Latest news with #DigestiveDiseaseWeek
New York Post
5 days ago
- Health
- New York Post
Just 3 ounces of these 3 tasty foods can help with constipation
Time to call for back up. There are few sensations as uncomfortable as being blocked up, feeling like there's a bowling bowl in your belly, taking several hopeful trips to the bathroom only to come up empty. Luckily, you don't necessarily need medication to get relief from constipation — just a few of these pantry staples will do the trick. 4 You don't necessarily need medication to get relief from constipation — just a few of these pantry staples will do the trick. Graphicroyalty – Research recently presented at the Digestive Disease Week conference suggests grandma really did know best: prunes, raisins and dried apricots will let your people go. The study put 150 participants with chronic constipation into one of three groups: one that consumed three ounces of the dried fruits daily, one that drank the juice of said fruits and one that took a sugar water placebo for a month. Because they are committed to science, the researchers took rigorous notes on any changes in poop at the end of every seven-day dump. While the juice helped, the most marked improvements in bowel movements — and mood — came from the fruit group. Stool weight — which is a good marker of how everything is operating down there — jumped by 21 grams per day in the dried fruit-eating group, compared to a paltry 1.6 grams with the placebo cohort. 4 Research recently presented at the Digestive Disease Week conference suggests grandma really did know best: prunes, raisins and dried apricots will let your people go. M-Production – And the lucky ducks in the groups that consumed the fruit in both its dry and juiced form had 1.3 times as many spontaneous bathroom breaks per week than the suckers stuck with the placebo. 'People who ate dried fruit had more complete bowel movements than those taking the placebo and the weight of their stools increased significantly,' Dr. Simon Steenson, Postdoctoral Research Associate in the Department of Nutritional Sciences at King's College London, told 'They also reported a higher level of treatment satisfaction, without any significant side effects.' Steenson noted that while 'chronic constipation is something that can be embarrassing…it affects one in 10 people globally,' which is nothing to fart at. 4 The magic of raisins, dried apricots and prunes lies in their high content of fiber — which aids digestion — and sorbitol, which pulls water into the intestines, making stools softer and easier to pass. Pixel-Shot – He also pointed out that 80% of the US population doesn't meet the recommendation guidelines for dried fruit, which is the three ounces used in the study or half a cup. The magic of raisins, dried apricots and prunes lies in their high content of fiber — which aids digestion — and sorbitol, which pulls water into the intestines, making stools softer and easier to pass. Just make sure not to have too much, otherwise it might literally backfire. And if you're concerned about the sugar content of these fruits, Steenson believes there are bigger baddies out there. 4 The sugar content in these dried fruits is 'less of a concern than the sugar in sodas and is unlikely to be an issue for our calorie intake or blood glucose,' Steenson said. Peruphotoart – 'It's true that dried fruit does contain quite a lot of sugar, but this is contained within the cells of the fruit and so it takes time for our bodies to break down and release this sugar,' he told the outlet. 'So, it is less of a concern than the sugar in sodas and is unlikely to be an issue for our calorie intake or blood glucose.' It's worth noting that this study has not yet been peer-reviewed and was funded by the International Nut and Dried Fruit Council (INC). However, it is also the largest clinical trial to date to see if these foods could relieve constipation — and, anyway, the evidence speaks for itself. Finally, in addition to giving your bowels their freedom back, you can keep raisins, prunes and dried apricot in the pantry for quite some time — because they will outlive you and everything you love.
