BACKGROUND:Gastric emptying scintigraphy (GES) is considered the standard for differentiating gastroparesis from functional dyspepsia and other foregut disorders characterized by nausea and vomiting but provides only a brief physiologic snapshot that may not accurately reflect daily function. We utilized a non-invasive wireless patch system (WPS) to characterize multiday gastric myoelectrical activity, evaluate its relationship with GES, and assess changes following a therapeutic intervention. METHODS:Adults referred for GES for symptoms thought to represent gastroparesis were enrolled in a prospective study. Patients wore a WPS for up to 6 days, starting on the day of scintigraphy. Gastric myoelectrical activity was analyzed and categorized into relatively weak, relatively moderate, and relatively strong activity phenotypes. A subset of patients underwent repeat monitoring following individualized therapeutic interventions (e.g., anti-emetics, proton pump inhibitors, lifestyle changes). RESULTS:Forty-eight patients (mean age 44; 79% female) completed the study. GES identified delayed gastric emptying in 18%, rapid in 22%, and normal in 60% of subjects. During the 4-h concurrent GES window, gastric activity in patients with delayed emptying was lower, but this difference did not reach statistical significance (p = 0.08). When compared to the full multiday recording period, GES results showed no correlation with the myoelectric readings. Significant day-to-day variability was observed, both random and systemic. In the latter category, a "Test-Day" dip was observed with gastric activity lowest on Day 1 (GES test day) and increasing significantly on subsequent days, stabilizing by Day 4 (p < 0.001). Healthy control subjects recorded during normal daily routines showed no such day-to-day variation. In the retesting cohort, anti-emetics produced robust increases in gastric amplitude, whereas PPIs showed minimal impact. CONCLUSIONS:The WPS effectively captures distinct gastric phenotypes and quantifies physiologic responses to therapy in both gastric and intestinal regions, demonstrating its clinical utility as a robust tool for evaluating and managing foregut symptoms in real-world settings. Importantly, the multiday WPS highlights significant day-to-day physiologic variability in gastric activity that extends beyond the single-day GES 'snapshot'.

Bowel disorders (BDs), previously termed functional bowel disorders, are highly prevalent disorders worldwide. These disorders affect individuals across all demographic and socioeconomic groups and have substantial economic consequences, in addition to significantly reducing quality of life. Since the Rome IV publication in 2016, research in the basic and clinical sciences has provided new insights in epidemiology, etiology, pathophysiology, diagnosis, and treatment of BDs, creating the need to revise the diagnostic framework of BDs. This article presents the updated Rome V classification of BDs in 6 distinct categories: irritable bowel syndrome, chronic constipation, functional diarrhea, functional abdominal bloating, unclassified BD, and opioid-induced constipation. Each disorder is defined, followed by sections on epidemiology, rationale for changes from prior criteria, clinical evaluation, pathophysiology, and treatment. It is in hope that the Rome V BD Committee will assist clinicians and researchers in improving diagnosis, patient care, and scientific endeavors of these common and burdensome disorders.

Sleep plays a critical role in maintaining good physical and emotional health. Sleep and circadian rhythms are fundamental regulators of human physiology, influencing most biological processes from the cellular to the organ-system level. Sleep disorders are common with a prevalence of 30% in adults. Impaired sleep reduces patients' quality of life and has a significant negative economic impact on the health care system. Sleep deprivation can affect the brain and alter normal circadian rhythms. These disturbances influence the brain-gut axis and subsequently affect both symptom development and symptom expression in patients with disorders of gut-brain interaction (DGBIs), including functional dyspepsia and irritable bowel syndrome. DGBIs are highly prevalent with at least 40% of adults worldwide meeting criteria for at least 1 DGBI. This article reviews the prevalence and impact of disordered sleep, discusses the basics of normal and abnormal sleep, examines the role of diagnostic testing for sleep disorders, and evaluates the role of disordered sleep in common DGBIs. Practical tips to evaluate and treat patients with DGBIs and disordered sleep are also discussed.

