Gastric Ulcer

Background: Helicobacter pylori (H. pylori) infection is the main cause of gastric cancer (GC), and long-term process occurs from premalignant lesions to carcinoma. H. pylori eradication during early stages of disease in young adults ("screen and treat") significantly impacts GC favoring survival, disease reversal and molecular changes. Effects of eradication therapy in affecting gut microbiome diversity and composition, and increasing antibiotic resistance rates in commensal bacteria, appear to be transient in most studies. The investigators have shown that infection is acquired mainly during the first 5 years of life, most infected children remain persistently infected with low rates of spontaneous eradication and persistently infected children have more abdominal complaints and higher levels of pepsinogen (PG) II (marker of gastric damage). A pilot eradication trial in persistently infected school-aged children showed that with sequential triple therapy, eradication was achieved in 96.8% of children, and treated children had a decrease in PG I and II levels compared to non-treated. The Investigators propose a "screen and treat" strategy aimed at a transition age between childhood and adulthood, in areas with intermediate-high gastric cancer prevalence, to assess efficacy of eradication, its clinical and molecular benefits and potential microbial side effects. Aims: The primary aim will be to determine the effectiveness of H. pylori eradication therapy in 14-18 years old adolescents in three regions with nearly 20-25% persistence rates, and determine the effect of eradication on clinical and serum biomarkers of gastric disease/damage. The secondary aims will be to determine the effects of H. pylori eradication therapy on antimicrobial resistance of potentially pathogenic enteric bacteria, and on gut microbiome composition. Exploratory aims: To determine the presence of clarithromycin resistance genes in H. pylori by stool analysis of children not achieving eradication, and determine the effects of reinfection on clinical findings indicative of gastric disease, and biomarkers indicative of "gastric damage", gut microbiota composition and antimicrobial resistance of H. pylori and other potentially pathogenic bacteria. Methods: The Investigators will invite, through contact with the health and educational authorities of Colina, Temuco and Coyhaique, 14-18 year old students until we reach up to 1000 adolescents enrolled. H. pylori screening test (Urea Breath Test; UBT) will be offered, and adolescents with a positive test will undergo two additional tests, separated by 30 days, in order to confirm infection persistence (at least two positive tests). It is expected that 20-25% of adolescents screened to be positive for H. pylori, of which over 90% will be persistently infected. 210 Subjects with persistent infection will then be randomized 2:1 to receive either an antimicrobial course targeting H. pylori eradication (7 days of lansoprazole and amoxicillin followed by 7 days of lansoprazole and clarithromycin plus metronidazole) or no treatment. Participants will be followed-up with UBT (1 month post treatment, and then every 6 months for the remaining surveillance period), gastroenterological evaluation (2 weeks pre treatment, 1 month, 3 months, 9 months and 18 months post treatment), blood samples and stool samples (2 weeks pre-treatment, 1 month and 6 months post treatment). A subset of 60 non-infected students from each site will be followed-up in matched times. To those subjects with persistent infection who do not receive treatment, the same eradication regimen will be offered after they have completed the initial 6-month follow-up with their blood and stool samples taken. Serum gastric damage biomarkers will be assessed using GastroPanel® (PGI, PGII, Gastrin) and ELISA commercial kits (VCAM-1, CXCL13). Escherichia coli and Enterococcus spp will be cultured from stools samples, and resistance to 6 antimicrobials will be assessed by disk diffusion method. H. pylori clarithromycin resistance gene will be amplified from stools using nested-qPCR. Composition of gut microbiome will be characterized by amplification and sequencing the 16SrRNA gene from stools, ant then bioinformatics analysis. Expected results: The prevalence of persistent H. pylori infection will be around 20-25% in adolescents from Colina, Coyhaique and Temuco. Eradication will be successful in \>90% of persistently infected students, and reinfection rates will not surpass 15% in a 2-3 year period. Eradication will be significantly associated with a decrease in clinical findings indicative of gastric disease, and a decrease in biomarker levels indicative of "gastric damage". Treatment will have a transitory effect on increasing antimicrobial resistance rates of potentially pathogen enteric bacteria (Escherichia coli, Enterococcus spp.). Treatment will have a transitory effect on disrupting gut microbiota composition at phylum, class, order, family and genus levels, which will be restored to levels comparable to non-infected healthy teenagers at the end of follow-up. In those adolescents for whom eradication therapy fails, clarithromycin resistance will be more prevalent in pretreatment samples compared to those eradicating H. pylori; in reinfected children, treatment will have a transitory effect on increasing detection rates of H. pylori clarithromycin resistance genes.

