Social media engagement has become an increasingly critical part of life, including in health care. Physicians, hospitals, and professional organizations are using social media to improve patient contact, share medical advances, and network.1George D.R. Rovniak L.S. Kraschnewski J.L. Dangers and opportunities for social media in medicine.Clin Obstet Gynecol. 2013; 56Crossref PubMed Scopus (172) Google Scholar The field of gastroenterology is no different, with a steady increase in social media representation over the past 10 years.2Chiang A.L. Vartabedian B. Spiegel B. Harnessing the hashtag: a standard approach to GI dialogue on social media.Am J Gastroenterol. 2016; 111: 1082-1084Crossref PubMed Scopus (32) Google Scholar,3Chiang A.L. Rabinowitz L.G. Kumar A. et al.Association between institutional social media involvement and gastroenterology divisional rankings: cohort study.J Med Internet Res. 2019; 21: e13345Crossref PubMed Scopus (7) Google Scholar Twitter is a dominant social media platform with an estimated 300 million monthly users.4Bilal M. Oxentenko A.S. The impact of Twitter: why should you get involved, and tips and tricks to get started.Am J Gastroenterol. 2020; 115: 1549-1552Crossref PubMed Scopus (13) Google Scholar Users can engage in the Twitter community by following others and sending posts, referred to as tweets. Tweets are limited to a maximum of 280 characters and can be “liked” or “retweeted,” by sharing another user’s tweet. Tweets often include hashtags, or unbroken words or phrases that are preceded by a # (hashtag), expanding the network even more as any tweets containing the identical hashtag are automatically linked.5Chang H.C. A new perspective on Twitter hashtag use: diffusion of innovation theory.Proceedings of the American Society for Information Science Technology. 2010; 47: 1-4Google Scholar Twitter is impactful because of its reach, interconnection, and effectiveness. Gastroenterologists have increasingly turned to Twitter to engage in interdisciplinary discussions, share original content, and bring attention to themselves and their respective fields of study.6Logghe H.J. Selby L.V. Boeck M.A. et al.The academic tweet: Twitter as a tool to advance academic surgery.J Surg Res. 2018; 226: viii-xiiAbstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar For example, Bilal et al7Bilal M. Simons M. Rahman A.U. et al.What constitutes urgent endoscopy? A social media snapshot of gastroenterologists’ views during the COVID-19 pandemic.Endoscopy Int Open. 2020; 8: E693Crossref PubMed Google Scholar used the polling feature on Twitter to analyze gastroenterologists’ views during the novel coronavirus disease-2019 pandemic. Controversies in gastroenterology, such as training in endoscopic retrograde cholangiopancreatography, have sparked Twitter “debates” and allowed the sharing of international perspectives.8Ishtiaq M. Rana F. Maurice J. et al.Controversies in ERCP: frontline Gastroenterology Twitter debate.Frontline Gastroenterol. 2020; 12: 158-161Crossref PubMed Scopus (1) Google Scholar Organizations and journals have also increased their engagement on Twitter. Gut and Gastroenterology created Twitter accounts in May 2010 and March 2017, respectively. In 2016, Nature undertook a massive project to build a standardized list of gastroenterology-related hashtags to help patients and physicians find and share content more readily.9Leake I. Standardized hashtags in# gastroenterology.Nat Rev Gastroenterol Hepatol. 2016; 13 (436–436)Crossref Scopus (1) Google Scholar The American Gastroenterological Association has used Twitter to share screening and surveillance guidelines for a variety of gastrointestinal disorders. In 2019, the American College of Gastroenterology and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Foundation launched a social media campaign to promote diversity and inclusion in gastroenterology through Twitter’s unique hashtag feature.10Balzora S. When the minority tax is doubled: being Black and female in academic medicine.Nat Rev Gastroenterol Hepatol. 2020; (1–1)PubMed Google Scholar Twitter is not without its pitfalls. Generalizability may be limited as Twitter has a younger demographic; more than one-half the users are under the age of 35.11Paul M.J. Dredze M. You are what you tweet: analyzing twitter for public health. Fifth International AAAI Conference on Weblogs and Social Media. Barcelona, Spain, July 17–21, 2011Google Scholar Additionally, the majority of users (approximately 65%) are from the United States.11Paul M.J. Dredze M. You are what you tweet: analyzing twitter for public health. Fifth International AAAI Conference on Weblogs and Social Media. Barcelona, Spain, July 17–21, 2011Google Scholar Misinformation is another important factor to consider when gathering information from internet-based media. User engagement with fictitious content via Twitter has steadily increased each year from 2015 to 2019,12Allcott H. Gentzkow M. Yu C. Trends in the diffusion of misinformation on social media.Research Politics. 