Gastroesophageal reflux disease (GERD) is a multifactorial condition characterized by the reflux of gastric contents into the esophagus, leading to bothersome symptoms and potentially serious complications. The mechanisms underlying lower esophageal sphincter dysfunction and hiatal hernia formation in GERD remain insufficiently understood. It is plausible that esophageal motility disorders and visceral hypersensitivity are influenced by alterations in the central, autonomic, and enteric nervous systems, particularly in the context of elevated stress levels commonly observed among students. Objective. To evaluate the role of psychoemotional status in the development of GERD symptoms in university students. Material and methods. The study included 157 students from higher education institutions in the Russian Federation. Participants completed an online questionnaire comprising the GerdQ, HADS, Spielberger-Hanin State-Trait Anxiety Inventory, and the Chalder Fatigue Scale. Statistical analysis was performed using multivariate covariance analysis. Results. Based on the GerdQ screening tool, 19.7% of respondents demonstrated symptoms suggestive of GERD. A statistically significant association was observed between GERD symptoms and (1) high anxiety according to HADS, (2) elevated situational anxiety (p=0.005), (3) fatigue severity on the Chalder scale (p<0.001), (4) depressive symptoms on HADS (p=0.017), and (5) the combination of high trait anxiety (Spielberger-Hanin) with pronounced mental fatigue (p=0.031). Multivariate covariance analysis identified seven psychoemotional profiles — distinct psychological patterns significantly associated with GERD symptom development, primarily driven by anxiety, trait anxiety, and depression. Conclusion. Screening for anxiety and depression should be incorporated into the comprehensive assessment of patients with GERD, particularly in populations exposed to elevated stress.

Achalasia is an esophageal motility disorder characterized by progressive dysphagia, leading to a significant decline in the quality of life of affected individuals. This study aimed to investigate hormone replacement therapy (HRT) as a risk factor for achalasia in postmenopausal women. Postmenopausal women who underwent healthcare screening in 2009 through the Korean National Health Insurance Service were enrolled and followed up till December 31, 2022. The risk of achalasia in relation to history and duration of HRT (none, <2 years, 2-5 years, and over 5 years) was calculated using adjusted hazard ratios with 95% confidence intervals. Subgroup analyses were conducted based on age, income, history of autoimmune diseases, and female reproductive factors. The overall cumulative incidence of achalasia in the study cohort was 731 of 1,101,080 subjects. Across all adjusted models, the risk of developing achalasia was significantly higher in participants who received HRT than in those with no history of HRT. The risk increased in a dose-dependent manner with the HRT duration, reaching an adjusted hazard ratio of 1.47 (95% confidence interval: 1.25-1.73) in those with prolonged use of HRT for 5 years or longer. Such a trend remained consistent in the subgroup analyses. In this study, HRT use was associated with an increased risk of achalasia in a dose-dependent manner. These findings underscore the need for vigilant monitoring of esophageal symptoms in postmenopausal women with a prolonged history of HRT.

Achalasia cardia is a rare oesophageal motility disorder characterised by the inability of the lower oesophageal sphincter to relax. The gold standard of care being surgical cardiomyotomy, the robotic approach is becoming more popular, over the last decade. This study evaluates the early outcomes of robotic Heller's cardiomyotomy performed at a single centre in central India. A retrospective data analysis of all the patients of achalasia cardia who underwent robotic cardiomyotomy from March 2024 to June 2025 was done. All the patients were operated using the SSi Mantra™ surgical robotic system (SSI Innovations International Inc., Gurugram). Patient demographics, high-resolution manometry findings, pre-operative Eckardt scores, docking and total console times were noted. Eleven patients were included in the study. Median age was 36 years (range 20-63 years), with males comprising 54.5%. Mean body mass index was 21.4 ± 2.2. Type 2 achalasia was found in 63.6% of patients. The median pre-operative integrated relaxation pressure was 28 mmHg. Mean docking and console time were 12.5 ± 7.4 min and 130.7 ± 34.2 min, respectively. The improvement of the Eckhardt score was from median score of 8 to 1 (P < 0.05). The magnified vision, precision and improved instrument manoeuvrability provided by the robotic platform help in improved patient outcomes. The modular design of the SSi Mantra™ surgical robotic system allows for better ergonomics, making it a viable platform for performing robotic Heller's cardiomyotomy. The initial outcomes appear comparable to those achieved with other robotic systems. Larger studies are needed to further evaluate these potential benefits.

