BMJ Open Gastroenterology最新文献

Objective: Colon capsule endoscopy (CCE) is a recognised diagnostic tool, but there is little research exploring patient experience of this relatively new technology. We aimed to understand the patient experience of CCE and explore similarities to and differences from colonoscopy and CT colonography (CTC).

Methods: We conducted a structured patient experience survey exploring preprocedural, procedural and postprocedural elements of CCE, alongside colonoscopy and CTC, using descriptive statistics. Consenting patients were recruited from the NHS England CCE pilot, referred either on a suspected colorectal cancer or a 3-year postpolypectomy surveillance pathway.

Results: 927 of 1937 patients (48%) responded to the survey invitation. 486 had CCE as their index procedure, 399 colonoscopy and 42 CTC. Two per cent of CCE patients found the procedure painful compared with 21% of colonoscopy and 12% of CTC patients (p<0.001). The CCE procedural information was easily understood by 81% of patients compared with 92% having colonoscopy (p<0.001). There was no significant difference in the bowel preparation experience with 20% of CCE and 16% of colonoscopy patients experiencing severe or more discomfort (p=0.439). However, 19% of CCE patients felt the bowel preparation would put them off a future CCE compared with 8% of colonoscopy patients (p<0.001). This was not wholly explained by the need for further investigations. Using regression analysis, we found that high-quality preprocedural information, tolerability of bowel preparation, procedural comfort and investigative closure were predictors of patient satisfaction with CCE. 74% of patients were satisfied with CCE in diagnosing or reassuring them compared with 91% in colonoscopy and 80% in CTC (p<0.001).

Conclusions: CCE was similarly or better tolerated than colonoscopy and CTC throughout the patient journey, with significantly less pain experienced. A future CCE clinical service should ensure that the patient is well informed and optimise the likelihood of the investigative closure.

Objective: Natural language processing (NLP) can identify cohorts of patients with inflammatory bowel disease (IBD) from free text. However, limited sharing of code, models, and data sets continues to hinder progress. The aim of this study was to evaluate multiple open-source NLP models for identifying IBD cohorts, reporting on document-to-patient-level classification, while exploring explainability, generalisability, fairness and cost.

Methods: 15 algorithms were assessed, covering all types of NLP spanning over 50 years of NLP development. Rule-based (regular expressions, spaCy with negation), and vector-based (bag-of-words (BoW), term frequency inverse document frequency (TF IDF), word-2-vector), to transformers: (two sentence-based sBERT models, three bidirectional encoder representations from transformers (BERT) models (distilBERT, BioclinicalBERT, RoBERTa), and five large language models (LLMs): (Mistral-Instruct-v0.3-7B, M42-Health/Llama-v3-8B, Deepseek-R1-Distill-Qwen-v2.5-32B, Qwen-v3-32B, and Deepseek-R1-Distill-Llama-v3-70B). Models were comparatively evaluated based on full confusion matrices, time/environmental costs, fairness, and explainability.

Results: A total of 9311 labelled documents were evaluated. The fine-tuned DistilBERT_IBD model achieved the best performance overall (micro F1: 93.54%), followed by sBERT-Base (micro F1: 93.05%); however, specificity was an issue for both: (67.80-64.41%) respectively. LLMs performed well, given that they had never seen the training data (micro F1: 86.47-92.20%), but were comparatively slow (18-300 hours) and expensive. Bias was a significant issue for all effective model types.

Conclusion: NLP has undergone significant advancements over the last 50 years. LLMs appear likely to solve the problem of re-identifying patients with IBD from clinical free text sources in the future. Once cost, performance and bias issues are addressed, they and their successors are likely to become the primary method of data retrieval for clinical data warehousing.

Objective: Metabolic dysfunction-associated steatotic liver disease (MASLD) presents considerable variability in disease progression and treatment outcomes. We aimed to determine whether specific patterns of liver inflammatory flares are correlated with distinct treatment responses.

Methods: We conducted an analysis of a well-characterised prospective cohort involving treatment-naïve MASLD patients from January 2015 to November 2023 at The First Affiliated Hospital of Sun Yat-sen University. Participants underwent a standardised 48-week lifestyle modification programme, with follow-up extending through December 2024. Liver fat content (LFC) was assessed using MRI-based proton density fat fraction (MRI-PDFF), whereas liver stiffness measurements (LSMs) were performed using two-dimensional shear wave elastography at baseline and after 48 weeks.

Results: Participants were stratified by alanine transaminase (ALT) and liver fibrosis status: normal ALT/no fibrosis (n=149), elevated ALT/no fibrosis (n=264), normal ALT/fibrosis (n=91) and elevated ALT/fibrosis (n=178). While MRI-PDFF (≥30% LFC decline) and ALT responses (≥17 U/L decrease) did not differ between groups, the elevated ALT/fibrosis group exhibited a significantly higher probability of LSM response (≥1 fibrosis stage improvement) than in the normal ALT/ fibrosis group (53.4% vs 31.9%, p=0.001; OR=2.53, 95% CI: 1.31 to 4.85, p=0.006). Receiver operating characteristic analysis revealed that the cut-offs for weight loss (8.55% vs 4.94%, p=0.023) and LFC reduction (39.85% vs 20.57%, p=0.062) associated with LSM response were higher in patients with normal ALT/fibrosis than in those with elevated ALT/fibrosis.

