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Gastroenterologists encounter many nutrition-related disorders in their practice, yet the nutritional needs of patients with chronic gastrointestinal (GI) and liver disease are largely unaddressed by treating physicians, due to suboptimal nutrition education. To address this gap, we developed and piloted a culinary medicine course for a GI fellowship training program. The objective of this study is to describe the development, implementation, and acceptability of the course. A registered dietitian, a chef instructor, and a gastroenterology clinical professor trained in culinary medicine developed the four-class tailored curriculum and delivered the classes remotely. Each class had a theme related to commonly encountered GI disorders and included hands-on meal preparation, a nutrition lecture, and a patient case study discussion. Post-course feedback surveys were disseminated. Twenty-three GI physicians enrolled in the course and the attendance rates in classes 1-4 were 83%, 65%, 61%, and 48%, respectively. Among 15 completed feedback surveys, 80% reported that the class contents were either moderately or extremely useful and all endorsed the curriculum for other gastroenterologists. Future studies of culinary medicine programs tailored to medical specialties should identify strategies to maintain engagement and assess the impact on nutrition knowledge, competencies, and translation of these new skills to clinical practice.

Bile acids (BAs) affect the intestinal environment by ensuring barrier integrity, maintaining microbiota balance, regulating epithelium turnover, and modulating the immune system. As a master regulator of BA homeostasis, farnesoid X receptor (FXR) is severely compromised in patients with inflammatory bowel disease (IBD) and colitis-associated colorectal cancer (CAC). At the front line, gut macrophages react to the microbiota and metabolites that breach the epithelium. We aim to study the role of the BA/FXR axis in macrophages. This study demonstrates that inflammation-induced epithelial abnormalities compromised FXR signaling and altered BAs' profile in a mouse CAC model. Further, gut macrophage-intrinsic FXR sensed aberrant BAs, leading to pro-inflammatory cytokines' secretion, which promoted intestinal stem cell proliferation. Mechanistically, activation of FXR ameliorated intestinal inflammation and inhibited colitis-associated tumor growth, by regulating gut macrophages' recruitment, polarization, and crosstalk with Th17 cells. However, deletion of FXR in bone marrow or gut macrophages escalated the intestinal inflammation. In summary, our study reveals a distinctive regulatory role of FXR in gut macrophages, suggesting its potential as a therapeutic target for addressing IBD and CAC.

BackgroundElectronic health record (EHR)-based clinical decision support is a scalable way to help standardize clinical care. Clinical decision support systems have not been extensively investigated in cirrhosis management. Human-centered design (HCD) is an approach that engages with potential users in intervention development. In this study, we applied HCD to design the features and interface for a clinical decision support system for cirrhosis management, called CirrhosisRx.MethodsWe conducted technical feasibility assessments to construct a visual blueprint that outlines the basic features of the interface. We then convened collaborative-design workshops with generalist and specialist clinicians. We elicited current workflows for cirrhosis management, assessed gaps in existing EHR systems, evaluated potential features, and refined the design prototype for CirrhosisRx. At the conclusion of each workshop, we analyzed recordings and transcripts.ResultsWorkshop feedback showed that the aggregation of relevant clinical data into 6 cirrhosis decompensation domains (defined as common inpatient clinical scenarios) was the most important feature. Automatic inference of clinical events from EHR data, such as gastrointestinal bleeding from hemoglobin changes, was not accepted due to accuracy concerns. Visualizations for risk stratification scores were deemed not necessary. Lastly, the HCD co-design workshops allowed us to identify the target user population (generalists).ConclusionsThis is one of the first applications of HCD to design the features and interface for an electronic intervention for cirrhosis management. The HCD process altered features, modified the design interface, and likely improved CirrhosisRx's overall usability. The finalized design for CirrhosisRx proceeded to development and production and will be tested for effectiveness in a pragmatic randomized controlled trial. This work provides a model for the creation of other EHR-based interventions in hepatology care.

Abstract Background Functional constipation (FC) in children is a common gastrointestinal disorder with a worldwide-pooled prevalence of 9.5%. Complaints include infrequent bowel movements, painful defecation due to hard and/or large stools, faecal incontinence, and abdominal pain. Prebiotic oligosaccharides have been shown to relieve constipation symptoms in young adults and elderly. However, sufficient evidence is lacking linking additional prebiotic intake to improve symptoms in children with FC. We hypothesise that prebiotic oligosaccharides are able to relieve symptoms of constipation in young children as well. Methods In the present randomised, double-blind, placebo-controlled, multi-centre study, we will study the effects of two prebiotic oligosaccharides in comparison to placebo on constipation symptoms in children of 1–5 years (12 to 72 months) of age diagnosed with FC according to the Rome IV criteria for functional gastrointestinal disorders. The primary outcome measure will be change in stool consistency. Secondary outcomes include stool frequency and stool consistency in a number of cases (%). Tertiary outcomes include among others painful defecation, use of rescue medication, and quality of life. In addition, the impact on gut microbiome outcomes such as faecal microbiota composition and metabolites will be investigated. Participants start with a run-in period, after which they will receive supplements delivered in tins with scoops for 8 weeks, containing one of the two prebiotic oligosaccharides or placebo, followed by a 4-week wash-out period. Discussion This randomised double-blind, placebo-controlled multi-centre study will investigate the effectiveness of prebiotic oligosaccharides in children aged 1–5 years with FC. Trial registration ClinicalTrials.gov NCT04282551. Registered on 24 February 2020.

Background: The prevalence of dyspepsia in general practice consultations ranges from 4% to 5%, whereas it accounts for approximately 20–40% of consultations in the field of gastroenterology. Aims and Objectives: This study was carried out with the objective of estimating the percentage of Helicobacter pylori-infected people who havedyspepsia and exploring the relationship between infection and clinical manifestation. Materials and Methods: This was a hospital-based observational study conducted at a tertiary care teaching health-care facility from January 2023 to June 2023. All 50 patients with symptoms of dyspepsia were included in the study with the help of non-probability purposive sampling after their written and informed consent. A pre-designed and pre-tested structured pro forma was used to collect detailed history, clinical findings, and endoscopic findings from patients with dyspepsia. Gastritis and ulceration characteristics were observed by endoscopy, while histopathological examination (HPE) and rapid urease test (RUT) (for confirmation of H. pylori) were performed on endoscopy-obtained biopsy specimens. Results: Mean age of the patients was 46.69±15.78 with 65.4% (n=34) being males. The sample was classified into cases positive for H. pylori (13; 25%) and cases negative for H. pylori (39; 75%), according to the RUT outcome, 21.20% (n=11) had a history of smoking, 25% (n=13) had Type II DM, and 25% of patients presented with upper abdominal bloating and epigastric pain. On endoscopy, the majority of patients revealed grade III (n=22, 42.30%) gastritis and no ulceration (n=29, 55.80%), with the maximum showing a chronic non-specific lesion (n=20, 38.5%) on HPE. Comorbidities (χ2=12.56, P=0.028), endoscopic findings (χ2=10.50, P=0.032), and ulcerations (χ2=20.02, P

The aim of review. To analyze reports and publications devoted to radiological methods at investigation and treatment of gastroenterological patients and to acquaint gastroenterologists, radiologists, doctors of other specialties with potential of these methods.Summary. Modern concepts of radiological methods of investigation and their application at detection and differential diagnostics of gastroenterological diseases are presented. Significant input of radiological methods to assessment of treatment approach at therapeutic and surgical pathology of digestive system, necessity of utilization of radiological methods at noninvasive medical manipulations, classical surgical interventions, long-term monitoring by patients is shown.Conclusion. Expansion of range of issues solved by radiological methods at investigation of patients with digestive diseases is marked. Priority of noninvasive ways of diagnostics is indicated.

