Gastroenterology Report最新文献

Background: Artificial intelligence-driven large language models demonstrate immense potential in the medical field. It remains unclear whether ChatGPT has the ability to provide appropriate recommendations for patients with inflammatory bowel disease (IBD) that are comparable to those of gastroenterologists. This study quantitatively assessed the performance of ChatGPT's generated IBD-related recommendations from the distinct perspectives of gastroenterologists and patients.

Methods: Healthcare questions regarding IBD were solicited from IBD patients and specialized physicians. Those questions were then presented to GPT-4 Omni and three independent senior gastroenterologists for responses. These responses were subsequently evaluated by a blinded panel of five board-certified gastroenterologists using a five-point Likert scale, assessing accuracy, completeness, and readability. Furthermore, 10 IBD patients as blinded assessors performed assessments of both ChatGPT's and gastroenterologists' responses.

Results: Thirty high-frequency questions were selected, encompassing basic knowledge, treatment, and management domains. ChatGPT demonstrated high reproducibility in responding to these questions. Regarding accuracy and readability, ChatGPT's performance was comparable to that of gastroenterologists. For completeness of responses, ChatGPT outperformed gastroenterologists (4.42 ± 0.67 vs 4.19 ± 0.65; P = 0.012). Overall, IBD patients were satisfied with both ChatGPT's and gastroenterologists' responses but, for treatment-related questions, patients rated gastroenterologists higher than ChatGPT (4.54 ± 0.32 vs 4.21 ± 0.38; P = 0.040).

Conclusions: ChatGPT has the potential to provide stable, accurate, comprehensive, and comprehensible healthcare-related information for IBD patients. Further validation of the reliability and practicality of large language models in real-world clinical settings is crucial.

Background: Incision and drainage (I&D) for perianal abscesses is associated with high rates of fistula formation. Our study aimed to evaluate the effectiveness of a novel technique, trans-intersphincteric double seton (TRISDS), designed to preserve anal sphincter integrity and improve clinical outcomes compared to I&D.

Methods: This prospective, randomized, non-blinded controlled study included adult patients with perianal abscesses located below the levator ani muscle with an internal opening. Patients were randomly assigned to either the TRISDS group (n = 55) or the I&D group (n = 51). The TRISDS technique involved two incisions: intersphincteric and drainage incisions with the placement of two loose setons. One seton was positioned to preserve the internal anal sphincter and facilitate drainage through the intersphincteric space, while the other seton aimed to protect the external anal sphincter to ensure comprehensive drainage. The I&D group underwent conventional I&D without damaging the anal sphincter complex. The primary outcome was the cure rate of perianal abscesses, which was defined as complete epithelialization of wounds without fistula or exudate and no recurrence within 12 months after surgery.

Results: The TRISDS group achieved a significantly higher cure rate of 78.2% (43/55) compared to 41.2% (21/51) in the I&D group (P < 0.05). There were no significant differences in anal function at 2 months postoperatively between the groups (median Wexner score, IQR: 1.0 [0.0-1.0] vs 1.0 [0.0-1.0], P > 0.05).

Conclusions: The study highlighted the effectiveness of TRISDS in improving cure rate without compromising anal function. The TRISDS technique represents a promising strategy for the treatment of perianal abscesses. Further multicenter studies are recommended to validate these findings and expand the application of TRISDS in diverse patient populations.

Colorectal cancer is one of the most prevalent malignant tumors worldwide, and it has one of the highest rates of mortality and morbidity. Its emergence and progression are intricately linked to various genetic and epigenetic factors influencing colonic epithelial cells. Long non-coding RNAs function as crucial regulators of the epigenetic landscape, playing significant roles in the development, progression, invasion, metastasis, and drug resistance of various tumors, particularly colorectal cancer. Epigenetic modifications, such as DNA methylation, RNA methylation, and histone modification, facilitate heritable gene expression regulation without changing the underlying DNA sequence. Recent studies have increasingly highlighted the intricate interactions between lncRNAs and these epigenetic modifications in colorectal cancer, illuminating their participation in critical processes, including cell proliferation, apoptosis, invasion, and metastasis. This review concentrates on the relationship between long non-coding RNAs and several significant epigenetic modifications that drive colorectal cancer development, offering fresh insights for future research that aims at devising more effective treatment strategies.