Gastric diseases-including atrophic gastritis, gastric polyps, peptic ulcers, submucosal lesions, gastric cancer, and precancerous conditions-have become a major global public health challenge. In China, the prevalence of gastric ulcers is as high as 17.2%, significantly higher than that in Western countries (4.1%) \[1\]. Gastric cancer also ranks among the top globally in both incidence and mortality, with approximately 400,000 new cases and over 300,000 deaths each year \[2-3\]. Notably, around 80% of patients are diagnosed at an advanced stage, and the 5-year survival rate is less than 30% \[4\]. Studies have shown that early gastric cancer, if detected and treated promptly, can achieve a 5-year survival rate of over 90% \[5\]. Moreover, if benign conditions such as atrophic gastritis and peptic ulcers are not treated in time, they may progress into precancerous lesions or even malignancies \[6\]. Therefore, early screening and accurate diagnosis are key to reducing the disease burden of gastric disorders. Although esophagogastroduodenoscopy (EGD) is considered the gold standard for gastric disease screening \[7-8\], its invasive nature, associated patient discomfort, and reliance on skilled endoscopists and specialized equipment limit its accessibility. In China, the scarcity of endoscopic resources in primary care settings, combined with low patient compliance, further restricts screening coverage and increases the risk of missed diagnoses \[9-10\]. In recent years, capsule endoscopy has emerged as a valuable complementary tool for gastrointestinal disease screening due to its non-invasive and user-friendly nature \[6,7\]. Among its modalities, magnetically controlled capsule gastroscopy (MCCG) provides comprehensive gastric visualization, with reported sensitivity and specificity of 90% and 92%, respectively, for common gastric lesions. However, its reliance on expensive magnetic navigation systems and trained operators limits its widespread adoption in community-based screening programs \[8\]. To address these limitations, a novel mobile-controlled capsule gastroscopy (MCG) system being more accessible and not requiring costly external magnetic control was developed. It consists only of a disposable capsule and a wireless portable receiver. Participants can complete the examination independently in community health centers or at home by following video instructions via a smartphone app and adjusting their body positions to guide the capsule. An AI algorithm ensures complete gastric coverage in real time. The video can be viewed directly on the smartphone and transmitted to the cloud for remote diagnosis. The MCG system is non-invasive, user-friendly, and compatible with remote diagnosis, making it well suited for gastric disease screening in community health centers. Compared with MCCG, MCG enables fully autonomous operation without magnetic navigation, substantially reducing technical complexity and healthcare costs. However, its diagnostic accuracy and real-world feasibility in community-based populations have yet to be validated through prospective studies. In 2025, the Guangzhou Municipal Health Commission issued the 'Gastric Pathologies Screening Programme for the Elderly and High Risk Groups in Guangzhou Municipality'. Organized by the Commission and led by Southern Medical University Nanfang Hospital, with participation from Guangzhou First People's Hospital, The Second Affiliated Hospital of Guangzhou Medical University, Guangdong Provincial Hospital of Traditional Chinese Medicine, and others, the program will conduct screening and surveillance of 10,000 elderly and high-risk individuals in community health centers across Guangzhou. This prospective cohort study will collect epidemiological data, examination results, follow-up outcomes, and other relevant information from the screening program. The primary endpoint is the detection rate of gastric pathologies, including common conditions (such as atrophic gastritis, gastric ulcers, and submucosal tumors), gastric cancer, and precancerous lesions. The operational feasibility, safety, and acceptability of the MCG system in primary care settings will also be assessed. Findings are expected to provide scientific evidence to support the optimization of gastric disease prevention and control strategies at the municipal level. 1\. Baseline Period 1. Record demographic data: gender, age 2. Record medical history and physical examination: including vital signs, anthropometric data (height and weight), comprehensive systemic assessment, history of smoking and alcohol use, Helicobacter pylori infection status, prior gastric pathologies, family history of gastric cancer, and mode of transportation to the clinic. 2\. Diagnostic \& Therapeutic Procedures 1. Record laboratory tests (if available), including complete blood count, stool analysis, prothrombin time, and the ¹³C/¹⁴C urea breath test. 2. Record the results of the MCG, the anatomical coverage of gastric regions, the rate of device failure and the overall image quality of the examination. 3. Record findings and therapeutic interventions from esophagogastroduodenoscopy (EGD) and histopathological biopsy results (if available). 3\. Follow-up prognostic data 1. Record short-term follow-up data, including capsule endoscopy expulsion status, adverse events, referral outcomes, subsequent treatment, and patient compliance. 