Conclusion: MASLD patients with liver fibrosis and persistently normal ALT levels exhibited a less favourable treatment response to fibrosis than those with elevated ALT levels, necessitating more substantial reductions in steatosis and weight to achieve the desired outcomes.

Objective: Ischaemic colitis is the most prevalent form of ischaemic enteritis and represents a major cause of acute lower gastrointestinal bleeding. Although the American College of Gastroenterology's clinical guidelines recommend colonoscopy after ischaemic colitis to screen for colorectal cancer, the actual detection rate of neoplastic lesions in patients without suspected malignancies on CT remains unclear. This study aimed to assess the efficacy of colonoscopy in detecting colorectal neoplasms after the resolution of ischaemic colitis.

Methods: This retrospective, single-centre, observational study included patients diagnosed with ischaemic colitis at the Isesaki Municipal Hospital in Japan between 2014 and 2023. Patients with CT-confirmed ischaemic colitis without a suspicion of colorectal cancer were eligible. Clinical data, colonoscopic findings and histopathological results were extracted from medical records. Comparative analyses were conducted between patients who underwent complete colonoscopy and those who did not.

Results: Among the 418 patients diagnosed with ischaemic colitis, 396 underwent CT imaging, and 116 underwent subsequent complete colonoscopy. Colorectal polyps were identified in 34.5% (40/116) of the patients, with 75 lesions predominantly located in the right-sided colon. Invasive colorectal carcinoma was detected in 3.4% (4/116) of the patients, along with an additional case of intramucosal carcinoma. Notably, one invasive adenocarcinoma was located proximal to the site of the ischaemic injury. Between the complete colonoscopy and incomplete/no colonoscopy groups, the patients in the incomplete/no colonoscopy group were significantly older, had a higher proportion of poor performance status and were more likely to have used saline laxatives.

Conclusion: Colonoscopy after ischaemic colitis revealed a non-negligible prevalence of colorectal neoplasms even in the absence of CT findings suggestive of malignancies. These results underscore the importance of colonoscopy after recovery, particularly in patients without a poor performance status. Further prospective, multicentre studies are warranted to validate these findings and optimise postischaemic colitis management strategies.

Objective: Upadacitinib is the first Janus kinase inhibitor and oral advanced therapy licensed for Crohn's disease (CD). Following NICE approval in 2023, real-world data on outcomes are limited. The effectiveness and safety of upadacitinib in a cohort of patients with CD was assessed.

Methods: A multicentre retrospective cohort analysis across 19 UK hospitals. Adult patients with active CD who started upadacitinib between April 2023 and October 2023 were included. Outcomes were reviewed over 24 weeks. The primary endpoint was clinical remission (Harvey Bradshaw Index (HBI) <4) at 12 and 24 weeks. Biochemical remission (faecal calprotectin <200 μg/g and C-reactive protein ≤5) and endoscopic remission (Simple Endoscopic Score for Crohn's Disease ≤3) were assessed at the same intervals. Adverse events (AEs) were recorded until 24 weeks or drug withdrawal.

Results: 312 patients were included, with a minimum follow-up of 12 weeks. The cohort had difficult-to-treat disease; 64% failing 3 or more biologics, 51% exhibiting penetrating or stricturing disease and 41% requiring prior resection. 50% (113/227) of patients achieved clinical remission at 12 weeks and 45% (77/172) at 24 weeks. Patients with colonic disease had higher remission rates at 24 weeks compared with other disease locations. At 24 weeks, 51 patients (16%) had discontinued upadacitinib. Treatment persistence was 90.3% at 12 weeks and 84.1% at 24 weeks. 28% had AEs, with 18% experiencing serious AEs and 16.6% requiring hospitalisation.

Conclusion: This is a large real-world study reporting outcomes in patients with CD treated with upadacitinib. Our data demonstrated good short-term effectiveness and tolerance in a clinically refractory population.

Objective: Colorectal cancer (CRC) is one of the most frequently diagnosed cancers and a leading cause of cancer-related deaths worldwide. While inflammatory bowel disease (IBD) is a well-established risk factor for CRC, the potential link between other autoimmune diseases and CRC is unclear. In light of the growing prevalence of autoimmune diseases and their recognised link to various malignancies, this study seeks to investigate whether different autoimmune diseases are associated with CRC.

Methods: A total of 20 146 patients with an initial diagnosis of CRC and 100 730 propensity score-matched cancer-free individuals were identified from the Disease Analyzer database (IQVIA). Univariable conditional logistic regression models were used to examine whether each autoimmune disorder was associated with subsequent CRC diagnosis.

