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Iacucci M, Santacroce G, Zammarchi I, Maeda Y, Del Amor R, Meseguer P, Kolawole BB, Chaudhari U, Di Sabatino A, Danese S, Mori Y, Grisan E, Naranjo V, Ghosh S. Artificial intelligence and endo-histo-omics: new dimensions of precision endoscopy and histology in inflammatory bowel disease. Lancet Gastroenterol Hepatol 2024:S2468-1253(24)00053-0. [PMID: 38759661 DOI: 10.1016/s2468-1253(24)00053-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/16/2024] [Accepted: 02/23/2024] [Indexed: 05/19/2024]
Abstract
Integrating artificial intelligence into inflammatory bowel disease (IBD) has the potential to revolutionise clinical practice and research. Artificial intelligence harnesses advanced algorithms to deliver accurate assessments of IBD endoscopy and histology, offering precise evaluations of disease activity, standardised scoring, and outcome prediction. Furthermore, artificial intelligence offers the potential for a holistic endo-histo-omics approach by interlacing and harmonising endoscopy, histology, and omics data towards precision medicine. The emerging applications of artificial intelligence could pave the way for personalised medicine in IBD, offering patient stratification for the most beneficial therapy with minimal risk. Although artificial intelligence holds promise, challenges remain, including data quality, standardisation, reproducibility, scarcity of randomised controlled trials, clinical implementation, ethical concerns, legal liability, and regulatory issues. The development of standardised guidelines and interdisciplinary collaboration, including policy makers and regulatory agencies, is crucial for addressing these challenges and advancing artificial intelligence in IBD clinical practice and trials.
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Affiliation(s)
- Marietta Iacucci
- APC Microbiome Ireland, College of Medicine and Health, University College of Cork, Cork, Ireland.
| | - Giovanni Santacroce
- APC Microbiome Ireland, College of Medicine and Health, University College of Cork, Cork, Ireland
| | - Irene Zammarchi
- APC Microbiome Ireland, College of Medicine and Health, University College of Cork, Cork, Ireland
| | - Yasuharu Maeda
- APC Microbiome Ireland, College of Medicine and Health, University College of Cork, Cork, Ireland
| | - Rocío Del Amor
- Instituto de Investigación e Innovación en Bioingeniería, HUMAN-tech, Universitat Politècnica de València, València, Spain
| | - Pablo Meseguer
- Instituto de Investigación e Innovación en Bioingeniería, HUMAN-tech, Universitat Politècnica de València, València, Spain; Valencian Graduate School and Research Network of Artificial Intelligence, Valencia, Spain
| | | | | | - Antonio Di Sabatino
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Yuichi Mori
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway; Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Enrico Grisan
- School of Engineering, London South Bank University, London, UK
| | - Valery Naranjo
- Instituto de Investigación e Innovación en Bioingeniería, HUMAN-tech, Universitat Politècnica de València, València, Spain
| | - Subrata Ghosh
- APC Microbiome Ireland, College of Medicine and Health, University College of Cork, Cork, Ireland
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2
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Ahmad HA, East JE, Panaccione R, Travis S, Canavan JB, Usiskin K, Byrne MF. Artificial Intelligence in Inflammatory Bowel Disease Endoscopy: Implications for Clinical Trials. J Crohns Colitis 2023; 17:1342-1353. [PMID: 36812142 PMCID: PMC10441563 DOI: 10.1093/ecco-jcc/jjad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Indexed: 02/24/2023]
Abstract
Artificial intelligence shows promise for clinical research in inflammatory bowel disease endoscopy. Accurate assessment of endoscopic activity is important in clinical practice and inflammatory bowel disease clinical trials. Emerging artificial intelligence technologies can increase efficiency and accuracy of assessing the baseline endoscopic appearance in patients with inflammatory bowel disease and the impact that therapeutic interventions may have on mucosal healing in both of these contexts. In this review, state-of-the-art endoscopic assessment of mucosal disease activity in inflammatory bowel disease clinical trials is described, covering the potential for artificial intelligence to transform the current paradigm, its limitations, and suggested next steps. Site-based artificial intelligence quality evaluation and inclusion of patients in clinical trials without the need for a central reader is proposed; for following patient progress, a second reading using AI alongside a central reader with expedited reading is proposed. Artificial intelligence will support precision endoscopy in inflammatory bowel disease and is on the threshold of advancing inflammatory bowel disease clinical trial recruitment.
