Gastroenterology's AI Policy: AGA and Elsevier Rules for GI Authors

Elsevier's company-wide AI policy is relatively permissive, it allows AI for "writing assistance" with disclosure. Gastroenterology, guided by the AGA's clinical sensibility, applies a narrower interpretation:

The distinction between "writing assistance" and "language editing" matters. Elsevier's broad framing could encompass using AI to draft a paragraph explaining a propensity-score-matched cohort. Gastroenterology's AGA-influenced interpretation would consider that too close to content generation.

Endoscopy and computer-aided detection

Gastroenterology publishes substantial research on AI-assisted endoscopy, CADe for polyp detection, CADx for polyp characterization, AI for Barrett's surveillance, capsule endoscopy reading algorithms. The AGA even published a Living Clinical Practice Guideline on CAD-assisted colonoscopy in 2025.

If your paper is about an AI endoscopy system, the AI is your research subject. It belongs in standard Methods with architecture, training data, validation design, and performance metrics. The manuscript preparation AI disclosure is entirely separate.

Example for an endoscopy AI paper:

"The CADx system was developed using a DenseNet-121 architecture trained on 85,000 annotated colonoscopy images (see Methods: Model Development). Separately, the authors used ChatGPT (GPT-4, OpenAI) to improve the language of the Discussion section. All text edits were reviewed by the senior author (R.S.). The authors take full responsibility for the published content."

Microbiome and bioinformatics

Gut microbiome studies are a major content category. 16S sequencing, shotgun metagenomics, metabolomics, all involve substantial bioinformatics. Standard analytical tools (QIIME2, MetaPhlAn, HUMAnN, PICRUSt2) don't require AI disclosure. But if ChatGPT or GitHub Copilot helped write the Python or R scripts calling those tools, that's AI-assisted code generation and needs disclosure.

Example for a microbiome paper:

"Microbiome analysis was performed using QIIME2 (v2024.2) and MetaPhlAn 4 as described in Methods. GitHub Copilot (Microsoft) assisted with writing custom R scripts for differential abundance analysis and visualization. All scripts were validated against published benchmark datasets. Claude (Claude 3.5, Anthropic) was used to improve the readability of the Introduction and Results sections. The authors take full responsibility for the published content."

Clinical trials and guideline content

Gastroenterology is a primary destination for IBD clinical trials, new biologics, small molecules, combination therapies. These papers influence treatment algorithms that gastroenterologists worldwide follow. AI involvement in interpreting treatment response rates, endoscopic endpoints, or histologic scores would undermine the clinical credibility of the paper.

The same principle applies to hepatology endpoints that sometimes appear in Gastroenterology: fibrosis staging, cirrhosis assessments, liver function outcomes. AI can help you say things more clearly. It shouldn't help you decide what to say about clinical outcomes.

AGA Clinical Practice Guidelines and Technical Reviews published in the journal directly guide decision-making for GERD, IBD, Barrett's esophagus, and colorectal cancer screening. The editorial expectation is that AI tools play zero role in guideline content generation. While the formal policy doesn't create separate rules for guidelines, the sensitivity is at its highest for these documents.

For an original research article (e.g., IBD cohort study):

"During the preparation of this manuscript, the authors used ChatGPT (GPT-4o, OpenAI) to improve the clarity of the Discussion section. All suggestions were reviewed and edited by the corresponding author (T.U.) and the senior gastroenterologist (V.W.). No AI tools were used in study design, data collection, statistical analysis, or interpretation of clinical outcomes. The authors take full responsibility for the content."

For a randomized controlled trial:

"The authors used Claude (Claude 3.5, Anthropic) to improve the English language of the Introduction and Methods sections. No AI tools were used for trial design, data management, statistical analysis, endpoint assessment, or clinical interpretation. All efficacy and safety conclusions were drawn by the principal investigators based on the pre-specified analysis plan."

