To compare camrelizumab plus capecitabine and oxaliplatin followed by camrelizumab plus apatinib (camre+CAPOX followed by camre+apa), CAPOX alone, and camrelizumab plus CAPOX followed by camrelizumab (camre+CAPOX followed by camre) as initial treatment for gastric or gastro-oesophageal junction adenocarcinoma. Randomised, open label, phase 3 study. 75 hospitals in China, 13 March 2019 to 16 August 2021. 885 adults (≥18 years) with previously untreated, human epidermal growth factor receptor 2 (HER2) negative, unresectable, locally advanced or metastatic gastric or gastro-oesophageal junction adenocarcinoma. Patients were randomised (2:2:1) to receive camre+CAPOX followed by camre+apa, CAPOX only, or camre+CAPOX followed by camre, stratified by Eastern Cooperative Oncology Group performance status, peritoneal metastasis, and programmed death ligand 1 (PD-L1) combined positive score. Assignment to camre+CAPOX followed by camre was introduced midway through enrolment. The primary endpoint was overall survival for camre+CAPOX followed by camre+apa versus CAPOX alone in the PD-L1 positive population (combined positive score >1) and the overall population who received at least one dose of study drug. Comparisons of camre+CAPOX followed by camre versus CAPOX alone and of camre+CAPOX followed by camre+apa versus camre+CAPOX-camre were descriptive. Safety was assessed in all patients who received at least one dose of study drug. 352 patients received camre+CAPOX followed by camre+apa, 349 received CAPOX alone, and 177 received camre+CAPOX followed by camre. At the time of data cut off, 454 of 592 (76.7%) deaths had occurred in the PD-L1 positive population and 709 of 878 (80.8%) in the overall population. Overall survival was longer with camre+CAPOX followed by camre+apa than with CAPOX alone in the PD-L1 positive population (median 15.0 v 12.5 months; hazard ratio 0.80 (95% CI 0.65 to 0.98); one sided P=0.02) and in the overall population (median 13.5 v 12.1 months; hazard ratio 0.80 (0.68 to 0.94); one sided P=0.004). Use of camre+CAPOX followed by camre also showed longer overall survival versus CAPOX in the PD-L1 positive population (median 15.3 v 12.5 months; hazard ratio 0.76 (0.58 to 0.97); one sided nominal P=0.01) and overall population (median 14.2 v 12.1 months; hazard ratio 0.80 (0.65 to 0.98); one sided nominal P=0.02). No overall survival benefit was observed with camre+CAPOX followed by camre+apa versus camre+CAPOX followed by camre. Treatment related adverse events of grade ≥3 occurred in 239 of 352 (67.9%) patients in the camre+CAPOX followed by camre+apa group, 158 of 349 (45.3%) in the CAPOX alone group, and 83 of 177 (46.9%) in the camre+CAPOX followed by camre group. Initial treatment with camrelizumab plus CAPOX followed by camrelizumab based maintenance was associated with longer overall survival than CAPOX alone in human epidermal growth factor receptor 2 (HER2) negative, unresectable, locally advanced or metastatic gastric or gastro-oesophageal junction adenocarcinoma. Exploratory comparisons between the two camrelizumab based regimens showed no additional survival benefit, with higher rates of treatment related adverse events of grade ≥3 and treatment discontinuations when apatinib was added during maintenance. ClinicalTrials.gov NCT03813784.

An 80-year-old woman presented with inspiratory stridor after eating. Imaging revealed a decompensated esophagus. Endoscopy showed food retention and a narrowed lower esophageal sphincter. Achalasia, a rare motility disorder, was diagnosed and a botulinum toxin injection was administered. Treatment options include botox, pneumatic dilation, or surgery, the patient opted to await botox effects.

