Abstract: Summary Background Irritable bowel syndrome (IBS) is a common, chronic disorder, characterized by abdominal pain/discomfort, bloating and altered bowel habit. Aim To conduct a systematic evidence-based review of pharmacological therapies currently used, or in clinical development, for the treatment of IBS in Europe. The safety and tolerability of these therapies are the subject of an accompanying review. Methods A literature search was completed for randomized controlled studies which included adult patients with IBS and an active or placebo control, assessed IBS symptoms, and were published in English between January 1980 and June 2005. The level of evidence for efficacy was graded according to the quality of the trial design and the study outcome. Results There is some evidence for improvement of individual IBS symptoms with antidiarrhoeals (diarrhoea), antispasmodics (abdominal pain/discomfort), bulking agents (constipation), tricyclic antidepressants (abdominal pain/discomfort) and behavioural therapy. In contrast, there is strong evidence for the improvement of global IBS symptoms with two new serotonergic agents: the 5-HT4 selective agonist tegaserod (IBS with constipation) and the 5-HT3 antagonist alosetron (IBS with diarrhoea). Further data are required for the 5-HT3 antagonist, cilansetron, and the mixed 5-HT3antagonist/5-HT4 agonist renzapride before their utility in IBS can be appraised. Conclusions There is limited evidence for the efficacy, safety and tolerability of therapies currently available in Europe for the treatment of IBS. Overall, there is an absence of pharmacological agents licensed specifically for the treatment of IBS subtypes, and new agents are awaited in Europe that will allow changes in clinical practice to focus on and improve global IBS symptoms.

Abstract: Carmint contains total extracts of Melissa officinalis, Mentha spicata, and Coriandrum sativum, which have antispasmodic, carminative, and sedative effects. As abdominal pain/discomfort and bloating are commonly observed in patients with irritable bowel syndrome, we decided to evaluate the effectiveness of Carmint in relieving these symptoms in irritable bowel syndrome patients. We randomly assigned 32 irritable bowel syndrome patients to receive either Carmint or placebo, plus Loperamide or psyllium (based on their predominant bowel function), for 8 weeks. T-test analysis of the results showed that the severity and frequency of abdominal pain/discomfort were significantly lower in the Carmint group than the placebo group at the end of the treatment (P=0.016 and P=0.001, respectively), as were the severity and frequency of bloating (P=0.02 and P=0.002, respectively). This pilot study suggests that Carmint plus loperamide or Carmint plus psyllium (depending on the irritable bowel syndrome subtype) might be effective in these patients.

Abstract: Chronic constipation is defined as a symptom-based disorder based on the presence for at least 3 months in the last year of unsatisfactory defecation characterized by infrequent stools, difficult stool passage, or both. On the other hand, the presence of clinically important abdominal discomfort or pain associated with constipation defines irritable bowel syndrome (IBS) with constipation. Intake of dietary fibre and bulking agents (psyllium) may be effective in alleviating chronic constipation in patients without slow colonic transit or disordered constipation. On the other hand, fibre may improve stool consistency in patients with IBS with constipation, but it is considered to be not effective in improving abdominal pain, distension or bloating. Probiotics may be effective in relieving constipation; however, the effect of lactic acid bacteria ingestion may be dependent on the bacterial strain used and the population being studied. Lactulose, which is a substrate for lactic acid bacteria (prebiotic), is effective to treat patients with chronic constipation.

Abstract: Journal of Clinical Nursing 15, 678–684The effect of nurse-led gut-directed hypnotherapy upon health-related quality of lifein patients with irritable bowel syndromeAims and objectives. This study quantified health-related quality of life in a group ofirritable bowel syndrome patients and measures changes following a treatmentprogramme of nurse-led gut-directed hypnotherapy.Background. It is well recognized that health-related quality of life can be severelyimpaired in patients suffering form the irritable bowel syndrome. Current conven-tional treatment for irritable bowel syndrome is often unsatisfactory. In contrast ithas been shown that gut-directed hypnotherapy is an effective treatment of irritablebowel syndrome with up to three-quarters of patients reporting symptomaticimprovement.Design/method. Seventy-five patients (55 females/20 males, median age 37AE1 years,age range 18–64) comprised the study group. Physical symptoms of irritable bowelsyndrome were recorded using seven-day diary cards. On presentation the pre-dominant symptoms were abdominal pain (61%), altered bowel habit (32AE5%), andabdominal distension/bloating (6AE5%) in the patient group. An irritable bowelsyndrome quality of life questionnaire was used to define health-related quality oflife. Psychological well-being was measured using the Hospital Anxiety andDepression Scale. Data analysis was carried out using MINITAB, Release 12 forWindows.Results. Physical symptoms statistically improved after hypnotherapy. There werealso significant statistical improvements (P < 0AE001) in six of the eight health-related quality of life domains measured (emotional, mental health, sleep, physicalfunction, energy and social role). These improvements were most marked in femalepatients who reported abdominal pain as their predominant physical symptom.Anxiety and depression improved following treatment.Conclusion. Gut-directed hypnotherapy has a very positive impact on health-relatedquality of life with improvements in psychological well-being and physical symp-toms. It appears most effective in patients with abdominal pain and distension.Relevance to clinical practice. This study demonstrates that by integrating com-plementary therapies into conventional care that gastrointestinal nurses have apotential role in the management of irritable bowel syndrome.Key words: gut-directed hypnotherapy, health-related quality of life, irritable bowelsyndrome, nurse-led clinics, nursing

