BACKGROUND: Gastrointestinal (GI) dysfunction is a common non-motor feature of Parkinson disease (PD). GI symptoms may start years before the onset of motor symptoms and impair quality of life. Robust clinical trial data is lacking to guide screening, diagnosis and treatment of GI dysfunction in PD.
OBJECTIVE: To develop consensus statements on screening, diagnosis, and treatment of GI dysfunction in PD.
METHODS: The application of a modified Delphi panel allowed for the synthesis of expert opinions into clinical statements. Consensus was predefined as a level of agreement of 100 % for each item. Five virtual Delphi rounds were held. Two movement disorders neurologists reviewed the literature on GI dysfunction in PD and developed draft statements based on the literature review. Draft statements were distributed among the panel that included five movement disorder neurologists and two gastroenterologists, both experts in GI dysmotility and its impact on PD symptoms. All members reviewed the statements and references in advance of the virtual meetings. In the virtual meetings, each statement was discussed, edited, and a vote was conducted. If there was not 100 % consensus, further discussions and modifications ensued until there was consensus.
RESULTS: Statements were developed for screening, diagnosis, and treatment of common GI symptoms in PD and were organized by anatomic segments: oral cavity and esophagus, stomach, small intestine, and colon and anorectum.
CONCLUSIONS: These consensus recommendations offer a practical framework for the diagnosis and treatment of GI dysfunction in PD.

Chronic constipation is one of the common gastrointestinal disorders, with an incidence rate that is gradually increasing yearly and becoming an important chronic disease that affects people\'s health and quality of life. In recent years, significant progress has been made in the basic and clinical research of chronic constipation, especially the gut microbiota therapy methods have received increasing attention. Therefore, under the initiative of the Parenteral and Enteral Nutrition Branch of the Chinese Medical Association, Chinese Society for the Promotion of Human Health Science and Technology, and Committee on Gut Microecology and Fecal Microbiota Transplantation, experts from relevant fields in China have been organized to establish the \"Chinese Expert Consensus on the Clinical Diagnosis and Treatment of Gut Microecology in Chronic Constipation (2024 Edition)\" committee. Focusing on the dysbiosis of gut microbiota, the indications for gut microbiota therapy, and the protocols for fecal microbiota transplantation, 16 consensus opinions were proposed based on the review of domestic and international literature and the clinical experience of experts, aiming to standardize the clinical application of gut microbiota in chronic constipation.
慢性便秘是常见的胃肠疾病之一，发病率呈逐年上升趋势，严重影响着人民的生活质量。近年来，慢性便秘的基础与临床研究取得了一定的进展，尤其是肠道微生态治疗方法日益受到关注。为此，在中华医学会肠外肠内营养学分会、中国人体健康科技促进会肠道微生态与肠菌移植专业委员会和上海市预防医学会肠道微生态专业委员会的倡议下，组织国内相关领域专家成立了《慢性便秘肠道微生态临床应用中国专家共识（2024版）》编写委员会，围绕肠道菌群紊乱、肠道微生态治疗的适应证和肠菌移植的方案，通过检索国内外文献、汇集专家们的临床经验，提出了16条推荐意见，旨在规范慢性便秘的肠道微生态临床应用。.

The irritable bowel syndrome (IBS) is a functional gastrointestinal disorder (FGID), whose prevalence has widely increased in pediatric population during the past two decades. The exact pathophysiological mechanism underlying IBS is still uncertain, thus resulting in challenging diagnosis and management. Experts from 4 Italian Societies participated in a Delphi consensus, searching medical literature and voting process on 22 statements on both diagnosis and management of IBS in children. Recommendations and levels of evidence were evaluated according to the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus was reached for all statements. These guidelines suggest a positive diagnostic strategy within a symptom-based approach, comprehensive of psychological comorbidities assessment, alarm signs and symptoms\' exclusion, testing for celiac disease and, under specific circumstances, fecal calprotectin and C-reactive protein. Consensus also suggests to rule out constipation in case of therapeutic failure. Conversely, routine stool testing for enteric pathogens, testing for food allergy/intolerance or small intestinal bacterial overgrowth are not recommended. Colonoscopy is recommended only in patients with alarm features. Regarding treatment, the consensus strongly suggests a dietary approach, psychologically directed therapies and, in specific conditions, gut-brain neuromodulators, under specialist supervision. Conditional recommendation was provided for both probiotics and specific fibers supplementation. Polyethylene glycol achieved consensus recommendation for specific subtypes of IBS. Secretagogues and 5-HT4 agonists are not recommended in children with IBS-C. Certain complementary alternative therapies, antispasmodics and, in specific IBS subtypes, loperamide and rifaximin could be considered.

Functional constipation (FC) is a common condition in childhood in the United Kingdom and worldwide. Various radiological approaches have been established for diagnostic purposes. The radiopaque marker study (ROMS) is universally accepted and used to assess colonic transit time (CTT) in children with FC. Despite being widely used, there is a lack of standardization with various technical protocols, reproducibility of different populations, the purpose for using investigation, variance in the number of markers used, the amount of study days and calculations, the need to empty the colon before performing the test, and whether to perform on medication or off, or the use of specific diets. As part of the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) motility working group (MWG), we decided to explore further into the evidence, in order to provide guidance regarding the use of ROMS in dealing with FC in the pediatric population.

