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

Coeliac disease (CeD) is a chronic immune-mediated enteropathy driven by dietary gluten proteins. Previous studies have indicated an increased risk of cardiovascular disease (CVD) in individuals with CeD [1-3]. However, results are inconsistent and specific guidelines on the management of CVD risk and comorbidities for individuals with CeD do not exist. In this study, we aimed to compare the distribution of traditional CVD risk factors in CeD patients and non-CeD controls from a population-based cohort.

Aims & Methods

We performed a CeD screening of 54,541 serum samples by anti-transglutaminase 2 immunoglobulin A and G serology from in total 56,042 adult participants in the fourth wave of the Norwegian Trøndelag Health Study (HUNT4) [4]. All seropositive participants were invited to upper endoscopy with duodenal biopsies to confirm a CeD diagnosis. Seronegative participants with previously diagnosed CeD were identified by linkage to hospital records and the Norwegian Patient Registry. We calculated SCORE2 and SCORE2-OP as predictors for 10-year risk of first-onset CVD [5, 6]. The groups “no CeD”, previously diagnosed CeD (“known CeD”) and CeD diagnosed in HUNT4 (“new CeD”), as well as “CeD” (known + new cases) were examined in this study. To compare group characteristics, we used the Wilcoxon rank sum test. Associations between groups and SCORE2(-OP) were assessed using ordinal logistic regression analysis.

Results

468 (0.80%) individuals received a CeD diagnosis in HUNT4, while 309 (0.57%) seronegative individuals had known CeD. Individuals with newly diagnosed CeD were younger, better educated, and had lower blood lipids compared to controls. Individuals with CeD smoked significantly less, had lower BMI and waist-hip-ratio, glycated hemoglobin levels, serum creatinine, and hsCRP levels compared to controls without CeD (n=52,438; p<0.05 for all variables mentioned, see table). We found a significantly lower SCORE2 for CeD cases (n=589) compared to controls (n=39,747; p<0.05). Adjustment for alcohol consumption did not affect group characteristics. A significantly lower SCORE2 was observed in CeD cases also after adjustment for level of education (OR .84, 95% CI .72-.98), high sensitivity C-reactive protein (hsCRP) and serum creatinine (OR .85, 95% CI .78-.99), but not for the combination of all three variables (OR .90, 95% CI .76-1.05).

Conclusion

Individuals with CeD appear to have a lower cardiovascular risk based on traditional risk factors like smoking habits, body fat, diabetes, renal function and inflammation compared to control individuals without CeD. In line with that, SCORE2 and SCORE2-OP as predictors for 10-year risk of first-onset CVD were lower in individuals with CeD.

References

1. Bathrellou, E., M.D. Kontogianni, and D.B. Panagiotakos, Celiac disease and non-celiac gluten or wheat sensitivity and health in later life: A review. Maturitas, 2018. 112: p. 29-33.
2. Ludvigsson, J.F., et al., Nationwide cohort study of risk of ischemic heart disease in patients with celiac disease. Circulation, 2011. 123(5): p. 483-90.
3. Figtree, G.A., et al., Mortality in STEMI patients without standard modifiable risk factors: a sex-disaggregated analysis of SWEDEHEART registry data. Lancet, 2021. 397(10279): p. 1085-1094.
4. Asvold, B.O., et al., Cohort Profile Update: The HUNT Study, Norway. Int J Epidemiol, 2023. 52(1): p. e80-e91.
5. SCORE2 working group and ESC Cardiovascular risk collaboration, SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. Eur Heart J, 2021. 42(25): p. 2439-2454.
6. SCORE2-OP working group and ESC Cardiovascular risk collaboration, SCORE2-OP risk prediction algorithms: estimating incident cardiovascular event risk in older persons in four geographical risk regions. European Heart Journal, 2021. 42(25): p. 2455-2467.

Disclosure

None.

Introduction

Dietary regimens for symptom management in irritable bowel syndrome (IBS) include a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) diet and a gluten-free diet. However, scientific evidence supporting these dietary recommendations for managing IBS symptoms is weak: trials have been non-blinded and underpowered, while mechanistic understanding and objective markers of response remain scarce.

Aims & Methods

We therefore conducted a large double-blind study to investigate the effect of FODMAPs and gluten on symptomatic and molecular data including gut microbiota and the metabolome, both at a group and subgroup (differential response) level. Moreover, the accuracy of the Bristol Stool Form Scale (BSFS) used in IBS subtype diagnosis was assessed, and thus overcome the lack of objective evaluation of IBS symptoms. The results were recently collected in a doctoral thesis.

