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.

Comparison of the safety, efficacy, and rates of gastroesophageal reflux disease between full-thickness versus modified peroral endoscopic myotomy for achalasia: a systematic review and meta-analysis.

Gastroesophageal reflux disease (GERD) is a widespread gastrointestinal disorder with a significant global burden. Its multifactorial etiology is influenced by unmodifiable risk factors such as sex-based differences; men, for instance, show a higher predisposition for more severe complications like esophageal adenocarcinoma. GERDs pathophysiology is heavily connected with mechanical failure of the anti-reflux barrier, a two-component system that consists of the intrinsic lower esophageal sphincter (LES) and the extrinsic crural diaphragm. Interference in the form of hiatal hernia, hypotensive LES pressure or transient LES relaxations leads to reflux. Modern approach highlights the critical role of microscopic mucosal damage, which causes visceral hypersensitivity and allows the distinction of various phenotypes like non-erosive reflux disease and reflux hipersensitivity. Diagnosis is guided by the Lyon Consensus 2.0 using endoscopy, manometry, and impedance-pH monitoring. Treatment is a multi-step process – it includes lifestyle modification, numerous pharmacological agents such as proton pump inhibitors or newer potassium-competitive acid blockers, and, for refractory cases, interventional treatment via laparoscopic Nissen fundoplication, transoral incisionless fundoplication or magnetic sphincter augmentation.

Remifentanil and dexmedetomidine are sedative agents used both in anaesthetic and critical care practice. Their effects on the gastro-oesophageal pressure gradient and hence on the potential risk for regurgitation have not been quantified. The aim of this study was to measure and compare the effects of both agents on the gastro-oesophageal pressure gradient. The study used a randomised, double blinded crossover study design, and 16 healthy volunteers were sedated on two separate occasions. Baseline lower oesophageal sphincter pressure (26 and 28 mmHg for dexmedetomidine and remifentanil, respectively) and gastro-oesophageal pressure gradient (20 mmHg for both dexmedetomidine and reminfentanil) were recorded. Then, each volunteer received increasing doses of target-controlled infusions of dexmedetomidine (1, 2, 4, 6 ng/ml) or remifentanil (1, 2, 3, 4 ng/ml). Each dose level was maintained for 20 minutes, and both lower oesophageal sphincter pressure and gastro-oesophageal pressure gradient were continuously recorded. Measurements were averaged. Out of 16 subjects recruited, data were analysable from 11 (aged 18-54 years, body mass index 17.7-27.9 kg/m2, five men and six women). The dose regimens of both agents provided similar profiles of progressive sedation over time, with sedation scores reaching a minimum of -2 on the 'observer's assessment of alertness and sedation score' with both medications. With dexmedetomidine, the bispectral index gradually decreased in line with sedation scores (P<0.05), but remifentanil produced little change in the bispectral index from baseline. Both agents decreased gastro-oesophageal pressure gradient (P<0.001) similarly, (P=0.199), in line with the decreases in sedation scores. In conclusion, when remifentanil or dexmedetomidine are administered to provide sedation they induce similar decreases in gastro-oesophageal pressure gradient. This may put patients at comparable risk of gastro-oesophageal reflux.

This study aimed to perform a rigorous comparison of perioperative and functional outcomes between the 3D laparoscopic Toupet (270° posterior partial fundoplication) vs. Nissen (360° total fundoplication) for hiatal hernia (HH) repair in gastroesophageal reflux disease (GERD) patients. This retrospective cohort study included 103 patients with HH and GERD who underwent surgery between January 2020 and May 2024. Patients were divided into two groups based on surgical technique: the Toupet group (n = 53) and the Nissen group (n = 50). Outcomes included surgical metrics, pre/postoperative high-resolution manometry, 24-hour pH-impedance, gastroesophageal reflux disease symptom questionnaire (GERD-Q) and gastroesophageal reflux disease health-related quality of life (GERD-HRQL) scores, and complications. Multivariable regression adjusted for baseline differences. The Toupet group demonstrated significantly shorter time to first postoperative oral intake (p = 0.012) and hospital stays (p = 0.023) compared to the Nissen group. At 6 months postoperatively, both groups showed significant increases in minimum lower esophageal sphincter (LES) resting pressure and respiratory mean values, along with decreases in reflux-related parameters and ineffective swallowing ratio (p < 0.001). Intergroup comparison revealed that the Toupet group had lower minimum LES resting pressure, respiratory mean LES pressure, and ineffective swallowing ratio, but higher 24-hour reflux episodes, percentage acid exposure time, and mean DeMeester scores than the Nissen group (p < 0.001). At 1 year postoperatively, both groups exhibited significant improvements in GERD-Q and GERD-HRQL scores (p < 0.001), with no intergroup differences observed (p > 0.05). The Toupet group had significantly lower overall complication rates (p = 0.031) and a lower incidence of dysphagia than the Nissen group (p = 0.019). Multivariable regression analyses confirmed that the Toupet procedure was an independent predictor for shorter time to first postoperative oral intake (p = 0.015), shorter hospital stays (p = 0.017), and lower overall complication rates (p = 0.020). In summary, when performed with 3D laparoscopy, Toupet and Nissen fundoplication show distinct and meaningful clinical profiles. Nissen fundoplication is the preferred option for achieving maximal anti-reflux efficacy in patients with normal esophageal motility, whereas Toupet fundoplication is preferred for minimizing postoperative dysphagia and enhancing rapid recovery, particularly in cases with impaired or borderline motility.