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Affiliation(s)
| | - James E East
- Translational Gastroenterology Unit, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Remo Panaccione
- Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, AB, Canada
| | - Simon Travis
- Translational Gastroenterology Unit, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | | | | | - Michael F Byrne
- University of British Columbia, Division of Gastroenterology, Department of Medicine, Vancouver, BC, Canada
- Satisfai Health, Vancouver, BC, Canada
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3
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Big Data in Gastroenterology Research. Int J Mol Sci 2023; 24:ijms24032458. [PMID: 36768780 PMCID: PMC9916510 DOI: 10.3390/ijms24032458] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/28/2023] Open
Abstract
Studying individual data types in isolation provides only limited and incomplete answers to complex biological questions and particularly falls short in revealing sufficient mechanistic and kinetic details. In contrast, multi-omics approaches to studying health and disease permit the generation and integration of multiple data types on a much larger scale, offering a comprehensive picture of biological and disease processes. Gastroenterology and hepatobiliary research are particularly well-suited to such analyses, given the unique position of the luminal gastrointestinal (GI) tract at the nexus between the gut (mucosa and luminal contents), brain, immune and endocrine systems, and GI microbiome. The generation of 'big data' from multi-omic, multi-site studies can enhance investigations into the connections between these organ systems and organisms and more broadly and accurately appraise the effects of dietary, pharmacological, and other therapeutic interventions. In this review, we describe a variety of useful omics approaches and how they can be integrated to provide a holistic depiction of the human and microbial genetic and proteomic changes underlying physiological and pathophysiological phenomena. We highlight the potential pitfalls and alternatives to help avoid the common errors in study design, execution, and analysis. We focus on the application, integration, and analysis of big data in gastroenterology and hepatobiliary research.
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Vulpoi RA, Luca M, Ciobanu A, Olteanu A, Barboi OB, Drug VL. Artificial Intelligence in Digestive Endoscopy—Where Are We and Where Are We Going? Diagnostics (Basel) 2022; 12:diagnostics12040927. [PMID: 35453975 PMCID: PMC9029251 DOI: 10.3390/diagnostics12040927] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/30/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
Artificial intelligence, a computer-based concept that tries to mimic human thinking, is slowly becoming part of the endoscopy lab. It has developed considerably since the first attempt at developing an automated medical diagnostic tool, today being adopted in almost all medical fields, digestive endoscopy included. The detection rate of preneoplastic lesions (i.e., polyps) during colonoscopy may be increased with artificial intelligence assistance. It has also proven useful in detecting signs of ulcerative colitis activity. In upper digestive endoscopy, deep learning models may prove to be useful in the diagnosis and management of upper digestive tract diseases, such as gastroesophageal reflux disease, Barrett’s esophagus, and gastric cancer. As is the case with all new medical devices, there are challenges in the implementation in daily medical practice. The regulatory, economic, organizational culture, and language barriers between humans and machines are a few of them. Even so, many devices have been approved for use by their respective regulators. Future studies are currently striving to develop deep learning models that can replicate a growing amount of human brain activity. In conclusion, artificial intelligence may become an indispensable tool in digestive endoscopy.
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Affiliation(s)
- Radu-Alexandru Vulpoi
- Institute of Gastroenterology and Hepatology, Saint Spiridon Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, 700111 Iași, Romania; (R.-A.V.); (A.O.); (V.L.D.)
| | - Mihaela Luca
- Institute of Computer Science, Romanian Academy—Iași Branch, 700481 Iași, Romania; (M.L.); (A.C.)
| | - Adrian Ciobanu
- Institute of Computer Science, Romanian Academy—Iași Branch, 700481 Iași, Romania; (M.L.); (A.C.)
| | - Andrei Olteanu
- Institute of Gastroenterology and Hepatology, Saint Spiridon Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, 700111 Iași, Romania; (R.-A.V.); (A.O.); (V.L.D.)
| | - Oana-Bogdana Barboi
- Institute of Gastroenterology and Hepatology, Saint Spiridon Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, 700111 Iași, Romania; (R.-A.V.); (A.O.); (V.L.D.)
- Correspondence: ; Tel.: +40-74-345-5012
| | - Vasile Liviu Drug
- Institute of Gastroenterology and Hepatology, Saint Spiridon Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, 700111 Iași, Romania; (R.-A.V.); (A.O.); (V.L.D.)
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5
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Stidham RW, Takenaka K. Artificial Intelligence for Disease Assessment in Inflammatory Bowel Disease: How Will it Change Our Practice? Gastroenterology 2022; 162:1493-1506. [PMID: 34995537 PMCID: PMC8997186 DOI: 10.1053/j.gastro.2021.12.238] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 11/02/2021] [Accepted: 12/06/2021] [Indexed: 02/07/2023]
Abstract
Artificial intelligence (AI) has arrived and it will directly impact how we assess, monitor, and manage inflammatory bowel disease (IBD). Advances in the machine learning methodologies that power AI have produced astounding results for replicating expert judgment and predicting clinical outcomes, particularly in the analysis of imaging. This review will cover general concepts for AI in IBD, with descriptions of common machine learning methods, including decision trees and neural networks. Applications of AI in IBD will cover recent achievements in endoscopic image interpretation and scoring, new capabilities for cross-sectional image analysis, natural language processing for automated understanding of clinical text, and progress in AI-powered clinical decision support tools. In addition to detailing current evidence supporting the capabilities of AI for replicating expert clinical judgment, speculative commentary on how AI may advance concepts of disease activity assessment, care pathways, and pathophysiologic mechanisms of IBD will be addressed.
