BACKGROUND: Hypercontractile esophagus is a rare hypercontractile esophageal motility disorder. The etiology of hypercontractile esophagus is unknown but an association between acid reflux and hypercontractile esophagus has been suggested. We present the first report on the use of potassium-competitive acid blockers in the treatment of hypercontractile esophagus.
METHODS: A 43-year-old man presented with dysphagia, chest pain and regurgitation for a period of 1 year. Initial workup showed a twisted lumen with abnormal contractions in the distal esophagus during upper gastrointestinal endoscopy and abnormal acid exposure under 24-h esophageal pH monitoring. The use of standard-dose proton pump inhibitors didn\'t relieve his symptoms. Subsequent high-resolution esophageal manometry made a diagnosis of hypercontractile esophagus. Treatment with vonoprazan resulted in symptomatic resolution and abnormal contractions were no longer detected on follow-up high-resolution manometry.
CONCLUSIONS: Potassium-competitive acid blockers like vonoprazan offer an alternative therapeutic method for patients with hypercontractile esophagus who are refractory to proton pump inhibitor therapy. The use of potassium-competitive acid blockers in hypercontractile esophagus warrants further research and may provide evidence for an acid-related etiology of hypercontractile esophagus.

This study aimed to explore the characteristics of laryngopharyngeal reflux (LPR) and the association between LPR and allergic rhinitis (AR).
In this prospective case-control study, a total of 102 patients with suspected LPR who visited the Department of Otolaryngology Head and Neck Surgery, Heping Hospital Affiliated to Changzhi Medical College, between June 2019 and June 2021 were consecutively included. They were divided into the LPR-positive group and the LPR-negative group according to 24-h Dx-pH monitoring. The influencing factors of LPR, including the scores for AR (SFAR) and AR prevalence, were compared between the two groups.
The total SFAR and scores in items 1, 3, 4, and 5 of the LPR-positive group were significantly higher than those of the LPR-negative group (p < 0.05). The prevalence of AR in the LPR-positive group was 60%, which was significantly higher than that in the LPR-negative group (36.54%) (p < 0.05). After excluding confounding factors, AR was positively correlated with the incidence of LPR, and the incidence of LPR with AR was 2.372 times that of non-AR. Receiver operating characteristic curve results show that AR has the highest predictive value for LPR, and the area of AR under the curve is was 0.617.
The SFAR and incidence of AR are high in patients with positive LPR, and AR may be a risk factor for LPR. The results of this study may deepen our understanding of the occurrence of LPR.

A 52-year-old woman had a 6-month history of frequent belching;however, esophagogastroduodenoscopy revealed no abnormal findings. She presented to our department with belching refractory to several medications. Abdominal radiography revealed no massive gas in the stomach and intestine. She had frequent belching during the medical interview but no belching during speaking. Findings from high-resolution esophageal manometry and esophageal impedance pH monitoring confirmed supragastric belching. Thus, she was diagnosed as having excessive supragastric belching, which improved with cognitive behavioral therapy.

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Esophageal pH monitoring via wireless probes is used to evaluate chest pain and atypical symptoms and diagnose gastroesophageal reflux. These probes are commonly placed during esophagogastroduodenoscopy performed by gastroenterologists in an ambulatory anesthesia setting. Dislodgment and aspiration of these probes can cause morbidity, require surgical removal, and involve the anesthesia provider in prolonged emergency care. We present a case of a probe dislodgment where aspiration was avoided and describe how retrieval of this device is different from typical hypopharyngeal foreign body removal.

OBJECTIVE: Patient reporting of symptom events during ambulatory reflux monitoring is commonly performed with little data regarding its accuracy. We employed a novel time-synchronized ambulatory audio recording of symptom events simultaneously with prolonged pH/impedance monitoring to assess temporal accuracy of patient-reported symptoms.
METHODS: An acoustic monitoring system was employed to detect cough events via tracheal and chest wall sounds and it was temporally synchronized with an ambulatory impedance/pH monitoring system. Patients were instructed to record their symptoms in the usual manner. Six separate observers independently listened to the 24-h audio recordings and logged the exact timing of each cough event. Patients were blinded to study design and the audio reviewers were blinded to their own reports and those of patients and other reviewers. Concurrence of audio recordings and patient-reported symptoms were tested for three separate time thresholds: 1, 2, and 5 min.
RESULTS: The median (interquartile range (IQR)) number of cough events by audio detection was significantly (P<0.001) higher than those reported by patients: 216 (90-275) and 34 (22-60), respectively. There was significantly (P<0.001) higher agreement among the audio recording listeners (substantial to almost perfect agreement; kappa=0.77-0.82) than between the audio recording and patient-reported symptoms (slight to fair agreement; kappa=0.13-0.27). Patients did not report 91, 82, and 71% of audible cough events based on 1-, 2-, and 5-min concordance time windows, respectively.
CONCLUSIONS: We found that patients do not report the majority of their symptoms during ambulatory reflux monitoring even within a 5-min time window of the true event and advise caution in clinical decision-making based solely on symptom indices.

The consensus meeting attempted to clarify concepts associated with the clinical entity often termed \'NERD\' and to define it in a way that would permit physicians to communicate accurately amongst each other when they use the term, so that there may be a common understanding of the condition. In this paper, eight clinical case scenarios are presented that illustrate some points of potential uncertainty and ambiguity in the use of the term NERD and the clinical management of patients. They are discussed in relation to views reached by the consensus group.

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Advances in lung transplantation have improved 1-year survival rates, but allograft dysfunction continues to be a significant cause of post-transplant death. Diffuse alveolar damage is an early indication of allograft dysfunction and has been linked to gastroesophageal reflux. We report a case of diffuse alveolar damage-associated allograft dysfunction in a patient found to have significant non-acid gastroesophageal reflux.