Non-motor symptoms (NMS) reduce quality of life in Parkinson\'s disease (PD) patients, who experience three times more NMS than individuals without PD. While there are international and national NMS treatment guidelines, their implication in clinical practice remains unclear.
This study aimed to investigate the adherence to pharmacological NMS treatment guidelines in patients with mild to moderately severe PD.
220 PD patients with ≥1 NMS based on the Non-Motor Symptom Questionnaire and a Hoehn and Yahr stage ≤4 were randomly selected from the Swedish Parkinson registry and screened for inclusion. NMS were evaluated using the International Parkinson and Movement Disorder Society-Non-Motor Rating Scale (MDS-NMS), Parkinson\'s Disease Sleep Scale 2, Epworth Sleepiness Scale, and Hospital Anxiety and Depression Scale. Treatment was compared with Swedish national guidelines and international guidelines from the MDS Evidence-Based Medicine Committee.
Among 165 included patients, the median number of NMS was 14, and in median 7 symptoms were estimated to require treatment. The most common NMS requiring treatment were pain (69%) and urinary problems (56%). Treatment of depression and constipation demonstrated the highest adherence to guidelines (79% and 77%), while dysphagia and excessive daytime sleepiness exhibited the lowest adherence (0% and 4%). On average, only 32% of NMS were treated in accordance with guidelines.
Adherence to pharmacological guidelines for NMS in patients with mild to severe PD was low. This study highlights the need for improved evaluation and treatment of NMS to enhance symptom management and quality of life among PD patients.

In recent years, advancements have been made in both basic and surgical research of slow-transit constipation (STC). However, compelling references for surgeons in the clinical practice of STC have been lacking, particularly on preoperative evaluation and the choice of surgical procedures. In order to further standardize the diagnosis, assessment and surgical management of STC, Chinese Medical Doctor Association Anorectal Doctor Branch and its Functional Diseases Committee selected relevant experts in the field of STC surgery in China to form the Editorial and Review Committee of the Expert Consensus on Diagnosis, Evaluation and Surgical Management of STC in China. By meticulously reviewing relevant literature from both domestic and international sources and integrating the clinical expertise of the panel of experts, the committee has formulated 20 recommendations. These recommendations aim to establish standardized processes for surgical diagnosis and treatment of STC, ultimately elevating the overall diagnostic and therapeutic standards for STC across China.
近年来，慢传输型便秘（STC）的基础与外科诊疗研究均取得了一定的进展，但我国外科医师在STC临床实践时，尤其在术前评估和术式选择等方面仍然缺乏权威的参考。为进一步规范STC的临床诊断、评估和外科处理，中国医师协会肛肠医师分会和功能性疾病专业委员会遴选我国STC外科领域相关专家，组成《中国慢传输型便秘诊断评估与外科处理专家共识》编审委员会，围绕STC的诊断、鉴别诊断、非手术治疗和手术治疗，通过检索国内外文献结合专家们的临床经验提出了20条推荐意见，旨在规范我国STC的外科诊疗流程，提高我国STC的总体诊治水平。.

Colonic and anorectal manometry includes anorectal manometry and colonic manometry. Anorectal manometry is a common method to evaluate anorectal function, which can objectively reflect the pathological and physiological abnormalities of outlet obstructive constipation and fecal incontinence, as well as the impact of anorectal surgery on continence. Colonic manometry is a new type of colon motility detection method developed in recent years. It can record the peristalsis and contraction of the whole colon through a pressure measuring catheter, which helps physicians further evaluate various colonic diseases. However, various factors such as testing equipment, operating standards, and evaluation parameters are difficult to unify. There is no consensus on the operation and interpretation of colorectal anal pressure measurement. Under the guidance of the Anorectal Branch of Chinese Medical Doctor Association, in collaboration with Clinical Guidelines Committee, Anorectal Branch of Chinese Medical Doctor Association, Anorectal motility disorders Committee , Colorectal Surgeons Branch of Chinese Medical Doctor Association, Colonic Branch of China international exchange and promotive association for medical and healthcare, Tianjin Union Medical Center is leading the organization of domestic experts in this field. Based on searching relevant literature and combining clinical experience at home and abroad, after multiple discussions, the \"Chinese expert consensus on colonic and anorectal manometry\" has been prepared. This consensus discusses the indications, contraindications, pre examination management and technical procedures, treatment of complications, and interpretation of examination reports for colonic and anorectal manometry , aiming to guide the standardized clinical practice of colonic and anorectal manometry.
结直肠肛门测压包括肛门直肠测压和全结肠测压。肛门直肠测压是评价肛门直肠功能的常用方法，能较为客观地反映出口梗阻型便秘和排便失禁的病理生理异常，以及肛门直肠手术等对排便控便的影响；全结肠测压是近年来发展的一种新型结肠动力检测方法，其能通过测压导管记录整个结肠的蠕动收缩情况，有助于医师进一步对多种结直肠疾病进行评估。由于检测设备、操作标准、评价参数等多种因素难以统一，结直肠肛门测压的操作及其结果的判读尚未形成共识。在中国医师协会肛肠医师分会指导下，联手中国医师协会肛肠医师分会临床指南工作委员会、中国医师协会肛肠医师分会肛肠动力异常性疾病学组和中国医疗保健国际交流促进会结直肠病学分会，由天津市人民医院牵头组织国内本领域的专家，在检索相关文献的基础上，结合国内外临床经验，经过多次讨论，编写了《结直肠肛门测压中国专家共识（2023版）》。本共识对结直肠肛门测压的适应证、禁忌证、检查前处置和技术操作、并发症的处理以及检查报告的判读等进行论述，旨在指导规范结直肠肛门测压的临床实践。.

