/II ratio decreases. Pepsinogen test positivity (PG+) has been evaluated as a promising screening test among Asian and European populations; however, its utility in multiethnic U.S. populations is poorly described. In this case-control study nested within the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial, In and colleagues evaluate the discrimination of PG+ in serum collected from individuals prior to the development of gastric cancer. The authors find that PG+ individuals were at nearly 10-fold increased risk for developing gastric cancer, and this effect remained robust after adjusting for Helicobacter pylori status, family history, education, smoking, and obesity. In subgroup analysis, the predictive ability of the test was particularly robust for noncardia gastric cancers, and nonpredictive of cardia gastric cancers. Serum pepsinogen testing holds promise as a noninvasive screening strategy to triage individuals at heightened risk for gastric cancer, and may help to improve early diagnosis in the United States. See related article by In et al., p. 1426.

  View details for DOI 10.1158/1055-9965.EPI-22-0372

  View details for PubMedID 35775231

• The Gastric Cancer Registry: A Genomic Translational Resource for Multidisciplinary Research in Gastric Cancer. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology Almeda, A. F., Grimes, S. M., Lee, H., Greer, S., Shin, G., McNamara, M., Hooker, A. C., Arce, M. M., Kubit, M., Schauer, M. C., Van Hummelen, P., Ma, C., Mills, M. A., Huang, R. J., Hwang, J. H., Amieva, M. R., Han, S. S., Ford, J. M., Ji, H. P. 2022

  Abstract

  Gastric cancer (GC) is a leading cause of cancer morbidity and mortality. Developing information systems which integrate clinical and genomic data may accelerate discoveries to improve cancer prevention, detection, and treatment. To support translational research in GC, we developed the GC Registry (GCR), a North American repository of clinical and cancer genomics data.Participants self-enrolled online. Entry criteria into the GCR included the following: (1) diagnosis of GC, (2) history of GC in a first- or second-degree relative, or (3) known germline mutation in the gene CDH1. Participants provided demographic and clinical information through a detailed survey. Some participants provided specimens of saliva and tumor samples. Tumor samples underwent exome sequencing, whole genome sequencing and transcriptome sequencing.From 2011-2021, 567 individuals registered and returned the clinical questionnaire. For this cohort 65% had a personal history of GC, 36% reported a family history of GC and 14% had a germline CDH1 mutation. 89 GC patients provided tumor samples. For the initial study, 41 tumors were sequenced using next generation sequencing. The data was analyzed for cancer mutations, copy number variations, gene expression, microbiome, neoantigens, immune infiltrates, and other features. We developed a searchable, web-based interface (the GCR Genome Explorer) to enable researchers access to these datasets.The GCR is a unique, North American GC registry which integrates clinical and genomic annotation.Available for researchers through an open access, web-based explorer, the GCR Genome Explorer will accelerate collaborative GC research across the United States and world.

  View details for DOI 10.1158/1055-9965.EPI-22-0308

  View details for PubMedID 35771165

• A Comparison of Logistic Regression Against Machine Learning Algorithms for Gastric Cancer Risk Prediction Within Real-World Clinical Data Streams. JCO clinical cancer informatics Huang, R. J., Kwon, N. S., Tomizawa, Y., Choi, A. Y., Hernandez-Boussard, T., Hwang, J. H. 2022; 6: e2200039

  Abstract

  Noncardia gastric cancer (NCGC) is a leading cause of global cancer mortality, and is often diagnosed at advanced stages. Development of NCGC risk models within electronic health records (EHR) may allow for improved cancer prevention. There has been much recent interest in use of machine learning (ML) for cancer prediction, but few studies comparing ML with classical statistical models for NCGC risk prediction.We trained models using logistic regression (LR) and four commonly used ML algorithms to predict NCGC from age-/sex-matched controls in two EHR systems: Stanford University and the University of Washington (UW). The LR model contained well-established NCGC risk factors (intestinal metaplasia histology, prior Helicobacter pylori infection, race, ethnicity, nativity status, smoking history, anemia), whereas ML models agnostically selected variables from the EHR. Models were developed and internally validated in the Stanford data, and externally validated in the UW data. Hyperparameter tuning of models was achieved using cross-validation. Model performance was compared by accuracy, sensitivity, and specificity.In internal validation, LR performed with comparable accuracy (0.732; 95% CI, 0.698 to 0.764), sensitivity (0.697; 95% CI, 0.647 to 0.744), and specificity (0.767; 95% CI, 0.720 to 0.809) to penalized lasso, support vector machine, K-nearest neighbor, and random forest models. In external validation, LR continued to demonstrate high accuracy, sensitivity, and specificity. Although K-nearest neighbor demonstrated higher accuracy and specificity, this was offset by significantly lower sensitivity. No ML model consistently outperformed LR across evaluation criteria.Drawing data from two independent EHRs, we find LR on the basis of established risk factors demonstrated comparable performance to optimized ML algorithms. This study demonstrates that classical models built on robust, hand-chosen predictor variables may not be inferior to data-driven models for NCGC risk prediction.

  View details for DOI 10.1200/CCI.22.00039

  View details for PubMedID 35763703

• ALTEN: A High-Fidelity Primary Tissue-Engineering Platform to Assess Cellular Responses Ex Vivo. Advanced science (Weinheim, Baden-Wurttemberg, Germany) Law, A. M., Chen, J., Colino-Sanguino, Y., Fuente, L. R., Fang, G., Grimes, S. M., Lu, H., Huang, R. J., Boyle, S. T., Venhuizen, J., Castillo, L., Tavakoli, J., Skhinas, J. N., Millar, E. K., Beretov, J., Rossello, F. J., Tipper, J. L., Ormandy, C. J., Samuel, M. S., Cox, T. R., Martelotto, L., Jin, D., Valdes-Mora, F., Ji, H. P., Gallego-Ortega, D. 2022: e2103332

  Abstract

  To fully investigate cellular responses to stimuli and perturbations within tissues, it is essential to replicate the complex molecular interactions within the local microenvironment of cellular niches. Here, the authors introduce Alginate-based tissue engineering (ALTEN), a biomimetic tissue platform that allows ex vivo analysis of explanted tissue biopsies. This method preserves the original characteristics of the source tissue's cellular milieu, allowing multiple and diverse cell types to be maintained over an extended period of time. As a result, ALTEN enables rapid and faithful characterization of perturbations across specific cell types within a tissue. Importantly, using single-cell genomics, this approach provides integrated cellular responses at the resolution of individual cells. ALTEN is a powerful tool for the analysis of cellular responses upon exposure to cytotoxic agents and immunomodulators. Additionally, ALTEN's scalability using automated microfluidic devices for tissue encapsulation and subsequent transport, to enable centralized high-throughput analysis of samples gathered by large-scale multicenter studies, is shown.

