F Tobori

Disruption of cancer screening programs and diagnoses of gastrointestinal cancers by the COVID-19 pandemic has been reported; however, little attention has been paid to the situation in depopulated areas with low infection rates. Akita Prefecture is one of the most depopulated areas of Japan and has the lowest COVID-19 infection rate per capita; at the same time, the prefecture has been top-ranked for mortality due to gastrointestinal cancer for years. In this population-based study in Akita Prefecture, we investigated the occurrence of gastrointestinal cancers and the number of cancer screening procedures over the five-year period of 2016-2020, employing a database from the collaborative Akita Prefecture hospital-based registration system of cancers. The occurrence of gastrointestinal cancers, especially esophago-gastric cancers, declined by 11.0% in 2020, when the COVID-19 pandemic affected the overall healthcare system, compared with the average of 2016-2019. Nonetheless, the occurrence of advanced-stage (stage IV) esophago-gastric cancers increased by 7.2% in 2020. The decrease in the gastrointestinal cancer diagnosis rate in 2020 coincided with a 30% decline in the total number of regular population-based screening programs. Under the ongoing COVID-19 pandemic, cancer screening was uniformly suspended throughout Japan. Accordingly, the COVID-19 pandemic has substantially disrupted the cancer screening system, leading to delays in diagnoses of gastrointestinal cancer, even in depopulated areas (Akita Prefecture) of Japan with a low prevalence of infection. Suspension of cancer screening procedures during an infectious disease pandemic should be thoroughly considered for each region based on the cancer incidence and infection status in that area.

: A number of extraintestinal complications of ulcerative colitis have been described. However, only a few cases of ulcerative colitis associated with dermatitis herpetiformis have been documented. We report a case of ulcerative colitis associated with dermatitis herpetiformis and primary sclerosing cholangitis in a Japanese woman. The patient first developed exanthema on the extremities at the age of 18 years. Subsequently, her skin disease was diagnosed as dermatitis herpetiformis with linear IgA deposits at the dermoepidermal junction. A biopsy specimen from the jejunum did not show villous atrophy. Subsequently, she was diagnosed with primary sclerosing cholangitis at age 34 years, and with ulcerative colitis 2 years later. The patient died of hepatic failure at age 40 years. Bile duct cancer was found at autopsy. Both dermatitis herpetiformis and primary sclerosing cholangitis are diseases of the immune system that are associated with HLA-B8 and -DR3 in whites. Our patient had neither of these serotypes. The immune mechanisms involved in the extraintestinal complications of inflammatory bowel disease are briefly discussed.