Diaphragmatic breathing training (DBT) improves symptoms in patients with gastroesophageal reflux disease; however, the effect of DBT on the anti-reflux barrier and esophageal motility is unclear. This study aimed to evaluate the changes in specific parameters of EGJ function and esophageal motility before and after DBT using high-resolution manometry (HRM) in patients with reflux symptoms. Prospectively collected data from adult patients with persistent reflux symptoms who underwent initial and follow-up HRM after at least 3 months of DBT were analyzed. Esophagogastric junction (EGJ) function was assessed using basal lower esophageal sphincter (LES) pressure (LESP), the EGJ contractile integral (EGJ-CI), and integrated relaxation pressure (IRP). Esophageal motility was assessed using the distal contractile integral (DCI) and percentage of ineffective esophageal motility (IEM). Data from 53 patients with a median age of 45 years (range 25-77) were analyzed. LES pressure increased after DBT (mean LES pressure 25.6 [SE 1.3] vs. 29.1 [SE 1.4] mmHg after DBT; p = 0.02). This effect was also observed in patients with an initially hypotensive LES, but no effect was found on the size of hiatus hernia. There was a trend to increased EGJ-CI (mean EGJ-CI 52.8 [SE 3.7] vs. 59.9 [SE 4.3] mmHg·cm after DBT, p = 0.07). Esophageal contractility improved (mean DCI 1046.6 [SE 112] vs. 1264.1 [SE 137] mmHg·s·cm after DBT; p < 0.01) with the prevalence of IEM reduced from 38.0% [SE 5] to 29.2% [SE 4] after DBT; p = 0.03. Diaphragmatic breathing training increased LES pressure and esophageal peristaltic vigor in patients with reflux symptoms.

Eosinophilic infiltration of the esophageal muscular layer, known as eosinophilic esophageal myositis (EoEM), is an exceptionally rare condition that can mimic primary motility disorders such as achalasia. We present the case of a 72-year-old male with progressive dysphagia and significant weight loss, whose high-resolution manometry revealed findings consistent with achalasia, but with unusually elevated lower esophageal sphincter pressures. Surgical myotomy was performed and histopathological analysis unexpectedly revealed intense eosinophilic infiltration of the muscularis propria. The patient was treated with systemic corticosteroids, followed by topical budesonide, leading to partial and temporary clinical improvement. This case highlights eosinophilic esophageal myositis as a potential, but underrecognized differential diagnosis in patients with atypical achalasia features and treatment-refractory dysphagia.

Laparoscopic Heller myotomy (LHM) is the preferred treatment approach to reducing lower oesophageal sphincter pressure (LOSP). However, less than half of the patients show high LOSP. This study primarily aims to evaluate how LOSP affects operative results. From 2019 to 2023, a total of 52 patients were treated with LHM combined with partial fundoplication, diagnosed by integrated relaxing pressure (IRP) >15 mmHg on high-resolution manometry (HRM). Based on HRM, patients were assigned into two arms: normal LOSP (≤35 mmHg, n = 30) and high LOSP (>35 mmHg, n = 22). Symptoms were assessed preoperatively, and the median duration of follow-up of 24 months using the Eckardt score (ES), the achalasia-specific quality of life (ASQ) score and the SF-36 questionnaire quality of Life (QOL). Treatment failure was defined as ES ≥4 or an ASQ score ≥16. Pre-operative Eckardt and ASQ scores were similar between groups. The high LOSP group had significantly younger populations (≤50 years: 90.90% vs. 60%, P = 0.013). The normal LOSP group had significantly less dysphagia (P = 0.007) and regurgitation (P = 0.011), reflecting significantly lower post-operative ES (0.80 vs. 2.00, P = 0.002). In addition, post-operative ASQ scores (11 vs. 14, P = 0.005) and QOL were significantly better in the normal LOSP group. The high LOSP group experienced a significantly greater failure rate (31.80% vs. 6.7%, P = 0.027). Normal LOSP results in better surgical outcomes and QOL, as younger patients with high LOSP have poorer responses, due to higher LOS muscle tone.

