Irritable bowel syndrome is a common disorder of gut-brain interaction characterized by chronic abdominal pain and altered bowel habits in the absence of structural pathology. Its pathophysiology reflects a complex interplay between the central nervous system, enteric nervous system, microbiota, immune signaling, epithelial barrier dysfunction etc. Despite advances in the understanding of the mechanisms causing IBS, the diagnosis of IBS remains primarily symptom-based, necessitating the use of objective tools to improve diagnostic precision and personalized management. This review synthesizes highlights existing literature on IBS biomarkers, including inflammatory markers (cytokines, C-reactive protein), microbial signatures (gut microbiota composition, anti-CdtB and anti-vinculin antibodies), metabolic indicators (bile acids, short-chain fatty acids), and markers of intestinal permeability (zonulin) to assess their applications in the diagnosis and management of IBS. We also examined emerging multi-omics technologies that identify the complex patterns linking the gut, the brain and the microbiota. Early research focusing on single biomarkers demonstrated limited diagnostic utility due to the heterogeneous and multifactorial nature of IBS. Recent advances support the development of composite, mechanism-based biomarker panels that integrate multiple biological domains, offering improved representation of underlying pathophysiological processes. These developments mark a shift from a single-marker approach toward multidimensional biomarker strategies. This narrative review synthesizes current evidence and proposes a framework for integrating biomarkers into clinical practice. Biomarkers are best utilized following a positive symptom-based diagnosis and exclusion of alarm features, to stratify patients into biologically relevant subtypes and guide targeted therapy. This supports a transition from exclusion-based diagnosis of IBS towards a positive and more precise one.

High-resolution manometry (HRM), the gold standard for diagnosing esophageal motility disorders, remains constrained by inter-rater variability, limited access to expert esophagologists, and inadequate training infrastructure. Many gastroenterology fellowship programs provide insufficient motility training, and dedicated expert centers remain geographically concentrated. Emerging Artificial intelligence (AI) tools have the potential to automate diagnosis, and augment clinician interpretive capacity and democratizing expert-level motility assessment.

Chronic gastroduodenal symptoms affect > 7% of adults, yet current diagnostic frameworks are challenged by limited mechanistic specificity, weak symptom correlation, and variable reproducibility. This review evaluates how body surface gastric mapping (BSGM), a non-invasive technology combining high-resolution gastric myoelectrical recording with validated symptom profiling, may improve the diagnosis and management of gastric motility disorders.

Malnutrition and sarcopenia are increasingly recognized as clinically meaningful but underappreciated components of gastrointestinal (GI) motility disorders. This review examines the prevalence, pathophysiology, assessment, and clinical care of malnutrition in the context of patients with GI motility disease.

This review evaluates the evolving management strategies for common bile duct stones (CBDSs), focusing on standard endoscopic techniques, advanced intraductal interventions for refractory stones, and contemporary minimally invasive surgical options.

Solitary rectal ulcer syndrome (SRUS) is a gastrointestinal disorder with a varied range of clinical, endoscopic and histological features. It is often misdiagnosed as inflammatory bowel disease or rectal malignancy. This review aims to outline a practical approach to diagnosing and managing SRUS.

The microbiome in the esophagus has been an area of early active investigation. In the past 5 years, advancements in next-generation sequencing and computational analysis have provided a more detailed picture of the esophageal microbiome. This review will examine the most recent advances in the past 5 years on the study of microbiome changes in healthy and diseased esophagus to better understand the link between microbiome and esophageal diseases, potentially leading to new prevention or treatment strategies.

Colorectal cancer (CRC) remains a major global and Malaysian public health concern, with increasing recognition of gut dysbiosis as a contributor to colorectal tumorigenesis. This review examines fermented durian tempoyak as a culturally relevant, probiotic-rich traditional food with potential application in CRC prevention through gut microbiome modulation.

PURPOSE OF REVIEW: Barrett’s esophagus (BE) is the only known precursor for esophageal adenocarcinoma. Patients diagnosed in endoscopy-based screening and surveillance programs have improved outcomes, but there are many limitations with current screening and surveillance paradigms. This review examines novel technologies aimed at improving current BE screening and surveillance strategies. RECENT FINDINGS: BE risk stratification algorithms have decent discriminatory performance but are cumbersome to implement. Non-endoscopic screening tools, including swallowable cell collection devices, have shown good sensitivity and cost-effectiveness. Early studies of serum biomarkers, such as microRNA assays, have yielded promising results but warrant further validation. WATS-3D appears to increase dysplasia yield among patients undergoing surveillance. Tissue-based biomarkers may assist in risk stratification. Novel, non-endoscopic technologies have the potential to enrich the BE screening population and improve outcomes, although most require further validation. Collaboration with primary care providers is critical to maximize the impact of such interventions.

PURPOSE OF REVIEW: This review synthesizes current literature on the use of Endoscopic ultrasound (EUS) in congenital gastrointestinal (GI) conditions. Special emphasis is placed on pediatric applications, where EUS is increasingly recognized as both feasible and safe. RECENT FINDINGS: EUS has transformed the evaluation and management of congenital anomalies affecting the GI tract and pancreaticobiliary system, and has been shown to be safe and effective in the pediatric population. By combining high-resolution imaging with the ability to perform real-time interventions, EUS addresses diagnostic uncertainties that historically required cross-sectional imaging or invasive surgery. EUS offers precise diagnostics, minimally invasive evaluation, and therapeutic guidance in pediatric patients, potentially avoiding surgical intervention. Larger pediatric multicenter registries are needed to further validate its use in children. Widespread adoption remains limited by the scarcity of EUS-trained pediatric gastroenterologists and the lack of specialized equipment designed for small children.

