Background: Although studies have reported on the impact of the COVID-19 pandemic on colorectal cancer (CRC) screening, data on long-term changes remain limited, particularly during the later phases of the pandemic (post 2021) and among racial and ethnic subgroups. Patients and Methods: We analyzed data from the 2019, 2021, and 2023 National Health Interview Survey to assess clinician recommendations for CRC screening, past 2-year screening rates, and screening modalities used. Trends were compared across racial/ethnic groups and social determinants of health, including insurance status and income. Results: Our sample represented 95 million individuals in 2019, 97 million in 2021, and 98 million in 2023. Compared with 2019, CRC screening recommendations dropped by 20% in 2021 ( P <.0001), with larger decreases among Hispanics (28%) and uninsured individuals (41%). Recommendations remained 11% lower in 2023 ( P =.03). In 2021, past 2-year colonoscopy use declined by 8% ( P =.001), whereas multitarget stool DNA testing (mt-sDNA) increased by 18% ( P =.03) and fecal immunochemical test/fecal occult blood test (FIT/FOBT) use increased by 55% ( P <.001). Colonoscopy declines were greatest among Asian individuals (32%), whereas increases in FIT/FOBT use were highest among Hispanic (78%) and Black (92%) individuals. By 2023, colonoscopy use had returned to prepandemic levels (28%), and mt-sDNA use increased by an additional 40%, resulting in an overall 8% increase in past 2-year screening compared with 2019 ( P <.001). Conclusions: Early in the pandemic, increased stool-based testing offset reduced colonoscopy uptake. Colonoscopy rates have since recovered, whereas stool-based testing continues to increase, with notable differences across ethnic groups. This sustained shift toward stool-based testing offers an opportunity to improve screening, especially where colonoscopy access is limited.

Background and Aims: Colonoscopy is the gold standard screening modality for colorectal cancer; however, it is operator-dependent and reliant on exam quality. Incorporating artificial intelligence (AI) into colonoscopy may improve adenoma detection and clinical outcomes, but this is a sociotechnical challenge that requires effective human–AI teaming incorporating provider attitudes. Methods: We conducted a systematic review of studies evaluating attitudes and perspectives of providers toward AI-assisted colonoscopy. Participant responses to outcome questions of interest were combined across the studies to calculate pooled proportion (Pp) and 95% confidence interval (CI). Top-ranked perceived advantages and disadvantages in each study were defined as the items that >50% of the study participants voted for. Results: Out of 2044 abstracts screened, 13 studies were included representing 1538 providers who were mostly gastroenterologists or trainees and 25%–100% had direct experience using AI in a clinical setting. Overall, a large majority were interested in using AI (Pp = 80%, 95% CI 70%–89%, n = 8 studies) and believed it can improve adenoma or polyp detection rate (Pp = 74%, 95% CI 68%–80%, n = 4 studies). Among 5 studies addressing financial implications, about half were concerned about the cost of using AI (52%, 95% CI 24%–79%). An average of 38% of respondents (95% CI 9%–73%) from 4 studies raised concern regarding accountability for misdiagnosis. High number of false positives and an absence of clinical guidelines were top-ranked perceived disadvantages in 2 studies. Conclusion: Most gastroenterology providers expressed interest in using AI systems with colonoscopy and believed it can improve adenoma detection rate. Cost, high number of false positives, and lack of professional society guidelines were among top perceived concerns.

Background and Aims:In inflammatory bowel disease, protein misfolding in the endoplasmic reticulum (ER) potentiates epithelial barrier dysfunction and impairs mucosal healing. Tauroursodeoxycholic acid (TUDCA), a naturally occurring bile acid, acts as a chemical chaperone to reduce protein aggregation and colitis severity in preclinical models. We conducted an open label trial evaluating oral TUDCA as therapy in patients with active ulcerative colitis (UC). Methods:Patients with moderate-to-severely active UC (Mayo score ≥6, endoscopic subscore ≥1) received oral TUDCA at 1.75 or 2 g/day for 6 weeks. Exclusion criteria included known hepatic disorders or change in UC therapy within 60 days. Clinical disease activity questionnaires, endoscopy with biopsy, blood, and stool were collected at enrollment and after 6 weeks. The primary outcome measure was change in ER stress markers while safety, tolerability and change in UC disease activity were secondary outcomes. Results:Thirteen participants completed the study with eleven evaluable for clinical response. TUDCA was well-tolerated with transient dyspepsia being the most common side effect. Mucosal biopsies revealed significant reductions in ER stress and inflammation as well as an increase in markers of epithelial restitution. Clinical, endoscopic, and histologic disease activity were significantly improved at week 6 (mean total Mayo Score: 9 to 4.5, p<0.001). Conclusions:Six weeks of oral TUDCA treatment was well-tolerated in patients with active ulcerative colitis and promoted mucosal healing, lessened ER stress, and reduced clinical disease activity. A randomized controlled trial of adjunctive TUDCA therapy in patients with UC is warranted. Trial registration:ClinicalTrials.gov (NCT04114292).