Constipation is a common problem in children, accounting for about 3% of all primary care visits and up to 25% of referrals to paediatric gastroenterologists. Although polyethylene glycol often proves effective, most children require prolonged treatment and about 50% of them have at least one relapse within the first 5 years after initial recovery. When conventional treatment fails, children are considered to have refractory constipation. Children with refractory constipation deserve specialist management and guidance. Over the last decades, there has been a remarkable increase in our knowledge of normal and abnormal colonic and anorectal motility in children, and a number of different techniques to measure transit and motility have been developed. The present review analyses the possible diagnostic investigations for children with refractory constipation, focusing on their actual indications and their utility in clinical practice. Moreover, we have also analytically reviewed medical and surgical therapeutic options, which should be considered in selected patients in order to achieve the best clinical outcome.

Functional constipation is the most common of the disorders of gut-brain interaction, affecting approximately 12% of the world population. Although classically considered a chronic condition, many individuals experience shorter yet repetitive bouts of constipation representing a different clinical entity. There has been increased interest in this latter disorder, which has recently been classified as occasional constipation. This Rome Foundation working group document reflects the consensus of an international team of specialists who summarized currently available research to provide a working definition of and treatment algorithm for occasional constipation. The recommendations herein are based on current evidence, accounting for gaps in the literature as well as international variance in definitions and health seeking behaviors for constipation.
The committee members reviewed the scientific literature, focusing specifically on occasional constipation, with the understanding that as a new entity, a paucity of data would be available. We used Rome IV research and clinical definitions to establish the framework for our definition of occasional constipation. Where possible, treatment recommendations were determined on the basis of the earliest extractable data from functional constipation studies, focusing on positive results within the first 2 weeks of treatment. We used the Delphi method to create consensus with 100% agreement between the authors.
An evidence-based review of the literature resulted in the definition of occasional constipation as follows: \"individuals who experience the presence of at least 1 functional constipation symptom, in the absence of alarm signs or symptoms, occurring at irregular and infrequent intervals, which is bothersome enough to induce a patient to seek medical management.\" Medical management whether seeking medical care or self-treatment was left to the individual\'s discretion, and we did not include time anchors because these thresholds require further investigation. Polyethylene glycol and stimulant laxatives are recommended as first-line interventions, whereas magnesium-containing compounds are suggested in individuals failing to respond to these therapies. There are insufficient data to make recommendations for using fiber or stool softeners. Prescription laxatives should be reserved for individuals with chronic constipation.
Occasional constipation is a unique clinical entity characterized by infrequent but recurrent symptoms. Data are limited because consensus definitions have been lacking. Establishing a standardized definition and therapeutic recommendations provides a framework for future studies focusing on epidemiologic and symptoms-based outcomes. Further studies are needed to confirm and refine these recommendations.

Chronic constipation is one of the most common digestive diseases encountered in clinical practice. Constipation manifests as a variety of symptoms, such as infrequent bowel movements, hard stools, feeling of incomplete evacuation, straining at defecation, a sense of anorectal blockage during defecation, and use of digital maneuvers to assist defecation. During the diagnosis of chronic constipation, the Bristol Stool Form Scale, colonoscopy, and a digital rectal examination are useful for objective symptom evaluation and differential diagnosis of secondary constipation. Physiological tests for functional constipation have complementary roles and are recommended for patients who have failed to respond to treatment with available laxatives and those who are strongly suspected of having a defecatory disorder. As new evidence on the diagnosis and management of functional constipation emerged, the need to revise the previous guideline was suggested. Therefore, these evidence-based guidelines have proposed recommendations developed using a systematic review and meta-analysis of the treatment options available for functional constipation. The benefits and cautions of new pharmacological agents (such as lubiprostone and linaclotide) and conventional laxatives have been described through a meta-analysis. The guidelines consist of 34 recommendations, including 3 concerning the definition and epidemiology of functional constipation, 9 regarding diagnoses, and 22 regarding managements. Clinicians (including primary physicians, general health professionals, medical students, residents, and other healthcare professionals) and patients can refer to these guidelines to make informed decisions regarding the management of functional constipation.