Abstract: Aerophagia, or excessive air swallowing, is a potential cause of belching, flatulence, bloating, and abdominal pain and may contribute to a worsening of gastrointestinal (GI) disorders. A limited number of published reports of aerophagia treatment indicate that behavioral methods may be of benefit. A case report is presented describing the behavioral treatment of chronic belching due to aerophagia in an adult female. The collaborative application of single-participant design research helped identify open-mouth, diaphragmatic breathing and minimized swallowing as an effective intervention. Belching frequency was reduced from an average rate of 18 per 5-min interval during the baseline period to 3 per 5-min period after treatment. Results were maintained at an 18-month follow-up. Recommendations for the use of a brief treatment protocol with adults referred for chronic belching or other GI complaints attributed to aerophagia are discussed.

Abstract: Irritable bowel syndrome is a common clinical condition that often presents a therapeutic challenge. There is no standard therapy and a multilevel approach is recommended. A high-fiber diet is often one of these components. Many investigators have studied the effectiveness of either fiber supplementation or bulking agents in patients with irritable bowel syndrome. The purpose of this review is to summarize the current literature on the use of fiber in irritable bowel syndrome and to provide some specific recommendations. Systematic reviews of these trials have generally not found fiber to be significantly more effective than placebo at relieving global irritable bowel syndrome symptoms. There may be differences between results obtained with soluble and insoluble fiber. Adverse effects of fiber use may include abdominal discomfort and bloating. Although dietary fiber or bulking agents do not appear to be useful as sole treatment of irritable bowel syndrome, they may have a limited role in empiric therapy depending upon the patient's symptom complex, especially if constipation is the most significant symptom. The basic principles for using fiber therapy are to start with a low dose and increase slowly, to give an adequate trial and to evaluate the results early and periodically.

Abstract: AIM Irritable bowel syndrome (IBS) is frequently associated with an imbalance in intestinal bacteria. To date, few studies have evaluated the efficacy and safety of probiotic administration in patients with constipation-variant IBS. A new agent recently available in clinical practice is a symbiotic consisting of a probiotic, Bifidobacterium longum W11, and the short chain oligosaccharide prebiotic Fos Actilight. The aim of this study was to evaluate the efficacy and safety of this symbiotic in patients with constipation-variant IBS. METHODS A total of 636 patients (250 men, 386 women) diagnosed with constipation-type IBS according to the Roma II criteria were enrolled in 43 centers and received the symbiotic at a dose of 3 g/die for at least 36 days. A validated questionnaire investigating symptoms and stool frequency was administered before and after treatment. RESULTS Based on patient responses to visual scale items, frequency increased significantly after treatment in the ''no symptom'' class from 3% to 26.7% for bloating and from 8.4% to 44.1% for abdominal pain (P<0.0001). In the more severe symptoms classes (moderate-severe), symptom frequency dropped significantly from 62.9% to 9.6% and from 38.8% to 4.1% for bloating and abdominal pain, respectively. Stool frequency significantly increased from 2.9+/-1.6 times/week to 4.1+/-1.6 times/ week. CONCLUSIONS The study product can increase stool frequency in patients with constipation-variant IBS and reduce abdominal pain and bloating in those with moderate-severe symptoms.

