BMJ Open Gastroenterology最新文献

{"title":"Derivation and validation of lifestyle-based and microbiota-based models for colorectal adenoma risk evaluation and self-prediction.","authors":"Yi-Lu Zhou, Jia-Wen Deng, Zhu-Hui Liu, Xin-Yue Ma, Chun-Qi Zhu, Yuan-Hong Xie, Cheng-Bei Zhou, Jing-Yuan Fang","doi":"10.1136/bmjgast-2024-001597","DOIUrl":"10.1136/bmjgast-2024-001597","url":null,"abstract":"<p><strong>Objective: </strong>Early warning and screening of colorectal adenoma (CRA) is important for colorectal cancer (CRC) prevention. This study aimed to construct a non-invasive prediction model to improve CRA screening efficacy.</p><p><strong>Methods: </strong>This study incorporated three cohorts, comprising 9747 participants who underwent colonoscopy. In cohort 1, 683 participants were prospectively recruited with comprehensive lifestyle information and faecal samples. CRA-associated bacteria were identified through 16S rRNA sequencing and quantitative real-time PCR. CRA prediction models were established using lifestyle and gut microbiota information. Cohort 2 prospectively enrolled 1529 participants to validate the lifestyle-based model, while cohort 3 retrospectively analysed 7535 individuals to determine the recommended initial colonoscopy screening ages for different risk groups based on age-specific CRA incidence rates.</p><p><strong>Results: </strong>Multivariable logistic regression yielded a prediction model incorporating 14 variables, demonstrating robust discrimination (c-statistic=0.79, 95% CI 0.75, 0.82). Other machine learning approaches showed comparable performance (random forest: 0.78, 95% CI 0.73, 0.81; gradient boosting: 0.78, 95% CI 0.76, 0.83). The ages for starting colonoscopy screening were established at 42 years for the high-risk group vs 53 years for the low-risk group. The inclusion of <i>Fusobacterium nucleatum</i> and <i>pks⁺ Escherichia</i>  <i>coli</i> enhanced the model's performance (c-statistic=0.84-0.86).</p><p><strong>Conclusion: </strong>Integrated mathematical modelling incorporating lifestyle parameters and gut microbial signatures provides an effective non-invasive strategy for CRA risk stratification, while the accompanying machine learning-assisted prediction application enables cost-effective, population-level screening implementation to optimise CRC prevention protocols.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the risk of gastroparesis following different modalities for treating obesity: semaglutide versus bupropion-naltrexone versus sleeve gastrectomy - a retrospective cohort study.","authors":"Chino Aneke-Nash, Kay Su Hung, Elizabeth Wall-Wieler, Feibi Zheng, Reem Z Sharaiha","doi":"10.1136/bmjgast-2024-001704","DOIUrl":"10.1136/bmjgast-2024-001704","url":null,"abstract":"<p><strong>Objective: </strong>The use of glucagon-like peptide 1 receptor agonists has been associated with gastroparesis, but little is known about the risk of gastroparesis in those with obesity but without type 2 diabetes (T2D), and how that risk compares with other treatment modalities for obesity. This study aims to characterise the relationship between different treatment modalities for obesity and the risk of gastroparesis in a population without pre-existing T2D.</p><p><strong>Methods: </strong>A retrospective cohort study using Merative MarketScan Research Databases of individuals with obesity who underwent treatment with semaglutide, bupropion-naltrexone or sleeve gastrectomy from 1 January 2018 to 31 December 2022. The incidence of gastroparesis diagnosis was evaluated using International Classification of Diseases, Version 10 codes. The risk of gastroparesis was compared between three intervention groups using Cox proportional hazards regression models.