Post-COVID presents a complex medical challenge characterized by persistent symptoms following SARS-CoV-2 infection. Similarities between post-COVID and post-infectious Irritable Bowel Syndrome (PI-IBS) suggest that the latter can serve as a useful model for understanding pathophysiological mechanisms and developing therapeutic approaches. Both conditions are functional disorders triggered by an acute infection, with multifactorial etiology and limited biomarker-based diagnostics. The variability of symptoms and the high frequency of comorbidities make these disorders particularly difficult to diagnose. Diagnostic efforts may be further hindered by the stigmatization of such disorders among healthcare providers, the health insurance industry, and the general public. This article explores the parallels between PI-IBS and post-COVID, highlighting, on the one hand, what can be learned from the management of IBS to better address the needs of patients with post-COVID long-term sequelae, and, on the other hand, raising doubts—based on decades of research into drug therapy development for IBS—about the likelihood of a rapidly available treatment for post-COVID.

ABSTRACT Background In patients with non‐cardiac chest pain (NCCP) and non‐obstructive dysphagia (NOD), standard esophageal high resolution manometry (HRM) with water swallows and/or solid meals may miss intermittent dysmotility. To what extent prolonged 24 h‐measurements may increase the diagnostic sensitivity is currently unclear. Methods 75 patients (47 female, 58 ± 16 years) with NCCP and/or NOD underwent standard HRM (single water swallows plus rice meal) and ambulatory 24‐h‐HRM with impedance. Results were analyzed according to Chicago Classification v3.0 for water‐swallow‐HRM; adapted criteria were used for rice‐meal and 24‐h‐HRM. Patients were followed by chart review. Key Results Contractility parameters obtained by different HRM procedures always correlated ( R > 0.27, p < 0.05). During 24 h‐measurements, all parameters showed circadian variability ( p < 0.001). In comparison with water‐swallow‐HRM, rice‐meal‐HRM markedly increased the proportion of patients diagnosed with achalasia III, esophagogastric outlet obstruction with spastic features, distal esophageal spasm, or hypercontractility (10.7% vs. 21.3%, p = 0.039). The diagnostic gain regarding spastic and/or hypercontractile disorders was further increased by 24‐h‐HRM (61.3% of patients, p < 0.001). In 11 out of 21 patients with normal results in both water‐swallow‐ and rice‐meal‐HRM (15% of total cohort), 24‐h‐HRM detected a major motor disorder. Results of 24‐h‐HRM altered treatment recommendations in 41 patients (54%). Conclusions&Inferences 24‐h‐HRM revealed spastic and/or hypercontractile esophageal motor disorders in about 60% of patients with NCCP/NOD and markedly improved diagnostic yield compared with standard HRM, probably partly due to the observed circadian variability of esophageal motility. 24‐h‐HRM findings frequently altered treatment recommendations, but the ultimate clinical consequences of the increased diagnostic yield have to be examined further.

Chronic constipation is one of the most common health disorders in all of medicine. Its extent ranges from mild discomfort, which is usually easy to improve, to severe functional limitations that may significantly reduce quality of life and may be refractory to various treatment approaches. Our understanding of the pathomechanism has grown considerably in recent years and has also led to important new therapeutic developments. The resulting treatment options and recommendations are presented in the current update of the S2k constipation guideline in an evidence-based and practical manner. The respective significance of traditional and recent drug developments is classified and categorized in modern "step-up" treatment strategies. In particular, numerous important aspects of everyday practice are addressed, such as questions on long-term treatment and therapeutic options in specific constellations (adequate treatment of constipation in older people, constipation during pregnancy, and drug-induced [especially opioid-induced]constipation).The most important new developments (i.e. new therapeutic approaches, but also re-evaluations of "traditional" laxatives and the importance of careful diagnostics in therapy-refractory patients) are summarized in this article.