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Affiliation(s)
- Ryan W. Stidham
- Division of Gastroenterology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA,Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| | - Kento Takenaka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
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6
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Takenaka K, Kawamoto A, Okamoto R, Watanabe M, Ohtsuka K. Artificial intelligence for endoscopy in inflammatory bowel disease. Intest Res 2022; 20:165-170. [PMID: 34986607 PMCID: PMC9081991 DOI: 10.5217/ir.2021.00079] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/25/2021] [Indexed: 12/09/2022] Open
Abstract
Inflammatory bowel disease (IBD), with its 2 subtypes, Crohn's disease and ulcerative colitis, is a complex chronic condition. A precise definition of disease activity and appropriate drug management greatly improve the clinical course while minimizing the risk or cost. Artificial intelligence (AI) has been used in several medical diseases or situations. Herein, we provide an overview of AI for endoscopy in IBD. We discuss how AI can improve clinical practice and how some components have already begun to shape our knowledge. There may be a time when we can use AI in clinical practice. As AI systems contribute to the exact diagnosis and treatment of human disease, we should continue to learn best practices in health care in the field of IBD.
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Affiliation(s)
- Kento Takenaka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ami Kawamoto
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryuichi Okamoto
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mamoru Watanabe
- TMDU Advanced Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuo Ohtsuka
- Endoscopic Unit, Tokyo Medical and Dental University, Tokyo, Japan
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Sutton RT, Zai Ane OR, Goebel R, Baumgart DC. Artificial intelligence enabled automated diagnosis and grading of ulcerative colitis endoscopy images. Sci Rep 2022; 12:2748. [PMID: 35177717 PMCID: PMC8854553 DOI: 10.1038/s41598-022-06726-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/04/2022] [Indexed: 02/07/2023] Open
Abstract
Endoscopic evaluation to reliably grade disease activity, detect complications including cancer and verification of mucosal healing are paramount in the care of patients with ulcerative colitis (UC); but this evaluation is hampered by substantial intra- and interobserver variability. Recently, artificial intelligence methodologies have been proposed to facilitate more objective, reproducible endoscopic assessment. In a first step, we compared how well several deep learning convolutional neural network architectures (CNNs) applied to a diverse subset of 8000 labeled endoscopic still images derived from HyperKvasir, the largest multi-class image and video dataset from the gastrointestinal tract available today. The HyperKvasir dataset includes 110,079 images and 374 videos and could (1) accurately distinguish UC from non-UC pathologies, and (2) inform the Mayo score of endoscopic disease severity. We grouped 851 UC images labeled with a Mayo score of 0-3, into an inactive/mild (236) and moderate/severe (604) dichotomy. Weights were initialized with ImageNet, and Grid Search was used to identify the best hyperparameters using fivefold cross-validation. The best accuracy (87.50%) and Area Under the Curve (AUC) (0.90) was achieved using the DenseNet121 architecture, compared to 72.02% and 0.50 by predicting the majority class ('no skill' model). Finally, we used Gradient-weighted Class Activation Maps (Grad-CAM) to improve visual interpretation of the model and take an explainable artificial intelligence approach (XAI).
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Affiliation(s)
- Reed T Sutton
- Division of Gastroenterology, University of Alberta, 130 University Campus, Edmonton, AB, T6G 2X8, Canada
| | - Osmar R Zai Ane
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
- Alberta Machine Intelligence Institute, University of Alberta, Edmonton, AB, Canada
| | - Randolph Goebel
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
- Alberta Machine Intelligence Institute, University of Alberta, Edmonton, AB, Canada
| | - Daniel C Baumgart
- Division of Gastroenterology, University of Alberta, 130 University Campus, Edmonton, AB, T6G 2X8, Canada.
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada.