Vagal nerve injury can cause nonspecific symptoms and is challenging to assess. Pancreatic polypeptide (PP) release after sham feeding is a surrogate marker of vagal function. This study evaluated vagal integrity using sham feeding-induced PP measurement and examined associations between symptoms, PP levels, and gastric emptying. This was a retrospective study of patients who underwent sham feeding from 2018 to May 2025. We collected demographic and clinical data, sham feeding results, indications for the study, and gastric emptying data. A 50

The management of patients with irritable bowel syndrome (IBS) remains a common clinical challenge for health care providers. IBS is a prevalent disorder that encompasses a constellation of symptoms that may be caused by a variety of underlying conditions; as a result, there is no one-size-fits-all approach, and clinicians must tailor their approach to the individual. This article outlines the challenges associated with the management of IBS and offers practical solutions to help providers care for patients with IBS.

The accurate diagnosis of disorders of gut-brain interaction (DGBI), such as functional dyspepsia and irritable bowel syndrome, is crucial for improving patient symptoms, outcomes, and, ultimately, quality of life. However, busy clinicians often face challenges in diagnosing and managing these conditions, particularly when patients present with nonspecific gastrointestinal symptoms together with psychosocial distress and/or social issues. DGBI are among the most common reasons for gastroenterology referral, with a global prevalence of approximately 40% in adults based on large-scale epidemiologic studies. Although diagnostic algorithms aid in positively identifying DGBI, they often overlook key factors influencing treatment decisions. The Rome V Multidimensional Clinical Profile offers a comprehensive, patient-centered framework that extends beyond diagnosis alone. It integrates 5 core domains: (i) the primary diagnosis, (ii) clinical modifiers, (iii) impact on daily activities and quality of life, (iv) psychosocial modifiers, and (v) physiological features and biomarkers. By considering comorbidities, illness severity, psychosocial contributors, and potential biomarkers, the Multidimensional Clinical Profile enables clinicians to develop a holistic understanding of the patient's condition. This multidimensional approach facilitates tailored, evidence-based treatment plans that address the biopsychosocial aspects of DGBI, ultimately enhancing symptom management and patient well-being. Furthermore, it highlights gaps in knowledge and stimulates targeted research into these highly prevalent disorders. This case-oriented educational review will evaluate 3 DGBI-functional dyspepsia, irritable bowel syndrome, and chronic abdominal pain-using the Multidimensional Clinical Profile approach.

Rapid gastric emptying (RGE) is conventionally defined as ≥ 70

Myths and misconceptions about the evaluation and treatment of constipation persist. Many widely prevalent misconceptions about laxatives, specifically stimulant laxatives, interfere with the effective management of constipation. Although some of these myths and misconceptions have been dispelled in recent years, there is additional room for improving the awareness and understanding of the pathophysiology of constipation, the mechanisms of action and the efficacy and safety of available therapies. An evolution in our understanding of pathophysiology and the availability of new treatments requires that primary care practitioners be better positioned to treat this common disorder that reduces patients’ quality of life and negatively impacts the healthcare system. This review defines constipation and elucidates various factors that contribute to its aetiology, including lifestyle, dietary habits, medications and underlying medical conditions. This review addresses and refutes common myths and misconceptions about constipation, such as the belief that regular bowel movements must occur daily or the use of laxatives leads to dependence. This review also highlights the importance of distinguishing between normal and abnormal bowel habits and emphasises the need for individualised management approaches to address constipation effectively. Finally, the review discusses different classes of laxatives, dispelling misconceptions about their safety, efficacy and potential for misuse, with a specific focus on stimulant laxatives. In summary, this review enhances awareness and knowledge of this prevalent disorder, provides evidence-based insights into common myths and misconceptions surrounding constipation and promotes more informed decision-making regarding constipation and the use of laxatives.

