{
  "abstract": "Background Gastrointestinal (GI) dysfunction is highly prevalent among patients with cognitive impairment, yet remains chronically underdiagnosed. Existing text-based questionnaires demand high verbal comprehension and are prone to interviewer bias, inter-observer variability, and caregiver-proxy inaccuracies. Non-verbal communication, however, remains relatively preserved across cognitive decline stages. We aimed to develop and validate the first animated pictogram-based diagnostic tool — the Gastrointestinal Animated Pictograms (GAPs) — to enhance GI symptom reporting and diagnosis in this population.Methods Following a literature review incorporating SAGIS and Rome IV criteria, a multidisciplinary team of gastroenterologists, animators, and software engineers developed 72 animated pictograms representing 24 GI symptoms across three severity levels (mild, moderate, severe), hosted on a web-based platform. ( IDDF2026-ABS-0193 Figure 1. Samples of 4 out of the 72 developed pictograms)Phase 1. Content Validity: 12 international experts across gastroenterology, geriatrics, linguistics, and neurodegenerative diseases independently rated each pictogram using a structured 5-point Likert scale across five domains: (1) medical alignment, (2) representational accuracy, (3) severity discrimination, (4) misinterpretation risk, and (5) cultural suitability.Phase 2. Expert Face Validity: The refined tool was subsequently rated by experts across five design domains: (1) appropriateness of pictogram design, (2) size, (3) colour, (4) animation speed, and (5) ease of understanding.Phase 3. Patient Face Validity: Piloting with 30 subjects (upper and lower GI patients, cognitively normal and impaired) assessed: animation speed, pictogram size, colour, risk of misinterpretation, and overall understanding.Results Content validity yielded a mean expert consensus score of 4.0 ± 0.5 across all five content domains. Expert face validity scored 3.6 ± 0.6, guiding iterative refinements. Following revisions, patient face validity improved to 4.2 ± 0.4, reflecting clarity and acceptability across both cognitively normal and impaired participants. ( IDDF2026-ABS-0193 Figure 2. GAP Tool - Validation Results across Three Phases)Conclusions GAP is the first animated pictogram-based tool for GI symptom reporting and functional disorder diagnosis, purpose-built to overcome communication barriers in cognitively impaired patients. Robust content and face validity have been established; a multicentre international validation study is underway to confirm superiority over traditional questionnaires and cement GAP as the gold standard for GI symptom assessment. Future AI-assisted diagnosis integration will enable automated pattern recognition.Abstract IDDF2026-ABS-0193 Figure 1Abstract IDDF2026-ABS-0193 Figure 2",
  "authors": [
    {
      "affiliations": [
        "Gastrointestinal Function & Motility Unit - Hospital Universiti Sains Malaysia, School of Medical Sciences - Univerisit Sains Malaysia - Kelantan, Malaysia"
      ],
      "name": "Mina Ehab Samir Ayad"
    },
    {
      "affiliations": [
        "Gastrointestinal Function & Motility Unit - Hospital Universiti Sains Malaysia, School of Medical Sciences - Univerisit Sains Malaysia - Kelantan, Malaysia"
      ],
      "name": "Yeong Yeh Lee"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia",
        "Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia"
      ],
      "name": "Gerald Holtmann"
    },
    {
      "affiliations": [
        "Division of Gastroenterology, Hepatology and Endoscopy, Massachusetts General Hospital, Boston, Massachusetts, USA",
        "Harvard Medical School, Harvard University, Boston, Massachusetts, United States"
      ],
      "name": "Braden Kuo"
    },
    {
      "affiliations": [
        "Aboratory of Liver, Pancreas and Motility (HIPAM), Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico"
      ],
      "name": "Max Schmulson"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam"
      ],
      "name": "Dao Viet Hang"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India"
      ],
      "name": "Uday Ghoshal"
    },
    {
      "affiliations": [
        "Department of Internal Medicine – Gastroenterology, De La Salle University Medical Center, Dasmariñas, Philippines"
      ],
      "name": "Rona Marie Lawenko"
    },
    {
      "affiliations": [
        "Vice Rector of Research, Innovation , and Community Development Universitas Airlangga Institute of Tropical Disease Gastroentero-Hepatology Section, Internal Medicine Department- Dr. Soetomo Teaching Hospital, Surabaya, Indonesia"
      ],
      "name": "Muhammad Miftahussurur"
    },
    {
      "affiliations": [
        "Tropical Medicine Department, Ain Shams University, Egypt"
      ],
      "name": "Enaam Ali"
    },
    {
      "affiliations": [
        "Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia"
      ],
      "name": "Mohd Faizal"
    },
    {
      "affiliations": [
        "Biostatistics and Research Methodology Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia"
      ],
      "name": "Erica Kueh"
    },
    {
      "affiliations": [
        "Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan"
      ],
      "name": "Tadayuki Oshima"
    }
  ],
  "title": "IDDF2026-ABS-0193 Development and validation of GI symptoms animated pictograms (GAPs) as a diagnostic tool for gi dysfunction among patients with cognitive impairment",
  "uid": "0b34de4b-eeb0-585f-9caf-94daee0478a7"
}