Introduction

Patients with cirrhosis often lack knowledge about how to manage and prevent complications related to their disease. ChatGPT, a natural language processing model developed by OpenAI, could offer support by providing clear and understandable answers to patients. While it has been used in medical applications, such as test preparation and report writing, few studies have evaluated its ability to accurately answer clinical questions specific to diseases like cirrhosis.

Aims & Methods

This study aims to evaluate the accuracy and completeness of ChatGPT's responses in order to assess its effectiveness as an informational tool for patients.
We analyzed 44 frequently asked questions about cirrhosis posed by patients in Facebook support groups, categorizing them into four groups: basic knowledge (19 questions), diagnosis (3 questions), treatment (15 questions), and lifestyle (7 questions). A liver specialist evaluated the answers on a scale from 1 to 4:

1. Complete
2. Correct but insufficient
3. Contains both correct and incorrect information
4. Completely incorrect"

Results

The results show that for basic knowledge, 47.3% of answers were complete, 31.5% were correct but insufficient, and 21.05% contained incorrect information. Regarding diagnosis, 66.6% of answers were correct but lacked detail, while 33.3% were complete. For treatment, 33.3% of answers were complete, 40 % were correct but insufficient, and 20% contained errors. Finally, for lifestyle, 42.8% of answers were complete, 28.5% were correct but insufficient, and 14.28% contained errors. Notably, no ChatGPT answer was deemed completely incorrect.
The model demonstrated its ability to provide detailed answers to questions related to basic knowledge and lifestyle. It offered comprehensive explanations of the symptoms, etiology, and prognosis of both compensated and decompensated cirrhosis, as well as risk factors and lifestyle changes that may influence outcomes. While the model provided correct answers in areas like diagnosis and treatment, most responses were rated as correct but insufficient.

Conclusion

This study shows that while the model was able to provide complete and useful answers on basic and lifestyle topics, there is still room for improvement, particularly in more technical areas such as diagnosis and treatment of cirrhosis. It is crucial that medical information is regularly updated to ensure its accuracy and relevance. Additionally, this analysis emphasizes the importance of consulting healthcare professionals for personalized medical advice tailored to each individual situation.

Clinical Case Summary

A 75-year-old male under follow-up for chronic anemia secondary to multiple gastrointestinal angiodysplasias. He required transfusions every two weeks and maintained a baseline hemoglobin level of around 7–8 g/dL despite repeated therapeutic endoscopy with argon plasma coagulation. In light of this, he began daily treatment with oral Thalidomide 50 mg, with a good response for three years. At that point, he developed persistent melena and also experienced a deep vein thrombosis attributed to the treatment, leading to its discontinuation. The regimen was then changed to subcutaneous Octreotide 10 mg monthly, later intensified to 30 mg per month. Despite this, he continued to have recurrent gastrointestinal bleeding and multiple hospital admissions due to anemia-related symptoms. With no other treatment options available, a weekly dose of 30 mg was prescribed, achieving a good response for two years. Eventually, due to loss of efficacy and refractoriness to other treatments, compassionate use of Bevacizumab was initiated at a dose of 7.5 mg/kg monthly. From the beginning and after three doses, the patient became asymptomatic and experienced no further bleeding episodes, maintaining hemoglobin levels around 12–13 g/dL.
Gastrointestinal angiodysplasias are a common and significant condition due to the increased demand they place on healthcare services. Their management is complex, and treatment options are limited, particularly in cases that are refractory to standardized therapies. In such patients, the use of Bevacizumab can be considered. Although evidence is limited, it shows promising results, as demonstrated in our case.

References

Figure 1. Enteroscopy image showing angiodysplasia in the small intestine
Figure 2. Therapeutic enteroscopy, image prior to argon plasma coagulation therapy
Figure 3. Capsule endoscopy image showing angiodysplasia in the small intestine
Figure 4. Another capsule endoscopy image showing active bleeding secondary to one of the angiodysplasias

Introduction

Besides analgesia, opioids affect gastrointestinal (GI) motility, including decreased bowel peristalsis and delayed gastric emptying. Peripherally acting mu-opioid receptor antagonists, like naloxegol, are approved for treating opioid-induced constipation.