</p><p><strong>Results: </strong>Of the 55 460 individuals included, 36 990 (66.7%) were treated with semaglutide, 7369 (13.3%) with bupropion-naltrexone and 11 101 (13.7%) with sleeve gastrectomy. Gastroparesis rates among those treated with semaglutide versus bupropion-naltrexone versus sleeve gastrectomy were 6.5 per 1000 person-years (PY) vs 2.1 per 1000 PY vs 1.1 per 1000 PY, respectively. After adjusting for baseline characteristics, individuals treated with semaglutide had a higher risk of gastroparesis than those treated with bupropion-naltrexone (adjusted HR 3.33, 95% CI 2.27, 4.98) and sleeve gastrectomy (adjusted HR 6.14, 95% CI 3.94, 9.57).</p><p><strong>Conclusions: </strong>There is an increased incidence of gastroparesis among individuals with obesity without T2D who are using semaglutide as compared with bupropion-naltrexone and sleeve gastrectomy. Understanding these potential side effects, though rare, may help guide personalised treatment regimens.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treat-to-target of endoscopic remission in patients with inflammatory bowel disease in symptomatic remission on advanced therapies (QUOTIENT): rationale, design and protocol for an open-label, multicentre, pragmatic, randomised controlled trial.","authors":"Siddharth Singh, Jasmine D Nguyen, David I Fudman, Mark E Gerich, Samir A Shah, David Hudesman, Ryan A McConnell, Dana J Lukin, Ann D Flynn, Caroline Hwang, Brandon Sprung, Jill K J Gaidos, Mark C Mattar, David T Rubin, Jana G Hashash, Mark Metwally, Tauseef Ali, Christopher Ma, Frank Hoentjen, Neeraj Narula, Talat Bessissow, Greg Rosenfeld, Jeffrey D McCurdy, Ashwin N Ananthakrishnan, Raymond K Cross, Jorge R Rodriguez Gaytan, Emily-Sophinie Gurrola, Sagar Patel, Corey A Siegel, Gil Y Melmed, S Alandra Weaver, Sydney Power, Guangyong Zou, Vipul Jairath, Jason K Hou","doi":"10.1136/bmjgast-2024-001615","DOIUrl":"10.1136/bmjgast-2024-001615","url":null,"abstract":"<p><strong>Introduction: </strong>Targeted immunomodulators (eg, advanced therapies) effectively achieve symptomatic remission in patients with inflammatory bowel disease (IBD). However, ~25%-50% of patients with IBD achieving symptomatic remission with an advanced therapy may have continued endoscopically/radiologically active bowel inflammation, and it is uncertain whether changing alternative advanced therapies in asymptomatic patients with IBD will reduce bowel inflammation and achieve durable deep remission.</p><p><strong>Methods and analysis: </strong>The QUality Outcomes Treating IBD to Target (QUOTIENT) study is an open-label, multicentre, pragmatic, randomised, controlled trial that aims to compare the efficacy and safety of switching to an alternative advanced therapy targeting endoscopic/radiological remission (treat-to-target) versus continuing the initial, or index, advanced therapy, in asymptomatic patients with IBD with moderate-to-severe endoscopic/radiological bowel inflammation. Enrolment is planned for ~250 participants in Canada/USA, randomised 1:1 to switching to alternative advanced therapy or continuing index advanced therapy, and then followed 104 weeks within routine clinical practice. Patient-reported outcomes measure efficacy and quality of life/treatment burden/safety. Primary endpoint is the time from randomisation to treatment failure.</p><p><strong>Ethics and dissemination: </strong>The study is conducted in compliance with the protocol, ICH Good Clinical Practice, applicable regulatory requirements and appropriate review boards/independent ethics committees (approval numbers: Pro00077486; Pro00061437; STUDY00002062; 22-004171; i22-01269; IRB22-0890; IRB_00154397; 2000032384; SHIRB#2022.095-2; STUDY00007146; MMC#2024-18; REB#125290; 17784; Pro00142214; 20240660-01H), with documented written informed consent. Findings will be disseminated through peer-reviewed journals, scientific presentations, and publicly available Patient-Centered Outcomes Research Institute (PCORI) websites, including lay summaries. The Crohn's & Colitis Foundation Education, Support, and Advocacy Department, and our patient advocacy stakeholder, will develop educational and marketing resources to communicate findings to a broad audience (>250 000 patients/caregivers/healthcare professionals).</p><p><strong>Trial registration number: </strong>NCT05230173.