The lack of data on the relationship between dysphagia and major esophageal motility disorders (MEMDs) in the United Arab Emirates (UAE) has presented challenges for clinical management of dysphagia. This study aims to describe the characteristics of patients with dysphagia and MEMDs. We created a retrospective cohort using data from all patients who underwent High Resolution Esophageal Manometry (HREM) at Sheikh Shakhbout Medical Center (SSMC) for different indications between July 2020 and February 2023. The patients were categorized into two groups based on whether findings included dysphagia or not. Data on age, gender, body mass index (BMI), nationality, opioid use, comorbidities and their endoscopic and or imaging findings were collected from electronic health records retrospectively. HREM was performed based on Chicago Classification version 3.0 protocol. There were 125 patients who underwent HREM; 104 patients met the inclusion criteria (48 men and 56 women) of which 64 (61.5%, 64/104) had dysphagia and 37 (35.6%, 37/104) had superimposed major motility disorder. Ineffective esophageal motility (IEM) was most common (37.8%, 14/37), followed by achalasia (27.0%, 10/37), esophagogastric junction outflow obstruction (EGJOO) (24%, 9/37), Aperistalsis (8.1%, 3/37), and 2.7% (1/37) had Distal Esophageal Spasm (DES). There was a statistically significant relationship with gender and nationality among those with and without a MEMDs who had dysphagia (p < 0.05). This is the first study in the UAE to investigate the association between non-obstructive dysphagia and MEMDs. It demonstrated that dysphagia as a presenting symptom is more likely to be associated with an MEMD on HREM.

Dysphagia is a difficulty in swallowing either solid food or liquid. Esophageal stricture being one of the most common causes of dysphagia can be caused by inflammation, fibrosis, or neoplasia damaging the esophageal lumen. If left untreated, dysphagia can lead to malnutrition, aspiration, and decreased quality of life. Another common cause of dysphagia is esophageal motility disorder, an impairment in peristalsis of the esophageal. Calcium channel blockers such as nifedipine have been reported to improve dysphagia and may serve as alternative therapy while waiting for endoscopic intervention. A 27-year-old man presented with a two-month history of progressive dysphagia to solids, semisolids, and liquids, after an episode of hematemesis. Esophagogram showed esophageal stricture with impaired peristaltic. Contrast-enhanced CT result was suggestive of an intraluminal esophageal stricture. The patient was given sublingual nifedipine before meals as an alternative therapy while waiting for endoscopic intervention, and showed gradual sympomatic improvement. Dysphagia caused by long-segment esophageal stricture can be exacerbated by secondary motility disorder. While definitive treatment requires endoscopic intervention, sublingual nifedipine offered effective short-term symptomatic relief by reducing esophagogastric junction pressure and improving bolus transit through the narrowed lumen.