Abstract: Irritable bowel syndrome (IBS) is characterized by abdominal discomfort, bloating and disturbed defecation in the absence of any identifiable physical, radiologic or laboratory abnormalities indicative of organic gastrointestinal disease. Diagnosis is based on the identification of symptoms according to Manning, Rome I and Rome II criteria and exclusion of alarm indicators. Approximately, 10-20% of the general population has IBS, and it affects female more often than male for unexplained pathophysiologic reasons. In Korea, it has been reported that the prevalence of IBS is 2.2-6.6% by Rome II criteria and 22.3% by Manning criteria. The health care-seeking population was only 28.6% of community population. Although most patients do not seek medical help, the disease accounts for huge costs for both patients and health-care systems and worsens patients' quality of life significantly.

Abstract: AIM: To compare the efficacy and tolerability of S-pantoprazole (20 mg once a day) versus racemic Pantoprazole (40 mg once a day) in the treatment of gastro-esophageal reflux disease (GERD). METHODS: This multi-centre, randomized, double-blind clinical trial consisted of 369 patients of either sex suffering from GERD. Patients were randomly assigned to receive either one tablet (20 mg) of S-pantoprazole once a day (test group) or 40 mg racemic pantoprazole once a day (reference group) for 28 d. Patients were evaluated for reduction in baseline on d 0, GERD symptom score on d 14 and 28, occurrence of any adverse effect during the course of therapy. Gastrointestinal (GI) endoscopy was performed in 54 patients enrolled at one of the study centers at baseline and on d 28. RESULTS: Significant reduction in the scores (mean and median) for heart burn (P < 0.0001), acid regurgitation (P < 0.0001), bloating (P < 0.0001), nausea (P < 0.0001) and dysphagia (P < 0.001) was achieved in both groups on d 14 with further reduction on continuing the therapy till 28 d. There was a statistically significant difference in the proportion of patients showing improvement in acid regurgitation and bloating on d 14 and 28 (P = 0.004 for acid regurgitation; P = 0.03 for bloating) and heart burn on d 28 (P = 0.01) between the two groups, with a higher proportion in the test group than in the reference group. Absolute risk reductions for heartburn/acid regurgitation/bloating were approximately 15% on d 14 and 10% on d 28. The relative risk reductions were 26%-33% on d 14 and 15% on d 28. GI endoscopy showed no significant difference in healing of esophagitis (P = 1) and gastric erosions (P = 0.27) between the two groups. None of the patients in either group reported any adverse effect during the course of therapy. CONCLUSION: In GERD, S-pantoprazole (20 mg) is more effective than racemic pantoprazole (40 mg) in improving symptoms of heartburn, acid regurgitation, bloating and equally effective in healing esophagitis and gastric erosions. The relative risk reduction is 15%-33%. Both drugs are safe and well tolerated.

Abstract: Celiac disease is a gastrointestinal disorder characterized by inflammation, leading to injury to the mucosal lining of the small intestine. The inflammation occurs when gliadin, a protein found in such gluten-containing foods as wheat, rye, and barley, is ingested by genetically susceptible individuals. The mucosal damage and subsequent malabsorption of nutrients leads to various complications. Researchers estimate that more than 2 million people in the United States have celiac disease-a prevalence that is greater than was previously believed. Approximately 60,000 Americans are diagnosed annually with celiac disease. Until recently, diagnosis has been complicated by the fact that the indicators of celiac disease are nonspecific. However, because of the development of new, easy-to-administer serology tests, diagnosis has become much less complicated. After conducting a review of the literature, the authors recommend a serologic testing sequence for diagnosis of celiac disease and urge that adults and children with an assortment of symptoms be tested for this disease. Common signs and symptoms of celiac disease include anemia, arthralgia, fatigue, infertility, neuropathy, and weight loss, in addition to such gastrointestinal symptomatology as abdominal pain, anorexia, bloating, constipation, and diarrhea. The only treatment for patients with celiac disease remains a gluten-free diet.