2019; 6 (2053168019848554)Crossref Scopus (178) Google Scholar and has been a particular challenge in the political arena. With these limitations, transparency or knowing who is responsible for posting the information in a Tweet is of paramount importance. A recent publication provides practical advice for gastroenterologists interested in contributing to Twitter in a professional and responsible manner.4Bilal M. Oxentenko A.S. The impact of Twitter: why should you get involved, and tips and tricks to get started.Am J Gastroenterol. 2020; 115: 1549-1552Crossref PubMed Scopus (13) Google Scholar In the era of social media misinformation, tweeting frequently and having numerous followers is not necessarily consistent with the goals of producing and circulating substantive and accurate information. In order to understand who is posting the most widely read information on Twitter within the field of gastroenterology, we compiled a list of the highest ranked social media influencers (the term social media influencer includes any individual, organization, or journal that engages on Twitter). We also studied the association between an individual’s status as a social media influencer and parameters of conventional academic success, and we investigated the relationship between the social media reach of specific gastrointestinal journals and their impact factors. For our investigation, we used proprietary software created by Cronycle13CronycleCuration for healthcare communities.2019www.cronycle.com/curation-for-healthcare-communities/Google Scholar to identify all Twitter accounts related to the term “gastroenterology.” Cronycle calculates an influencer score based on engagement (including retweets, likes and views) to determine the “influence” of a Twitter account. Twitter influence scores were obtained using the Cronycle software on September 12, 2020. For all noninstitutional influencers, we evaluated that individual’s advanced degrees, the year that they graduated from medical school, residency and fellowship, gender, h-index (a validated measure of the quantity and quality of research publications), job type, and amount of funding by the National Institutes of Health (NIH). For journals, we recorded their 2019 impact factors. To retrieve this information we looked at Twitter pages, Doximity accounts, and practice or institutional websites. For the h-index, we searched the Scopus Preview website,14Krauskopf E. An analysis of discontinued journals by Scopus.Scientometrics. 2018; 116: 1805-1815Crossref Scopus (13) Google Scholar and for NIH funding, we queried the NIH RePORTER website.15Powell K. Searching by grant number: comparison of funding acknowledgments in NIH RePORTER, PubMed, and Web of Science.J Med Libr Assoc. 2019; 107: 172Crossref PubMed Scopus (5) Google Scholar Journal impact factors were as listed in InCites Journal Citation Reports.16Pagell R.A. Insights into InCites.Online Searcher. 2014; 38: 16Google Scholar Descriptive statistics were used to report count and percentages for categorical data, and mean ± standard deviation for continuous data. Pearson’s χ2 and Kruskal-Wallis tests were used to compare categorical and continuous data, respectively. A subanalysis was performed which compared the top 50 Twitter accounts to the lower 50 twitter accounts (ranked 201–250). Data analysis was formed using MATLAB version R2017b (The MathWorks, Inc., Natick, MA) and STATA version 16 (StataCorp, College Station, TX). Statistical significance was defined as a P value of <.05. The network graph was created using NodeXL (Social Media Research Foundation, CA).17Smith M. Milic-Frayling N. Shneiderman B. et al.NodeXL: a free and open network overview, discovery and exploration add-in for Excel 2007/2010.2010Google Scholar There were 250 Twitter accounts associated with the term “gastroenterology.” The highest score was for the American Gastroenterological Association. Of the 250 social media influencers analyzed, 131 were gastroenterologists (18 pediatric gastroenterology), 9 were surgeons, 23 were journals, 68 were organizations, and 19 were other professions (Table 1). The top 3 organizations were the American Gastroenterological Association, American College of Gastroenterology, and Digestive Disease Week.Table 1Social Influencer DemographicsCharacteristicAll Social Influencers“Top 50” Social Influencers“Lower 50” Social InfluencersP Valuen (%)n (%)n (%)Common characteristicsCharacteristic.04aStatistically significant difference between top 50 and lower 50 