Objectives: The current study compared potential risks, complications, and the impact on clinical outcomes among elderly and younger patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Methods: Procedure-related complications, risk factors, and clinical outcomes following complications in elderly patients (aged ≥75 years) and younger who underwent biliary ERCP were evaluated. Results: Median age of 63 (48–74) of 1164 patients who underwent biliary ERCP for the first time, and 266 (22.8%) were elderly. Comorbidities were statistically significant (81 [30.5%] versus 78 [8.7%], p < 0.001), and periampullary diverticulum (PAD) was detected more commonly in the elderly group (79 [29.7%] vs. 103 [11.5%], p < 0.001). There was no statistical difference in cannulation technique, cannulation time, and cannulation success in both groups, while the total ERCP procedure time was higher in the elderly group (22 [16–29] vs. 20 [14–29], p = 0.030). Regarding the procedure-related complications, there was no statistically significant difference between the two groups (26 [9.8%] vs. 71 [7.9%], p = 0.292). In the case of complications, the length of hospitalization stay was statistically longer in the elderly group. Moreover, the elderly had a longer length of hospitalization, experiencing pancreatitis and a higher probability of developing moderate/severe pancreatitis. In multivariate and univariate analysis, prolonged cannulation time was found to be an independent risk factor in patients ≥75 years of age. Conclusions: This study showed that while ERCP-related complication rates in elderly patients are comparable to younger patients, it can be associated with worse outcomes following the complication and prolonged length of hospitalization.

To evaluate the optimal endoscopy time in elderly patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) based on clinical outcomes. Patients over 65 years of age presenting with NVUGIB are three patient groups based on endoscopy timing: very early endoscopy (< 12 h), early endoscopy (12–24 h) and late endoscopy (> 24 h). Endoscopic intervention was undertaken during the first 12 h for patients who had unstable hemodynamic settings, ongoing bleeding, or a low hematocrit despite transfusion. The clinical outcomes investigated were: The primary endpoint was 30-day mortality, with the need for endoscopic intervention, rebleeding, and length of hospital stay considered as secondary endpoints. The study population was 468, 260 of whom were ≥ 65 years. Based on the timing of endoscopy, very early endoscopy (within 12 h) was performed in 180 (69.2%) patients aged > 65 years and 150 (72.1%) younger patients (p > 0.05). Early endoscopy (12–24 h) was performed in patients aged > 65 years and younger patients 53 (20.4%) vs. 41 (19.7%), respectively, while late endoscopy (24–48 h) was performed in 27 (10.4%) vs. 17 (8.2%) patients, respectively (p > 0.05, for all parameters). The clinical results of subgroups based on endoscopy time in the ≥ 65 population and comparisons between groups. When groups were compared, it was found that the very early endoscopy group had a considerably lower likelihood of need for surgical/radiological intervention than the late endoscopy group [3 (1,7) vs. (3,7), p = 0.016], and 30-day mortality rates by the endoscopy timing were statistically significantly different in the very early group (15.6%), early endoscopy group (7.5%), and late endoscopy group (29.6%) (p < 0.05, for all groups). Endoscopy time within 24–48 h (late) (OR: 3.133, 95%Cl: 1.127–8.713, p: 0.029) was an independent predictor of rebleeding during the hospital stay. Early endoscopy may benefit the management of acute UGIB, especially in the elderly population with high comorbidities and the severity of bleeding. UGIB is a significant clinical concern in older persons, who have higher rates of hospitalized adverse events and death than young patients. Because mortality tends to be higher in older patients with UGIB, determining the best endoscopic time becomes even more difficult. Close monitoring, risk stratification, and good endoscopic and medical treatment are important approaches for decreasing poor clinical outcomes in the elderly with UGIB. Very early endoscopy group over the age of 65 is associated with less surgical/radiological intervention and lower 30-day mortality. The establishment of a health assessment strategy for older patients presenting with acute UGIB should be advantageous, considering the rise in comorbidities associated with aging concomitant medications, and various chronic diseases that have contributed to morbidity and death. Early endoscopy may be beneficial in the therapy of acute UGIB, particularly in the elderly with significant comorbidities and severe bleeding.

