Digestion最新文献

{"title":"Esophageal Hyposensitivity: A Key Link to Aspiration Pneumonia in Patients with Achalasia.","authors":"Kazuki Inamura, Masafumi Wada, Eikichi Ihara, Yoshitaka Hata, Hirotaka Tsuru, Hiroki Fukuya, Mitsuru Esaki, Yosuke Minoda, Xiaopeng Bai, Yoshimasa Tanaka, Takatoshi Chinen, Haruei Ogino, Yoshihiro Ogawa","doi":"10.1159/000552159","DOIUrl":"10.1159/000552159","url":null,"abstract":"<p><strong>Introduction: </strong>Aspiration pneumonia (AP) is a serious complication of achalasia; however, its risk factors and mechanisms remain unclear. We aimed to identify the clinical characteristics associated with AP and explore its underlying pathophysiology.</p><p><strong>Methods: </strong>This retrospective single-center study included 70 patients diagnosed with achalasia using high-resolution manometry (HRM) between 2016 and 2022. Patients were categorized into non-AP (n = 42) and AP (n = 28) groups based on chest computed tomography findings. Clinical symptoms (Eckardt score), esophagographic findings, and HRM parameters were compared. Propensity score matching (PSM) was performed to adjust for age and disease duration. In a matched sub-cohort, esophageal mucosal biopsies were analyzed using quantitative real-time PCR to compare mechanosensory/chemosensory channels and inflammatory cytokines.</p><p><strong>Results: </strong>Patients with AP were older and tended to have a longer disease duration than those without AP. The Eckardt score was significantly lower in the AP group, despite no differences in HRM-defined or morphological subtypes on contrast esophagography. This difference remained significant after PSM. Expression levels of TRPV1, TRPV4, and PIEZO1 were significantly reduced in the achalasia (comprising both non-AP and AP patients) group compared with controls and were further decreased in the AP group compared with the non-AP group. Cytokine levels did not differ between the non-AP and AP groups.</p><p><strong>Conclusion: </strong>Esophageal hyposensitivity is a key risk factor for AP in achalasia, independent of HRM-defined or morphological subtypes. Downregulation of TRPV1, TRPV4, and PIEZO1 may underlie reduced symptom perception, providing novel insights into the pathophysiology of aspiration in achalasia.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-12"},"PeriodicalIF":3.4,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sequential Janus Kinase Inhibitor Switching in Ulcerative Colitis Patients Maintaining Remission: A Multicenter Experience.","authors":"Genta Uchida, Tsunaki Sawada, Masanao Nakamura, Takeshi Yamamura, Keiko Maeda, Eri Ishikawa, Kentaro Murate, Tomoyuki Tsuzuki, Hiroki Kawashima","doi":"10.1159/000552136","DOIUrl":"10.1159/000552136","url":null,"abstract":"<p><strong>Introduction: </strong>Given the safety concerns associated with the long-term use of Janus kinase (JAK) inhibitors, establishing effective \"exit strategies\" is crucial for patients with ulcerative colitis (UC). This study investigated the efficacy and safety of switching from tofacitinib (TOF) or upadacitinib (UPA) to the JAK1-selective filgotinib (FIL) in patients maintaining remission.</p><p><strong>Methods: </strong>We conducted a retrospective, multicenter study involving 13 UC patients who achieved clinical remission with TOF or UPA and subsequently switched to FIL. The primary endpoint was the cumulative non-relapse rate.</p><p><strong>Results: </strong>During a median follow-up of 679 days, symptomatic relapse occurred in 53.8% (7/13) of patients. The 1-year cumulative non-relapse rate was 71.4% for the TOF-switch group and 31.3% for the UPA-switch group. However, many relapses were successfully managed through temporary treatment adjustments, including FIL dose escalation or topical therapy. No serious adverse events were recorded.</p><p><strong>Conclusion: </strong>Sequential switching to FIL may represent a practical intermediate maintenance strategy before complete drug withdrawal, balancing disease control with potential safety benefits.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-6"},"PeriodicalIF":3.4,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Equol Production Status with the Presence of Precancerous Colorectal Lesions in Japan.","authors":"Yoshihiro Kaneta, Taiki Yamaji, Kouji Harada, Tomoko Fujitani, Zhaoqing Lyu, Mariko Harada Sassa, Hiroaki Ikematsu, Kinichi Hotta, Masau Sekiguchi, Yasuo Kakugawa, Nozomu Kobayashi, Takahisa Matsuda, Motoki Iwasaki","doi":"10.1159/000552061","DOIUrl":"10.1159/000552061","url":null,"abstract":"<p><strong>Introduction: </strong>Epidemiological evidence regarding the association between equol and precancerous colorectal lesions, including adenomas, sessile serrated lesions, and traditional serrated adenomas, remains unclear. Moreover, since equol production status depends on the composition of the gut microbiota and varies widely among individuals, evaluation based on plasma levels is essential. In this study, we evaluated the association between plasma equol levels and precancerous colorectal lesions.