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the optimal first-line treatment of autoimmune hepatitis? A systematic review with meta-analysis of randomised trials and comparative cohort studies.","authors":"Dermot Gleeson, Marrissa Martyn-StJames, Ye Oo, Sarah Flatley","doi":"10.1136/bmjgast-2024-001549","DOIUrl":"10.1136/bmjgast-2024-001549","url":null,"abstract":"<p><strong>Objectives: </strong>Uncertainty remains about many aspects of first-line treatment of autoimmune hepatitis (AIH).</p><p><strong>Design: </strong>Systemic review with meta-analysis (MA).</p><p><strong>Data sources: </strong>Bespoke AIH Endnote Library, updated to 30 June 2024.</p><p><strong>Eligibility criteria: </strong>Randomised controlled trials (RCTs) and comparative cohort studies including adult patients with AIH, reporting death/transplantation, biochemical response (BR) and/or adverse effects (AEs).</p><p><strong>Data extraction and synthesis: </strong>Data pooled in MA as relative risk (RR) under random effects. Risk of bias (ROB) assessed using Cochrane ROB-2 and ROBINS-1 tools.</p><p><strong>Results: </strong>From seven RCTs (five with low and two with some ROB) and 18 cohort studies (12 moderate ROB, six high for death/transplant), we found lower death/transplantation rates in (a) patients receiving pred+/-aza (vs no pred): overall (RR 0.38 (95% CI 0.20 to 0.74)), in patients without symptoms (0.38 (0.19-0.75)), without cirrhosis (0.30 (0.14-0.65)), and with decompensated cirrhosis (RR 0.38 (0.23-0.61)), and (b) patients receiving pred+aza (vs pred alone) (0.38 (0.22-0.65)). Patients receiving higher (vs lower) initial pred doses had similar BR rates (RR 1.07 (0.92-1.24)) and mortality (0.71 (0.25-2.05)) but more AEs (1.73 (1.17-2.55)). Patients receiving bud (vs pred) had similar BR rates (RR 0.99 (0.71-1.39)), with fewer cosmetic AEs (0.46 (0.34-0.62)). Patients receiving mycophenolate mofetil (MMF) (vs aza) had similar BR rates (RR 1.32 (0.73-2.38)) and fewer AEs requiring drug cessation (0.20 (0.09-0.43)).</p><p><strong>Conclusions: </strong>Mortality is lower in pred-treated (vs untreated) patients, overall and in several subgroups, and in those receiving pred+aza (vs pred). Higher initial pred doses confer no clear benefit and cause more AEs. Bud (vs pred) achieves similar BR rates, with fewer cosmetic AEs. MMF (vs aza) achieves similar BR rates, with fewer serious AEs.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-colonoscopy colorectal cancer and the association with endoscopic findings in the Danish colorectal cancer screening programme.","authors":"Simon Ladefoged Rasmussen, Lasse Pedersen, Christian Torp-Pedersen, Morten Rasmussen, Inge Bernstein, Ole Thorlacius-Ussing","doi":"10.1136/bmjgast-2024-001692","DOIUrl":"10.1136/bmjgast-2024-001692","url":null,"abstract":"<p><strong>Objective: </strong>Colorectal cancer (CRC) is the third most common cancer in Denmark, with a 5-year mortality of 40%. To reduce CRC incidence and mortality, a faecal immunochemical test (FIT)-based screening programme was introduced in 2014. Adenoma detection rate (ADR) is an established quality marker inversely associated with post-colonoscopy CRC (PCCRC), but evidence mainly stems from non-FIT populations. Using ADR in a FIT-based setting may be costly due to histopathological examination. Alternative markers like polyp detection rate (PDR) and sessile serrated lesion detection rate (SDR) could be viable but lack evidence for their association with PCCRC.</p><p><strong>Methods: </strong>We conducted a nationwide cohort study of 77 009 FIT-positive participants undergoing colonoscopy (2014-2017). National registry data on CRC outcomes were linked, and endoscopy units were grouped by ADR, PDR and SDR levels. Poisson regression adjusted for age, sex and comorbidities was used to assess PCCRC risk.