Background/Objectives: Chat Generative Pretrained Transformer (ChatGPT) is a useful resource for individuals working in the healthcare field. This paper will include descriptions of several ways in which ChatGPT-4 can achieve greater accuracy in its diagnosis and treatment plans for ulcerative colitis (UC) and Crohn’s disease (CD) by following the guidelines set out by the European Crohn’s and Colitis Organization (ECCO). Methods: The survey, which comprised 102 questions, was developed to assess the precision and consistency of respondents’ responses regarding the UC and CD. The questionnaire incorporated true/false and multiple-choice questions, with the objective of simulating real-life scenarios and adhering to the ECCO guidelines. We employed Likert scales to assess the responses. The inquiries were put to ChatGPT-4 on the initial day, the 15th day, and the 180th day. Results: The 51 true or false items demonstrated stability over a six-month period, with an initial accuracy of 92.8% at baseline, 92.8% on the 15th day, and peaked to 98.0% on the 180th day. This finding suggests a negligible effect size. The accuracy of the multiple-choice questions was initially 90.2% on Day 1, reached its highest point at 92.2% on Day 15, and then decreased to 84.3% on Day 180. However, the reliability of the data was found to be suboptimal, and the impact was deemed negligible. A modest, transient increase in performance was observed at 15 days, which subsequently diminished by 180 days, resulting in negligible effect sizes. Conclusions: ChatGPT-4 demonstrates potential as a clinical decision support system for UC and CD, but its assessment is marked by temporal variability and the inconsistent execution of various tasks. Essential initiatives that should be carried out before involving artificial intelligence (AI) technology in IBD trials are routine revalidation, multi-rater comparisons, prompt standardization, and the cultivation of a comprehensive understanding of the model’s limitations.

Background: Oral manifestations of Crohn’s disease (CD) include non-specific lesions and specific lesions directly related to intestinal inflammation. Oral lesions that can be overlooked in CD are sometimes challenging to treat. Methods: In this retrospective single-center study, patients with CD aged over 18 years who complied with follow-up and treatment were included. Clinical definitions of specific oral lesions included pyostomatitis vegetans, glossitis with fissuring, lip swelling with fissuring, cobblestoning, and orofacial granulomatosis. Experienced dentists confirmed the specific lesions in each case. Three groups of patients were identified: those without oral lesions, those with non-specific oral lesions, and those with specific oral lesions. The groups were compared based on demographics, disease extent and behavior (based on the Montreal classification), extraintestinal involvement, biologic and steroid treatment, and the requirement of resective surgery. Results: A total of 96 patients (14.2%) with oral lesions were found among the 676 patients with CD (59.7% male, median age 38 years) who were followed for 6.83 years (IQR 0.5–29.87 years). Eight patients (1.2%, 9 lesions) had specific oral lesions, while eighty-eight patients (13%) had non-specific lesions. Orofacial granulomatosis (n = 3), cobblestoning (n = 2), glossitis with fissuring (n = 2), and lip swelling with fissuring (n = 2) were among the specific lesions. The majority of patients (75%) with specific lesions were male, and their median age was 46.5 years (range: 23–68 years). Disease localization was commonly ileocolonic (50%), and perianal disease was present in 25% of patients. Three patients were active smokers. Extraintestinal manifestations were peripheral arthritis/arthralgia (n = 7) and sacroiliitis (n = 1). All specific lesions were associated with moderate-to-severe disease. Five patients improved with biologic therapy, and two patients with immunomodulatory therapy. Conclusions: Specific oral lesions in CD were associated with active disease and improved with immunomodulators or biologic therapy. Close cooperation between gastroenterologists and dentists is essential for early diagnosis and optimal management of CD.

Inflammatory bowel diseases (IBD), including ulcerative colitis and Crohn’s disease (CD), exhibit clinical heterogeneity, with sex-related differences potentially influencing disease course and prognosis. This study investigates the impact of sex on IBD prognosis in a large cohort. Data were collected from patients diagnosed with IBD at our clinics between July 1993 and April 2025. Demographic, clinical, and treatment variables were analyzed, focusing on sex-based differences in disease onset, disease activity, extraintestinal manifestations (EIMs), treatment escalation, hospitalizations, and surgical interventions. A total of 1774 patients diagnosed with IBD were included in the study. A male predominance (61%) was observed in IBD, with higher male-to-female ratios in both ulcerative colitis (1.6:1) and CD (1.47:1). Female patients presented earlier with IBD (mean age 34.7 vs 37.0 years; P = .001) and had a higher frequency of EIMs, particularly peripheral arthritis and erythema nodosum ( P < .001). No significant sex differences were observed in disease severity, hospitalizations, or need for treatment escalation. However, female patients with CD demonstrated higher disease activity at baseline, as measured by the Crohn’s disease activity index. Both sexes exhibited similar rates of biologic therapy use, the number of biologic therapies, hospitalizations, and major surgeries. Despite the male predominance in IBD prevalence, sex-related differences in clinical outcomes were minimal, with both sexes experiencing comparable disease activity, treatment escalation, and need for surgery. However, female patients exhibited a higher frequency of EIMs, highlighting the importance of a sex-based approach in clinical management.