Achalasia is an uncommon primary esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter and esophageal body peristalsis, with a rising prevalence among the elderly due to global population aging. This review summarizes the current evidence on the clinical presentation, diagnostic algorithm, and management of achalasia in geriatric patients. A literature search was conducted focusing on age-related differences in symptoms, endoscopic and functional testing, and outcomes of available therapeutic modalities. Clinical presentation of achalasia differs among younger and geriatric patients, with the latter presenting less pronounced symptoms. Geriatric patients experience a higher risk of malnutrition and aspiration and exhibit more often advanced disease stages, including sigmoid esophagus. High-resolution manometry represents the gold standard for diagnosis, and upper gastrointestinal endoscopy should precede it in order to exclude causes of mechanical obstruction. The treatment remains non-causative and encompasses botulinum toxin injection, pneumatic dilation, peroral endoscopic myotomy, and laparoscopic Heller's myotomy with fundoplication. Considering the evolving potential of minimally invasive techniques, advanced age should not be regarded as a contraindication for the definitive treatment of achalasia, and evidence-based, age-specific recommendations should be developed for optimizing clinical outcomes.

As peroral endoscopic myotomy (POEM) indications expand, proactive identification and management of technically challenging cases are critically important. This study comprehensively evaluated characteristics, perioperative outcomes, and predictors of technically difficult POEM. In this retrospective cohort study (2011-2023), consecutive POEM procedures for esophageal motility disorders at a tertiary center were analyzed. Technically difficult POEM was defined as procedure time ≥90min or aborted POEM. Characteristics and operation parameters were compared between the technically difficult and non-difficult groups. Weighted logistic regression, with stabilized inverse probability of treatment weighting controlled for operator- and technique-related confounders, was used to identify predictors of technically difficult POEM. The final cohort included 676 POEM procedures, comprising 34 (5.0%) technically difficult POEM (3 aborted) and 642 (95.0%) non-difficult POEM. Technically difficult POEM demonstrated significantly higher hemostatic forceps utilization (79.4% vs. 48.8%), prolonged postoperative stays (4 vs. 3days), and increased hospital costs (¥21,542 vs. ¥19,490) (P < 0.01). Clinically significant adverse events were more frequent in the technically difficult group (17.7% vs. 1.6%, P < 0.001). Weighted multivariable analysis identified prior pneumatic dilation, prior POEM, and prolonged disease duration as independent risk factors for technically difficult POEM (P < 0.05). Technically difficult POEM was associated with higher incidence of perioperative adverse events, increased healthcare utilization, and significant financial burdens. Prior pneumatic dilation, prior POEM, and prolonged disease duration were the independent risk factors for technically difficult POEM. Centralized referral of high-risk patients to expert centers may optimize patient outcomes and enhance procedural safety.

Abstract Background Esophageal motility disorders are underreported in Canada and remain a clinical challenge that impacts quality of life. High-resolution esophageal manometry (HREM) is the gold standard for their diagnosis. Aims Primary Aim: To determine the prevalence of esophageal motility disorders in a population of patients from Southwestern Ontario referred for (HREM). Secondary Aim: To evaluate various HREM parameters across normal and abnormal studies. Methods A retrospective analysis was conducted on patients who underwent HREM at St. Joseph Hospital, in London, Ontario, from Jan 1st, 2014, until Sep 15, 2024. Data was extracted from a motility database of patients who had undergone HREM. The data included patient characteristics, medications, symptoms, and comorbidities, along with indications for HREM, HREM parameters, measurements, and the final diagnosis. Results A total of 1352 patients were included in the final analysis, with the majority being Female (822/1352, 60.8%). Mean age was 54.12 (18-96) years, with an average weight of 80.4 kg (25.4 - 185 kg) and a mean height of 168.03 cm (81–201 cm). The most common indication for HREM was dysphagia (587/1352;43.4%), followed by typical GERD symptoms, both heartburn and regurgitation (514/1352;38%). HREM revealed abnormal findings in 582/1352 (43%) of patients, whereas 770/1352 (57%) had normal study results. Ineffective esophageal motility (IEM) was the most prevalent diagnosis (98/1352; 7.2%), followed by achalasia (95/1352; 7.03%) and EGJ outflow obstruction (31/1352; 2.3%). The prevalence of dysphagia was significantly higher among patients with achalasia (80/95; 84.2%) than among those with normal manometry (282/770; 36.6%; p &amp;lt; 0.001). Referral for GERD symptoms occurred in 53.1% (52/98) of IEM patients versus 42.3% (326/770) of those with normal manometry (p = 0.056), indicating no significant difference. PPI use vs no PPI use was associated with lower LES residual pressure (6.81 ± 8.11 mmHg vs 9.16 ± 10.41 mmHg) and LES basal pressure (24.33 ± 15.85 mmHg vs 28.75 ± 16.98 mmHg), both p &amp;lt; 0.001. Opioid use vs non-opioid use showed higher LES basal pressure (30.57 ± 18.67 vs 25.32 ± 16.11, p = 0.007), but no significant difference in LES residual pressure. Conclusions Most HREM studies were normal, with achalasia and IEM being the most common abnormalities—achalasia mostly in dysphagia referrals and IEM in GERD referrals (not statistically significant). These findings highlight indication-specific likelihoods and HREM’s role in triage. Larger, multicenter studies with adjustments and linked pH/EGD data are needed to confirm their robustness and clinical relevance. Funding Agencies None