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Kröner PT, Engels MML, Glicksberg BS, Johnson KW, Mzaik O, van Hooft JE, Wallace MB, El-Serag HB, Krittanawong C. Artificial intelligence in gastroenterology: A state-of-the-art review. World J Gastroenterol 2021; 27:6794-6824. [PMID: 34790008 PMCID: PMC8567482 DOI: 10.3748/wjg.v27.i40.6794] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/15/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
The development of artificial intelligence (AI) has increased dramatically in the last 20 years, with clinical applications progressively being explored for most of the medical specialties. The field of gastroenterology and hepatology, substantially reliant on vast amounts of imaging studies, is not an exception. The clinical applications of AI systems in this field include the identification of premalignant or malignant lesions (e.g., identification of dysplasia or esophageal adenocarcinoma in Barrett’s esophagus, pancreatic malignancies), detection of lesions (e.g., polyp identification and classification, small-bowel bleeding lesion on capsule endoscopy, pancreatic cystic lesions), development of objective scoring systems for risk stratification, predicting disease prognosis or treatment response [e.g., determining survival in patients post-resection of hepatocellular carcinoma), determining which patients with inflammatory bowel disease (IBD) will benefit from biologic therapy], or evaluation of metrics such as bowel preparation score or quality of endoscopic examination. The objective of this comprehensive review is to analyze the available AI-related studies pertaining to the entirety of the gastrointestinal tract, including the upper, middle and lower tracts; IBD; the hepatobiliary system; and the pancreas, discussing the findings and clinical applications, as well as outlining the current limitations and future directions in this field.
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Affiliation(s)
- Paul T Kröner
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, United States
| | - Megan ML Engels
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, United States
- Cancer Center Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam UMC, Location AMC, Amsterdam 1105, The Netherlands
| | - Benjamin S Glicksberg
- The Hasso Plattner Institute for Digital Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Kipp W Johnson
- The Hasso Plattner Institute for Digital Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Obaie Mzaik
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, United States
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Amsterdam 2300, The Netherlands
| | - Michael B Wallace
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, United States
- Division of Gastroenterology and Hepatology, Sheikh Shakhbout Medical City, Abu Dhabi 11001, United Arab Emirates
| | - Hashem B El-Serag
- Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX 77030, United States
- Section of Health Services Research, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX 77030, United States
| | - Chayakrit Krittanawong
- Section of Health Services Research, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX 77030, United States
- Section of Cardiology, Michael E. DeBakey VA Medical Center, Houston, TX 77030, United States
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Oka A, Ishimura N, Ishihara S. A New Dawn for the Use of Artificial Intelligence in Gastroenterology, Hepatology and Pancreatology. Diagnostics (Basel) 2021; 11:1719. [PMID: 34574060 PMCID: PMC8468082 DOI: 10.3390/diagnostics11091719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 12/15/2022] Open
Abstract
Artificial intelligence (AI) is rapidly becoming an essential tool in the medical field as well as in daily life. Recent developments in deep learning, a subfield of AI, have brought remarkable advances in image recognition, which facilitates improvement in the early detection of cancer by endoscopy, ultrasonography, and computed tomography. In addition, AI-assisted big data analysis represents a great step forward for precision medicine. This review provides an overview of AI technology, particularly for gastroenterology, hepatology, and pancreatology, to help clinicians utilize AI in the near future.
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Affiliation(s)
- Akihiko Oka
- Department of Internal Medicine II, Faculty of Medicine, Shimane University, Izumo 693-8501, Shimane, Japan; (N.I.); (S.I.)
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Abstract
Irritable bowel syndrome (IBS) is a common symptom-based condition of heterogeneous pathogenesis and clinical phenotype. This heterogeneity and multidimensional nature creates significant diagnostic and treatment challenges. Recent evidence has documented the benefits of diet and behavioral interventions. These nonmedical strategies are causing a shift from the traditional care model to a multidisciplinary care model. Recent evidence suggests that collaborative, team-based integrated care leads to better clinical outcomes and reduced cost per cure compared with traditional care. Although it is growing increasingly clear that integrated care offers significant benefits to IBS patients, widespread dissemination will require solutions to structural, cultural, and financial barriers.
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11
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Almomani A, Hitawala A, Abureesh M, Qapaja T, Alshaikh D, Zmaili M, Saleh MA, Alkhayyat M. Implications of artificial intelligence in inflammatory bowel disease: Diagnosis, prognosis and treatment follow up. Artif Intell Gastroenterol 2021; 2:85-93. [DOI: 10.35712/aig.v2.i3.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/18/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023] Open
Abstract
Driven by the tremendous availability of data, artificial intelligence (AI) using deep learning has emerged as a breakthrough computer technology in the last few decades and has recently been acknowledged by the Task Force on AI as a golden opportunity for research. With its ability to understand, learn from and build on non-linear relationships, AI aims to individualize medical care in an attempt to save time, cost, effort and improve patient’s safety. AI has been applied in multiple medical fields with substantial progress made in gastroenterology mainly to facilitate accurate detection of pathology in different disease processes, among which inflammatory bowel disease (IBD) seems to drag significant attention, specifically by interpreting imaging studies, endoscopic images and videos and -to a lesser extent- disease genomics. Moreover, models have been built to predict IBD occurrence, flare ups, persistence of histological inflammation, disease-related structural abnormalities as well as disease remission. In this article, we will review the applications of AI in IBD in the present medical literature at multiple points of IBD timeline, starting from disease prediction via genomic assessment, diagnostic phase via interpretation of radiological studies and AI-assisted endoscopy, and the role of AI in the evaluation of therapy response and prognosis of IBD patients.