2. Record long-term follow-up data, including gastric pathologies incidence and survival rates of project participants. 3.1 Short-term follow-up will be conducted on Days 1, 3, and 14 following MCG. 1. Participants are instructed to inspect stool for capsule excretion and report the time of passage. If the capsule is not passed within 72 hours and gastrointestinal symptoms occur (e.g., constipation, abdominal pain), the research team will arrange clinical evaluation. Capsule retention will be confirmed via abdominal X-ray or CT. Management may include prokinetic therapy or surgical retrieval as needed; the study will be discontinued post-retrieval in such cases. 2. All participants will receive a report summarizing the findings of the MCG examination. Researchers from community centers will follow up with individuals whose reports indicate significant gastric abnormalities to facilitate further medical management. Additionally, the overall study findings will be disseminated through publication in a peer-reviewed scientific journal. 3.2 Long-term follow-up will be conducted annually for a duration of five years through telephone interviews and/or routine monitoring at community health centers.

Eligible children were randomly divided into four groups: standard triple therapy, sequential therapy, bismuth quadruple therapy and concomitant therapy. The course of treatment is 14 days. The primary outcome measure was the Hp eradication rate at 4-6 weeks after completion of treatment which was confirmed by a negative of 13 UBT. Secondary outcome measures included side effects, impact factor and changes of microbiome after the therapy.

This study follows a rescue design: patients in the SOC arm who fail to heal during the BIOCAMP Prospective Modified Dual Platform Multicenter Randomized Controlled Clinical Trial will enter the Rescue trial and receive one of the study products. Patients enrolled in this trial must still meet medical necessity criteria for cellular, acellular, matrix-like, products (CAMPs) recently published by the Medicare Administrative Contractor's (MAC) in their local coverage determinations (LCD).

The purpose of this post-market clinical follow up study is to assess the efficacy on clinical symptoms of LARS of low volume Transanal Irrigation by MiniGo in conjunction with conservative treatment versus conservative treatment at 3 months.

The main objective of the study is to compare the maternal, fetal, and infant outcomes of pregnant women who are exposed to vonoprazan during pregnancy with outcomes of an internal comparison cohort of pregnant women who are unexposed to vonoprazan during pregnancy but who may be exposed to other products for the treatment of conditions for which vonoprazan may be prescribed.

Rationale and clinical significance of the hypothesis It has already been stated that nutritional support represents a crucial component in the care of critically ill patients. High metabolic demand encountered for critically ill patients may cause significant energy deficits responsible for increased risk of infection, prolonged mechanical ventilation and ICU stay. Aditionally, providing nutritional support in ICU patients is often deeemd challenging, as enteral feeding intolerance devolps secondary to gastrointestinal dysfunction. Although some authors opinioned that reducing energy targets might be beneficial, several studies proved that permissive underfeeding has no positive impact on outcome. Morover, reduction of energy target recommendation was associated with a scondary decrease of protein supplementation. Apart from disscussing nutritional intake, great emphasis should be placed on nutritional uptake as an increased percentage of critically ill patients fail to reach nutritional targets often due to gastrointestinal dysfunction. Gastrointestinal dyfunction may be defined by a variety of functional impairements affecting motility, absorbtion, microbiome composition or perfusion, but still, at this momement there is a lack of recommendation regarding monitoring methods\[6\]. At the bedside, assesement of gastrointestinal dysfunction often relies on measuring GRV. However, gastric emptying rate proved to be poorly correlated with GRV. This monitoring technique may also result in a decresed amount of nutrients delivery. Since ultrasound has became a popular diagnostic tool also in the ICU, several studies indicated that ultrasonographic measurement of gastric antral cross-sectional area has a good correlation with both aspirated GRV and gastric volume measured by computerised tomography. Considering that paracetamol has little to no absorption in the stomach and is completely absorbed at the intestinal level, paracetamol absorption test (PAT) has been proposed as a simple, indirect method for evaluating gastric emptying. As the pharmacokinetic studies have established that gastric emptying is a rate-limiting step for paracetamol absorbtion, studies where PAT was used, validated a significant correlation with scintigraphy results. The combination of reduced tolerance to enteral feeding at the initiation of nutritional support, along with the initiation of nutritional support within 48 hours, has been proven to be responsible for a progressively significant and intractable energy deficit. It has been found that continuing enteral feeding under these circumstances is ineffective in