https://siftingsignal.com/gisignals/Motility papers worth knowing in GI this week. A SiftingSignal publication.https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42609157https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42609157Mon, 24 Aug 2026 19:12:09 +0000Journal of gastroenterology and hepatology. In IBS-D patients responding to rifaximin, consolidation with 4 weeks of Medilac-S (Bacillus subtilis and Enterococcus faecium) may be considered to reduce relapse risk. Clinicians should note this contradicts current ACG recommendations against probiotics in IBS (conditional, very low evidence against).https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42613095https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42613095Mon, 24 Aug 2026 19:12:09 +0000Journal of gastroenterology and hepatology. No clinical action yet. This observational study describes associations between bile acids, microbiota, and IBS phenotypes but does not establish causality or test therapeutic interventions; whether modifying these factors improves symptoms remains unknown.https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42613193https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42613193Mon, 24 Aug 2026 19:12:09 +0000Gut. Heighten clinical recognition that DGBI are prevalent in pediatric populations; systematically assess using Rome V criteria in children with GI symptoms, especially when anxiety, depression, or functional impairment present.https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42613978https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42613978Mon, 24 Aug 2026 19:12:09 +0000Journal of neurogastroenterology and motility. In chronic constipation patients suspected of dyssynergic defecation who cannot or decline HR-ARM, MRD may provide a non-invasive diagnostic alternative with moderate-to-good diagnostic odds ratios (8.25-14.25). Requires prospective external validation and clarification of specific diagnostic thresholds and their directional criteria before adoption as primary diagnostic criteria.https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42617106https://siftingsignal.com/gisignals/2026-W35/#card-pmid-42617106Mon, 24 Aug 2026 19:12:09 +0000Clinical and translational gastroenterology. Systematize IBS-C treatment response assessment using expert consensus domains: before starting treatment, establish baseline severity of the patient's most bothersome symptom(s) and quality-of-life impact; at follow-up, reassess these domains alongside patient satisfaction and side effects to inform shared decision-making on treatment continuation or adjustment. However, no validated standardized measure is yet available; assessment relies on clinical judgment.https://siftingsignal.com/gisignals/2026-W34/#card-pmid-42584763https://siftingsignal.com/gisignals/2026-W34/#card-pmid-42584763Thu, 20 Aug 2026 18:40:03 +0000Digestive diseases and sciences. Review proposes mechanisms for CAM in IBS-D without specific protocols or comparative efficacy data. Dietary modification is already standard adjunct; TCM or acupuncture may be discussed with refractory patients based on mechanistic plausibility and preference.https://siftingsignal.com/gisignals/2026-W34/#card-pmid-42600900https://siftingsignal.com/gisignals/2026-W34/#card-pmid-42600900Thu, 20 Aug 2026 18:40:03 +0000Gastroenterology. Consider psyllium for IBS patients as a trial therapy. Clinical response (endpoint varies by trial) occurred in 52% vs 44% with placebo, but this did not translate to significant improvement in overall symptom severity scores (SMD −0.25), suggesting the benefit may reside in patient perception or non-severity endpoints rather than objective symptom reduction. Beta-galacto-oligosaccharides (B-GOS) improved overall symptom scores in limited trials (n=2) but did not demonstrate clinical response benefit. Subtype-specific benefits (diarrhea-predominant, constipation-predominant, mixed) are unknown. Clinicians should clarify with patients what outcome they are pursuing before recommending.https://siftingsignal.com/gisignals/2026-W34/#card-pmid-42609157https://siftingsignal.com/gisignals/2026-W34/#card-pmid-42609157Thu, 20 Aug 2026 18:40:03 +0000Journal of gastroenterology and hepatology. In IBS-D patients responding to rifaximin, consolidation with 4 weeks of Medilac-S (Bacillus subtilis and Enterococcus faecium) may be considered to reduce relapse risk. Clinicians should note this contradicts current ACG recommendations against probiotics in IBS (conditional, very low evidence