Influence of Lower Esophageal Sphincter Manometric Characteristics on the Technical Success of Peroral Endoscopic Myotomy in Achalasia: A Prospective Cohort Study

To evaluate dysphagia, pharyngeal high-resolution impedance manometry (P-HRM-I) is used in conjunction with videofluoroscopic examination of swallowing (VF) or videoendoscopic evaluation of swallowing to obtain additional objective data that cannot be captured by conventional assessment methods. Based on the Leuven Consensus of the International Pharyngeal Manometry Working Group for diagnosing pharyngeal and upper esophageal sphincter (UES) motility disorders, we present a case series of two patients illustrating the recovery process of dysphagia following lateral medullary syndrome. Two patients with severe dysphagia due to lateral medullary infarction caused by vertebral artery dissection were evaluated. In both patients, the initial P-HRM-I showed profound impairment of the UES opening and bolus passage, preventing oral intake. Balloon dilation of the UES, laryngeal elevation exercises, tongue strengthening exercises, and direct swallowing training were performed, and the functions of the pharynx and UES were regularly evaluated using VF and P-HRM-I. Following UES dilation, PHRM-I revealed improved UES opening, enhanced pharyngeal contraction, and restoration of pharyngeal peristalsis. Both patients regained sufficient swallowing function to resume a regular diet. P-HRM-I may be a useful tool for quantitatively assessing UES function and bolus propulsion, identifying the pathophysiological components of dysphagia, guiding individualized treatment, and monitoring post-intervention recovery.

Achalasia is a rare esophageal motility disorder marked by impaired lower esophageal sphincter relaxation. Peroral endoscopic myotomy (POEM) has become a first-line therapy owing to its minimally invasive approach and proven efficacy. This study aimed to define the POEM learning curve for experienced endoscopists at a tertiary Chinese medical center. We retrospectively reviewed 168 POEM procedures performed between 2015 and 2021 by three endoscopists, each with experience in > 100 endoscopic submucosal dissections (ESD) cases and trainings on three animal-model. Cumulative sum (CUSUM) analysis of procedure time was the primary measure. Secondary outcomes included complications, length of hospital stay, and 3-year clinical success rate (Eckardt score ≤ 3). Learning curve inflection points occurred at 15-20 cases, after which procedure time decreased significantly (94.9 ± 27.4 vs. 55.5 ± 15.5min, p < 0.001). Complication rates were stable (competence phase: 19.6% vs. proficiency phase: 17.1%, p = 0.70), while hospital stay was shorter in the proficiency phase (7.6 ± 2.5 vs. 6.6 ± 2.0days, p = 0.009). Both phases achieved high 3-year success rates (90% vs. 95%, p = 0.563), consistent with published benchmarks. For endoscopists with prior ESD expertise, POEM proficiency can be achieved after 15-20 cases, with safety and efficacy maintained throughout training. Shorter hospital stays in the proficiency phase likely reflect improvements in perioperative management.

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&lt;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.

Gastroesophageal reflux disease (GERD)-A frequent gastro-esophageal manifestation that presents as the reflux of gastric contents into the esophagus causing symptoms such as heartburn and regurgitation; this is with and without some apparent mucosal injury. GERD is a significant burden in terms of the impaired ability to function in daily life, sleep quality, and overall quality of life, and it can develop a whole series of complications such as erosive esophagitis, Barrett's esophagus and esophageal adenocarcinoma. Notable sex-related differences in the presentation &amp; outcome of GERD point to possible sex hormone, particularly estrogen, roles in the disease pathophysiology. Estrogen receptors are in fact present along the gastrointestinal tract including epithelial of the esophagus, lymphocyte, and smooth muscle suggesting that estrogen signaling may modulate both reflux mechanisms and the condition of tissues. The objective of this narrative review is to provide a summary of biochemical mechanisms through which the level of hormones and hormone signaling pathways affect the symptoms of GERD and associated complications. A thorough literature search was performed based on PubMed database search, focusing mainly on studies that have been published the last 10-15 years. Key search terms were GERD, estrogen, estradiol, estrogen receptors, nitric oxide, lower esophageal sphincter, hormone replacement therapy and pregnancy. Evidence from human and animal studies indicates that estrogen may have a beneficial effect on reflux episodes, because of the nitric oxide relaxation of the lower esophageal sphincter throwing out of balanced control of gastroesophageal reflux. On the other hand, estrogen seems to have protective effects in the esophageal mucosa by improving the epithelial barrier integrity by regulating tight junctions and modulating inflammatory responses. These dual and sometimes opposing actions point to the complexity of the role of estrogen in GERD pathogenesis. Further mechanistic human studies combining hormonal measures and formulations of objective reflux parameters, as well as mucosal injury, are required to elucidate the clinical importance and therapeutic implications of estrogen in the pathogenesis of GERD.

