The clinician–patient relationship is a vital component of therapeutic success in disorders of gut–brain interaction (DGBI), recently codified as the foundational “Level 1” psychosocial care within the Rome V biopsychosocial framework. This systematic review aimed to identify evidence-based methods for building and maintaining effective clinician–patient relationships in adult DGBI care. Following the PRISMA 2020 and Synthesis Without Meta-analysis (SWiM) guidelines, we searched PubMed, Cochrane CENTRAL, and Ichushi Web for studies published through January 2026. Quality assessment was performed using AMSTAR 2 and RoB 2/ROBINS-I tools, facilitated by a human–AI collaborative verification process. Twelve studies (four systematic reviews and eight primary studies) were identified. Narrative synthesis revealed that “augmented encounters,” characterized by empathy, warmth, and active listening improved clinical outcomes, including symptom severity and quality of life, particularly in irritable bowel syndrome. Strategic communication providing a confident positive diagnosis and psychoeducation regarding the gut–brain axis (rather than a diagnosis of exclusion) was found to be superior for enhancing treatment adherence in functional dyspepsia. Furthermore, multidisciplinary care models (spanning from provider-delivered self-management education to fully integrated Level 3 gastropsychology) and the use of non-deceptive placebos optimized the therapeutic context. The review also identified potential cultural moderators, hypothesizing that disease-centered reassurance might play a distinct role in certain East Asian clinical settings compared to Western contexts, though this warrants further investigation. This review structurally organized multiple relational tools, highlighting their fundamental role in DGBI management. Although current evidence is heterogeneous and partly relies on indirect findings, these promising supportive strategies conceptually align with Rome V psychosocial care. Further high-quality, direct clinical studies are needed to clarify which relational strategies are most effective for specific DGBI populations and clinical contexts. CRD420251126617.

INTRODUCTION:Dietary factors, including fermentable oligo-, di-, monosaccharides, and polyols (FODMAPs), have been implicated in symptom generation among patients with functional dyspepsia (FD). Accordingly, a low-FODMAP diet (LFD) has been proposed as a potential therapeutic approach. However, no systematic review has yet been conducted. This study aimed to evaluate the effects of an LFD on gastrointestinal symptoms and quality of life (QoL) in patients with FD. METHODS:Following PRISMA guidelines, Medline, Embase, and Central were searched through October 2025. Studies involving adults or children diagnosed with FD and treated with a structured LFD or lower habitual FODMAP intervention were included. Randomized controlled trials (RCTs) and non-RCTs were assessed for methodological quality using the Cochrane RoB 2 tool and the Newcastle-Ottawa Scale, respectively. RESULTS:Ten studies involving 4,329 patients (two RCTs and eight non-RCTs) met the inclusion criteria. Both RCTs demonstrated significant improvements in dyspeptic symptoms and QoL following an LFD compared with the control or baseline. Non-RCTs consistently showed symptom relief and improved QoL in adults and children under dietitian supervision, whereas lower habitual FODMAP intake was associated with a higher risk of FD prevalence in cross-sectional studies. Overall, the studies exhibited a predominantly moderate risk of bias. CONCLUSION:Current evidence suggests that an LFD may alleviate gastrointestinal symptoms and enhance QoL in patients with FD. However, existing studies remain few and heterogeneous. High-quality, adequately powered clinical and mechanistic studies are warranted to confirm its therapeutic efficacy and clarify the underlying physiological mechanisms.

BACKGROUND:Functional dyspepsia (FD) is a common gastrointestinal disorder that significantly impacts patients' quality of life. Over a decade ago, the Asian Neurogastroenterology and Motility Association (ANMA) and the Asian Pacific Association of Gastroenterology (APAGE) jointly developed the first Asian consensus report on FD. In this consensus report, members of ANMA and APAGE provide updated recommendations on the definition, diagnosis, epidemiology, pathophysiology, and management of FD, focusing on Asian populations. METHODS:The task force members conducted a systematic literature review and used a modified Delphi process to develop updated consensus statements. Based on members' feedback, statements that failed to reach at least 80% consensus in the first round of voting were revised. Revisions included rephrasing for clarity, incorporating additional evidence, and subgroup voting during a second round of discussion at a hybrid meeting. RESULTS:The task force developed 32 statements covering key aspects of FD. Major updates include new insights into the pathophysiology and emerging treatment options. The task force acknowledged that the limited scope and heterogeneity of available studies limit definitive conclusions about the utility of some emerging therapies such as probiotics and potassium-competitive acid blockers in FD management. CONCLUSIONS:The second Asian Consensus Report on FD provides updated evidence-based recommendations to improve the diagnosis and management of FD in clinical practice, particularly in the Asian setting.