against).https://siftingsignal.com/gisignals/2026-W33/#card-pmid-42570075https://siftingsignal.com/gisignals/2026-W33/#card-pmid-42570075Thu, 20 Aug 2026 21:35:47 +0000Digestive diseases and sciences. While this is a large real-world cohort, there is no established clinical action. Outcomes are coded EHR data, not validated IBS symptom scales, and the study is observational without randomization. For patients with IBS and concomitant diabetes or obesity who have independent indication for GLP-1, this suggests possible added benefit on IBS symptoms, but the absolute reductions are modest (1.7-4.2 percentage points) and require prospective confirmation. Do not prescribe GLP-1 for IBS alone.https://siftingsignal.com/gisignals/2026-W33/#card-pmid-42584763https://siftingsignal.com/gisignals/2026-W33/#card-pmid-42584763Thu, 20 Aug 2026 21:35:47 +0000Digestive diseases and sciences. Review proposes mechanisms for CAM in IBS-D without specific protocols or comparative efficacy data. Dietary modification is already standard adjunct; TCM or acupuncture may be discussed with refractory patients based on mechanistic plausibility and preference.https://siftingsignal.com/gisignals/2026-W33/#card-pmid-42600900https://siftingsignal.com/gisignals/2026-W33/#card-pmid-42600900Thu, 20 Aug 2026 21:35:47 +0000Gastroenterology. Consider psyllium for IBS patients as a trial therapy. Clinical response (endpoint varies by trial) occurred in 52% vs 44% with placebo, but this did not translate to significant improvement in overall symptom severity scores (SMD −0.25), suggesting the benefit may reside in patient perception or non-severity endpoints rather than objective symptom reduction. Beta-galacto-oligosaccharides (B-GOS) improved overall symptom scores in limited trials (n=2) but did not demonstrate clinical response benefit. Subtype-specific benefits (diarrhea-predominant, constipation-predominant, mixed) are unknown. Clinicians should clarify with patients what outcome they are pursuing before recommending.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42504654https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42504654Thu, 06 Aug 2026 18:00:11 +0000Journal of neurogastroenterology and motility. Consider integrated care pathways addressing psychological comorbidities (anxiety, depression, somatization) in patients with DGBI, particularly women and younger adults, as these factors independently associate with higher symptom burden and healthcare use.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42504655https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42504655Thu, 06 Aug 2026 18:00:11 +0000Journal of neurogastroenterology and motility. Consider premature supine contraction frequency (median ≥8) as a potential marker for DES patients who may benefit from lower esophageal sphincter-directed therapies like POEM, though validation in larger studies is needed due to the rarity of DES.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42504656https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42504656Thu, 06 Aug 2026 18:00:11 +0000Journal of neurogastroenterology and motility. FODMAP diet (already a conditional SOC option for all IBS subtypes) may be considered for IBS-C: it did not worsen constipation in this study and showed symptom relief rates similar to IBS-D, particularly in patients who shifted to IBS-U.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42504657https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42504657Thu, 06 Aug 2026 18:00:11 +0000Journal of neurogastroenterology and motility. Moderate-intensity exercise (e.g., swimming, cycling) may be considered for FD symptom management, but evidence is preliminary and not yet incorporated into formal guidelines.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42504660https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42504660Thu, 06 Aug 2026 18:00:11 +0000Journal of neurogastroenterology and motility. No clinical action yet: mechanistic study in human tissue explaining post-takedown motility recovery but not altering current ileostomy management.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42504661https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42504661Thu, 06 Aug 2026 18:00:11 +0000Journal of neurogastroenterology and motility. No clinical action yet: a mechanistic finding in IBS patients post-FMT, suggesting pathways for future therapy but no current intervention.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42533381https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42533381Thu, 06 Aug 2026 18:00:11 +0000JPEN. Journal of parenteral and enteral nutrition. No clinical action yet: evidence is based on case reports and small observational studies. Await randomized controlled trials for definitive evidence.