Clinical guidelines in the use of fibre supplementation for patients with IBS provide one-size-fits-all advice, which has limited value. This narrative review addresses data and concepts around the functional characteristics of fibre and subsequent physiological responses induced in patients with IBS with a view to exploring the application of such knowledge to the precision use of fibre supplements. The key findings are that first, individual fibres elicit highly distinct physiological responses that are associated with their functional characteristics rather than solubility. Second, the current evidence has focused on the use of fibres as a monotherapy for IBS symptoms overall without attempting to exploit these functional characteristics to elicit specific, symptom-targeted effects, or to use fibre types as adjunctive therapies. Personalisation of fibre therapies can therefore target several therapeutic goals. Proposed goals include achieving normalisation of bowel habit, modulation of gut microbiota function towards health and correction of microbial effects of other dietary therapies. To put into perspective, bulking fibres that are minimally fermented can offer utility in modulating indices of bowel habit; slowly fermented fibres may enhance the activities of the gut microbiota; and the combination of both fibres may potentially offer both benefits while optimising the activities of the microbiota throughout the different regions of the colon. In conclusion, understanding the GI responses to specific fibres, particularly in relation to the physiology of the individual, will be the future for personalising fibre therapy for enhancing the personalised management of patients with IBS.

Summary: Background: Advances in microelectronics have greatly expanded the capabilities and clinical potential of ingestible electronic devices.Aim: To provide an overview of the structure and potential impact of ingestible devices in development that are relevant to the gastrointestinal tract.Methods: We performed a detailed literature search to inform this narrative review.Results: Technical success of ingestible electronic devices relies on the ability to miniaturise the microelectronic circuits, sensors and components for interventional functions while being sufficiently powered to fulfil the intended function. These devices offer the advantages of being convenient and minimally invasive, with real‐time assessment often possible and with minimal interference to normal physiology. Safety has not been a limitation, but defining and controlling device location in the gastrointestinal tract remains challenging. The success of capsule endoscopy has buoyed enthusiasm for the concepts, but few ingestible devices have reached clinical practice to date, partly due to the novelty of the information they provide and also due to the challenges of adding this novel technology to established clinical paradigms. Nonetheless, with ongoing technological advancement and as understanding of their potential impact emerges, acceptance of such technology will grow. These devices have the capacity to provide unique insight into gastrointestinal physiology and pathophysiology. Interventional functions, such as sampling of tissue or luminal contents and delivery of therapies, may further enhance their ability to sharpen gastroenterological diagnoses, monitoring and treatment.Conclusions: The development of miniaturised ingestible microelectronic‐based devices offers exciting prospects for enhancing gastroenterological research and the delivery of personalised, point‐of‐care medicine.

Summary: Background: Accurate definition of the gastroduodenal and ileocaecal junctions (GDJ, ICJ) is essential for the measurement of regional transit times.Aims: To compare the assessment of these landmarks using the novel gas‐sensing capsule and validated wireless motility capsule (WMC), and to evaluate intra‐subject variance in transit timesMethods: Healthy subjects ingested the gas‐sensing capsule and WMC tandemly in random order. Inter‐observer agreement was evaluated by intra‐class correlation coefficient (ICC). Agreement between the paired devices' transit times was assessed using Bland–Altman analysis; coefficient of variation was performed to express intra‐individual variance in transit times. Similar analyses were completed with tandemly ingested gas‐sensing capsules.Results: The inter‐observer agreement for landmarks for both capsules was excellent (mean ICC ≥0.97) in 50 studies. The GDJ was identifiable in 92% of the gas‐sensing capsule studies versus 82% of the WMC studies (p = 0.27); the ICJ in 96% versus 84%, respectively (p = 0.11). In the primary cohort (n = 26), median regional transit times differed by less than 6 min between paired capsules. Bland–Altman revealed a bias of −0.12 (95% limits of agreement, −0.94 to 0.70) hours for GDJ and − 0.446 (−2.86 to 2.0) hours for ICJ. Similar results were found in a demographically distinct validation cohort (n = 24). For tandemly ingested gas‐sensing capsules, coefficients of variation of transit times were 11%–35%, which were similar to variance between the paired gas‐sensing capsule and WMC, as were the biases. The capsules were well tolerated.Conclusions: Key anatomical landmarks are accurately identified with the gas‐sensing capsule in healthy individuals. Intra‐individual differences in transit times between capsules are probably due to physiological factors. Studies in populations with gastrointestinal diseases are now required.