World Journal of Gastroenterology最新文献

Background: Inflammatory bowel disease (IBD) is a global health burden that affects millions of individuals worldwide, necessitating extensive patient education. Large language models (LLMs) hold promise for addressing patient information needs. However, LLM use to deliver accurate and comprehensible IBD-related medical information has yet to be thoroughly investigated.

Aim: To assess the utility of three LLMs (ChatGPT-4.0, Claude-3-Opus, and Gemini-1.5-Pro) as a reference point for patients with IBD.

Methods: In this comparative study, two gastroenterology experts generated 15 IBD-related questions that reflected common patient concerns. These questions were used to evaluate the performance of the three LLMs. The answers provided by each model were independently assessed by three IBD-related medical experts using a Likert scale focusing on accuracy, comprehensibility, and correlation. Simultaneously, three patients were invited to evaluate the comprehensibility of their answers. Finally, a readability assessment was performed.

Results: Overall, each of the LLMs achieved satisfactory levels of accuracy, comprehensibility, and completeness when answering IBD-related questions, although their performance varies. All of the investigated models demonstrated strengths in providing basic disease information such as IBD definition as well as its common symptoms and diagnostic methods. Nevertheless, when dealing with more complex medical advice, such as medication side effects, dietary adjustments, and complication risks, the quality of answers was inconsistent between the LLMs. Notably, Claude-3-Opus generated answers with better readability than the other two models.

Conclusion: LLMs have the potential as educational tools for patients with IBD; however, there are discrepancies between the models. Further optimization and the development of specialized models are necessary to ensure the accuracy and safety of the information provided.

Per oral endoscopic myotomy (POEM) is rapidly emerging as the treatment of choice for achalasia cardia, but its success is marred by problematic reflux. Although symptomatic reflux rates are low and often comparable to that after laparoscopic Hellers myotomy (LHM), a high incidence of pathologic reflux has been noted after POEM. This poses a dilemma as to what is true reflux, and in determining the indications and optimal endpoints for managing post-POEM reflux. The two pertinent reasons for the difference in reflux rates between LHM and POEM are the variation in length and location of myotomy and the absence of an anti-reflux procedure in POEM. Proton pump inhibitor remains the most sought-after treatment of POEM derived reflux. Nevertheless, modifications in the procedural technique of POEM and the addition of endoscopic fundoplication can probably emerge as a game changer. This article briefly reviews the incidence, causes, controversies, predictive factors, and management strategies related to post-POEM reflux.

Rectal neuroendocrine neoplasms pose significant challenges due to their varied presentations and prognoses. Traditional prognostic models, while useful, often fall short of accurately predicting clinical outcomes for these patients. This article discusses the development and implications of a novel prognostic tool, the GATIS score, which aims to enhance predictive accuracy and guide treatment strategies more effectively than current methods. Utilizing data from a large cohort and employing sophisticated statistical models, the GATIS score integrates clinical and pathological markers to provide a nuanced assessment of prognosis. We evaluate the potential of this score to transform clinical decision-making processes, its integration into current medical practices, and future directions for its development. The integration of genetic markers and other biomarkers could further refine its predictive power, highlighting the ongoing need for innovation in the management of rectal neuroendocrine neoplasms.

In this article, we comment on the article by Blüthner et al. The article provides a comprehensive analysis of the factors contributing to the late detection of Crohn's disease and ulcerative colitis within a German cohort. It highlights the consequences on patient outcomes, particularly disease progression and the increased risk of developing complications. The study identifies specific predictors associated with both patient-related and physician-related delays, offering a detailed exploration of the initial approach. Additionally, the article delves into the distinct patterns observed in the German population, stressing the unique aspects of diagnostic delays that may differ from those reported in other regions. This detailed examination offers valuable insights into the specific challenges faced within the German healthcare system and underscores the necessity of targeted interventions to facilitate early diagnosis. The importance of improved screening tools, patient education, and better healthcare infrastructure is emphasized as crucial steps toward improving patient care in inflammatory bowel disease.

Background: Diagnosing bacterial infections (BI) in patients with cirrhosis can be challenging because of unclear symptoms, low diagnostic accuracy, and lengthy culture testing times. Various biomarkers have been studied, including serum procalcitonin (PCT) and presepsin. However, the diagnostic performance of these markers remains unclear, requiring further informative studies to ascertain their diagnostic value.

Aim: To evaluate the pooled diagnostic performance of PCT and presepsin in detecting BI among patients with cirrhosis.

Methods: We performed a systematic search of the MEDLINE, EMBASE, and Scopus databases for studies that evaluated the diagnostic role of PCT and presepsin from inception to June 2024. Sensitivity and specificity values were pooled using a random effects model. BI was diagnosed based on clinical manifestations, physical examination, laboratory data, and radiological findings.