resolving this energy debt which is proportional with an increased risk of nosocomial infections. Using SPN for patients who cannot tolerate EN proved to be safe and was associated with improved cumulative energy balance, decreased rate of infections and significant cost reduction. Although SPN is proposed both by ESPEN and ASPEN guideline as an efficient alternative when energy and protein target are not achieve by oral or enteral route, recent data revealed that SPN use is rather limited\[14\]. The primary concern regarding SPN use is the risk of overfeeding. However, utilizing the appropriate concept of SPN and measuring energy needs by indirect calorimetry may overcome administering feeds in an unphysiological manner. Besides intake and uptake, muscle capacity to respond to nutritional protein should also be taken into account. Several different tools have been proposed for body composition analysis of critically ill patients. Ultrasound with different protocols has also been used to assess muscle mass even in ICU patients with greater fluid shifts\[16\]. Studies have indicated that a significant reduction in muscle mass may be identified by both rectus femoris cross-sectional area and quadriceps muscle layer thickness measurements. Bioelectrical impedance analysis is another non-invasive, low-cost technique used for body composition assesment. Despite reported limitations related with frequent overhydration states in critically ill patients, this method can still provide reliable data if the appropriate timing for examination is chosen. Nevertheless, bioelectrical impedance analysis-derived phase angle proved to be a trustworthy parameter not only for evaluating fat-free mass, but also mortality. Functional parameters, such as handgrip strengts measurements should be also included when effectivness of nutritional support is evaluated. However, it is important to acknowledge barriers to collecting functional outcome data particularly when critically ill patients are studied. Study design 1. Study type This single-center controlled randomized pragmatic trial will be conducted in the 34-bed general intensive care of Clinical Emergency Hospital of Bucharest, a tertiary-care university affiliated hospital. Participating site data: Department of Anaesthesia and Intensive Care from the Clinical Emergency Hospital of Bucharest disposes in total of 86 intensive care beds Considering that there is no globally validated single definition that can be used to objectify this gastrointestinal dysfunction, real prevalence of this dysfunction is not quantified. It has been reported that one-third of all enterally fed, mechanically ventilated, critically ill patients are presenting enteral feed intolerance, but many more patients may have subclinical gastrointestinal dysmotility, the estimated percentage could reach as high as 80%. Taking into account the annual rate of admission in our unit it is feasible to complete the inclusion process by July 2025 (1 year and 8 months). Nevertheless, maintaining this study as monocentric will provide better control over potential confounding factors and reduce heterogeneity. Furthermore, it will enhance internal validity and streamline coordination efforts. Ethics: Study protocol together with a a model of informed consent were submitted to the Clinical Emergency Hospital of Bucharest Ethics Committee and the final approval has been obtained on 18.05.2023. Taking into account that the included patients are not able to provide informed consent at the time of recruitment (on ICU admission), a Power of Attorney or a Legal tutor will act as Consultee and will be asked to consent/decline participation to the study on legal behalf of the patient. If patients have Advance Decision Plan including participation in research studies the Plan will be respected and recruitment pursued/abandoned accordingly. After regaining capacity, all patients will be asked to provide Informed Consent for using their personal data and will be given the possibility to: Provide Informed Consent for the acute data and follow-up. Deny research participation and request destruction of acute data collected. 2. Description of the study population (inclusion and exclusion criteria) All adults (\> 18 years old) are eligible for inclusion if it will be expected to require mechanical ventilation for more than four days, have a controlled shock state (hemodynamic and tissue perfusion goals are reached) and impaired intestinal absorbtion, defiend by both ultrasound measurement of gastric residual volume and paracetamol absorbtion test. Exclusion criteria are patients on non-invasive mechanichal ventilation, contraindication for EN for \> 48 h after admission, patients with gastrointestinal surgical intervention within 3 months, history of malabsorption, inflammatory bowel disease, short bowel syndrom, anorexia nervosa, gastrointestinal bleeding, cirrhosis, traumatic brain injury, subarahnoidal hemorrhage, neoplasia, post cardiac arrest patients, patients on chronic therapy with corticosteroids and pregnant women. e. Methods and techniques Randomisation: Selected patients for inclusion will be allocated in one of the two groups after stratified randomisation. The patient population can be stratified into three groups based on their admission type, which includes General Surgery, Multiple Trauma, and Internal Medicine. To perform stratified