Australian neuro-gastroenterologist Professor Nick Talley was one of three luminaries to present the prestigious Josephine & Michael Camilleri lecture at Digestive Disease Week (DDW) 2026 in Chicago earlier this month.

Taking on the topic ‘State of the Art in Neurogastroenterology’, Professor Talley delved into the developments and controversies in gastroduodenal disorders, including some of his personal views on the terminology used and a word of caution against following the new Rome V criteria too strictly.

Here are some of the highlights from his talk.

Professor Nick Talley.

Call to change disorder names

Professor Talley proposed replacing the term functional GI disorder (FGID) with the term neurogastrointestinal disorder (NGID) in line with research that now offered a better explanation of the underlying pathophysiological processes.

He also suggested dropping the term functional dyspepsia and instead using chronic dyspepsia, similar to the change from functional to chronic constipation by the Rome committee.

“I hate the word functional. I’m really sorry, I think it’s pejorative and it’s a problem. Is DGBI a problem as well? Some people have suggested it might be, although I think that remains to be determined, but functional is definitely a problem,” he told delegates in the packed theatre.

“So I think we need to sort out the terminology, and I would suggest we need to have experts, patients and a consensus on this in some fashion or another.”

Challenging the prevalence of DGBI

Professor Talley said according to the epidemiology work for the Rome IV criteria, about 40% of the world had a disorder of gut-brain interaction (DGBI).

He suggested there should be better classification of the severity of DGBIs.

“If you add those with sub-threshold, there’s another 30% who are affected. It’s abnormal to be normal. It’s got to be wrong. It cannot be right. We are misclassifying ‘so called’ mild disease as disease. It’s actually mild health, and we need to think about that. So I think we haven’t done enough,” he said.

Functional dyspepsia mortality question

On the prognosis of functional dyspepsia, Professor Talley said despite being “always taught” that functional dyspepsia had no increased mortality risk, disturbing data from a nationwide Taiwanese study suggested otherwise.

“What they found is, if you’ve got IBS or functional dyspepsia for that matter, you have an increased risk of psychiatric hospitalisation, increased risk of suicide, which we never talk about, and an all-cause mortality increase as well,” he said.

“And the other piece of disturbing data… although I think it needs replication, is that the safety of antidepressants that we do use in difficult functional dyspepsia and in difficult IBS has been recently challenged in this retrospective nationwide US cohort study, where antidepressants were associated with an increased all-cause mortality.

“This has got to be replicated. This is an important question. We need to know the answer to this, and we can’t forget this is the case.”

Does epigastric pain syndrome exist?

Despite epigastric pain syndrome (EPS) being listed in the new Rome V criteria, Professor Talley posed the “challenging thought” of whether it really existed after pointing out that epigastric pain itself was not necessarily a one disease syndrome.

Differential diagnoses of non-specific epigastric pain included coeliac disease, eosinophilic gastritis/duodenitis, infiltrative diseases, abdominal wall pain, metabolic and vascular diseases, but there were many more, he stressed.

“There are many diseases and disorders that can potentially induce epigastric pain. In fact, I don’t know of a study that has really carefully excluded almost everything we know that can cause epigastric pain and then come up with what’s left as epigastric pain syndrome. I even wonder if EPS exists,” he told delegates.

New syndrome on the block 

Professor Talley highlighted ‘inability to belch syndrome’ as a new syndrome in the gastroduodenal disorder section of Rome V. Its criteria includes a bothersome inability, or impaired ability to belch at least 3 days per week with no evidence of underlying major oesophageal diseases/dysfunction that could explain symptoms.

Symptoms include chest pain, gurgling noises in the chest, bloating, flatulence and epigastric pain. Prevalence is estimated to be about 3%.

Professor Talley said the syndrome could present with classic functional dyspepsia symptoms and could help explain some oesophageal and gastroduodenal syndromes. “That is new thinking, and I think it’s important to recognise, but you’ve got to test, you cannot diagnose this purely on clinical grounds,” he said.

“The rapid drinking challenge with sparkling water is one approach you can use, which seems very reasonable and has been published on and it does seem to differentiate. You can certainly use appropriate cutoffs to make a diagnosis.”

Dr Talley suggested inability to belch syndrome was most likely an unconscious learned behavior syndrome that was “totally curable” with Botox in a subset of patients – up to 90% in the literature, although he argued this value was “too high”.

However, he added that “really exciting” emerging approaches from unpublished data suggested patients could be taught to belch for relief without a procedure.