Gastroenterology

Best-practice methods for treatment trials in disorders of gut–brain interaction

This review summarizes contemporary trial design, conduct, and reporting standards for disorders of gut–brain interaction (DGBI). Randomized, placebo-controlled trials remain the gold standard, while pragmatic designs can demonstrate real-world effectiveness. The authors emphasize validated patient-reported outcomes, adherence to Good Clinical Practice, and tailored methods for nondrug interventions like dietary or brain–gut therapies. 1

Rome/IOIBD consensus on IBD with IBS-like symptoms

A multidisciplinary panel endorses the term 'IBD with IBS-like symptoms' and requires objective exclusion of active inflammation or structural disease for diagnosis. For clinical care the group recommends combining Rome criteria with endoscopic, histologic, biomarker, or imaging evidence of remission before labeling symptoms as functional. Appropriate treatments listed include psyllium (if no stricture), short-term low FODMAP diet, targeted drugs, and brain–gut behavioral therapies. 2

Metabolomics in IBD: consistent signals but limited validation

This systematic review of 14 studies (~3,700 participants) found reproducible metabolic perturbations in amino acids, bile acids, lipids, and short‑chain fatty acids in IBD. Only two studies reported diagnostic performance exceeding 80% sensitivity and specificity for subtype differentiation. Heterogeneity in methods and sparse diagnostic validation currently limit clinical translation and require standardized protocols. 3