← Issue №1/ week of Jun 24, 2026/ the whole section, in full

Motility, in full.

All 4 Motility papers in this issue, as full cards, ranked by clinical utility. The issue page carries the strongest few; this is the section, whole.

Sections this issue
IBD5Hepatology2Esophagus/Reflux2Pancreas/Biliary3Endoscopy5Motility4Colorectal5Nutrition3
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All 4, in full

most clinically useful first · the 1 the issue led with is ruled in green
Everything here, in one line each4
Motility prospective cohort · n=726 · Jul 2, 2026 · Lancet GH · IF 30.9

The Rome V criteria for the diagnosis of irritable bowel syndrome in secondary care: a diagnostic accuracy study.

New evidenceIBS
Clinical takeawayRome 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.
What it foundRome V criteria for IBS had sensitivity of 66.1% (95% CI 62.1-69.9) and specificity of 80.1% (72.4-86.5), identifying a different patient group compared to Rome IV (sensitivity 78.9%, specificity 81.0%) and Rome III (sensitivity 87.5%, specificity 75.0%).
ContextRome V shifts diagnostic balance versus Rome IV (higher specificity, lower sensitivity) and Rome III (higher specificity, much lower sensitivity). This challenges prior reliance on Rome criteria alone for case identification in referrals.
Reinforcessuggested applicable standard· American College of Gastroenterology, 'ACG Clinical Guideline: Management of Irritable Bowel Syndrome', 2021

Decision at stakethe use of Rome IV criteria for IBS diagnosis

No single passage of this standard matched the paper closely enough to quote, so none is shown. The standard is cited above.

Our full summary of this standard

Diagnosis: use a positive diagnostic strategy based on Rome IV criteria rather than a strategy of exclusion (strong for cost-effectiveness, high quality; consensus for time-to-therapy), and categorize by IBS subtype (consensus). In patients with IBS and diarrhea symptoms: check celiac serology (strong, moderate) and, in those WITHOUT alarm features, fecal calprotectin (or fecal lactoferrin) plus CRP to rule out IBD (strong; moderate quality for CRP/calprotectin, very low for lactoferrin). Recommend AGAINST routine stool testing for enteric pathogens (conditional, low) and AGAINST routine colonoscopy in patients younger than 45 without warning signs (conditional, low). Anorectal physiology testing only when symptoms suggest a pelvic floor disorder and/or for refractory constipation not responding to standard medical therapy (consensus). Treatment, all subtypes: soluble, not insoluble, fiber (strong, moderate); a LIMITED trial of a low-FODMAP diet (conditional, very low); gut-directed psychotherapies for global symptoms (conditional, very low); TCAs for global symptoms (strong, moderate); peppermint suggested (conditional, low); antispasmodics for abdominal pain (conditional, low); AGAINST probiotics (conditional, very low), AGAINST fecal transplant (strong, very low). IBS-C: chloride channel activators (strong, moderate) and guanylate cyclase activators (strong, high); AGAINST PEG products for global IBS-C symptoms (conditional, low); tegaserod reserved for women younger than 65 with ≤1 cardiovascular risk factor who have not adequately responded to secretagogues (strong/conditional, low). IBS-D: rifaximin (strong, moderate); alosetron only for women with severe IBS-D who have failed conventional therapy (conditional, low); mixed opioid agonists/antagonists, i.e. eluxadoline (conditional, moderate); AGAINST bile acid sequestrants (conditional, very low).

American College of Gastroenterology, 'ACG Clinical Guideline: Management of Irritable Bowel Syndrome', 2021 · reviewed 2026-07-21 ↗
Staller K … Ford AC · Lancet Gastroenterology & Hepatology · IF 30.9 · PubMed ↗Permalink
Motility prospective cohort · n=214 · Jul 1, 2026 · Aliment Pharm Ther · IF 6.7

Elobixibat Versus Prucalopride in Functional Constipation: A Prospective Comparative Effectiveness Study.

New evidencechronic constipation
Clinical takeawayWhere 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.
What it foundElobixibat achieved a sustained complete spontaneous bowel movement (CSBM) response in 55.6% of patients vs. 33.9% with prucalopride (p=0.024).
ContextThis study directly compares two second-line therapies with distinct mechanisms, addressing a gap in evidence-based decision-making for functional constipation.
Emergingsuggested applicable standard· American Gastroenterological Association & American College of Gastroenterology, "American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation" (Chang L, Chey WD, Imdad A, et al.), 2023

Decision at stakethe choice of second-line therapy in functional constipation

No single passage of this standard matched the paper closely enough to quote, so none is shown. The standard is cited above.

Our full summary of this standard

In adults with chronic idiopathic constipation, the AGA-ACG panel makes 10 GRADE-based pharmacological recommendations, and the strength tier is part of the recommendation. Unqualified as to prior therapy: STRONG recommendation (moderate certainty) for polyethylene glycol; STRONG recommendation (moderate certainty) for bisacodyl or sodium picosulfate, but explicitly qualified as short-term or rescue therapy; CONDITIONAL suggestion for fiber supplementation (low certainty), magnesium oxide (very low certainty), and senna (low certainty). Reserved for patients who do not respond to, fail, or are intolerant of over-the-counter agents: STRONG recommendation (moderate certainty) for linaclotide, plecanatide, and prucalopride; CONDITIONAL suggestion for lubiprostone (low certainty) and lactulose (very low certainty). The guideline states no specific doses, no mandatory ordering algorithm, and no fixed trial duration; it notes only that nonpharmacological therapies 'often represent the initial steps in management' and directs clinicians to shared decision making incorporating patient preference, cost, and availability. The guideline explicitly does not cover anorectal evacuation disorders, referring those to the ACG 2021 benign anorectal guideline.