ObjectiveTo compare postoperative dysphagia and anti-reflux efficacy between laparoscopic floppy Nissen fundoplication with V-flap suturing (LNF-V) and conventional laparoscopic Nissen fundoplication (LNF).MethodsThis retrospective cohort study included patients with gastroesophageal reflux disease (GERD) who underwent LNF-V or LNF between January 2022 and January 2024 at the Department of General Surgery of Xuanwu Hospital, Xiong an Xuanwu Hospital, and Beijing Feng tai Hospital of Traditional Chinese Medicine. After applying inclusion and exclusion criteria, 173 patients were enrolled, including 113 in the LNF-V group and 60 in the LNF group. In the LNF-V procedure, following the standard 360° fundoplication, the wrap was further sutured to the left and right diaphragmatic crura to form a V-shaped configuration. Saeed dysphagia scores and Gerd-Q scores were assessed preoperatively and at 3, 6, and 12 months postoperatively. Operative time, intraoperative blood loss, hospital stay, and postoperative complications were also recorded.ResultsThere were no significant differences between the two groups in baseline characteristics including sex, age, BMI, symptom duration, lower esophageal sphincter (LES) pressure, and DeMeester score (P > 0.05). Intraoperative blood loss and hospital stay were also similar. The operative time was slightly longer in the LNF-V group than in the LNF group (P < 0.001). Regarding dysphagia, Saeed scores were significantly lower in the LNF-V group at 3 to 6 months postoperatively (P < 0.001), indicating better recovery of swallowing function; by 12 months, scores were comparable between the groups (P = 0.785). Gerd-Q scores at 3 months were significantly lower in the LNF-V group (P = 0.008), reflecting better reflux symptom control, while no significant differences were observed at 6 and 12 months (P = 0.078 and 0.541, respectively).ConclusionIn this retrospective cohort, LNF-V was associated with a lower incidence of early postoperative dysphagia and showed superior short-term anti-reflux efficacy compared with conventional LNF. Prospective studies are needed to confirm these findings. While the LNF-V procedure appears safe and feasible, its long-term durability requires further validation in prospective studies with extended follow-up.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12876-025-04426-5.

This report describes a case in which a patient with an open tracheostomy, following surgery for severe dysphagia, acquired vacuum swallowing and exhibited rapid bolus inflow into the esophagus. A 39-year-old man with bulbar palsy caused by medullary surgery demonstrated impaired pharyngeal contraction and upper esophageal sphincter opening. After undergoing laryngeal suspension and cricopharyngeal myotomy, videofluoroscopic evaluation of swallowing revealed rapid passage of the bolus from the pharynx into the esophagus. High-resolution manometry demonstrated markedly negative intraesophageal pressure accompanied by simultaneous elevation of lower esophageal sphincter pressure during swallowing. These findings suggest that the patient had spontaneously acquired vacuum swallowing despite the presence of a tracheostoma communicating with the atmosphere. Recognition of this compensatory mechanism is important because it may facilitate bolus transport in individuals with tracheostomy. Increased awareness of this swallowing pattern may prevent underdiagnosis and offer new insights into rehabilitation strategies for dysphagia.