</p><p><strong>Methods: </strong>This cross-sectional study included residents aged 40-79 years in Izu Oshima, Japan. Blood samples were collected at study registration prior to colonoscopy under fasting conditions. In 2024, plasma equol levels were analyzed by gas chromatography-mass spectrometry, and individuals above the measurement quantification limit were classified as equol producers. Colonoscopy was performed for screening, and lesions were assessed based on endoscopic and pathological findings. Odds ratios (ORs) and their 95% confidence intervals (CIs) for precancerous lesions were calculated.</p><p><strong>Results: </strong>Of the 993 participants analyzed, 509 had precancerous colorectal lesions, while 484 served as controls. No significant association was observed between equol production status and the presence of precancerous colorectal lesions (OR: 1.04, 95% CI: 0.77-1.40). Although not statistically significant, an inverse trend was suggested in advanced lesions, defined as advanced adenomas or sessile serrated lesions with dysplasia (OR: 0.63, 95% CI: 0.34-1.18).</p><p><strong>Conclusion: </strong>This study did not provide significant evidence of an association between equol production status and the presence of precancerous colorectal lesions. Future prospective cohort studies and detailed analysis of intestinal microbiota are needed to clarify the effects of equol on colorectal carcinogenesis.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-10"},"PeriodicalIF":3.4,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potassium-Competitive Acid Blocker Increases Ileal Permeability and Exacerbates Ileal Inflammation under Stress Conditions in a Mouse Model of Eosinophilic Enteritis.","authors":"Kei Yamamoto, Fumio Tanaka, Yu Nishida, Hirotsugu Maruyama, Masaki Ominami, Yuji Nadatani, Koji Otani, Shusei Fukunaga, Shuhei Hosomi, Yasuhiro Fujiwara","doi":"10.1159/000552062","DOIUrl":"10.1159/000552062","url":null,"abstract":"<p><strong>Introduction: </strong>Potassium-competitive acid blockers (P-CABs) have been empirically administered to treat non-esophageal eosinophilic gastrointestinal diseases, although their efficacy remains unproven. Our previous findings demonstrated that psychological stress impairs the intestinal barrier and exacerbates eosinophilic enteritis (EoN) in a mouse model. Moreover, we demonstrated that P-CAB increased intestinal permeability under psychological stress. The aim of this study was to clarify the hypothesis that P-CAB exacerbate EoN by increasing intestinal permeability under stressful conditions.</p><p><strong>Methods: </strong>An EoN model was established in BALB/c mice using ovalbumin (OVA) sensitization and challenge. Mice were subjected to water avoidance stress (WAS) or sham stress (SS) and were administered P-CAB or saline as a vehicle. The ileum was collected for the analysis of ileal microscopic inflammation, mRNA and protein expression levels of T helper type 2 (Th2) cytokines, and ex vivo ileal permeability using a Ussing chamber.</p><p><strong>Results: </strong>Compared with the WAS + vehicle group, WAS + P-CAB significantly exacerbated the incidence of diarrhea, villus/crypt ratio, eosinophil and mast cell counts, mRNA and protein levels of Th2 cytokines, OVA-specific immunoglobulin E protein levels, and ileal permeability. Larazotide acetate, a zonulin inhibitor, significantly improved ileal inflammation and decreased ileal permeability in the WAS + P-CAB-treated EoN mice.</p><p><strong>Conclusions: </strong>P-CAB increased ileal permeability and exacerbated EoN under stressful conditions. Furthermore, a zonulin inhibitor demonstrated therapeutic effects in EoN with P-CAB under stressful conditions.