  View details for DOI 10.1002/advs.202103332

  View details for PubMedID 35611998

• Leading causes of death in Asian Indians in the United States (2005-2017). PloS one Fernandez Perez, C., Xi, K., Simha, A., Shah, N. S., Huang, R. J., Palaniappan, L., Chung, S., Au, T., Sharp, N., Islas, N., Srinivasan, M. 2022; 17 (8): e0271375

  Abstract

  OBJECTIVE: Asian Indians are among the fastest growing United States (US) ethnic subgroups. We characterized mortality trends for leading causes of death among foreign-born and US-born Asian Indians in the US between 2005-2017.STUDY DESIGN AND SETTING: Using US standardized death certificate data, we examined leading causes of death in 73,470 Asian Indians and 20,496,189 non-Hispanic whites (NHWs) across age, gender, and nativity. For each cause, we report age-standardized mortality rates (AMR), longitudinal trends, and absolute percent change (APC).RESULTS: We found that Asian Indians' leading causes of death were heart disease (28% mortality males; 24% females) and cancer (18% males; 22% females). Foreign-born Asian Indians had higher all-cause AMR compared to US-born (AMR 271 foreign-born, CI 263-280; 175.8 US-born, CI 140-221; p<0.05), while Asian Indian all-cause AMR was lower than that of NHWs (AMR 271 Indian, CI 263-278; 754.4 NHW, CI 753.3-755.5; p<0.05). All-cause AMR increased for foreign-born Asian Indians over time, while decreasing for US-born Asian Indians and NHWs.CONCLUSIONS: Foreign-born Asian Indians were 2.2 times more likely to die of heart disease and 1.6 times more likely to die of cancer. Asian Indian male AMR was 49% greater than female on average, although AMR was consistently lower for Asian Indians when compared to NHWs.

  View details for DOI 10.1371/journal.pone.0271375

  View details for PubMedID 35947608

• The risk of diffuse-type gastric cancer following diagnosis with gastric precancerous lesions: a systematic review and meta-analysis. Cancer causes & control : CCC Wang, J. E., Kim, S. E., Lee, B. E., Park, S., Hwang, J. H., Huang, R. J. 2021

  Abstract

  PURPOSE: Gastric cancers are classified as diffuse-type (DTGC) or intestinal-type (ITGC). DTGCs have distinct clinical and histopathologic features, and carry a worse overall prognosis compared to ITGCs. Atrophic gastritis (AG) and intestinal metaplasia (IM) are known precursors to ITGC. It is unknown if AG and IM increase risk for DTGC.METHODS: We performed a systematic review to identify studies reporting on the association of AG/IM and DTGC. We extracted the odds ratio (OR) of the association from studies, and performed pool analysis. Subgroup analysis was performed on studies reporting histologic severity (using operative link systems) to assess if histologic severity of AG/IM was associated with higher risk.RESULTS: We identified six case-control and eight cohort studies for inclusion. Both AG (pooled OR=1.9, 95% CI 1.5 to 2.4, p<0.001) and IM (pooled OR=2.3, 95% CI 1.9 to 2.9, p<0.001) demonstrated an association with DTGC. High AG severity was associated with increased risk for DTGC compared to low AG severity (OR=1.7, 95% CI 1.2 to 2.3, p=0.002). Similarly, high IM severity was associated with increased risk compared to low IM severity (OR=1.9, 95% CI 1.3 to 2.7, p=0.001).CONCLUSION: Both AG and IM are associated with DTGC. Increasing histologic severity of both AG and IM increases risk for DTGC. There may exist a common pathway between ITGC and some DTGCs mediated through mucosal precursor lesions. These data may inform future strategies of cancer risk attenuation and control.

  View details for DOI 10.1007/s10552-021-01522-1

  View details for PubMedID 34797436

• Diverging Patterns of Cardia and Non-Cardia Gastric Adenocarcinoma Incidence by Race and Age in the United States From 2000-2018 Kim, S., Huang, R. J., Hwang, J. LIPPINCOTT WILLIAMS & WILKINS. 2021: S635-S636

  View details for Web of Science ID 000717526102382

• Impact of Race and Ethnicity on Risks of Cardia and Non-Cardia Gastric Adenocarcinomas in the US, 2000-2019: A Large Single-Center Retrospective Cohort Study Kim, S., Hwang, J., Huang, R. J., Kwon, S., Park, S., Choi, C., Lee, B. LIPPINCOTT WILLIAMS & WILKINS. 2021: S635

  View details for Web of Science ID 000717526102381

• Improving the Early Diagnosis of Gastric Cancer. Gastrointestinal endoscopy clinics of North America Huang, R. J., Hwang, J. H. 2021; 31 (3): 503-517

  Abstract

  Gastric cancer (GC) remains a leading cause of cancer morbidity and mortality worldwide. Outcomes from GC remain poor, especially in Western nations where cancer diagnosis is usually at advanced stages where curative resection is not possible. By contrast, nations of East Asia have adopted methods of population-level screening with improvements in stage of diagnosis and survival. In this review, the authors discuss the epidemiology of GC in Western populations, highlight at-risk populations who may benefit from screening, overview screening modalities, and discuss promising approaches to early GC detection.

  View details for DOI 10.1016/j.giec.2021.03.005

  View details for PubMedID 34053636

• Reply to Letter to the Editor. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association Huang, R., Hwang, J. H. 2021

  View details for DOI 10.1016/j.cgh.2021.03.010

  View details for PubMedID 33716138

• Disaggregated Mortality from Gastrointestinal Cancers in Asian Americans: Analysis of United States Death Records. International journal of cancer Huang, R. J., Sharp, N., Talamoa, R., Kapphahn, K., Sathye, V., Lin, B., Srinivasan, M., Palaniappan, L. P. 2021

  Abstract

  Asian Americans (AAs) are heterogeneous, and aggregation of diverse AA populations in national reporting may mask high-risk groups. Gastrointestinal (GI) cancers constitute one-third of global cancer mortality, and an improved understanding of GI cancer mortality by disaggregated AA subgroups may inform future primary and secondary prevention strategies. Using national mortality records from the United States from 2003-2017, we report age-standardized mortality rates, standardized mortality ratios, and annual percent change trends from GI cancers (esophageal, gastric, colorectal, liver, and pancreatic) for the six largest AA subgroups (Asian Indians, Chinese, Filipinos, Japanese, Koreans and Vietnamese). Non-Hispanic Whites (NHWs) are used as the reference population. We found that mortality from GI cancers demonstrated nearly 3-fold difference between the highest (Koreans, 61 per 100 000 person-years) and lowest (Asian Indians, 21 per 100 000 person-years) subgroups. The distribution of GI cancer mortality demonstrates high variability between subgroups, with Korean Americans demonstrating high mortality from gastric cancer (16 per 100 000), and Vietnamese Americans demonstrating high mortality from liver cancer (19 per 100 000). Divergent temporal trends emerged, such as increasing liver cancer burden in Vietnamese Americans, which exacerbated existing mortality differences. There exist striking differences in the mortality burden of GI cancers by disaggregated AA subgroups. These data highlight the need for disaggregated data reporting, and the importance of race-specific and personalized strategies of screening and prevention. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1002/ijc.33490

  View details for PubMedID 33527405

• Quality metrics in the performance of EUS: a population-based observational cohort of the United States. Gastrointestinal endoscopy Huang, R. J., Barakat, M. T., Park, W. n., Banerjee, S. n. 2021

