Peroral endoscopic myotomy (POEM) is an established treatment for achalasia. Conventionally, esophageal myotomy of 6-10cm length is performed, although its necessity in type-I and type-II achalasia remains debatable. Recent studies suggest that a shorter myotomy may offer similar efficacy with potential advantages. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing short vs. standard (long) esophageal myotomy during POEM in patients with type-I and type-II achalasia. This review was conducted in accordance with PRISMA 2020 guidelines and registered with PROSPERO (CRD42024611252). A systematic search of PubMed, Embase and Scopus was performed to identify RCTs comparing short and long esophageal myotomy during POEM. The primary outcome was clinical success at ≥ 1year (Eckardt score ≤ 3). Secondary outcomes included procedure time, adverse events, post-POEM integrated relaxation pressure (IRP), barium column height and gastroesophageal reflux disease (GERD). Risk of bias was assessed using the Cochrane RoB 2.0 tool and the certainty of evidence was evaluated using the GRADE framework. Four RCTs including 419 patients (short, n = 206; long, n = 213) were analyzed. Clinical success at one year was comparable between the two groups (OR 2.17; 95% CI = 0.76-6.23; p = 0.15; I2 = 12%). Procedure time was significantly shorter with short myotomy (MD - 17.69min; p < 0.001). Rates of adverse events and physiological outcomes (IRP, barium retention) were similar. While overall GERD rates were comparable, esophageal acid exposure was significantly lower in the short myotomy group (OR 0.69; p = 0.04). Short esophageal myotomy is non-inferior to long myotomy in clinical efficacy with the added benefit of shorter procedure time and potentially reduced acid exposure. These findings support the use of short myotomy as a safe and efficient alternative in type-I and type-II achalasia.

Cough hypersensitivity is characterized by exaggerated cough responses to mild stimuli, which is frequently associated with laryngeal abnormal sensation (LAS). However, the clinical characteristics of LAS and its prevalence in a non-clinical working population remain unclear. This study aimed to investigate the clinical characteristics and prevalence of LAS. This cross-sectional study included 556 healthcare workers (aged 20-72) from Gamagori City Hospital, Japan. Participants completed the Newcastle Laryngeal Hypersensitivity Questionnaire (NLHQ), Hull Airway Reflux Questionnaire, and Leicester Cough Questionnaire (LCQ). LAS was defined as an NLHQ score < 17.1. Binary logistic regression was used to analyze LAS-associated factors. LAS was present in 9.5% of participants. The LAS-positive group had significantly higher prevalence of asthma (13.2% vs. 3.4%, P = 0.005), chronic rhinosinusitis (7.5% vs. 1.0%, P = 0.006), and gastroesophageal reflux disease (GERD; 11.3% vs. 1.2%, P < 0.001). Cough prevalence was significantly higher in the LAS( +) group (45.2% vs. 9.5%, P < 0.001), and quality of life was impaired, as indicated by lower LCQ scores. Multivariate analysis revealed that asthma (OR = 5.092, P = 0.002), GERD (OR = 12.397, P < 0.001), and mood swings (OR = 2.957, P = 0.003) were independent risk factors for LAS. LAS markedly affects symptoms like cough and impairs quality of life, and is independently associated with asthma, GERD, and mood swings. It may reflect a sensory phenomenon of vagal hypersensitivity that could contribute to the pathophysiology of such chronic conditions.

Describe the occurrence of warning signs of gastroesophageal reflux disease (GERD) and esophagitis in children with eating behavior (EB) alterations associated with autism spectrum disorder (ASD). Descriptive study of 115 children aged 3 to 12 years, followed at a tertiary hospital and previously diagnosed with ASD. The BREB-ASD instrument was applied to identify children with EB alterations, and the 17-ATN-GISSI instrument was applied to identify those with warning signs of GERD. The selected children were invited for a medical consultation to identify those with suspected esophagitis and an indication for upper gastrointestinal (GI) endoscopy with biopsies. Sixty-nine children (60 %) were classified with alterations in the EB and, among these, 62 (89.8 %) presented warning signs of GERD. Eighteen children had suspected esophagitis and an indication for upper GI endoscopy. Among the 8 children who underwent the exam, 1 child had grade A erosive esophagitis, 1 child had grade B erosive esophagitis, and 1 child had eosinophilic esophagitis. A high frequency of EB alterations was found in children with ASD. The high frequency of GERD warning signs may be related to EB alterations in this group. Cases of esophagitis highlight the possibility of an organic disease. In these cases, performing upper GI endoscopy with biopsies is essential for diagnosis.