Medscape
02-06-2025
- Health
- Medscape
AI Algorithm Predicts Transfusion Need in Acute GI Bleeds
SAN DIEGO — A novel generative artificial intelligence (AI) framework known as trajectory flow matching (TFM) can predict the need for red blood cell transfusion and mortality risk in intensive care unit (ICU) patients with acute gastrointestinal (GI) bleeding, researchers reported at Digestive Disease Week (DDW) 2025. Acute GI bleeding is the most common cause of digestive disease–related hospitalization, with an estimated 500,000 hospital admissions annually. It's known that predicting the need for red blood cell transfusion in the first 24 hours may improve resuscitation and decrease both morbidity and mortality. However, an existing clinical score known as the Rockall Score does not perform well for predicting mortality, Xi (Nicole) Zhang, an MD-PhD student at McGill University, Montreal, Quebec, Canada, told attendees at DDW. With an area under the curve of 0.65-0.75, better prediction is needed, Zhang said, whose coresearchers included Dennis Shung, MD, MHS, PhD, assistant professor of medicine and director of Applied Artificial Intelligence at Yale University School of Medicine, New Haven, Connecticut. 'We'd like to predict multiple outcomes in addition to mortality,' said Zhang, who is also a student at the Mila-Quebec Artificial Intelligence Institute. As a result, the researchers turned to the TFM approach, applying it to ICU patients with acute GI bleeding to predict both the need for transfusion and in-hospital mortality risk. The all-cause mortality rate is up to 11%, according to a 2020 study by James Y. W. Lau, MD, and colleagues. The rebleeding rate of nonvariceal upper GI bleeds is up to 10.4%. Zhang said the rebleeding rate for variceal upper gastrointestinal bleeding is up to 65%. The AI method the researchers used outperformed a standard deep learning model at predicting the need for transfusion and estimating mortality risk. Defining the AI Framework 'Probabilistic flow matching is a class of generative artificial intelligence that learns how a simple distribution becomes a more complex distribution with ordinary differential equations,' Zhang told Medscape Medical News. 'For example, if you had a few lines and shapes you could learn how it could become a detailed portrait of a face. In our case, we start with a few blood pressure and heart rate measurements and learn the pattern of blood pressures and heart rates over time, particularly if they reflect clinical deterioration with hemodynamic instability.' Another way to think about the underlying algorithm, Zhang said, is to think about a river with boats where the river flow determines where the boats end up. 'We are trying to direct the boat to the correct dock by adjusting the flow of water in the canal. In this case we are mapping the distribution with the first few data points to the distribution with the entire patient trajectory.' The information gained, she said, could be helpful in timing endoscopic evaluation or allocating red blood cell products for emergent transfusion. Study Details The researchers evaluated a cohort of 2602 patients admitted to the ICU, identified from the publicly available MIMIC-III database. They divided the patients into a training set of 2342 patients and an internal validation set of 260 patients. Input variables were severe liver disease comorbidity, administration of vasopressor medications, mean arterial blood pressure, and heart rate over the first 24 hours. Excluded was hemoglobin, since the point was to test the trajectory of hemodynamic parameters independent of hemoglobin thresholds used to guide red blood cell transfusion. The outcome measures were administration of packed red blood cell transfusion within 24 hours and all-cause hospital mortality. The TFM was more accurate than a standard deep learning model in predicting red blood cell transfusion, with an accuracy of 93.6% vs 43.2%; P ≤ .001. It was also more accurate at predicting all-cause in-hospital mortality, with an accuracy of 89.5% vs 42.5%, P = .01. The researchers concluded that the TFM approach was able to predict the hemodynamic trajectories of patients with acute GI bleeding defined as deviation and outperformed the baseline from the measured mean arterial pressure and heart rate. Expert Perspective 'This is an exciting proof-of-concept study that shows generative AI methods may be applied to complex datasets in order to improve on our current predictive models and improve patient care,' said Jeremy Glissen Brown, MD, MSc, an assistant professor of medicine and a practicing gastroenterologist at Duke University who has published research on the use of AI in clinical practice. He reviewed the study for Medscape Medical News but was not involved in the research. 