Clinical Case Summary

A 75-year-old woman was admitted to our department for weight loss (25 kg in 10 months) and chronic diarrhea (> 6 months). In history: hypertension in olmesartan 20 mg/day, multinodular goiter. The patient was already tested for anti-transglutaminase antibodies (negative, IgA in normal range) but EGDS showed severe duodenal villous atrophy. On suspicion of ARBsII-associated enteropathy olmesartan was suspended with partial but not complete benefit on clinical. During hospitalization, the patient presented asthenic, occasionally soporific, severely malnourished (Table1) and with a picture of pan-cytopenia (Table1). We excluded neurological (brain CT scan), infectious (blood cultures and co-cultures) and hematologic (bone marrow biopsy) causes. Ultrasound of the intestinal loops and ileo-colonoscopy were normal. Video capsule endoscopy showed marked scalloping of DII and jejunum with extensive ulcers (Figure1). Later, she performed at referral center anterograde double-balloon enteroscopy (DBE). DBE confirmed marked atrophy and map ulcers primarily suggestive of refractory celiac disease type II/EATL with ulcerative jejunum-ileitis. Histologic examination described findings referable to chronic exacerbated, erosive enteritis, not diagnostic for celiac disease. HLA search for celiac disease was negative therefore celiac disease was excluded. Hemotransfusions and nutritional supplementation were administered in consideration of anemia and nutritional deficiency. Empiric/ex-juvantibus therapy with steroid was also set up with marked improvement in symptomatology.
Following hospitalization, she was re-evaluated on an outpatient basis at enteropathy referral center. Here she was first imposed high-dose steroid therapy with marked improvement and weight gain, then Azathioprine in maintenance. She was therefore discharged with a diagnosis of autoimmune enteropathy with likely previous overlap with sartane enteropathy.

References

1. Schiepatti A, et al.. Nomenclature and diagnosis of seronegative coeliac disease and chronic non-coeliac enteropathies in adults: the Paris consensus. Gut. 2022 Nov;71(11):2218-2225. doi: 10.1136/gutjnl-2021-326645. Epub 2022 Jun 8. PMID: 35676085; PMCID: PMC9554081.
2. van Wanrooij RLJ, et al. Adult-Onset Autoimmune Enteropathy in an European Tertiary Referral Center. Clin Transl Gastroenterol. 2021 Aug 1;12(8):e00387. doi: 10.14309/ctg.0000000000000387. PMID: 34333499; PMCID: PMC8323799.
3. Schiepatti A, et al. Systematic review: Clinical phenotypes, histopathological features and prognosis of enteropathy due to angiotensin II receptor blockers. APT. 2024 Feb;59(4):432-444. doi: 10.1111/apt.17855. Epub 2024 Jan 7. PMID: 38185985.

Introduction

Fatigue is highly prevalent in patients with Inflammatory bowel disease (IBD)and associated with reduced quality of life. However, effective treatments for IBD fatigue are lacking.

Aims & Methods

We aimed to assess the real-world efficacy of modafinil – a stimulant medication – on fatigue in IBD patients. The was a prospective evaluation in a tertiary IBD centre in the UK. Adults with a confirmed diagnosis of IBD, who were fatigued for at least 6 months, were referred for fatigue evaluation using the Inflammatory Bowel Disease Fatigue Self-Assessment Scale (IBD-F). The IBD-F includes 5 questions scored 0-4 using a Likert scale to identify fatigue. Scores range from 0-20 and scores ≥11 denote severe fatigue.
After treating organic causes of fatigue (anaemia, B12 deficiency, hypothyroidism, mucosal inflammation) and excluding contraindications, patients with a baseline IBD-F score ≥11 were offered modafinil. Modafinil was started at 100mg daily and titrated in 100mg increments to a maximum of 400mg daily if needed. If unable to tolerate 100mg, dosage was reduced to 50mg.
Patients were followed up until week 12 or drug withdrawal. IBD-F scores were reviewed at 12 weeks and compared to baseline. A clinically significant fatigue improvement was a reduction in the IBD-F score ≥3¹. Any patient who withdrew drug before 12 weeks was regarded as having severe fatigue at follow up.
Descriptive statistics were presented as means with standard deviation [SD]. A paired t-test was used to assess change in IBD-F scores from baseline with 5% significance level used.