Esophagectomy was considered the first line for advanced sigmoid (aSg) achalasia (esophageal angulation < 90°), while laparoscopic Heller myotomy (LHM) has a lower percentage of success. The pull-down LHM (PD-LHM) technique has emerged as a promising and more effective rescue therapy to avoid esophagectomy for aSg achalasia. However, the long-term functional results of PD-LHM are inconclusive. To compare the outcome of aSg achalasia (< 90°) who underwent the PD-LHM technique with those of non-advanced (naSg) achalasia (≥ 90°) and LHM. This ambispective nested cohort study evaluated 34 achalasia patients with megaesophagus divided into two groups: (a) aSg (< 90°; n = 20; 59%) PD-LHM treated, and (b) naSg (≥ 90°; n = 14; 41%) LHM treated. The assessments included esophageal angulation and symptom questionnaires. All patients were clinically and manometrically evaluated before and at 1- and 12-month post-surgery intervals. Clinical outcomes focused on achieving esophageal angulation ≥ 90° and an Eckardt score < 3. 65% of patients were men, and 65% had achalasia type I. The mean esophageal angulation in aSg was 79.6 ± 8.8°, and in naSg was 116.3 ± 16.3°. aSg improved to 99.5 ± 15.2°, and 17/20 patients (85%) shifted to the naSg group. aSg significantly improved in Eckard symptom score at 1month (1.2 ± 1.3) vs. preoperative score (8.9 ± 1.6). The three aSg patients who experienced PD-LHM failure were male, type I achalasia, had higher preoperative IRP and LES pressure, were older, and had longer disease duration vs. success. A good clinical and manometric outcome was obtained in 85% of aSg. Our findings suggest that PD-LHM is an effective treatment for aSg with a success rate of 85%.

The incidence of hiatal hernia is on the rise due to population aging and improved awareness of the disease. Laparoscopic repair is the main treatment modality; however, there remains a lack of consensus on the selection of mesh materials and operative specifications. Based on high-level evidence, this expert consensus has formulated 11 recommendations regarding the indications for mesh application, material selection, and operative methods: For patients with giant hiatal hernias (defect area >10 cm², hiatal diameter ≥ 5 cm, or over 1/3 of the gastric body entering the thoracic cavity), complex hernias, recurrent hernias, or those with weak diaphragmatic crura, mesh-reinforced repair is recommended to reduce the risk of recurrence. Synthetic meshes are suitable for giant/complex hernias; biological meshes help reduce foreign body reactions; and bioabsorbable synthetic meshes combine mechanical strength with safety. The preferred shape of the mesh is U-shaped, and fixation methods (non-absorbable sutures, absorbable staplers, or medical adhesives) are selected based on hernia size and anatomical features. For suturing the diaphragmatic crura, non-absorbable sutures are recommended, with the choice between interrupted or continuous suturing techniques tailored to patient characteristics. The method of fundoplication is determined according to esophageal pH measurement and lower esophageal sphincter pressure, and non-absorbable sutures are recommended for plication.

A case is reported where consuming the main meal at lunch and an earlier smaller sized dinner reduced averaged, refractory pre-bedtime reflux scores (over 5 days and three months later over 8 days) from a maximum of 3 (significant symptoms) to 0.23 ± 0.44, nocturnal reflux scores from 1 or 2 (mild to moderate symptoms) to 0.69 ± 0.85 and sore throat and cough scores from 1 or 2 to 0.85 ± 0.90. Anecdotal evidence suggested mealtime and meal volume changes brought significant benefits for pre-bedtime and nocturnal gastroesophageal reflux (GER) but was less effective for laryngopharyngeal reflux (LPR) symptoms of early morning sore throat and cough. A review of the literature found early meals before bedtime and reduced meal volumes were likely to reduce the risk of GER and developing GERD. When recumbent, it was reported meals were digested more slowly and gastric emptying rates decreased. Meals were also digested faster in the morning than in the evening even when awake, with circadian rhythm and air swallowing also influencing the metabolism and the absorption of food. These reports indicate a biochemical basis for the benefit of early meals before bedtime and reduced meal volumes, to reduce the risk of GER. It was also reported that when recumbent, for meals close to bedtime or large meals, gravity could assist the backflow of stomach contents into the esophagus, indicating a biophysical basis for GER. To understand the role of gravity in GER, values for hydrostatic pressure were calculated for pre-meal to meal volumes of 1000 ml and found to be from 2-23 mmHg, in the same order of magnitude as reported tonically contracted lower esophageal sphincter pressure of 15-30 mmHg. Hypothetical models are developed to show how gastric content (GC) and body orientation change the hydrostatic pressure on the lower esophageal sphincter and influence the risk of GER in the fed state. In summary, it is likely there is both a biochemical and biophysical basis for GER and LPR, wi

