Summary: Background: Well informed patients who are in cohesive partnership with physicians and who have realistic expectations towards therapy are more likely to be adherent, which results in better disease control.Aim: To assess which therapy goals adults with eosinophilic oesophagitis consider relevant.Methods: Following refinement during three focus groups, a study brochure and questionnaire were sent to 148 patients. Patients ranked the importance (five levels) of short‐term (in the next 3 months) and long‐term (≥1 year) treatment effect on symptoms, quality of life (QoL), histologically‐detected inflammation and fibrosis, endoscopically‐detected inflammation, and stricture formation as well as achieving histological remission while asymptomatic. Patients’ characteristics associated with treatment goals were identified using logistic regression.Results: Of 109 respondents (mean age 43 years), 85 were men. Over 90% chose symptoms and QoL improvement as important short‐ and long‐term therapy goals. A greater proportion attributed more importance to long‐term reduction in endoscopic (90% vs 73%, P < 0.001) and histological (81% vs 62%, P = 0.002) inflammation, and histologically‐detected fibrosis (79% vs 64%, P = 0.018) when compared to short‐term reduction in these features. Patients (88%) ranked achieving histological remission while being asymptomatic as important. Gender, therapy use, education level, QoL, symptom severity, and history of dilation were associated with patients’ choice of treatment goals.Conclusions: Patients attributed most importance to improvement in symptoms and QoL. Reduction in biological activity was judged less important, but more relevant in the long‐ compared to the short‐term.

Background: Disorders of gut–brain interaction (DGBIs) have a complex pathophysiology that is often characterized by a relationship between food ingestion and triggering of symptoms. Understanding of the underlying mechanisms and the role of nutrients as a therapeutic target are rapidly evolving. Aims and methods: We performed a narrative review of the literature using the following keywords, their acronyms, and their associations: nutrients, disorders of gut–brain interaction; functional dyspepsia; malabsorption; irritable bowel syndrome; diarrhea; constipation. Results: Functional dyspepsia displayed a significant correlation between volume, fat and/or wheat abundance, chemical composition of ingested food and symptoms of early satiety, fullness and weight loss. Carbohydrate malabsorption is related to enzyme deficiency throughout the GI tract. Food composition and richness in soluble vs. non-soluble fibers is related to constipation and diarrhea. The elimination of fermentable oligo-, di-, monosaccharides and polyols (FODMAPs) has a significant and non-unidirectional impact on irritable bowel syndrome (IBS) symptoms. Conclusions: Food volume, nutritive and chemical composition, and its malabsorption are associated with symptom generation in DGBIs. Further multicenter, randomized-controlled clinical trials are needed to clarify the underlying pathophysiology.

Background and Study Aims: Probe‐based confocal laser endomicroscopy (pCLE) enables real‐time microscopic visualization of the duodenal mucosa and has shown acute food–triggered disruption of the duodenal epithelial barrier of patients with irritable bowel syndrome (IBS). The interpretation of the recordings is subjective, with unknown agreement rates. The aim of this study was to investigate the intra‐ and interobserver variability of this technique.Patients and Methods: An international multicenter study was performed, including pCLE recordings from three centers. Recordings were randomized and re‐evaluated by five blinded experienced assessors. Low‐quality recordings were excluded. The mucosa was considered altered if both fluorescein leakage and luminal particles were observed. Agreement was quantified using Fleiss' and Cohen's kappa (κ). Reference videos (i.e., videos with 100% agreement) were used to assess the optimal characteristics of videos needed to make a judgment based on the optimal receiver operating characteristic curve cutoff.Results: Of the 119 individual recordings, 87 could be used for analyses (total of 86,408 frames). Intraindividual agreement rate was 80%–100%, whereas the interindividual agreement rate was 85% (κ = 0.68). The agreement rate with the endoscopist ranged 54%–95% (κ = 0.15–0.89). The optimal cutoff to distinguish altered from unaltered was by observing alterations in ≥ 2 out of 6 mucosal spots (100% sensitivity and specificity).Conclusion: Our study showed a substantial to perfect intraobserver agreement and a substantial interobserver agreement for the judgment of acute food‐triggered disruption of the duodenal epithelial barrier by pCLE, confirming that this real‐time readout is reliable and reproducible.

INTRODUCTION: Functional dyspepsia (FD), a disorder of gut-brain interaction defined by Rome IV criteria, overlaps frequently with irritable bowel syndrome (IBS) and reflux symptoms. Overlapping gastrointestinal (GI) disorders are associated with more psychological comorbidities and decreased quality of life, but data on physiological parameters in overlapping syndromes are scarce. The aim of this study was to evaluate the impact of overlapping disorders and FD subtypes on psychological and GI symptoms, as well as relevant physiological outcomes. METHODS: In total, 202 patients with predominant Rome IV FD symptoms and overlapping IBS and/or reflux were pooled from 7 studies conducted at University Hospitals Leuven. GI and psychological symptoms, as well as GI-related quality of life were recorded. Physiological measurements included salivary cortisol, gastric emptying, systemic and duodenal immune activation, and duodenal permeability. RESULTS: GI (Patient Assessment of Upper GI Symptom Severity and Leuven Postprandial Distress Scale [ P < 0.0001]) and psychological (anxiety [ P = 0.0014], depression [ P = 0.0017] and extraintestinal somatic symptoms [ P < 0.0001]) were more pronounced in FD with overlapping disorders, whereas all physiological parameters were similar. Patients with epigastric pain syndrome reported a milder symptom pattern compared with other FD subtypes, with similar physiological alterations. Duodenal eosinophils were associated with anxiety in FD, independent of overlapping GI disorders or subtype ( P = 0.043). DISCUSSION: The common overlap between FD, IBS, and reflux is characterized by a high GI-specific, psychological, and somatic symptom burden. By contrast, key pathophysiological parameters were not different between FD with and without overlapping disorders or between FD subtypes. Central integration of multiple GI manifestations rather than more severely impaired peripheral alterations is more likely to explain the high symptom burden in overlapping disorders.

Our investigation breaks new ground by directly examining the effects of corticotropin-release hormone (CRH) on duodenal alterations, including permeability and immune activation, in healthy subjects. Intriguingly, our findings highlight disparities between ex vivo and in vivo pathways affecting duodenal permeability, offering novel insights into the potential pathophysiology of CRH on the duodenum.