Background: The management of high complex anal fistulas has posed a significant challenge for surgeons. In this study, we presented a novel surgical procedure for managing high complex anal fistulas that combines core-out fistulectomy with suture repair of the external anal sphincter defect and endorectal advancement flap.

Methods: A cohort of patients with high complex anal fistulas undergoing core-out fistulectomy combined with suture repair of the external anal sphincter defect and endorectal advancement flap between December 2020 and December 2021 was reviewed retrospectively.

Results: The median age of the patients was 43 (range: 25-53) years. All patients had high transsphincteric fistulas. Two of the five cases involved recurrent anal fistulas. During the median follow-up period of 23 (range: 23-34) months, no recurrence events were observed in the cohort. Furthermore, it was noted that no patients developed anal incontinence after the operation.

Conclusion: Core-out fistulectomy combined with suture repair of the external anal sphincter defect and endorectal advancement flap is an effective procedure for the treatment of high complex anal fistulas.

Background: Current techniques for monitoring gastroesophageal reflux are limited to measuring physicochemical parameters. We presented a novel pH-integrated ultrathin endoscope (the EndoMonitor System) for simultaneous acquisition of reflux images and pH data. This preclinical study evaluated the performance of the latest version of the EndoMonitor System.

Methods: The stability and hydrogen ion selectivity of the pH electrode in the EndoMonitor System were evaluated. Subsequently, six types of reflux events were simulated in an isolated organ (porcine esophagus-stomach). Complete duodenal ligation was used to create porcine gastroesophageal reflux models. The number of reflux episodes and acid exposure time were assessed and compared with the pH-impedance catheter results.

Results: The detection rates for distal acid reflux, distal mixed reflux, and horizontal acid reflux events of the EndoMonitor System were significantly higher than those of the pH-impedance catheter (100% vs 18.6%, 100% vs 32.7%, and 100% vs 49.1%, respectively; all P < 0.001). Furthermore, the EndoMonitor System demonstrated superior detection performance in proximal acid and mixed reflux events compared with the pH-impedance catheter (100% vs 90.9% and 100% vs 88.1%, respectively; both P < 0.05). In vivo reflux monitoring demonstrated statistically higher detection rates of reflux events with the EndoMonitor System in two-thirds of the experimental groups (P < 0.05), with a more remarkable overall detection advantage (100% vs 82.0%; P < 0.001). The acid exposure time measurement results for these two devices were comparable (mean ± standard deviation: 2.62 ± 1.82 vs 2.52 ± 1.74 min; P = 0.161).

Conclusions: The EndoMonitor System improves the accuracy of identifying reflux events and simplifies the monitoring process. It was also highly operable. This study provided important preclinical experience for clinical trials.

Background: Inflammatory bowel disease (IBD) imposes a significant economic and social burden. We aimed to assess the burden of IBD globally, regionally, and nationally.

Methods: The incidence, mortality, prevalence, and disability-adjusted life year were obtained from Global Burden of Disease 2021. Estimated annual percentage change, average annual percent change, and age-period-cohort model were used to access trends. Associations between age-standardized rate (ASR) and socio-demographic index were explored. Predictions were made using Bayesian age-period-cohort model and Nordpred.

Results: In 2021, IBD affected 3.8 million people, with ASR of incidence and death of 4.4 and 0.5. The global ASR of incidence increased from 1990 to 2021, while ASR of death, prevalence, and disability-adjusted life year decreased. The age-standardized death rate (ASDR) did not show a significant increase from 2019 to 2021 in most regions and countries. High-incidence regions, such as Western Europe, continued to face significant burdens. East Asian, especially China, was experiencing a sharp increase in incidence. ASR of incidence and death increased with rising socio-demographic index. By 2035, the ASR of incidence and death of IBD will gradually decline.

Conclusion: The global burden of IBD remains severe with changing epidemiological trends. Reducing the burden requires changes in public health policies, disease prevention, and healthcare services.