Abstract: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that can present with a wide array of symptoms that make treatment difficult. Current therapies are directed at relieving symptoms of abdominal pain or discomfort, bloating, constipation, and diarrhea. Pharmacologic agents used to treat IBS-associated pain include myorelaxants, peppermint oil, and peripherally acting opiates. Dicyclomine and hyoscyamine, the two myorelaxants available in the United States, have not been proven effective in reducing abdominal pain in patients with IBS. The efficacy of peppermint oil is debated, but methodological problems with existing studies preclude definitive judgment. Loperamide is ineffective for relief of abdominal pain. For IBS patients with excessive abdominal bloating, a small number of studies suggest that bacterial eradication with gut-directed antibiotics and bacterial reconstitution with nonpathogenic probiotics may reduce flatulence. For constipation-predominant (C-IBS) symptoms, current treatment options include fiber supplementation, polyethylene glycol, and tegaserod. Soluble fibers (ispaghula, calcium polycarbophil, psyllium) are more effective than insoluble fibers (wheat bran, corn fiber) in alleviating global symptoms and relieving constipation, although fiber in general has marginal benefit in treatment of overall IBS symptoms. Polyethylene glycol increases bowel frequency in chronic constipation, but its overall efficacy against IBS is unclear. Tegaserod, a 5-HT4 agonist, demonstrates superiority over placebo in improving bowel frequency and stool consistency and alleviating abdominal pain and bloating in women with C-IBS. Overall global symptoms are modestly improved with tegaserod when compared with placebo. Additional agents under investigation for C-IBS include the ClC2 chloride channel opener lubiprostone, μ-opioid receptor antagonist alvimopan, and 5-HT4 agonist renzapride. For diarrhea-predominant (D-IBS) symptoms, available therapies include loperamide, alosetron, and clonidine. Alosetron, a 5-HT3 antagonist, is superior to placebo for reducing bowel frequency, improving stool consistency, and relieving abdominal pain in women with D-IBS. However, alosetron is available under a restricted license because of concerns for ischemic colitis and severe constipation necessitating colectomy. Clonidine may be helpful in alleviating global symptoms for D-IBS patients.

Abstract: Irritable bowel syndrome (IBS) is a symptomatic motility and sensory disorder of the lower gastrointestinal (GI) tract and is characterized by abdominal pain/ discomfort, bloating and altered bowel activity. It is usually classified according to the predominant bowel habit – IBS with constipation (C-IBS), IBS with diarrhoea (D-IBS) or IBS with alternating symptoms of both constipation and diarrhoea. Despite intensive research, the complicated and multifactorial pathophysiology underlying IBS is not completely understood. Recently, there is growing emphasis on identifying specific biological pathways that contribute to the complex pathophysiology of this disease.

Abstract: Summary Background Tegaserod has been shown to be effective in chronic constipation in Western population. Aim We investigated if tegaserod is equally effective in Chinese population. Materials and methods Two hundred and fifty patients were randomized to a double-blinded 8-week treatment of tegaserod 6 mg b.d. or placebo. Response during weeks 1–4 was defined as an increase in complete spontaneous bowel motion ≥1/week. Secondary efficacy included response during weeks 1–8, individual symptoms and scores, quality of life and global assessment of bowel habits and constipation. Results One hundred and nine patients from the treatment group and 107 from the placebo group completed the 8-week treatment. Responder rates was 47.7% vs. 29% for the treatment and placebo groups (P = 0.005). The sustained complete spontaneous bowel motion rate was 29.4% vs. 15.7% in the two groups (P = 0.016). The response rates were higher than that reported previously in the Caucasian studies. There was improvement in the scores for stool form scale, bothersomeness of constipation, abdominal distension/bloating and satisfaction of bowel habit (P < 0.05). The mental score was higher in the treatment group (46.8 ± 9 vs. 43.6 ± 10, P = 0.01). Conclusions Tegaserod is effective in relieving chronic constipation in Chinese population. The efficacy observed may be higher than that in Western population.

Abstract: Patients with intractable chronic constipation should be evaluated with physiologic tests after structural disorders and extracolonic causes have been excluded. Conservative treatment options should be tried excessively. If surgery is indicated subtotal colectomy with IRA is the treatment method of choice. However, segmental resection may be a good option for isolated megasigmoid, sigmoidocele or recurrent sigmoid volvulus. In general patients with GID should not be offered any surgical options because of their anticipated poor results. Moreover, patients with psychiatric disorders should be actively discouraged from resection as they tend to have poorer prognosis. Patients must be counseled that preoperative pain and/or bloating will likely persist even if surgery normalizes bowel frequency. Patients with associated problems may be better served by having a stoma without resection as both a therapeutic maneuver and a diagnostic trial. Colectomy is no option to treat pain and/or abdominal bloating.

Abstract: Functional dyspepsia and gastroparesis are the most common functional and motility disorders of the stomach. Functional dyspepsia is a heterogeneous syndrome with multiple pathophysiologies that refers to symptoms originating in the gastroduodenal region in the absence of an organic cause. Patients with functional dyspepsia may present with primarily postprandial symptoms including fullness, early satiety, and bloating, while other patients may present with the predominant symptom of epigastric pain. Gastroparesis is a symptomatic chronic disorder characterized by delayed gastric emptying without mechanical obstruction. Although gastroparesis is often caused by diabetes and prior gastric surgery, the underlying cause may not be found in many patients. Clinical manifestation of gastroparesis is variable. Patients present with debilitating nausea and vomiting resulting in weight loss and dehydration. Other patients may present with postprandial symptoms of postprandial fullness, early satiety, and effortless regurgitation. In this review, an update on the underlying mechanisms, clinical features, diagnostic evaluation, and treatment for functional dyspepsia and gastroparesis is provided.