Gastroesophageal reflux disease (GERD) is a common chronic condition mainly caused by the dysfunction of the antireflux mechanism at the gastroesophageal junction. This is composed of the lower esophageal sphincter and the crural diaphragm. Increasing evidence suggests that diaphragmatic dysfunction and reduced inspiratory muscle strength may contribute to the persistence of GERD symptoms. Although respiratory physiotherapy has shown beneficial effects, the role of a structured inspiratory muscle training (IMT) program has not been sufficiently examined. This study aims to investigate the effects of an inspiratory muscle training program on inspiratory muscle strength and secondary clinical outcomes in individuals with GERD. A total of thirty adults with a confirmed GERD diagnosis will be enrolled in a two-arm randomized controlled trial. These volunteers will be randomly assigned either to the experimental group, which will undergo a 3-month inspiratory muscle training (IMT) using tapered flow resistive loading at 40% of maximal inspiratory pressure (MIP), or to the control group, which will receive sham IMT with a consistent low resistance. Primary outcomes will include maximal inspiratory pressure (MIP) and maximal dynamic inspiratory pressure (S-index). Secondary outcomes will assess GERD symptoms, disease-related quality of life, and pulmonary function. Measurements will be performed at baseline, at three months of intervention, and at six months from recruitment (follow-up). IMT is expected to lead to significant improvements in inspiratory muscle strength, symptom burden, and quality of life compared with sham training. This trial will provide novel evidence regarding the role of inspiratory muscle training as a non-pharmacological intervention in the management of GERD. Trial registration: ClinicalTrials.gov Identifier: NCT07131397.

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.

Gastroesophageal reflux disease (GERD) is a prevalent condition that, beyond esophageal involvement, is associated with extraesophageal manifestations, particularly otolaryngological disorders. This article aims to analyze recent scientific evidence on otolaryngological conditions related to GERD in adult patients. A descriptive narrative review of studies published between 2022 and 2026 was conducted using regional and international databases. The findings indicate a high prevalence of symptoms such as dysphonia, pharyngodynia, chronic cough, and oral alterations, with a predominance among females. Incompetence of the lower esophageal sphincter and abnormalities in pH-metric parameters were identified as the main pathophysiological mechanisms. GERD is therefore considered a relevant cause of otolaryngological disorders in adults, highlighting the importance of early diagnosis and multidisciplinary management.

Esophageal duplication cysts (EDCs) are rare congenital foregut anomalies often presenting with nonspecific gastrointestinal (GI) symptoms in childhood. Diagnosis requires a high index of suspicion and comprehensive work-up. We report a 56-year- old male with type 2 diabetes mellitus and benign prostatic hyperplasia. He presented with a one-month history of intermittent, burning epigastric pain exacerbated by eating and accompanied by nausea. Physical examination revealed mild epigastric tenderness. Upper GI endoscopy showed a bulging lesion in the lower esophagus, a large cardia polyp, a small gastric body polyp, and antral erythema. Endoscopic ultrasound (EUS) identified a well-defined, homogeneous, round lesion (33 × 20 mm) demonstrating acoustic enhancement in the lower esophagus. Contrast-enhanced abdominopelvic computed tomography (CT) revealed an intraluminal, non-enhancing lesion (25 × 26 mm) at the lower esophageal sphincter (LES), suggestive of a duplication cyst. Thoracic imaging showed no abnormalities. Due to persistent symptoms, the patient underwent successful video-assisted thoracoscopic surgery without complications; no recurrences occurred during follow-up. EDCs should be considered in the differential diagnosis of submucosal or intraluminal esophageal lesions, even in adults despite their rarity. EUS yields high accuracy in characterizing these lesions. Thoraco-abdominal CT scans delineate relationships to surrounding structures. For symptomatic lesions, video-assisted thoracoscopic surgery demonstrates a successful outcome with low complication rates.