Results: Only IBD was significantly associated with CRC (OR 1.53; 95% CI 1.33 to 1.75). Type 1 diabetes, rheumatic diseases, autoimmune thyroiditis, and multiple sclerosis did not show a significant association with CRC. Psoriasis showed a non-significant trend towards an association with CRC (OR 1.11; 95% CI 0.97 to 1.27). Coeliac disease was not associated with the development of CRC (OR 1.06; 95% CI 0.69 to 1.64). A sex-stratified analysis revealed that the association between IBD and CRC was similar in both women (OR 1.48; 95% CI 1.22 to 1.81) and men (OR 1.57; 95% CI 1.29 to 1.89). No significant sex differences for any other autoimmune disease were observed.

Conclusion: The presence of IBD, but not any other autoimmune diseases, was significantly associated with a subsequent CRC. This finding serves to emphasise the significance of routine screening for patients suffering from IBD.

The integration of machine learning (ML) into medical diagnostics has significantly advanced endoscopic examinations for gastrointestinal diseases. By leveraging extensive datasets and sophisticated algorithms, ML technologies enhance diagnostic precision, detect subtle abnormalities, classify diverse pathologies and predict disease progression. However, their widespread adoption is hindered by the inherent heterogeneity of gastrointestinal diseases, technical limitations, limited generalisability across different populations and ethical challenges related to patient privacy, data security and algorithmic bias.This review provides a comprehensive structural analysis of ML approaches in endoscopy, starting with an overview of the classical endoscopic methodology that relies on direct visualisation of the gastrointestinal tract for diagnosis and therapeutic interventions. Then, current ML applications that hold promise for reducing physician-dependent variability, improving diagnostic accuracy and streamlining procedural workflows were explored. Despite these advances, the effectiveness of ML models often remains constrained by the quality and diversity of training data, which can undermine both reliability and generalisability.Ethical considerations - such as safeguarding patient information, upholding data security and mitigating biases embedded in algorithms - are integral to responsibly deploying ML in clinical settings. By examining these technical and ethical barriers, this work contributes to the evolving discourse on integrating advanced ML techniques into gastroenterology. Ultimately, our goal is to pave the way for more effective and reliable ML-driven endoscopic practices that will enhance disease detection, optimise patient care and benefit healthcare providers worldwide.

Objective: Food-related quality of life (FR-QoL) is the psychosocial impact of food, nutrition, eating and drinking on QoL and can be profoundly affected by inflammatory bowel disease (IBD). We aimed to translate and validate the FR-QoL-29 Questionnaire in a Belgian IBD population and investigate associations with relevant clinical variables.

Methods: The English FR-QoL-29 was translated to Dutch using the forward-backward method. Consecutive patients with IBD attending the outpatient clinic in a university hospital in Belgium completed the FR-QoL-29 Dutch (Flemish), alongside questionnaires assessing disease severity and IBD-related disability. Clinical and biochemical data were collected. Exploratory factor analysis (EFA) with promax rotation assessed the underlying factor structure. Reliability measures (internal consistency, test-retest reliability) were evaluated. Pearson and Spearman correlations assessed relationships between FR-QoL-29 Score and continuous demographic and clinical variables, while categorical parameters were analysed using independent t-tests and one-way analysis of variance with Tukey post hoc tests.

Results: 301 patients were included, with 31 (10.3%) completing the retest. EFA revealed a one-factor structure explaining 55% of the variance. The FR-QoL-29-Dutch (Flemish) showed excellent internal consistency (Cronbach's α=0.97) and very good test-retest reliability (intraclass correlation=0.94). Lower FR-QoL-29 Score was associated with higher serum albumin levels, younger age, disease activity and IBD-related disability. FR-QoL-29 Score was lower in females, those with Crohn's disease (CD), CD patients with a stricturing phenotype and those previously receiving IBD-related surgery.

Conclusion: The FR-QoL-29-Dutch (Flemish) is valid and reliable and correlates with disease activity and IBD-related disability. Patients with CD, stricturing disease and who previously underwent IBD-related surgery have a significantly lower FR-QoL and should be targeted for support.

The incidence of incidental pancreatic cystic lesions (PCLs) has risen in recent years, largely due to advances in and increased use of imaging techniques. Endoscopic ultrasound (EUS) has become a crucial tool for evaluating and characterising PCLs, allowing for detailed morphological assessment and aiding in the identification of lesions with a higher risk of progression to high-grade dysplasia or invasive pancreatic carcinoma. This review aims to outline the key aspects of EUS in the evaluation of PCLs, covering a range of modalities from morphological assessment and contrast-enhanced imaging to elastography, fine-needle aspiration for biomarker analysis, cytology, DNA sequencing, histological evaluation and the emerging role of confocal laser endomicroscopy or artificial intelligence. Additionally, we address therapeutic EUS modalities for PCLs, the current limitations of EUS, anticipated technological advancements and the diverse management strategies recommended by leading scientific societies for the clinical handling of PCLs.