Gastrointestinal tolerance, healthcare resource utilization, and cost analysis of whey peptide-based enteral formula in pediatric post-acute care: A retrospective study.

Outcome of Esophageal Atresia: What Choice of Suture Material?

Lemon gum blankets esophageal mucosa and promotes therapeutic effects in experimental models of gastroesophageal reflux disease: Grasps for prevention and treatment.

Topical effect of polysaccharide cashew gum on the mitigation of dentin erosion progression under in vitro supraesophageal reflux simulation.

Refractory symptoms of gastroesophageal reflux disease after fundoplication may be associated with food intolerance/malabsorption

Tegoprazan (TEG) is a commonly used drug in the treatment of gastroesophageal reflux disease. This work aimed to develop and validate an ultra-high-performance liquid chromatography-tandem mass Spectrometry (UPLC-MS/MS) method to determine the levels of TEG in rat plasma and to apply it for a rat pharmacokinetic study. Electrospray ionization source (ESI) positive and multiple reaction monitoring (MRM) mode were selected. The internal standard revaprazan (REV) and TEG were analyzed separately on a Waters ACQUITY UPLC BEH column. Gradient elution with a flow rate of 0.5 mL/min was used. Accuracy and precision were from -8.5% to 12.2%. Linearity was from 2 to 1000 ng/mL. IS-normalized recovery ranged from 109.3% to 113.6%. IS-normalized matrix effect was from 99.0% to 102.8%. The coefficient of variation of matrix effect was less than 10%. Dilution integrity showed that a tenfold dilution also met the guidelines. In the rat pharmacokinetic study, AUC(0 - ∞) and Cmax of TEG were 9129.6 ± 1823.3 μg/L*h and 2513.2 ± 707.0 ng/mL, respectively. Tmax and T1/2 were 1.8 ± 1.1 h and 1.6 ± 0.8 h, respectively. We finally established a rapid and robust UPLC-MS/MS quantitative analysis of TEG in rat plasma. Rat pharmacokinetics indicated that TEG was absorbed quickly and fast reached the maximum concentration.

Sebaceous gland ectopia of the esophagus: A clinical, endoscopic, and pathologic study of a rare condition with literature review.

Prevalence of gastroesophageal reflux disease (GERD) has shown an upward trend over the years. Even though patients with GERD have a poor quality of life, the current treatment options are highly limited. In recent years, however, the development of anti-reflux mucosal intervention (ARMI), a novel strategy for treating GERD, has provided hope to such patients. ARMI comprises three main steps: Anti-reflux mucosectomy, anti-reflux mucosal ablation, and peroral endoscopic cardial constriction. ARMI involves the constriction of the pericardial mucosa through endoscopic surgery so as to reduce the damage caused by the reflux of gastric contents. This study compares different ARMI techniques, their therapeutic efficacy in treating GERD, indications and contraindications, endoscopic operational procedures, perioperative management, and adverse events, in an attempt to provide clinical guidance.

Background: Gastroesophageal reflux disease (GERD) is a common gastrointestinal problem that can affect many body systems. Studies have suggested a possible connection between GERD and musculoskeletal complaints, but the relationship is not fully clear Objective: This study examined the relationship between GERD and musculoskeletal complaints in patients treated at Siloam Hospitals Balikpapan. Methods: This cross-sectional study included 60 participants, divided into 30 GERD and 30 non-GERD patients. Musculoskeletal symptoms were measured using the Indonesian version of the Nordic Musculoskeletal Questionnaire. Data were analyzed with the Shapiro–Wilk test, Spearman correlation, and Mann–Whitney U test. Results: Back pain (55%), waist pain (45%), and left shoulder pain (41.7%) were the most frequent complaints. The total musculoskeletal score was higher in the GERD group (279) than in the non-GERD group (65). The data were not normally distributed (p &lt; 0.001). There was a moderate positive correlation between GERD and musculoskeletal complaints (r = 0.460, p &lt; 0.001). The Mann–Whitney test also showed a significant difference between groups (U = 283.5, Z = −3.536, p &lt; 0.001. Conclusion: GERD is related to higher and more widespread musculoskeletal complaints. Screening for musculoskeletal symptoms in GERD patients may help improve early management and patient quality of life.