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Affiliation(s)
- Ashraf Almomani
- Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH 44111, United States
| | - Asif Hitawala
- Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH 44111, United States
| | - Mohammad Abureesh
- Department of Internal Medicine, Staten Island University Hospital, New York City, NY 10305, United States
| | - Thabet Qapaja
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Dana Alshaikh
- School of Medicine, Mutah University, Alkarak 61710, Jordan
| | - Mohammad Zmaili
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Mohannad Abou Saleh
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Motasem Alkhayyat
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
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Rufino MN, da Costa AL, Jorge EN, Paiano VF, Camparoto ML, Keller R, Bremer-Neto H. Synbiotics improve clinical indicators of ulcerative colitis: systematic review with meta-analysis. Nutr Rev 2021; 80:157-164. [PMID: 34010402 DOI: 10.1093/nutrit/nuab017] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
CONTEXT Inflammatory bowel diseases are chronic, relapsing diseases that compromise life quality and expectancy. The increased incidence and prevalence of these diseases reinforce the need for research on prevention, therapy, and management innovations. Synbiotics (ie, probiotic plus prebiotic combinations) are suggested as an alternative or complementary therapy to conventional treatments for inflammatory bowel disease. OBJECTIVE The aim for this systematic review was to gather and analyze data from randomized controlled trials to provide more information to increase the current evidence level about the safety and efficacy of synbiotic use as a supplemental treatment for ulcerative colitis. DATA SOURCES Searches were performed in the Medline, Science Direct, Scielo, Scopus, and Embase databases between January 2017 and March 2019, using the keywords "colitis" and "synbiotics". DATA EXTRACTION The data extraction method performed for each trial was based on the recommendations of the Consolidated Standards of Reporting Trials for randomized clinical trials. The trials included in this meta-analysis presented low risk of bias, based on the Cochrane Handbook for Systematic Reviews of Interventions guidelines. DATA ANALYSIS The results demonstrated that synbiotics significantly improved colonic endoscopic and histologic scores, the Clinical Activity Index, serum C-reactive protein levels, intestinal microbiota, Bowel Habits Index, and levels of messenger RNAs, tumor necrosis factor-α, interleukin-1α, interleukin-10, and myeloperoxidase in the patients. In addition, the use of synbiotics increased probiotic microorganisms, reduced proinflammatory colonic cytokines, and elevated anti-inflammatory cytokines. CONCLUSIONS Therefore, the results of this meta-analysis reinforce the evidence that synbiotics provide benefits to patients when used as an alternative or complementary therapy for those with ulcerative colitis.
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Affiliation(s)
- Marcos Natal Rufino
- M.N. Rufino is with the Department of Functional Sciences, Faculty of Pharmacy, Universidade do Oeste Paulista, Presidente Prudente, Sao Paulo, Brasil. A.L. Costab, E.N. Jorgeb, V.F. Paianob, M.L. Camparoto, and H. Bremer-Neto are with the Department of Functional Sciences, Faculty of Medicine, Universidade do Oeste Paulista, Presidente Prudente, Sao Paulo, Brasil. R. Keller is with the Department of Microbiology, Faculty of Biological Sciences, Universidade do Oeste Paulista, Presidente Prudente, Sao Paulo, Brasil
| | - Airan Lobo da Costa
- M.N. Rufino is with the Department of Functional Sciences, Faculty of Pharmacy, Universidade do Oeste Paulista, Presidente Prudente, Sao Paulo, Brasil. A.L. Costab, E.N. Jorgeb, V.F. Paianob, M.L. Camparoto, and H. Bremer-Neto are with the Department of Functional Sciences, Faculty of Medicine, Universidade do Oeste Paulista, Presidente Prudente, Sao Paulo, Brasil. R. Keller is with the Department of Microbiology, Faculty of Biological Sciences, Universidade do Oeste Paulista, Presidente Prudente, Sao Paulo, Brasil
| | - Eloisa Nascimento Jorge
- M.N. Rufino is with the Department of Functional Sciences, Faculty of Pharmacy, Universidade do Oeste Paulista, Presidente Prudente, Sao Paulo, Brasil. A.L. Costab, E.N. Jorgeb, V.F. Paianob, M.L. Camparoto, and H. Bremer-Neto are with the Department of Functional Sciences, Faculty of Medicine, Universidade do Oeste Paulista, Presidente Prudente, Sao Paulo, Brasil. R. Keller is with the Department of Microbiology, Faculty of Biological Sciences, Universidade do Oeste Paulista, Presidente Prudente, Sao Paulo, Brasil