Abstract: Management of patients with irritable bowel syndrome (IBS) is based on the positive diagnosis of the symptom complex, limited exclusion of underlying organic disease and institution of a therapeutic trial. As a general approach, physician should establish an effective therapeutic relationship by providing clearly understood explanation to patients of the causes and implications of their symptoms, supported by reassurance and appropriate therapy. Treatment of IBS needs to be individualized, focusing on patients' predominant symptoms. In diarrhea- predominant IBS, loperamide and some antispasmodic agents are efficacious. In constipation-predominant IBS, fiber and bulk laxatives are used empirically, but their efficacy is variable and may aggravate bloating. The 5-HT4 receptor agonist, tegaserod is efficacious in female patients with IBS and constipation. In patients with IBS and abdominal pain, antispasmodics and antidepressants can be used but there is weak evidence of potential benefit. New novel pharmacological agents are being carefully appraised as potential drugs for the future.

Abstract: Elective colectomy for chronic constipation can potentially yield very rewarding results. As has been shown in this chapter, dramatic symptomatic relief including improvement in the frequency of spontaneous bowel movements, decrease in the use of enemas and digitation, and in some cases improvement or resolution of pain or bloating may occur. However, conversely in other patients constipation may persist and abdominal pain may even worsen. It should also be remembered that potential adverse sequelae may result from surgery for a benign condition, including anastomotic leak, small bowel obstruction, and even an ileostomy. The chapter authors and the book editors concur that very stringent investigation including physiological, medical, and psychosocial investigations are required before contemplating this type of resectional surgery for a functional disorder. Sufficiently motivated patients who have been carefully selected through intensive investigation in a specialist unit may, in appropriate circumstances, be offered this option. It is the book editors’ belief that the “ideal” patient is one with reproducible colonic inertia on multiple transit studies with normal gastric emptying and small-bowel function; no evidence of any physiologic, functional, or structural pelvic outlet obstruction; and no associated symptoms like nausea, bloating, abdominal or pelvic pain, or difficult or incomplete evacuation. The patient who understands that all of these symptoms may either persist or develop after surgery and a permanent stoma may be necessary is best prepared to pursue this option.

Abstract: Breath tests are quick, noninvasive, simple to perform and reliable. In particular in patients with diarrhea, bloating, nausea and uncharacteristic abdominal symptoms, the H2 breath test is highly useful. Using this procedure, malabsorption of various different carbohydrates, the absorptive performance of the upper abdominal tract, the orocecal transit time, or bacterial overgrowth in the small bowel, can be determined. Using 24-hour pH-metry, the acidity in the stomach and esophagus can be measured, and reflux disease, for example, diagnosed. Today, elevated fat in the stool is detected on the basis of the beta carotene level in the serum. Further function tests for the detection of pancreatic insufficiency, such as the determination of fecal pancreatic elastase, are also available.

Abstract: Irritable bowel syndrome (IBS) is a common chronic gastrointestinal (GI) disorder, but its pathophysiology remains unknown. 5-hydroxytryptamine (5-HT, serotonin) is an important neurotransmitter involved in the brain-gut connection. Alosetron, a 5-HT3 receptor antagonist, has been demonstrated in randomized, placebo-controlled trials (RCT) to be effective in diarrhea-predominant IBS(IBS-D). Constipation is the most common adverse event. Alosetron improved abdominal pain and discomfort and stool consistency in both female and male patients, but it did not improve other symptoms (sense of urgency, stool frequency and bloating) in male patients. Although less is known about the gender differences in therapeutic benefit, a new 5-HT3 antagonist, cilansetron, has demonstrated effectiveness in male and female IBS-D patients and is currently under clinical trials.

Abstract: Irritable bowel syndrome is a common condition for which, until recently, treatment options have been limited. Tegaserod has selective serotonin subtype 4 receptor agonist activity and acts by increasing gastrointestinal motility, secretion and possibly reducing visceral sensitivity. It has been developed to treat patients with irritable bowel syndrome who suffer from abdominal pain, constipation and bloating. Studies so far suggest that it is an effective treatment for these symptoms with an excellent safety profile. Its role in other functional gastrointestinal disorders, such as functional dyspepsia, is still being assessed. This review describes the structure, pharmacokinetic and pharmacodynamic properties of tegaserod and its effect on gastrointestinal physiology, as well as its clinical utility.