groups. Gastroenterologist131 (52.4)24 (49)28 (56) Organization68 (27.2)15 (30.6)11 (22) Journal23 (9.2)10 (20)4 (8) Surgeon9 (3.6)06 (42) Other19 (7.6)1 (2)1 (2)Location.18 United States162 (64.8)34 (69.4)27 (56.2) Other countries78 (31.2)15 (30.9)21 (43.8)Individual influencers Sex (male)119 (75.3)20 (80)31 (88.6).36 Additional degree(s)54 (38.8)10 (40)16 (57.4).21Graduation year Medical school2000 ± 9.41997 ± 8.82002 ± 10.1.11 Residency2005 ± 9.12001 ± 92007 ± 9.6.02aStatistically significant difference between top 50 and lower 50 groups. Fellowship2008 ± 8.72003 ± 92009 ± 10.1.04aStatistically significant difference between top 50 and lower 50 groups.Practice setting.04aStatistically significant difference between top 50 and lower 50 groups. Academic114 (78.1)17 (68)27 (77.1) Private26 (17.8)4 (16)8 (22.9) Privademics6 (4.1)4 (16)0Faculty position.11 Professor34 (31.2)10 (47.62)7 (40.48) Associate35 (32.1)7 (33.3)8 (38.1) Assistant21 (19.3)4 (19)2 (9.5) Instructor4 (3.7)01 (4.8) Fellow/house staff15 (13.8)03 (14.3)3-Year average NIH funding (dollars)442,172 ± 340,112 (n = 13)510,029 ± 369,176 (n = 6)n/aH-Index21.6 ± 20.634.4 ± 24.322.5 ± 20.7.05Journal influencers Impact factor11.8 ± 8.516.2 ± 3.43.3 ± 0.4.02aStatistically significant difference between top 50 and lower 50 groups.NIH, National Institutes of Health.a Statistically significant difference between top 50 and lower 50 groups. Open table in a new tab NIH, National Institutes of Health. The majority of individuals were academic male gastroenterologists practicing in the United States. The adult gastroenterologists can be further classified based on their specified area of expertise with 35.7% specializing in inflammatory bowel disease, 17.9% in advanced endoscopy, 7.1% in transplant hepatology, and 6.3% in neurogastroenterology and motility (Table 2). The top 5 locations in the United States included New York (n = 18, 11%), California (n = 13, 8.2%), North Carolina (n = 12, 7.5%), Massachusetts (n = 9, 5.7%), Ohio (n = 8, 5%), and Illinois (n = 7, 4.4%). One-fourth of the social influencers were located outside the United States. This included the United Kingdom (n = 20, 12.6%), Spain (n = 7, 4.4%), Canada (n = 6, 3.8%), Australia (n = 2, 1.3%), Abu Dhabi (n = 1, 0.63%), Austria (n = 1, 0.63%), Belgium (n = 1, 0.63%), France (n = 1, 0.63%), Ireland (n = 1, 0.63%), and Malaysia (n = 1, 0.63%). An additional degree, aside from medical, was listed by 38.8% of individual social influencers. The most common of these degrees was a Doctor of Philosophy (42%), followed by Master of Public Health (23.7%) and Master of Science (13.6%).Table 2Specialty Interests of the Adult GastroenterologistsSubjectn (%)Inflammatory bowel disease40 (35.7)Advanced endoscopy20 (17.9)Transplant hepatology8 (7.1)Neurogastroenterology and motility7 (6.3)Hepatology6 (5.4)Nutrition5 (4.5)Bariatrics4 (3.6)Celiac disease2 (1.8)Microbiome2 (1.8)Biopsychology1 (0.9)Health Policy1 (0.9)Integrative medicine1 (0.9)General and unspecified30 (26.8) Open table in a new tab The average h-index for individuals was 21.6 ± 20.6. This can be benchmarked by the average h-index for gastroenterology academic faculty, which is 8 (men) and 4 (women).18Diamond S.J. Thomas C.R. Desai S. et al.Gender differences in publication productivity, academic rank, and career duration among US academic gastroenterology faculty.Acad Med. 2016; 91: 1158-1163Crossref PubMed Scopus (71) Google Scholar More than one-half of the gastroenterology social influencers (78.1%) worked in academia, followed by private practice (17.8%) and the hybrid term privademics (4.1%). Privademics was defined as belonging to both a private practice and holding an academic appointment. This was determined based on current affiliations found on personal websites and Twitter accounts. Of the academic influencers, 31.2% held the rank of full professor, 32.1% were associate professors, 19.3% were assistant professors, and 9.4% were at the instructor rank. Gastroenterology fellows composed 13.8% of social influencers. The average year of graduation from medical school and residency was 2000 ± 9.4 years and 2005 ± 9.1 years, respectively. Only 8.8% (n = 13) of social influencers received current NIH funding, of which the median amount was $442,172 ± 340,112. The relationship among the top 50 and lower 50 Twitter accounts in gastroenterology were visualized in the network graph (Figure 1), in which the lines between nodes represented the mutual following. The larger node size demonstrated the upper rank; the top 5 accounts had the largest node size and the lower 50 had the smallest node size. We used color to help visualize different account types: organization (red), journal (blue), and individual (green). To provide specific insight into the very about top