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Such algorithms are based on sequential therapeutic trials and modifying the treatment strategy based on efficacy and adverse events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The aims of this review are to evaluate the evidence for efficacy of second\u2010 and third\u2010line pharmacotherapies and to assess the evidence for the alternative option to manage subgroups of patients with symptoms suggestive of lower DGBI based on diagnostic tests or documented dysfunctions. The preeminent tests to identify such subgroups that present with symptoms that overlap with lower DGBI are detailed: digital rectal examination as well as anorectal manometry and balloon expulsion for evacuation disorders, detailed measurements of colonic transit, and diagnosis of bile acid diarrhea or carbohydrate malabsorption based on biochemical measurements. The review also addresses the cost implications of screening to exclude alternative diagnoses and the costs of therapy associated with the therapeutic options following an algorithmic approach to treatment from the perspective of society, insurer, or patient. Finally, the costs of the diagnostic tests to identify actionable biomarkers and the evidence of efficacy of individualized therapy based on formal diagnosis or documentation of abnormal functions are detailed in the review.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.14856","type":"journal-article","created":{"date-parts":[[2024,6,27]],"date-time":"2024-06-27T11:20:07Z","timestamp":1719487207000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Algorithms or biomarkers in patients with lower <scp>DGBI<\/scp>?"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6472-7514","authenticated-orcid":false,"given":"Michael","family":"Camilleri","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Mayo Clinic Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.)  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Yi","family":"Yang","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Mayo Clinic Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.)  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