  Abstract

  There exist few data on the quality of endoscopic ultrasound (EUS) in the community setting. We characterized EUS performance at the individual facility level in 3 large American states, using need for repeat biopsy (NRB) as a metric for procedural failure, and rate of unplanned hospital encounter (UHE) as a metric for adverse event.We collected data on 76,614 EUS procedures performed at 166 facilities in California, Florida, and New York (2009-2014). The endpoints for the study were 7-day rate of UHE after EUS, and 30-day rate of NRB after EUS with fine-needle aspiration. Facility-level factors analyzed included annual procedure volume, urban/rural location, and free-standing status (facilities not attached to a larger hospital). Predictors for UHE and NRB were analyzed in both multivariable regression and nonparametric local regression.Facility volume did not predict risk for UHE. However, high facility volume protected against NRB (p-trend <0.001) even after adjustment for other facility-level factors. When regressing facility volume against risk for NRB in local regression, a join-point (inflection point) was identified at 97 procedures per annum. Once facilities reached this threshold volume, there appeared little additional protective effect of higher volume. Rural facility location (OR, 1.81; 95% CI, 1.36-2.40) and free-standing status (OR, 1.57; 95% CI, 1.16-2.13) also associated with NRB.Facility volume does not predict risk for adverse events after EUS. However, high facility volume is associated with decreased rates of technical failure (as assessed by NRB). These data provide one of the first descriptions of EUS practice in community settings and highlight opportunities to improve endoscopic quality nationally.

  View details for DOI 10.1016/j.gie.2020.12.055

  View details for PubMedID 33476611

• An Approach to the Primary and Secondary Prevention of Gastric Cancer in the United States. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association Huang, R. J., Epplein, M., Hamashima, C., Choi, I. J., Lee, E., Deapen, D., Woo, Y., Tran, T., Shah, S. C., Inadomi, J. M., Greenwald, D. A., Hwang, J. H. 2021

  Abstract

  /Aims: Gastric cancer (GC) remains a leading cause of mortality among certain racial, ethnic, and immigrant groups in the United States (US). The majority of GCs are diagnosed at advanced stages, and overall survival remains poor. There exist no structured national strategies for GC prevention in the US.On March 5-6, 2020 a Summit of researchers, policy makers, public funders, and advocacy leaders was convened at Stanford University to address this critical healthcare disparity. Following this Summit, a writing group was formed to critically evaluate the effectiveness, potential benefits, and potential harms of methods of primary and secondary prevention through structured literature review. This White Paper represents a consensus statement prepared by the writing group.The burden of GC is highly inequitably distributed in the US, and disproportionately falls on Asian, African American, Hispanic, and American Indian/Alaskan Native populations. In randomized controlled trials, strategies of Helicobacter pylori testing and treatment have been demonstrated to reduce GC-specific mortality. In well-conducted observational and ecological studies, strategies of endoscopic screening have been associated with reduced GC-specific mortality. Notably however, all randomized controlled trial data (for primary prevention), and the majority of observational data (for secondary prevention) are derived from non-US sources.There exists substantial, high-quality data supporting GC prevention derived from international studies. There is an urgent need for cancer prevention trials focused on high-risk immigrant and minority populations in the US. The authors offer recommendations on how strategies of primary and secondary prevention can be applied to the heterogeneous US population.

  View details for DOI 10.1016/j.cgh.2021.09.039

  View details for PubMedID 34624563

• Pepsinogens and Gastrin Demonstrate Low Discrimination for Gastric Precancerous Lesions in a Multi-Ethnic United States Cohort. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association Huang, R. n., Park, S. n., Shen, J. n., Longacre, T. n., Ji, H. n., Hwang, J. H. 2021

  View details for DOI 10.1016/j.cgh.2021.01.009

  View details for PubMedID 33434656

• A Summary of the 2020 Gastric Cancer Summit at Stanford University. Gastroenterology Huang, R. J., Koh, H., Hwang, J. H., Summit Leaders, Abnet, C. C., Alarid-Escudero, F., Amieva, M. R., Bruce, M. G., Camargo, M. C., Chan, A. T., Choi, I. J., Corvalan, A., Davis, J. L., Deapen, D., Epplein, M., Greenwald, D. A., Hamashima, C., Hur, C., Inadomi, J. M., Ji, H. P., Jung, H., Lee, E., Lin, B., Palaniappan, L. P., Parsonnet, J., Peek, R. M., Piazuelo, M. B., Rabkin, C. S., Shah, S. C., Smith, A., So, S., Stoffel, E. M., Umar, A., Wilson, K. T., Woo, Y., Yeoh, K. G. 2020

  View details for DOI 10.1053/j.gastro.2020.05.100

  View details for PubMedID 32707045

• A case-control study of risk factors for advanced gastric intestinal metaplasia in a multiethnic United States population (The Stanford GAPS Study) Huang, R. J., Park, S., Chitre, T., Shen, J., Longacre, T., Ha Hwang, J. AMER ASSOC CANCER RESEARCH. 2020

  View details for DOI 10.1158/1538-7755.DISP19-C059

  View details for Web of Science ID 000580647800293

• Regional disparities in gastric cancer survival in the United States: An observational cohort study of the Surveillance Epidemiology and End Results Program, 2004-2016 Huang, R., Hsing, A., Palaniappan, L., Hwang, J. AMER ASSOC CANCER RESEARCH. 2020

  View details for DOI 10.1158/1538-7755.DISP19-C058

  View details for Web of Science ID 000580647800292

• Disaggregation of gastric cancer risk Between Asian American subgroups Huang, R. J., Hwang, J., Hsing, A., Palaniappan, L. AMER ASSOC CANCER RESEARCH. 2020

  View details for DOI 10.1158/1538-7755.DISP19-PR03

  View details for Web of Science ID 000580647800524

• County Rurality and Socioeconomic Deprivation is Associated with Reduced Survival from Gastric Cancer in the United States. Gastroenterology Huang, R. J., Shah, S. C., Camargo, M. C., Palaniappan, L., Hwang, J. H. 2020

  View details for DOI 10.1053/j.gastro.2020.05.006

  View details for PubMedID 32387539

• The Management of Gastric Intestinal Metaplasia in the United States - A Controversial Topic. Gastroenterology Huang, R. J., Hwang, J. H. 2020

  View details for DOI 10.1053/j.gastro.2020.02.066

  View details for PubMedID 32234304

• Goff Septotomy Is a Safe and Effective Salvage Biliary Access Technique Following Failed Cannulation at ERCP. Digestive diseases and sciences Barakat, M. T., Girotra, M., Huang, R. J., Choudhary, A., Thosani, N. C., Kothari, S., Sethi, S., Banerjee, S. 2020