| | - Viviane Ferreira Paiano
- M.N. Rufino is with the Department of Functional Sciences, Faculty of Pharmacy, Universidade do Oeste Paulista, Presidente Prudente, Sao Paulo, Brasil. A.L. Costab, E.N. Jorgeb, V.F. Paianob, M.L. Camparoto, and H. Bremer-Neto are with the Department of Functional Sciences, Faculty of Medicine, Universidade do Oeste Paulista, Presidente Prudente, Sao Paulo, Brasil. R. Keller is with the Department of Microbiology, Faculty of Biological Sciences, Universidade do Oeste Paulista, Presidente Prudente, Sao Paulo, Brasil
| | - Marjori Leiva Camparoto
- M.N. Rufino is with the Department of Functional Sciences, Faculty of Pharmacy, Universidade do Oeste Paulista, Presidente Prudente, Sao Paulo, Brasil. A.L. Costab, E.N. Jorgeb, V.F. Paianob, M.L. Camparoto, and H. Bremer-Neto are with the Department of Functional Sciences, Faculty of Medicine, Universidade do Oeste Paulista, Presidente Prudente, Sao Paulo, Brasil. R. Keller is with the Department of Microbiology, Faculty of Biological Sciences, Universidade do Oeste Paulista, Presidente Prudente, Sao Paulo, Brasil
| | - Rogéria Keller
- M.N. Rufino is with the Department of Functional Sciences, Faculty of Pharmacy, Universidade do Oeste Paulista, Presidente Prudente, Sao Paulo, Brasil. A.L. Costab, E.N. Jorgeb, V.F. Paianob, M.L. Camparoto, and H. Bremer-Neto are with the Department of Functional Sciences, Faculty of Medicine, Universidade do Oeste Paulista, Presidente Prudente, Sao Paulo, Brasil. R. Keller is with the Department of Microbiology, Faculty of Biological Sciences, Universidade do Oeste Paulista, Presidente Prudente, Sao Paulo, Brasil
| | - Hermann Bremer-Neto
- M.N. Rufino is with the Department of Functional Sciences, Faculty of Pharmacy, Universidade do Oeste Paulista, Presidente Prudente, Sao Paulo, Brasil. A.L. Costab, E.N. Jorgeb, V.F. Paianob, M.L. Camparoto, and H. Bremer-Neto are with the Department of Functional Sciences, Faculty of Medicine, Universidade do Oeste Paulista, Presidente Prudente, Sao Paulo, Brasil. R. Keller is with the Department of Microbiology, Faculty of Biological Sciences, Universidade do Oeste Paulista, Presidente Prudente, Sao Paulo, Brasil
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Solitano V, D’Amico F, Allocca M, Fiorino G, Zilli A, Loy L, Gilardi D, Radice S, Correale C, Danese S, Peyrin-Biroulet L, Furfaro F. Rediscovering histology: what is new in endoscopy for inflammatory bowel disease? Therap Adv Gastroenterol 2021; 14:17562848211005692. [PMID: 33948114 PMCID: PMC8053840 DOI: 10.1177/17562848211005692] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 03/08/2021] [Indexed: 02/04/2023] Open
Abstract
The potential of endoscopic evaluation in the management of inflammatory bowel diseases (IBD) has undoubtedly grown over the last few years. When dealing with IBD patients, histological remission (HR) is now considered a desirable target along with symptomatic and endoscopic remission, due to its association with better long-term outcomes. Consequently, the ability of endoscopic techniques to reflect microscopic findings in vivo without having to collect biopsies has become of upmost importance. In this context, a more accurate evaluation of inflammatory disease activity and the detection of dysplasia represent two mainstay targets for IBD endoscopists. New diagnostic technologies have been developed, such as dye-less chromoendoscopy, endomicroscopy, and molecular imaging, but their real incorporation in daily practice is not yet well defined. Although dye-chromoendoscopy is still recommended as the gold standard approach in dysplasia surveillance, recent research questioned the superiority of this technique over new advanced dye-less modalities [narrow band imaging (NBI), Fuji intelligent color enhancement (FICE), i-scan, blue light imaging (BLI) and linked color imaging (LCI)]. The endoscopic armamentarium might also be enriched by new video capsule endoscopy for monitoring disease activity, and high expectations are placed on the application of artificial intelligence (AI) systems to reduce operator-subjectivity and inter-observer variability. The goal of this review is to provide an updated insight on contemporary knowledge regarding new endoscopic techniques and devices, with special focus on their role in the assessment of disease activity and colorectal cancer surveillance.