BACKGROUND/AIM:An 80-year-old male patient had complained of proximal paresis of the left leg, pain and sensory disturbances in the left abdomen, exanthema in the left lower abdomen, coprostasis, and severe abdominal pain, as well as a progressive deterioration of his general condition for weeks. The patient had already presented to three other medical centers. Colonoscopy and computed tomography of the abdomen could not explain the pronounced symptomatology. In addition, there was acute elevator paresis of the left leg and severe pruritic rash on both sides of the trunk.CASE REPORT:At the Israelitisches Krankenhaus Hamburg (IKH), laboratory parameters of urine, stool, and blood, ultrasound, electrocardiogram, and transthoracic echocardiography diagnosis showed no abnormalities. Esophago-gastro-duodenoscopy revealed patchy erythema and moderately severe chronic low-activity Helicobacter-positive gastritis. Colonoscopically, two polyps were ablated. A neurological examination with magnetic resonance imaging and electroneurography also showed normal findings. Evidence of autoimmune or rheumatoid disease was also absent. Finally, analysis of the cerebrospinal fluid revealed a lympho-granulocytic cell count (32/3 lymphocytes, 21/3 granulocytes) and an elevated Borrelia-specific IgG index (Ai) of 20.82. This finding was confirmed by a complementary serological diagnosis, in which Borrelia-specific IgM and IgG antibodies were detected. In sum, Bannwart's syndrome was assumed to be the cause of the neurological symptoms. The 21-day borreliosis therapy included doxycycline administration and analgesia with novaminsulfone and pregabalin as needed.CONCLUSION:A complex symptomatology of leg paresis, lower abdominal pain and sensory disturbances, exanthema, and coprostasis in combination with a long-lasting poor general condition were found to be the consequences of atypical neuroborreliosis.

Chronic constipation is one of the most common health disorders in all of medicine. Its extent ranges from mild discomfort, which is usually easy to improve, to severe functional limitations that may significantly reduce quality of life and may be refractory to various treatment approaches. Our understanding of the pathomechanism has grown considerably in recent years and has also led to important new therapeutic developments. The resulting treatment options and recommendations are presented in the current update of the S2k constipation guideline in an evidence-based and practical manner. The respective significance of traditional and recent drug developments is classified and categorized in modern "step-up" treatment strategies. In particular, numerous important aspects of everyday practice are addressed, such as questions on long-term treatment and therapeutic options in specific constellations (adequate treatment of constipation in older people, constipation during pregnancy, and drug-induced [especially opioid-induced]constipation).The most important new developments (i.e. new therapeutic approaches, but also re-evaluations of "traditional" laxatives and the importance of careful diagnostics in therapy-refractory patients) are summarized in this article.

Das Reizdarmsyndrom (RDS) ist eine chronische Erkrankung des Verdauungstrakts mit oft jahrzehntelanger Chronizität. Gleichzeitig ist die Therapie besonders anspruchsvoll, weil ein Behandlungserfolg häufig eine Kombination medikamentöser und nichtmedikamentöser Maßnahmen erfordert. Die Pathomechanismen des RDS sind erst in Ansätzen aufgeklärt, entsprechend fehlen kausal wirksame Therapien weitgehend. Im Gegensatz zu früheren Vorstellungen einer „psychosomatischen Störung“ handelt es sich beim RDS in der großen Mehrzahl der Fälle um eine organische Erkrankung. Die üblicherweise dominierenden Beschwerden sind Darmkrämpfe oder Leibschmerzen, Meteorismus/Flatulenz, Obstipation und Diarrhö. Der Patient sollte von Anfang an umfassend in ein gemeinsames Behandlungskonzept einbezogen werden. Aufgrund des Fehlens kausaler Behandlungsverfahren hat jeder Behandlungsansatz zunächst probatorischen Charakter, bei fehlender Wirkung sollte eine Therapie spätestens nach 3 Monaten beendet werden. Wirksame Behandlungen können als Bedarfs- oder Dauertherapie fortgesetzt, adaptiert und/oder mit weiteren Verfahren kombiniert werden. Es hat sich bewährt, die gezielte medikamentöse Behandlung der dominanten Einzelsymptome durch eher unspezifische, aber oft relevant wirksame Basis- oder Begleittherapien zu ergänzen. Eine solche multimodale Therapiestrategie, in der Allgemeinmaßnahmen, Ernährungs‑, Psycho- und Pharmakotherapien individuell kombiniert werden, ist einer medikamentösen Monotherapie signifikant überlegen. Im vorliegenden Beitrag werden medikamentöse Erst- und Zweitlinientherapien sowie Optionen bei refraktärer Symptomatik beschrieben. Die Wahl der medikamentösen Therapie wird hauptsächlich durch die dominanten Symptome bestimmt. Abhängig von der Symptomkonstellation kann es sinnvoll sein, verschiedene Substanzen zu kombinieren.