</p><p><strong>Results: </strong>Among 70 009 colonoscopies within 6 months of FIT positivity, 4401 (92.7%) had CRC, while 342 (7.2%) were PCCRC cases. PCCRC risk was inversely associated with ADR, PDR and SDR. High ADR endoscopy units had a 35% lower PCCRC risk than low ADR units. Similar associations were found for PDR and SDR, with high SDR units showing a 33% lower PCCRC risk than low SDR units.</p><p><strong>Conclusions: </strong>ADR, PDR and SDR predict PCCRC risk, with SDR emerging as a feasible, cost-efficient quality marker in FIT-based screening. This study supports SDR as a primary performance indicator in future protocols.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relapse in gallstone disease after non-operative management of acute cholecystitis: a population-based study.","authors":"Louise Helenius, Fredrik Linder, Erik Osterman","doi":"10.1136/bmjgast-2024-001680","DOIUrl":"10.1136/bmjgast-2024-001680","url":null,"abstract":"<p><strong>Objective: </strong>Non-operative management (NOM) of acute cholecystitis (ACC) may be preferable in patients with advanced inflammation, long duration of symptoms or severe comorbidities. This study aims to investigate time to recurrence and patient factors predicting relapse in gallstone complications after NOM.</p><p><strong>Methods: </strong>Records of 1634 patients treated for ACC at three Swedish centres between 2017 and 2020 were analysed, with 909 managed non-operatively. Data were linked to the National Gallstone Surgery registry for those who later underwent surgery. The time to relapse of gallstone complications was calculated and Cox proportional hazards regression was used to analyse new gallstone complications and adjust for multiple variables.</p><p><strong>Results: </strong>Of the 909 non-operatively managed patients, 348 patients suffered a new gallstone complication. The median time to recurrence was 82 days. Of those who recurred, 27% did so within 30 days, 17% between 31 and 60 days, 27% between 61 days and 6 months, 16% between 6 months and 1 year and 13% later than 1 year. Younger patients with their first gallstone complication had a lower risk of new complications compared with those with previous gallstone complications. In older individuals, there was no difference in the risk of relapse regardless of previous gallstone complications, but they were more likely to be readmitted than younger patients.</p><p><strong>Conclusion: </strong>Delayed cholecystectomy should be prioritised for younger patients with a history of gallstone disease if early cholecystectomy is not feasible. Delayed cholecystectomy should be scheduled without a prior outpatient clinic visit to minimise delays.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contraception, fertility and inflammatory bowel disease (IBD): a survey of the perspectives of patients, gastroenterologists and women's healthcare providers.","authors":"Guillaume Le Cosquer, Cyrielle Gilletta, Florian Béoletto, Barbara Bournet, Louis Buscail, Emmeline di Donato","doi":"10.1136/bmjgast-2024-001669","DOIUrl":"https://doi.org/10.1136/bmjgast-2024-001669","url":null,"abstract":"<p><strong>Objective: </strong>Despite guidelines indicating no contraindications for contraceptives in women with inflammatory bowel disease (IBD), this population shows increased voluntary childlessness and lower contraceptive use. Knowledge gaps among healthcare providers on IBD's impact on fertility and contraception may drive these trends. This survey assessed knowledge discrepancies among IBD patients, gastroenterologists (GEs), and women's healthcare providers (WHPs) regarding fertility and contraception.</p><p><strong>Methods: </strong>An anonymous survey was conducted between August and December 2023, targeting IBD patients of childbearing age, GEs and WHPs. The questionnaire was offered consecutively to all patients consulting or hospitalised in our department. Additionally, the survey link was shared with healthcare professionals during dedicated training sessions. It assessed awareness of IBD-related fertility and contraception impacts.