  Abstract

  BACKGROUND: Biliary cannulation is readily achieved in>85% of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). When standard cannulation techniques fail, salvage techniques utilized include the needle knife precut, double wire technique, and Goff septotomy.METHODS: Records of patients undergoing ERCP from 2005 to 2016 were retrospectively examined using a prospectively maintained endoscopy database. Patients requiring salvage techniques for biliary access were analyzed together with a control sample of 20 randomly selected index ERCPs per study year. Demographic and clinical variables including indications for ERCP, cannulation rates, and adverse events were collected.RESULTS: A total of 7984 patients underwent ERCP from 2005 to 2016. Biliary cannulation was successful in 94.9% of control index ERCPs, 87.2% of patients who underwent Goff septotomy (significantly higher than for all other salvage techniques, p≤0.001), 74.5% of patients in the double wire group and 69.6% of patients in the needle knife precut group. Adverse event rates were similar in the Goff septotomy (4.1%) and index ERCP control sample (2.7%) groups. Adverse events were significantly higher in the needle knife group (27.2%) compared with all other groups.CONCLUSIONS: This study represents the largest study to date of Goff septotomy as a salvage biliary access technique. It confirms the efficacy of Goff septotomy and indicates a safety profile similar to standard cannulation techniques and superior to the widely employed needle knife precut sphincterotomy. Our safety and efficacy data suggest that Goff septotomy should be considered as the primary salvage approach for failed cannulation, with needle knife sphincterotomy restricted to Goff septotomy failures.

  View details for DOI 10.1007/s10620-020-06124-6

  View details for PubMedID 32052216

• Single cell genomic characterization reveals the cellular reprogramming of the gastric tumor microenvironment. Clinical cancer research : an official journal of the American Association for Cancer Research Sathe, A. n., Grimes, S. M., Lau, B. T., Chen, J. n., Suarez, C. n., Huang, R. J., Poultsides, G. A., Ji, H. P. 2020

  Abstract

  The tumor microenvironment (TME) consists of a heterogenous cellular milieu that can influence cancer cell behavior. Its characteristics havean impact on treatments such as immunotherapy. These features can be revealed with single-cell RNA sequencing (scRNA-seq). We hypothesized that scRNA-seq analysis ofgastric cancer (GC) together with paired normal tissue and peripheral blood mononuclear cells (PBMCs) would identify critical elements of cellular deregulation not apparent with other approaches.scRNA-seq was conducted on seven patients with GC and one patient with intestinal metaplasia. We sequenced 56,167 cells comprising GC (32,407 cells), paired normal tissue (18,657 cells) and PBMCs (5,103 cells). Protein expression was validated by multiplex immunofluorescence.Tumor epithelium had copy number alterations, a distinct gene expression program from normal, with intra-tumor heterogeneity. GC TME was significantly enriched for stromal cells, macrophages, dendritic cells (DCs) and Tregs. TME-exclusive stromal cells expressed distinct extracellular matrix components than normal. Macrophages were transcriptionally heterogenous and did not conform to a binary M1/M2 paradigm. Tumor-DCs had a unique gene expression program compared to PBMC DCs. TME-specific cytotoxic T cells were exhausted with two heterogenous subsets. Helper, cytotoxic T, Treg and NK cells expressed multiple immune checkpoint or costimulatory molecules. Receptor-ligand analysis revealed TME-exclusive inter-cellular communication.Single-cell gene expression studies revealed widespread reprogramming across multiple cellular elements in the GC TME. Cellular remodeling was delineated by changes in cell numbers, transcriptional states and inter-cellular interactions. This characterization facilitates understanding of tumor biology and enables identification of novel targets including for immunotherapy.

  View details for DOI 10.1158/1078-0432.CCR-19-3231

  View details for PubMedID 32060101

• One Size Does Not Fit All: Marked Heterogeneity in Incidence of and Survival from Gastric Cancer among Asian American Subgroups. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology Huang, R. J., Sharp, N. n., Talamoa, R. O., Ji, H. P., Hwang, J. H., Palaniappan, L. P. 2020

  Abstract

  Asian Americans are at higher risk for non-cardia gastric cancers (NCGCs) relative to non-Hispanic Whites (NHWs). Asian Americans are genetically, linguistically, and culturally heterogeneous, yet have mostly been treated as a single population in prior studies. This aggregation may obscure important subgroup-specific cancer patterns.We utilized data from 13 regional United States cancer registries from 1990-2014 to determine secular trends in incidence and survivorship from NCGC. Data were analyzed for NHWs and the six largest Asian American subgroups: Chinese, Japanese, Filipino, Korean, Vietnamese, and South Asian (Indian/Pakistani).There exists substantial heterogeneity in NCGC incidence between Asian subgroups, with Koreans (48.6 per 100,000 person-years) having seven-fold higher age-adjusted incidence than South Asians (7.4 per 100,000 person-years). Asians had generally earlier stages of diagnosis and higher rates of surgical resection compared to NHWs. All Asian subgroups also demonstrated higher five-year observed survival compared to NHWs, with Koreans (41.3%) and South Asians (42.8%) having survival double that of NHWs (20.1%, p<0.001). In multivariable regression, differences in stage of diagnosis and rates of resection partially explained the difference in survivorship between Asian subgroups.We find substantial differences in incidence, staging, histology, treatment, and survivorship from NCGC between Asian subgroups, data which challenge our traditional perceptions about gastric cancer in Asians. Both biological heterogeneity and cultural/environmental differences may underlie these findings.These data are relevant to the national discourse regarding the appropriate role of gastric cancer screening, and identifies high-risk racial/ethnic subgroups who many benefit from customized risk attenuation programs.

  View details for DOI 10.1158/1055-9965.EPI-19-1482

  View details for PubMedID 32152216

• Risk of ambulatory colonoscopy in patients with cirrhosis: a propensity-score matched cohort study. Endoscopy international open Huang, R. J., Banerjee, S. n., Friedland, S. n., Ladabaum, U. n. 2020; 8 (10): E1495–E1501

  Abstract

  Background and study aims  Patients with cirrhosis demonstrate alterations in physiology, hemodynamics, and immunity which may increase procedural risk. There exist sparse data regarding the safety of performing ambulatory colonoscopy in patients with cirrhosis. Patients and methods  From a population-based sample of three North American states (California, Florida, and New York), we collected data on 3,590 patients with cirrhosis who underwent ambulatory colonoscopy from 2009 to 2014. We created a control cohort propensity score-matched for cirrhotic severity who did not undergo colonoscopy (N = 3,590) in order to calculate the attributable risk for adverse events. The primary endpoint was the rate of unplanned hospital encounters (UHEs) within 14 days of colonoscopy (or from a synthetic index date for the control cohort). Predictors for UHE were assessed in multivariable regression. Results  The attributable risk for any UHE following colonoscopy was 3.1 % (confidence interval [CI] 2.1-4.1 %, P  < 0.001). There was increased risk for infection (0.9 %, CI 0.7-1.1 %), spontaneous bacterial peritonitis (0.1 %, CI 0.0-0.3 %), decompensation of ascites (0.3 %, CI 0.2-0.4 %), and cardiovascular event (0.4 %, CI 0.3-0.5 %). There was no increased attributable risk for gastrointestinal bleeding, perforation, or development of the hepatorenal syndrome. The presence of ascites at time of procedure was the only predictor for UHE in the fully-adjusted model (OR 2.6, CI 1.9-3.5, P  < 0.001). Conclusions  There is a moderate though detectable increase in risk for adverse event following ambulatory colonoscopy in patients with cirrhosis. The presence of ascites in particular portends higher risk. These data may guide clinicians when counseling patients with cirrhosis on the choice of colorectal cancer screening modality.

