The Helicobacter pylori AI-Clinician: Harnessing Artificial Intelligence to Personalize H. pylori Treatment Recommendations

Helicobacter pylori (H. pylori) is the most common carcinogenic pathogen worldwide. Infecting roughly 1 in 2 individuals globally, it is the leading cause of peptic ulcer disease, chronic gastritis, and gastric cancer. To investigate whether personalized treatments would be optimal for patients suffering from infection, we developed the H. pylori AI-clinician recommendation system. This system was trained on data from tens of thousands of H. pylori-infected patients from Hp-EuReg, orders of magnitude greater than those experienced by a single real-world clinician. We first used a simulated dataset and demonstrated the ability of our AI Clinician method to identify patient subgroups that would benefit from differential optimal treatments. Next, we trained the AI Clinician on Hp-EuReg, demonstrating the AI Clinician reproduces known quality estimates of treatments, for example bismuth and quadruple therapies out-performing triple, with longer durations and higher dose proton pump inhibitor (PPI) showing higher quality estimation on average. Next we demonstrated that treatment was optimized by recommended personalized therapies in patient subsets, where 65% of patients were recommended a bismuth therapy of either metronidazole, tetracycline, and bismuth salts with PPI, or bismuth quadruple therapy with clarithromycin, amoxicillin, and bismuth salts with PPI, and 15% of patients recommended a quadruple non-bismuth therapy of clarithromycin, amoxicillin, and metronidazole with PPI. Finally, we determined trends in patient variables driving the personalized recommendations using random forest modelling. With around half of the world likely to experience H. pylori infection at some point in their lives, the identification of personalized optimal treatments will be crucial in both gastric cancer prevention and quality of life improvements for countless individuals worldwide.

Foundational Models for Pathology and Endoscopy Images: Application for Gastric Inflammation

The integration of artificial intelligence (AI) in medical diagnostics represents a significant advancement in managing upper gastrointestinal (GI) cancer, a major cause of global cancer mortality. Specifically for gastric cancer (GC), chronic inflammation causes changes in the mucosa such as atrophy, intestinal metaplasia (IM), dysplasia and ultimately cancer. Early detection through endoscopic regular surveillance is essential for better outcomes. Foundation models (FM), which are machine or deep learning models trained on diverse data and applicable to broad use cases, offer a promising solution to enhance the accuracy of endoscopy and its subsequent pathology image analysis. This review explores the recent advancements, applications, and challenges associated with FM in endoscopy and pathology imaging. We started by elucidating the core principles and architectures underlying these models, including their training methodologies and the pivotal role of large-scale data in developing their predictive capabilities. Moreover, this work discusses emerging trends and future research directions, emphasizing the integration of multimodal data, the development of more robust and equitable models, and the potential for real-time diagnostic support. This review aims to provide a roadmap for researchers and practitioners in navigating the complexities of incorporating FM into clinical practice for prevention/management of GC cases, thereby improving patient outcomes.