Chronic primary constipation is common and burdensome yet is often labeled idiopathic despite growing evidence of physiologic heterogeneity. This invited, clinically oriented review examines emerging mechanisms underlying chronic constipation and their implications for phenotyping, diagnosis, and treatment. Microbial composition, methanogenesis, enteric serotonergic signaling, neuromuscular function, gut–brain interactions, and sex-related biological factors may contribute to distinct constipation phenotypes, although most associations lack validated biomarkers. Clinically, careful phenotyping remains essential, including exclusion of secondary causes, digital rectal examination, anorectal manometry with balloon expulsion testing, and, in a minority of patients, transit testing or defecography. Emerging diagnostic approaches, including artificial intelligence applied to anorectal testing and location-aware ingestible devices, may improve classification, but require prospective multicenter validation and demonstration of clinical benefit. Therapeutic options are also expanding: tenapanor is modestly effective for irritable bowel syndrome with constipation, vibrating capsules are authorized for chronic idiopathic constipation, and elobixibat provides proof of concept for ileal bile acid transport inhibition as a therapeutic target. Chronic primary constipation encompasses heterogeneous mechanisms that are incompletely captured by current diagnostics. Advances in physiologic phenotyping, novel diagnostic technologies, and mechanism-based therapies may enable more individualized management. Future progress will depend on phenotype-enriched trials that link reproducible mechanisms with actionable diagnostics and targeted therapy.
Crohn’s disease typically presents with primarily, luminal disease that progresses transmurally, producing structural bowel damage (strictures and fistula). This review examines the rationale for early treatment in Crohn’s disease, summarizing the clinical evidence supporting early intervention to prevent transmural progression, an increased inflammatory burden and associated refractory disease. Translational studies show that transmural inflammation shifts from a reversible to an irreversible, fibrotic process over time. Randomized trials, including the PROFILE study, demonstrate that early combined or top-down therapy improves long-term outcomes compared with conventional step-up management. Similar benefits have since been reported across non-anti-TNF therapeutic classes, suggesting that treatment responsiveness declines with disease duration as a shared biological feature of early disease, rather than a drug-specific effect. Emerging evidence also indicates that immune and mucosal changes may be detectable years before clinical recognition, raising the question of whether this decline in responsiveness begins even earlier than currently appreciated. Early treatment in Crohn’s disease is associated with better long-term outcomes across multiple classes of advanced therapies. However, disease duration alone is an insufficient marker of where a patient stands in this process. Future efforts should refine the biological definition of early disease, improve patient selection, and move toward disease interception.
Gastrointestinal disorders fluctuate between clinical encounters, creating a need for objective longitudinal monitoring. We review wearable technologies across gastrointestinal disorders, emphasizing clinical applications, current evidence, and barriers to implementation. Wearables capture physiologic, biochemical, and acoustic signals relevant to gastrointestinal disease. In inflammatory bowel disease, wearable-derived physiologic changes may precede inflammatory and symptomatic flares and help distinguish inflammatory from non-inflammatory symptoms. Sweat biosensors can measure inflammatory analytes, including calprotectin. Beyond inflammatory bowel disease, autonomic measures characterize disorders of gut-brain interaction, electrogastrographic and acoustic devices assess gastrointestinal motility, and activity and sleep metrics may aid postoperative recovery assessment and risk stratification in chronic liver disease. Evidence remains predominantly observational, and validated clinical thresholds are lacking, limiting the current clinical applicability of wearable derived signals. Wearables enable continuous, noninvasive monitoring across gastrointestinal disorders, but prospective trials are needed to establish clinical utility, actionable thresholds, workflow integration, and patient-centered implementation, and demonstrate improvement in clinically meaningful outcomes.
Eosinophilic esophagitis (EoE) is a chronic inflammatory esophageal condition increasingly recognized across the age spectrum. Although EoE is traditionally associated with younger population, it also affects older patients aged 65 years and older. This review summarizes the current literature on EoE specifically in older adults, with a focus on clinical presentation, endoscopic and histologic findings, diagnostic challenges, management considerations, and gaps in current knowledge. EoE is thought to be less frequently diagnosed in older patients, but the true prevalence in this population remains uncertain. Older patients may have overlapping symptoms and are likely to have comorbid conditions that can obscure the diagnosis, including age-related presbyesophagus and gastroesophageal reflux disease. Recent evidence indicates older adults are less likely to undergo esophageal biopsies during endoscopic evaluation for dysphagia, which may be a potentially barrier to diagnosis of EoE. Current treatment options for EoE include proton pump inhibitors, swallowed topical corticosteroids, dietary elimination, endoscopic dilation, and biologic therapy. However, evidence specifically addressing their efficacy and safety in older adults remains limited. EoE should be considered in older patients presenting with esophageal symptoms such as dysphagia, especially when symptoms persist despite treatment for more common conditions like GERD. Maintaining high index of suspicion and obtaining esophageal biopsies are important to reduce diagnostic delay in these patients. Management should be individualized according to patient goals, comorbidities, polypharmacy, nutritional status, and procedural risk. Further prospective studies involving adults aged 65 years and older are essential to better understand the epidemiology, appropriate management, treatment outcomes, and long-term consequences of EoE in the elderly population.
Subcutaneous infliximab (IFX-SC; CT-P13 SC/infliximab-dyyb/Remsima-SC/Zymfentra) is an approved maintenance option after intravenous (IV) induction in adults with inflammatory bowel disease (IBD), but it is not approved for patients < 18 years, and the pediatric evidence remains dispersed across small, largely observational cohorts. This review synthesizes the published pediatric experience of transitioning from IV to SC infliximab, examining maintenance of remission, drug concentrations, safety, and acceptability, and situates it within the adult evidence base and the distinctly pediatric concerns of access and dosing. A systematic search (PROSPERO: CRD420261465026) identified six independent, non-overlapping pediatric switch cohorts (n = 173). Random-effects proportional meta-analysis yielded pooled treatment persistence of 92