Background:Chronic constipation, common in clinical practice, requires treatment to enhance quality of life and possibly extend life expectancy. However, predictors of treatment efficacy remain largely unexplored. This study aimed to identify factors predicting treatment success in patients with chronic constipation. Methods:A multicenter, prospective observational study evaluated patients with moderate to severe chronic constipation using the Chronic Constipation-Therapeutic Efficacy and Satisfaction Test (CC-TEST) questionnaire. Symptoms were assessed before treatment and at 2 and 4 weeks post-treatment. Multivariate analyses identified predictive factors based on three treatment efficacy assessment criteria: patient's impression, numeric rating scale (NRS) for symptom intensity, and spontaneous bowel movement (SBM) frequency status. Results:Constipation medications were administered to 97 patients, with significant symptom improvements observed at 2 and 4 weeks (CC-TEST). The greatest effects were seen in hard stools, difficulty in defecation, and infrequent bowel movements. In the multiple regression analysis, baseline clinical characteristics and symptom profiles were not significant predictors of treatment response. Incorporating 2-week treatment responsiveness revealed that non-responsiveness at 2 weeks (β = 0.487), and a lower stool symptom subscale score (β = -0.344), were associated with poorer patient's impression. For the NRS, non-responsiveness at 2 weeks (β = 0.279) was a significant predictor. For SBM, non-responsiveness at 2 weeks (β = -0.274) predicted outcomes. Including 2-week non-responsiveness improved the predictive accuracy for 4-week efficacy. Conclusions:The therapeutic response at 2 weeks is the most significant predictor of subsequent treatment response at 4 weeks in patients with chronic constipation.

Introduction: Chronic constipation is common, but its characteristics and impact on various aspects of daily life remain unclear. This study examined patient characteristics and assessed how background factors, constipation symptoms, and defecation status impact daily life dissatisfaction, quality of life (QOL), and psychological states. METHODS:A multicenter, prospective, observational study on outpatients with moderate to severe chronic constipation was conducted. The Chronic Constipation-Therapeutic Efficacy and Satisfaction Test (CC-TEST) and validated questionnaires such as the Hospital Anxiety and Depression Scale (HADS) and Short Form Health Survey-8 (SF-8) were administered to assess symptoms, defecation status, and daily life. Correlation and multiple regression analyses explored factor relationships. RESULTS:The analysis included 201 participants. Despite treatment, with over half using magnesium oxide, many patients remained dissatisfied. Younger patients and females reported more severe abdominal symptoms, while older patients experienced greater defecation difficulty. All constipation symptoms correlated with daily life dissatisfaction, with abdominal discomfort showing the strongest association. Abdominal symptoms were significantly associated with the Mental Component Summary (MCS) of the SF-8, HADS anxiety, and HADS depression scores. Most defecation status components showed no correlation with SF-8 MCS, HADS anxiety, or HADS depression scores. Multivariate analysis revealed that abdominal symptoms, especially discomfort, significantly impacted daily life dissatisfaction, and reduced SF-8 MCS scores. CONCLUSIONS:Many patients with moderate to severe chronic constipation experience long-term symptoms and remain dissatisfied with treatment. Abdominal symptoms such as discomfort and pain significantly affect their daily life, QOL, and psychological well-being. Reducing abdominal symptoms may be crucial for improving treatment outcomes. .