'Future work will likely look into the implementation of a version of this model on real-time data.' He added: 'We are at an exciting inflection point in predictive models within GI and clinical medicine. Predictive models based on deep learning and generative AI hold the promise of improving how we predict and treat disease states, but the excitement being generated with studies such as this needs to be balanced with the trade-offs inherent to the current paradigm of deep learning and generative models compared to more traditional regression-based models. These include many of the same 'black box' explainability questions that have risen in the age of convolutional neural networks as well as some method-specific questions due to the continuous and implicit nature of TFM.' Elaborating on that, Glissen Brown said: 'TFM, like many deep learning techniques, raises concerns about explainability that we've long seen with convolutional neural networks — the 'black box' problem, where it's difficult to interpret exactly how and why the model arrives at a particular decision. But TFM also introduces unique challenges due to its continuous and implicit formulation. Since it often learns flows without explicitly defining intermediate representations or steps, it can be harder to trace the logic or pathways it uses to connect inputs to outputs. This makes standard interpretability tools less effective and calls for new techniques tailored to these continuous architectures.' 'This approach could have a real clinical impact,' said Robert Hirten, MD, associate professor of medicine and artificial intelligence, Icahn School of Medicine at Mount Sinai, New York City, who also reviewed the study. 'Accurately predicting transfusion needs and mortality risk in real time could support earlier, more targeted interventions for high-risk patients. While these findings still need to be validated in prospective studies, it could enhance ICU decision-making and resource allocation.' 'For the practicing gastroenterologist, we envision this system could help them figure out when to perform endoscopy in a patient admitted with acute gastrointestinal bleeding in the ICU at very high risk of exsanguination,' Zhang told Medscape Medical News. The approach, the researchers said, will be useful in identifying unique patient characteristics, make possible the identification of high-risk patients and lead to more personalized medicine. Hirten, Zhang, and Shung had no disclosures. Glissen Brown reported consulting relationships with Medtronic, OdinVision, Doximity, and Olympus.
Medscape
22-05-2025
- Health
- Medscape
Chatbot Helps Users Adopt a Low FODMAP Diet
SAN DIEGO — Low fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) dietary advice has been shown to be effective in easing bloating and abdominal pain, especially in patients with irritable bowel syndrome (IBS), but limited availability of dietitians makes delivering this advice challenging. Researchers from Thailand have successfully enlisted a chatbot to help. In a randomized controlled trial, they found that chatbot-assisted dietary advice with brief guidance effectively reduced high FODMAP intake, bloating severity, and improved dietary knowledge, particularly in patients with bothersome bloating. 'Chatbot-assisted dietary advice for FODMAPs restriction was feasible and applicable in patients with bloating symptoms that had baseline symptoms of moderate severity,' study chief Pochara Somvanapanich, with the Division of Gastroenterology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand, told Medscape Medical News. Somvanapanich, who developed the chatbot algorithm, presented the study results at Digestive Disease Week (DDW) 2025. More Knowledge, Less Bloating The trial enrolled 86 adults with disorders of gut-brain interaction experiencing bloating symptoms for more than 6 months and consuming more than seven high-FODMAPs items per week. Half of them had IBS. At baseline, gastrointestinal (GI) symptoms and the ability to identify FODMAPs were assessed. All participants received a 5-minute consultation on FODMAPs avoidance from a GI fellow and were randomly allocated (stratified by IBS diagnosis and education) into two groups. The chatbot-assisted group received real-time dietary advice via a chatbot which helped them identify high, low, and non-FODMAP foods from a list of more than 300 ingredients/dishes of Thai and western cuisines. The control group received only brief advice on high FODMAPs restriction. Both groups used a diary app to log food intake and postprandial symptoms. Baseline bloating, abdominal pain and global symptoms severity were similar between the two groups. Data on 64 participants (32 in each group) were analyzed. After 4 weeks, significantly more people in the chatbot group than the control group responded — achieving a 30% or greater reduction in daily worst bloating, abdominal pain or global symptoms (19 [59%] vs 10 [31%], P < .05). Responder rates were similar in the IBS and non-IBS subgroups. Subgroup analysis revealed significant differences between groups only for participants with bothersome bloating, not those with mild bloating severity. In those with bothersome bloating severity, the chatbot group had a higher response rate (69.5% vs 36.3%) and fewer bloating symptoms ( P < .05). They also had a greater reduction in high FODMAPs intake (10 vs 23 items/week) and demonstrated improved knowledge in identifying FODMAPs ( P < .05). 