The algorithmic epistemic inversion in gastroenterology: how social media and psychological vulnerability fuel secondary risks in IBD and IBS management

The unchecked proliferation of medical misinformation on short-video platforms has crystallized into a critical digital public health crisis. For patients managing chronic gastrointestinal diseases such as IBD and IBS, recommendation algorithms routinely override evidence-based medicine (EBM), engendering a phenomenon we term "algorithmic epistemic inversion." This inversion amplifies unproven "miracle cures" and fear-based narratives, driving population-level secondary risks, ranging from indiscriminate probiotic abuse and extreme elimination diets, malnutrition, and orthorexia nervosa. Although IBD and IBS are primarily gastrointestinal diseases, these algorithmically induced secondary risks impose severe, systemic damage on the central nervous system (CNS) and broader neurocognitive functions. To conceptualize this crisis, we introduce the novel framework of the Brain-Gut-Algorithm Axis, which delineates how algorithm-amplified anxiety acts as a social contagion exacerbating somatic symptoms through established gut-brain pathways. To counter this infodemic, we advocate for a public health governance framework grounded in AI-driven algorithmic pharmacovigilance. We urge policymakers and clinicians to recognize algorithm hegemony as a critical digital determinant of health by advancing health equity and integrating psychogastroenterology into routine clinical practice. This Perspective provides specific regulatory and clinical strategies that are crucial to protecting vulnerable populations and strengthening digital public health governance.