Background/Aims:The incidence of eosinophilic esophagitis (EoE) has been increasing recently. The role of regulatory T cells (Tregs) and correlations with other inflammatory cells in EoE remain unknown. We aim to clarify the role of Tregs and their correlations with inflammatory cells in EoE patients.Methods:Biopsies from controls and EoE patients before and after treatments were analyzed. Eosinophil infiltration was evaluated by hematoxylin and eosin staining. Immunohistochemical staining was performed to examine infiltration of T cells, Tregs, and mast cells. Gene expressions of chemokines were evaluated by reverse transcription-quantitative polymerase chain reaction.Results:Tregs and mast cells were increased in the esophageal epithelial layers of EoE patients. After treatments, Tregs and mast cells were decreased when histologic remission was achieved. Infiltration of Tregs correlated significantly with numbers of eosinophils and mast cells. Filaggrin mRNA was decreased in patients with EoE before treatment and upregulated after treatment, even when histologic remission was not achieved.Conclusions:Tregs were increased in esophageal epithelium of patients with EoE, and correlated with mast cell infiltration.

Background: Functional dyspepsia (FD) is a common disorder characterized by chronic or recurrent upper abdominal pain or discomfort without any structural abnormalities in the gastrointestinal tract. FD is categorized into two subgroups based on symptoms: postprandial distress syndrome (PDS) and epigastric pain syndrome. Summary: The pathophysiology of FD involves several mechanisms. Delayed gastric emptying is observed in approximately 30% of FD patients but does not correlate with symptom patterns or severity. Impaired gastric accommodation is important in the pathophysiology, particularly for PDS. Visceral hypersensitivity, characterized by heightened sensitivity to normal activities, contributes to the perception of discomfort or pain in FD. Alterations to the duodenal mucosa, including impaired mucosal barrier function and low-grade inflammation, are also implicated in the pathogenesis of FD. Microbial dysbiosis and psychological factors such as stress can further exacerbate symptoms. Treatment options include dietary modifications, establishing a physician-patient relationship, acid suppressants, prokinetics, neuromodulators, and behavioral therapies. Dietary recommendations include eating smaller, more frequent meals, and avoiding trigger foods. Acid suppressants are used as the first-line treatment. Prokinetics and neuromodulators aim to improve gastric motility and central pain processing, respectively. Behavioral therapies, including cognitive behavioral therapy and hypnotherapy, have shown benefits for refractory FD. Severe and refractory cases may require combination therapies or experimental treatments. Key Messages: FD is a disorder of gut-brain interaction involving diverse pathophysiological mechanisms. Individualized treatment based on symptoms and responses to interventions is crucial. Further research is needed to improve the understanding of FD and advance the development of effective therapies.