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-14"},"PeriodicalIF":3.4,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autoantibodies Are Useful in Monitoring Disease Activity and Predicting Relapses in Autoimmune Pancreatitis.","authors":"Lena Falk, Katharina Murillo, Matthias P Ebert, Alexander Schneider, Michael Hirth","doi":"10.1159/000551498","DOIUrl":"10.1159/000551498","url":null,"abstract":"<p><strong>Introduction: </strong>Autoimmune pancreatitis (AiP) is an inflammatory disease typically treated with corticosteroids. But repeated corticosteroid treatment (CST) can cause significant side effects, raising the need for better management strategies. This study investigated the role of \"conventional\" autoantibodies in monitoring disease activity and progression in AiP to establish individualized treatment strategies.</p><p><strong>Methods: </strong>The study examined 55 AiP patients from the University Medical Centre Mannheim (Germany) and aimed to correlate \"conventional\" autoantibodies with disease severity, relapse risk, and other clinical parameters by analyzing 769 treatment appointments.</p><p><strong>Results: </strong>A total of 56% of AiP patients have elevated levels of \"conventional\" autoantibodies, particularly smooth muscle antibody, anti-neutrophil cytoplasmic antibodies (ANCA), and rheumatoid factor. Rheumatoid factor was especially elevated in AiP type 1, whereas ANCA was elevated in AiP type 2. Increased disease activity is assumed in case of high AiP activity score, before (vs. after) CST, in the case of emergency (vs. elective) treatment, and in the presence of other organ involvement. Autoantibodies were found to correlate with these clinical markers of disease activity. Furthermore, symptomatic inflammatory bowel disease in AiP type 2 was associated with increased ANCA titers. The presence of a focal mass was especially associated with an increase in rheumatoid factor. Notably, patients with elevated autoantibodies at baseline and particularly those with insufficient reduction of autoantibody titers after CST had a higher likelihood of relapse.</p><p><strong>Conclusion: </strong>While conventional autoantibodies are not diagnostic for AiP, they are useful in monitoring disease activity and predicting relapse. Testing for autoantibodies could help guide individual treatment decisions.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-8"},"PeriodicalIF":3.6,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis of Eosinophilic Enteritis Using Double Balloon Enteroscopy-Guided Multisite Biopsies.","authors":"Takeshi Yamashina, Masaaki Shimatani, Tatsuya Nakagawa, Takuya Takayama, Haruka Toyonaga, Yasuki Sano, Masahiro Orino, Hironao Matsumoto, Natsuko Saito, Kimi Sumimoto, Masahiro Takeo, Norimasa Fukata, Katsunori Yoshida, Makoto Naganuma, Yoshiyuki Yamada","doi":"10.1159/000550992","DOIUrl":"10.1159/000550992","url":null,"abstract":"<p><strong>Introduction: </strong>Eosinophilic enteritis (EoN) remains underrecognized because of nonspecific symptoms and difficulty obtaining deep small intestinal biopsies. We evaluated the diagnostic utility of double balloon enteroscopy (DBE)-guided multisite biopsy and explored tissue and blood eosinophil thresholds distinguishing EoN from non-EoN conditions.</p><p><strong>Methods: </strong>This single-center retrospective cohort included consecutive patients who underwent DBE with small intestinal biopsies (January 2021-December 2024). Biopsies were obtained from up to six predefined segments (duodenum, upper/lower jejunum, upper/lower ileum, terminal ileum). EoN diagnosis required abdominal pain and/or diarrhea, exclusion of competing diagnoses, and small intestinal biopsy-proven eosinophilic infiltration. Peripheral eosinophil percentage and computed tomography (CT) findings were recorded. The primary outcome was the extent of small intestinal eosinophil infiltration in patients with EoN. Secondary outcomes were the peripheral blood eosinophil count, clinical background, and exploratory comparisons with non-EoN cases.</p><p><strong>Results: </strong>Eighteen patients were included (5 EoN, 13 non-EoN). CT showed small intestinal wall edema in 3 patients with EoN. Peripheral eosinophil proportion was significantly higher in EoN (median, 15.2% vs. 1.9%; p < 0.01). Across 83 biopsy specimens (25 EoN, 58 non-EoN), patient-level peak eosinophil counts were greater in EoN (median, 77/HPF [22-213] vs. 23/HPF [12-111]; p < 0.001). All patients with EoN had at least one segment with ≥50 eosinophils per high-power field, while two with non-EoN reached this threshold. No DBE-related serious adverse events occurred.</p><p><strong>Conclusion: </strong>EoN exhibits significantly greater eosinophil infiltration than non-EoN. DBE-guided multisite biopsy enables accurate recognition of EoN. Prospective multicenter studies are needed to refine site-specific thresholds and standardize HPF reporting.