randomization, three separate randomization lists would be required - one for each stratum. These lists could be generated using techniques such as block randomization. Depending on the stratum a patient belongs to, the corresponding randomization list would be utilized to allocate the patient to one of the nutritional protocol being compared. Nutritional protocol: Nutritional targets are based on ESPEN guidelines recommendation (calories administration based on indirect calorimetry study, proteins 1.3 g/kg/day). From the first day of ICU admission indirect calorimetry will be performed daily in order to evaluate energy requirements. For both groups enteral nutritional support will be started after 48 hours since admission or after controlled shock state will be confirmed. Enteral nutrition will be incrementally escalated using a ramped fashioned approach, with the goal of reaching 25 to 50% of the energy target determined by indirect calorimetry by day 2. Subsequently, on days 3 and 4, the target will be gradually raised to 75%. Enteral nutrition will be administered continuously. On the fourth day, the patient will undergo a gastric residual volume measurement and a paracetamol absorption test. If gastrointestinal dysfunction is detected, the patient will be assigned to a study group based on the randomization protocol. In the EN group, enteral nutrition intake will progressively be increased according to the gastrointestinal tolerance (evaluated based on ultrasound guided gastric residual volume measurement) until the target of 100% is attained following admission to the ICU. The SPN group will gradually initiate supplemental parenteral nutrition in order to achieve the target of 80% by the fifth day. Trophic feed will be administered to cover the remaining 20% of the targeted nutrition intake. Figure 1 depicts a graphical illustration of the nutritional protocol. Products: EN formula for EN group and trophic feeds: polymeric, fibre-enriched formulas - Fresubin® Original Fibre (15% proteins, 30% lipids, 52% carbohydrates, Fibre 3 %) PN formula for SPN group: SMOFKABIVEN EXTRA NITROGEN 16 gN - 1518 ml - 10% amino acids, 20% lipid emulsion (SMOFlipid 20%), 42% glucose, and electrolytes Ultrasound guided gastric residual volume measurement: Gastric ultrasound assessment will be performed by two independent observers in supine position. Both sets of measurements will be performed after a minimum of six hours of fasting. Antral cross-sectional area (ACSA) area will be calculated by using antero-posterior and cranio-caudal antral diameters (measured from serosa to serosa) and the formula of the area of an elipse ( )/4). Furthermore, the gastric volume will be calculated according to the model proposed by Perlas et al. Gastric Volume (ml) = 27.63 + 0.16 x weight (kg) + 1.24 x BMI - 0.013 x (time since last meal in hours) x (antral cross-sectional area in cm²). A gastric residual volume above 200 ml will be considered positive for impaired gastric motility. Paracetamol absorbtion test: In order to evaluate paracetamol absorbtion, area under the plasma concentration curve was chosen to be calculated at 240 mins (AUC240) by using the trapezoidal method. In order to be able to obtain AUC240 five different measurements will be carried out at predetermined intervals, namely at the baseline (before paracetamol administration), at 30 minutes, 60 minutes, 120 minutes, and 240 minutes. Paracetamol 15 mg/kg disolved in 10 ml aqueous solution followed by 20 ml of water will be adminsitered. Afterwards Enzyme Multiplied Immunoassay Technique (EMIT) will be used to detect paracetamol level. Principle of technique: The technique involves conjugating an enzyme with a small target molecule specific to the analyte being tested, in this case acetaminophen. Binding of a specific target antibody inhibits the enzymatic activity. The enzyme glucose-6-phosphate dehydrogenase is bound to the antigen for acetaminophen, which oxidizes glucose-6-phosphate to gluconolactone-6-phosphate and reduces NAD to NADH. If a free target molecule such as acetaminophen is present in the plasma, inhibition is weakened by competition for the antibody, leading to restoration of enzymatic activity and intensity of the signal proportional to the concentration of the free target molecule. Enzymatic activity is measured by spectroscopic analysis of the amount of NADH produced, which correlates directly to the amount of acetaminophen in the specimen. Blood samples will be collected from patients in vacutainer tubes with sodium citrate or EDTA anticoagulant under vacuum to facilitate plasma separation and prevent hemolysis. Bioelectrical impedance analysis (BIA): We will use the InBody BWA 2.0 BIA machine to perform BIA measurements. The following measurements will be collected for analysis: impedance, phase angle, resistance, reactance, Waist/Hip Ratio, body cellular mass, lean body mass and fat-free mass index. Measurement of rectus femoris cross sectional area: B-mode ultrasonography utilizing an 8 MHz 5.6 cm linear transducer array will be employed to measure the Cross-sectional area of the rectus femoris (RFCSA), employing a previously described technique. The transducer will be positioned perpendicularly to the long axis of the thigh, on its superior aspect, specifically three-fifths of the way from the anterior superior iliac spine to the superior patellar border.