Results

Trial data revealed that gluten caused no symptoms and that FODMAPs triggered only modest symptoms of IBS. Subjective reporting according to the BSFS conformed only modestly with stool water content. FODMAPs increased saccharolytic microbial genera, phenolic-derived metabolites and 3-indolepropionate, but decreased bile acids. Saccharolytic genera correlated with increased plasma concentrations of phenolic-derived metabolites and 3-indolepropionate, metabolites related to decreased risk of incident type 2 diabetes and inflammation. Indeed, among FODMAP-related metabolites, only weak correlations to IBS symptoms were detected, as with 3-indolepropionate to abdominal pain and interference with quality of life, warranting further investigation. Gluten displayed a modest effect on metabolites involved in lipid metabolism, but with no interpretable link to health. No molecular biomarkers of a differential response to the challenges were found, despite comprehensive exploration with multiple analytical approaches. This could be explained by the absence of baseline variables, such as other omics layers or psychological factors, that could have determined the difference.

Conclusion

Diet only had a modest effect on IBS symptoms. Caution should be taken when subtyping IBS with BSFS.

Introduction

Enteroscopy is an established method for endoscopic diagnosis and interventions in the small intestine. Currently, there are three procedures available: single-balloon enteroscopy, double-balloon enteroscopy, and motorized spiral enteroscopy. Recent studies have shown that motorized spiral enteroscopy is very effective but also associated with more complications. There are no comparative studies between double-balloon and motorized spiral enteroscopy.

Aims & Methods

This randomized, prospective trial was conducted at two tertiary centers. All consecutive patients with an indication for enteroscopy were asked to participate in the study. Patients were randomly assigned to the motorized spiral or double-balloon arm after being informed. The examination was then performed with the respective procedure.
This study aims to compare the effectiveness of the new motorized spiral enteroscopy with double-balloon enteroscopy. The time to diagnosis or complete enteroscopy and possible complications of both procedures were investigated.

Results

39 enteroscopies (19 motorized spiral, 20 double-balloon) were performed in 36 patients. In the spiral group, access was achieved orally in 58% of cases. A complete enteroscopy was possible in 26% of cases with a median time of 36 minutes. In 16%, a complete enteroscopy was possible via the oral route. In the double-balloon group, access was achieved orally in 85% of cases. A complete enteroscopy was possible in 10% of cases with a median time of 45 minutes. In 5%, a complete enteroscopy was possible via the oral route. Diagnostic yield was higher in double balloon enteroscopy compared to spiral enteroscopy with positive findings in 75% and 32% respectively. There was one perforation in the motorized spiral group. There were no severe complications in the balloon group.

Conclusion

Motorized spiral enteroscopy seems to be more effective in terms of speed and depth. However, it is also associated with more complications

Introduction

The presence of an aberrant clonal IEL population is the hallmark of RCDII. We have observed patients who have clinical features of RCDII but do not fit the classical immunophenotypic or molecular features of same.

Aims & Methods

Our aim was to describe the profile of RCDII patients who present with classical aberrancy in the absence of clonality or atypical aberrancy +/- clonality.
We conducted a retrospective review of flow cytometry and TCR-GR analysis of RCDII patients in University Hospital Galway over a 14 year period.

Results

We included 13 RCDII patients, 5 males and 7 females, with a median age of 62 years at RCDII diagnosis. 6 patients had classical RCDII, median 80% aberrant IELs (cytoCD3+/sCD3-/sCD8-) and had a clonal TCR-GR. Of the remaining 7 patients, 4 had classical aberrancy (median 52%) without clonality, including 1 who lost the TCR-GR clone 1 year post autologous stem cell transplant but whose aberrancy persisted (43%) 10 years later, and 1 who subsequently developed a clonal TCR-GR on follow up. 2 patients had an atypical aberrant IEL population without clonal TCR-GRs; one of whom developed lymphoma 3 years post RCDII diagnosis and the other remains under surveillance (16% classical aberrancy, 41%NK cells). The remaining patient has a mixed aberrant IEL population (71% cytoCD3+/sCD3-/sCD8+, 19% cytoCD3+/sCD3-/sCD8-) but has a clonal TCR-GR. Mortality rate for the classical RCD II was 66% compared to 14% in variant RCD II.