Achalasia is a rare esophageal motility disorder that causes dysphagia owing to impaired lower esophageal sphincter (LES) relaxation. This study aimed to evaluate a modified dissection and radial myotomy technique during peroral endoscopic myotomy (POEM) and to compare its outcomes with those of the standard approach. This prospective, single-center study was conducted between February 2022 and December 2022. Eighty total with 80 achalasia patients undergoing POEM were divided into 2 groups: Group A (n=40), treated with the novel technique, and Group B (n=40), treated with the standard approach. Demographics, Eckardt score (ES), submucosal tunnel (ST), myotomy length, intervention duration, and adverse events were recorded. The follow-up period ranged from 3 to 20 months. Patients who underwent the novel radial myotomy technique (Group A) had significantly longer myotomy lengths (11.8±2.4 vs. 8.1±2.0cm, P<0.001), greater myotomy extension beyond the esophagogastric junction (4.2±0.8 vs. 2.7±0.6cm, P<0.001), and improved postoperative Eckardt scores (median 1 [0-1] vs. 2,1-3P=0.006) compared with the conventional POEM group (Group B). Subgroup analysis revealed that in Type III achalasia patients, the novel approach yielded longer submucosal tunnel lengths (15.6±0.8cm, P=0.038) and favorable symptom relief. Despite extended dissection, there was no increase in gastroesophageal reflux disease (GERD)-related symptoms. The novel dissection and radial myotomy technique demonstrated superior outcomes in reducing dysphagia symptoms and LES resistance compared with the standard approach. Tailoring ST and myotomy lengths based on the achalasia type and EGJ involvement may optimize outcomes without increasing the risk of GERD.

ations, emphasizing muscle-specific outcomes and translational myology applications. In pediatric patients with primary or neurological dysphagia, NMES improves suprahyoid, facial, and tongue muscle activation, enhances swallowing efficiency and reduces tube-feeding dependency In adults, particularly post-stroke, NMES improves laryngeal elevation, Upper Esophageal Sphincter (UES) opening, and quality of life, though efficacy in head and neck cancer patients is limited. Methations, emphasizing muscle-specific outcomes and translational myology applications. In pediatric patients with primary or neurological dysphagia, NMES improves suprahyoid, facial, and tongue muscle activation, enhances swallowing efficiency and reduces tube-feeding dependency In adults, particularly post-stroke, NMES improves laryngeal elevation, Upper Esophageal Sphincter (UES) opening, and quality of life, though efficacy in head and neck cancer patients is limited. Methations, emphasizing muscle-specific outcomes and translational myology applications. In pediatric patients with primary or neurological dysphagia, NMES improves suprahyoid, facial, and tongue muscle activation, enhances swallowing efficiency and reduces tube-feeding dependency In adults, particularly post-stroke, NMES improves laryngeal elevation, Upper Esophageal Sphincter (UES) opening, and quality of life, though efficacy in head and neck cancer patients is limited. Methations, emphasizing muscle-specific outcomes and translational myology applications. In pediatric patients with primary or neurological dysphagia, NMES improves suprahyoid, facial, and tongue muscle activation, enhances swallowing efficiency and reduces tube-feeding dependency In adults, particularly post-stroke, NMES improves laryngeal elevation, Upper Esophageal Sphincter (UES) opening, and quality of life, though efficacy in head and neck cancer patients is limited. Methations, emphasizing muscle-specific outcomes and translational myology applications. In pediatric patients with primary or neurological dysphagia, NMES improves suprahyoid, facial, and tongue muscle activation, enhances swallowing efficiency and reduces tube-feeding dependency In adults, particularly post-stroke, NMES improves laryngeal elevation, Upper Esophageal Sphincter (UES) opening, and quality of life, though efficacy in head and neck cancer patients is limited. Methations, emphasizing muscle-specific outcomes and translational myology applications. In pediatric patients with primary or neurological dysphagia, NMES improves suprahyoid, facial, and tongue muscle activation, enhances swallowing efficiency and reduces tube-feeding dependency In adults, particularly post-stroke, NMES improves laryngeal elevation, Upper Esophageal Sphincter (UES) opening, and quality of life, though efficacy in head and neck cancer patients is limited. Meth

