Introduction

Current therapeutic strategies for inflammatory bowel disease (IBD) remain limited, with clinical efficacy often falling short of expectations. Post-translational modifications play a pivotal role in IBD pathogenesis. This study aims to elucidate the functional significance of ubiquitination in IBD development and progression.

Aims & Methods

By analyzing colon RNA sequencing (RNA-seq) data from healthy and dextran sulfate sodium (DSS)-induced colitis mice, combined with RNA-seq datasets from healthy individuals and ulcerative colitis (UC) patients, we identified differential RNA expression levels of ATDC between healthy and inflammatory groups. Single-cell RNA sequencing (scRNA-seq) analysis further pinpointed the primary cell types exhibiting ATDC expression discrepancies. These findings were validated through immunohistochemistry, immunofluorescence, and western blot. Co-immunoprecipitation (Co-IP) assays and molecular docking simulations were employed to confirm and model the interaction between ATDC and PRMT5 in vitro. The role of ATDC in IBD pathogenesis was investigated using an ATDC-knockout (ATDC-KO) murine DSS model, with flow cytometry analyses delineating its impact on immune status.

Results

RNA-seq analysis revealed elevated ATDC mRNA levels in DSS-treated mice and UC patient intestinal tissues. scRNA-seq data indicated ATDC upregulation predominantly in the intestinal epithelial cells of UC patients. Protein-level upregulation of ATDC was further confirmed in both DSS mice and UC patient specimens. Lipopolysaccharide stimulation increased ATDC expression in Caco2 cells. Overexpression of ATDC in Caco2 cells, coupled with mass spectrometry, identified ATDC-PRMT5 binding, which was corroborated by Co-IP assays and molecular docking simulations. ATDC overexpression downregulated PRMT5 protein (but not mRNA) levels. In DSS models, PRMT5 expression was reduced compared to healthy controls; however, ATDC-KO mice exhibited PRMT5 upregulation and exacerbated colitis severity. Flow cytometry demonstrated an elevated Th17 cell proportion in ATDC-KO DSS mice relative to wild-type counterparts.

Conclusion

This study is the first to demonstrate the protective role of ATDC in colitis. ATDC attenuates colonic inflammation by promoting the degradation of PRMT5, thereby suppressing Th17 cell-mediated immune responses. Enhancing ATDC activity may represent a novel therapeutic strategy for mitigating colitis progression.

References

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Introduction

Endoscopic scores are crucial for assessing Crohn's disease (CD) severity, guiding therapy, and monitoring progression. The Simplified Endoscopic Score for Crohn's Disease (SES-CD) is widely used for this purpose [1]. Accurate scoring is vital for patient care. Recently, artificial intelligence has demonstrated potential in medical image interpretation [2]. This study aims to evaluate ChatGPT's effectiveness in rating the SES-CD.

Aims & Methods

This retrospective study evaluated ChatGPT's accuracy in assessing CD endoscopic activity using the SES-CD. One representative still image was selected for each bowel segment, and stricture degrees were provided separately if present. ChatGPT scored the SES-CD based on these images. The IBD expert's ratings were validated by calculating the intra-class correlation coefficient (ICC) with clinical trial central readers. The ICC between the IBD expert and ChatGPT scores was calculated to determine ChatGPT's reliability in SES-CD scoring.

Results

Nine (mean age 32.0 ± 11.8 years, 77.8% male) were included, with 45 bowel segments. Three (33.4%), 5 (55.6%), and 1 (11.1%) had nonstricturing nonpenetrating, structuring, and penetrating disease, respectively. Four (44.4%) had ileal disease and 5 (55.6%) had ileocolonic disease. Five (55.6%) had previous IBD surgery.
The SES-CD scores of the participants, rated by IBD expert in the hospital, revealed the following mean and standard deviation for each segment of the bowel: 6.9 ± 2.3 in the ileum, 1.3 ± 2.6 in the right colon, 1.6 ± 2.4 in the transverse colon, 1.3 ± 2.6 in the left colon, and 1.3 ± 2.6 in the rectum. The total SES-CD score was 12.4 ± 10.9. The score reliability of the institute IBD expert was tested compared to the clinical trial central reader and an intraclass correlation coefficient was calculated and found to be 0.96 (95% CI, 0.84-0.99) which is considered extremely correlated.
The mean and standard deviation of ChatGPT score in each segment were: 6.4 ± 2.4 in the ileum, 2.4 ± 3.8 in the right colon, 0.9 ± 2.7 in the transverse colon, 0.3 ± 1.0 in the left colon, 0.6 ± 1.3 in the rectum, with total SES-CD score of 10.6 ± 6.8. The calculated ICC between the expert and ChatGPT obtained SES-CD scores was 0.80 (95% IC, 0.64- 0.89) which is considered highly correlated.