Results

Seventy-two patients (50% male) were included with a mean age of 38 (SD 11.1) years . Of these, 53 (74%) had Crohn’s and 19 (27%) had UC with a mean disease duration of 13.2 (10.4) years (Table 1). The cohort showed refractory disease with 23 (32%) of patients having used at least 3 biologics, 24 (33%) had a stoma and 41(57%) had at least one bowel resection. The most common total modafinil dose was 200mg. Dosages ranged from 50mg to 400mg per day.
Both UC (15.9 [SD 2.58]) and Crohn’s (15.0 [2.31]) had similar mean (SD) baseline IBD-F scores. After treatment with modafinil, there was a statistically significant improvement in mean IBD-F score from baseline 15.3 [SD 2.38] to 10.4 [SD 3.83] (p<0.0001). There was no difference in the score improvement between UC and Crohn’s p=0.29. No difference was observed between those with and without irritable bowel syndrome (p=0.35). At follow up, 53 (74%) had a clinically significant improvement in fatigue and 38 (53%) were no longer severely fatigued.
Nine patients (13%) reported side effects: headache (n=5), and anxiety, mood changes, nausea, and visual issues (n=1 each). Three patients withdrew before the 12 week follow up. No serious adverse events were recorded.

Table1

Conclusion

In this real-world evaluation, modafinil was associated with a statistically significant improvement in fatigue in patients with mostly refractory IBD. Modafinil was generally well tolerated. Randomised, placebo-controlled trials of modafinil for IBD fatigue are now warranted.

References

1 Nocerino A, Nguyen A, Agrawal M, Mone A, Lakhani K, Swaminath A. Fatigue in Inflammatory Bowel Diseases: Etiologies and Management. Adv Ther. 2020;37(1):97-112. doi:10.1007/s12325-019-01151-w

Introduction

Gallstone disease affects approximately 6% of the global population. Adequate knowledge about gallstone disease among the public can facilitate early medical consultation and enable them to navigate healthcare pathways effectively. In the digital age, patients increasingly turn to the internet for health-related information, with over half of the global population relying on it for access to knowledge.

Aims & Methods

This study aimed to evaluate the quality, readability, usability, and reliability of patient-oriented websites providing information on gallstone disease, using validated assessment tools. The three most widely used search engines, Google, Yahoo, and Bing were searched employing keywords related to gallstone disease. The first 50 search results per keyword per engine were screened. Applying the inclusion and exclusion criteria, 52 websites were selected for detailed analysis. The information was assessed for readability using the Flesch Reading Ease Score (FRES), for usability and reliability using the LIDA tool, and for overall quality using the DISCERN instrument. Statistical analysis was performed using SPSS (v27), with significance set at p < 0.05.

Results

Among the 52 websites analyzed, only sixteen (30.8%) sites had obtained Health on the Net (HON) code certification. The median FRES score of the included websites was 60.5 out of 100 (range: 33-79.6), indicating readability appropriate for readers aged 13–15 years. The median LIDA usability and reliability scores were 40 out of 54 (range: 31–54) and 24.5 out of 51 (range: 10–51), respectively. The median DISCERN score was 69.8 out of 80 (range: 30-80) with 5.8% (n=3) of websites scoring below 50%. A low DISCERN score (≤ 50%) was found in three (5.8%) websites. The DISCERN score was found to be significantly associated with LIDA reliability and LIDA overall scores (p < 0.001), government run websites (p= 0.028) and HON code certification (p = 0.01). However, no significant association was found between DISCERN scores and LIDA usability or FRES. Most websites (86.5%) provided accurate clinical information, but only 76.9% discussed treatment complications.