'Responders in a chatbot group consistently engaged more with the app, performing significantly more weekly item searches than nonresponders ( P < .05),' the authors noted in their conference abstract. 'Our next step is to develop the chatbot-assisted approach for the reintroduction and personalization phase based on messenger applications (including Facebook Messenger and other messaging platforms),' Somvanapanich told Medscape Medical News . 'Once we've gathered enough data to confirm these are working effectively, we definitely plan to create a one-stop service application for FODMAPs dietary advice,' Somvanapanich added. Lack of Robust Data on Digital GI Health Apps Commenting on this research for Medscape Medical News , Sidhartha R. Sinha, MD, Director of Digital Health and Innovation, Division of Gastroenterology and Hepatology, Stanford University in Stanford, California, noted that there is a 'notable lack of robust data supporting digital health tools in gastroenterology. Despite hundreds of apps available, very few are supported by well-designed trials.' 'The study demonstrated that chatbot-assisted dietary advice significantly improved bloating symptoms, reduced intake of high-FODMAP foods, and enhanced patients' dietary knowledge compared to brief dietary counseling alone, especially in those with bothersome symptoms,' said Sinha, who wasn't involved in the study. 'Patients actively used the chatbot to manage their symptoms, achieving a higher response rate than those in the control arm who received brief counseling on avoiding high-FODMAP food,' he noted. Sinha said in his practice at Stanford, 'in the heart of Silicon Valley,' patients do use digital resources to manage their GI symptoms, including diseases like IBS and inflammatory bowel disease (IBD) — and he believes this is 'increasingly common nationally.' 'However, the need for evidence-based tools is critical and the lack here often prevents many practitioners from regularly recommending them to patients. This study aligns well with clinical practice, and supports the use of this particular app to improve IBS symptoms, particularly when access to dietitians is limited. These results support chatbot-assisted dietary management as a feasible, effective, and scalable approach to patient care,' Sinha told Medscape Medical News .
Medscape
21-05-2025
- Health
- Medscape
Blood Test May Predict Crohn's Disease 2 Years Before Onset
SAN DIEGO — Crohn's disease (CD) has become more common in the United States, and an estimated 1 million Americans have the condition. Still, much is unknown about how to evaluate the individual risk for the disease. 'It's pretty much accepted that Crohn's disease does not begin at diagnosis,' said Ryan Ungaro, MD, associate professor of medicine at the Icahn School of Medicine at Mount Sinai, New York City, speaking at Digestive Disease Week (DDW) 2025. Although individual blood markers have been associated with the future risk for CD, what's needed, he said, is to understand which combination of biomarkers are most predictive. Now, Ungaro and his team have developed a risk score they found accurate in predicting CD onset within 2 years before its onset. It's an early version that will likely be further improved and needs additional validation, Ungaro told Medscape Medical News . 'Once we can accurately identify individuals at risk for developing Crohn's disease, we can then imagine a number of potential interventions,' Ungaro said. Approaches would vary depending on how far away the onset is estimated to be. For people who likely wouldn't develop disease for many years, one intervention might be close monitoring to enable diagnosis in the earliest stages, when treatment works best, he said. Someone at a high risk of developing CD in the next 2 or 3 years, on the other hand, might be offered a pharmaceutical intervention. Developing and Testing the Risk Score To develop the risk score, Ungaro and colleagues analyzed data of 200 patients with CD and 100 healthy control participants from PREDICTS, a nested case-controlled study of active US military service members. The study is within the larger Department of Defense Serum Repository, which began in 1985 and has more than 62.5 million samples, all stored at −30 °C. The researchers collected serum samples at four timepoints up to 6 or more years before the diagnosis. They assayed antimicrobial antibodies using the Prometheus Laboratories platform, proteomic markers using