Aims & Methods

We aimed to evaluate the effects of naloxegol on opioid-induced lower GI tract dysfunction using magnetic resonance imaging (MRI) to assess changes in colonic volumes in healthy volunteers (HV).
In this double-blind, randomised, three-way crossover study, 15 HV complete three study visits, separated by ≥1 week washout, with administration of 25 mg naloxegol + 60 mg codeine, 60 mg codeine + placebo, or double placebo. During each visit, five abdominal MRI scans (each 20 min.) are obtained at 30 min intervals, at baseline, after drug intake, after a standardized 44 g oatmeal and 100 mL Nutridrink (313 kCal) meal, after a second drug dose, and after a bisacodyl 10 mg suppository administration. Colonic segmental volumes were quantified from all MRI scans using Entrolytics (Motilent, London, UK) in the ascending, transverse, descending, and rectosigmoid colon. We recorded the passage of stool during the study visit. Results are presented as medians with min. and max. P-values <0.05 are considered statistically significant. Adjusted p-values are used in case of post-hoc analysis.

Results

Interim analysis on 8 HVs (mean age 36±5y, 75% females) revealed that two subjects made stool on 2 mornings before the study visit. Four subjects passed stool in the double placebo group (2 postprandial, 2 post-bisacodyl), and 2 of them passed stool in the other 2 groups as well, around the same time. A significant scan x group effect was found for the whole colon volumes (p<0.05). More specifically, there was a significant difference in median ascending colon volumes between the scans (p=0.03), and especially in the double placebo group (Table). Although there was no significant difference in the median transverse colon volumes, bisacodyl led to a significant decrease in descending colon volume (p<0.0001), more specifically in the naloxegol+codein group and the double placebo group (ps<0.05), but not in the codein+placebo group. No significant differences in volumes of the rectosigmoid were detected.

Conclusion

Interim MRI analysis of 8 HVs suggests different colonic motility responses across groups and timepoints. Toilet visits were suppressed in both codeine groups. Different responses to drug and food intake were found in the ascending and descending colon between the naloxegol+codein and double placebo group on one hand compared to the codein+placebo group. Expansion and analysis of the full number of subjects will further clarify insights into the acute colonic responses to opioids and potential reversal by naloxegol.

Introduction

Gastric emptying is controlled by phasic gastric contractions which occur at a frequency of ~3 cycles per minute (cpm) in phase with gastric slow waves. Tests to measure slow waves cannot directly detect abnormal contractions. The Atmo Capsule possesses an accelerometer that measures changes in capsule orientation and can thus detect gastric contractions. We analyzed accelerometer data to define its capability to characterize gastric contraction frequency and amplitude in patients with suspected dysmotility, and to assess if frequency or amplitude vary in relation to transit delay.

Aims & Methods

Gut transit was measured by the Atmo Capsule in 209 subjects: 48 with predominant upper GI (UGI) symptoms alone (suspected gastroparesis), 21 with lower GI (LGI) symptoms (suspected slow colon transit) alone, and 140 with combined UGI+LGI symptoms. This analysis utilized data from subjects recording valid gastric emptying time (GET) measures and did not incur protocol deviations affecting gastric transit. Delays in GET were categorized as: normal, <5 h; delayed, 5-10 h; severely delayed, ≥10 h. Fast Fourier Transformation (FFT) of the accelerometer data allows for the identification and analysis of the dominant gastric frequency and amplitude using 10-minute windows and a cutoff frequency of 4.5 cpm. Variability of frequency and amplitude measures were estimated by calculating interquartile range (IQR) and range (max-min) values and were analyzed in relation to presenting symptoms and gastric emptying delays.

Results

Gastric data from 190 subjects were suitable for analysis: gastric contractions with dominant frequencies of 3.30 cpm (IQR 0.47, range 1.47) and amplitudes of 0.10 arbitrary units (au) (IQR 0.04, range 0.14) were detected in 185 (97%) of subjects. Mean contraction frequency tended to be higher in those with delayed GET compared with no delay (p=0.016) and severe delay (p=0.005) (Table 1). Frequency IQR (p=0.002) and range (p=0.002) were higher for GET delay vs. no delay, while range was higher in severe GET delay vs no delay (p<0.001). Mean amplitude was higher in subjects with severe GET delay compared with normal delay (p=0.008) and normal transit (p=0.001). Amplitude IQR and range were both higher in those with severe GET delay compared with normal delay (p=0.002; p=0.001) and no delay (p<0.001 for both). Frequency metrics were similar irrespective of predominant symptoms. Amplitude means (p=0.022), IQR (p=0.030) and range (p=0.0004) were higher for UGI vs. LGI symptoms.

Table 1. Dominant gastric frequencies and amplitudes in relation to gastric emptying delays. Data shown as median (interquartile range) and analyzed via Kruskal-Wallis test.

Conclusion

The Atmo Capsule accelerometer reliably characterizes 3 cpm gastric contraction frequency and amplitude in subjects with proposed delays in gut transit. Increased variabilities in contraction frequency and amplitude were defined in those with severely delayed gastric emptying and increased amplitude variability was found for predominant upper GI symptoms. We propose these higher variations identified by accelerometry may reflect hypomotility or contractile dropout, suggesting additional clinical utility of the Atmo Capsule in suspected gastroparesis.