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Affiliation(s)
- Virginia Solitano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Ferdinando D’Amico
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy,IBD Center, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Mariangela Allocca
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy,IBD Center, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Gionata Fiorino
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy,IBD Center, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Alessandra Zilli
- IBD Center, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Laura Loy
- IBD Center, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Daniela Gilardi
- IBD Center, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Simona Radice
- IBD Center, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Carmen Correale
- IBD Center, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy,IBD Center, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
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14
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Cohen-Mekelburg S, Berry S, Stidham RW, Zhu J, Waljee AK. Clinical applications of artificial intelligence and machine learning-based methods in inflammatory bowel disease. J Gastroenterol Hepatol 2021; 36:279-285. [PMID: 33624888 PMCID: PMC8917815 DOI: 10.1111/jgh.15405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 12/12/2022]
Abstract
Our objective was to review and exemplify how selected applications of artificial intelligence (AI) might facilitate and improve inflammatory bowel disease (IBD) care and to identify gaps for future work in this field. IBD is highly complex and associated with significant variation in care and outcomes. The application of AI to IBD has the potential to reduce variation in healthcare delivery and improve quality of care. AI refers to the ability of machines to mimic human intelligence. The range of AI's ability to perform tasks that would normally require human intelligence varies from prediction to complex decision-making that more closely resembles human thought. Clinical applications of AI have been applied to study pathogenesis, diagnosis, and patient prognosis in IBD. Despite these advancements, AI in IBD is in its early development and has tremendous potential to transform future care.
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Affiliation(s)
- Shirley Cohen-Mekelburg
- Health Services Research and Development Center of Clinical Management Research and Gastroenterology Service, VA Ann Arbor,Michigan Medicine, Department of Internal Medicine, Division of Gastroenterology and Hepatology
| | - Sameer Berry
- Michigan Medicine, Department of Internal Medicine, Division of Gastroenterology and Hepatology
| | - Ryan W Stidham
- Michigan Medicine, Department of Internal Medicine, Division of Gastroenterology and Hepatology,Department of Computational Medicine and Bioinformatics,Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, Michigan, USA
| | - Ji Zhu
- Department of Statistics, University of Michigan,Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, Michigan, USA
| | - Akbar K Waljee
- Health Services Research and Development Center of Clinical Management Research and Gastroenterology Service, VA Ann Arbor,Michigan Medicine, Department of Internal Medicine, Division of Gastroenterology and Hepatology,Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, Michigan, USA
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15
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Seyed Tabib NS, Madgwick M, Sudhakar P, Verstockt B, Korcsmaros T, Vermeire S. Big data in IBD: big progress for clinical practice. Gut 2020; 69:1520-1532. [PMID: 32111636 PMCID: PMC7398484 DOI: 10.1136/gutjnl-2019-320065] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 12/12/2022]
Abstract
IBD is a complex multifactorial inflammatory disease of the gut driven by extrinsic and intrinsic factors, including host genetics, the immune system, environmental factors and the gut microbiome. Technological advancements such as next-generation sequencing, high-throughput omics data generation and molecular networks have catalysed IBD research. The advent of artificial intelligence, in particular, machine learning, and systems biology has opened the avenue for the efficient integration and interpretation of big datasets for discovering clinically translatable knowledge. In this narrative review, we discuss how big data integration and machine learning have been applied to translational IBD research. Approaches such as machine learning may enable patient stratification, prediction of disease progression and therapy responses for fine-tuning treatment options with positive impacts on cost, health and safety. We also outline the challenges and opportunities presented by machine learning and big data in clinical IBD research.