Abstract Background Functional esophageal symptoms such as heartburn and dysphagia are common, often occurring in the absence of demonstrable reflux or major motility disorders. Pathophysiology is multifactorial, involving visceral hypersensitivity, altered central processing, and impaired esophageal perception. The relationship between demographic factors and symptom burden in patients with normal motility and no reflux remains unclear. The Esophageal Symptom Questionnaire (ESQ-30) is a validated tool measuring frequency and severity of dysphagia (ESQ-D), reflux (ESQ-R), and globus (ESQ-G). Aims To determine the effect of age and sex on esophageal symptoms in reflux-negative patients with normal esophageal motility. Methods We retrospectively analyzed consecutive high-resolution manometry (HRM) studies between July 2022–October 2024. Inclusion required normal esophageal motility (no esophageal motility disorder by Chicago Classification v4.0) and complete ESQ-30 data. Patients with evidence of GERD by Lyon 2.0 criteria (LA grade B-D esophagitis/Barrett’s esophagus, off-therapy AET &amp;gt;6%, on-therapy AET &amp;gt;4%) were excluded. ESQ subscales were summarized as median (IQR). Group comparisons used Mann-Whitney U tests. Correlations between ESQ subscales, manometric variables (IRP, DCI, % failed, % weak, % incomplete bolus clearance), and age were assessed with Spearman’s bivariate correlations. Results Within the study period, 184 patients (median age 52 [40–62] years, 122 [63.1%] female) met inclusion criteria with normal motility, complete ESQ-30 questionnaires and no evidence of GERD. Median ESQ-D, ESQ-R, and ESQ-G scores were 4 [0–17], 23 [7–41.75], and 16 [4-36], respectively. Females reported higher symptom scores than males: ESQ-D (7.5 vs 1.5, p = .004), ESQ-R (28.0 vs 15.5, p = .012), and ESQ-G (19.5 vs 9, p = .007). Males demonstrated lower mean DCI (p = .024 and 1918.3 vs 2442.2 mmHg●cm●s, p = .029). Increasing age correlated negatively with reflux symptoms (ESQ-R ρ = .178, p = .016) and mean DCI (ρ = .156, p = .035). No other significant associations between age, manometric parameters, or symptoms were observed. Conclusions Symptom profiles in reflux-negative patients with normal esophageal motility vary by age and sex. Women reported greater symptom burden across dysphagia, reflux, and globus domains, while older patients reported fewer reflux symptoms. These findings suggest demographic factors influence symptom perception independent of motility or reflux. Subgroup analyses (e.g., functional heartburn vs functional dysphagia) may clarify pathophysiologic differences and guide individualized management strategies. Funding Agencies None