Results: Of the 6639 articles retrieved, 28 met the inclusion criteria and included 4287 patients with 1789 cases of BI (41.7%). The bivariate pooled sensitivity and specificity estimates of PCT for BI diagnosis were 0.73 [95% confidence interval (CI): 0.64-0.81] and 0.83 (95%CI: 0.79-0.87), respectively. The diagnostic odds ratio (DOR) of PCT was 17.21 (95%CI: 9.57-30.95). Presepsin showed a pooled sensitivity of 0.75 (95%CI: 0.60-0.86), specificity of 0.80 (95%CI: 0.68-0.88), and DOR of 12.33 (95%CI: 5.10-29.83) for diagnosing BI. The pooled sensitivity and specificity of PCT for diagnosing spontaneous bacterial peritonitis (SBP) were 0.76 (95%CI: 0.67-0.84) and 0.87 (95%CI: 0.78-0.92), respectively. The positive likelihood ratio of PCT was 5.57 (95%CI: 3.34-9.29), which was sufficiently indicative of SBP. The DOR of PCT was 29.50 (95%CI: 12.30-70.80).

Conclusion: PCT and presepsin have high sensitivity and specificity for detecting BI in patients with cirrhosis. Furthermore, PCT has good diagnostic value as a rule-in test for SBP diagnosis.

Inflammatory bowel diseases (IBDs) are classified into two distinct types based on the area and severity of inflammation: Crohn's disease (CD) and ulcerative colitis. In CD, gut bacteria can infiltrate mesenteric fat, causing expansion known as creeping fat, which may limit bacterial spread and inflammation but can promote fibrosis. The gut bacteria composition varies depending on whether the colon or ileum is affected. Fecal microbiota transplantation (FMT) transfers feces from a healthy donor to restore gut microbiota balance, often used in IBD patients to reduce inflammation and promote mucosal repair. The use of FMT for CD remains uncertain, with insufficient evidence to fully endorse it as a definitive treatment. While some studies suggest it may improve symptoms, questions about the duration of these improvements and the need for repeated treatments persist. There is a pressing need for methods that provide long-term benefits, as highlighted by Wu et al's research.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters host cells via the angiotensin-converting enzyme 2 (ACE2) receptor. Mounting evidence has indicated the presence of hepatic SARS-CoV-2 infection and liver injury in patients with coronavirus disease 2019 (COVID-19). Understanding the mechanisms of hepatic SARS-CoV-2 infection is crucial for addressing COVID-19-related liver pathology and developing targeted therapies. This editorial discusses the significance of ACE2 in hepatic SARS-CoV-2 infection, drawing on the research by Jacobs et al. Their findings indicate that hepatic ACE2 expression, frequency of hepatic SARS-CoV-2 infection, and severity of liver injury are elevated in patients with pre-existing chronic liver diseases. These data suggest that hepatic ACE2 could be a promising therapeutic target for COVID-19.

In this manuscript, we comment on a recent publication by Yuan et al. This article provides a detailed scientific diagnostic process for a multiple endocrine neoplasia type 1 patient, thus offering strong guidance for clinical practice. However, we believe that the authors should also provide information on the patient's long-term prognosis.

Gastric cancer (GC), a multifaceted and highly aggressive malignancy, represents challenging healthcare burdens globally, with a high incidence and mortality rate. Although endoscopy, combined with histological examination, is the gold standard for GC diagnosis, its high cost, invasiveness, and specialized requirements hinder widespread use for screening. With the emergence of innovative technologies such as advanced imaging, liquid biopsy, and breath tests, the landscape of GC diagnosis is poised for radical transformation, becoming more accessible, less invasive, and more efficient. As the non-invasive diagnostic techniques continue to advance and undergo rigorous clinical validation, they hold the promise of significantly impacting patient outcomes, ultimately leading to better treatment results and improved quality of life for patients with GC.

In this article, we discussed the article by Zeng et al, published in a recent issue of the World Journal of Gastroenterology. The publication represents a significant advancement in the prognostic evaluation of rectal neuroendocrine neoplasms. The GATIS score is a single nomogram model that incorporates five key prognostic factors: Tumor grade; T stage; tumor size; age; and the prognostic nutritional index. This innovation optimizes the prognostic process, delivering more accurate predictions of overall survival and progression-free survival compared to traditional TNM staging and World Health Organization classification systems. The findings of the study were based on a retrospective analysis spanning 12 years and involving 1408 patients from 17 reference centers in China. In this editorial, we specifically examined the strengths and limitations of the study, the clinical implications of the GATIS score, and the questions arising from its conclusions.