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with early-appearing social communication deficits and repetitive behaviors. ASD is associated with various comorbidities, including gastrointestinal (GI) conditions. This study aims to identify shared genetic mutations between ASD, inflammatory bowel disease (IBD), and celiac disease through bioinformatics, to uncover mechanisms contributing to GI issues in ASD patients. In this study, databases including DisGeNET, Genome Wide Association Study (GWAS) Catalog, and Ensembl were utilized to identify variation disease associations (VDAs) for ASD, celiac disease and IBD. Shared VDAs were identified using the Molbiotools website and validated by reviewing original articles and resources provided by the databases. In our screening 2367 VDAs found for ASD, 458 for Celiac disease and 1912 for IBD. However, search across these databases revealed only 3 shared VDAs among ASD, celiac disease and IBD. These shared VDAs were found in the Methylenetetrahydrofolate reductase (MTHFR), Myosin IXB (MYO9B), and Transcobalamin 2 (TCN2) genes. However, the association between the TCN2 gene and celiac disease was not confirmed during the validation process. In this study, we investigated the shared genetic basis between ASD and genetically defined GI disorders based on previously published papers. The findings of this study provide valuable insights into the shared genetic basis of these diseases; however, further investigations are needed to understand these genetic implications.

Background: Gastric cancer (GC) patients have a poor prognosis mainly due to late diagnosis. We aimed to study the prognostic effects of various biomarkers, including HER2, CD34, p53, Ki67, Cox2, MMP7, and vimentin in GC. Methods: We performed immunohistochemistry (IHC) to examine the expression of potential biomarkers in 140 GC patients. CD34 protein expression was quantified to assess angiogenesis through scoring microvessel density (MVD). We used a multivariable Cox-proportional hazard model to estimate hazard ratios (HRs) representing the prognostic role of the biomarkers and the clinicopathological parameters. Results: Patients diagnosed at the advanced tumor stage exhibited a significantly higher risk of mortality than those diagnosed at the early stages (HR = 5.96, CI: 3.73 – 9.51). We also observed higher risks of mortality in patients with high MVD-CD34 (HR = 5.35, CI: 2.36 – 12.12), HER2-positive (HR = 2.82, CI: 1.69 – 4.37), p53-positive (HR = 4.03, CI: 2.53 – 6.4), high Ki67 (HR = 4.34, CI: 2.64 – 7.13), high Cox2 (HR = 4.77, CI: 2.39 – 9.49), high MMP7 (HR = 2.75, CI: 1.53 – 4.94), and high vimentin (HR = 3.78, CI: 1.7 – 8.39) tumors compared to their corresponding reference groups. The association was statistically significant for HER2, p53, Ki67, Cox2, and MVD-CD34 among those diagnosed in an early stage. Conclusion: Overall, evaluation of tumor biomarkers in GC patients can result in more precise estimates of prognosis, especially in early-stage tumors. These biomarkers could potentially be considered for targeted therapy of GC patients to improve their survival.

BACKGROUND:Randomized clinical trials (RCTs) of computer-aided detection (CADe) system-enhanced colonoscopy compared with conventional colonoscopy suggest increased adenoma detection rate (ADR) and decreased adenoma miss rate (AMR), but the effect on detection of advanced colorectal neoplasia (ACN) is unclear. PURPOSE:To conduct a systematic review to compare performance of CADe-enhanced and conventional colonoscopy. DATA SOURCES:Cochrane Library, Google Scholar, Ovid EMBASE, Ovid MEDLINE, PubMed, Scopus, and Web of Science Core Collection databases were searched through February 2024. STUDY SELECTION:Published RCTs comparing CADe-enhanced and conventional colonoscopy. DATA EXTRACTION:Average adenoma per colonoscopy (APC) and ACN per colonoscopy were primary outcomes. Adenoma detection rate, AMR, and ACN detection rate (ACN DR) were secondary outcomes. Balancing outcomes included withdrawal time and resection of nonneoplastic polyps (NNPs). Subgroup analyses were done by neural network architecture. DATA SYNTHESIS:Forty-four RCTs with 36 201 cases were included. Computer-aided detection-enhanced colonoscopies have higher average APC (12 090 of 12 279 [0.98] vs. 9690 of 12 292 [0.78], incidence rate difference [IRD] = 0.22 [95% CI, 0.16 to 0.28]) and higher ADR (7098 of 16 253 [44.7%] vs. 5825 of 15 855 [36.7%], rate ratio [RR] = 1.21 [CI, 1.15 to 1.28]). Average ACN per colonoscopy was similar (1512 of 9296 [0.16] vs. 1392 of 9121 [0.15], IRD = 0.01 [CI, -0.01 to 0.02]), but ACN DR was higher with CADe system use (1260 of 9899 [12.7%] vs. 1119 of 9746 [11.5%], RR = 1.16 [CI, 1.02 to 1.32]). Using CADe systems resulted in resection of almost 2 extra NNPs per 10 colonoscopies and longer total withdrawal time (0.53 minutes [CI, 0.30 to 0.77]). LIMITATION:Statistically significant heterogeneity in quality and sample size and inability to blind endoscopists to the intervention in included studies may affect the performance estimates. CONCLUSION:Computer-aided detection-enhanced colonoscopies have increased APC and detection rate but no difference in ACN per colonoscopy and a small increase in ACN DR. There is minimal increase in procedure time and no difference in performance across neural network architectures. PRIMARY FUNDING SOURCE:None. (PROSPERO: CRD42023422835).