Difficult airway is defined as a situation where a trained anaesthesiologist encounters challenges in either face mask ventilation, tracheal intubation, or both, as stated by the American Society of Anaesthesiologists. A case of a difficult airway due to Calcinosis Universalis was encountered, which is a rare subtype of connective tissue disorder. In Calcinosis Cutis, calcium is diffusely deposited in the skin, subcutaneous tissue, muscles, and tendons. Calcinosis Universalis typically appears secondary to a connective tissue disorder such as juvenile dermatomyositis, systemic lupus erythematosus, Sjögren’s syndrome, and Calcinosis, Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia (CREST) syndrome, predominantly affecting females. There is no specific treatment available for this condition. Medically, it can be managed with calcium channel blockers like diltiazem, colchicine, immunosuppressants, and painkillers to alleviate discomfort. Antibiotics may be required for infected wounds. Surgically, lesions can be removed; however, there is a higher likelihood of recurrence. Patients with Calcinosis Universalis present a challenge for anaesthesiologists due to the involvement of joints and tendons. The present case report involves a 22-year-old female with a history of juvenile dermatomyositis for the past 15 years and Calcinosis Cutis universalis for the past 11 years presented to the Anaesthesiology department for nasal bone reduction. Upon examination, it was determined that she had a difficult airway, and awake fiberoptic intubation was performed. The present case report aims to provide unique insights into a rare case, highlighting the unusual presentation of a difficult airway and the associated perioperative challenges from an anaesthesiologist’s perspective.

A new, minimally invasive method is needed to evaluate both esophageal muscle contraction and esophageal wall distensibility under physiological conditions. The primary objective of this study was to establish a novel examination method for evaluating esophageal wall motion using a transnasal endoscope with an endoscopic ultrasonography (EUS) probe. The secondary objective was to apply this method to gain new pathophysiological insights into the clinical subtypes of achalasia diagnosed by high resolution manometry. The study included 20 patients with dysphagia. Patients were instructed to swallow 20 ml of oral rehydration solution while a transnasal endoscope and a 20 MHz EUS probe were used to record the swallowing motion. The esophageal lumen area and muscle layer thickness were measured on still images from recorded videos. The reproducibility of the method was evaluated for both internal and external consistency. The study also analyzed differences in esophageal wall motion among achalasia subtypes using two new parameters: the muscle layer contraction rate and the esophageal wall distension rate. The new transnasal EUS method was safely performed in all 20 patients without complications, and the images were sufficient for analysis. The reproducibility evaluation showed significant positive correlations for both internal and external reproducibility. The esophageal wall distensibility and muscle layer contraction rates differed between esophageal achalasia subtypes. This pilot study successfully established a new, safe, and reproducible method for evaluating esophageal wall motion using transnasal EUS. This method will lead to a deeper understanding of the pathophysiology of esophageal motility disorders and potentially to the development of new treatment strategies.

ABSTRACTIntroduction: Achalasia is a primary esophageal motility disorder of unclear etiology. The development of third-space endoscopy has enabled the advancement of peroral endoscopic myotomy (POEM) as a promising therapeutic alternative.Aim: To assess the safety profile of the POEM procedure in patients with diverse clinical characteristics.Methodology: A retrospective analysis of 484 consecutive POEM procedures performed between 2015 and 2024 at PCZ in Brzeziny was conducted. The analysis included demographic data, procedure duration, type of achalasia, as well as intraoperative and early postoperative complications.Results: Significant complications during or posthospitalization occurred in 26 patients (5.4%), including bleeding, mucosal perforation, pain requiring prolonged treatment, and asymptomatic elevation of inflammatory markers. Two cases of mediastinitis and seven readmissions were recorded. All complications were successfully managed conservatively.