the Olink inflammation panel, and anti–granulocyte macrophage colony-stimulating factor autoantibodies using enzyme-linked immunosorbent assay. Participants (median age, 33 years for both groups) were randomly divided into equally sized training and testing sets. In both the group, 83% of patients were White and about 90% were men. Time-varying trajectories of marker abundance were estimated for each biomarker. Then, logistic regression modeled disease status as a function of each marker for different timepoints and multivariate modeling was performed via logistic LASSO regression. A risk score to predict CD onset within 2 years was developed. Prediction models were fit on the testing set and predictive performance evaluated using receiver operating characteristic curves and area under the curve (AUC). Blood proteins and antibodies have differing associations with CD depending on the time before diagnosis, the researchers found. The integrative model to predict CD onset within 2 years incorporated 10 biomarkers associated significantly with CD onset. The AUC for the model was 0.87 (considered good, with 1 indicating perfect discrimination). It produced a specificity of 99% and a positive predictive value of 84%. The researchers stratified the model scores into quartiles and found the CD incidence within 2 years increased from 2% in the first quartile to 57.7% in the fourth. The relative risk of developing CD in the top quartile individuals vs lower quartile individuals was 10.4. The serologic and proteomic markers show dynamic changes years before the diagnosis, Ungaro said. A Strong Start The research represents 'an ambitious and exciting frontier for the future of IBD [inflammatory bowel disease] care,' said Victor G. Chedid, MD, MS, consultant and assistant professor of medicine at Mayo Clinic, Rochester, Minnesota, who reviewed the findings but was not involved in the study. Currently, physicians treat IBD once it manifests, and it's difficult to predict who will get CD, he said. The integrative model's AUC of 0.87 is impressive, and its specificity and positive predictive value levels show it is highly accurate in predicting the onset of CD within 2 years, Chedid added. Further validation in larger and more diverse population is needed, Chedid said, but he sees the potential for the model to be practical in clinical practice. 'Additionally, the use of blood-based biomarkers makes the model relatively noninvasive and easy to implement in a clinical setting,' he said. Now, the research goal is to understand the best biomarkers for characterizing the different preclinical phases of CD and to test different interventions in prevention trials, Ungaro told Medscape Medical News . A few trials are planned or ongoing, he noted. The trial PIONIR trial will look at the impact of a specific diet on the risk of developing CD, and the INTERCEPT trial aims to develop a blood-based risk score that can identify individuals with a high risk of developing CD within 5 years after initial evaluation. Ungaro reported being on the advisory board of and/or receiving speaker or consulting fees from AbbVie, Bristol Myer Squibb, Celltrion, ECM Therapeutics, Genentech, Jansen, Eli Lilly, Pfizer, Roivant, Sanofi, and Takeda. Chedid reported having no relevant disclosures.
Medscape
19-05-2025
- Health
- Medscape
Blood Detection Capsule May Help in Upper GI Bleeding
SAN DIEGO — A real-time, blood-sensing capsule (PillSense) is a safe and effective diagnostic tool for patients with suspected upper gastrointestinal (GI) bleeding that can aid patient triage, reduce unnecessary procedures, and optimize resource use, a study found. Notably, patients with negative capsule results had shorter hospital stays and lower acuity markers, and in more than one third of cases, an esophagogastroduodenoscopy (EGD) was avoided altogether without any observed adverse events or readmissions, the study team found. 'Our study shows that this novel capsule that detects blood in the upper GI tract (PillSense) was highly sensitive and specific (> 90%) for detecting recent or active upper GI blood, influenced clinical management in 80% of cases and allowed about one third of patients to be safely discharged from the emergency department, with close outpatient follow-up,' Linda Lee, MD, medical director of endoscopy, Brigham and Women's Hospital and associate professor of medicine, Harvard Medical School, Boston, told Medscape Medical News . The study was presented at Digestive Disease Week (DDW) 2025. Real-World Insights EGD is the gold standard for diagnosing suspected upper GI bleeding, but limited access to timely EGD complicates diagnosis and resource allocation. Approved by the US Food and Drug Administration, PillSense (EnteraSense) is an ingestible capsule with a reusable receiver that provides a rapid, noninvasive method for detecting upper GI bleeding. The capsule analyzes light absorption