  View details for DOI 10.1055/a-1242-9958

  View details for PubMedID 33043119

  View details for PubMedCentralID PMC7541192

• Risk Factors for Advanced Gastric Intestinal Metaplasia in a Multi-Ethnic United States Cohort Huang, R., Park, S., Chitre, T., Shen, J., Longacre, T., Hwang, J. LIPPINCOTT WILLIAMS & WILKINS. 2019: S689–S690

  View details for Web of Science ID 000509756003037

• Disaggregation of Gastric Cancer Risk Between Asian American Subgroups Huang, R., Hwang, J., Palaniappan, L. LIPPINCOTT WILLIAMS & WILKINS. 2019: S688–S689

  View details for DOI 10.14309/01.ajg.0000594460.74476.13

  View details for Web of Science ID 000509756003035

• Diagnosis and Management of Gastric Intestinal Metaplasia: Current Status and Future Directions. Gut and liver Huang, R. J., Choi, A. Y., Truong, C. D., Yeh, M. M., Hwang, J. H. 2019

  Abstract

  Gastric intestinal metaplasia (GIM) is a known premalignant condition of the human stomach along the pathway to gastric cancer (GC). Histologically, GIM represents the replacement of normal gastric mucosa by mucin-secreting intestinal mucosa. Helicobacter pylori infection is the most common etiologic agent of GIM development worldwide. The prevalence of GIM is heterogeneous among different regions of the world and correlates with the population endemicity of H. pylori carriage, among other environmental factors. GC remains the third leading cause of cancer-related mortality globally. GIM is usually diagnosed by upper endoscopy with biopsy, and histologic scoring systems have been developed to risk-stratify patients at highest risk for progression to GC. Several recent endoscopic imaging modalities may improve the optical detection of GIM and early GC. Appropriate surveillance of GIM may be cost effective and represents an opportunity for the early diagnosis and therapy of GC. Certain East Asian nations have established population-level programs for the screening and surveillance of GIM; guidelines regarding GIM surveillance have also recently been published in Europe. By contrast, few data exist regarding the appropriateness of surveillance of GIM in the United States. In this review, we discuss the pathogenesis, epidemiology, diagnosis, and management of GIM with an emphasis on the role of appropriate endoscopic surveillance.

  View details for DOI 10.5009/gnl19181

  View details for PubMedID 31394893

• A Chance to Cut Is a Chance to Cure: Endoscopic Submucosal Dissection for Early Gastric Cancer DIGESTIVE DISEASES AND SCIENCES Huang, R. J., Charville, G. W., Hwang, J., Friedland, S. 2019; 64 (5): 1129–32

  View details for DOI 10.1007/s10620-018-5317-8

  View details for Web of Science ID 000466886100013

• Unplanned Hospital Encounters After Endoscopic Retrograde Cholangiopancreatography in 3 Large North American States GASTROENTEROLOGY Huang, R. J., Barakat, M. T., Girotra, M., Lee, J. S., Banerjee, S. 2019; 156 (1): 119-+

  View details for DOI 10.1053/j.gastro.2018.09.037

  View details for Web of Science ID 000453401000028

• ASGE review of adverse events in colonoscopy. Gastrointestinal endoscopy Kothari, S. T., Huang, R. J., Shaukat, A. n., Agrawal, D. n., Buxbaum, J. L., Abbas Fehmi, S. M., Fishman, D. S., Gurudu, S. R., Khashab, M. A., Jamil, L. H., Jue, T. L., Law, J. K., Lee, J. K., Naveed, M. n., Qumseya, B. J., Sawhney, M. S., Thosani, N. n., Yang, J. n., DeWitt, J. M., Wani, S. n. 2019

  Abstract

  Colonoscopy is the most commonly performed endoscopic procedure and overall is considered a low-risk procedure. However, adverse events (AEs) related to this routinely performed procedure for screening, diagnostic, or therapeutic purposes are an important clinical consideration. The purpose of this document from the American Society for Gastrointestinal Endoscopy's Standards of Practice Committee is to provide an update on estimates of AEs related to colonoscopy in an evidence-based fashion. A systematic review and meta-analysis of population-based studies was conducted for the 3 most common and important serious AEs (bleeding, perforation, and mortality). In addition, this document includes an updated systematic review and meta-analysis of serious AEs (bleeding and perforation) related to EMR and endoscopic submucosal dissection for large colon polyps. Finally, a narrative review of other colonoscopy-related serious AEs and those related to specific colonic interventions is included.

  View details for DOI 10.1016/j.gie.2019.07.033

  View details for PubMedID 31563271

• Prevalence, Risk Factors, and Surveillance Patterns for Gastric Intestinal Metaplasia Among Patients Undergoing Upper Endoscopy with Biopsy. Gastrointestinal endoscopy Huang, R. J., Ende, A. R., Singla, A. n., Higa, J. T., Choi, A. Y., Lee, A. B., Whang, S. G., Gravelle, K. n., D'Andrea, S. n., Bang, S. J., Schmidt, R. A., Yeh, M. M., Hwang, J. H. 2019

  Abstract

  Gastric intestinal metaplasia (GIM) is an important precursor lesion to gastric cancer (GC), the second leading cause of cancer deaths worldwide. There exist few data regarding the prevalence of, risk factors for, and clinical practice patterns regarding gastric intestinal metaplasia (GIM) in the United States. Furthermore, there are currently no U.S. guidelines regarding screening/surveillance for GIM.All consecutive upper endoscopic procedures from 2 academic medical centers in Seattle between 1999 and 2014 are reviewed. Demographic, clinical, and endoscopic covariates are recorded at time of endoscopy. Procedures with gastric biopsy are matched to final histologic diagnoses, including presence of Helicobacter pylori. Cases of GIM and dysplasia are recorded and compared with non-GIM controls using univariate and multivariable regression. Surveillance patterns for cases of GIM are recorded.Data from 36,799 upper endoscopies, 17,710 gastric biopsies, 2,073 cases of GIM, 43 cases of dysplasia, and 78 cases of GC were captured. The point prevalence of GIM is 11.7% in patients who underwent gastric biopsy. Non-white race (P<0.001), increasing age (P<0.001), and presence of H pylori (P<0.001) associated with GIM. Once GIM is present, increasing age (P<0.001) and male gender (P<0.001) associate with progression, and presence of H pylori (P<0.001) inversely associates with progression to dysplasia/GC. Few cases of GIM/dysplasia/GC are made during procedures for GIM screening/surveillance. Only 16% of patients with a diagnosis of GIM received a recommendation for surveillance.There is a high prevalence of GIM among non-white and Hispanic Americans. Risk factors for development of GIM may be distinct from risk factors for progression to GC.