</p><p><strong>Results: </strong>Two hundred twenty-two participants fulfilled the survey (100 patients, 50 GEs and 72 WHPs). Among patients (63% with Crohn's disease), 95% were on biologic or immunosuppressant therapy. Nearly half (47%) of women had not discussed fertility or contraception with their GE, and only 22% had done so on request. A majority (80% of women, 54% of GEs) were unsure if IBD affects contraception efficacy, and 50% of WHPs believed oral contraceptives to be less effective for IBD patients. Key concerns influencing patients' fertility decisions included the impact of IBD medication on pregnancy (51%), risk of passing IBD to offspring (47%) and potential flare-ups during pregnancy (39%).</p><p><strong>Conclusion: </strong>Significant knowledge gaps on fertility and contraception in IBD persist among patients, GEs and WHPs.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Granulomatous liver disease in Thailand: a 20-year retrospective clinicoradiopathological analysis.","authors":"Siwanon Nawalerspanya, Apichat Kaewdech, Naichaya Chamroonkul, Pimsiri Sripongpun","doi":"10.1136/bmjgast-2024-001675","DOIUrl":"10.1136/bmjgast-2024-001675","url":null,"abstract":"<p><strong>Objective: </strong>Granulomatous liver disease (GLD) is a rare condition with various aetiologies and is characterised by the formation of hepatic granulomas. A comprehensive evaluation of GLD from a broad perspective is lacking. We aimed to investigate the aetiology and the clinicoradiopathological characteristics of patients with GLD in recent decades in Thailand.</p><p><strong>Methods: </strong>This retrospective study was conducted at a tertiary care centre in Thailand. All patients who underwent liver biopsy between 2003 and 2023 were reviewed. Patients with a histopathological report of granulomas in liver specimens were included. Clinical presentations, radiological data, and laboratory data closest to the procedure date were also collected.</p><p><strong>Results: </strong>Of the 4384 liver biopsy specimens collected during the study period, 89 (2%) had GLD. Of these, 58.4% were men, with the following aetiologies: 61 (68.5%) infectious, 16 (18%) non-infectious, and 12 (13.5%) undetermined. Common presentations included abnormal liver test results (81.4%) and fever (56.1%). Among infectious granulomas, mycobacterial infections (tuberculosis: 28; non-tuberculous mycobacteria (NTM): 11) were predominant. Compared with other causes, NTM was associated with a significantly lower body mass index, more extragastrointestinal involvement, and lower serum albumin levels. Caseating-type granulomas were also observed in 16% of non-mycobacterial cases. Nearly 40% of patients with GLD demonstrated no focal lesions on liver imaging, whereas multifocal lesions were found in a third of patients.</p><p><strong>Conclusions: </strong>Infectious causes, especially mycobacterial infections, remain the primary aetiology of GLD in Thailand. Granuloma types are not pathognomonic of specific diseases, emphasising the need for extensive evaluation beyond liver biopsy to determine the underlying aetiology.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vision-language large learning model, GPT4V, accurately classifies the Boston Bowel Preparation Scale score.","authors":"Daniel Yan Zheng Lim, Yu Bin Tan, Jonas Ren Yi Ho, Sushmitha Carkarine, Tian Wei Valerie Chew, Yuhe Ke, Jen Hong Tan, Ting Fang Tan, Kabilan Elangovan, Le Quan, Li Yuan Jin, Jasmine Chiat Ling Ong, Gerald Gui Ren Sng, Joshua Yi Min Tung, Chee Kiat Tan, Damien Tan","doi":"10.1136/bmjgast-2024-001496","DOIUrl":"10.1136/bmjgast-2024-001496","url":null,"abstract":"<p><strong>Introduction: </strong>Large learning models (LLMs) such as GPT are advanced artificial intelligence (AI) models. Originally developed for natural language processing, they have been adapted for multi-modal tasks with vision-language input. One clinically relevant task is scoring the Boston Bowel Preparation Scale (BBPS). While traditional AI techniques use large amounts of data for training, we hypothesise that vision-language LLM can perform this task with fewer examples.