Introduction

Low fermentable oligo-, di-, and monosaccharides and polyol (FODMAP) diet is currently recommended for the treatment of irritable bowel syndrome (IBS). However, long-term adherence is not high due to its complex nature.
Recently, ChatGPT (OpenAI, San Francisco, California, USA), a large scale unsupervised language model, was introduced as an easily accessible internet based chat, and demonstrated unprecedented capabilities of processing natural conversations and the ability to provide insightful and comprehensive replies.

Aims & Methods

In this brief proof of concept study, we aimed to evaluate the feasibility of using ChatGPT as a readily available guide for adherence to a low FODMAP diet.
We presented ChatGPT with 3 sets of questions concerned with low FODMAP:
(1) 10 questions in the form of “is Bⁱ low FODMAP” were prompted to ChatGPT in which Bⁱ is the i element of a list of 10 base products, 5 of which are considered low FODMAP, and 5 high FODMAP; We chose base products upon which there was unanimous agreement among different available lists of FODMAP-containing foods.
(2) 10 questions in the form of “is Dⁱ low FODMAP” were prompted to ChatGPT in which Dⁱ is the i element of a list of 10 popular dishes, 5 of which are considered low FODMAP, and 5 high FODMAP
(3) 7 questions in the form of “suggest a low FODMAP Cⁱ recipe” were prompted to ChatGPT in which Cⁱ is the I course of a traditional 7 course meal.
Questions and answers were then presented to two dietitians from our gastroenterology institute (M.D and C.P), both experienced in the care of IBS patients and low FODMAP guidance.
Dietitians were independently asked to grade each answer as correct or incorrect, and check whether they would use this answer as future recommendation for patients.

Results

A complete agreement between the two dietitians was observed (100% same review of chatGPT answers).
Out of the 27 submitted questions, 22 answers were reviewed as correct (81%).
From the 5 answers that were deemed as wrong, 4 (80%) were from the base products list, and 3 of these 4 were of high FODMAP base products. The additional wrong answer was from the popular dishes list, in which, a dish that contained high FODMAP ingredients was suggested as low FODMAP by the ChatGPT answer.
In the dishes and recipes section ChatGPT provided suggestions for alternative ingredients and food preparation techniques that would make the dishes low FODMAP. All the suggestions were deemed as correct by both dietitians.

Conclusion

ChatGPT perfomed well in answering questions regarding low FODMAP diet. It could possibly be used as an auxiliary tool for daily decisions on low FODMAP diet.

Introduction

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) induce weight loss, and have been associated with an overall decreased risk of esophageal cancer. Obesity is strongly associated with esophageal adenocarcinoma and substantial weight loss may decrease the risk of this malignancy, whereas weight loss does not decrease the risk of esophageal squamous cell carcinoma. We examined the hypotheses that GLP-1RA treatment decreases the risk of esophageal adenocarcinoma.

Aims & Methods

This population-based case-control study included all cases of esophageal adenocarcinoma and esophageal squamous cell carcinoma in adults who had dispensed medication for type 2 diabetes in Denmark (2007-2020), Finland (2011-2018), Iceland (2009-2019), Norway (2007-2019), or Sweden (2007-2020). For each case participant, >10 control participants who had dispensed medication for type 2 diabetes were randomly sampled from the general populations. Data came from well-validated nationwide health-data registries with prospectively collected data. Multivariable logistic regression provided odds ratios (OR) for esophageal adenocarcinoma and esophageal squamous cell carcinoma with 95% confidence intervals (CI), adjusted for sex, age, calendar year, country, comorbidity, obesity, alcohol overconsumption, and tobacco smoking.

Results

This study included 2,909 case participants with esophageal adenocarcinoma, 670 case participants with esophageal squamous cell carcinoma, and 55,408 control participants. The risk of esophageal adenocarcinoma was not decreased in GLP-1RA users compared with non-users (adjusted OR 1.3, 95% CI 1.1-1.5). However, the risk of esophageal squamous cell carcinoma was decreased (adjusted OR 0.5, 95% CI 0.3-0.8).