Summary: Background: Telehealth is a growing model of care, greatly accelerated with the demands of the COVID‐19 pandemic. Telecare is a synchronous audio‐visual or audio‐only format of health delivery. Aims: To evaluate the existing literature on telecare within adult gastroenterology subspecialties to determine if outcomes are comparable to traditional in‐person consultations and to highlight the Pokapū Network, a local initiative in the Lakes Region of New Zealand, amongst these international findings. Methods: We completed an OVID MEDLINE search using the terms gastroenterology, endoscopy, digestive system, inflammatory bowel disease, functional, hepatology, liver, telemedicine, telehealth, videoconferencing, remote consultation, video clinic and telephone clinic. Results: Patients showed positive attitudes towards telecare and, in several reports, would elect to have telecare consults in the future. Telecare reduces travel time and out‐of‐pocket costs for patients and the need for patients to take time off work. Generally, patients engaging with telecare show equivalent health outcomes to patients engaging with traditional models of care. Patients from ethnic minority groups or lower socio‐economic backgrounds, or who are older, are less likely to complete a 'successful' telecare consult. Conclusion: Telecare is a useful model of care to allow gastroenterology centres to function within the context of COVID‐19 isolation and beyond. It has significant benefits for patients who face geographical and financial barriers to accessing healthcare. Telecare models such as the Pokapū Network hold promise in reducing inequities for gastroenterology patients. Such models must be introduced with consideration of digital disparities that exist amongst patients to avoid worsening the digital divide. [ABSTRACT FROM AUTHOR]

Objective: The DSM‐5 classification introduced new Feeding and Eating Disorders (FED) diagnostic categories, notably Avoidant and Restrictive Food Intake Disorder (ARFID), which, like other FED, can present psychiatric and gastrointestinal symptoms. However, paediatric clinical research that focuses on children below the age of 12 years remains scarce. The aim of this study was first to investigate the clinical features of FED in a cohort of children, second to compare them according to their recruitment (gastroenterology or psychiatry unit). Method: This non‐interventional retrospective cohort study analysed 191 patients in a French paediatric tertiary care centre (gastroenterology n = 100, psychiatry n = 91). The main outcome variables were clinical data (type of FED, BMI, nutritional support, chronic diseases, psychiatric comorbidities, sensory, sleep, language disorders, gastrointestinal complaints, adverse life events, family history). The outcome was defined by a Clinical Global Impression of Change‐score. Results: FED diagnoses were ARFID (n = 100), Unspecified FED (UFED, n = 57), anorexia nervosa (AN, n = 33) and one pica/rumination. Mean follow‐up was 3.28 years (SD 1.91). ARFID was associated with selective and sensory disorders (p < 0.001); they had more anxiety disorders than patients with UFED (p < 0.001). Patients with UFED had more chewing difficulties, language disorder (p < 0.001), and more FED related to chronic disease (p < 0.05) than patients with ARFID and AN. Patients with AN were female, underweight, referred exclusively to the psychiatrist, and had more depression than patients with ARFID and UFED (p < 0.001). The gastroenterology cohort included more UFED, while the psychiatry cohort included more psychiatric comorbidities (p < 0.001). A worse clinical outcome was associated with ARFID, a younger age at onset (p < 0.001), selective/sensory disorders and nutritional support (p < 0.05). Conclusion: ARFID and UFED children were diagnosed either by gastroenterologists or psychiatrists. Due to frequently associated somatic and psychiatric comorbidities, children with FED should benefit from a multidisciplinary assessment and care. [ABSTRACT FROM AUTHOR]

Aim Method Results Conclusion To describe the characteristics of patients with chronic hepatitis B (CHB) presenting to a tertiary paediatric hospital in Perth, Western Australia. Review of implementation of previous follow‐up recommendations for the cohort was also undertaken.A retrospective data analysis of all individuals aged between 0 and 17 years presenting to the tertiary children's hospital who were hepatitis B surface antigen (HBsAg) positive over 8 years (2013–2020). Demographic features, clinical progress and follow up are described, including proportion transferred to adult services.Seventy‐four patients were identified to have CHB; mean age at diagnosis 11 years; standard deviation 4 years; 41 (55%) male. Cultural and ethnolinguistic diversity was high; 74% (n = 55) were from refugee‐like backgrounds. Many did not demonstrate English proficiency (23/40; 75%) and 7 (10%) Australian born including 4 patients who were Aboriginal. Most patients (58%) with CHB were in the hepatitis B e antigen‐positive chronic infection phase with no intervention provided. Seventeen children had undergone liver ultrasonography and one underwent liver biopsy; none received antiviral treatment. Follow up was concerning; 28 (38%) had at least one clinic non‐attendance, 24 (32%) lost to follow‐up and interpreter utilisation was poorly documented. Thirty‐nine (53%) were transferred to adult services with only 56% attending follow‐up.CHB burden is higher in those from culturally and ethnolinguistically diverse backgrounds. There is a significant loss to follow‐up and suboptimal transfer to adult services. Improved recall, education and referral processes are necessary to overcome language, socioeconomic and cultural barriers. Although childhood complications are infrequent, longitudinal monitoring is crucial to prevent long‐term complications and adult morbidity. [ABSTRACT FROM AUTHOR]

Background and Aim Methods Results Conclusion Rapidly aging societies have become a major issue worldwide including Japan. This study aimed to elucidate relative changes in the characteristics of inpatients in Japan related to this issue.A total of 23 835 Japanese inpatients treated from 2010 to 2021 were enrolled (2010–2013, period I; 2014–2017, period II; 2018–2021, period III). Changes in clinical features were retrospectively analyzed based on ICD‐10 diagnosis data.The percentage of patients aged over 75 years increased over time (period I, 38.0%; II, 39.5%, III, 41.4%). Emergency admissions comprised 27.5% of all in period I, which increased to 43.2% in period II and again to 44.5% in period III (P < 0.001). In period I, gastrointestinal disease, liver disease, pancreatic‐biliary disease, and other disease types were noted in 47.4%, 29.5%, 19.2%, and 3.9%, respectively, while those values were 44.0%, 18.0%, 33.9%, and 4.1%, respectively, in period III (P < 0.001). The frequency of liver disease decreased by approximately 0.6‐fold from periods I to III, while that of biliary‐pancreatic disease increased by approximately 1.8‐fold during that time. Both percentage and actual numbers of patients with biliary‐pancreatic disease increased during the examined periods. Analysis of changes in the proportion of organs affected by malignancy during periods I, II, and III showed a marked increase in cases of biliary‐pancreatic malignancy (11.6%, 19.5%, 26.6%, respectively) (P < 0.001).In association with the rapidly aging Japanese society, there has been an increasing frequency of biliary‐pancreatic disease cases requiring hospitalization for treatment in the west Japan region of Shikoku. [ABSTRACT FROM AUTHOR]

Simple Summary: Horse stomach problems are common, with gastric ulcers being the most common. These diseases affect horses' athletic performance and their health. This study evaluated the pH of the stomach of anesthetized horses in dorsal recumbency and also for 24 h after anesthesia, seeking to evaluate the harmful effects of anesthesia on the horse's stomach. It was found that anesthesia and lying positioning did not affect the pH of the stomach, which remained acidic. After waking from anesthesia, the pH became slightly basic, as with the pH of the stomach of non-anesthetized horses, whether fed or not. It was concluded that there is no need for protective measures prior to an anesthetic procedure in horses. The prevalence of gastric disorders in high-performance horses, especially gastric ulceration, ranges from 50 to 90%. These pathological conditions have negative impacts on athletic performance and health. This study was designed to evaluate changes in gastric pH during a 24 h period and to compare gastrin concentrations at different time points in horses undergoing general inhalation anesthesia and dorsal recumbency. Twenty-two mixed-breed mares weighing 400 ± 50 kg and aged 8 ± 2 years were used. Of these, eight were fasted for 8 h and submitted to 90 min of general inhalation anesthesia in dorsal recumbency. Gastric juice samples were collected prior to anesthesia (T0), and then at 15 min intervals during anesthesia (T15–T90). After recovery from anesthesia (45 ± 1 min), samples were collected every hour for 24 h (T1 to T24) for gastric juice pH measurement. During this period, mares had free access to Bermuda grass hay and water and were fed a commercial concentrate twice (T4 and T16). In a second group (control), four non-anesthetized mares were submitted to 8 h of fasting followed by nasogastric intubation. Gastric juice samples were then collected at T0, T15, T30, T45, T60, T75, and T90. During this period, mares did not receive food or water. After 45 min, mares had free access to Bermuda grass hay and water, and gastric juice samples were collected every hour for four hours (T1 to T4). In a third group comprising ten non-fasted, non-anesthetized mares with free access to Bermuda grass hay and water, gastric juice samples were collected 30 min after concentrate intake (T0). In anesthetized mares, blood gastrin levels were measured prior to anesthesia (8 h fasting; baseline), during recovery from anesthesia, and 4 months after the anesthetic procedure, 90 min after the morning meal. Mean values of gastric juice pH remained acidic during general anesthesia. Mean pH values were within the physiological range (4.52 ± 1.69) and did not differ significantly between time points (T15–T90; p  >  0.05). After recovery from anesthesia, mean gastric pH values increased and remained in the alkaline range throughout the 24 h period of evaluation. Significant differences were observed between T0 (4.88 ± 2.38), T5 (7.08 ± 0.89), T8 (7.43 ± 0.22), T9 (7.28 ± 0.36), T11 (7.26 ± 0.71), T13 (6.74 ± 0.90), and T17 (6.94 ± 1.04) (p  <  0.05). The mean gastric juice pH ranged from weakly acidic to neutral or weakly alkaline in all groups, regardless of food and water intake (i.e., in the fasted, non-fasted, and fed states). Mean gastric pH measured in the control group did not differ from values measured during the 24 h post-anesthesia period or in the non-fasted group. Gastrin concentrations increased significantly during the post-anesthetic period compared to baseline (20.15 ± 7.65 pg/mL and 15.15 ± 3.82 pg/mL respectively; p  <  0.05). General inhalation anesthesia and dorsal recumbency did not affect gastric juice pH, which remained acidic and within the physiological range. Gastric juice pH was weakly alkaline after recovery from anesthesia and in the fasted and fed states. Serum gastrin levels increased in response to general inhalation anesthesia in dorsal recumbency and were not influenced by fasting. Preventive pharmacological measures are not required in horses submitted to general anesthesia and dorsal recumbency. [ABSTRACT FROM AUTHOR]