Gastroesophageal reflux disease remains one of the most pressing issues in modern gastroenterology due to its high prevalence, chronic course, and risk of severe complications, including Barrett esophagus. This review summarizes research published between 2014 and 2024 in international (PubMed, Web of Science) and Russian (Russian Science Citation Index) scientific databases addressing epidemiology, pathophysiology, and treatment of gastroesophageal reflux disease. Epidemiological data demonstrate a global increase in disease burden—from 442 million cases in 1990 to 784 million in 2019—with marked regional variability (from 2.5% in China to 45.4% in the Middle East). In the Russian Federation, gastroesophageal reflux disease prevalence reaches 25.6%, with the highest rates observed in individuals older than 50 years. Key risk factors include abdominal obesity, tobacco smoking, and use of nonsteroidal anti-inflammatory drugs. Management of gastroesophageal reflux disease includes both non-pharmacologic approaches (lifestyle modification, diet therapy, breathing exercises) and pharmacotherapy. Proton pump inhibitors remain the standard of care; however, their long-term use is associated with risk of adverse effects. Promising areas include combination regimens incorporating antacids, alginates, esophagoprotective agents, and novel potassium-competitive acid blockers, which demonstrate advantages in treatment of resistant gastroesophageal reflux disease. Special attention is given to non-pharmacologic treatment strategies. Optimization of pharmaceutical counseling remains an important challenge aimed at minimizing self-medication and improving treatment adherence. The findings underscore the need to develop personalized therapeutic strategies considering clinical heterogeneity of gastroesophageal reflux disease, as well as the incorporation of innovative methods into clinical practice. Review results confirm the importance of a multidisciplinary approach to reduce healthcare system burden and improve patient quality of life.

Background: Adrenal myelolipoma is a rare, benign neoplasm of the adrenal cortex characterized by a mixture of mature adipose tissue and hematopoietic elements, including erythroid, myeloid, and megakaryocytic lineages. Typically asymptomatic and non-functional, these tumors are often discovered incidentally during imaging for unrelated conditions. Larger lesions, however, may present with symptoms due to mass effect or hemorrhage. Case presentations: Case 1: A 56-year-old female with a history of gastroesophageal reflux disease (GERD) presented with hematemesis. Abdominal CT revealed a left adrenal nodule, which was monitored for 18 months. Due to growth and abdominal discomfort, she underwent left adrenalectomy. Histopathology confirmed a benign adrenal myelolipoma. Case 2: A 47-year-old male with abdominal pain and hematuria was found to have a large right adrenal mass on CT. Despite an elevated aldosterone-to-renin ratio, the lesion was not hormonally functional. Right adrenalectomy was performed, and histology confirmed myelolipoma. Case 3: A 57-year-old male undergoing routine health screening was incidentally found to have two well-defined lesions in the left adrenal gland on abdominal ultrasound and CT. Both lesions were resected, and histopathology revealed benign adrenal myelolipomas. Conclusion: Adrenal myelolipomas are rare benign tumors that are often incidentally discovered during imaging. While they are typically non-functional and asymptomatic, larger or symptomatic lesions require surgical resection. Early diagnosis, careful imaging interpretation, and histopathological examination are crucial for ensuring appropriate management and distinguishing these tumors from other adrenal pathologies.

Hiatal hernia (HH) can cause iron deficiency anemia (IDA) development. In 5-10% patients with HH, the anemia syndrome is refractory to conservative ferrotherapy, which necessitates the antireflux surgery. A prospective study includes 42 patients with verified HH and comorbid IDA who underwent fundoplication by the method of Petrovsky National Research Center of Surgery for the period from 2023 to 2024. A complex diagnostic algorithm including extensive laboratory testing with determination of red blood cells and ferrokinetic parameters was used in all patients. The effectiveness of intervention was assessed 6 and 12 months after surgery with analysis of clinical and laboratory parameters. A complete regression of gastroesophageal reflux disease symptoms was achieved in 39 (92.8%) patients. Laboratory monitoring after 6 months demonstrated normalization of haemoglobin and serum iron levels in 35 (94.5%) of 37 examined patients. It is noteworthy that the preservation of normal haematological parameters was observed 12 months after the surgery despite the absence of additional ferrotherapy during the second half of the year that indicates a persistent clinical effect of the surgical treatment and the elimination of main anemia pathogenetic factor. The obtained data confirm a high effectiveness of HH surgery in the treatment of refractory IDA associated with Cameron syndrome and emphasize the necessity of timely detection of this pathology to optimize treatment tactics for patients.