Conclusion

Standard GLP-1RA treatment in patients with type 2 diabetes might not decrease the risk of esophageal adenocarcinoma. Confounding by indication may have been the most important, or even the sole, contributor to the decreased risk of esophageal squamous cell carcinoma observed, although anticarcinogenic mechanisms of GLP-1RAs other than weight loss cannot be ruled out.

Introduction

The indications for colonoscopy are clearly defined and its main objective is to look for neoplasia or lesions at high risk of colorectal neoplasia, even if benign lesions are much more frequent. Common indications for young adults < 50 years include rectal bleeding and diarrhea, while for subjects over 50 years, the indications may be larger given the risk of colorectal cancer, despite the recent increase in neoplastic lesions in young adults.

Aims & Methods

A retrospective descriptive and analytical study, including 1518 patients, was carried out over 3 and a half years. The patients were divided into 2 groups: group A for patients aged less than 50 years, and group B for patients aged greater than 50 years. We compared epidemiological, clinical, and endoscopic data between the two groups. Patients known to have inflammatory bowel disease (IBD) were excluded from our study. The statistical analysis was carried out by the JAMOVI software.
Our study aims to compare the indications and results of colonoscopy between those under and over 50 years old and to determine the indications associated with a risk of neoplastic lesion.

Results

65.1% of patients were over 50 years old, and 34.9% were under 50 years old. The average age was 37.5 ± 9 years in group A and 64.4 ± 9 years in group B. The female gender predominated among those under 50 years old (55.3%), while the male gender predominated among those over 50 years old (56.3%) (p<0.001).
History of colorectal cancer predominated among those over 50 years old at 10.5% (vs 4.4%; p<0.001). The indications for colonoscopy were dominated by constipation in patients in group B at 29.1% (vs 22%; p=0.01) and by diarrhea in patients in group A at 33.3% (vs 19. 3%; p<0.001).
Colonoscopy was pathological in 49.1% of patients in group B vs 32.9% of patients in group A (p<0.001). It was dominated by colitis or rectocolitis (47.9%) in subjects under 50 years old (vs 11.7%; p<0.001), by polyps (61.5% vs 41.3%; p<0.001) and colorectal neoplasia (16% vs 5%; p=0.002) in older patients.
A higher risk of neoplastic lesions was associated with rectal bleeding and constipation (p < 0.001) in subjects > 50 years old, and with constipation in subjects < 50 years old (p = 0.007).

Conclusion

The presence of neoplastic lesions was strongly associated with the presence of constipation in subjects < 50 years old and with rectal bleeding and constipation in subjects > 50 years old. Early screening with colonoscopy might be beneficial for young individuals with these higher-risk lesions of colorectal cancer.

Introduction

The prevalence of functional dyspepsia (FD) and gastroparesis in diabetic patients remains unknown. A high prevalence of gastroparesis has been reported in diabetic patients reaching up to 5%.¹ However, recent consensus specified the symptom pattern for gastroparesis, with nausea and/or vomiting as predominant symptoms, now defined as “gastroparesis-like symptoms” (GPLS).² The global prevalence of GPLS has been estimated to reach only 1.2% in diabetic patients, but type 1 and type 2 diabetes were not assessed separately.²

Aims & Methods

We aimed to assess the prevalence and burden of FD and GPLS in primary care patients with diabetes, comparing patients with type 1 and type 2 diabetes. An online survey was addressed to diabetic patients through general practitioners and diabetic patient associations. The survey included the Rome IV questionnaire and the Patient Assessment of Gastro-Intestinal Disorders-Symptom Severity Index (PAGI-SYM) for upper gastro-intestinal symptoms. Anxiety, depression, somatization, and quality of life were also assessed by specific questionnaires (Generalized Anxiety Disorder GAD-7, Patient Health Questionnaire PHQ-9, PHQ-15, and PAGI-QoL questionnaires respectively).

