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Algorithms or biomarkers in patients with lower DGBI?
Michael Camilleri1, David Yi Yang1
1Division of Gastroenterology and Hepatology, Mayo Clinic, Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), Rochester, Minnesota, USA.
Neurogastroenterology and Motility
|June 27, 2024
Summary
This review evaluates second- and third-line pharmacotherapies for lower digestive tract disorders of gut-brain interactions (DGBI). It assesses diagnostic tests and cost-effectiveness for personalized treatment strategies in irritable bowel syndrome and constipation.
Area of Science:
- Gastroenterology
- Neurogastroenterology
- Pharmacology
Background:
- Guidelines exist for managing lower digestive tract disorders of gut-brain interactions (DGBI).
- Current management often involves sequential therapeutic trials.
- Treatment adjustments are based on efficacy and adverse events.
Purpose of the Study:
- Evaluate evidence for second- and third-line pharmacotherapies in DGBI.
- Assess diagnostic tests for subgroup identification in DGBI.
- Analyze cost implications of diagnostic screening and algorithmic treatment.
Main Methods:
- Systematic review of pharmacotherapy efficacy.
- Analysis of diagnostic tests: digital rectal exam, anorectal manometry, balloon expulsion, colonic transit, bile acid diarrhea, carbohydrate malabsorption.
- Cost-effectiveness analysis from societal, insurer, and patient perspectives.
Main Results:
- Evidence for second- and third-line pharmacotherapies will be detailed.
- Diagnostic tests for identifying actionable biomarkers will be presented.
- Cost implications of screening and individualized therapy will be discussed.
Conclusions:
- Evidence-based recommendations for pharmacotherapy in DGBI.
- Guidance on utilizing diagnostic tests for personalized DGBI management.
- Framework for evaluating cost-effectiveness in DGBI treatment algorithms.