Conclusion

Despite being based on only one photo per segment, ChatGPT demonstrated satisfactory performance in estimating endoscopic activity in CD. The differences between the IBD expert obtained scores and ChatGPT scores were acceptable, suggesting that artificial intelligence has the potential to be a useful tool in clinical and research settings, providing an accurate estimation of disease severity based on limited visual data.

References

1- Daperno M, D'Haens G, Van Assche G, et al. Development and validation of a new, simplified endoscopic activity score for Crohn's disease: the SES-CD. Gastrointest Endosc. 2004;60(4):505-512.
2- Levartovsky A, Albshesh A, Grinman A, et al. Enhancing diagnostics: ChatGPT-4 performance in ulcerative colitis endoscopic assessment. Endosc Int Open. 2025;13:a25420943. Published 2025 Mar 14.

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

Artificial intelligence (AI) is increasingly integrated into medical decision-making and education, particularly through large language models such as ChatGPT. In gastroenterology, where clinical reasoning relies heavily on imaging, biological interpretation, and complex decision processes, the effective implementation of AI tools remains poorly documented in real-world settings.

Aims & Methods

This study aimed to compare how gastroenterologists and physicians from other specialties perceive the usefulness and practical applications of AI in gastroenterology, with a focus on diagnostic, therapeutic, and educational support.
A cross-sectional survey was distributed to physicians practicing in various hospital settings in March 2025. Participants were grouped as gastroenterologists or non-gastroenterologists. The questionnaire assessed demographics, clinical exposure to digestive diseases, prior AI usage, and perceived utility of AI in gastroenterology. Statistical comparisons were conducted using the Chi-squared test, with significance set at p<0.05.

Results

Gastroenterologists were significantly more likely to have used AI for gastroenterology-specific clinical questions (64% vs. 41% among other physicians). While 96% of all respondents acknowledged the potential usefulness of AI in gastroenterology, gastroenterologists expressed greater caution: 60% described AI as useful but with limitations, 36% viewed it as a promising tool, and 4% saw no particular benefit. Similar distributions were observed among other physicians (56%, 42%, and 2%, respectively), with no statistically significant difference in overall perception (p = 0.77).
However, the perceived domains of utility differed significantly between the groups (p = 0.047). Gastroenterologists most often highlighted the role of AI in continuing medical education (24.5%), diagnostic support (20.8%), and public education (15.1%). In contrast, other physicians emphasized diagnostic assistance (21.9%), pedagogical support (23.5%), and notably, therapeutic decision-making (13.8%), which was less frequently cited by gastroenterologists (7.5%).

Conclusion

Gastroenterologists—although more experienced with AI in their field—tend to adopt a more cautious and targeted perspective on its clinical integration. They see it as a complementary tool for interpretation and professional development, rather than a primary decision-making assistant. Meanwhile, non-specialist physicians show a slightly broader enthusiasm, seeing AI as helpful both in clinical decisions and educational support. While both groups recognize the potential of AI in gastroenterology, its successful implementation will require tailoring to the specific expectations, workflows, and trust levels of each medical discipline.

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].

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

Primary sclerosing cholangitis (PSC) is known to present characteristic cholangiographic findings; however, detailed observations using peroral cholangioscopy (POCS) have rarely been reported. We previously reported that POCS findings in PSC can be classified into three types: active (inflammatory), chronic (scarring), and tumorous (tumor-like). These findings may aid in the differential diagnosis of PSC and may be useful in predicting prognosis.