to identify blood and transmits the result within 10 minutes. Lee and colleagues evaluated the real-world impact of this point-of-care device on clinical triage and resource allocation, while assessing its safety profile. They analyzed data on 43 patients (mean age 60 years; 72% men) with clinical suspicion of upper GI bleeding in whom the device was used. The most common symptoms were symptomatic anemia (70%), melena (67%), and hematemesis (33%). Sixteen PillSense studies (37%) were positive for blood detection, and 27 (63%) were negative. Compared to patients with a positive capsule results, those without blood detected by the capsule had shorter hospital stays (mean, 3.8 vs 13.4 days, P = .02), lower GBS scores (mean, 7.93 vs 12.81; P = .005), and fewer units of blood transfused (mean, 1.19 vs 10.94; P = .01) and were less apt to be hemodynamically unstable (5 vs 8 patients; P = .03). Capsule results influenced clinical management in 80% of cases, leading to avoidance of EGD in 37% and prioritization of urgent EGD in 18% (all had active bleeding on EGD). Capsule use improved resource allocation in 51% of cases. This included 12 patients who were discharged from the ED, six who were assigned an inpatient bed early, and four who underwent expedited colonoscopy as upper GI bleeding was ruled out, they noted. Among the eight patients who did not undergo EGD, there were no readmissions within 30 days and no adverse events. There were no capsule-related adverse events. 'Clinicians should consider using this novel capsule PillSense as another data point in the management of suspected upper GI bleed,' Lee told Medscape Medical News . 'This could include in helping to triage patients for safe discharge from the ED or to more urgent endoscopy, to differentiate between upper vs lower GI bleed and to manage ICU patients with possible rebleeding,' Lee said. Important Real-World Evidence Reached for comment, Shahin Ayazi, MD, esophageal surgeon, Director, Allegheny Health Network Chevalier Jackson Esophageal Research Center, Pittsburgh, Pennsylvania, said this study is important for several reasons. 'Prior investigations have established that PillSense possesses a high negative predictive value for detecting upper GI bleeding and have speculated on its utility in triage, decision-making, and potentially avoiding unnecessary endoscopy. This study is important because it substantiates that speculation with clinical data,' Ayazi, who wasn't involved in the study, told Medscape Medical News . 'These findings support the capsule's practical application in patient stratification and clinical workflow, particularly when diagnostic uncertainty is high and endoscopic resources are limited,' Ayazi noted. In his experience, PillSense is 'highly useful as a triage adjunct in the evaluation of suspected upper GI bleeding. It provides direct and objective evidence as to whether blood is currently present in the stomach,' he said. 'In patients whose presentation is ambiguous or whose clinical scores fall into an intermediate risk zone, this binary result can provide clarity that subjective assessment alone may not achieve. This is particularly relevant in settings where the goal is to perform endoscopy within 24 hours, but the volume of consults exceeds procedural capacity,' Ayazi explained. 'In such scenarios, PillSense enables physicians to stratify patients based on objective evidence of active bleeding, helping to prioritize those who require urgent endoscopy and defer or even avoid endoscopic evaluation in those who do not. The result is a more efficient allocation of endoscopic resources without compromising patient safety,' he added. Ayazi cautioned that the PillSense capsule should not be used as a replacement for clinical evaluation or established risk stratification protocols. 'It is intended for hemodynamically stable patients and has not been validated in cases of active or massive bleeding. Its diagnostic yield depends on the presence of blood in the stomach at the time of capsule transit; intermittent or proximal bleeding that has ceased may not be detected, introducing the potential for false-negative results,' Ayazi told Medscape Medical News. 'However, in prior studies, the negative predictive value was high, and in the present study, no adverse outcomes were observed in patients who did not undergo endoscopy following a negative PillSense result,' Ayazi noted. 'It must also be understood that PillSense does not localize the source of bleeding or replace endoscopy in patients with a high likelihood of active hemorrhage. It is not designed to detect bleeding from the lower GI tract or distal small bowel. Rather, it serves as an adjunct that can provide immediate clarity when the need for endoscopy is uncertain, and should be interpreted within the broader context of clinical findings, laboratory data, and established risk stratification tools,' he added.
