Qiu Dekai, Second-Level Professor of Internal Medicine and Former Director of the Shanghai Institute of Digestive Disease.

Introduction

In a world of finite time and infinite possibilities, focus is essential to any meaningful pursuit. He believes that becoming a good doctor requires breaking free from dogma, embracing innovation, and, above all, having the courage to follow one’s own vision. For him, the path of a physician is a journey without end, demanding continuous exploration. He is particularly dedicated to the vast field of autoimmune liver disease, convinced that only through constant learning and practice can he improve diagnostic and treatment methods for his patients.

The Path to Medicine

“I chose to study medicine with a simple aspiration: to help as many patients as I could and alleviate their suffering.”

Qiu Dekai’s path was set during his primary school years when several classmates and close friends died from tuberculosis. The profound sadness he felt planted a determination to become a doctor. With excellent academic performance, he applied to the Shanghai First Medical College (now Fudan University Shanghai Medical College) upon graduating from high school.

“I was fortunate to be admitted to the college’s six-year program.”

Medical education was a demanding journey, filled with challenges and a vast body of knowledge.

“At that time, Shanghai First Medical College was one of the best in the country, so the competition was extremely intense. A third of our faculty had studied abroad and shared their extensive experience with us. I poured all my energy into my studies. Most of my classmates were from outside Shanghai and lived very frugally. The academic atmosphere was so strong that students had to rush to classrooms every afternoon and evening to secure a seat. Sleep became a luxury.”

Qiu recognized early on that becoming a good doctor was no easy task. It required mastering both basic sciences and clinical practice, as medical technology is constantly evolving. He emphasized practical experience, often joining clinical directors in their diagnostic and therapeutic work to hone his own skills. During his internships, he learned the importance of the doctor-patient relationship, realizing that proactive communication was key to effective treatment.

“I was also fortunate to have many excellent teachers. Whenever I had questions, I could consult them directly, and they were always willing to answer. As medical students destined to save lives, our knowledge had to be solid and our skills proficient, with no room for error.”

Beyond acquiring knowledge, Qiu found mentors and lifelong friends among his professors and like-minded classmates.

“Besides studying, I loved sports. The physical stamina I built from exercise helped me better cope with academic pressure.”

During his university years, he was a baseball and softball player, representing both Shanghai and his university in national competitions.

In 1965, Qiu graduated with honors. Following his graduation assignment, he and seven other classmates were sent to work in the Shanghai Second Medical College system.

“After graduation, a classmate and I were assigned to Renji Hospital. It was already very famous, with an excellent culture where serving patients was the top priority. I chose internal medicine and, after passing the hospital’s exam, was assigned to the Department of Gastroenterology. That’s how I found my specialty.”

Advancing the Field of Gastroenterology

“Professors Jiang Shaoji and Xiao Shudong from Renji Hospital once advised me to continuously improve my professional expertise. In 1985, they recommended me for advanced studies at Chiba University in Japan. There, I saw advanced diagnostic tools like MRI and CT for the first time. The academic rigor of the Japanese professors left a deep impression on me.”

In 1987, building on his studies in Japan and his clinical work in China, Qiu published a groundbreaking paper as first author, “The Diagnostic Value of Combined Detection of Serum Tumor Markers for Primary Liver Cancer.” This research confirmed and promoted the use of combined tumor marker detection for the clinical diagnosis and early screening of liver cancer.

His study addressed a critical limitation: while alpha-fetoprotein (AFP) detection is highly sensitive for liver cancer, it yields negative results in 30-40% of patients, especially those with small tumors. Qiu proposed that combining multiple tumor markers could significantly improve diagnostic accuracy.

This new method provided more reliable results through a comprehensive analysis of various serum markers. Its greatest advantage was the earlier detection of liver cancer, helping to reduce mortality rates. Furthermore, this technology guided treatment decisions and monitored patient prognosis, ultimately improving survival rates through earlier intervention. This achievement provided a new framework for liver cancer diagnosis and treatment and served as a model for the early screening of other tumors.

“At that time, tests for liver disease markers were limited, and imaging technology was primitive. I compared the results of using AFP alone versus combining it with other indicators. I found that combined detection improved specificity. My idea was to integrate three or four indicators, including imaging, to help doctors formulate surgical plans and predict outcomes earlier, reducing missed diagnoses. Later studies confirmed this: the combined application of multiple indicators reduces the risk of missed detection.”

In 1988, Qiu returned to Japan for further studies in gastroenterology at Chiba University and Yamagata University. The experience deepened his understanding of Japanese research rigor, patient education, and medical technology.

In 1990, he traveled to the United States to study at the Department of Gastroenterology at the University of Colorado School of Medicine.

Exploring Alcoholic Liver Disease and Guiding Research Trends

In 1993, Qiu Dekai published “A Preliminary Observation of HCV and HBV Infections in Chronic Liver Diseases in the Shanghai Area.” This was the first systematic study of hepatitis B and C patients in the region, compiling a valuable dataset that guided subsequent clinical work and became a foundation for future research.

That same year, Qiu published a paper highlighting the growing concern of alcoholic liver disease. At the time, the condition’s prevalence was rising in China, but it remained a small fraction of overall liver diseases and cancers, leading to low public awareness. Qiu argued that the prevention and treatment of alcoholic liver disease deserved serious attention.

Qiu made significant strides in the diagnosis and treatment of alcoholic liver disease. He developed an objective, simple diagnostic method and established a comprehensive treatment plan with detailed protocols. He also investigated the link between the highly prevalent hepatitis B and the increasingly common alcoholic liver disease.

In 1997, Qiu returned to the Organ Transplantation Center at the University of Colorado Hospital in the United States to work with US colleagues for farther exploration.