Background and Objectives: Diminutive polyps present a unique challenge in colorectal cancer (CRC) prevention strategies. This study aims to assess the characteristics and variables of diminutive polyps in a Romanian cohort, intending to develop a combined resect-and-retrieve or resect-and-discard strategy that reduces the need for an optical diagnosis. Materials and Methods: A prospective cohort study was conducted at two endoscopy centers in Romania from July to December 2021. Adult patients undergoing colonoscopies where polyps were identified and resected were included. Endoscopic procedures employed advanced diagnostic features, including blue-light imaging (BLI) and narrow-band imaging (NBI). Logistic regression analysis was utilized to determine factors impacting the probability of adenomatous polyps with high-grade dysplasia (HGD). Results: A total of 427 patients were included, with a mean age of 59.42 years (±11.19), predominantly male (60.2%). The most common indication for a colonoscopy was lower gastrointestinal symptoms (42.6%), followed by screening (28.8%). Adequate bowel preparation was achieved in 87.8% of cases. The logistic regression analysis revealed significant predictors of HGD in adenomatous polyps: age (OR = 1.05, 95% CI: 1.01–1.08, p = 0.01) and polyp size (>5 mm vs. ≤5 mm, OR = 4.4, 95% CI: 1.94–10.06, p < 0.001). Polyps classified as Paris IIa, Ip, and Isp were significantly more likely to harbor HGD compared to the reference group (Is), with odds ratios of 6.05, 3.68, and 2.7, respectively. Conclusions: The study elucidates significant associations between the presence of HGD in adenomatous polyps and factors such as age, polyp size, and Paris classification. These findings support the feasibility of a tailored approach in the resect-and-discard and resect-and-retrieve strategies for diminutive polyps, potentially optimizing CRC prevention and intervention practices. Further research is warranted to validate these strategies in broader clinical settings. [ABSTRACT FROM AUTHOR]

Background: Since the COVID-19 pandemic in 2020, virtual interviews have become a norm for gastroenterology (GI) fellowship recruitment. Most interviews hold a session for applicant and current fellow interaction. There is wide variability of the sessions across programs. There are a paucity of data on the influence of these sessions on applicants' ranking of programs. Aims: We aim to describe applicants' experiences and perceptions of virtual happy hours (i.e., applicant-fellow sessions) during the GI fellowship application process. Methods: We surveyed applicants participating in the 2022 GI fellowship match cycle to understand their experience with virtual fellow-only happy hours. Mixed methods analyses were performed. Results: The survey was completed by 68 (13.91%) applicants, of which, 75% reported that at least half of the interviews they attended had conducted a virtual, fellow-only happy hour. Most respondents preferred that the virtual happy hours should be conducted prior to the interview day (58%) and that breakout rooms with a smaller ratio of applicants to fellows are helpful (78%). The majority (87%) of respondents reported attending these sessions at least 75% of the time. Nearly half (44%) of respondents reported that these sessions influenced/altered their ranking decisions with respect to programs. Conclusion: Given the advantages associated with virtual interviews and their ongoing support by professional societies, the virtual platform is likely here to stay in future. Virtual fellow-only happy hours help provide a representation of the program's mission and when successfully implemented, can be leveraged to optimize recruitment and attract qualified, diverse candidates. [ABSTRACT FROM AUTHOR]

Background: The prevalence of dyspepsia in general practice consultations ranges from 4% to 5%, whereas it accounts for approximately 20-40% of consultations in the field of gastroenterology. Aims and Objectives: This study was carried out with the objective of estimating the percentage of Helicobacter pylori-infected people who have dyspepsia and exploring the relationship between infection and clinical manifestation. Materials and Methods: This was a hospital-based observational study conducted at a tertiary care teaching health-care facility from January 2023 to June 2023. All 50 patients with symptoms of dyspepsia were included in the study with the help of non-probability purposive sampling after their written and informed consent. A pre-designed and pre-tested structured pro forma was used to collect detailed history, clinical findings, and endoscopic findings from patients with dyspepsia. Gastritis and ulceration characteristics were observed by endoscopy, while histopathological examination (HPE) and rapid urease test (RUT) (for confirmation of H. pylori) were performed on endoscopy-obtained biopsy specimens. Results: Mean age of the patients was 46.69±15.78 with 65.4% (n=34) being males. The sample was classified into cases positive for H. pylori (13; 25%) and cases negative for H. pylori (39; 75%), according to the RUT outcome, 21.20% (n=11) had a history of smoking, 25% (n=13) had Type II DM, and 25% of patients presented with upper abdominal bloating and epigastric pain. On endoscopy, the majority of patients revealed grade III (n=22, 42.30%) gastritis and no ulceration (n=29, 55.80%), with the maximum showing a chronic non-specific lesion (n=20, 38.5%) on HPE. Comorbidities (Χ²=12.56, P=0.028), endoscopic findings (Χ²=10.50, P=0.032), and ulcerations (Χ²=20.02, P<0.001) were the significant findings associated with H. pylori infection. Conclusion: The timely identification and expeditious management of H. pylori infection are imperative to mitigate the occurrence of severe complications. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Until recently, the Centers of Medicare and Medicaid were restricted from negotiating drug cost. We assessed the potential impact of alternative drug sourcing models on Medicare Part D spending. METHODS: Twenty-seven drugs were extracted from 2021 Medicare Part D claims. Drug-specific/total spending was compared against cost at Mark Cuban Cost Plus Drugs Company, Costco Member Prescription Program, and Veterans Health Administration price point. RESULTS: Potential Part D savings were $798.99 million, $573.84 million, and $1.02 billion (Mark Cuban Cost Plus Drugs Company, Costco Member Prescription Program, and Veterans Health Administration, respectively). DISCUSSION: Disproportionate PartDspending likely reflects less competitive acquisition cost. Provider awareness of medications with advantaged price may promote targeted prescribing with potentially tremendous health care savings. [ABSTRACT FROM AUTHOR]

This article provides practical advice for gastroenterologists on optimizing care for patients with alcohol-associated liver disease (ALD) and alcohol use disorder (AUD). It emphasizes the importance of addressing AUD in patients with ALD and suggests implementing alcohol screening, brief interventions, and referral to treatment. The article also discusses the use of pharmacotherapy and psychotherapy for AUD treatment, including the caution needed when using Naltrexone in patients with liver disease. It concludes by providing resources for locating AUD treatment and highlighting the role of gastroenterologists in providing education, counseling, and referrals for at-risk patients. [Extracted from the article]

