Performance of large language models in addressing patient queries on colorectal cancer screening in different languages: An international study across 28 countries

Theodor Bilharz Research Institute

Bibliographic Information

Authors: M M.; A P.; S G.; T V.; LHS L.; S B.; P P.; M M.; T Z.; H U.; EJT A.; D B.; H D.; T D.; A G.; T K.; S L.; B L.; H M.; R N.; Y O.; A R.; A T.; I M.

Journal: Digestive and Liver Disease

Publisher: Elsevier B.V.

Publication Date: February 2026

Volume / Issue: Volume 58 / Issue 2

Pages: 250–257

ISSN: 15908658

DOI: 10.1016/j.dld.2025.11.026

Scopus: View on Scopus

PubMed: 41436291

Document Type: Article

Access: All Open Access; Hybrid Gold Open Access

Authors and Affiliations

M M., Department of Medicine and Surgery, University of Enna `Kore', Enna, Italy, Gastroenterology Unit, Umberto I Hospital, Enna, Italy; A P., Department of Gastroenterology, General University Hospital of Larissa, Larissa, Greece; S G., Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia, Clinical School of Medicine, University of Sydney, Sydney, Australia, The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, University of Toronto, St. Michael's Hospital, Toronto, Canada; T V., Gastroenterology Department, Colentina Clinical Hospital, Carol Davila Faculty of Medicine, Bucharest, Romania; LHS L., Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, China, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, China, Institute of Digestive Diseases, The Chinese University of Hong Kong, China; S B., Department of Endoscopy, Barretos Cancer Hospital, Barretos, Brazil; P P., Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Somajiguda, India; M M., Department of Surgery and Gastroenterology, Avenue HealthCare, Nairobi, Kenya, College of Surgeons of East, Central and Southern Africa, Arusha, Tanzania; T Z., Division of Internal Medicine, Henry Ford Hospital, Department of Gastroenterology and Hepatology, Detroit, United States; H U., Hospital Universitario Germans Trias I Pujol and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Badalona, Spain; EJT A., Institute of Digestive and Liver Diseases, St. Luke's Medical Center Global City, Taguig, Philippines, School of Medicine and Public Health, Ateneode Manila University, Pasig, Philippines; D B., Centre Anti Cancer de Batna, Algeria; H D., Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Department of Gastroenterology and Hepatology, Belgium, Brussels, Belgium; T D., Department of Gastroenterology, Hitit University Faculty of Medicine, Çorum, Turkey; A G., Department of Internal Medicine, Hepatology and Gastroenterology unit, Mansoura University, Mansoura, Egypt; T K., Endoscopy Center, Mongolia-Japan Hospital, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia; S L., Robert Wood Johnson Barnabas Health, NJ, United States; B L., Gastroenterology and Endoscopy Department, Ulaanbaatar Songdo Hospital, Ulaanbaatar, Mongolia; H M., Division of Gastroenterology, Pancreatobiliary and Digestive Endoscopy. Department of Internal Medicine, Universitas Indonesia, Cipto Mangunkusumo National Hospital, Indonesia; R N., Department of Gastroenterology, Sao Paulo Cancer Institute, Sao Paulo, Brazil; Y O., Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Osaka, Japan; A R., Interventional Digestive Endoscopy, ASST Spedali Civili di Brescia, Brescia, Italy; A T., The Mohammed VI university of Health Sciences, Mohammed VI international University Hospital, Bouskoura, Casablanca, Morocco; I M., Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute Cairo, Egypt

Abstract

Background: Colorectal cancer (CRC) screening reduces incidence and mortality, yet patient adherence remains suboptimal. Large language models may improve participation by addressing patient questions in native languages, but their multilingual performance has not been systematically assessed. Methods: From April to June 2025, we conducted a cross-continental study involving 28 countries and 23 languages. A standardized set of 15 CRC screening-related questions was translated into each language and submitted to ChatGPT (GPT-4o). Responses were independently evaluated by 140 gastroenterologists (five per country) for accuracy, completeness, and comprehensibility on a 5-point Likert scale. Statistical analyses included t-test, Chi-square, and two-way ANOVA. Results: The study included experts and data from Europe, Asia, Africa, America, and Oceania. Mean scores (±SD) for accuracy, completeness, and comprehensibility were 4.1 ± 1.0, 4.1 ± 1.0, and 4.2 ± 0.9, respectively. Most languages achieved high ratings, with 73.9%, 86.9%, and 82.6% scoring ≥4 for accuracy, completeness, and comprehensibility. However, lower scores were observed in Chinese, Dutch, and Greek. Variability was also noted between countries sharing the same language, highlighting language- and context-dependent performance. Discussion: ChatGPT showed strong ability to answer CRC screening questions across multiple languages, supporting its promise as a multilingual patient education tool. Nonetheless, regional variability requires careful validation before clinical integration. © 2025 The Author(s)

Keywords

Artificial Intelligence; ChatGPT; Colorectal Cancer; Languages; Screening; Africa; Asia; Colorectal Neoplasms; Comprehension; Early Detection of Cancer; Europe; Female; Humans; Language; Large Language Models; Male; Mass Screening; Multilingualism; Surveys and Questionnaires; Article; cancer patient; cancer screening; controlled study; diagnostic accuracy; diagnostic value; follow up; gastroenterologist; human; large language model; Likert scale; occult blood test; patient education; colorectal tumor; diagnosis; early cancer diagnosis; questionnaire

Citation Information

Scopus Citations: 1

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