The Unignorable “Metabolic Associated Fatty Liver Disease”

Thinking about his study and clinical work, Qiu observed that many severe liver cases stemmed not from alcohol abuse or hepatitis viruses, but from fatty liver disease. At the time, this was an area of research largely unexplored in China.

In 1998, Qiu made a significant breakthrough with his paper, “Experimental Observation of the Relationship Between Fatty Liver and Liver Fibrosis.” The study examined the effects of common dietary foods on fatty liver and fibrosis, revealing a direct link between the two conditions.

“In the past, people thought that fatty liver problems could be solved through dietary control alone, but we found that this was not always the case. The progression of fatty liver can lead to liver fibrosis and further develop into cirrhosis. Therefore, we need more indicators to enable early diagnosis and screening. Only by discovering problems early can we take timely measures.”

The study concluded that while early-stage fatty liver could be effectively managed with proper diet and exercise, high-fat diets and excessive meat intake could accelerate the progression to liver fibrosis.

Qiu’s findings had a major impact on the field of gastroenterology by scientifically linking diet to liver disease and promoting a new concept of healthy eating. His work provided a roadmap for future research on the fatty liver-fibrosis connection and offered clear guidance for the prevention and treatment of fatty liver disease.

After 2000, Qiu launched a series of studies on Metabolic Associated Fatty Liver Disease (MAFLD), exploring its pathogenesis and providing crucial theoretical support for the field.

In one study on MAFLD patients with gallstones, he explored the disease at a genetic level. His research revealed a significant increase in the abnormal expression of genes related to lipid metabolism, offering new insights into the pathogenesis of both conditions.

As Qiu himself stated, “While everyone knows about alcoholic fatty liver, non-alcoholic metabolic fatty liver is not well understood. Once it progresses to the fibrosis stage, its reversibility is limited. Therefore, this disease also demands early intervention and timely treatment.”

Exploring Autoimmune Liver Disease

In 2012, Qiu Dekai advocated for greater focus on the early diagnosis and treatment of autoimmune liver disease (AILD). Although a common condition globally, AILD was relatively rare in China compared to other liver diseases, often leading to neglect and misdiagnosis.

Qiu’s interest in AILD began much earlier. During his time at the University of Colorado, he assisted in treating a Chinese patient with autoimmune hepatitis—his first direct encounter with the disease. He was struck by how common AILD was in the U.S., where it represented a significant portion of chronic liver cases, a stark contrast to the limited awareness of the condition in China at the time.

“In China, the focus was almost exclusively on viral hepatitis,” Qiu recalled. “In contrast, the U.S. had already established an Autoimmune Liver Disease Study Group within the American Association for the Study of Liver Diseases, advancing clinical diagnosis, treatment, and research, and even publishing dedicated journals.”

This experience solidified his mission to persuade the Chinese medical community to prioritize AILD, paving the way for improved patient outcomes and prognoses.

“That trip to the U.S. had a profound impact,” Qiu said. “After returning to China, I realized the critical importance of liver biopsy, especially for fatty liver, and that treatment required comprehensive management, not just exercise. At Renji Hospital, I focused on two initiatives: promoting liver biopsy for accurate pathological diagnosis and developing laparoscopic liver exploration to directly observe the liver’s surface. We also pioneered research into cholestatic liver disease, a field highly valued in the West, and achieved significant results.”

Today, AILD is a rapidly growing subspecialty in China, with its overall incidence now surpassing that of hepatitis C. An increasing number of patients are being diagnosed and treated, many showing significant improvement in their symptoms and indicators after receiving care at the Department of Gastroenterology of Renji Hospital.

“Through precise diagnosis and comprehensive therapies, such as the judicious use of corticosteroids, azathioprine, and liver-protecting drugs, many patients achieve excellent outcomes here. Looking ahead, we still need to refine medication protocols and determine the optimal point for patients to discontinue treatment. I believe these are key directions for future research.”

Thanks to the efforts of several generations of gastroenterologists, the Department of Gastroenterology at Renji Hospital and the Shanghai Institute of Digestive Disease have become China’s leading research institutions for autoimmune liver disease.

Outstanding Academic Achievements and Widespread Acclaim

Qiu Dekai’s academic achievements are both extensive and influential. His representative works, co-authored with Professor Ma Xiong, include titles like Clinical Complications of Chronic Liver Disease and Autoimmune Liver Disease - Basic and Clinical. He has edited or co-edited more than 10 books and published over 180 high-level papers as first or corresponding author. These publications cover the full spectrum of digestive and liver diseases, serving as invaluable resources for doctors and researchers.

He has also served as an editor or editorial board member for several prominent Chinese and international journals, including the Journal of Digestive Diseases, Gastroenterology, and the Chinese Medical Journal.

Today, though advanced in years, Qiu Dekai remains a dedicated scholar. His study is lined with professional texts on gastroenterology, and three to four days a week, he can be found at his desk, quietly focused on the latest research on autoimmune and other liver diseases.

“I often interact and exchange ideas with younger scholars like Professor Ma Xiong from our department,” he shares. “It makes my life quite fulfilling.”

In Qiu’s view, a doctor’s duty transcends location or retirement status. One must constantly pursue new knowledge and refresh one’s thinking. This, he believes, is the essence of medicine and his own lifelong pursuit.

Editor: Chen Qing @ ShanghaiDoctor.cn

Note: Chinese Sources from “The Path of Benevolent Medicine” which was published in 2024. It records 90 important medical figures in the history of Renji Hospital. Yewen Renyi (ShanghaiDoctor.cn) team was one of the major writers of the book and is authorized by Renji hospital to create English version on the website of ShanghaiDoctor.cn