Objectives: The health‐care sector contributes 4.6% of global greenhouse gas emissions, with gastroenterology playing a significant role due to the widespread use of gastrointestinal (GI) endoscopy. In this review, we aim to understand the carbon footprint in gastroenterology practice associated with GI endoscopy, conferences and recruitment, identify barriers to change, and recommend mitigating strategies. Methods: A comprehensive search of PubMed, Embase, and the Cochrane Library was conducted to explore the carbon footprint in gastroenterology practice, focusing on endoscopy, inpatient and outpatient settings, and recruitment practices. Recommendations for mitigating the carbon footprint were derived. Results: This narrative review analyzed 34 articles on the carbon footprint in gastroenterology practice. Carbon footprint of endoscopy in the United States is approximately 85,768 metric tons of CO2 emission annually, equivalent to 9 million gallons of gasoline consumed, or 94 million pounds of coal burned. Each endoscopy generates 2.1 kg of disposable waste (46 L volume), of which 64% of waste goes to the landfill, 28% represents biohazard waste, and 9% is recycled. The per‐case manufacturing carbon footprint for single‐use devices and reusable devices is 1.37 kg CO2 and 0.0017 kg CO2, respectively. Inpatient and outpatient services contributed through unnecessary procedures, prolonged hospital stays, and excessive use of single‐use items. Fellowship recruitment and gastrointestinal conferences added to the footprint, mainly due to air travel and hotel stays. Conclusion: Gastrointestinal endoscopy and practice contribute to the carbon footprint through the use of disposables such as single‐use endoscopes and waste generation. To achieve environmental sustainability, measures such as promoting reusable endoscopy equipment over single‐use endoscopes, calculating institutional carbon footprints, establishing benchmarking standards, and embracing virtual platforms such as telemedicine and research meetings should be implemented. [ABSTRACT FROM AUTHOR]

Fewer adenomas are detected at colonoscopy in women compared to men and failure to detect adenomas and sessile serrated polyps is associated with an increased risk of post-colonoscopy colorectal cancer. The aim of this study was to investigate whether this was in part due to the greater difficulty of conducting colonoscopy in women, with the difference being more apparent in colonoscopies conducted by less skilled endoscopists. Cross-sectional exploratory analysis of data on 16,551 individuals undergoing a primary colonoscopy (PCOL group) or colonoscopy after positive faecal immunochemical test (FIT group) within the randomized controlled trial SCREESCO. Endoscopist adenoma detection rate (ADR; low or high) was determined based on each endoscopist's colonoscopies performed in SCREESCO. In each study group, the relationship between the sex difference in colonoscopy outcome and endoscopist ADR was assessed using multiplicative interaction tests. Endoscopists performed equally many colonoscopies in men and women (median 52% men). There were no signs of effect modification of the risk ratio of any finding (men vs women) by endoscopist ADR in the PCOL group (p = 0.33) or the FIT group (p = 0.30). The proportion of incomplete index colonoscopies was lower in men than in women in both groups and there was no effect modification by endoscopist ADR in either the PCOL group (p = 0.41) or the FIT group (p = 0.96). This study provides no evidence that endoscopist skill measured by ADR underlies the sex difference in adenoma detection at colonoscopy. This study has trial number NCT02078804 and is registered with ClinicalTrials.gov. [ABSTRACT FROM AUTHOR]

Background The field of radiology relies on accurate interpretation of medical images for effective diagnosis and patient care. Recent advancements in artificial intelligence (AI) and natural language processing have sparked interest in exploring the potential of AI models in assisting radiologists. However, limited research has been conducted to assess the performance of AI models in radiology case interpretation, particularly in comparison to human experts. Objective This study aimed to evaluate the performance of ChatGPT, Google Bard, and Bing in solving radiology case vignettes (Fellowship of the Royal College of Radiologists 2A [FRCR2A] examination style questions) by comparing their responses to those provided by two radiology residents. Methods A total of 120 multiple-choice questions based on radiology case vignettes were formulated according to the pattern of FRCR2A examination. The questions were presented to ChatGPT, Google Bard, and Bing. Two residents wrote the examination with the same questions in 3 hours. The responses generated by the AI models were collected and compared to the answer keys and explanation of the answers was rated by the two radiologists. A cutoff of 60% was set as the passing score. Results The two residents (63.33 and 57.5%) outperformed the three AI models: Bard (44.17%), Bing (53.33%), and ChatGPT (45%), but only one resident passed the examination. The response patterns among the five respondents were significantly different (p = 0.0117). In addition, the agreement among the generative AI models was significant (intraclass correlation coefficient [ICC] = 0.628), but there was no agreement between the residents (Kappa = –0.376). The explanation of generative AI models in support of answer was 44.72% accurate. Conclusion Humans exhibited superior accuracy compared to the AI models, showcasing a stronger comprehension of the subject matter. All three AI models included in the study could not achieve the minimum percentage needed to pass an FRCR2A examination. However, generative AI models showed significant agreement in their answers where the residents exhibited low agreement, highlighting a lack of consistency in their responses. [ABSTRACT FROM AUTHOR]

Background: Evidence suggests that the low fermentable oligo‐, di‐, mono‐saccharides, and polyols (FODMAP) diet improves irritable bowel syndrome (IBS) symptoms when delivered by a dietitian. However, demand for dietetic appointments exceeds supply. Prerecorded webinars are acceptable and cost‐effective for delivering first‐line IBS dietary advice. Methodology: This study, using a pre–post design, aimed to evaluate the effectiveness of a low‐FODMAP diet restriction phase webinar at improving IBS symptoms. Participants with self‐reported IBS symptoms were asked to report their IBS symptoms, stool frequency, stool consistency and IBS medication use, before and 8 weeks postwebinar via an online questionnaire. The presence and severity of participants' symptoms and bowel habits were captured using validated tools and a global symptom question. Results: In total 228 participants responded to both pre‐ and postsurveys. A statistically significant improvement in all symptoms was observed 8 weeks postwebinar (p < 0.05). The proportion of participants rating their overall symptoms as moderate‐to‐severe reduced from 85.5% at baseline to 34.6% postwebinar (50.9% reduction [p < 0.001]). The proportion of participants reporting normal stool consistency and frequency significantly increased postwebinar (23.2%–39.9% [p < 0.001] and 76.3%–89% [p < 0.001], respectively). Satisfactory relief of symptoms increased from 16.7% to 53.1%, (p < 0.001) 8 weeks postwebinar. Conclusions: These results are comparable with literature on the efficacy of face‐to‐face delivery of low‐FODMAP diet education. Dietitians should consider directing triaged patients with IBS, who have tried first‐line dietary advice, to this webinar as an alternative or alongside current practice. Key points: The low fermentable oligo‐, di‐, mono‐saccharides, and polyols (FODMAP) diet has been shown to be effective in alleviating symptoms of irritable bowel syndrome (IBS) when administered by a dietitian. However, demand for dietetic appointments currently exceeds capacity.Prerecorded webinars have been shown to be a cost‐effective and acceptable method for delivering first‐line IBS dietary advice in previous research.This study aimed to evaluate the effectiveness of a dietitian‐developed low‐FODMAP diet webinar in improving IBS symptoms. Participants with self‐reported IBS symptoms (n = 228) completed online questionnaires before and 8 weeks after viewing the webinar.There was a statistically significant improvement across all IBS symptoms (p < 0.05) 8 weeks postwebinar.The proportion of participants rating their overall symptoms as moderate‐to‐severe reduced from 85.5% at baseline to 34.6% postwebinar (50.9% reduction [p < 0.001]).The proportion of participants reporting normal stool consistency and frequency significantly increased postwebinar (23.2%–39.9% (p < 0.001) and 76.3%–89% (p < 0.001).Satisfactory relief of symptoms increased from 16.7% to 53.1%, (p < 0.001) 8 weeks postwebinar.These findings align with previous research on the efficacy of face‐to‐face dietitian delivery of low‐FODMAP diet education, and the use of prerecorded webinars supports the objectives of the long‐term plan of the NHS to digitise healthcare and reduce the number of outpatient appointments.Dietitians should consider signposting triaged patients with IBS to the low‐FODMAP diet webinar as an alternative or to supplement current practice.Long‐term follow‐up of this cohort will be explored in future research to determine how long participants experienced satisfactory relief from symptoms. [ABSTRACT FROM AUTHOR]

Gelatin capsules deliver their contents to the stomach, while delayed‐release (DR) capsules are designed to allow delivery to the small intestine. This study evaluated the gastrointestinal release site of DR capsules in six healthy adult dogs compared to gelatin capsules. Both gelatin and DR capsules were filled with barium‐impregnated polyethylene spheres (BIPS™), and following enteral administration, release site was assessed using abdominal radiographs at baseline, immediately after ingestion, 15 min post‐ingestion, 30 min post‐ingestion, and then every 30 min thereafter. The evaluated phases included fasted conditions (phase 1, n = 6), increased meal size (phase 2, n = 2), double encapsulation (phase 3, n = 2), and altered capsule size (phase 4, n = 1). The released site was the stomach in all phases for both capsule types. In phase 1, DR capsules had a significantly prolonged time (median 60 min, range 60–90) to release BIPS™ compared to gelatin capsules (15 min, range 15–30; p = .03). In phase 2 (full meal size), 3 (double encapsulation), and 4 (smaller capsule size) pilot studies, release time was prolonged but still occurred in the stomach. This is similar to the release site for gelatin capsules but differs from the release site for DR capsules in people. This has implications for pharmacologic outcomes for products that are affected by gastric physiology (e.g. fecal microbiota transplantation). Based on this pilot data, clinicians and researchers should not assume DR capsules will allow for intestinal delivery of contents in dogs. Future studies should be conducted on larger and varied populations of dogs. [ABSTRACT FROM AUTHOR]