Per-oral endoscopic myotomy (POEM) achieves an 80-90% success rate for the treatment of esophageal motility disorders, but approximately 10% of patients experience persistent symptoms. This study evaluated the results of a repeat POEM procedure, or redoPOEM, as a second-line therapy. We conducted a retrospective multicenter study involving 15 French tertiary centers, including all patients undergoing redoPOEM between April 2015 and September 2023. Short and long-term success rates were defined as an Eckardt score < 4 at 3months, and at the last follow-up visit with no need for additional treatment, respectively. Adverse events were graded using the AGREE classification. Eighty-seven patients (mean age 56.5years, 57% male) were included; 89.7% had achalasia and 10.3% had non-achalasia motility disorders. The median pre-redoPOEM Eckardt score was 6. The average follow-up duration was 22months. At 3months, 78.2% achieved clinical success (median Eckardt score: 1). Long-term success was obtained in 57.1% at 1year follow-up. Additional treatments were required in 28%. Univariate and multivariate analyses identified a high pre-redoPOEM Eckardt score and prior treatments before POEM as predictors of failure. Adverse events (grade II or higher) occurred in 11.4%, including pneumonia and mucosal breaches, but no deaths were reported. RedoPOEM is effective and safe for managing primary failure or symptomatic recurrence after a first POEM. A high pre-redoPOEM Eckardt score and previous treatments are predictive of primary failure. NCT06044155.

Esophageal high-resolution manometry (HRM) is an important tool for diagnosing and assessing esophageal achalasia. Artificial intelligence (AI)-assisted HRM image processing has the potential to aid in the diagnosis of esophageal achalasia. However, addressing the challenges associated with the 'black-box' problem is important. In the present study, an automated system that utilizes AI with class-activation maps to highlight diagnostic areas in HRM images was developed. A total of 211 HRM images, which led to the diagnosis of controls and patients with achalasia, were used to train the system using Resnet34, a convolutional neural network model. The diagnoses included normal, type I achalasia, type II achalasia, type III achalasia and hypercontractile esophagus based on the Chicago classification v3.0 for esophageal motility disorders. A gradient class activation map (Grad-CAM) technique was used. The discrimination model for the control and achalasia groups yielded a 100% correct response rate for evaluating the validation images (n=30). Grad-CAM analysis revealed that the model focused on the area around the lower esophageal sphincter pressure in type 1 achalasia for differentiation, closely aligning with expert perspectives. An AI-based HRM imaging assistance system may not only support physicians in distinguishing esophageal motility disorders with improved diagnostic accuracy but also serve as a novel tool that provides deeper clinical insights and highlights key interpretative features in HRM evaluations. Further large-scale validation is required to confirm its clinical utility.

Functional dyspepsia (FD) is a prevalent gastrointestinal (GI) disorder characterized by persistent upper abdominal discomfort without identifiable structural abnormalities. Its pathophysiology remains poorly understood, and conventional diagnostic tools often fail to detect underlying motility disorders. The objective of this study was to evaluate the role of high-resolution esophageal manometry (HRM) in diagnosing esophageal motility abnormalities in patients with FD and normal upper GI endoscopy findings. This prospective observational study was conducted at Dr. D. Y. Patil Medical College, Pune, from January 2023 to March 2025. Thirty adult patients aged 18-60 years with persistent dyspeptic symptoms unresponsive to standard medical therapy and normal upper GI endoscopy were included. After Helicobacter pylori eradication therapy and proton pump inhibitor treatment, patients underwent HRM to assess esophageal motility. HRM findings were correlated with clinical symptoms to guide management decisions. The study cohort had a mean age of 32.03 ± 8.8 years, with a female predominance (60%). Common symptoms included epigastric pain (80%), anorexia (60%), nausea/vomiting (53.3%), and regurgitation (50%). HRM revealed abnormal findings in 50% of patients, with the most frequent abnormalities being hypertensive upper esophageal sphincter (10%) and low amplitude contractions (10%). Based on HRM findings, 60% of patients underwent surgical interventions, whereas 40% received conservative management. HRM identified clinically significant esophageal motility abnormalities in a substantial subset of patients with FD and normal endoscopic findings. These findings suggest that esophageal dysmotility may underlie persistent symptoms in such patients and support the integration of HRM into the diagnostic workup of refractory FD.