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42538844https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42538844Thu, 06 Aug 2026 18:00:11 +0000Neurogastroenterology and motility. When referring patients with constipation or fecal incontinence for biofeedback or pelvic floor therapy, consider the differing techniques and equipment used by BTs (more manometry) and PTs (more electromyography/ultrasound). No clinical action yet: this is a practice pattern survey without outcome data.https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42547873https://siftingsignal.com/gisignals/2026-W32/#card-pmid-42547873Thu, 06 Aug 2026 18:00:11 +0000Neurogastroenterology and motility. No clinical action yet: a novel preclinical monitoring tool in development, not yet validated for routine use. Consider future adoption if WPS proves reliable in larger trials.https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42502003https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42502003Thu, 30 Jul 2026 22:01:39 +0000Gut. Consider smartphone-based self-guided hypnotherapy as a cost-effective alternative for Rome IV IBS patients (16-75 years) when in-person hypnotherapy is unavailable, but counsel that it may be less effective than in-person therapy (33% vs 48% response) and that non-inferiority was not proven.https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42504653https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42504653Thu, 30 Jul 2026 22:01:39 +0000Journal of neurogastroenterology and motility. No clinical action yet: a novel FLIP parameter (FSA) correlates with sphincter defects but requires validation before clinical use.https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42504654https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42504654Thu, 30 Jul 2026 22:01:39 +0000Journal of neurogastroenterology and motility. Consider integrated care pathways addressing psychological comorbidities (anxiety, depression, somatization) in patients with DGBI, particularly women and younger adults, as these factors independently associate with higher symptom burden and healthcare use.https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42504655https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42504655Thu, 30 Jul 2026 22:01:39 +0000Journal of neurogastroenterology and motility. Consider premature supine contraction frequency (median ≥8) as a potential marker for DES patients who may benefit from lower esophageal sphincter-directed therapies like POEM, though validation in larger studies is needed due to the rarity of DES.https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42504656https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42504656Thu, 30 Jul 2026 22:01:39 +0000Journal of neurogastroenterology and motility. FODMAP diet (already a conditional SOC option for all IBS subtypes) may be considered for IBS-C: it did not worsen constipation in this study and showed symptom relief rates similar to IBS-D, particularly in patients who shifted to IBS-U.https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42504657https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42504657Thu, 30 Jul 2026 22:01:39 +0000Journal of neurogastroenterology and motility. Moderate-intensity exercise (e.g., swimming, cycling) may be considered for FD symptom management, but evidence is preliminary and not yet incorporated into formal guidelines.https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42504660https://siftingsignal.com/gisignals/2026-W31/#card-pmid-42504660Thu, 30 Jul 2026 22:01:39 +0000Journal of neurogastroenterology and motility. No clinical action yet: mechanistic study in human tissue explaining post-takedown motility recovery but not altering current ileostomy management.https://siftingsignal.com/gisignals/2026-W30/#card-pmid-42474623https://siftingsignal.com/gisignals/2026-W30/#card-pmid-42474623Sat, 25 Jul 2026 22:16:33 +0000Digestive diseases and sciences. For adult IBS patients aged 19-65 years requiring dietary management, recommend restriction-based diets (LFD, GFD, or LFGFD) over traditional advice; all three achieve clinical symptom improvement in substantially more patients (100% vs 61.5%). LFD and LFGFD specifically showed greater mean symptom severity reduction. Since quality-of-life benefits were equivalent across all approaches, choice among restricted diets can be individualized by patient tolerability and preference. Note that these findings reflect the