influencers, we have displayed the name of top 20 accounts in this figure. The “top 50” ranked social influencers tended to graduate from residency (2001 ± 9 vs. 2007 ± 9.6; P = .02) and fellowship (2003 ± 9 vs. 2009 ± 10.1; P = .04) at an earlier date than the “lower 50” ranked influencers. The “top 50” ranked individual influencers also tended to have a higher h-index (34.4 ± 24.3 vs. 22.5 ± 20.7; P = .05). The “lower 50” ranked influencers had no NIH funding. There were no differences between the two groups in regards to gender, additional degree, location, year of graduation from medical school, and faculty position (Table 1). Of the 23 journals included in the study, 10 were ranked in the top 50 influencers and 4 were in the lower 50. The average impact factor of the top 50 journals was 16.2 ± 3.4 compared with 3.3 ± 0.4 in the lower 50 journals (P = .04). Five of the 14 journals (4 in the top 50 group and 1 in the lower 50 group) did not have impact factors reported, and were not included in this calculation. Our studies offers insight into the top 250 Twitter accounts associated with gastroenterology and compares the top 50 and lower 50 Twitter accounts. However, engagement on social media does not necessarily correlate with influence on social media, nor does academic success correlate with less misinformation. Additionally, we were unable to perform a multivariable analysis to determine the independent predictors of the top 50 influencers when compared with the lower 50 influencers. There was only one specific factor related to journals, which was impact factor. For individual influencers, we could not find more than one significant predictor in a multivariate logistic regression model, given the nature of the highly correlated data that were publicly available. An inherent weakness of this study is the use of a single proprietary software. The use of other programs could have derived different results if other variables were emphasized. We chose Cronycle because of its sophisticated algorithm that relies on more than a single metric to determine social media influence. Our results also reflect a single point in time and a single social media platform. Social media is a dynamic industry with influence and engagement varying on a day-to-day basis. There are multiple social media platforms where information is shared. However, Twitter is particularly conducive to medical discussions and many social media platforms allow for cross-platform posting.6Logghe H.J. Selby L.V. Boeck M.A. et al.The academic tweet: Twitter as a tool to advance academic surgery.J Surg Res. 2018; 226: viii-xiiAbstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar,19Terry M. Twittering healthcare: social media and medicine.Telemedicine and e-health. 2009; 15: 507-510Crossref PubMed Scopus (65) Google Scholar Last, we performed 1 search (“gastroenterology”) to determine our results. Cronycle includes several related topics when determining influence for a given niche and does not rely on flat topic taxonomies, but instead more complex semantic topic graphs with machine inspection of content shared by an entity. So that although we only searched using the term gastroenterology, topics such as hepatology, inflammatory bowel disease, and endoscopy were identified because they had overlapping characteristics In our study of the gastroenterology, “Twitterati” we have identified multiple characteristics that distinguish the more influential from the less influential gastroenterology social media accounts. Interestingly, although Twitter is predominantly used by a more youthful demographic, there was a significant correlation between the social media presence of gastroenterology influencers and how long they have been established practitioners in their field of practice. Top individual influencers tended to have higher h-indices. Thus, greater social media presence in gastroenterology is associated with higher academic status, as judged by more conventional criteria In addition, journals in the top quintile of influencer scores were found to have significantly higher impact factors than those in the lowest quintile. With misinformation at an all-time high across all social media platforms, it is reassuring to note that individuals and journals with higher scores of conventional academic/publishing success and impact also tended to carry the most influence on Twitter.12Allcott H. Gentzkow M. Yu C. Trends in the diffusion of misinformation on social media.Research Politics. 2019; 6 (2053168019848554)Crossref Scopus (178) Google Scholar We hope that, based on our evaluation, consumers of gastroenterology material can feel more confident with what is shared on social media, and consider engaging in gastroenterology Twitter discussions themselves.