Laryngopharyngeal reflux disease (LPRD) has been associated with dysfunction of the autonomic nervous system (ANS), which may contribute to esophageal motility disorders and reflux events. However, the interactions between ANS function, esophageal motility, and psychological factors in LPRD remain poorly understood. This study aims to investigate ANS dysfunction in LPRD and its relationship with esophageal motility and reflux symptoms. Heart rate variability (HRV) analysis was conducted to assess ANS function in LPRD patients and healthy controls at rest. The impact of acid-base reflux on ANS activity was evaluated using pH-specific beverage challenge tests. Esophageal motility parameters were analyzed in relation to ANS function. LPRD patients exhibited reduced vagal and sympathetic activity at rest compared to controls. Although LPRD patients with elevated upper esophageal sphincter pressure (UESP) showed a trend toward higher overall autonomic activity, and those with decreased lower esophageal sphincter pressure (LESP) exhibited concurrent increases in both sympathetic and vagal activity, these differences were not statistically significant. Impaired peristalsis indicated diminished vagal function. LPRD patients reported higher levels of depression (45.09 ± 11.00 vs. 37.38 ± 12.85, P = 0.001) and anxiety (42.83 ± 9.19 vs. 36.5 ± 9.44, P = 0.001), with anxiety correlating with reflux severity. LPRD is associated with autonomic dysfunction, reduced vagal activity, esophageal motility disturbances, and reflux events. Psychological factors, particularly anxiety and depression, may exacerbate the condition. Monitoring ANS function and incorporating targeted interventions could improve treatment outcomes and quality of life for LPRD patients.

Achalasia is a rare esophageal motility disorder often underrecognized due to nonspecific symptoms and limited physician awareness. Although diagnostic tools have advanced, delays remain common. Previous studies in Türkiye were mainly singlecenter or review-based, with no nationwide assessment of physician-related factors. This study evaluated physician knowledge, diagnostic practices, high-resolution esophageal manometry (HREM) access, and factors influencing diagnostic delay, providing the first nationwide achalasia-focused dataset. A web-based survey was conducted among 4216 physicians; 675 responses (16.0%) were analyzed. The 32-item questionnaire included demographics, achalasia knowledge, diagnostic/referral practices, HREM accessibility, and training. Participants included 12.3% primary care physicians, 26.4% secondary-level, 26.2% tertiary training/research, and 35.1% university hospital physicians. Overall, 89.6% practiced internal medicine, 9.8% surgical sciences, and 0.6% basic medical sciences. Male physicians demonstrated higher knowledge (60.8% vs. 39.2%; P < .001) and diagnostic recognition, whereas females reported more self-perceived deficiencies (P < .001). Gastroenterologists had superior diagnostic accuracy (P < .001), but easy HREM access was limited (9.1%). Physicians in tertiary hospitals showed higher knowledge and diagnostic accuracy (P = .025 and P = .040). Participation in training programs and treatment familiarity did not vary by hospital type (P = .437 and P = .512). Variations in physician knowledge and diagnostic practices across specialties, hospital types, and gender may contribute to delayed achalasia recognition. Persistent gaps in practical competence, HREM familiarity, and access to diagnostic resources highlight the need for targeted education and structured interventions. Improving diagnostic infrastructure and HREM access may enable earlier diagnosis and enhance outcomes. Cite this article as: Eroğlu Haktanır A, Çelebi A. Achalasia: Physician practices and knowledge in Türkiye. Turk J Gastroenterol. 2026;37(2):260-269.