PURPOSE OF REVIEW: Fundoplication is still the cornerstone of surgical intervention for patients with gastroesophageal reflux disease unresponsive to medical management. While generally successful in resolving typical symptoms and improving patients’ quality of life, post-fundoplication symptoms unrelated to anatomical failure occur in a notable proportion of individuals. These complaints include persistent dysphagia, gas-bloat syndrome, delayed gastric emptying, dumping syndrome, chest pain, and diarrhea. Advances in physiological research has contributed to a more comprehensive understanding of the pathogenesis, prevention, and management of these postoperative symptoms. FINDINGS: This review synthesizes recent literature regarding gastrointestinal functional complaints following fundoplication, with emphasis on pathophysiology, diagnostic approaches, and evidence-based management strategies. Post-fundoplication complaints may be associated with incomplete preoperative work-up, untailored surgical procedure, defective surgical technique, or pre-existing disorders. Persistent dysphagia, gas-bloat syndrome, delayed gastric emptying, diarrhea, chest pain, and dumping syndrome are reported in up to 50%, 50%, 40%, 20%, 20%, and < 1% of patients, respectively. Various contributing factors have been identified, including defective esophageal motility and functional reserve, decrease of the fundic accommodation reflex, technical aspects of fundoplication and cruroplasty, iatrogenic injury to the vagus nerve, and exacerbation of pre-existing irritable bowel symptoms. Complete preoperative workup, patient’s education, and intraoperative EndoFLIP impedance planimetry have the potential to mitigate the incidence of persistent symptoms. The integration of artificial intelligence and machine learning algorithms offers promise for risk stratification and may enhance the prediction of postoperative functional outcomes. Functional gastrointestinal complaints are commonly encountered following fundoplication and can influence surgical outcomes, potentially impacting patients quality of life and overall satisfaction. A comprehensive knowledge of the underlying pathophysiological mechanisms is essential for optimizing patient selection, refining surgical approaches, planning targeted management strategies, and enhancing long-term functional results.

PURPOSE OF REVIEW: Crohn’s disease (CD) often causes intestinal strictures that impair quality of life. Endoscopic balloon dilation (EBD) has long been the standard, but durability is limited. This review summarizes advances in endoscopic management, focusing on updates from 2019–2025. RECENT FINDINGS: EBD achieves high technical success (90–95%) and short-term symptom relief (70–82%) but has recurrence rates up to 78% at two years. Endoscopic stricturotomy (ES) shows superior outcomes, with > 90% technical success, ~ 15% one-year recurrence, and > 70% five-year surgery-free survival. Hybrid ES + EBD approaches and novel stents—including fully covered self-expanding, biodegradable, and lumen-apposing devices—offer options for refractory lesions. Emerging imaging (EUS, elastography, hyperspectral imaging) and AI-assisted decision-making enhance stricture assessment, though data remain preliminary. Advances in endoscopy and adjunctive technologies are shifting Crohn’s stricture management toward more precise and durable, minimally invasive therapies. Ongoing trials, including HEIST, will help define optimal strategies.

Endoscopic retrograde cholangiopancreatography is an advanced endoscopic procedure used mainly for the purpose of biliary intervention. During an ERCP a duodenoscope is used to assess the ampulla of Vater to inject contrast medium into the common bile duct through biliary cannulation. Biliary cannulation can be challenging, with studies showing unsuccessful biliary cannulation with standard technique greater than 10%. Needle-knife fistulotomy is a unique precut sphincterotomy technique that can assist with difficult biliary cannulation.

PURPOSE OF REVIEW: Underwater Endoscopic Submucosal Dissection (U-ESD) is a novel technique used to overcome the limitations of conventional ESD, particularly for gravity-side and fibrotic gastrointestinal lesions. This review aims to highlight the recent advancements in U-ESD, emphasizing its practical advantages as well as challenges that should be addressed for future applications. RECENT FINDINGS: Due to the buoyancy effect created by saline, U-ESD provides natural traction as well as magnification to facilitate en bloc lesion resection without the need for additional traction devices. Recent findings, including “bubble-free” U-ESD techniques have addressed previous concerns by minimizing trapped air bubbles and visual obstruction to further advance the U-ESD method. U-ESD offers an effective and safe method for the removal of complex gastrointestinal lesions through enhanced visualization and natural traction. Although challenges such as bleeding control remain, with ongoing refinements in the technique, U-ESD may become the standard in advanced therapeutic endoscopy.

PURPOSE OF REVIEW: To provide an overview of current dietary elimination strategies for eosinophilic esophagitis (EoE) and propose a practical, patient-centered approach to guide dietary therapy. RECENT FINDINGS: Empiric elimination diets, including one- (1FED), two- (2FED), four- (4FED), and six-food (6FED) elimination strategies, have demonstrated varying efficacy, with broader elimination generally associated with higher histologic remission rates. Elemental diets remain the most effective but are often impractical. Allergy testing-directed diets have limited utility due to poor predictive accuracy. Recent data support a step-up approach—beginning with 1FED or 2FED and escalating as needed—as effective and better tolerated. Dietary elimination remains a cornerstone of EoE treatment. A stepwise, empiric approach that minimizes dietary burden while maintaining clinical efficacy is recommended. Personalizing diet therapy based on patient preferences and response can improve adherence and outcomes, and future research should continue refining strategies to balance efficacy, cost, and quality of life.