Simple Summary: Inflammatory bowel disease (IBD) is a common chronic gastrointestinal disorder in dogs. Hematological ratios, in particular red blood cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR), are considered cost-effective predictors of clinical disease activity in human patients with IBD and Crohn's disease. This study evaluated the diagnostic value of hematological parameters and ratios in 85 client-owned dogs, comparing 60 dogs with IBD to 25 clinically healthy dogs. Monocytes count and the hematological ratios MLR, NLR, and PLR can be useful in the diagnostic work-up of dogs with IBD. This is an observational retrospective study on 85 client-owned dogs, 60 with IBD and 25 clinically healthy dogs. This study aims to assess the clinical relevance of some easy to obtain and cost-effective hematological parameters including red blood cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) in dogs with IBD. Comparison of clinical and laboratory parameters between dogs with IBD and control dogs was carried out and the ability to distinguish between these two groups of dogs was evaluated by calculating the area under the receiver-operating characteristic curve (AUCROC). Univariate and multivariable logistic regression analysis estimated the odds ratio (OR) of developing IBD with a 95% confidence interval (CI). MLR and monocytes count had the highest accuracy in facilitating the discrimination of dogs with IBD from control dogs with an AUCROC of 0.839 and 0.787 at the cut-off of >0.14% and >3.7 cells*102/µL, respectively. According to two multivariable models, monocytes count (OR = 1.29; p = 0.016), NLR (OR = 1.80; p = 0.016), and MLR > 0.14 (OR = 8.07; p < 0.001) and PLR > 131.6 (OR = 4.35; p = 0.024) were significant and independent predictors of IBD for models one and two, respectively. Monocytes count and the hematological ratios MLR, NLR, and PLR can be useful in the diagnostic work-up of dogs with IBD. [ABSTRACT FROM AUTHOR]

Background: Minimal hepatic encephalopathy (MHE) is the mildest form of hepatic encephalopathy. One of the neuropsychological tests that detects MHE is the Stroop test (via EncephalApp). The aim was to evaluate the Stroop test for the screening and diagnosis of MHE. Methods: This prospective case–control study was performed at the Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, and included patients with cirrhosis and MHE and healthy controls. In all patients, the presence of MHE was confirmed using the animal naming test. The Stroop test was performed on each participant, and the results were compared between the two groups. The test has two components, the "OFF" and "ON" states. Results: A total of 111 participants were included. The median OFF time did not differ between the two groups, 106.3 and 91.4, p > 0.05. However, in patients with MHE, the median values of ON time and total time were significantly higher, with 122.3 vs. 105.3 and 228.0 vs. 195.6, respectively, p < 0.05. Statistical significance between patients and controls in examined parameters was detected in younger participants and the group with higher educational levels. Conclusions: The Stroop test displayed limited sensitivity in Serbian patients. Age and education affect time measurements and test performance. [ABSTRACT FROM AUTHOR]

Amidst the obesity and type II diabetes mellitus (T2DM) epidemics, glucagon-like peptide-1 receptor agonists (GLP-1RAs) stand out as a promising therapeutic ally, achieving notable success in glycemic control and weight management. While GLP-1RAs' positive clinical outcomes are commendable, they introduce significant gastrointestinal (GI) challenges, emphasizing the pivotal role of gastroenterologists in understanding and managing these implications. Physicians should be vigilant of potential complications if endoscopy is indicated and considered. A protocol coined "The Three E's: Education, Escalation, and Effective Management" is essential as the first defense against GLP-1RA-induced dyspepsia, necessitating routine GI consultations. Awareness and intervention of potential aspiration due to GLP-1RA-induced gastroparesis are vital in clinical management. Furthermore, the evolving recognition of GLP-1RAs' beneficial effects on non-alcoholic steatohepatitis (NASH) suggests gastroenterologists will increasingly prescribe them. Thus, a comprehensive understanding of pharmacological properties and potential GI complications, including the undetermined cancer risk landscape, becomes paramount. This review accentuates the nuances of GLP-1RA therapy from a gastroenterological lens, juxtaposing the therapeutic potential, manageable side effects, and circumstantial challenges, ensuring that GI specialists remain at the forefront of holistic care in obesity and T2DM management. [ABSTRACT FROM AUTHOR]

The quality of upper gastrointestinal endoscopy (EGD) is crucial and carries significant consequences for patient outcomes, the employment of healthcare resources, and the future course of gastroenterology as a medical specialty. In this review, we navigate through the terrain of the Quality Indicators (QIs) for EGD, shedding light on their indispensable function in ensuring and augmenting the quality of patient care throughout the pre-procedural, intra-procedural, post-procedural, and outcome-oriented facets of the practice. We delve into the comprehensive scope of the QIs and the challenges impeding the delivery of high-quality EGD, from variability in practitioner training and patient compliance to the systemic limitations of current QIs and the barriers hindering the adoption of advanced techniques. Future directions for bolstering the quality of EGD are highlighted, encapsulating the integration of emergent endoscopic technologies, the evolution of patient-centered metrics, the refinement of endoscopist training and credentialing processes, and the promise held by Artificial Intelligence (AI). Particular emphasis is placed on the role of advanced endoscopic techniques and equipment in enhancing EGD quality. This article presents a cogent narrative, promoting the pursuit of excellence in EGD as an ever-evolving endeavor that necessitates the collective dedication of clinicians, researchers, educators, and policymakers. [ABSTRACT FROM AUTHOR]

Acute pancreatitis (AP), defined as acute inflammation of the pancreas, is one of the most common diseases of the gastrointestinal tract leading to hospital admission in the United States. It is important for clinicians to appreciate that AP is heterogenous, progressing differently among patients and is often unpredictable.While most patients experience symptoms lasting a few days, almost one-fifth of patients will go on to experience complications, including pancreatic necrosis and/or organ failure, at times requiring prolonged hospitalization, intensive care, and radiologic, surgical, and/or endoscopic intervention. Early management is essential to identify and treat patients with AP to prevent complications. Patients with biliary pancreatitis typically will require surgery to prevent recurrent disease and may need early endoscopic retrograde cholangiopancreatography if the disease is complicated by cholangitis. Nutrition plays an important role in treating patients with AP. The safety of early refeeding and importance in preventing complications from AP are addressed. This guideline will provide an evidence-based practical approach to the management of patients with AP. [ABSTRACT FROM AUTHOR]

Aim: To explore patient experiences of intimacy and sexuality in those living with inflammatory bowel disease. Design: An interpretative phenomenological study guided by van Manen's framework. Thematic analysis was conducted through interpretation and reflection on four existential domains: body, relationships, time and space. Methods: Data were collected during 2019-2021 from 43 participants via face-to-face or telephone interviews, as well as anonymous collection of narratives submitted via Google Forms. Results: Four themes were identified: Sexuality as lived incompleteness was the over-arching theme representing the essence of the experiences of intimacy and sexuality. This theme covered the four main themes: Otherness of the body, Interrupted connectedness, Missing out on life fullness and Fragmented openness and each corresponded to an existential domain. Intimacy and sexuality are negatively affected by inflammatory bowel disease, with impact on quality of life. Patients experienced grieving multiple losses, from body image and control, to choice of partners and future opportunities. The four domains were difficult to separate and a close inter-relationship between each domain was acknowledged. Conclusions: A model was developed to draw new theoretical insights to understanding the relationship between sexual well-being and psycho-emotional distress similar to grief. Impact: • First qualitative study to explore intimacy and sexuality experiences of those living with inflammatory bowel disease. • Illness impact on sexuality has negative psycho-emotional implications as a result of losing the old self and capacity to have the desired relationships/sex life. • A theoretical model was developed in an attempt to illustrate the close relationship of intimacy, sexuality and psycho-emotional well-being. Patient or Public Contribution: Patients were involved in the study design. [ABSTRACT FROM AUTHOR]