Gastroesophageal reflux disease (GERD) is a highly prevalent disorder with a significant impact on patients' quality of life (QOL), and its global prevalence is increasing. Therapy goals for GERD encompass symptom resolution, healing of esophageal inflammation, and prevention of complications. Healing of esophageal erosions, in particular, has been traditionally emphasized as an objective measure and primary endpoint in clinical trials. In this context, the findings presented by Simadibrate et al.1 in this journal issue support the potential superiority of potassium-competitive acid blockers (P-CABs) as a maintenance therapy for GERD. P-CABs have been developed to meet the unmet needs of conventional proton pump inhibitors (PPIs), providing rapid, long-lasting, and reversible inhibition of the proton pump (H+, K+ ATPase α subunit).2 Recent other meta-analyses and network meta-analyses have evaluated the efficacy of vonoprazan, keverprazan, and tegoprazan for the maintenance therapy of GERD. Vonoprazan, especially, has demonstrated superior efficacy over conventional PPIs in maintaining GERD treatment, particularly in cases of severe reflux esophagitis.3, 4 While mucosal healing remains crucial in GERD maintenance, the importance of heartburn-free days should not be underestimated. However, only one study has shown a significant increase in 24-h heartburn-free days during maintenance, and one-fifth of GERD patients still experienced symptoms despite maintenance treatment with vonoprazan 20 mg or lansoprazole 15 mg.5 Consequently, further investigations are necessary to definitively determine the superior efficacy of P-CABs over conventional PPIs. Moreover, there is still room for devising treatments to improve GERD symptoms, beyond simply suppressing acid secretion. Furthermore, it is essential to consider the minimal effective dose in treatment to mitigate the risk of side effects. The safety profile of P-CABs remains uncertain, particularly regarding the contentious issue of gastric cancer development and alterations in gut microbiota. Additionally, data on the long-term safety of keverprazan and tegoprazan are scarce. Given the incomplete assessment of gastric acid suppression levels with these medications, caution is warranted in interpreting the available data, especially regarding effective dosages and the comparative characteristics among P-CABs. When assessing the efficacy of GERD treatment, the varying degrees of gastric acid suppression among P-CABs with different doses emerge as a crucial consideration. Given the observed differences in Helicobacter pylori eradication rates and gastrin levels among P-CABs, it becomes essential to evaluate the extent of gastric acid suppression and potential disparate effects among these medications. Notably, with increasing doses of vonoprazan, the occurrence of nocturnal acid breakthrough (NAB) is markedly reduced,6 in contrast to conventional PPIs that exhibit limited nocturnal acid suppression. These distinctions likely contribute to the increased rate of H. pylori eradication seen in regimens including vonoprazan.7 In the context of initial GERD treatment, reflux symptoms often persist inadequately after the initial dose of PPIs in approximately two-thirds of patients due to the slow onset of action, with around half of patients still experiencing symptoms even after 3 days of treatment. Vonoprazan has demonstrated rapid acid suppression compared with lansoprazole and has shown superior efficacy in achieving complete heartburn relief, particularly within the first week of therapy, in patients with erosive esophagitis.8 Moreover, vonoprazan has been found to provide more effective nighttime heartburn relief than lansoprazole in this patient population and has been shown to improve sleep quality within 1 week, a benefit not observed with lansoprazole. Recent research has indicated that tegoprazan exhibits more rapid and potent nighttime acid suppression compared with vonoprazan or esomeprazole when administered nocturnally.9 A network meta-analysis has further highlighted that vonoprazan is either equally or more effective than conventional PPIs in resolving heartburn on both Day 1 and Day 7 in patients with erosive esophagitis.10 Consequently, vonoprazan may be considered as a first-line therapy to alleviate symptoms and enhance patients' QOL. The treatment efficacy of P-CABs for GERD requires meticulous assessment. Given the potential variation in acid suppressive effects and approved doses among P-CABs, direct comparison of treatment effects among them is challenging. Therefore, individual evaluation of each P-CAB is essential for future analyses, rather than considering them collectively as a group.

Introduction: This study evaluated the psychometric properties of the newly developed chronic constipation-therapeutic efficacy and satisfaction test (CC-TEST) among patients with chronic constipation. Methods: Japanese patients with moderate or severe chronic constipation underwent a 4-week remedy. The baseline, 2-week, and 4-week assessments included the CC-TEST, Constipation Scoring System (CSS), Medical Outcome Study Short Form-8 Health Survey (SF-8), and Hospital Anxiety and Depression Scale (HADS). The CC-TEST comprises three domains: (1) symptoms; chronic constipation symptom severity (seven items), defecation status (five items), (2) impact for daily life; dissatisfaction with daily life level (DS; four items), and (3) therapeutic response; therapeutic efficacy measured by patients and medication compliance (four items). Results: Of 201 eligible patients at baseline, 110 completed the 4-week treatment and the survey responses. Cronbach's alpha values for the stool, defecation, and abdominal symptom subscales, as well as the total symptom score and DS subscale, showed good internal consistency reliability (0.72-0.80). Pearson's r for comparisons between corresponding items (CC-TEST symptoms with CSS, and CC-TEST DS with SF-8 physical and mental component summary scores) was significant. After 4 weeks, scores for symptoms, defecation status, and DS items/subscales notably decreased, with a significant effect size (p < 0.005, Cohen's d; 0.30-1.16). Statistically significant differences emerged between treatment responders and nonresponders using the three responder definitions, in changes in scores for most CC-TEST symptoms, defecation status, and DS items/subscales (p < 0.05). Conclusion: CC-TEST demonstrates commendable reliability, convergent and known-group validity, and responsiveness to treatment effects. As a simple, comprehensive, and versatile patient-reported outcome measure, CC-TEST may be well suited for clinical trials and primary care of Japanese patients with chronic constipation.

