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Purpose of Review <p>Esophageal disorders of gut–brain interaction (e-DGBIs), including functional heartburn, reflux hypersensitivity, functional chest pain, globus, and functional dysphagia, are characterized by chronic esophageal symptoms in the absence of structural, inflammatory, or major motor abnormalities. Esophageal hypersensitivity represents the unifying pathophysiologic mechanism across these conditions. This review outlines the current approaches to managing esophageal DGBI, emphasizing both evidence-based treatments and emerging therapeutic options.</p> Recent Findings <p>Emerging therapeutic strategies include novel neuromodulators such as pregabalin and low-dose naltrexone, noninvasive neuromodulation techniques including transcranial magnetic stimulation, and microbiome-targeted interventions. Digital therapeutics and artificial intelligence–supported collaborative care models represent promising approaches to scale evidence-based treatment delivery.</p> Summary <p>Management of e-DGBIs requires a patient-centered approach that prioritizes the therapeutic relationship between the provider and the patient, early introduction of the brain–gut model, and multidisciplinary collaboration. Pharmacologic neuromodulation remains the cornerstone of therapy, with tricyclic antidepressants, selective serotonin reuptake inhibitors, and serotonin–norepinephrine reuptake inhibitors demonstrating efficacy across the different e-DGBIs. For reflux hypersensitivity, proton pump inhibitors and potassium-competitive acid blockers may reduce symptom-triggering reflux events, while antireflux surgery and endoscopic interventions may benefit carefully selected patients. Brain–gut behavioral therapies, particularly cognitive behavioral therapy and gut-directed hypnotherapy, have shown meaningful improvements in symptom severity and quality of life in patients with functional heartburn, functional chest pain, and globus. Future progress will depend on rigorous randomized controlled trials and translational research to develop personalized treatment algorithms that incorporate genetic, microbial, and neurophysiologic biomarkers.</p>

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New Insights in the Management of Esophageal Disorders of Gut-Brain Interaction

  • 期刊论文

  • 发表日期：

    2026年7月13日

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  • Michael Kurin,
  • Ronnie Fass

摘要

Purpose of Review

Esophageal disorders of gut–brain interaction (e-DGBIs), including functional heartburn, reflux hypersensitivity, functional chest pain, globus, and functional dysphagia, are characterized by chronic esophageal symptoms in the absence of structural, inflammatory, or major motor abnormalities. Esophageal hypersensitivity represents the unifying pathophysiologic mechanism across these conditions. This review outlines the current approaches to managing esophageal DGBI, emphasizing both evidence-based treatments and emerging therapeutic options.

Recent Findings

Emerging therapeutic strategies include novel neuromodulators such as pregabalin and low-dose naltrexone, noninvasive neuromodulation techniques including transcranial magnetic stimulation, and microbiome-targeted interventions. Digital therapeutics and artificial intelligence–supported collaborative care models represent promising approaches to scale evidence-based treatment delivery.

Summary

Management of e-DGBIs requires a patient-centered approach that prioritizes the therapeutic relationship between the provider and the patient, early introduction of the brain–gut model, and multidisciplinary collaboration. Pharmacologic neuromodulation remains the cornerstone of therapy, with tricyclic antidepressants, selective serotonin reuptake inhibitors, and serotonin–norepinephrine reuptake inhibitors demonstrating efficacy across the different e-DGBIs. For reflux hypersensitivity, proton pump inhibitors and potassium-competitive acid blockers may reduce symptom-triggering reflux events, while antireflux surgery and endoscopic interventions may benefit carefully selected patients. Brain–gut behavioral therapies, particularly cognitive behavioral therapy and gut-directed hypnotherapy, have shown meaningful improvements in symptom severity and quality of life in patients with functional heartburn, functional chest pain, and globus. Future progress will depend on rigorous randomized controlled trials and translational research to develop personalized treatment algorithms that incorporate genetic, microbial, and neurophysiologic biomarkers.