LVSG seems to increase the risk of GERD despite significant weight loss. We compared pre- and postoperative esophageal function test data (in conjunction with the BMI loss) to evaluate the impact of post-LVSG on lower esophageal sphincter pressure (LESP), lower esophageal sphincter length (LESL), and DeMeester Score (DMS). Articles analyzing esophageal manometry ±24 h pH-study pre- and post-LVSG were identified using electronic databases from 1999 to 2023. The Critical Appraisal Skills Programme Checklist for Cohort Studies was used for quality assessment. The DerSimonian and Laird random effects model was used for continuous data analysis. Heterogeneity was assessed using the Cochrane Q statistic and I2 index. Leave one out sensitivity analysis was undertaken to assess the robustness and validity of our analysis. Egger's test was used to evaluate potential publication bias in our meta-analysis. Nineteen studies totaling 668 patients were evaluated (F = 445, M = 131). A significant reduction of 3.82 mm Hg in LESP was observed after LVSG based on 16 studies (WMD 3.82, 95% CI 1.74, 5.90; p < 0.001, I2 = 88.6%). LESL did not reveal any significant difference between pre- and post-LVSG based on nine studies (WMD 0.05, 95% CI -0.15, 0.26; p = 0.625, I2 = 83.1%). DMS showed a significant increase of 11.72 post LVSG based on 12 studies (WMD -11.72, 95% CI -17.15 to -6.30; p < 0.001, I2 = 91.5%). Significant BMI loss of 13.26 kg/m2 was observed post LVSG based on 12 studies (WMD 13.26, 95% CI 11.65 to 14.88, Z = 16.07, p < 0.001). LVSG is associated with a significant decrease in LESP and a significant increase in the DMS post-LVSG, leading to the worsening or development of new GERD symptoms despite significant BMI reduction. The limitations of our meta-analysis include small sample sizes, short follow-up, heterogeneity, lack of data on some confounders and inadequate quality of some studies.

AimsThis randomised controlled trial compared the efficacy of modified laparoscopic sleeve gastrectomy with fundoplication (LSGFD) versus standard laparoscopic sleeve gastrectomy (LSG) in achieving weight loss and alleviating gastroesophageal reflux disease (GERD) in patients with obesity.Materials and MethodsEighty patients with obesity (body mass index [BMI] ≥27.5 kg/m2 with comorbidities or ≥32.5 kg/m2) with mild‐to‐moderate GERD were randomised to LSGFD (n = 27) or LSG (n = 53). Assessments included weight, BMI, waist–hip ratio, percentage of excess weight loss (%EWL), GERD Questionnaire scores, endoscopy, lower oesophageal sphincter (LES) pressure and DeMeester scores preoperatively and at 6–12 months postoperatively. Fundoplication type (180° Dor, 270° Toupet or 360° Nissen) was intraoperatively adjusted based on LES pressure. Statistical analyses used t‐tests, analysis of variance and chi‐square tests (SPSS v19.0).ResultsNo significant differences were observed between the two groups in preoperative parameters. However, at 6 and 12 months postoperatively, both groups showed significant reductions in body weight, BMI, waist circumference, hip circumference and waist–hip ratio, along with a significant increase in the %EWL. The LSGFD group demonstrated superior outcomes in treating GERD and other obesity‐related comorbidities, particularly notable improvements in reflux esophagitis.ConclusionsLSGFD provides equivalent weight loss to LSG but significantly superior control of GERD symptoms and resolution of reflux esophagitis. It offers enhanced management of obesity‐related comorbidities without increasing surgical risk, supporting its use in obese patients with GERD.

Background and study aimsAchalasia is a condition related to failure of relaxation of the lower esophageal sphincter (LES). Treatment is based on reducing LES pressure. Although treatment is traditionally surgical, poor candidates for this modality may be treated with peroral endoscopic myotomy (POEM). However, POEM is associated with a relatively high incidence of gastroesophageal reflux disease (GERD). For cases refractory to proton pump inhibitors (PPIs), transoral incisionless fundoplication (TIF) is one of the endoscopic therapies proposed.Patients and methodsThis was a pilot single-center prospective cohort study including 10 patients with post-POEM GERD refractory to clinical management who underwent endoscopic treatment with the TIF procedure between February and November 2021. We included patients ≥ 18 years old who developed GERD after POEM.ResultsTechnical success was achieved in all 10 cases treated with TIF. In 6- and 12-month follow-up, seven patients (70%) reduced PPI use. Two patients (20%) had no esophagitis initially, increasing to five (55%) at 6 months and four (44%) at 12 months. Symptom evaluation and GERD-HRQL questionnaire showed a significant score reduction at 6 months and a downward trend at 12 months. Mean Eckardt score showed a decreasing trend, although mean dysphagia score showed a slight tendency to increase in 1 year. The procedure was considered safe, with no adverse events.ConclusionsUse of TIF seems to be a feasible alternative for treating GERD after POEM, improving both clinical and endoscopic parameters and pHmetry in a considerable percentage of cases.