Aims & Methods

We aimed to analyze POCS findings in PSC in detail based on this classification and to clarify their characteristics by evaluating the frequency of each finding, their temporal changes, and comparisons with other biliary diseases.
We retrospectively reviewed 22 patients with PSC who underwent POCS between February 2018 and February 2023. For comparison, we included 19 cases of hepatolithiasis, 25 cases of cholangiocarcinoma, and 3 cases of IgG4-related sclerosing cholangitis (IgG4-SC). Twelve POCS findings were categorized into three types: active (mucosal erythema, ulcers, fibrous white exudates, irregular surface), chronic (longitudinal scarring, annular scarring, pseudodiverticula, stenosis), and tumorous (dilated vessels, tortuous vessels, friability, mass formation). In addition, we included “punched-out lesion (POL)” as an original finding. Each finding was graded on a 5-point scale (0–4) based on the extent or number of lesions, and scores were calculated for each type. We conducted three analyses: (1) correlation between cholangiographic and POCS findings in PSC, (2) temporal changes in POCS findings in PSC, and (3) comparison of POCS findings between PSC and other biliary diseases.

Results

In the first analysis, annular scarring (100%), stenosis (89%), POL (89%), and longitudinal scarring (86%) were frequently observed in PSC. Annular scarring was identified in all cases with a shaggy appearance on cholangiography, and stenosis were present in all ducts with band-like stricture. In ducts showing diverticulum-like outpouchings, longitudinal and annular scarring, pseudodiverticula, and POL were consistently seen, whereas other findings were absent. In the second analysis, active and tumorous scores varied over time even within the same case, whereas chronic scores remained stable or showed a progressive increase. A negative correlation was observed between active and chronic scores (p-value <0.001, r =-0.702). In the third analysis, chronic findings and POL were significantly more common in PSC compared to other diseases (p-value <0.001). Pseudodiverticula were seen exclusively in PSC, while dilated and tortuous vessels and friability were significantly more frequent in cholangiocarcinoma and IgG4-SC (p-value <0.001).

Conclusion

These findings suggest that the characteristic cholangiographic findings of PSC are mainly formed by chronic scarring. Diverticulum-like outpouchings reflect only fibrotic changes. Furthermore, the coexistence of inflammation and fibrosis, along with the time-dependent progression of fibrosis, is a unique feature of PSC, although active inflammation may obscure chronic findings. Finally, longitudinal scarring and POL were particularly prominent in PSC, and pseudodiverticula were highly specific to this disease, suggesting their usefulness in differential diagnosis. In conclusion, chronic findings on POCS are characteristic of PSC and may serve as a helpful tool in its diagnosis and differentiation from other biliary diseases.

References

T Fujisawa, M Ushio, S Takahashi, et al., Role of Peroral Cholangioscopy in the Diagnosis of Primary Sclerosing Cholangitis. Diagnostics (Basel), 2020. 10(5).
T Itoi, T Kamisawa, Y Igarashi, et al., The role of peroral video cholangioscopy in patients with IgG4-related sclerosing cholangitis. J Gastroenterol, 2013. 48(4): p. 504-14.
T H Karlsen, T Folseraas, D Thorburn, et al., Primary sclerosing cholangitis - a comprehensive review. J Hepatol, 2017. 67(6): p. 1298-1323.
T Nakazawa, K Notohara, S Tazuma, et al., The 2016 diagnostic criteria for primary sclerosing cholangitis. J Gastroenterol, 2017. 52(7): p. 838-844.
T Nakazawa, H Ohara, H Sano, et al., Cholangiography can discriminate sclerosing cholangitis with autoimmune pancreatitis from primary sclerosing cholangitis. Gastrointest Endosc, 2004. 60(6): p. 937-44.
H Isayama, S Tazuma, N Kokudo, et al., Clinical guidelines for primary sclerosing cholangitis 2017. J Gastroenterol, 2018. 53(9): p. 1006-1034.
W L Campbell, M S Peterson, M P Federle, et al., Using CT and cholangiography to diagnose biliary tract carcinoma complicating primary sclerosing cholangitis. AJR Am J Roentgenol, 2001. 177(5): p. 1095-100.