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Affiliation(s)
| | - Matthew Madgwick
- Organisms and Ecosystems, Earlham Institute, Norwich, UK
- Gut microbes in health and disease, Quadram Institute Bioscience, Norwich, UK
| | - Padhmanand Sudhakar
- Department of Chronic Diseases, Metabolism and Ageing, TARGID, KU Leuven, Leuven, Belgium
- Organisms and Ecosystems, Earlham Institute, Norwich, UK
- Gut microbes in health and disease, Quadram Institute Bioscience, Norwich, UK
| | - Bram Verstockt
- Translational Research in GastroIntestinal Disorders, KU Leuven, Leuven, Belgium
- Department of Gastroenterology and Hepatology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Tamas Korcsmaros
- Organisms and Ecosystems, Earlham Institute, Norwich, UK
- Gut microbes in health and disease, Quadram Institute Bioscience, Norwich, UK
| | - Séverine Vermeire
- Department of Chronic Diseases, Metabolism and Ageing, TARGID, KU Leuven, Leuven, Belgium
- Department of Gastroenterology and Hepatology, KU Leuven University Hospitals Leuven, Leuven, Belgium
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16
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Abadir AP, Ali MF, Karnes W, Samarasena JB. Artificial Intelligence in Gastrointestinal Endoscopy. Clin Endosc 2020; 53:132-141. [PMID: 32252506 PMCID: PMC7137570 DOI: 10.5946/ce.2020.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/17/2020] [Indexed: 02/06/2023] Open
Abstract
Artificial intelligence (AI) is rapidly integrating into modern technology and clinical practice. Although in its nascency, AI has become a hot topic of investigation for applications in clinical practice. Multiple fields of medicine have embraced the possibility of a future with AI assisting in diagnosis and pathology applications. In the field of gastroenterology, AI has been studied as a tool to assist in risk stratification, diagnosis, and pathologic identification. Specifically, AI has become of great interest in endoscopy as a technology with substantial potential to revolutionize the practice of a modern gastroenterologist. From cancer screening to automated report generation, AI has touched upon all aspects of modern endoscopy. Here, we review landmark AI developments in endoscopy. Starting with broad definitions to develop understanding, we will summarize the current state of AI research and its potential applications. With innovation developing rapidly, this article touches upon the remarkable advances in AI-assisted endoscopy since its initial evaluation at the turn of the millennium, and the potential impact these AI models may have on the modern clinical practice. As with any discussion of new technology, its limitations must also be understood to apply clinical AI tools successfully.
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Affiliation(s)
- Alexander P Abadir
- Department of Medicine, University of California Irvine, Orange, CA, USA
| | - Mohammed Fahad Ali
- Department of Medicine, University of California Irvine, Orange, CA, USA
| | - William Karnes
- Division of Gastroenterology & Hepatology, Department of Medicine, H. H. Chao Comprehensive Digestive Disease Center, University of California Irvine, Orange, CA, USA
| | - Jason B Samarasena
- Division of Gastroenterology & Hepatology, Department of Medicine, H. H. Chao Comprehensive Digestive Disease Center, University of California Irvine, Orange, CA, USA
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17
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Dulai PS, Singh S, Jairath V, Ma C, Narula N, Casteele NV, Peyrin-Biroulet L, Vermeire S, D’Haens G, Feagan BG, Sandborn WJ. Prevalence of endoscopic improvement and remission according to patient-reported outcomes in ulcerative colitis. Aliment Pharmacol Ther 2020; 51:435-445. [PMID: 31755121 PMCID: PMC6989392 DOI: 10.1111/apt.15577] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Treatment targets for ulcerative colitis are evolving towards achievement of endoscopic improvement and remission in addition to symptom resolution. It remains to be accurately quantified what proportion of patients with symptom resolution have residual endoscopic activity that might warrant treatment modification. AIM To quantify the prevalence of endoscopic improvement and remission amongst ulcerative colitis patients with various permutations of patient-reported outcomes. METHODS Individual participant data from active intervention and placebo arms of clinical trials of infliximab, golimumab, vedolizumab and tofacitinib were pooled to estimate the prevalence of endoscopic improvement (Mayo endoscopic sub-score [MES] 0 or 1) and remission (MES 0) scores with various permutations of the rectal bleeding sub-score (RBS) and stool frequency sub-score (SFS) of the Mayo score, following induction (6-8 weeks) and maintenance (30-54 weeks) therapy. Subgroup analyses were performed by year of publication and centrally read endoscopy scoring. RESULTS Data from 2586 trial participants were analysed. Using locally scored endoscopy, the prevalence of endoscopic improvement and remission was highest among participants with a RBS 0 + SFS 0 post-induction (MES 0/1:81%, [95% CI 78-84]; MES 0:29% [26-33]) and during maintenance (MES 0/1:91% [87-93]; MES 0:57% [52-62]). Prevalence estimates were lower for more recently performed trials (P < .01). In comparison to locally scored endoscopy, when using central endoscopy scoring, the prevalence of endoscopic improvement and remission was lower post-induction (MES 0/1 57% [50-64], P < .001; MES 0 15% [11-21], P = .09) and during maintenance (MES 0/1 74% [67-81], P = .001; MES 0 31% [24-38], P = .001) for participants achieving a RBS 0 + SFS 0. CONCLUSIONS Approximately 8 of 10 patients with normalisation of rectal bleeding and stool frequency have improvement in endoscopic disease activity, whereas approximately only half of these patients have endoscopic remission.
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Affiliation(s)
| | | | - Vipul Jairath
- University of Western Ontario, London, Ontario, Canada
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