Abstract: Irritable bowel syndrome (IBS) is considered to be a functional disease, chracterised by the presence of symptoms of abdominal pain, bloating and abnormal defecation in the absence of organic disease (diagnosis of exclusion). Although it does not increase mortality, it strongly impairs quality of life and increases health-care costs. The prevalence of the disease varies from 3% to 22%, depending on the criteria used and the health-care system of the country, being most accurate figure the second one, since a lot of sufferers do not seek medical advice or adopt paramedical treatment. Little is known regarding etiology. There are several theories supporting an altered intestinal motility, visceral hypersensitivity, abnormal brain interpretation of pain signals, abnormal gas propulsion, altered gut flora, and food constituent intolerance as etiopathogenetic factors, with a background of a disturbed psychological profile. The majority of patients with IBS present with increased scores of stress, anxiety, depression and hypochondriasis, symptoms that are rather part of the cause than the outcome of the disease. A subgroup of patients who are initially diagnosed as suffering from IBS, are subsequently found to have microscopic colitis or celiac disease. The latter is present in 3% to 5% of patients with IBS symptoms. These entities, as well as lactose intolerance, low-grade Crohnis disease or the less frequent idiopathic bile-salt malabsorption, should always be included in the differential diagnosis.

Abstract: Primary sclerosing cholangitis (PSC) is associated with an increased risk of cholangiocarcinoma. Awadallah et al. investigated whether the use of cholangioscopy, which allows direct visualization of the biliary tree, adds any advantage to conventional biopsy techniques in the detection of cholangio carcinoma in patients with PSC. They also assessed its usefulness in the detection and removal of biliary stones. The study included 41 consecutive patients with PSC (30 male) referred between March 2000 and November 2004 for cholangioscopic evaluation of biliary strictures or stones. Biopsies were taken of lesions visualized by cholangioscopy in 33 patients: cholangiocarcinoma was found in only 1 patient. During follow-up, two further patients were discovered to have cholangiocarcinomas that had not been detected by cholangioscopy. These two patients were examined using preexisting percutaneous tracts, however, and this might have limited visualization of the biliary tree. Cholangioscopy detected stones in more patients than conventional cholangiography did (23 versus 16). Stone clearance was not attempted in 6/23 patients; of the remaining 17, 9 were treated with cholangioscopy -assisted methods and 8 with conventional methods. Complete clearance was achieved in 7 and 3 patients, respectively. The authors conclude that cholangioscopyassisted techniques might be more effective than conventional techniques in detecting biliary stones and achieving complete stone clearance; however, the small number of patients in this study with cholangiocarcinoma precludes any conclusions being drawn about its usefulness in the detection of cancer in PSC. Katherine Sole

Abstract: Myotonic dystrophy (MD) is characterized by myotonic phenomena and progressive muscular weakness. Involvement of the gastrointestinal tract is frequent and may occur at any level. The clinical manifestations have previously been attributed to motility disorders caused by smooth muscle damage, but histologic evidence of alterations has been scarce and conflicting. A neural factor has also been hypothesized. In the upper digestive tract, dysphagia, heartburn, regurgitation and dyspepsia are the most common complaints, while in the lower tract, abdominal pain, bloating and changes in bowel habits are often reported. Digestive symptoms may be the first sign of dystrophic disease and may precede the musculo-skeletal features. The impairment of gastrointestinal function may be sometimes so gradual that the patients adapt to it with little awareness of symptoms. In such cases routine endoscopic and ultrasonographic evaluations are not sufficient and targeted techniques (electrogastrography, manometry, electromyography, functional ultrasonography, scintigraphy, etc.) are needed. There is a low correlation between the degree of skeletal muscle involvement and the presence and severity of gastrointestinal disturbances whereas a positive correlation with the duration of the skeletal muscle disease has been reported. The drugs recommended for treating the gastrointestinal complaints such as prokinetic, anti-dyspeptic drugs and laxatives, are mainly aimed at correcting the motility disorders. Gastrointestinal involvement in MD remains a complex and intriguing condition since many important problems are still unsolved. Further studies concentrating on genetic aspects, early diagnostic techniques and the development of new therapeutic strategies are needed to improve our management of the gastrointestinal manifestations of MD.