Irritable bowel syndrome (IBS) is a widespread gastrointestinal disorder with a global prevalence estimated at 8.8% (8.7-8.9%) in adults, as indicated by literature reviews. 1 Regional heterogeneity is notable, ranging from 5.8% in the Middle East and Africa to 17.5% in Latin America, with a higher prevalence in females. 1 The overall prevalence of IBS in a recent study in East Asia, including Japan, China, and South Korea, using Rome III criteria was slightly higher than the global prevalence, and male patients comprised 54.9% of the cases. 2IBS is associated with a significant financial burden on healthcare and adversely affects patients' quality of life. 3With these challenges, there is an urgent need to develop and implement novel IBS drugs.The application of these treatments should consider the unique characteristics of each region.Diagnosis and management primarily depend on whether patients have diarrhea or constipation as their predominant symptom.However, the multifactorial pathogenesis and complex symptoms of IBS present challenges for physicians in selecting appropriate drugs.Recognizing these therapeutic difficulties, major academic societies, including the American Gastroenterological Association (AGA), have published authoritative guidelines 4,5 to assist general physicians in providing standard treatment.The AGA clinical guidelines for IBS with constipation (IBS-C) 4 and IBS with diarrhea (IBS-D) 5 published in 2022 include novel drugs targeting various aspects of IBS pathogenesis (Table 1).Unlike traditional drugs, these novel drugs have shown efficacy in clinical trials with the United States Food and Drug Administration responder endpoint. 6rofessor Yong Sung Kim presented a lecture on novel drugs on IBS at the 7th Biennial Congress of the Asian Neurogastroenterology and Motility Association (ANMA) in Taipei, Taiwan, on November 10-11, 2023.He noted that a substantial number of AGA guidelines-recommended IBS drugs were not prescribed in Korea.This led to a systematic survey via email and social network services to experts across Asia, uncovering an unexpected and widespread limitation in the availability of novel IBS drugs across the majority of Asian nations (Table 2).With this lecture, the audience in ANMA 2023 was rather relieved to know that there are shared concerns in all Asian countries, and they questioned the practicality of major society guidelines, highlighting a noticeable gap between recommendations and actual clinical drug use.Such a gap was also found in related Asian guidelines. 7Prucalopride, a 5-hydroxytryp-

Neoadjuvant docetaxel, cisplatin, and 5-fluorouracil (DCF) therapy is a new standard for locally advanced esophageal squamous cell carcinoma. The optimal timing of pegfilgrastim with the DCF regimen to prevent febrile neutropenia (FN) remains controversial. The effectiveness of concomitant pegfilgrastim administration with continuous 5-fluorouracil (5-FU) infusion in the DCF regimen was therefore assessed. All patients who received neoadjuvant DCF for esophageal cancer were retrospectively assessed. Patients who had been scheduled to receive pegfilgrastim on days 3–5 (early group) or days 7–9 (regular group) of the DCF regimen were included. Uni- and multivariate analyses were used to assess risk factors for FN. Eighty-eight patients were included in the analysis. The 26 patients in the early group received pegfilgrastim as scheduled. In the 62 patients of the regular group, 51 received pegfilgrastim at a median of 7 days after starting DCF chemotherapy. However, 11 patients in the regular group could not receive pegfilgrastim. Twenty-two patients of the regular group and 2 patients of the early group developed FN after the first session of DCF. Early administration of pegfilgrastim and grade 4 neutropenia were significantly associated with onset of FN, with multivariate analysis identifying early administration of pegfilgrastim as an independent preventive factor and grade 4 neutropenia as a risk factor, after adjusting for sex and age. Early pegfilgrastim administration is a safe approach that reduces the incidence of FN in DCF therapy. Using pegfilgrastim with continuous 5-FU infusion in the DCF regimen represents a reasonable option to prevent FN.

