Alimentary Pharmacology & Therapeutics最新文献

We thank Drs. Chang, Wei and Liu for their interest in our paper on the ageing gastrointestinal tract,¹ as expressed in their letter.² We would like to make a few clarifications in response.

The most important point to clarify is that missing data were not an issue of concern in our analyses, and did not affect the findings. Therefore, the use of multiple imputations and sensitivity analysis suggested by the authors is not relevant to our study. The gastrointestinal symptom data from the 54,127 individuals, whose survey responses we analysed, did not have any missing data points. This reflects one of the strengths of the Internet-based electronic survey methodology we used, where responses can be automatically checked and answers enforced page by page by the survey software in order to prevent missing data.

Chang et al. also commented that it would have been important to include variables in our study on lifestyle factors, socioeconomic factors and chronic comorbidities, as well as doing sub-group analyses by country or centre, in order to reveal disparities in care and to guide tailoring of intervention strategies. We agree that examining healthcare disparities and elucidating ways to improve healthcare related to disorders of gut–brain interaction (DGBI) are important research aims. However, these were not the goals of our study, which explicitly focused on examining whether older individuals in society generally have lower DGBI prevalence rates. However, future investigations of age differences in DGBI would do well to include assessment of lifestyle and socioeconomic factors, as these might be relevant to understanding the causes of reduced DGBI rates with advancing age. In particular, differences between younger and older adults in living conditions, lifestyle and daily stress, as well as generational differences in emotional factors, could play a role. We hope that our paper will spur further studies that can reveal the factors that explain the mysterious universal ageing-related decline in DGBI rates in populations across the world that we described.

Ami D. Sperber: Writing – original draft; conceptualization. Tamar Freud: Writing – review and editing. Olafur S. Palsson: Writing – original draft; conceptualization. Shrikant I. Bangdiwala: Writing – review and editing. Magnus Simren: Writing – review and editing.

This article is linked to Sperber et al papers. To view these articles, visit https://doi.org/10.1111/apt.18103 and https://doi.org/10.1111/apt.18225

Fitzpatrick et al.¹ examined the influence of high-emulsifier and low-emulsifier diets on intestinal barrier function of healthy people in unstressed and acutely stressed circumstances. Although the study offered important perspectives on the connection between dietary emulsifiers, intestinal barrier function and stress reactions, multiple aspects can be enhanced or explored further.

First, the study's sample comprising 22 healthy adults might restrict the generalisation of the results. A larger and more diverse group of participants, encompassing individuals with different health conditions and demographic characteristics, could boost the external validity of the findings. Second, the study's single-blinded design, where participants are not informed of their dietary allocations, is prone to bias. A double-blind design, where neither participants nor researchers were aware of the dietary interventions, would fortify the internal validity of the study. Additionally, the study's dependence on self-reported dietary adherence might have led to measurement errors. Integrating objective measurements of dietary intake, such as food diaries or biomarkers, could offer more precise data regarding participant compliance. Moreover, the study concentrated on the impacts of emulsifiers and thickeners on intestinal barrier function and stress responses in healthy individuals. It would be advantageous to investigate the long-term consequences of these dietary components, and their potential implications for individuals with pre-existing gastrointestinal disorders, such as inflammatory bowel disease.

In conclusion, although this study has provided valuable information, addressing the aforementioned limitations could improve its validity and furnish a more all-encompassing comprehension of the effects of dietary emulsifiers and thickeners on intestinal barrier function and stress responses.

Liqi Li: Conceptualization; investigation; methodology; writing – review and editing; writing – original draft; validation.

The author declares no conflicts.

This article is linked to Fitzpatrick et al papers. To view these articles, visit https://doi.org/10.1111/apt.18172 and https://doi.org/10.1111/apt.18267.