Abstract Background In the post-pandemic era, a wide range of COVID-19 sequelae is of growing health concern. However, the risks of digestive diseases in long COVID have not been comprehensively understood. To investigate the long-term risk of digestive diseases among COVID patients. Methods In this large-scale retrospective cohort study with up to 2.6 years follow-up (median follow-up: 0.7 years), the COVID-19 group (n = 112,311), the contemporary comparison group (n = 359,671) and the historical comparison group (n = 370,979) predated the COVID-19 outbreak were built using UK Biobank database. Each digestive outcome was defined as the diagnosis 30 days or more after the onset of COVID-19 infection or the index date. Hazard ratios (HRs) and corresponding 95% confidence intervals (CI) were computed utilizing the Cox regression models after inverse probability weighting. Results Compared with the contemporary comparison group, patients with previous COVID-19 infection had higher risks of digestive diseases, including gastrointestinal (GI) dysfunction (HR 1.38 (95% CI 1.26 to 1.51)); peptic ulcer disease (HR 1.23 (1.00 to 1.52)); gastroesophageal reflux disease (GERD) (HR 1.41 (1.30 to 1.53)); gallbladder disease (HR 1.21 (1.06 to 1.38)); severe liver disease (HR 1.35 (1.03 to 1.76)); non-alcoholic liver disease (HR 1.27 (1.09 to 1.47)); and pancreatic disease (HR 1.36 (1.11 to 1.66)). The risks of GERD were increased stepwise with the severity of the acute phase of COVID-19 infection. Even after 1-year follow-up, GERD (HR 1.64 (1.30 to 2.07)) and GI dysfunction (HR 1.35 (1.04 to 1.75)) continued to pose risks to COVID-19 patients. Compared to those with one SARS-CoV-2 infection, reinfected patients were at a higher risk of pancreatic diseases (HR 2.57 (1.23 to 5.38)). The results were consistent when the historical cohort was used as the comparison group. Conclusions Our study provides insights into the association between COVID-19 and the long-term risk of digestive system disorders. COVID-19 patients are at a higher risk of developing digestive diseases. The risks exhibited a stepwise escalation with the severity of COVID-19, were noted in cases of reinfection, and persisted even after 1-year follow-up. This highlights the need to understand the varying risks of digestive outcomes in COVID-19 patients over time, particularly those who experienced reinfection, and develop appropriate follow-up strategies.

Macrophages intimately interact with intestinal epithelial cells, but the consequences of defective macrophage-epithelial cell interactions for protection against enteric pathogens are poorly understood. Here, we show that in mice with a deletion in protein tyrosine phosphatase nonreceptor type 2 (PTPN2) in macrophages, infection with Citrobacter rodentium, a model of enteropathogenic and enterohemorrhagic E. coli infection in humans, promoted a strong type 1/IL-22-driven immune response, culminating in accelerated disease but also faster clearance of the pathogen. In contrast, deletion of PTPN2 specifically in epithelial cells rendered the epithelium unable to upregulate antimicrobial peptides and consequently resulted in a failure to eliminate the infection. The ability of PTPN2-deficient macrophages to induce faster recovery from C. rodentium was dependent on macrophage-intrinsic IL-22 production, which was highly increased in macrophages deficient in PTPN2. Our findings demonstrate the importance of macrophage-mediated factors, and especially macrophage-derived IL-22, for the induction of protective immune responses in the intestinal epithelium, and show that normal PTPN2 expression in the epithelium is crucial to allow for protection against enterohemorrhagic E. coli and other intestinal pathogens.

Since its release as a "research preview" in November 2022, ChatGPT, the conversational interface to the Generative Pretrained Transformer 3 large language model built by OpenAI, has garnered significant publicity for its ability to generate detailed responses to a variety of questions. ChatGPT and other large language models generate sentences and paragraphs in response to word patterns in training data that they have previously seen. By allowing users to communicate with an artificial intelligence model in a human-like way, however, ChatGPT has crossed the technological adoption barrier into the mainstream. Existing examples of ChatGPT use-cases, such as negotiating bills, debugging programing code, and writing essays, indicate that ChatGPT and similar models have the potential to have profound (and yet unknown) impacts on clinical research and practice in hepatology. In this special article, we discuss the general background and potential pitfalls of ChatGPT and associated technologies-and then we explore its uses in hepatology with specific examples.

IntroductionIn the setting of increasing attention to representation in medicine, we aimed to assess current perspectives of racial and ethnic workforce diversity and health care disparities among gastroenterology (GI) and hepatology professionals in the United States.MethodsWe developed and administered a 33-item electronic cross-sectional survey to members of 5 national GI and hepatology societies. Survey items were organized into thematic modules and solicited perspectives on racial and ethnic workforce diversity, health care disparities in GI and hepatology, and potential interventions to enhance workforce diversity and improve health equity.ResultsOf the 1,219 survey participants, 62.3% were male, 48.7% were non-Hispanic White, and 19.9% were from backgrounds underrepresented in medicine. The most frequently reported barriers to increasing racial and ethnic diversity in GI and hepatology were insufficient representation of underrepresented racial and ethnic minority groups in the education and training pipeline (n = 431 [35.4%]), in professional leadership (n = 340 [27.9%]), and among practicing GI and hepatology professionals (n = 324 [26.6%]). Suggested interventions were to increase career mentorship opportunities (n = 545 [44.7%]), medical student opportunities (n = 520 [42.7%]), and program and professional society leadership roles for underrepresented racial and ethnic minority groups (n = 473 [38.8%]).DiscussionOur survey explored imperative and timely perspectives on racial and ethnic representation and health equity among professionals in GI and hepatology. The findings should inform future interventions to address workforce diversity and establish priorities toward improving health equity, ultimately serving as a springboard for professional societies, academic institutions, and other organizations that aim to increase diversity, equity, and inclusion in our field.

Summary: Skeletal muscle may mutually interact with gastrointestinal disease through metabolic homeostasis and nutritional status and therefore may be a marker for early risk detection. We conducted a prospective cohort analysis including 393,606 participants (mean age 56.0 years, 53.9% female) from the UK Biobank. The exposures were grip strength and skeletal muscle mass (SMM). The primary outcomes were 24 incident gastrointestinal diseases. During a mean follow-up of 12.1 years, we found that one sex-specific SD increase in grip strength and SMM were associated with reduced risk of 16 and 19 gastrointestinal diseases, respectively. For grip strength, the HRs ranged from 0.94 (for ulcerative colitis) to 0.80 (for liver cancers). For SMM, the HRs ranged from 0.92 (for colorectal cancer) to 0.51 (for non-alcoholic fatty liver disease). Our finding suggested that grip strength and SMM might be significant indicators for gastrointestinal diseases risk screen.

Eosinophilic gastroenteritis (EGE) is a rare disease which mainly consists of an abnormal eosinophile infiltration of the gastrointestinal tract. It’s classified according to its location: eosinophilic esophagitis, eosinophilic gastritis, eosinophilic enteritis (including duodenum, jejunum and/or ileum) and eosinophilic colitis and degree of infiltration (mucosal, muscular, serosal). Depending on eosinophile concentration, type of EGE and the patient’s condition it may manifest with different clinical presentations such as functional dyspepsia, abdominal pain, irritability, hypoproteinemia, diarrhea, anemia, among others. Few research has been done on such an uncommon pathology to the extent that treatment evidence is mostly limited to small case series. This case study reports an infrequent presentation of EGE in the small and large intestine as an undifferentiated gastrointestinal disease and successful corticoid management given to the patient in order to further broaden knowledge on this subject and facilitate an established clinical conduct for the treating physician.

Summary: Gastrointestinal immune cells, particularly muscularis macrophages (MM) interact with the enteric nervous system and influence gastrointestinal motility. Here we determine the human gastric muscle immunome and its changes in patients with idiopathic gastroparesis (IG). Single cell sequencing was performed on 26,000 CD45+ cells obtained from the gastric tissue of 20 subjects. We demonstrate 11 immune cell clusters with T cells being most abundant followed by myeloid cells. The proportions of cells belonging to the 11 clusters were similar between IG and controls. However, 9/11 clusters showed 578-11,429 differentially expressed genes. In IG, MM had decreased expression of tissue-protective and microglial genes and increased the expression of monocyte trafficking and stromal activating genes. Furthermore, in IG, IL12 mediated JAK-STAT signaling involved in the activation of tissue-resident macrophages and Eph-ephrin signaling involved in monocyte chemotaxis were upregulated. Patients with IG had a greater abundance of monocyte-like cells. These data further link immune dysregulation to the pathophysiology of gastroparesis.