Conclusion

The quality of online patient information on gallstone disease varied considerably, with only a minority meeting optimal standards for readability and certification. While clinical accuracy was generally satisfactory, gaps remain in presenting treatment risks and maintaining content currency. These findings emphasize the need for improved oversight and standardization of online health content to support patient education and informed decision-making.

References

1. Internet World Stats. Internet world stats: Usage and population statistics, http://www.internetworldstats.com/stats.htm (2013, accessed 16 June 2023).
2. Lee JS, Seo HS, Hong TH. YouTube as a source of patient information on gallstone disease. World J Gastroenterol 2014; 20: 4066–4070.
3. Raptis DA, Sinanyan M, Ghani S, et al. Quality assessment of patient information on the management of gallstone disease in the internet. HPB 2019; 21: 1632–1640.
4. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol 2016; 65: 146–181.

Disclosure

There is no conflict of interest

Introduction

Interest in large language models (LLMs) across multiple medical specialities has grown rapidly as a source of patient‑facing advice., No systematic review has appraised the accuracy and readability of LLM‑generated responses for gastrointestinal (GI) procedures, resulting in a lack of current evidence on the reliability of these tools.

Aims & Methods

We aimed to quantify the accuracy and readability of LLM responses to both patient‑ and clinician‑facing questions on GI investigations and interventions, and to identify limitations hindering clinical use. We searched PubMed, Ovid MEDLINE, Ovid Embase, and Google Scholar for peer‑reviewed studies published from 2023 to 2025 that evaluated text-based answers from any LLM on at least one GI diagnostic or therapeutic procedure (colonoscopy, endoscopy, EGD, ERCP, EUS, PEG, GI surgery and others). Inclusion criteria were English language, full‑text primary studies reporting at least one accuracy or readability metric; exclusion criteria included studies with a non-GI focus, image-only tasks, reviews, abstracts, or missing data.. Multiple reviewers independently screened records and extracted data, resolving disagreements by consensus. Risk of bias was appraised using the NIH Quality Assessment Tool (NIH‑QAT) for observational cross‑sectional studies [1]. Accuracy was quantified using a binary (accurate/inaccurate), three-point (accurate, partially accurate, inaccurate), or numerical 1-5 point scales. Readability was assessed using a five‑point Likert scale.

Results

Of the 409 records screened, 45 full‑text articles were reviewed, and 14 met the inclusion criteria, covering seven LLMs. Accuracy varied across models: on the binary scale, Google Bard performed best (82 %, n = 11), followed by Microsoft Copilot (60 %, n = 10). On the three‑point scale, Claude performed best (2.44 / 3, n = 124), with ChatGPT second (2.15 / 3, n = 124). On the five‑point scale, ChatGPT ranked first (3.6 / 5, n = 308), and Claude next (3.04 / 5, n = 16).

By procedure, colonoscopy scored highest on binary (73 %, n = 30) and three‑point (2.73 / 3, n = 14) scales, whereas endoscopy topped the five‑point scale (4.01 / 5, n = 32). Surgery showed mixed performance — binary 59 % (n = 141), three‑point 1.93 / 3 (n = 105), and five‑point 3.54 / 5 (n = 244). ERCP, EUS, PEG, and EGD were represented by smaller samples, giving variable three‑point scores (ERCP 2.66, EUS 2.56, EGD 2.22, PEG 1.83).

Conclusion

LLMs can provide readable answers on GI procedures, but none reach the ≥ 95 % accuracy typically expected for clinical use, with performance still inconsistent across procedures. Standardised benchmarking, balanced prompt libraries, and updated model evaluations are needed before LLMs can be safely used in clinical gastroenterology.

References

[1] National Heart, Lung, and Blood Institute. Study Quality Assessment Tools [https://www. nhlbi. nih. gov/health-topics/study-quality-assessment-tools].