Was ist neu? Anorektale Funktionsdiagnostik Eine frühzeitige anorektale Funktionsdiagnostik zur Stratifizierung der weiteren Therapiewege ist kosteneffizient. Therapie mit Laxanzien Klassische Laxanzien wie Macrogol, Bisacodyl und Natriumpicosulfat können nach aktueller Studienlage unbedenklich auch langfristig eingesetzt werden. Moderne Obstipations-Medikamente wie z.B. Linaclotid und Plecanatid sind oft hochwirksame Reservemedikament für die anderweitig nicht therapierbare Obstipation, insbesondere auch bei begleitenden Reizdarmsymptomen. Die Hürden der Verschreibung limitieren den Einsatz. Neue Therapieentwicklungen Eine mögliche neue Therapieoption könnte eine vibrierende Kapsel sein, die oral eingenommen wird und die auf ihrem Weg durch den Gastrointestinaltrakt die Darmmotorik von innen stimulieren soll. Die Kapsel ist derzeit nur in den USA zugelassen. Die aktualisierte Leitlinie Chronische Obstipation empfiehlt weiter eine therapeutische Stufenstrategie. Therapiemaßnahmen sollten bedarfsadaptiert eingesetzt werden. Um Fehltherapien zu vermeiden, ist die Detektion der Ursachen einer Stuhlentleerungsstörung von großer Bedeutung.

Irritable bowel syndrome (IBS) is a chronic disease of the digestive tract that is characterised by decades-long chronicity. At the same time, it is particularly challenging to treat since successful treatment often requires a combination of pharmacological and non-pharmacological measures. The pathomechanisms of IBS have only just started to be elucidated, meaning that causally effective treatments are largely lacking. In contrast to earlier notions of a "psychosomatic disorder", IBS is an organic disease in the vast majority of cases. The predominant symptoms are usually intestinal cramps or abdominal pain, meteorism/flatulence, constipation, and diarrhea. The patient should be fully included in a joint treatment concept from the outset. Given the lack of causal treatment methods, each treatment approach is initially by way of trial; if there is no effect, treatment should be discontinued after 3 months at the latest. Effective treatments can be continued, adapted, and/or combined with other procedures as an on-demand or permanent treatment. Supplementing the targeted drug treatment of the dominant individual symptoms with somewhat unspecific but often relevantly effective basic or accompanying treatments has proven useful. Such a multimodal treatment strategy, in which general measures as well as nutritional, psychological, and pharmacotherapies are individually combined, is significantly superior to drug monotherapy. This article describes first- and second-line drug treatments in addition to options for refractory symptoms. The choice of drug therapy is primarily determined by the dominant symptoms. Depending on the symptom constellation, it may be beneficial to combine different drugs.