  View details for DOI 10.1016/j.gie.2019.07.038

  View details for PubMedID 31425693

• Routine gastric biopsies: Should we be doing more? Gastrointestinal endoscopy Huang, R. J., Hwang, J. H. 2019; 89 (6): 1150–51

  View details for DOI 10.1016/j.gie.2019.02.010

  View details for PubMedID 31104747

• Recent Trends and the Impact of the Affordable Care Act on Emergency Department Visits and Hospitalizations for Gastrointestinal, Pancreatic, and Liver Diseases. Journal of clinical gastroenterology Barakat, M. T., Mithal, A., Huang, R. J., Sehgal, A., Sehgal, A., Singh, G., Banerjee, S. 2018

  Abstract

  BACKGROUND: The Affordable Care Act (ACA) with Medicaid expansion implemented in 2014, extended health insurance to >20-million previously uninsured individuals. However, it is unclear whether enhanced primary care access with Medicaid expansion decreased emergency department (ED) visits and hospitalizations for gastrointestinal (GI)/pancreatic/liver diseases.METHODS: We evaluated trends in GI/pancreatic/liver diagnosis-specific ED/hospital utilization over a 5-year period leading up to Medicaid expansion and a year following expansion, in California (a state that implemented Medicaid expansion) and compare these with Florida (a state that did not).RESULTS: From 2009 to 2013, GI/pancreatic/liver disease ED visits increased by 15.0% in California and 20.2% in Florida and hospitalizations for these conditions decreased by 2.6% in California and increased by 7.9% in Florida. Following Medicaid expansion, a shift from self-pay/uninsured to Medicaid insurance was seen California; in addition, a new decrease in ED visits for nausea/vomiting and GI infections, was evident, without associated change in overall ED/hospital utilization trends. Total hospitalization charges for abdominal pain, nausea/vomiting, constipation, and GI infection diagnoses decreased in California following Medicaid expansion, but increased over the same time-period in Florida.CONCLUSIONS: We observed a striking payer shift for GI/pancreatic/liver disease ED visits/hospitalizations after Medicaid expansion in California, indicating a shift in the reimbursement burden in self-pay/uninsured patients, from patients and hospitals to the government. ED visits and hospitalization charges decreased for some primary care-treatable GI diagnoses in California, but not for Florida, suggesting a trend toward lower cost of gastroenterology care, perhaps because of decreased hospital utilization for conditions amenable to outpatient management.

  View details for PubMedID 30285976

• Unplanned Hospital Encounters Following Endoscopic Retrograde Cholangiopancreatography in 3 Large American States. Gastroenterology Huang, R. J., Barakat, M. T., Girotra, M., Lee, J. S., Banerjee, S. 2018

  Abstract

  BACKGROUND & AIMS: We have few population-level data on the performance of endoscopic retrograde cholangiopancreatography (ERCP) in the United States. We investigated the numbers of unplanned hospital encounters (UHEs), patient and facility factors associated with UHEs, and variation in quality and outcomes in the performance of ERCP in 3 large American states.METHODS: We collected data on 68,642 ERCPs, performed at 635 facilities in California, Florida, and New York from 2009 through 2014. The primary endpoint was number of UHEs with an ERCP-related event within 7 days of ERCP; secondary endpoints included numbers of UHE within 30 days and mortality within 30 days. Each facility was assigned a risk-standardized cohort, and variations in numbers of UHE were analyzed using multivariable analysis.RESULTS: Among all ERCPs, 5.8% resulted in an UHE within 7 days, and 10.2% by 30 days. Performance of sphincterotomy was significantly associated with a higher risk of UHE at 7 and 30 days (P<.001). Younger age, female sex, and more advanced comorbidity associated with UHE. There was substantial heterogeneity in rates of UHE among facilities: 4.2% at facilities in the lower 5th percentile and 25.2% at facilities in the 95th percentile. Increasing facility volume and ability to perform endoscopic ultrasound associated inversely with risk. The median number of ERCPs performed each year was 68.7, but 69% of facilities performed 100 or fewer ERCPs per year. Risk for UHE following sphincterotomy decreased with increasing facility volume until an inflection point of 157 ERCPs per year was reached.CONCLUSIONS: In an analysis of outcomes of 68,642 ERCPs performed in three states, we found a higher than expected number of UHEs. There is substantial unexplained variation in risk for adverse event following ERCPs among facilities-volume is the strongest predictor of risk. Annual facility volumes above approximately 150 ERCPs per year may protect against UHE.

  View details for PubMedID 30243620

• Chronic pancreatitis changes in high-risk individuals for pancreatic ductal adenocarcinoma. Gastrointestinal endoscopy Thiruvengadam, S. S., Chuang, J., Huang, R., Girotra, M., Park, W. G. 2018

  Abstract

  BACKGROUND AND AIMS: Pancreatic intraepithelial neoplasia is associated with chronic pancreatitis (CP) changes on EUS. The objective of this study was to determine whether CP changes were more common in high-risk individuals (HRIs) than in controls and whether these changes differed among higher-risk subsets of HRIs.METHODS: HRIs and controls were identified from an endoscopy database. HRIs were defined as having predisposing mutations or a family history (FH) of pancreatic ductal adenocarcinoma. HRIs were classified as vHRIs who met cancer of the pancreas screening (CAPS) criteria for high risk and mHRIs who did not. Multivariable logistic regression was used to adjust for confounders and CP risk factors.RESULTS: 65 HRIs (44 vHRIs, 21 mHRIs) and 118 controls were included. HRIs were included for FH (25), Lynch syndrome (5), Peutz-Jeghers syndrome (2), and mutations in BRCA1/2 (26), PALB2 (3), ATM (3), and CDKN2A (1). After adjustment for relevant variables, HRIs were 16 times more likely to exhibit 3 or more CP changes than controls (95% CI, 2.6-97.0; P = .003). HRIs were also more likely to have hypoechoic foci (OR, 8.0; 95% CI, 1.9-32.9; P = .004). vHRIs and mHRIs did not differ in frequency of three or more CP changes on EUS.CONCLUSIONS: HRIs were more likely to exhibit CP changes and hypoechoic foci on EUS compared with controls. HRIs with these findings may require closer surveillance. HRIs who did or did not meet CAPS criteria did not differ with regard to CP findings, supporting a more inclusive approach to screening.

