SUMMARY BackgroundThere has been increasing interest in small intestinal bacterial overgrowth (SIBO) after reports of a link with irritable bowel syndrome (IBS), yet our understanding of this entity is limited.

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Eosinophilic granulomatosis with polyangiitis (EGPA), formerly named Churg-Strauss syndrome, is a rare systemic small- and medium-sized-vessel vasculitis, characterized by the presence of severe asthma as well as blood and tissue eosinophilia. Gastrointestinal (GI) symptoms, like diarrhea and abdominal pain, are common; however, there are few reports of histologic evidence of GI involvement. We report the case of a patient on treatment for EGPA who presented with recurrent small bowel obstruction and choledocholithiasis. Biopsies of the esophagus, small bowel and common bile duct showed diffuse eosinophilia, with clear EGPA in the GI tract. Improved awareness of GI EGPA may allow for timely management of this disorder.

A major change in the Rome III criteria relates to the condition previously called functional dyspepsia (FD). Rome I and Rome II defined FD as pain or discomfort centered in the upper abdomen without a definite structural or biochemical explanation. The condition was further sub-classified into ulcer-like or dysmotility-like dyspepsia. However, subsequent studies failed to show that single-symptoms are present in the vast majority of patients, and most symptoms failed to correlate with any physiological abnormalities. In Rome III, FD as a broad category was no longer considered useful in terms of research, but rather was defined by two new symptom entities, namely epigastric pain (epigastric pain syndrome) and meal-related symptoms (postprandial distress syndrome). We predict these changes will stimulate new research into the underlying pathophysiological disturbances, as well as impact the diagnosis and treatment of dyspepsia; the classification should advance the field, and we review the challenges ahead.