Diarrhea-predominant irritable bowel syndrome (IBS-D)-like symptoms are distressing for patients with quiescent Crohn's disease (qCD) and worsen their quality of life. In the present study, we assessed the effect of the probiotic Bifidobacterium bifidum G9-1 (BBG9-1) on the intestinal environment and clinical features in patients with qCD. Eleven patients with qCD, who met the Rome III diagnostic criteria for IBS-D, received BBG9-1 (24 mg) orally three times daily for 4 weeks. Indices of the intestinal environment (fecal calprotectin level and gut microbiome) and clinical features (CD/IBS-related symptoms, quality of life and stool irregularities) were evaluated before and after treatment. Treatment with BBG9-1 tended to reduce the IBS severity index in the studied patients (p = 0.07). Among gastrointestinal symptoms, abdominal pain and dyspepsia tended to be improved by the BBG9-1 treatment (p = 0.07 and p = 0.07, respectively), and IBD-related QOL showed a significant improvement (p = 0.007). With regard to mental status, the patient anxiety score was significantly lower at the endpoint of BBG9-1 treatment than at the baseline (p = 0.03). Although BBG9-1 treatment did not affect the fecal calprotectin level, it suppressed the serum MCP-1 level significantly and increased the abundance of intestinal Bacteroides in the study patients. The probiotic BBG9-1 is able to improve IBD-related QOL with a reduction of anxiety score in patients with quiescent CD and IBS-D-like symptoms.

機能性消化管障害の1つである機能性ディスペプシアは，つらいと感じる食後のもたれ感や心窩部灼熱感といった慢性の上腹部症状があるにもかかわらず器質的疾患を認めない症候群である．その病態の1つに胃酸の関与があり，酸に対する知覚過敏が症状発現の原因となっている．機能性ディスペプシアの病態は複雑で，酸分泌抑制薬の効果は限定的であるが，胃酸がかかわる病態に効率的に酸分泌抑制薬による治療を行うことが重要である．