American Gastroenterological Association & American College of Gastroenterology, "American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation" (Chang L, Chey WD, Imdad A, et al.), 2023 · reviewed 2026-07-19 ↗
Goyal O … Sood A · Alimentary Pharmacology & Therapeutics · IF 6.7 · PubMed ↗Permalink
Motility review · Jul 7, 2026 · Lancet GH · IF 30.9

Barrier restoration as a therapeutic strategy for disorders of gut-brain interaction.

New evidenceIBSfunctional dyspepsiamicrobiometranslational
Clinical takeawayThis 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.
What it foundShort-chain fatty acids, amino acids (glutamine and tryptophan), and targeted probiotics enhance tight junction integrity and mucin secretion, while psychological stress, low-fiber diets, and high-fat diets disrupt gut barrier function.
ContextConfirms and refines the growing recognition of gut barrier dysfunction in disorders of gut-brain interaction but highlights the lack of validated clinical interventions targeting barrier restoration.
Emergingsuggested applicable standard· American College of Gastroenterology, 'ACG and CAG Clinical Guideline: Management of Dyspepsia', 2017

Decision at stakethe potential for barrier restoration therapies in functional dyspepsia

After excluding organic causes and confirming H. pylori test-of-cure, manage functional dyspepsia by eradicating H. pylori if positive and giving a PPI (4-8 weeks, dosed 30-60 min before meals); for persistent symptoms consider neuromodulators (e.g., low-dose TCAs like amitriptyline 10-50 mg QHS) for refractory cases, particularly in EPS, or prokinetics cautiously in selected PDS cases. Initial evaluation follows ACG/CAG 2017: test-and-treat H. pylori in patients under 60 without alarm features, and EGD for age ≥60, alarm features, or high gastric-cancer-risk groups. Add psychological therapies (CBT, gut-directed hypnotherapy) and lifestyle measures.

American College of Gastroenterology, 'ACG and CAG Clinical Guideline: Management of Dyspepsia', 2017 · reviewed 2026-07-21 ↗
Britton TA, Grover M · Lancet Gastroenterology & Hepatology · IF 30.9 · PubMed ↗Permalink
Motility meta analysis · n=1,105 · Jul 7, 2026 · Gastroenterology · IF 25.1

Acupuncture versus sham non-acupoint acupuncture for irritable bowel syndrome: a systematic review and meta-analysis.

New evidenceIBSsystematic reviewmeta-analysis
Clinical takeawayAcupuncture 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.
What it foundAcupuncture improved IBS response rate by 61% vs sham (RR 1.61, 95% CI 1.25-2.07) and reduced symptom severity (SMD 0.79, 95% CI 0.30-1.28) at end of treatment.
ContextThis meta-analysis provides stronger evidence for acupuncture's efficacy in IBS compared to prior inconsistent findings, though heterogeneity and low certainty remain limitations.
Emergingsuggested applicable standard· American College of Gastroenterology, 'ACG Clinical Guideline: Management of Irritable Bowel Syndrome', 2021

Decision at stakewhether to recommend acupuncture as a supplemental therapy for IBS

No single passage of this standard matched the paper closely enough to quote, so none is shown. The standard is cited above.

Our full summary of this standard

Diagnosis: use a positive diagnostic strategy based on Rome IV criteria rather than a strategy of exclusion (strong for cost-effectiveness, high quality; consensus for time-to-therapy), and categorize by IBS subtype (consensus). In patients with IBS and diarrhea symptoms: check celiac serology (strong, moderate) and, in those WITHOUT alarm features, fecal calprotectin (or fecal lactoferrin) plus CRP to rule out IBD (strong; moderate quality for CRP/calprotectin, very low for lactoferrin). Recommend AGAINST routine stool testing for enteric pathogens (conditional, low) and AGAINST routine colonoscopy in patients younger than 45 without warning signs (conditional, low). Anorectal physiology testing only when symptoms suggest a pelvic floor disorder and/or for refractory constipation not responding to standard medical therapy (consensus). Treatment, all subtypes: soluble, not insoluble, fiber (strong, moderate); a LIMITED trial of a low-FODMAP diet (conditional, very low); gut-directed psychotherapies for global symptoms (conditional, very low); TCAs for global symptoms (strong, moderate); peppermint suggested (conditional, low); antispasmodics for abdominal pain (conditional, low); AGAINST probiotics (conditional, very low), AGAINST fecal transplant (strong, very low). IBS-C: chloride channel activators (strong, moderate) and guanylate cyclase activators (strong, high); AGAINST PEG products for global IBS-C symptoms (conditional, low); tegaserod reserved for women younger than 65 with ≤1 cardiovascular risk factor who have not adequately responded to secretagogues (strong/conditional, low). IBS-D: rifaximin (strong, moderate); alosetron only for women with severe IBS-D who have failed conventional therapy (conditional, low); mixed opioid agonists/antagonists, i.e. eluxadoline (conditional, moderate); AGAINST bile acid sequestrants (conditional, very low).

American College of Gastroenterology, 'ACG Clinical Guideline: Management of Irritable Bowel Syndrome', 2021 · reviewed 2026-07-21 ↗
Zheng HZ … Huang XB · Gastroenterology · IF 25.1 · PubMed ↗Permalink
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