Disclosure

These authors disclose the following: Braden Kuo, Anthony J. Lembo, Eammon M.M. Quigley, Satish S.C. Rao, and William D. Chey serve on the Medical Advisory Board of Atmo Biosciences. Michael Cline and Baharak Moshiree served on the Medical Advisory Board of Atmo Biosciences. Braden Kuo has received funding from NIH, Vanda, Atmo Biosciences, and Takeda and has consulted for Evoke, Takeda, Ironwood, Novo Nordisk, Cindome, and Neurogastrx. Thomas Abell has received funding from Gastric Dysrhythmias, Neurogastrx, NIH GpCRC, and Vanda and has consulted for Enterra Medical, Novo Nordisk, Nuvaira, and Vanda. Anthony J. Lembo has received funding from Ardelyx, Biomerica, GSK, Ironwood, Takeda, and Vibrant and holds stock with Allurion, Bristol Myer Squibb, and J&J. Abigail Stocker has received funding from Cindome, Enterra Medical, and Vanda. William D. Chey has received funding from Atmo Biosciences, Commonwealth Diagnostics Intl, QOL Medical, and Salix; has consulted for AbbVie, Ardelyx, Biomerica, Comvita, Gemelli, Ironwood, Nestle, QOL Medical, Phathom, Redhill, Salix, Vibrant, and Takeda; has filed patents with My Nutrition Health, Digital Manometry, and Rectal Expulsion Device; and holds stock options with Coprata, Evinature, Food Marble, Kiwi Bioscience, and Modify Health. The remaining authors disclose no conflicts.

Introduction

Although traditionally regarded as a vestigial organ, the appendix is increasingly recognized for its potential role in modulating gut immunity and contributing to the development of significant inflammatory or neoplastic intestinal diseases [1]. However, the underlying mechanisms linking the appendix to these immune and pathological processes remain poorly understood. This study aimed to investigate the relationship between the local immune microenvironment and the mutational landscape of rectal carcinomas in the context of prior or progressive appendectomy status.

Aims & Methods

This study aimed to investigate the relationship between the local immune microenvironment and the mutational landscape of rectal carcinomas in the context of prior or progressive appendectomy status.
Patients enrolled in the IMMUNOREACT 1 and 2 studies (NCT04915326 and NCT04917263, respectively) were stratified according to appendectomy status. Immunohistochemical analysis was performed to assess a range of immune markers, including CD3, CD4, CD8, CD8β, Tbet, FoxP3, PD-L1, MSH6, PMS2, and CD80. Additionally, flow cytometry was employed to evaluate the percentage of epithelial cells expressing CD80, CD86, CD40, HLA-ABC, or HLA-DR, as well as to quantify activated CD8+ T cells, CD4+ Th1 cells, and regulatory T cells (Tregs). Non-parametric tests were used.

Results

In this cohort, 41 patients out of 163 underwent appendectomy for other causes (e.g. appendicitis) before having been diagnosed with a rectal cancer. When the two groups were compared for microenvironmental features, in the normal mucosa of patients who had a previous appendectomy there was a higher rate of epithelial cells expressing HLA-abc (p=0,04) and a higher expression of CTLA4 on CD3+ T cells (p=0,03) when compared to appendectomy-naive patients. Within the rectal cancer tissue, a higher expression of CD86 on epithelial (cancer) cells expression was found in patients who already had an appendectomy (p=0,03). In therapy naïve patients, previous appendectomy was associated to a higher activation of CD4+ T helpers (expression of CD25), (p=0.04), and to tendency of higher rate of epithelial cells expressing HLA-abc (p=0,06) and of T cells expressing CTLA-4 (p=0.08). In patients who had neoadjuvant therapy, lower level of PD-L1 on the leukocyte surface were observed in patients who had a previous appendectomy (p=0.039).

Conclusion

Our findings suggest that prior appendectomy may be associated with distinct alterations in the local immune microenvironment of rectal carcinomas, including increased expression of antigen-presenting and immune-regulatory molecules such as HLA-BC, CTLA4, and CD86. In therapy naïve patients, appendectomy seem to increase the activation of T helper cells counterbalanced by an increase of the number of T cells expressing CTLA-4. These immune shifts in both tumour tissue and adjacent healthy mucosa support the hypothesis that the appendectomy may in somehow alter the interaction between epithelia cells and intraepithelial T cells. Further trancriptomic ​analysis will shed light on the effect of appendectomy on mucosal microevironment of ​rectal cancer patients.