Currently, there are no established treatments for esophagogastric junction outflow obstruction (EGJOO). In this study, we evaluated the efficacy and safety of acotiamide for EGJOO by targeting impaired lower esophageal sphincter (LES) function. This investigator-initiated, multicenter, randomized, double-blind, placebo-controlled phase II trial enrolled 35 patients with EGJOO between December 2021 and December 2023. Patients were randomized to receive either placebo (n = 11) or acotiamide (300mg/day, n = 12; 600mg/day, n = 12) for 4weeks (placebo-controlled period). Subsequently, all patients received 600mg/day acotiamide for an additional 4weeks (open-label period). As a primary endpoint, during the placebo-controlled period, the improvement rate of food-sticking symptoms in the chest was 12.5% and 0.0% in the acotiamide and placebo groups, respectively (p = 0.3092). In terms of secondary endpoints, the integrated relaxation pressure (IRP) normalization rate was significantly higher in the acotiamide group (41.7%) than in the placebo group (0.0%) (p = 0.0107). No other secondary endpoints showed significant differences between the groups. Regarding the exploratory endpoints, during the open-label period, among the 24 patients treated with ≥ 300mg/day of acotiamide for 8weeks, the improvement rate of food-sticking symptoms in the chest increased to 37.5%, and the IRP normalization rate rose to 54.2%. Acotiamide is effective in normalizing impaired LES relaxation in patients with EGJOO and may improve food-sticking symptoms in the chest. Japan Registry of Clinical Trials ( https://jrct.mhlw.go.jp/en-top ); registration number jRCT2071210072.

Background: Gastric and gastro oesophageal junction cancers remain major contributors to global cancer mortality. In Nigeria, late diagnosis is common, and this pattern continues to drive high cancer related deaths. Materials and Methods: Clinico pathological data were retrieved from four major histopathology laboratories in Anambra State, southeast Nigeria. Statistical analysis was conducted using the Chi square test in SPSS version 25 to assess differences in proportions. Results: Gastric and gastro oesophageal junction cancers were most frequently diagnosed in individuals in their sixth and seventh decades of life, with a median age of 56.7 years. There was no clear sex predilection in the study population. The pylorus and antrum were the most common tumour locations, and intestinal type adenocarcinoma was the predominant histological subtype. Most cases presented at advanced stages, with the majority staged as T3 or T4. Conclusion: Gastric and gastro oesophageal junction cancers in this setting are characterised by late presentation and are predominantly antral adenocarcinomas. These findings highlight the need for a regional screening initiative aimed at earlier detection and improved outcomes.

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.

The value of esophageal baseline impedance (BI) in assessing proximal reflux and laryngopharyngeal symptoms (LPSs) is unclear. Two hundred eighteen patients with LPS underwent 24-hour combined hypopharyngeal-esophageal impedance-pH monitoring. Proximal/distal BI was obtained, and a slope-and-intercept model of proximal BI contour was constructed. Proximal BI correlated with proximal/pharyngeal reflux (r = -0.21, P < 0.01) and reflux symptom index (r = -0.14, P = 0.08). The proximal BI contour model incorporating both the BI change (slope) and BI just below upper esophageal sphincter (intercept) outperformed models using individual BI measures in predicting proximal (Akaike information criterion: 110 vs 251-253) or pharyngeal (akaike information criterion: 32 vs 141-148) reflux. Proximal esophageal impedance contour predicts proximal reflux in patients with LPS.