For a technical review or meta-analysis:

"During the preparation of this technical review, ChatGPT (GPT-4, OpenAI) was used to improve sentence-level readability of the evidence synthesis sections. The systematic literature search, study screening, data extraction, risk of bias assessment, and evidence grading were performed entirely by the author team without AI assistance. The authors take full responsibility for the published content."

All three disclosures share the same structure: specific tool identification, clear scope, explicit statement of what wasn't AI-assisted, and a responsibility declaration. Clinical papers should emphasize that AI didn't touch clinical interpretations, that's what Gastroenterology's editors expect to see.

Consequences follow COPE-based escalation, with Elsevier's institutional infrastructure adding reach:

During review: If a reviewer or editor suspects undisclosed AI use, you'll receive a query. This doesn't guarantee rejection, but it changes the editorial relationship. Your paper moves from "under normal review" to "under scrutiny," and that's not a helpful shift.

After acceptance: Discovery during the production phase halts publication. You'll need to add a proper disclosure and explain the omission. Elsevier's editorial system tracks these incidents, and the record follows the manuscript through any future correspondence.

After publication, the escalation ladder:

1. Published correction. For cases where AI use was limited to language editing, a corrigendum adding the disclosure may be sufficient.
2. Expression of concern. If AI use raises questions about the reliability of findings (for instance, if AI was used to draft clinical interpretations) the editor may issue an expression of concern.
3. Retraction. Reserved for cases where AI involvement was extensive enough to undermine confidence in the paper's conclusions. Rare, but possible.
4. Elsevier Research Integrity involvement. Serious cases get escalated to Elsevier's central RI team, which can investigate across all 2,700+ journals. If they find a pattern of undisclosed use by the same author across multiple Elsevier titles, that's a bigger problem than one missed disclosure.
5. Institutional notification. The journal may contact the corresponding author's institution, triggering a formal integrity investigation.

The combination of AGA's clinical reputation and Elsevier's publishing infrastructure means that integrity issues at Gastroenterology get attention from both the clinical community and the publishing industry.

All five journals agree on fundamentals: no AI authorship, mandatory disclosure, no AI-generated images, full author responsibility. Where they diverge is in mechanics. Lancet Gastroenterology & Hepatology places the disclosure in acknowledgments (not Methods) and limits AI to "readability and language" improvements only, more restrictive than Gastroenterology's approach.

The Elsevier submission system: Gastroenterology uses Editorial Manager. During upload, you'll encounter specific AI-related questions. Your answers become part of the formal submission record, inconsistencies between what you declare in the system and what's in your manuscript will be noticed.

Multi-center studies: Large IBD registries, screening colonoscopy databases, and NAFLD cohorts can have dozens of co-authors across institutions in different countries. Each co-author may have different habits with AI tools. The corresponding author must actively survey all co-authors about AI use before finalizing the disclosure. This isn't just good practice, it's a requirement. If a co-author used AI tools without telling you and this surfaces after publication, the corresponding author bears primary responsibility for the incomplete disclosure.

Supplementary materials: Many Gastroenterology papers include extensive supplementary content, additional tables, figures, extended methods. The AI disclosure requirement covers all of it. If AI helped edit your supplementary methods section, that needs to be declared. Don't assume the disclosure only applies to the main manuscript.

Patient data and external AI tools: Clinical data and trial data should never be processed through external generative AI services. Even de-identified patient data entered into ChatGPT or similar tools raises privacy and compliance concerns that go beyond the AI disclosure policy.

When in doubt, disclose. Standard spell checkers are exempt. DeepL for basic translation is exempt. But DeepL Write, Grammarly's AI rewriting features, and any tool that generates or substantially rewrites text does need disclosure. There's no penalty for over-disclosing. There is a penalty for under-disclosing.

Comply proactively if:

• You used any AI tool (ChatGPT, Grammarly, Copilot) during manuscript preparation
• The journal requires AI use disclosure in the methods or acknowledgments
• Your institution has its own AI use policy that may be stricter

Less concerned if:

• You used AI only for grammar/spell checking (most journals exempt this)
• The journal does not have a formal AI policy yet
• Your use was limited to literature search or reference management