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-8"},"PeriodicalIF":3.6,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<italic>Bifidobacterium bifidum</italic> G9-1 and Quality of Life in Chronic Constipation: A Multicenter, Double-Blind, Randomized Controlled Trial.","authors":"Noboru Misawa, Takaomi Kessoku, Kojiro Inoue, Hitomi Suzuki, Shigeki Tamura, Tomohiro Takatsu, Tsutomu Yoshihara, Keiichi Ashikari, Takayuki Kato, Akiko Fuyuki, Shingo Kato, Hidenori Ohkubo, Takuma Higurashi, Masato Yoneda, Takeo Kurihashi, Atsushi Nakajima","doi":"10.1159/000551504","DOIUrl":"10.1159/000551504","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with constipation often experience impaired quality of life (QOL). A previous open-label study of Bifidobacterium bifidum G9-1 (BBG9-1) in patients with chronic constipation reported a significant improvement in defecation-related QOL. Thus, we conducted a multicenter, randomized controlled study to assess the efficacy of BBG9-1 in patients with chronic constipation.</p><p><strong>Methods: </strong>Patients diagnosed with or being treated for chronic constipation between July 2020 and January 2022 and having an overall score of ≥1 on the Japanese version of the patient assessment of constipation quality of life scale (JPAC-QOL) were included. Following a 2-week baseline period, BBG9-1 or placebo was administered for 8 consecutive weeks. The primary endpoint was the change in the JPAC-QOL overall score pre-administration and 8 weeks post-administration of BBG9-1; secondary endpoints were changes in JPAC-QOL subscale scores, number of days of defecation, stool consistency, straining during defecation, and feeling of incomplete evacuation after defecation pre-administration and 8 weeks post-administration.</p><p><strong>Results: </strong>Data from 140 patients (83 women) were analyzed. The JPAC-QOL overall score improved by 0.65 ± 0.56 in the treatment group and 0.54 ± 0.67 in the placebo group, with no significant difference (p = 0.282). However, the physical discomfort subscale showed a nominally significant improvement in the treatment group (p = 0.041). Stratified analysis revealed increased defecation frequency and reduced straining in those with high baseline straining scores. No adverse events were reported.</p><p><strong>Conclusion: </strong>BBG9-1 administration reduced physical discomfort but did not significantly improve the JPAC-QOL overall score, indicating its limited effect on chronic constipation.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-12"},"PeriodicalIF":3.4,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13160506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147472885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond <italic>Helicobacter pylori</italic>: Current Insights into <italic>H. pylori</italic>-Naive Gastric Cancer.","authors":"Samuel W D Woo, Valerie S X Yeap, Victor S F Hau, Yu Bin Tan, Louis H S Lau, Hon Chi Yip, Rashid Lui, Shannon Melissa Chan, Philip Chiu","doi":"10.1159/000551483","DOIUrl":"10.1159/000551483","url":null,"abstract":"<p><strong>Background: </strong>The increasing global incidence of Helicobacter pylori-naive gastric cancer (HPnGC) has established it as a clinical entity warranting further study of its diagnosis, pathogenesis, aetiologies, classifications, and management.</p><p><strong>Summary: </strong>HPnGC is an emerging and distinct clinical entity, with its relative burden increasing as global efforts for H. pylori eradication succeeds. The cancer is linked to specific aetiologies such as Epstein-Barr virus, autoimmune gastritis, and certain hereditary cancer predisposition syndromes, and is also linked to more aggressive histological subtypes, unfavourable anatomical locations, advanced stages at diagnosis, and potentially carries a poorer prognosis compared to its H. pylori-positive counterpart. Diagnosis requires stringent multi-modal confirmation of absent infection. Currently, endoscopic, surgical, and systemic treatments are similar to those for H. pylori-positive gastric cancer.</p><p><strong>Key messages: </strong>This review demonstrates wide knowledge gaps and areas requiring further clarification. Accurate diagnosis remains challenging due to the absence of standardized criteria, highlighting the need for a robust diagnostic framework. Furthermore, it is imperative for further research into the different molecular subtypes and carcinogenic mechanisms to identify cost-effective surveillance methods and effective treatment strategies that contribute to the development of a comprehensive and practical clinical guideline.