Graduating general surgery residents are faced with the difficult decision of whether to pursue further specialized surgical fellowship training or to begin independent general surgical practice. Advanced GI Fellowship is a relatively new area of fellowship surgical training, with only 8 fellowships currently recognized by the Fellowship Council of the United States. The previous survey assessed the need for such a fellowship among health systems, departments, and practice groups interested in hiring a GI surgeon. More data is coming out showing that graduating surgical residents are unprepared to independently perform core general surgery procedures. Therefore, it is vitally important to be able to understand not only who are teaching general surgery residents GI surgical procedures, but also the residents' self-reported competence with GI procedures, and personal experience and degree of comfort managing both common and complex GI surgical pathologies.

This is a prospective, open-label, single-arm clinical study designed to evaluate changes in gut and digestive health parameters following daily use of a dietary supplement system over an eight-week period. Gut and digestive health are essential to overall human health and are closely associated with immune regulation, nutrient absorption, metabolic function, and systemic inflammation. The gastrointestinal tract contains a complex microbial ecosystem that supports digestion, produces bioactive metabolites, and modulates immune responses. Disruptions in gut microbiota composition, intestinal barrier integrity, and immune balance have been associated with digestive symptoms, inflammation, and reduced well-being. This study will enroll approximately 50 adult male and female subjects between 18 and 80 years of age who meet all inclusion and exclusion criteria, including self-reported gastrointestinal symptoms as assessed by the Gastrointestinal Symptom Rating Scale (GSRS). All participants will consume the study product daily for a total of eight weeks while maintaining their usual diet and lifestyle habits, as outlined in the protocol. The dietary supplement system consists of two study products that contain a combination of plant-derived nutrients, fibers, probiotics, digestive enzymes, and antioxidant-rich botanical ingredients. These components are intended to support gut microbial diversity, digestive processes, immune balance, and intestinal barrier integrity. Objective assessments of gut and digestive health will be conducted using stool-based laboratory evaluations at baseline and at the end of the study. These assessments include biomarkers related to microbial diversity, inflammation and immune activity (such as calprotectin, beta-defensin 2, and secretory IgA), digestive health markers (including short-chain fatty acids, bile acids, and malabsorption markers), and markers associated with intestinal barrier integrity and permeability. Participant-reported outcomes will be collected using validated questionnaires, including the Gastrointestinal Symptom Rating Scale (GSRS) and a Subjective Digestive Health and Well-Being Questionnaire. These assessments will be administered at baseline and at regular intervals throughout the study to evaluate changes in gastrointestinal symptoms, digestive comfort, overall well-being, and product tolerability. Safety assessments will be conducted throughout the study period, including monitoring of adverse events, concomitant medications, and study product compliance. The overall safety and tolerability of the dietary supplement system will be evaluated based on reported adverse events and clinical assessments.

Primary study objective: to assess the difference in the incidence of gastric cancer between carriers of high-risk SNP subtypes of H. pylori and the non-high-risk population during the follow-up period. Secondary research objectives: 1. To observe and compare the cumulative incidence and progression of gastric precancerous lesions (e.g., atrophic gastritis, intestinal metaplasia, etc.) in each population group during the follow-up period.2. To explore the interaction of high-risk SNPs on the risk of gastric cancer in the context of different age, gender or other risk factors (e.g. diet, smoking, alcohol abuse, family history, etc.).