Ehlers-Danlos syndromes (EDS) are hereditary connective tissue disorders increasingly linked to gastrointestinal conditions, including irritable bowel syndrome (IBS). However, large-scale epidemiologic evidence describing this association, its subtype patterns, and related healthcare burden remains limited. To examine the association between EDS and IBS among hospitalized patients, including variation across IBS subtypes and differences in healthcare utilization. We conducted a retrospective cross-sectional analysis of the 2017–2019 National Inpatient Sample, representing over 106 million weighted U.S. hospitalizations. EDS and IBS were identified using ICD-10-CM codes, excluding Marfan syndrome and hypermobility spectrum disorders. Survey-weighted logistic and linear regression models assessed associations between EDS and IBS, IBS subtypes, age distribution, length of stay (LOS), hospitalization costs, and in-hospital mortality, with sequential adjustment for demographic, socioeconomic, hospital-level, and clinical confounders. Among 953,430 weighted IBS hospitalizations, 2475 (0.26

Rigorous treatment trials have resulted in substantial therapeutic advances in disorders of gut-brain interaction (DBGI) over the past several decades. However, much of this work has been conducted in adults with irritable bowel syndrome, and some of the challenges of DGBI trials (eg, symptom-based diagnoses and outcomes) have experienced more limited progress, especially for less common DGBI. Randomized, placebo-controlled trials remain the time-tested gold standard for DGBI, although more recent pragmatic trials have demonstrated real-world efficacy. Moreover, treatment trials have expanded into dietary interventions and brain-gut behavioral therapies, now with greater guidance and recognition of the nuances of these nondrug trials. Development of validated patient-reported outcome measures and adherence to Good Clinical Practice standards will yield novel DGBI therapies and more sophisticated treatment strategies for the management of these complex disorders. This article summarizes best practice, methodology, conduct, and reporting of treatment trials in DGBI as well as regulatory guidance and recent advances in trial design.

BACKGROUND:Data on the global prevalence of alarm features in the general population and among individuals with disorders of gut-brain interaction (DGBI) are limited. METHODS:We analysed data from the Rome Foundation Global Epidemiology Study to estimate the prevalence of fourteen self-reported alarm features in the global population and among individuals with Rome IV defined DGBI, including 54,127 participants from 26 countries. Differences between participants with and without DGBI were evaluated in a sample excluding those with self-reported organic gastrointestinal disease, using univariable logistic regression. Analyses were stratified by age (< 50 vs. ≥ 50 years). RESULTS:Alarm features were reported by 63.1% of participants aged < 50 years and 51.8% of those aged ≥ 50 years. Individual self-reported alarm features ranged from 0.9% to 18.3% in younger participants to 0.3%-13.3% in older participants. Haematemesis was the least frequently reported feature, while a major change in bowel movements was the most frequent in both age groups. Self-reported alarm features were more frequent among participants with than without DGBI (< 50 years: 75.3% vs. 50.7%; OR 3.0 [2.8-3.1]; ≥ 50 years: 67.5% vs. 38.8%; OR 3.3 [3.1-3.5]). Participants with DGBI were also more likely to report multiple alarm features. DISCUSSION:Self-reported alarm features are common in the general population and more prevalent among individuals with DGBI. These findings underscore the importance of interpreting alarm features within a broader clinical context rather than in isolation. Further studies are needed to clarify the diagnostic utility of alarm features in unselected populations, particularly among individuals with DGBI.

INTRODUCTION: This post hoc analysis evaluated the efficacy of tenapanor on abdominal symptoms in patients with irritable bowel syndrome with constipation. Abdominal symptoms assessed included pain, discomfort, bloating, cramping, and fullness. METHODS: The abdominal symptom data were pooled from 3 randomized controlled trials (NCT01923428, T3MPO-1 [NCT02621892], and T3MPO-2 [NCT02686138]). Weekly scores were calculated for each abdominal symptom, and the Abdominal Score (AS) was derived as the average of weekly scores for abdominal pain, discomfort, and bloating. The overall change from baseline during the 12 weeks was assessed for each symptom weekly score and the AS. The AS 6/12-week and 9/12-week response rates (AS improvement of ≥2 points for ≥6/12- or ≥9/12-week) were also evaluated. The association of weekly AS response status (reduction of ≥30%) with weekly complete spontaneous bowel movement (CSBM) status (=0 and >0) was assessed. RESULTS: Among 1,372 patients (684 tenapanor [50 mg twice a day] and 688 placebo), the least squares mean change from baseline in AS was −2.66 for tenapanor vs −2.09 for placebo ( P < 0.0001). The 6/12-week AS response rate was 44.4% for tenapanor vs 32.4% for placebo ( P < 0.0001), and for 9/12-week AS, 30.6% for tenapanor vs 20.5% for placebo ( P < 0.0001). A significant association between weekly CSBM status and weekly AS response status was observed each week ( P < 0.0001), with a greater proportion achieving an AS reduction in patients with >0 CSBMs in a week. DISCUSSION: Tenapanor significantly reduced abdominal symptoms in patients with irritable bowel syndrome with constipation, particularly pain, discomfort, and bloating measured by AS, compared with placebo.

