Colorectal: every paper in GI Signals issue №8

Colorectal rct · n=500 · Aug 19, 2026 · Clin Gastro Hep · IF 16.2

Effectiveness of theory-based WhatsApp chatbot outreach in colorectal cancer screening uptake: a randomized controlled trial.

Practice-changingcolorectal cancer screeninghealth servicesartificial intelligence

Clinical takeawayConsider implementing WhatsApp-based chatbot outreach for adults aged 50-75 in your CRC screening program. The intervention delivers health education video and tailored behavior-change messaging based on readiness stage, improving uptake by 8-9 percentage points.

What it foundWhatsApp chatbot with video education and personalized risk-assessment increased CRC screening uptake to 36% vs 27.6% at 3 months (p=0.043) in adults aged 50-75, sustained at 6 months (45.6% vs 36.4%, p=0.045)

ContextCRC screening uptake remains suboptimal despite known mortality benefit. This trial demonstrates that structured digital outreach with education and personalized risk assessment significantly outperforms minimal reminder text, refining evidence on how to close screening gaps in community populations.

Reinforcessuggested applicable standard· U.S. Multi-Society Task Force on Colorectal Cancer (Rex DK, Boland CR, Dominitz JA, et al.), "Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer," Gastroenterology, 2017

Decision at stakeHow to improve patient uptake of colorectal cancer screening among eligible individuals

Begin average-risk colorectal cancer screening at age 45 using a patient-centered shared-decision modality choice, colonoscopy every 10 years (preferred) or annual FIT as Tier 1 options, with multi-target stool DNA every 3 years, CT colonography every 5 years, or flexible sigmoidoscopy every 5 to 10 years as Tier 2 alternatives. A positive stool-based test requires diagnostic colonoscopy, and stool tests should not be ordered for patients who would decline follow-up colonoscopy. Generally stop at age 75 with individualized decisions for ages 76-85 and no screening beyond 85.

U.S. Multi-Society Task Force on Colorectal Cancer (Rex DK, Boland CR, Dominitz JA, et al.), "Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer," Gastroenterology, 2017 · reviewed 2026-07-23 ↗

Tung Lam TY … Yiu Sung JJ · Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association · IF 16.2 · PubMed ↗Permalink

Colorectal retrospective · n=12,275 · Aug 18, 2026 · Dis Colon Rectum · IF 3.5

Traditional Risk Factors Are Not Associated with the Rise of Early-Onset Colorectal Cancer: An All of Us Study.

Epidemiologycolorectal cancerepidemiology

Clinical takeawayThis negative finding reveals that traditional environmental and genetic risk factors do not explain the rising incidence of early-onset colorectal cancer. Do not use their absence to reassure younger patients about CRC risk. Family history remains significantly associated (OR 2.10) and should guide risk assessment. Current risk models are incomplete; novel environmental or early-life exposures likely drive early-onset disease but remain unidentified.

What it foundFamily history was associated with higher colorectal cancer odds uniformly across ages (OR 2.10, 95% CI 1.69-2.61), but heavy smoking during ages 20-40, alcohol use disorders, BMI, and 283 established genetic variants demonstrated no age-specific associations with early-onset disease.

ContextChallenges the assumption that traditional environmental risk factors (smoking, alcohol, obesity) explain the rising early-onset CRC incidence. Current risk stratification models may fail to identify younger patients at true risk, indicating that preventable or modifiable exposures causing the rise remain unknown.

Refinessuggested applicable standard· American Gastroenterological Association, 'AGA Clinical Practice Guidelines on the Management of Moderate to Severe Ulcerative Colitis', 2020

Decision at stakeCounsel against smoking to prevent colorectal cancer risk

… In Crohn's disease, prioritize cessation as a disease-modifying intervention equal to biologics; in ulcerative colitis, counsel against smoking despite the paradoxical protective effect because cancer and cardiovascular risks outweigh it. …

From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text.

Our full summary of this standard

Address tobacco use at every visit using the 5 A's framework (Ask, Advise, Assess, Assist, Arrange) and combine behavioral support with pharmacotherapy; varenicline is the most effective single agent, and combination NRT (patch plus gum/lozenge) is effective. Set a quit date within 2 weeks, start pharmacotherapy 1-2 weeks before the quit date, and schedule follow-up at 1 week, 1 month, and 3 months. In Crohn's disease, prioritize cessation as a disease-modifying intervention equal to biologics; in ulcerative colitis, counsel against smoking despite the paradoxical protective effect because cancer and cardiovascular risks outweigh it. For patients with inadequate response to monotherapy, consider combining varenicline with NRT based on individual assessment, though evidence for superiority over single agents is inconsistent.

American Gastroenterological Association, 'AGA Clinical Practice Guidelines on the Management of Moderate to Severe Ulcerative Colitis', 2020 · reviewed 2026-07-21 ↗

Nigam A … Goffredo P · Diseases of the Colon and Rectum · IF 3.5 · PubMed ↗Permalink

Colorectal, in full.

All 2, in full

Effectiveness of theory-based WhatsApp chatbot outreach in colorectal cancer screening uptake: a randomized controlled trial.

Traditional Risk Factors Are Not Associated with the Rise of Early-Onset Colorectal Cancer: An All of Us Study.