To evaluate the efficacy of pharmacologic agents for the irritable bowel syndrome.Electronic literature search of MEDLINE (1966 to 1999), EMBASE (1980 to 1999), PsycINFO (1967 to 1999), and the Cochrane controlled trials registry and a manual search of references from bibliographies of identified articles.Randomized, double-blind, placebo-controlled, parallel, or crossover trials of a pharmacologic intervention for adult patients that reported outcomes of improvement in global or irritable bowel-specific symptoms.Qualitative and quantitative data reported on study groups, interventions, treatment outcomes, and trial methodologic characteristics.70 studies met the inclusion criteria. The most common medication classes were smooth-muscle relaxants (16 trials), bulking agents (13 trials), prokinetic agents (6 trials), psychotropic agents (7 trials), and loperamide (4 trials). The strongest evidence for efficacy was shown for smooth-muscle relaxants in patients with abdominal pain as the predominant symptom. Loperamide seems to reduce diarrhea but does not relieve abdominal pain. Although psychotropic agents were shown to produce global improvement, the evidence is based on a small number of studies of suboptimal quality. Psychotropic drugs, 5-hydroxytryptamine (5-HT)-receptor antagonists, peppermint oil, and Chinese herbal medicine require further study.Smooth-muscle relaxants are beneficial when abdominal pain is the predominant symptom. In contrast, the efficacy of bulking agents has not been established. Loperamide is effective for diarrhea. Evidence for use of psychotropic agents is inconclusive; more high-quality trials of longer duration are needed. Evidence for the efficacy of 5-HT-receptor antagonists seems favorable, although more studies are needed.

This protocol has been withdrawn from publication by Cochrane Neuromuscular with the agreement of the authors, as it has not progressed to a full review.

Autoren Jutta Keller1, Thilo Wedel2, Holger Seidl3, Martin E. Kreis4, Ivo van der Voort5, Maximilian Gebhard6, Jost Langhorst7, Petra Lynen Jansen8, Oliver Schwandner9, Martin Storr10, Pia van Leeuwen8, Viola Andresen1, Jan C. Preiß11, Peter Layer1 Collaborators: H. Allescher, T. Andus, S. C. Bischoff, S. Buderus, M. Claßen, U. Ehlert, S. Elsenbruch, M. Engel, A. Enninger, W. Fischbach, M. Freitag, T. Frieling, A. Gillessen, M. Goebel-Stengel, J. Gschossmann, F. Gundling, S. Haag, W. Häuser, U. Helwig, S. Hollerbach, G. Holtmann, M. Karaus, M. Katschinski, H. Krammer, W. Kruis, R. Kuhlbusch-Zicklam, P. Lynen Jansen, A. Madisch, H. Matthes, S. Miehlke, H. Mönnikes, S. Müller-Lissner, B. Niesler, C. Pehl, D. Pohl, C. Posovszky, M. Raithel, G. Röhrig-Herzog, R. Schäfert, M. Schemann, A. Schmidt-Choudhury, S. Schmiedel, A. Schweinlin, J. Schwille-Kiuntke, A. Stengel, J. Tesarz, W. Voderholzer, G. von Boyen, J. von Schönfeld in Zusammenarbeit mit: Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM), Deutsche Gesellschaft für Allergologie und Klinische Immunologie (DGAKI), Deutsche Gesellschaft für Allgemeinund Viszeralchirurgie (DGAV), Deutsche Gesellschaft für Ernährungsmedizin (DGEM), Deutsche Gesellschaft für Geriatrie (DGG), Deutsche Gesellschaft für Innere Medizin (DGIM), Deutsche Gesellschaft für Naturheilkunde (DGNHK), Deutsche Gesellschaft für Pathologie und Bundesverband deutscher Pathologen e. V. (DGP/BDP), Deutsche Gesellschaft für Psychosomatische Medizin und Ärztliche Psychotherapie (DGPM), Deutsche Gesellschaft für Verhaltensmedizin und Verhaltensmodifikation (DGVM), Deutsche Schmerzgesellschaft e. V., Deutsches Kollegium für Psychosomatische Medizin (DKPM), Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit (DTG), Gesellschaft für Pädiatrische Gastroenterologie und Ernährung (GPGE), Deutsche Gesellschaft für Kinderund Jugendmedizin (DGKJ), Swiss Society of Neurogastroenterology and Motility (SwissNGM), Informationsforum für Patient:innen mit Magen-Darm-Erkrankungen (MAGDA)