Topic: Esophagus benign - gerd, achalasia, motilityAbstract ID: 105Findings on Functional Lumen Imaging Probe (FLIP) Can Guide Treatment in Symptomatic Patients With Hypertensive Lower Esophageal Sphincter Pressure (LES) But Normal LES Relaxation on High Resolution Manometry: A Case Series

The efficacy of nonpharmacological therapies for patients with gastroesophageal reflux disease (GERD) has been progressively proved. However, the specific differences in effectiveness among various nonpharmacological interventions and their combinations with pharmacological interventions remain unclear, and the optimal intervention strategy has yet to be conclusively determined. Systematic searches were conducted in PubMed, Web of Science, Embase, Cochrane, and CNKI from inception to November 6, 2024. A network meta-analysis was conducted using a random effects consistency model within a Bayesian framework with lower esophageal sphincter (LES) pressure as the primary outcome indicator. Thirty-three studies involving 10 nonpharmacological interventions were included. Acupoint stimulation with traditional Chinese medicine (TCM) (SMD=5.83, 95% CI: 1.23 to 10.16), and breathing training with conventional Western medicine (CWM) (SMD=3.88, 95% CI: 0.45 to 7.52) significantly improved LES pressure and reduced esophageal acid exposure time (AET) (SMD=-5.01 to -3.32). In terms of safety, acupoint stimulation with TCM (logOR=-2.51, 95% CI: -5.91 to -0.19) exhibited a significant advantage over CWM. However, acupoint stimulation combined with TCM and breathing training with CWM did not demonstrate a significant improvement in GERD health-related quality of life questionnaire (HRQL) scores. Acupoint stimulation combined with TCM and breathing training with CWM, when compared with CWM and other nonpharmacological interventions, is considered a potential adjunctive therapeutic approach for GERD, demonstrating both efficacy and safety. However, methodological limitations necessitate cautious interpretation of results.

Role of ligamentum teres cardiopexy during laparoscopic sleeve gastrectomy in patients with obesity with gastroesophageal reflux disease: a short-term retrospective study.

To explore the research history, hotspots and development trends of acupuncture and moxibustion in the treatment of gastroesophageal reflux disease（GERD）based on knowledge graph technology, and to provide references for clinical and basic research in this field. The literature of acupuncture and moxibustion for gastroesophageal reflux disease was searched from the CNKI, Wanfang, VIP and SinoMed, from the establishment of the databases to December 31th, 2023. CiteSpace 6.2.R6 Advance was used to draw the knowledge graph of authors, institutions, keywords and other elements, and then perform the visual analysis. A total of 341 articles were included, with the number of publications showing an upward trend and the research types continually diversifying. A total of 832 authors and 308 institutions were analyzed, with XIE Sheng from the First Affiliated Hospital of Guangxi University of CM and BAI Xinghua from the Beijing University of CM as representative figures, forming core research teams. However, there was a lack of close collaboration between institutions, and no significant cross-regional research networks had been formed. A total of 192 keywords were included, forming 8 cluster labels, which mainly included 4 categories：treatment methods, disease types, TCM syndrome types, and literature types. The burst analysis showed that the methods of acupuncture and moxibustion in the treatment of gastroesophageal reflux disease had gradually become more integrated, the treatment methods had transitioned from simple acupuncture therapy to combined therapies with proton pump inhibitors or TCM decoctions, the disease types had become more refined, the focus of mechanism research had shifted from lower esophageal sphincter pressure and esophageal motility to changes in gastrointestinal hormone levels, and the research hotspots had gradually shifted from improving clinical symptoms to considering both mental and psychological states. Twenty-three high-frequency acupoints were obtained, forming 8 clusters of "acupuncture techniques-acupoints" for the treatment of gastroesophageal reflux disease with acupuncture and moxibustion, indicating a gradual enrichment of acupuncture and acupoint treatment protocols. The research on acupuncture and moxibustion in the treatment of gastroesophageal reflux disease has gradually deepened, in the future, the cooperation among research teams should be strengthened, the quality of clinical research should be improved, more multi-dimensional mechanism research and horizontal comparative research of different acupuncture and moxibustion methods should be made, to provide a basis for clinical promotion and deeper exploration.