Conclusion

​The heterogeneity of RCDII poses many diagnostic challenges. Newer sequencing technologies will likely aid the expansion of the diagnostic criteria to include variant RCDII. While follow up is ongoing, variant RCDII maybe associated with a lower mortality.

Introduction

Fatigue, defined as “an overwhelming sense of tiredness, lack of energy and feeling of exhaustion” [1] is a frequent complaint in celiac disease. A strict, lifelong gluten free diet is the only established treatment for celiac disease, however its long-term effect on fatigue is unknown.

Aims & Methods

Our aims were to investigate the course of fatigue severity and prevalence in celiac patients from diagnosis to five to seven years on a gluten free diet, and to investigate whether diet adherence, disease activity and selected biochemical markers are associated with fatigue.
We conducted a single-center prospective study in 45 patients with newly diagnosed celiac disease. The primary endpoints were fatigue severity, as measured by the Fatigue Severity Scale (FSS) [2], the fatigue Visual Analog Scale (fVAS) [3], and the Vitality subscale of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36vs) [4]. SF-36vs scores were inverted (100 – SF-36vs = inverted SF-36vs) to ease comparison between the other scales, so that higher scores indicate more fatigue. Clinically relevant fatigue was defined by an FSS score of ≥4, a fVAS score of ≥50, and an inverted SF-36vs score of ≥65. Study visits were performed at the time of diagnosis (Visit 1), after adhering to a gluten free diet for one year (Visit 2) and for five to seven years (Visit 3). Diet adherence was evaluated through urinary gluten immunogenic peptides (GIP) and the Celiac Diet Adherence test (CDAT) [5]. Disease activity was assessed through Celiac Symptom Index (CSI) [6], celiac autoantibodies (anti tissue transglutaminase IgA and deamidated gliadin peptide IgG) and histologic evaluation (Marsh score). Nutritional status was assessed through BMI, hemoglobin, 25-hydroxy vitamin D, cobalamin, ferritin and folic acid levels.

Results

Fatigue severity was significantly reduced from time of diagnosis, for all three instruments (Table 1). Fatigue prevalence rates were significantly decreased from Visit 1 (40-53%) to Visit 3 (27-31%). Fatigue was significantly lower in patients with good adherence compared to patients with poor adherence according to CDAT scores (For FSS p=0.022, fVAS p=0.017, and for inverted SF-36vs p=0.033). There was however no difference in fatigue severity between adherent and nonadherent patients when evaluating adherence through urinary GIP. Fatigue was lower in patients in clinical remission according to CSI scores (for FSS p=0.002, fVAS p=0.004, and for inverted SF-36vs p=0.002), but not associated with autoantibodies or nutritional status. In multiple linear regression analysis, depression was the only independent variable significantly associated with all three fatigue measures at Visit 3, whereas pain was positively associated with inverted SF-36vs scores.

Table 1.

Conclusion

Fatigue remains a frequent complaint in celiac disease even after five to seven years on a gluten free diet. However, fatigue severity is reduced from time of diagnosis. Fatigue was associated with dietary adherence as assessed by CDAT. Disease activity according to CSI was associated with fatigue, whereas nutritional status, autoantibodies and histologic changes were not.

References

1. Krupp, L.B. and D.A. Pollina, Mechanisms and management of fatigue in progressive neurological disorders. Curr Opin Neurol, 1996. 9(6): p. 456-60.
2. Krupp, L.B., et al., The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol, 1989. 46(10): p. 1121-3.
3. Wolfe, F., Michaud K, Pincus T, Preliminary evaluation of a visual analog function scale for use in rheumatoid arthritis. J Rheumatol, 2005. 32(7): p. 1261-6.
4. Ware, J.E., Jr. and C.D. Sherbourne, The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care, 1992. 30(6): p. 473-83.
5. Leffler, D.A., et al., A simple validated gluten-free diet adherence survey for adults with celiac disease. Clin Gastroenterol Hepatol, 2009. 7(5): p. 530-6, 536.e1-2.
6. Leffler, D.A., et al., A validated disease-specific symptom index for adults with celiac disease. Clin Gastroenterol Hepatol, 2009. 7(12): p. 1328-34, 1334.e1-3.

Disclosure

Berit Mære Skjellerudsveen: Received lecture honoraria from Takeda for lectures on IBD and pregnancy. This study is partly funded by a grant from the patient organization “The Norwegian Coeliac Society”.