Background. The functional state of the digestive system depends on complex neurohumoral regulatory mechanisms. Given the ability of thyroid hormones to influence gastrointestinal homeostasis, it is essential to assess the functional state of the thyroid gland and its role in the development of various gastrointestinal diseases. The aim of the research was to investigate the prevalence of major digestive system disorders (gastroesophageal reflux disease, peptic ulcer disease, gastritis, and functional dyspepsia) in patients with impaired thyroid function. Materials and methods. The study included 294 patients with thyroid dysfunction. Among them, drug-induced euthyroidism maintained with levothyroxine therapy was observed in 196 patients (66.7 %). In 24 individuals (8.2 %), incomplete compensation of thyroid hypofunction with levothyroxine was noted, since the mean thyroid-stimulating hormone (TSH) level was 5.42 ± 0.55 mIU/mL and clinical symptoms were present. Hypothyroidism with TSH levels ranging from 6.0 to 10.0 mIU/mL was found in 35 patients (11.9 %), while TSH levels &gt; 10.0 mIU/mL were registered in 18 (6.1 %). Hyperthyroidism was observed in 21 out of 294 patients (7.1 %). Elevated antithyroid antibody levels (more than twofold above the reference range) were detected in 70 patients (23.8 %). Results. Gastroenterological symptoms among individuals with thyroid dysfunction were identified in 81.6 % (240/294) of patients and were cha­racterized by heartburn in 66.3 % (195/294), a sensation of heaviness in the epigastric region in 80.9 % (238/294), loss of appetite in 21.4 % (63/294), belching in 31.9 % (94/294), nausea in 27.9 % (82/294), and vomiting in 11.9 % (35/294). Flatulence was reported by 13.6 % (40/294), constipation by 14.3 % (42/294), pain along the esophagus by 11.9 % (35/294), epigastric pain by 21.4 % (63/294), and palpitations by 8.2 % (24/294) people. Helicobacter pylori infection was detected in 59.5 % (175/294) of patients. Gastroesophageal reflux disease was diagnosed in 36.7 % (108/294), functional dyspepsia in 31.3 % (92/294), chronic gastritis in 32.6 % (96/294), and peptic ulcer disease in 12.9 % (38/294) of patients. Conclusions. It was found that patients with hypothyroidism more frequently presented with gastroesophageal reflux disease and functional dyspepsia (16.7 and 13.5 %, respectively), those with drug-induced euthyroidism were more likely to develop functional dyspepsia (23.0 %), while patients with hyperthyroidism more commonly had peptic ulcer disease (15.7 %). Further studies should evaluate the relationships between thyroid hormone, gastrin, and pepsinogen levels, as well as clarify the influence of thyroid hormones on esophageal motility.

Growing epidemiological evidence suggests a bidirectional relationship between gastroesophageal reflux disease (GERD) and ischemic stroke (IS), yet the shared molecular mechanisms remain poorly characterized. This study aims to identify common biomarkers and elucidate the pathogenic links between GERD and IS using integrative bioinformatics and machine learning approaches. Transcriptomic datasets for GERD (GSE26886 and GSE39491) and IS (GSE22255 and GSE58294) were obtained from the Gene Expression Omnibus. Batch effects were corrected using ComBat, and shared differentially expressed genes were identified via limma. Functional enrichment analyses (gene ontology and Kyoto encyclopedia of genes and genomes) were performed to uncover involved pathways. Key hub genes were selected using 3 machine learning algorithms: least absolute shrinkage and selection operator, support vector machine with recursive feature elimination, and random forest. Diagnostic utility was assessed through receiver operating characteristic curve analysis. We identified 52 upregulated and 57 downregulated differentially expressed genes common to both diseases. Enriched pathways included IL-17 signaling, glycosphingolipid biosynthesis, and PI3K-Akt signaling. Machine learning integration revealed 9 hub genes (FAM46C, FUT4, ODC1, UQCRB, ID2, TSC22D1, IL17RB, AHR, and MGAT4B) with consistent dysregulation in GERD and IS. These genes demonstrated high diagnostic accuracy, with combined area under the curve values between 0.9 and 1.0 across validation cohorts. IL17RB and FUT4 were notably upregulated, suggesting roles in inflammatory and glycosylation pathways. Our findings reveal convergent molecular pathways and potential diagnostic biomarkers linking GERD and IS. The identified hub genes may serve as dual-purpose therapeutic targets aimed at mitigating shared inflammatory and vascular mechanisms. Further experimental validation is needed to confirm their clinical relevance.