Achalasia, a rare esophageal motility disorder, is managed with medications, botulinum toxin, pneumatic dilation (PD), or surgery. In resource-limited settings like Pakistan, PD is preferred first-line non-surgical treatment due to its accessibility and cost-effectiveness so we aim to assess remission rates and clinical outcomes of PD.Between 2015 and 2024, 213 achalasia patients were diagnosed via HRM at Center for Liver & Digestive Diseases, Holy Family Hospital, Rawalpindi. 191 patients opted for PD and completed follow-up interviews using Eckardt score and ASQ questionnaire. Data analysis was performed using SPSS.Among 191 patients (107 males, 84 females), 53% underwent one, 30% two, and 17% three PD session. Success rates were 58% for one, 78% for two, and 87.5% for three sessions, with no severe complications. The cumulative re-dilation rate was 20%, with a 76% success rate for repeat dilations. Multiple PDs significantly outperformed single PDs(p=0.01), reducing mean Eckardt score from 6.7 to 1.9. QoL improved with successful dilations but not in failed cases.PD provides sustained symptom relief for up to five years, with repeat sessions enhancing long-term success, reinforcing PD as an effective, durable, and accessible treatment option for achalasia in low-resource settings for evidence-based clinical decision-making.

Aim Gastroesophageal reflux disease (GERD) is closely linked to esophageal motility dysfunction. While high-resolution manometry (HRM) remains the gold standard for evaluating esophageal motility, the conventional single water swallow (SWS) protocol may not fully capture motility abnormalities. This study investigates esophageal motility characteristics in GERD patients using solid food swallows (SFS) to better assess clinically relevant dysfunction. Methods Esophageal motility parameters were compared between GERD and non-GERD groups during both SWS and SFS. Correlations between SFS findings and dysphagia symptoms, endoscopic findings and reflux metrics were analyzed, followed by multivariate regression to identify independent GERD risk factors. Results Among 151 participants, 54 were diagnosed with GERD. Impaired SFS esophageal body motility was more prevalent in GERD versus non-GERD patients (p < 0.01). Moreover, the GERD group exhibited significantly higher rate of esophageal hypomotility during SFS compared to SWS (p < 0.001). With SFS testing, 35.2% (19/54) of GERD with normal SWS esophageal motility demonstrated Impaired SFS esophageal body motility. Multivariate analysis identified SFS esophageal body hypomotility (OR: 5.158, 95%CI: 2.439–10.909, p < 0.001) as independent GERD predictors. The prevalence of dysphagia symptom and esophagitis were higher in patients with esophageal hypomotility of SFS. Distal contractile integral of SFS positively correlated with mean nocturnal baseline impedance (r = 0.393), while inversely correlating with supine bolus clearance time (r=-0.326) and acid exposure (r=-0.403). Conclusions SFS unmask clinically significant esophageal dysmotility in GERD patients that SWS miss, revealing pathophysiology linked to prolonged acid exposure and mucosal injury. SFS-enhanced HRM protocols may improve GERD evaluation and risk stratification.

Gastroesophageal Reflux Disease (GERD) is a condition, which is frequently encountered by gastroenterologists, otorhinolaryngologists, surgeons and general physicians and requires a multidisciplinary treatment when there is a high symptom burden in patients. Besides lower oesophageal sphincter (LES) dysfunction there are several other risk factors that contribute to the development and symptoms (worsening) of GERD. While these lifestyle modifications and pharmacological therapies, particularly proton pump inhibitors (PPIs), are first-line treatments, a subset of patients requires surgical intervention due to refractory symptoms or complications. This review traces the evolution of anti-reflux surgery, examining its historical milestones, advancements, and future prospects. This review discusses the epidemiology of GERD, its pathophysiology, but also the development of Anti-Reflux Surgery (ARS). We will discuss the available evidence regarding different ARS procedures and will focus on individualised treatment for patients with GERD. In the treatment of patients with GERD we have to take into account that it might be challenging to personalise treatment and therefore optimise results. In this instance special considerations need to be taken for patients with GERD and obesity, patients with Barretts oesophagus, patients after bariatric and metabolic surgery (BMS) and patients with oesophageal motility disorders.