Broadly speaking, findings obtained from a particular cohort of patients might not readily apply to the entire population, even when dealing with the same medical condition. In this regard, the data presented by Melgaard et al. in this issue of the journal seem well-supported and credible. However, it is important to acknowledge that the applicability of their findings to a broader spectrum of individuals with eosinophilic esophagitis (EoE) within academic medical institutions is limited. This limitation stems from the fact that their study focused solely on patients referred to a single academic hospital. When seeking to identify characteristics of severe types of the disease, it is advisable to analyze data from tertiary care centers, as the severe forms of these diseases might not be adequately represented for analysis within the general population. Thus, while there may be differences between disease characteristics in the general population and those in tertiary care centers, the choice of study focus remains crucial. As studying patients referred to academic medical institutions is important, conducting multicenter studies involving participants from a wider range of geographic locations, socioeconomic backgrounds, and ethnicities enhances the applicability of study results to a broader population. In any case, understanding the attributes of these severe cases also becomes a pivotal aspect deserving attention, as they present potentially challenging or intricate clinical scenarios. The global pooled incidence and prevalence of EoE were 5.3 cases per 100 000 inhabitant-years (95% CI, 4.0–6.6) and 40.0 cases per 100 000 inhabitant-years (95% CI, 31.1–49.0), respectively. While understanding the incidence and prevalence of EoE holds significance, it is essential to recognize that they distinctly vary in terms of lesions and diagnostic methodologies. Even within a single country, variations were observed in both the prevalence and incidence. These disparities could potentially stem from differences in diagnostic criteria, the utilization of diagnostic codes for disease classification, awareness levels regarding the condition, and the inclusion or exclusion of patients with proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE). EoE represents a chronic immune-mediated inflammation of the esophagus, with type 2 inflammation induced by food and aeroallergens contributing to the dysregulation of esophageal epithelial barrier function. This chronic inflammation leads to tissue remodeling and fibrosis. However, the precise etiology of EoE remains unclear. The mean age at which EoE is diagnosed among adults is approximately 30 years. The temporal span between the onset of symptoms and the definitive diagnosis varies, spanning a spectrum of 3–8 years in the adult population. Notably, the study conducted by Melgaard et al. in this journal reported an average age of 40, and the significance of this difference remains unclear. Despite increased physician awareness leading to a rise in the incidence and prevalence of EoE, delays in diagnosing the condition still pose a significant challenge. The delay in diagnosing EoE is a major concern, particularly due to the correlation between the presence of esophageal strictures and the duration of untreated disease. Diagnostic delays are associated with the emergence of endoscopic findings such as rings and strictures, which may necessitate endoscopic treatment. The percentage of patients with stricture increased from 19% (diagnostic delay 2 years or less) to 52% (diagnostic delay 21 years or more) as demonstrated in a study conducted in the Netherlands. Additionally, each additional year of undiagnosed EoE was linked with a 9% increase in the probability of stricture development within that population. Several factors contribute to the risk of esophageal strictures in EoE, including delayed diagnosis, male gender, age at diagnosis, and a positive family history of the condition. However, the incidence of stricture reported by Melgaard et al. in their study from Denmark appears to be lower. The most commonly reported symptoms in adult EoE include dysphagia, food impaction, chest pain, and acid regurgitation. Symptom patterns have been found to vary by age and race. In terms of the impact of race on symptoms such as dysphagia and food impaction, both of these symptoms were more prevalent in Caucasians compared with African-Americans and individuals of other races. Regarding differences based on sex, a report indicated that chest pain is more frequently reported by females, while dysphagia and food impaction are more common in males. However, it is important to note that the data supporting these differences were somewhat limited and remain subject to controversy. In any case, when patients present with these symptoms, it is crucial to consider EoE as a potential differential diagnosis. The anticipated natural progression of EoE entails a transition from an inflammatory state to a fibrostenotic phenotype. However, no prospective study has been conducted due to ethical considerations. Furthermore, a study carried out in Sweden did not identify any increase in mortality rates among individuals with EoE. Consequently, the primary treatment strategy should focus on managing patients’ symptoms and preventing the development of strictures. Advanced techniques for early detection and intervention of EoE, including the use of proton pump inhibitors and endoscopic dilation, have been recognized as effective strategies for preventing and managing EoE-associated strictures. While new biologics are being developed for eosinophilic gastrointestinal diseases (EGIDs), targeted therapies for EGIDs have proven to be relatively unsatisfactory compared with treatments for other autoimmune diseases. Currently, dupilumab is the only approved drug for treating EoE in the United States. These drugs have demonstrated histological improvements, but clinical trials have not shown sufficient symptom resolution. doi:10.1002/jgh3.12962

Background/Aims:Diarrhea-predominant irritable bowel syndrome (IBS-D)-like symptoms frequently occur in patients with quiescent Crohn's disease (CD). To investigate the factors underlying IBS-D-like symptoms in patients with quiescent CD, we performed a comprehensive analysis of the clinical features and intestinal environment in those patients.Methods:We performed a prospective observational study of 27 patients with quiescent CD (CD activity index [CDAI] ≤ 150; C-reactive protein ≤ 0.3 mg/dL). The presence and severity of IBS-D-like symptoms, health-related quality of life, disease-specific quality of life, and status of depression and anxiety were evaluated. The level of intestinal permeability, fecal calprotectin and organic acids and the profiles of gut microbiome were analyzed.Results:Twelve of the 27 patients with quiescent CD (44.4%) had IBS-like symptoms, and these patients showed a significantly higher CDAI, IBS severity index and anxiety score than those without. The inflammatory bowel disease questionnaire score was significantly lower in the patients with IBS-D-like symptoms. There were no significant differences in small intestinal/colonic permeability or the levels of organic acids between the patients with and without IBS-D-like symptoms. Fusicatenibacter was significantly less abundant in the patients with IBS-D-like symptoms whereas their fecal calprotectin level was significantly higher (384.8 ± 310.6 mg/kg) than in patients without (161.0 ± 251.0 mg/kg). The receiver operating characteristic curve constructed to predict IBS-D-like symptoms in patients with quiescent CD using the fecal calprotectin level (cutoff, 125 mg/kg) showed a sensitivity and specificity of 73.3% and 91.7%, respectively.Conclusion:Minimal inflammation is closely associated with the development of IBS-D-like symptoms in patients with quiescent CD.