Search

Artificial intelligence (AI) applications are used in gastroenterology for automatic imaging diagnostic methods such as ultrasonography, computer tomography, magnetic resonance imaging, but also in endoscopy, capsule endoscopy and biopsy followed by automatic digital pathology evaluation. The accuracy of AI-based systems is superior to human expertise. Furthermore, in reality, a very small percentage of the patients are being investigated by a human expert in endoscopy, so implementing AI in this investigation would only increase the diagnostic accuracy. The existence of an unimaginable number of digital images and different types of medical information made possible the analysis and training of convolutional neural network (CNN), which consists of multilayers of artificial neural networks (ANN) with step-by-step minimal processing, creating a fundamental resource for any AI-based system to learn by itself how to automatically perform medical tasks, which were performed only by human experts in the past. The main objectives for AI applications used in gastroenterology are to improve the medical procedures with enhanced precision, to reduce the number of medical errors and to perform repetitive tasks.

Background and Aims: Irritable bowel syndrome (IBS) is associated with a high prevalence of psychiatric comorbidities. While psychosocial determinants were intently studied, coping strategies with stress used by IBS patients were never comprehensively reviewed. Therefore, this systematic review aimed to summarize the coping strategies used by IBS patients and to identify which tools are frequently used to measure coping strategies. Methods: According to PRISMA guidelines, we searched for articles indexed in PubMed, EBSCOhost, EMBASE and Cochrane Library. The search terms included: (coping OR coping strategies OR coping mechanism) AND (irritable bowel syndrome OR IBS). The initial search identified 756 articles. After applying all filters (human filters, excluding conference abstracts and conference papers), 96 studies remained. Finally, a total of 21 articles were included in this systematic review. Results: Twenty-one articles using fifteen coping instruments and six measures of quality of life were found. One was interventional, one longitudinal, and the rest were cross-sectional studies. One study was qualitative, while the rest used quantitative measures. Emotion-focused coping was associated with worse psychological outcomes, while the effect of problem-focused coping was not regularly associated with better psychological outcomes. Catastrophizing was negatively associated with health-related quality of life. Psychological distress (anxiety, depression) was significantly related to the impairment of health-related quality of life. Conclusion: Patients with IBS cope in different ways when confronted with health and daily-life stressors. The maladaptive strategy of coping is associated with poor health-related quality of life and psychiatric comorbidities but methodological problems limit conclusions regarding the strength and nature of this association. Future research needs to focus on which strategies are most effective at reducing psychological distress in IBS patients.

Over recent decades, a new antibiotic crisis has been unfolding due to a decreased research in this domain, a low return of investment for the companies that developed the drug, a lengthy and difficult research process, a low success rate for candidate molecules, an increased use of antibiotics in farms and an overall inappropriate use of antibiotics. This has led to a series of pathogens developing antibiotic resistance, which poses severe threats to public health systems while also driving up the costs of hospitalization and treatment. Moreover, without proper action and collaboration between academic and health institutions, a catastrophic trend might develop, with the possibility of returning to a pre-antibiotic era. Nevertheless, new emerging AI-based technologies have started to enter the field of antibiotic and drug development, offering a new perspective to an ever-growing problem. Cheaper and faster research can be achieved through algorithms that identify hit compounds, thereby further accelerating the development of new antibiotics, which represents a vital step in solving the current antibiotic crisis. The aim of this review is to provide an extended overview of the current artificial intelligence-based technologies that are used for antibiotic discovery, together with their technological and economic impact on the industrial sector.

Hyperemesis gravidarum (HG) refers to severe nausea and emesis noted during pregnancy. However, no consensus exists on the specific diagnostic criteria that can be used for this condition. The aim of the present systematic review was to summarize the available evidence regarding the severe complications observed during HG with a heightened risk of fatality. A systematic search was conducted on PubMed, Cochrane Library, EMBASE and WILEY databases for the relevant publications regarding the severe and life-threatening complications of HG. The search terms were as follows: ‘(Hyperemesis gravidarum)’ AND (‘complications’ OR ‘severe’ OR ‘adverse pregnancy outcomes’ OR ‘stroke’ OR ‘seizures’ OR ‘Wernicke's encephalopathy’ OR ‘arrhythmias’ OR ‘pneumomediastinum’ OR ‘coagulopathy’ OR ‘electrolytic imbalance’). Abstracts, conference presentations, letters to the editor, studies written in languages other than English and editorials were all excluded. This search identified 43 studies analyzing life-threatening complications of HG, of which 11, seven, eight and 17 articles analyzed neurological, cardiovascular, thoracic and systemic complications, respectively. Reports on life-threatening complications were exceptionally rare in HG. The most frequent severe complications noted were Wernicke's encephalopathy, electrolyte imbalance and vitamin K deficiency. The low mortality rate for patients with HG over the last decade could be explained by the high efficiency of modern therapy, and the precise management of every complication according to current guidelines.