Summary: Background: Advances in microelectronics have greatly expanded the capabilities and clinical potential of ingestible electronic devices. Aim: To provide an overview of the structure and potential impact of ingestible devices in development that are relevant to the gastrointestinal tract. Methods: We performed a detailed literature search to inform this narrative review. Results: Technical success of ingestible electronic devices relies on the ability to miniaturise the microelectronic circuits, sensors and components for interventional functions while being sufficiently powered to fulfil the intended function. These devices offer the advantages of being convenient and minimally invasive, with real‐time assessment often possible and with minimal interference to normal physiology. Safety has not been a limitation, but defining and controlling device location in the gastrointestinal tract remains challenging. The success of capsule endoscopy has buoyed enthusiasm for the concepts, but few ingestible devices have reached clinical practice to date, partly due to the novelty of the information they provide and also due to the challenges of adding this novel technology to established clinical paradigms. Nonetheless, with ongoing technological advancement and as understanding of their potential impact emerges, acceptance of such technology will grow. These devices have the capacity to provide unique insight into gastrointestinal physiology and pathophysiology. Interventional functions, such as sampling of tissue or luminal contents and delivery of therapies, may further enhance their ability to sharpen gastroenterological diagnoses, monitoring and treatment. Conclusions: The development of miniaturised ingestible microelectronic‐based devices offers exciting prospects for enhancing gastroenterological research and the delivery of personalised, point‐of‐care medicine. [ABSTRACT FROM AUTHOR]

This article explores the importance of fostering a diverse, equitable, and inclusive culture in the field of gastroenterology. It identifies two challenges to this culture: microaggressions and impostor phenomenon. Microaggressions are actions that devalue or disrespect individuals or groups, while impostor phenomenon refers to feeling like a fraud despite accomplishments. These issues can lead to burnout, poor mental health, and hinder career advancement. The article emphasizes the need for organizations to address these challenges and offers strategies to mitigate microaggressions and impostor phenomenon in gastroenterology. It also discusses the efforts of the Cleveland Clinic Lerner College of Medicine to address racial justice and racism as a public health crisis, including the implementation of a mandatory workshop on microaggressions for all hospital employees. The goal is to create a culture of inclusion and safety, promoting diverse and equitable workplaces. [Extracted from the article]

Background: The use of proton pump inhibitors (PPIs) has increased over the past decades. One potential gateway into new PPI use is following a hospital admission. The study aimed to examine the incidence of new PPI usage following admission to internal medicine services and the ratio of new persistent users. Methods: A retrospective descriptive study was conducted among all adults who had been admitted to internal medicine wards at the National University Hospital of Iceland from 2010–2020. Data was obtained from the Icelandic Internal Medicine Database. The proportion of patients who started treatment with PPI within 3 months of discharge (new users) and the proportion of patients who continued to use it after 3 months (persistent users) were examined. Results: Among 85.942 admissions during the study period, 7238 (15.6%) became new users, and of those 4942 (68%) were new persistent users. The incidence of new PPI use was highest for patients discharged from gastroenterology (32.2%), hematology (31.8%), and oncology (29.2%). Patients with new PPI use more commonly had a history of malignancy (19.5%) and liver disease (22.7%) and more commonly were admitted to the ICU during their hospitalization. The highest ratio of persistent usage was among patients discharged from geriatric medicine (84%). Conclusion: One in every six patients admitted to internal medicine wards filled out a prescription for PPI within 3 months from discharge, and a large proportion of them became persistent users. The high rate of new PPI users from oncology and hematology is noteworthy and requires further research. [ABSTRACT FROM AUTHOR]

Objective: Artificial intelligence (AI) has gradually found its way into healthcare, and its future integration into clinical practice is inevitable. In the present study, we evaluate the accuracy of a novel AI algorithm designed to predict admission based on a triage note after clinical implementation. This is the first of such studies to investigate real‐time AI performance in the emergency setting. Methods: The novel AI algorithm that predicts admission using a triage note was translated into clinical practice and integrated within St Vincent's Hospital Melbourne's electronic emergency patient management system. The data were collected from 1 January 2021 to 17 August 2022 to evaluate the diagnostic accuracy of the AI system after implementation. Results: A total of 77 125 ED presentations were included. The live AI algorithm has a sensitivity of 73.1% (95% confidence interval 72.5–73.8), specificity of 74.3% (73.9–74.7), positive predictive value of 50% (49.6–50.4) and negative predictive value of 88.7% (88.5–89) with a total accuracy of 74% (73.7–74.3). The accuracy of the system was at the lowest for admission to psychiatric units (34%) and at the highest for gastroenterology and medical admission (84% and 80%, respectively). Conclusion: Our study showed the diagnostic evaluation of a real‐time AI clinical decision‐support tool became less accurate than the original. Although real‐time sensitivity and specificity of the AI tool was still acceptable as a decision‐support tool in the ED, we propose that continuous training and evaluation of AI‐enabled clinical support tools in healthcare are conducted to ensure consistent accuracy and performance to prevent inadvertent consequences. [ABSTRACT FROM AUTHOR]

Background: Faecal microbiota transplantation (FMT) has mainly been studied in quantitative research to investigate effect rates. However, there is a lack of qualitative studies to explore patient perspectives. Aim: To explore perceptions of quality of life in older patients with Clostridioides difficile infection (CDI) at least 1 week after receiving FMT. Method: A qualitative study examining quality of life for patients treated with FMT. Findings: Patients with a permanent or transient treatment effect experienced an increase in quality of life in the physical, psychological and social domains. However, patients who did not respond to the treatment experienced negative impacts on their psychological, physical, and social domains. Although patients found the content unappealing, none had reservations about receiving the treatment. Conclusion: This study highlights the importance of considering the psychological, social and physical wellbeing of patients when assessing the efficacy of FMT as a treatment option for patients with CDI. It further emphasises the importance of health professionals identifying patients' individual ways of handling the disease and everyday life to improve their quality of life [ABSTRACT FROM AUTHOR]

Background: In the post-pandemic era, a wide range of COVID-19 sequelae is of growing health concern. However, the risks of digestive diseases in long COVID have not been comprehensively understood. To investigate the long-term risk of digestive diseases among COVID patients. Methods: In this large-scale retrospective cohort study with up to 2.6 years follow-up (median follow-up: 0.7 years), the COVID-19 group (n = 112,311), the contemporary comparison group (n = 359,671) and the historical comparison group (n = 370,979) predated the COVID-19 outbreak were built using UK Biobank database. Each digestive outcome was defined as the diagnosis 30 days or more after the onset of COVID-19 infection or the index date. Hazard ratios (HRs) and corresponding 95% confidence intervals (CI) were computed utilizing the Cox regression models after inverse probability weighting. Results: Compared with the contemporary comparison group, patients with previous COVID-19 infection had higher risks of digestive diseases, including gastrointestinal (GI) dysfunction (HR 1.38 (95% CI 1.26 to 1.51)); peptic ulcer disease (HR 1.23 (1.00 to 1.52)); gastroesophageal reflux disease (GERD) (HR 1.41 (1.30 to 1.53)); gallbladder disease (HR 1.21 (1.06 to 1.38)); severe liver disease (HR 1.35 (1.03 to 1.76)); non-alcoholic liver disease (HR 1.27 (1.09 to 1.47)); and pancreatic disease (HR 1.36 (1.11 to 1.66)). The risks of GERD were increased stepwise with the severity of the acute phase of COVID-19 infection. Even after 1-year follow-up, GERD (HR 1.64 (1.30 to 2.07)) and GI dysfunction (HR 1.35 (1.04 to 1.75)) continued to pose risks to COVID-19 patients. Compared to those with one SARS-CoV-2 infection, reinfected patients were at a higher risk of pancreatic diseases (HR 2.57 (1.23 to 5.38)). The results were consistent when the historical cohort was used as the comparison group. Conclusions: Our study provides insights into the association between COVID-19 and the long-term risk of digestive system disorders. COVID-19 patients are at a higher risk of developing digestive diseases. The risks exhibited a stepwise escalation with the severity of COVID-19, were noted in cases of reinfection, and persisted even after 1-year follow-up. This highlights the need to understand the varying risks of digestive outcomes in COVID-19 patients over time, particularly those who experienced reinfection, and develop appropriate follow-up strategies. [ABSTRACT FROM AUTHOR]