</p><p><strong>Methods: </strong>We used the GPT4V vision-language LLM developed by OpenAI, via the OpenAI application programming interface. A standardised prompt instructed the model to grade BBPS with contextual references extracted from the original paper describing the BBPS by Lai <i>et al</i> (GIE 2009). Performance was tested on the HyperKvasir dataset, an open dataset for automated BBPS grading.</p><p><strong>Results: </strong>Of 1794 images, GPT4V returned valid results for 1772 (98%). It had an accuracy of 0.84 for two-class classification (BBPS 0-1 vs 2-3) and 0.74 for four-class classification (BBPS 0, 1, 2, 3). Macro-averaged F1 scores were 0.81 and 0.63, respectively. Qualitatively, most errors arose from misclassification of BBPS 1 as 2. These results compare favourably with current methods using large amounts of training data, which achieve an accuracy in the range of 0.8-0.9.</p><p><strong>Conclusion: </strong>This study provides proof-of-concept that a vision-language LLM is able to perform BBPS classification accurately, without large training datasets. This represents a paradigm shift in AI classification methods in medicine, where many diseases lack sufficient data to train traditional AI models. An LLM with appropriate examples may be used in such cases.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing brodalumab in the treatment of primary sclerosing cholangitis (SABR-PSC pilot study): protocol for a single-arm, multicentre, pilot study.","authors":"Amera Elzubeir, Juliet High, Matthew Hammond, Lee Shepstone, Martin Pond, Martine Walmsley, Palak Trivedi, Emma Culver, Guruprasad Aithal, Jessica Dyson, Douglas Thorburn, Leo Alexandre, Simon Rushbrook","doi":"10.1136/bmjgast-2024-001596","DOIUrl":"10.1136/bmjgast-2024-001596","url":null,"abstract":"<p><strong>Introduction: </strong>Primary sclerosing cholangitis (PSC) is a rare immune-mediated hepatobiliary disease, characterised by progressive biliary fibrosis, cirrhosis, and end-stage liver disease. As yet, no licensed pharmacological therapy exists. While significant advancements have been made in our understanding of the pathophysiology, the exact aetiology remains poorly defined. Compelling evidence from basic science and translational studies implicates the role of T helper 17 cells (Th17) and the interleukin 17 (IL-17) pro-inflammatory signalling pathway in the pathogenesis of PSC. However, exploration of the safety and efficacy of inhibiting the IL-17 pathway in PSC is lacking.</p><p><strong>Methods and analysis: </strong>This is a phase 2a, open-label, multicentre pilot study, testing the safety of brodalumab, a recombinant human monoclonal antibody that binds with high affinity to interleukin-17RA, in adults with PSC. This study will enrol 20 PSC patients across five large National Health Service tertiary centres in the UK. The primary outcome of the study relates to determining the safety and feasibility of administering brodalumab in early, non-cirrhotic PSC patients. Secondary efficacy outcomes include non-invasive assessment of liver fibrosis, changes in alkaline phosphatase values and other liver biochemical readouts, assessment of biliary metrics through quantitative MR cholangiography+, and quality of life evaluation on completion of follow-up (using the 5D-itch tool, the PSC-patient-reported outcome and PSC-specific Chronic Liver Disease Questionnaire).</p><p><strong>Ethics and dissemination: </strong>Ethical approval for this study has been obtained from the London Bridge Research Ethics Committee (REC23/LO/0718). Written informed consent will be obtained from all trial participants prior to undertaking any trial-specific examinations or investigations. On completion of the study, results will be submitted for publication in peer-reviewed journals and presented at national and international hepatology meetings. A summary of the findings will also be shared with participants and PSC communities.</p><p><strong>Trial registration number: </strong>ISRCTN15271834.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}