Background and Aims: The Western diet is rich in saturated fats, refined sugars and meat consistent with a high-energy load and secondary risk of increased metabolic diseases including nonalcoholic fatty liver disease (NAFLD). However, no data are available on potential benefit of vegan diets in NAFLD and/or nonalcoholic steatohepatitis (NASH). We aimed to study prospectively the effect of a vegan diet, excluding all animal products on liver chemistry in a group of consecutive NAFLD patients. Methods: This was a prospective, pilot study run on 40 consecutive patients affected by NAFLD. Eight subjects refused to join the study for poor diet palatability, leaving 32 patients (19 males, mean age 50 years), with abnormal measures of liver function who agreed to adhere to a vegan diet for six months. The caloric intake was tailored by the dietitian to obtain a weight loss ≥5% of body weight in overweight patients [body-mass index (BMI) ≥25] and ranged from 1500 Kcal to 1800 Kcal. Patients were contacted monthly by phone to reinforce diet and lifestyle advice and were seen at the gastrointestinal clinic when doubtful about diet advice. Results: At six-month follow-up, 6 subjects did not attend the clinic leaving only 26 patients for data analysis. Initial anthropometric values were mean weight 78 kg (range 52-95), mean body mass index (BMI) 26.8 Kg/m2 (range 20.3-31.2). Liver function tests showed mean ALT value 99 U/L (SD±45), mean AST value 54 U/L (SD±44), mean GGT value 160 U/L (SD±122), pre-treatment. After six months mean body weight was 73 Kg (range 52-87), mean BMI was 25.2 Kg/m2 (range 20.3-29.7) (p

Crohn’s disease (CD) is a chronic, progressive, and destructive granulomatous inflammatory bowel disorder that can involve any part of the gastrointestinal tract. It has been presumed that different types of diet might improve gastrointestinal symptoms in CD patients. The aim of this review was to clarify the efficiency and indications of a low-“fermentable oligo-, di-, mono-saccharides and polyols” (FODMAP) diet (LFD) in CD and to further analyze the available data on other types of diets. PubMed, Cochrane Library, EMBASE and WILEY databases were screened for relevant publications regarding the effect of FODMAP diets on CD. Our search identified 12 articles analyzing the effect of an LFD in CD, 5 articles analyzing the effect of a Mediterranean diet (MD), 2 articles analyzing the effect of a vegetarian diet (VD), and 2 articles analyzing the effect of a low-lactose diet (LLD). The majority of the studies included in this review show the significant efficiency of the LFD in CD patients. We found significant evidence demonstrating that the LFD has a favorable impact on gastrointestinal symptoms in CD patients. Notwithstanding the evidence, it remains to be established if an LFD is more efficient than other types of diets in the short term and especially in the long term.

Prompt diagnosis in the emergency department in the case of a patient with emesis may be difficult due to the increasing prevalence of diseases which manifest with emesis. Furthermore, in the case of chronic symptomatology, management and therapy are even more complicated. One episode of emesis rarely causes complications, but severe or repetitive episodes of emesis can cause life-threatening complications. For this reason, the diagnosis of the underlying disease which manifests with emesis is mandatory to be established in a short time in order to choose the correct therapeutic option. In order to systemize the process of diagnosis, this clinical narrative review will discuss only rare causes of emesis.

Irritable Bowel Syndrome (IBS) is the most prevalent functional gastrointestinal disorder. Psychosocial stress is one of the pathogenic factors involved in the pathogenesis of IBS. The Pressure Management Indicator (PMI) is a validated questionnaire to analyze all aspects of occupational stress—a model involving sources of pressure, the mechanisms of coping, the personality, and the resulting effects of the interaction between these 3 elements. The purpose of this study was to analyze the association between socio-professional stress effects in IBS, and the relationship of IL-6 levels and salivary cortisol with occupational stress. We conducted a prospective cross-sectional study on 76 patients (39 patients with IBS, diagnosed according to the Rome III criteria and 37 healthy controls) who were investigated using a validated self-administered questionnaire: PMI. The biologic markers of chronic stress were analyzed using salivary cortisol and the immune response with serum interleukin 6 (IL-6). The IBS patients corresponded to the following subtypes: diarrhea-predominant: 22, constipation-predominant: 14 and mixed: 3. All the socio-professional pressure effects variables and scales were statistically significant, in an inversely proportional relation with IBS. Lower scores (poor effects) were found in IBS subjects. The adjusted odds ratios of having IBS versus healthy subjects for the socio-professional pressure effects scales were: 0.81 (95% confidence interval (CI) 0.72–0.88), for satisfaction, 0.85 (95% CI 0.78–0.91) for organization, 0.85 (95% CI 0.79–0.91) for mental wellbeing and 0.8 (95% CI 0.71–0.87) for physical wellbeing (P