This article provides an overview of the use of live biotherapeutic products (LBPs) in the field of gastroenterology. LBPs are biological products containing live organisms that can be used for the prevention, treatment, or cure of diseases or conditions in humans. The article focuses on the current clinical trials and research on LBPs for non-Clostridioides difficile infection gastrointestinal indications, such as inflammatory bowel disease and disorders of gut-brain interaction. It also discusses the challenges and potential benefits of LBPs in gastrointestinal disorders. Additionally, the article includes a list of references related to the use of LBPs in various gastrointestinal conditions, providing further resources for research. [Extracted from the article]

This study sought to provide a protocol for searching complex medical cases of grand rounds. A clinical informationist was embedded in gastroenterology grand rounds to use comprehensive search strategies and summarize patients' information through concept mapping. Our proposed protocol classifies into three categories: (1) The general search strategy, (2) The protocol for searching for evidence about rare diseases, and (3) Identifying other resources more than routine medical databases. This approach represents a novel method beyond previous studies which were focused on usual ward rounds to facilitate evidence-based decision-making by providing and simplifying a comprehensive summary view of complex medical cases. [ABSTRACT FROM AUTHOR]

Data are being generated, collected, and aggregated in massive quantities at exponentially increasing rates. This "big data," discussed in depth in the first section of this two-part series, is increasingly important to understand the nuances of the gastrointestinal tract and its complex interactions and networks involving a host of other organ systems and microbes. Creating and using these datasets correctly requires comprehensive training; however, current instruction in the integration, analysis, and interpretation of big data appears to lag far behind data acquisition. While opportunities exist for those interested in acquiring the requisite training, these appear to be underutilized, in part due to widespread ignorance of their existence. Here, to address these gaps in knowledge, we highlight existing big data learning opportunities and propose innovative approaches to attain such training. We offer suggestions at both the undergraduate and graduate medical education levels for prospective clinical and basic investigators. Lastly, we categorize training opportunities that can be selected to fit specific needs and timeframes. [ABSTRACT FROM AUTHOR]

A multitude of federally and industry-funded efforts are underway to generate and collect human, animal, microbial, and other sources of data on an unprecedented scale; the results are commonly referred to as "big data." Often vaguely defined, big data refers to large and complex datasets consisting of myriad datatypes that can be integrated to address complex questions. Big data offers a wealth of information that can be accessed only by those who pose the right questions and have sufficient technical knowhow and analytical skills. The intersection comprised of the gut-brain axis, the intestinal microbiome and multi-ome, and several other interconnected organ systems poses particular challenges and opportunities for those engaged in gastrointestinal and liver research. Unfortunately, there is currently a shortage of clinicians, scientists, and physician-scientists with the training needed to use and analyze big data at the scale necessary for widespread implementation of precision medicine. Here, we review the importance of training in the use of big data, the perils of insufficient training, and potential solutions that exist or can be developed to address the dearth of individuals in GI and hepatology research with the necessary level of big data expertise. [ABSTRACT FROM AUTHOR]

This study analyzed the results of a transition program in a patient population with a rare liver disease of pediatric onset. Data were collected on the clinical course of an adolescent population with a rare disease of pediatric onset and enrolled in a transition program between 1994 and 2022. A total of 238 adolescents (including 34 having undergone a liver transplant on enrolling in the program) were included. Eight patients were lost to follow-up before the first transition consultation and 16 families requested follow-up in an adult hepatology department closer to their home. Overall, 214 initial transition consultations were carried out; 29 patients were subsequently lost to follow-up and 13 switched center. Overall, 15.4 % of the patients enrolled in our program were lost to follow-up. Five adult patients underwent a liver transplantation during this 28-year period. Overall mortality was 3.2 %, graft survival was 91.5 %, and posttransplant survival was 92 %. In total, the current active file represents 183 patients with a median age of 24.3 years (18–51) and a median follow-up period of 5.8 years (6 months to 28 years). The implementation of a transition program to adult medicine for adolescents with a rare liver disease should follow the recommendations but must be adapted in line with local practice conditions. This process requires close collaboration between the pediatric and adult medicine teams based on a mutual desire to constantly improve practices and enhance knowledge. [ABSTRACT FROM AUTHOR]

Background: The integration of artificial intelligence (AI) into healthcare has opened new avenues for enhancing patient care and clinical research. In gastroenterology, the potential of AI tools, specifically large language models like ChatGPT, is being explored to understand their utility and effectiveness. Objectives: The primary goal of this systematic review is to assess the various applications, ascertain the benefits, and identify the limitations of utilizing ChatGPT within the realm of gastroenterology. Design: Through a systematic approach, this review aggregates findings from multiple studies to evaluate the impact of ChatGPT on the field. Data sources and methods: The review was based on a detailed literature search of the PubMed database, targeting research that delves into the use of ChatGPT for gastroenterological purposes. It incorporated six selected studies, which were meticulously evaluated for quality using the Joanna Briggs Institute critical appraisal instruments. The data were then synthesized narratively to encapsulate the roles, advantages, and drawbacks of ChatGPT in gastroenterology. Results: The investigation unearthed various roles of ChatGPT, including its use in patient education, diagnostic self-assessment, disease management, and the formulation of research queries. Notable benefits were its capability to provide pertinent recommendations, enhance communication between patients and physicians, and prompt valuable research inquiries. Nonetheless, it encountered obstacles in decoding intricate medical questions, yielded inconsistent responses at times, and exhibited limitations in generating novel content. The review also considered ethical implications. Conclusion: ChatGPT has demonstrated significant potential in the field of gastroenterology, especially in facilitating patient–physician interactions and managing diseases. Despite these advancements, the review underscores the necessity for ongoing refinement, customization, and ethical regulation of AI tools. These findings serve to enrich the dialog concerning AI's role in healthcare, with a specific focus on ChatGPT's application in gastroenterology. Plain language summary: Checking how ChatGPT works in gastroenterology: a detailed look at its uses, advantages, and challenges Goal We looked at how ChatGPT, a computer program, is used in the study Gastroenterology. We wanted to understand what's good about it, what's challenging, and how it can help doctors and patients. How We Did It We searched for articles about ChatGPT in Gastroenterology on PubMed. We found six suitable articles and checked their quality using the Joanna Briggs Institute (JBI) critical appraisal tools. Then, we put all the information together to get a clear picture. What We Found Doctors and researchers use ChatGPT in many ways. Some use it to teach patients about their health, while others use it to help patients check their symptoms or manage their conditions. It can even help come up with research questions. The good things about ChatGPT are that it gives helpful advice, makes talking between doctors and patients easier, and helps come up with research topics. But, sometimes it doesn't understand hard medical questions, gives different answers for the same question, or lacks new ideas. There are also concerns about using it the right way. What This Means ChatGPT can be a helpful tool in Gastroenterology, especially when talking with patients and managing their health. But, there are challenges that need to be fixed. Our review helps people understand how ChatGPT can be used in health care, especially in the field of Gastroenterology. [ABSTRACT FROM AUTHOR]

Objective: According to the diagnosis-related group (DRG) requirement, issues of diagnosis and procedure coding in the gastroenterology department of our hospital were analyzed and improvement plans were proposed to lay the foundation for effective implementation of DRGs. Methods: The title page of case-history of 1600 patients admitted to the Department of Gastroenterology of this hospital from January 1, 2021 to December 31, 2021 was sampled as a data source, and the primary and other diagnostic codes, operation or procedure codes involved in the title page of case-history were categorized and statistically analyzed. Results: Of the 531 cases treated with gastrointestinal endoscopy in our hospital in 2021, coding errors were identified in 66 cases and unsuccessful DRG enrollment in 35 cases, including 14 cases with incorrect coding of the primary diagnosis (8 cases with unsuccessful DRG enrollment), 37 cases with incorrect coding of the primary operation (23 cases with unsuccessful DRG enrollment), and 8 cases with incorrect coding of both the primary diagnosis and the primary operation (4 cases with unsuccessful DRG enrollment). Analysis of 66 inpatient cases with coding problems showed a total of 167 deficiencies, including 36 deficiencies in major diagnoses, 84 deficiencies in other diagnoses, and 47 deficiencies in surgery or operation coding. Conclusion: The accuracy of coding of disease diagnosis and surgical operation is the basis for the smooth implementation of DRGs. The medical staff of this hospital has poor cognition of DRGs coding and fails to recognize the important role of the title page of case-history quality to DRGs system, and their attention to DRGs and knowledge base of disease classification coding should be improved. In addition, the high incidence of coding errors, especially the omission of disease diagnosis, requires increased training of physicians and nurses on clinical knowledge and requirements for DRGs medical records, thereby improving the quality of medical cases and ensuring the accuracy of DRGs information. [ABSTRACT FROM AUTHOR]