restriction phase only; full dietary management typically includes reintroduction, which was not evaluated here.https://siftingsignal.com/gisignals/2026-W30/#card-pmid-42482523https://siftingsignal.com/gisignals/2026-W30/#card-pmid-42482523Sat, 25 Jul 2026 22:16:33 +0000Alimentary pharmacology & therapeutics. Consider StaySure anal insert for women with moderate-to-severe fecal incontinence unresponsive to conservative treatment (diet, pelvic floor physical therapy, medications), as an alternative to injectable agents or sacral nerve stimulation; device size (10 or 13 mm) is individualized during a 2-4 week fitting period when tolerance can be assessed. Applicability in male patients less established.https://siftingsignal.com/gisignals/2026-W30/#card-pmid-42484589https://siftingsignal.com/gisignals/2026-W30/#card-pmid-42484589Sat, 25 Jul 2026 22:16:33 +0000Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. In motivated patients, particularly older patients with severe baseline symptoms, singing therapy may be considered as an alternative to first-line diaphragmatic breathing, pending validation in broader practice settings and with longer follow-up. Diaphragmatic breathing remains guideline-recommended first-line care; singing therapy's delivery model (individual, group, self-directed) and feasibility outside research centers require clarification.https://siftingsignal.com/gisignals/2026-W30/#card-pmid-42485161https://siftingsignal.com/gisignals/2026-W30/#card-pmid-42485161Sat, 25 Jul 2026 22:16:33 +0000JAMA. In diabetic patients with nausea, vomiting, or early satiety, gastroparesis should be high on the differential and glycemic optimization is core to management. Confirm diagnosis with scintigraphy or C13 breath test; before testing, discontinue medications that delay gastric emptying (opioids, cannabis, anticholinergics, GLP-1 agonists). Then stratify by severity: mild cases use a small-particle, low-fat diet plus antiemetics (5-HT3 or H1 antagonists); moderate cases add prokinetics (metoclopramide or erythromycin); severe cases require liquid diet or jejunal feeding.https://siftingsignal.com/gisignals/2026-W30/#card-pmid-42486340https://siftingsignal.com/gisignals/2026-W30/#card-pmid-42486340Sat, 25 Jul 2026 22:16:33 +0000Gastroenterology. For gastroparesis, use 5-HT4 agonists per international guidelines to improve gastric emptying and symptoms. For functional dyspepsia, serotonergic agents may be selectively considered off-label based on dominant symptoms: mirtazapine for early satiety with weight loss, buspirone for early satiety/postprandial fullness/bloating, and 5-HT3 antagonists for nausea/vomiting. Do not use SSRIs or SNRIs for gastroparesis or functional dyspepsia (despite established pain-disorder efficacy). Monitor emerging selective 5-HT4 agonists (e.g., naronapride) as safer alternatives to earlier prokinetics.https://siftingsignal.com/gisignals/2026-W26/#card-pmid-42387275https://siftingsignal.com/gisignals/2026-W26/#card-pmid-42387275Thu, 09 Jul 2026 16:47:07 +0000Alimentary pharmacology & therapeutics. Where it is available (Japan, India, not the US), a single non-randomized study suggests elobixibat may outperform prucalopride on sustained CSBM in refractory functional constipation, but this is hypothesis-generating and does not change guideline-based US practice, where elobixibat is unavailable.https://siftingsignal.com/gisignals/2026-W26/#card-pmid-42392123https://siftingsignal.com/gisignals/2026-W26/#card-pmid-42392123Thu, 09 Jul 2026 16:47:07 +0000The lancet. Gastroenterology & hepatology. Rome V criteria show lower sensitivity (66.1%) compared to Rome IV (78.9%) and Rome III (87.5%) in this secondary care study. No clinical action yet; await further validation and SOC updates.https://siftingsignal.com/gisignals/2026-W26/#card-pmid-42413530https://siftingsignal.com/gisignals/2026-W26/#card-pmid-42413530Thu, 09 Jul 2026 16:47:07 +0000The lancet. Gastroenterology & hepatology. This mechanistic review of gut-barrier restoration (SCFAs, glutamine or tryptophan, probiotics) is hypothesis-generating only; barrier-targeted diet or probiotic therapy for disorders of gut-brain interaction is not yet guideline-supported and should await clinical trials.https://siftingsignal.com/gisignals/2026-W26/#card-pmid-42413705https://siftingsignal.com/gisignals/2026-W26/#card-pmid-42413705Thu, 09 Jul 2026 16:47:07 +0000Gastroenterology. Acupuncture may improve IBS symptoms compared to sham, but the high heterogeneity and low certainty of evidence limit clinical applicability. Discuss these limitations if patients inquire about acupuncture.