References

1. Collard MK, Tourneur-Marsille J, Uzzan M, Albuquerque M, Roy M, Dumay A, Freund JN, Hugot JP, Guedj N, Treton X, Panis Y, Ogier-Denis E. The Appendix Orchestrates T-Cell Mediated Immunosurveillance in Colitis-Associated Cancer. Cell Mol Gastroenterol Hepatol. 2023;15(3):665-687.

Introduction

Musculoskeletal disorders (MSDs) are the leading cause of occupational disease and represent a major public health concern. Endoscopy plays a central role in hepatogastroenterology, and its practice is associated with a high prevalence of MSDs, ranging from 40% to 90% among endoscopists. The increasing complexity of endoscopic procedures may further exacerbate musculoskeletal strain on practitioners. However, few studies have been conducted on this topic, and most rely on observational and self-reported data, limiting their level of evidence. Quantitative studies assessing the impact of digestive endoscopy, particularly endoscopic retrograde cholangiopancreatography (ERCP), on MSD risk under real working conditions remain scarce.

Aims & Methods

To obtain objective and reliable data, we used the KIMEA tool, which analyzes an operator’s movements by generating a digital twin based on data collected through a depth camera and wrist-mounted sensors. This system allows for an objective assessment of musculoskeletal strain by estimating MSD risk using the Rapid Upper Limb Assessment (RULA) method. Our study was conducted on two experienced endoscopists performing a total of 10 ERCP procedures.

Results

Motion analysis revealed an average global RULA score of 4.2, indicating a moderate risk of MSDs. Musculoskeletal strain was predominantly observed in the forearms, particularly in the wrists, which remained in constrained postures for more than 50% of the procedure time. The musculoskeletal load was asymmetrical, with greater strain on the left side. These findings were consistent across all 10 procedures.

Conclusion

Discussion: This study confirms the significant musculoskeletal strain on the upper limbs during ERCP procedures. Our findings align with existing literature. The KIMEA tool appears to be a suitable method for analyzing movements in digestive endoscopy and represents a methodological advancement for the objective evaluation of musculoskeletal strain in this field.
Conclusion: Motion analysis using the KIMEA tool provides objective evidence that ERCP practice poses a risk for MSD development. Further studies with larger sample sizes are needed to strengthen the level of evidence, assess the impact of factors such as age, experience, gender, and procedure type, and promote the integration of ergonomic measures into endoscopic practice to reduce MSD risk.

Introduction

Advanced colorectal neoplasia (ACN) has a high potential for malignancy, and its early detection and removal can effectively reduce the incidence and mortality of colorectal cancer (CRC). A predictive model to estimate the risk of ACN could help direct patients and providers to improve screening efficiency.

Aims & Methods

We aimed to develop a comprehensive risk prediction model specifically for ACN.
A retrospective cross-sectional study was conducted on patients who underwent endoscopy at the Affiliated Wuxi People's Hospital of Nanjing Medical University from January 1, 2021, to December 31, 2023. The researchers collected clinical data, including histopathological results, demographic information, lifestyle features, and medical history. Univariate and multivariable analyses were used to derive a risk prediction model based on the training cohort of the sample, and points were assigned to each variable to create a risk score. Scores with comparable risks were grouped into different risk categories. The model and its scores were tested using the validation cohort.

Results

Among the 2054 participants in the training cohort [mean age, 60 (52, 68) years; 1022 (50.0%) female], the prevalence of ACN was 271 (13.3%). The eight-variable model (sex, age, diabetes, family history of CRC in a first-degree relative, history of colonoscopy history, smoking, gastric histopathological results, and Helicobacter pylori infection history) resulted in two risk categories, with an area under the receiver operating characteristic curve (AUC) of 0.710 (95% CI: 0.679-0.742). In the validation cohort of 495 participants with an ACN prevalence of 62 (12.5%), model performance was comparable (AUC=0.715, 95% CI: 0.649-0.781). The ACN risk was 6.9% and 23.9% in the low- and high-risk groups, respectively, and 14 and 4 participants needed to be screened in the low- and high-risk groups, respectively. Further analysis revealed that three other prediction methods, including the Asia-Pacific Colorectal Screening (APCS) score [0.622 (0.556-0.688), p=0.049], the APCS score-revised edition [0.589 (0.524-0.653), p=0.007], and the colorectal tumor prediction score [0.570 (0.504-0.636), p=0.002], displayed significantly lower AUCs than our prediction ACN model.

Conclusion

The developed and validated prediction model performed well in identifying individuals with ACN at high risk in asymptomatic Chinese populations. Colonoscopy examinations in these patients were necessary, as they not only facilitated early detection of ACN but also enabled timely intervention to prevent CRC.