This case report describes an investigational, non-standard technique performed in a high-expertise center. It should not be considered standard of care and should not be attempted outside carefully selected indications, multidisciplinary oversight, and appropriate institutional governance (e.g., IRB/innovation review). The coexistence of achalasia in a patient with morbid obesity presents a unique, rare, and complex clinical challenge. One might consider a staged approach, addressing the achalasia first and morbid obesity at a later date. Alternatively, a myotomy (POEM or Heller) may be performed along with a bariatric procedure. However, the technical expertise required would be beyond the abilities of most surgeons. To describe, for educational and hypothesis-generating purposes, a novel, single-stage surgical technique that addresses both morbid obesity and achalasia using a stapled trans-sphincteric esophagojejunostomy, achieving full-thickness myotomy while preserving the stomach and avoiding the technical limitations of standard dual approaches. Academic tertiary care center, United States. We present a case of a 54-year-old woman with a BMI of 45kg/m², severe GERD, and type II achalasia confirmed by EGD, manometry, and esophagogram. The procedure involved a stapled esophagojejunostomy through the lower esophageal sphincter, achieving a full-thickness myotomy combined with a Roux-en-Y Gastric Bypass anatomy. The patient demonstrated resolution of dysphagia and reflux symptoms, tolerance of oral intake, and 76% excess weight loss at two years without perioperative complications and with excellent nutrition and vitamin levels. These findings are limited to a single case and carry specific risks and can only be considered cautiously, while this technique allows definitive treatment of both disorders while avoiding the technical challenges of the traditional approaches and potentially minimizing recurrence, its broader safety and efficacy remain unproven. This report illustrates a technically feasible but investigational approach for a highly selected patient with concurrent achalasia and morbid obesity. It simplifies the anatomy, preserving gastric tissue and enabling a complete myotomy; however, it is based on a single case, and broader application would require formal evaluation under controlled investigational protocols.

Dysphagia is one of the most common complications following anti-reflux surgery (ARS). The factors affecting the development of new onset or worsening dysphagia are not well understood. This study aimed to investigate how lower esophageal sphincter distensibility impacts the development of new onset or worsening dysphagia after ARS. A review of patients who underwent robotic ARS was conducted. All patients had intra-operative EndoFLIP monitoring at two-time points, pre-repair, and post-wrap. Dysphagia was assessed pre-operatively and at 3-6months after surgery. Out of 168 patients (63.8%) with 3- to 6-month follow-up, 24 patients (14.2%) developed new onset or worsening post-operative dysphagia. Among these, 13 patients reported mild symptoms, and 11 patients experienced moderate-to-severe dysphagia. Patients with new onset or worsening post-operative dysphagia had lower DI values compared to those without [0.9 IQR (0.7-1.5) mm2/mmHg vs 1.3 IQR (0.9-1.8) mm2/mmHg, p = 0.04]. No significant differences were observed in post-wrap high pressure zone length (HPZ) between groups [3.5 IQR (3-4) cm vs 3.5 IQR (3-3.8) cm, p = 0.71]. A post-wrap DI value of ( 0.9 mm2/mmHg) was associated with increased risk of new onset/worsening dysphagia [4.1 95% CI (1.3-13), p = 0.02]. Patients who developed new onset or worsening dysphagia after ARS had lower post-wrap LES DI values compared to those who did not. A post-wrap DI value of ( 0.9 mm2/mmHg) was associated with increased risk of new onset/worsening dysphagia. While clinicians should consider optimizing post-wrap DI values during ARS to reduce the risk of post-operative new onset/worsening dysphagia, larger scale prospective studies are needed to validate the application of this cutoff and determine its role in tailoring fundoplication, given the single-center design and the limited sample size of our cohort.

Complex Diagnosis of Clinical Forms of Laryngitis Caused by Laryngopharyngeal Reflux Disease (LPRD).