Dynamic precision therapy in chronic gastrointestinal diseases: A focus on gastroesophageal reflux disease and inflammatory bowel disease-A narrative review and conceptual perspective.

Chronic gastrointestinal diseases, including inflammatory bowel disease (IBD), gastroesophageal reflux disease (GERD), and irritable bowel syndrome (IBS), impose a growing global burden. Their relapsing-remitting nature and variable clinical course challenge the paradigm of long-term continuous therapy, which is associated with adverse effects, poor adherence, and high costs. While dynamic precision therapy (DPT) has emerged as an intuitive solution, its conventional definition-symptom-driven, intermittent drug use-is too narrow and fails to harness the full potential of precision medicine. As a narrative review and perspective article, this paper proposes a paradigm shift by introducing a novel, multidimensional framework for DPT that integrates four synergistic dimensions: symptom-guided relief for acute episodes, disease subtype-guided baseline therapy, pathophysiology-guided dynamic adjustments using biomarkers and smart technologies, and individual patient context-guided shared decision-making. Applying this framework to IBD, GERD, and IBS, we demonstrate how it transforms precision treatment from a simple dosing strategy into a comprehensive platform for precision management. We review cutting-edge tools enabling this vision, from 24-hour pH-impedance monitoring and therapeutic drug monitoring to smart drug delivery systems like MMP-responsive hydrogels. This framework provides a practical guide for transitioning from empirical methods to mechanism-based, patient-centered care, presenting a forward-looking model that could transform future treatment approaches in gastroenterology.