Results

A total of 216 patients completed the questionnaires, among which 146 had type 1 diabetes, and 68 had type 2 diabetes, (2 patients did not know their type of diabetes). The median age of the population was 56 (50-61) years old, with 134 female patients (61.8%). The prevalence of FD was 13.0% with no difference between the 2 groups. The prevalence of GPLS reached 4.2% and was significantly higher in patients with type 2 diabetes (8.9% vs 2.1%; p=0.03). The burden of upper gastro-intestinal symptoms and their impact on quality of life was higher in type 2 diabetes patients with higher PAGI-SYM and PAGI-QoL scores while anxiety and somatization were not different between type 1 and type 2 diabetes patients (see Table). Overall, patients with GPLS had higher anxiety (9 vs 3; p=0.003), depression (12 vs 3; p=0.001) and somatization scores (16 vs 6; p<0.001) than patients without. Compared to patients with FD without GPLS, GPLS patients had numerically higher but not statistically different scores for symptom severity (51 vs 28; p=0.46), anxiety (9 vs 7; p=0.29), depression (12 vs 7; p=0.07), somatization (16 vs 11.5; p=0.16) and quality of life scores (52 vs 24; p=0.16).

Conclusion

This study confirms that the prevalence of GPLS seems to be higher in diabetic patients compared to available population data, especially in patients with type 2 diabetes. The impact of the symptoms was similar to the impact of FD in this population. Further studies are required to assess the prevalence of delayed gastric emptying in diabetic type 1 and 2 patients with GPLS.

References

1. Choung RS, Locke GR, Schleck CD, et al. Risk of Gastroparesis in Subjects with Type 1 and 2 Diabetes in the General Population. Am J Gastroenterol 2012;107:82-88.
2. Huang I-H, Schol J, Khatun R, et al. Worldwide prevalence and burden of gastroparesis-like symptoms as defined by the United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on gastroparesis. United European Gastroenterol J 2022;10:888-897.

Introduction

Dietary and lifestyle recommendations are the cornerstones of the treatment of GERD. However, the evidence of the efficacy of those recommendations is lacking. We performed a retrospective analysis of the GISTAR study¹ participants evaluating the symptoms of GERD and dietary and lifestyle parameters developing a tool for predicting GERD symptoms based on the aforementioned criteria.

Aims & Methods

The aim of the study was to analyse the factors pointing to GERD symptoms through the use of data mining and decision tree classifier.
Methods: GERD diagnosis was evaluated using a self-assessment questionnaire ². Dietary, demographic and lifestyle data were collected within the GISTAR study protocol¹. 3340 40-64 year old participants from the GISTAR study were included in the analysis. 1670 of them did not have GERD symptoms. 41 attributes describing demographic, lifestyle, and dietary habits were used for these respondents to induce a decision tree classification model using Orange Data Mining software³.

Results

Fried potatoes including French fries were the most predictive factor of GERD symptoms (65.3% with symptoms; 1516 from 2321), especially for females (82.6%; 1048/1228). This was more pronounced in the group who consumed sweets once per week (87.2%, 950/1090). In males, who consumed fried potatoes, the next most important factor was the consumption of sweets (46.3%, 431/930).
For participants who didn’t consume fried potatoes (14.6%; 147/1008), 1-3 cups of green tea (37.9%; 66/174) and male gender (71.4 % 20/28) were predictors of GERD symptoms.
The accuracy of the decision tree model was: sensitivity (74.8%), precision (75.6%), specificity (75.9%) and AUC (0.841%).

Conclusion

Fried potatoes, female gender and consumption of sweets are the risk factors predicting the diagnosis of GERD. None of the lifestyle factors were displayed as significant.

References

1. Leja M, Park JY, Murillo R, et al. Multicentric randomised study of Helicobacter pylori eradication and pepsinogen testing for prevention of gastric cancer mortality: the GISTAR study. BMJ Open 2017;7:e016999. doi: 10.1136/bmjopen-2017-016999
2. Jones R, Junghard O, Dent J, Vakil N, Halling K, Wernersson B, Lind T. Development of the GerdQ, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care. Aliment Pharmacol Ther. 2009 Nov 15;30(10):1030-8. doi: 10.1111/j.1365-2036.2009.04142.x. Epub 2009 Sep 8. PMID: 19737151.
3. Demsar J, Curk T, Erjavec A, Gorup C, Hocevar T, Milutinovic M, Mozina M, Polajnar M, Toplak M, Staric A, Stajdohar M, Umek L, Zagar L, Zbontar J, Zitnik M, Zupan B (2013) Orange: Data Mining Toolbox in Python, Journal of Machine Learning Research 14(Aug): 2349−2353.