Gastroesophageal reflux disease (GERD) and its manifestation as reflux esophagitis (RE) involves mucosal inflammation and autonomic dysfunction. Vitamin D3 deficiency is increasingly implicated in gastrointestinal inflammation and immune imbalance. This study investigated the therapeutic and prophylactic effects of 1,25-dihydroxyvitamin D3 on esophageal inflammation and autonomic nervous system disruption in a non-surgical rat model of RE. RE was induced via intermittent fasting and refeeding. Rats received either no treatment, prophylactic vitamin D3 (1250 IU/day pre- and post-induction), or therapeutic vitamin D3 (post-induction only). We assessed esophageal histopathology, immunohistochemical expression of tumor necrosis factor α (TNF-α) and transforming growth factor β (TGF-β), serum interleukin 6 (IL-6) levels via ELISA, and heart rate variability (HRV) indices. RE rats exhibited characteristic mucosal damage, elevated IL-6 and TNF-α expression, and impaired HRV (reduced standard deviation of normal to normal intervals (SDNN), High frequency (HF); increased low frequency/high frequency ratio (LF/HF)). Vitamin D3 supplementation significantly reversed these alterations. Prophylactic administration showed superior efficacy in preserving mucosal integrity and autonomic function compared to therapeutic intervention. Notably, TNF-α expression was abolished and IL-6 was significantly reduced. 1,25-dihydroxyvitamin D3 exerts protective and therapeutic effects in RE through suppression of inflammatory cytokines and restoration of autonomic balance. These findings support its potential as a neuroimmune modulator in esophageal inflammatory diseases. Heart rate variability (HRV) was assessed as an autonomic marker, and correlations with cytokine levels were explored. Scale bars and schematic workflow diagrams were included for clarity. A Limitations section was added to acknowledge constraints such as absence of a DMSO control.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-24842-7.

Redo Rates and Outcomes of Gastric Peroral Endoscopic Myotomy (G-POEM) vs. Pyloroplasty for Gastroparesis: A Retrospective Analysis.

Esophageal hypervigilance and symptom-specific anxiety are emerging as key factors influencing symptom severity in patients with dysphagia and gastro-esophageal reflux disease (GERD). We aimed to evaluate the relative contributions of esophageal hypervigilance, alongside parameters of high-resolution manometry (HRM) and pH study, to esophageal symptom severity. Consecutive patients attending HRM with or without a 24-hour pH study at a tertiary referral center were prospectively included from March 2022 to June 2024. Patients completed the following questionnaires: Esophageal Hypervigilance and Anxiety Scale (EHAS-7), Brief Esophageal Dysphagia Questionnaire, and Gastroesophageal Reflux Disease Questionnaire (GERDQ). Pearson's correlation was used to determine the interrelationships between questionnaire results, HRM, and pH study metrics. A total of 380 patients were included (median age 54; 63.2% female), with 226 undergoing pH studies. EHAS-7 showed stronger correlations with dysphagia symptom severity compared with manometry metrics in patients with normal manometry findings (r = 0.306, P < 0.001), achalasia (r = 0.429, P < 0.050), absent contractility and ineffective esophageal motility (r = 0.611, P < 0.001), and distal esophageal spasm and hypercontractile esophagus (r = 0.536, P = 0.048). Regression analysis showed EHAS-7 independently explained 14.1% of variance (β = 0.382, P < 0.001) in dysphagia severity. In the pH study cohort, both EHAS-7 and pH study metrics had either weak or no correlations with the severity of patients' GERD symptoms. Esophageal hypervigilance and symptom-specific anxiety correlate more strongly with dysphagia symptom severity than HRM metrics in select patient groups, emphasizing its role in symptom perception.