BACKGROUND & AIMS:Personalized dietary therapies for irritable bowel syndrome (IBS) are needed and an immunoglobulin (Ig)G-antibody-based elimination diet presents a potential solution. However, existing studies have serious methodological limitations. This study aimed to assess the efficacy of an elimination diet by using a novel IBS-specific IgG assay. METHODS:We conducted a randomized, double-blind, sham-controlled trial enrolling subjects with IBS from 8 centers. Subjects positive for ≥1 food on an 18-food IgG assay and an average daily abdominal pain intensity score between 3.0 and 7.5 on an 11.0-point scale during a 2-week run-in period were randomized to either an experimental antibody-guided diet or sham diet for 8 weeks. The primary outcome was a ≥30% decrease in abdominal pain intensity for ≥2 of the last 4 weeks of the treatment period. RESULTS:Among 238 randomized subjects with IBS, 223 were included in the modified intention-to-treat analysis. A significantly greater proportion of subjects in the experimental diet group met the primary outcome than those in the sham diet group (59.6% vs 42.1%, P = .02). Subgroup analysis revealed that a higher proportion of subjects with constipation-predominant IBS and IBS with mixed bowel habits in the experimental diet group met the primary endpoint vs the sham group (67.1% vs 35.8% and 66% vs 29.5%, respectively). CONCLUSIONS:Subjects on an IgG-guided elimination diet were more likely to achieve the primary endpoint than those on a sham elimination diet. Subgroup analysis suggests a more robust benefit for subjects with constipation-predominant IBS and IBS with mixed bowel habits. This highlights the potential effectiveness of a personalized elimination diet based on a novel IBS-specific IgG assay. A larger study is warranted to validate these observations. (ClinicalTrials.gov, Number NCT03459482.).

INTRODUCTION:Investigation of an evacuation disorder is often pursued in patients with symptoms of obstructive defecation. High-resolution anorectal manometry (HR-ARM) is a simple, safe, and widely available test to diagnose pelvic floor dysfunction. A more costly and less accessible test is magnetic resonance defecography (MRD). This study aims to quantify the added value of MRD in diagnosing pelvic floor disorders. METHODS:HR-ARM and MRD performed in patients with a diagnosis of constipation between January 1, 2020 and May 15, 2022 at Mayo Clinic were identified using Epic Slicer Dicer. Univariate and multivariate analyses were used to compare findings on MRD in patients with and without abnormal HR-ARM. Categorical variables were compared using the Pearson's chi-square test, and continuous variables were compared using the two-sample t-test. RESULTS:Seventy-six consecutive patients (81.8% female, 94.8% White, ages 19-82) who underwent both HR-ARM and MRD were included. The majority had evidence of dyssynergia on HR-ARM (n = 49, 64.5%). Patients with dyssynergia on HR-ARM were significantly more likely to have prolonged balloon expulsion at both > 60 and > 30 s (p < 0.001) and incomplete gel expulsion on MRD (p < 0.001). However, they were not more likely to have a clinically significant rectocele measuring > 2 cm (p = 0.17) or evidence of rectal prolapse (p = 0.07). DISCUSSION:Anatomic findings on MRD were similar between patients with and without evidence of dyssynergia identified by HR-ARM. In this retrospective review, simultaneously undergoing MRD in addition to HR-ARM does not appear to provide significant additional diagnostic information to guide therapeutic recommendations. Large prospective studies to evaluate the added value of MRD are needed.