  View details for DOI 10.1016/j.gie.2018.08.029

  View details for PubMedID 30145314

• NO INCREASED RISK OF POST-PROCEDURAL UNPLANNED HOSPITAL ENCOUNTERS FOLLOWING AMBULATORY COLONOSCOPY IN PATIENTS WITH CIRRHOSIS: A POPULATION-LEVEL, COHORT-CONTROLLED STUDY. Huang, R. J., Barakat, M. T., Friedland, S., Banerjee, S. MOSBY-ELSEVIER. 2018: AB91–AB92

  View details for Web of Science ID 000434248200085

• RISK OF POST-PROCEDURAL UNPLANNED HOSPITAL ENCOUNTERS FOLLOWING ENDOSCOPIC ULTRASOUND WITH FINE-NEEDLE ASPIRATION OF THE PANCREAS: A POPULATION-LEVEL, PROPENSITY-SCORE CONTROLLED COHORT STUDY Huang, R. J., Barakat, M. T., Park, W. G., Banerjee, S. MOSBY-ELSEVIER. 2018: AB107–AB108

  View details for Web of Science ID 000434248200111

• Video-based performance assessment in endoscopy: Moving beyond "see one, do one, teach one"? GASTROINTESTINAL ENDOSCOPY Huang, R. J., Limsui, D., Triadafilopoulos, G. 2018; 87 (3): 776–77

  View details for PubMedID 29454450

• A Chance to Cut Is a Chance to Cure: Endoscopic Submucosal Dissection for Early Gastric Cancer. Digestive diseases and sciences Huang, R. J., Charville, G. W., Hwang, J. H., Friedland, S. n. 2018

  View details for PubMedID 30350240

• Practice Patterns for Cholecystectomy Following Endoscopic Retrograde Cholangio-Pancreatography for Patients With Choledocholithiasis. Gastroenterology Huang, R. J., Barakat, M. T., Girotra, M., Banerjee, S. 2017

  Abstract

  Cholecystectomy (CCY) following an episode of choledocholithiasis requiring endoscopic retrograde cholangio-pancreatography (ERCP) with stone extraction reduces recurrent biliary events, compared to expectant management. We studied practice patterns for performance of CCY following ERCP for choledocholithiasis using data from 3 large states and evaluated the effects of delaying CCY.We conducted a retrospective cohort study using the ambulatory surgery, inpatient, and emergency department databases from the states of California (years 2009-2011), New York (2011-2013), and Florida (2012-2014). We collected data from 4516 patients hospitalized with choledocholithiasis who underwent ERCP. We compared outcomes of patients who underwent CCY at index admission (early CCY), elective CCY within 60 days of discharge (delayed CCY), or did not undergo CCY (no CCY), calculating rate of recurrent biliary events (defined as an emergency department visit or unplanned hospitalization due to symptomatic cholelithiasis, cholecystitis, choledocholithiasis, cholangitis, or biliary pancreatitis), mortality, and cost by CCY cohort. We also evaluated risk factors for not undergoing CCY. The primary outcome measure was the rate of recurrent biliary events in the 365 days following discharge from index admission.Of the patients who underwent ERCP for choledocholithiasis, 41.2% underwent early CCY, 10.9% underwent delayed CCY, and 48.0% underwent no CCY. Early CCY reduced relative risk of recurrent biliary events within 60 days by 92%, compared with delayed or no CCY (P<.001). After 60 days following discharge from index admission, patients with early CCY had an 87% lower risk of recurrent biliary events than patients with no CCY (P<.001) and patients with delayed CCY had an 88% lower risk of recurrent biliary events than patients with no CCY (P<.001). A strategy of delayed CCY performed on an outpatient basis was least costly. Performance of early CCY was inversely associated with low facility volume. Hispanic race, Asian race, Medicaid insurance, and no insurance associated inversely with performance of delayed CCY.In a retrospective analysis of over 4500 patients hospitalized with choledocholithiasis, we found that CCY was not performed following ERCP for almost half of the cases. Although early and delayed CCY equally reduce the risk of subsequent recurrent biliary events, patients are at 10-fold higher risk of recurrent biliary event while waiting for a delayed CCY compared with patients who underwent early CCY. Delayed CCY is a cost-effective strategy that must be balanced against the risk of loss to follow up, particularly among patients who are ethnic minorities or have little or no health insurance.

  View details for DOI 10.1053/j.gastro.2017.05.048

  View details for PubMedID 28583822

• The Gastroenterology Fellowship Match: A Decade Later. Digestive diseases and sciences Huang, R. J., Triadafilopoulos, G., Limsui, D. 2017; 62 (6): 1412-1416

  Abstract

  Following a period of uncertainty and disorganization, the gastroenterology (GI) national leadership decided to reinstitute the fellowship match (the Match) under the auspices of the National Residency Matching Program (NRMP) in 2006. Although it has now been a decade since the rebirth of the Match, there have been limited data published regarding progress made. In this piece, we discuss reasons for the original collapse of the GI Match, including most notably a perceived oversupply of GI physicians and a poor job market. We discuss the negative impacts the absence of the Match had on programs and on applicants, as well as the impetus to reorganize the Match under the NRMP. We then utilize data published annually by the NRMP to demonstrate that in the decade since its rebirth, the GI Match has been remarkably successful in terms of attracting the participation of applicants and programs. We show that previous misguided concerns of an oversupply of GI physicians were not realized, and that GI fellowship positions remain highly competitive for internal medicine applicants. Finally, we discuss possible implications of recent changes in the healthcare landscape on the GI Match.

  View details for DOI 10.1007/s10620-017-4593-z

  View details for PubMedID 28474142

  View details for PubMedCentralID PMC5535767

• Evolution in the utilization of biliary interventions in the United States: results of a nationwide longitudinal study from 1998 to 2013. Gastrointestinal endoscopy Huang, R. J., Thosani, N. C., Barakat, M. T., Choudhary, A., Mithal, A., Singh, G., Sethi, S., Banerjee, S. 2017

  Abstract

  Bile duct surgery (BDS), percutaneous transhepatic cholangiography (PTC), and ERCP are alternative interventions used to treat biliary disease. Our aim was to describe trends in ERCP, BDS, and PTC on a nationwide level in the United States.We used the National Inpatient Sample to estimate age-standardized utilization trends of inpatient diagnostic ERCP, therapeutic ERCP, BDS, and PTC between 1998 and 2013. We calculated average case fatality, length of stay, patient demographic profile (age, gender, payer), and hospital characteristics (hospital size and metropolitan status) for these procedures.Total biliary interventions decreased over the study period from 119.8 to 100.1 per 100,000. Diagnostic ERCP utilization decreased by 76%, and therapeutic ERCP utilization increased by 35%. BDS rates decreased by 78% and PTC rates by 24%. ERCP has almost completely supplanted surgery for the management of choledocholithiasis. Fatality from ERCP, BDS, and PTC have all decreased, whereas mean length of stay has remained stable. The proportion of Medicare-insured, Medicaid-insured, and uninsured patients undergoing biliary procedures has increased over time. Most of the increase in therapeutic ERCP and decrease in BDS occurred in large, metropolitan hospitals.Although therapeutic ERCP utilization has increased over time, the total volume of biliary interventions has decreased. BDS utilization has experienced the most dramatic decrease, possibly a consequence of the increased therapeutic capacity and safety of ERCP. ERCPs are now predominantly therapeutic in nature. Large urban hospitals are leading the shift from surgical to endoscopic therapy of the biliary system.