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-17"},"PeriodicalIF":3.4,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13225794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147467453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short- and Long-Term Outcomes of Mirikizumab for Ulcerative Colitis: A Real-World Multicenter Retrospective Cohort Study from the INSIGHT Study.","authors":"Tsunaki Sawada, Takeshi Yamamura, Keiko Maeda, Eri Ishikawa, Kentaro Murate, Nobuyuki Miyake, Rinzaburo Matsuura, Toshihisa Fujiyoshi, Genta Uchida, Hiroto Suzuki, Takahiro Nishikawa, Takeshi Kuno, Shun Hattori, Noboru Urata, Ayako Ohashi, Issei Hasegawa, Masanao Nakamura, Hiroki Kawashima","doi":"10.1159/000551500","DOIUrl":"10.1159/000551500","url":null,"abstract":"<p><strong>Introduction: </strong>Mirikizumab (MIR), a selective IL-23p19 inhibitor, has shown efficacy in clinical trials for ulcerative colitis (UC). However, real-world data, especially on long-term outcomes and in treatment-experienced populations, remain limited.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective cohort study involving 85 patients with moderate-to-severe UC who initiated MIR between July 2023 and December 2024 across 12 Japanese centers. Co-primary endpoints were clinical remission (Simple Clinical Colitis Activity Index [SCCAI] ≤2 and with no rectal bleeding) at weeks 12 and 52. Secondary outcomes included corticosteroid (CS)-free remission, C-reactive protein normalization, treatment persistence, and safety.</p><p><strong>Results: </strong>Clinical remission was achieved in 62.4% at week 12 and 55.3% at week 52. CS-free remission rates were identical to overall remission at both time points. MIR maintained effectiveness regardless of prior exposure to biologics or JAK inhibitors. Early clinical response at week 4 independently predicted week 52 remission, while steroid dependence was a predictor at week 12. Among patients receiving extended induction, 27.3% of initial nonresponders achieved remission by week 24. Treatment was generally well tolerated, with 17.6% experiencing adverse events and 9.4% discontinuing due to these events. No serious infections or hospitalizations occurred.</p><p><strong>Conclusion: </strong>MIR demonstrated durable effectiveness and a favorable safety profile over 52 weeks in a real-world UC population, including those with prior treatment failures. These findings support MIR as a viable long-term therapeutic option in routine clinical practice.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-13"},"PeriodicalIF":3.6,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147456446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Involvement of Gastrointestinal Functional Disorder in the Management of Inflammatory Bowel Disease.","authors":"Ruby Arai, Masayuki Fukata","doi":"10.1159/000551457","DOIUrl":"10.1159/000551457","url":null,"abstract":"<p><strong>Background: </strong>Recent therapeutic advances have yielded higher remission rates than before in patients with inflammatory bowel disease (IBD), while many patients in remission still experience gastrointestinal symptoms. These persistent symptoms could be caused by functional bowel disorders and are associated with increased psychological distress.</p><p><strong>Summary: </strong>Patients with IBD may have symptoms like functional gastrointestinal disorders (FGID) even before the disease onset, and distinguishing between disease flare and functional symptoms is often difficult. Gastrointestinal infections such as Campylobacter infection may contribute to the onset of both IBD and FGID. The pathophysiology of FGIDs in IBD is complex and multifactorial, involving genetic predisposition, dysregulation of the gut-brain axis, intestinal dysbiosis, impaired mucosal permeability, and low-grade inflammation. These factors further interact with each other to cause symptoms.</p><p><strong>Key messages: </strong>Management of patients with IBD who present symptoms of FGIDs requires a multifaceted approach based on the principles of FGID treatment under the premise of complete control of intestinal inflammation. In this review, we discuss the clinical overlap, pathophysiology, diagnostic challenges, and a structured approach for patients with IBD who are complicated by symptoms of FGIDs.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-11"},"PeriodicalIF":3.6,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147389764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}