  View details for DOI 10.1016/j.gie.2016.12.021

  View details for PubMedID 28062313

• Adenosine triphosphate bioluminescence for bacteriological surveillance and reprocessing strategies for minimizing risk of infection transmission by duodenoscopes. Gastrointestinal endoscopy Sethi, S., Huang, R. J., Barakat, M. T., Banaei, N., Friedland, S., Banerjee, S. 2016

  Abstract

  Recent outbreaks of duodenoscope-transmitted infections underscore the importance of adequate endoscope reprocessing. Adenosine triphosphate (ATP) bioluminescence testing allows rapid evaluation of endoscopes for bacteriologic/biologic residue. In this prospective study we evaluate the utility of ATP in bacteriologic surveillance and the effects of endoscopy staff education and dual cycles of cleaning and high-level disinfection (HLD) on endoscope reprocessing.ATP bioluminescence was measured after precleaning, manual cleaning, and HLD on rinsates from suction-biopsy channels of all endoscopes and elevator channels of duodenoscopes/linear echoendoscopes after use. ATP bioluminescence was remeasured in duodenoscopes (1) after re-education and competency testing of endoscopy staff and subsequently (2) after 2 cycles of precleaning and manual cleaning and single cycle of HLD or (3) after 2 cycles of precleaning, manual cleaning, and HLD.The ideal ATP bioluminescence benchmark of <200 relative light units (RLUs) after manual cleaning was achieved from suction-biopsy channel rinsates of all endoscopes, but 9 of 10 duodenoscope elevator channel rinsates failed to meet this benchmark. Re-education reduced RLUs in duodenoscope elevator channel rinsates after precleaning (23,218.0 vs 1340.5 RLUs, P < .01) and HLD (177.0 vs 12.0 RLUs, P < .01). After 2 cycles of manual cleaning/HLD, duodenoscope elevator channel RLUs achieved levels similar to sterile water, with corresponding negative cultures.ATP testing offers a rapid, inexpensive alternative for detection of endoscope microbial residue. Re-education of endoscopy staff and 2 cycles of cleaning and HLD decreased elevator channel RLUs to levels similar to sterile water and may therefore minimize the risk of transmission of infections by duodenoscopes.

  View details for DOI 10.1016/j.gie.2016.10.035

  View details for PubMedID 27818222

• Colonoscopy with polypectomy is associated with a low rate of complications in patients with cirrhosis. Endoscopy international open Huang, R. J., Perumpail, R. B., Thosani, N., Cheung, R., Friedland, S. 2016; 4 (9): E947-52

  Abstract

  Cirrhotic patients are at a theoretically increased risk of bleeding. The safety of polypectomy in cirrhosis is poorly defined.We performed a retrospective review of patients with cirrhosis who underwent colonoscopic polypectomy at a tertiary-care hospital. Patient characteristics and polyp data were collected. Development of complications including immediate bleeding, delayed bleeding, hospitalization, blood transfusion, perforation, and death were recorded to 30-day follow-up. Clinical characteristics between bleeders and non-bleeders were compared, and predictors of bleeding were determined.A total of 307 colonoscopies with 638 polypectomies were identified. Immediate bleeding occurred in 7.5 % (95 % CI 4.6 % - 10.4 %) and delayed bleeding occurred in 0.3 % (95 % CI 0.0 % - 0.9 %) of colonoscopies. All cases of immediate bleeding were controlled endoscopically and none resulted in serious complication. The rate of hospitalization was 0.7 % (95 % CI 0.0 % - 1.6 %) and repeat colonoscopy 0.3 % (95 % CI 0.0 % - 0.9 %); no cases of perforation, blood transfusion, or death occurred. Lower platelet count, higher INR, presence of ascites, and presence of esophageal varices were associated with increased risk of bleeding. Use of electrocautery was associated with a lower risk of immediate bleeding. There was no significant difference between bleeding and non-bleeding polyps with regard to size, morphology, and histology.Colonoscopy with polypectomy appears safe in patients with cirrhosis. There is a low risk of major complications. The risk of immediate bleeding appears higher than an average risk population; however, most bleeding is self-limited or can be controlled endoscopically. Bleeding tends to occur with more advanced liver disease. Both the sequelae of portal hypertension and coagulation abnormalities are predictive of bleeding.

  View details for DOI 10.1055/s-0042-111317

  View details for PubMedID 27652299

  View details for PubMedCentralID PMC5025305

• Response. Gastrointestinal endoscopy Huang, R. J., Draper, K. V., Gerson, L. B. 2015; 81 (3): 777-?

  View details for DOI 10.1016/j.gie.2014.09.056

  View details for PubMedID 25708772

• Colonic plasmacytomas: a rare complication of plasma cell leukemia. Endoscopy Hang, C. T., Perumpail, R. B., Huang, R. J., Fernandez-Pol, S., Fernandez-Becker, N. Q. 2015; 47: E77-8

  View details for DOI 10.1055/s-0034-1390722

  View details for PubMedID 25926223

• Locally advanced gastric cancer complicated by mesenteric invasion and intestinal malrotation. Digestive diseases and sciences Huang, R. J., Visser, B. C., Chen, A. M., Ladabaum, U. 2014; 59 (2): 267-269

  View details for DOI 10.1007/s10620-013-2869-5

  View details for PubMedID 24036993

• Manometric abnormalities in the postural orthostatic tachycardia syndrome: a case series. Digestive diseases and sciences Huang, R. J., Chun, C. L., Friday, K., Triadafilopoulos, G. 2013; 58 (11): 3207-3211

  Abstract

  Postural orthostatic tachycardia syndrome (POTS) is a rare disease that is believed to be mediated by dysautonomia. Gastrointestinal complaints in POTS patients are common and disturbing but not well characterized.We hypothesized that gastrointestinal dysmotility may be contributory to these symptoms.We studied 12 POTS patients who presented with gastrointestinal symptoms to a tertiary referral center. Gastrointestinal symptoms were quantified using a previously validated symptom questionnaire. All patients underwent gastroduodenal manometry (GDM); select patients also underwent further testing including esophageal manometry (EM), anorectal manometry (ARM), plain abdominal radiography (AXR), abdominal computed tomography (CT), gastric emptying studies (GES), and colonic transit time (CTT) studies.The four most common symptoms were bloating, constipation, abdominal pain, and nausea/vomiting, all experienced by greater than 70 % of patients. On GDM testing, 93 % of patients demonstrated signs of neuropathy, and the most common abnormalities observed included bursts of uncoordinated phasic activity in both fasting (59 %) and post-prandial (42 %) states, low contractility in the post-prandial state (67 %), and lack of post-prandial pattern (42 %). A total of 67 % of patients undergoing EM and 86 % of those undergoing ARM demonstrated abnormalities consistent with dysmotility. On AXR or CT, 58 % demonstrated either dilated intestinal loops or air-fluid levels. On CTT 80 % demonstrated delayed colonic transit, while on GES 60 % demonstrated delayed gastric emptying.In this cohort of POTS patients with gastrointestinal symptoms, there is a high prevalence of abnormal manometric and radiographic findings suggestive of dysmotility.

  View details for DOI 10.1007/s10620-013-2865-9

  View details for PubMedID 24068608

• Acute Fulminant Hepatic Failure Associated with Parvovirus B19 Infection in an Immunocompetent Adult DIGESTIVE DISEASES AND SCIENCES Huang, R. J., Varr, B. C., Triadafilopoulos, G. 2012; 57 (11): 2811-2813

  View details for DOI 10.1007/s10620-012-2110-y

  View details for Web of Science ID 000309867800028

  View details for PubMedID 22395961