Proton pump inhibitors (PPIs) are widely used for acid-related disorders, but limited data exist regarding their excretion into human breast milk. This study aimed to quantify pantoprazole levels in plasma and breast milk of lactating women and to assess potential infant exposure. Sixteen mothers who had discontinued breastfeeding and were prescribed 40 mg pantoprazole once daily participated. Blood and breast milk samples were collected on days 1 and 7 at 0, 1.5, 3, 4.5, and 6 h post-dose. Pantoprazole was quantified using a validated high-performance liquid chromatography (HPLC) method with omeprazole as the internal standard. Samples were extracted via liquid–liquid extraction, and the method was validated over a linear range of 0.03–1 µg/mL (LOQ 0.03 µg/mL). Pantoprazole was detected in 46

BACKGROUND:The recently published Rome V adult diagnostic criteria facilitated an updated epidemiological survey of disorders of gut-brain interaction (DGBI). OBJECTIVE:We aimed to describe the global epidemiology of DGBI using the Rome V criteria and compare it with the Rome IV Rome Foundation Global Epidemiology Study. METHODS:A population-based Internet survey of 28,771 adults was conducted in 15 countries using the Rome V diagnostic questionnaire. DGBI prevalence was determined and compared with the Rome IV data. Multivariable logistic regression models were used to examine associations of demographic factors to Rome V DGBI status in the global population and to assess potentially associated clinical factors. RESULTS:The surveys yielded similar results. The prevalence of at least one DGBI using the Rome V criteria was 40.9%, compared with 40.5% for Rome IV. In both, the prevalence was higher among females and decreased with increasing age. In the Rome V sample (25 DGBI), the most prevalent oesophageal disorder was functional dysphagia at 4.1%, the most prevalent gastroduodenal disorder was functional dyspepsia at 8.1%, unclassified bowel disorder was the most prevalent bowel disorder (9.6%), followed by chronic constipation (8.9%) and IBS (8.5%) and proctalgia fugax was the most prevalent anorectal disorder (7.3%). The prevalence rates for two new DGBI were 5.1% for abdominal migraine and 1.4% for inability to belch syndrome. CONCLUSION:The Rome V global prevalence of DGBI is consistent with Rome IV. This bolsters confidence in the validity of prevalence rates for DGBI and reaffirms their high global burden.

Dysphagia is a prevalent symptom of the upper gastrointestinal tract causing health related consequences, impacting quality of life and is associated with global economic burden. Swallowing difficulties are classified into oropharyngeal dysphagia (OD) and esophageal dysphagia. Despite its clinical importance, dysphagia is associated with several uncertainties regarding its optimal diagnostic work-up and management, particularly, considering the progress with diagnostic modalities and technologies. A Delphi consensus was performed with experts from various disciplines who conducted a literature summary and voting process on 41 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation criteria. Consensus was reached for all the statements. The panel agreed with the definition and prevalence of esophageal and OD types. The role of endoscopy, high-resolution manometry, EndoFLIP, barium swallow and other imaging tests in evaluating esophageal dysphagia has reached overall strong agreement. Videofluoroscopic swallow study, alongside fiber-endoscopic evaluation of swallowing, as the methods of choice for the instrumental assessment of oropharyngeal dysfunction is a strong recommendation. Regarding treatment, a weak recommendation was achieved for the use of PPIs, calcium-channel blockers, nitrates, phosphodiesterase type 5 inhibitors, antidepressants or peppermint oil for the treatment of hypercontractile esophagus. A strong recommendation exists for endoscopic and surgical treatment of achalasia, while a weak recommendation is provided for other esophageal motility disorders. Regarding OD, a weak recommendation was achieved for swallow therapy, to improve swallowing mechanics, reduce symptoms, and enhance quality of life. Swallow therapy could be more effective when using validated assessment tools, consistent treatment parameters, and considering long-term follow-up. A multinational group of European experts summarized the current state of consensus on the definition, diagnosis, and management of dysphagia.

Background/Aims: Manometric measurements are crucial for diagnosing esophageal motility disorders. High-resolution manometry (HRM) studies mainly use 2 catheter systems: solid state (SS) and water perfused (WP), each with distinct advantages. This study aimed to establish normal values for esophageal manometry using both 36-channel WP and SS catheters in healthy volunteers. Materials and Methods: This study, conducted between January 2017 and September 2018, included 44 healthy volunteers with no upper gastrointestinal symptoms or history of gastrointestinal surgery (except inguinal hernia repair or appendectomy). Participants gave written informed consent, abstained from medications and alcohol, and underwent normal endoscopy. They then had 2 consecu tive esophageal manometry sessions, 1 day apart, using a 36-channel SS-HRM catheter and a 36-channel WP-HRM catheter. All trac ings were analyzed using the Chicago classification version 3.0. Results: Four participants were excluded due to gastroesophageal reflux disease (GERD). Of the remaining 40 (age 37.4 ± 7.6, 62.5% male), all underwent WP-HRM, and 34 underwent SS-HRM. In SS-HRM, 74 of 386 swallows were <450 mm Hg·s·cm; in WP-HRM, 151 of 441 swallows were <<450 mm Hg·s·cm. Thus, 4 of 34 volunteers (11.8%) in SS-HRM and 12 of 40 (30%) in WP-HRM had ≥50% swallows with DCI <450 mm Hg·s·cm. Median IRP4 was 17 (7-27) mm Hg in SS-HRM vs. 6 (0-18) mm Hg in WP-HRM. The 5th-95th percentile DCI was 183-2962 mm Hg·s·cm in SS-HRM vs. 65.5-1711.5 mm Hg·s·cm in WP-HRM. Conclusion: This study compares normal values and differences in WP-HRM and SS-HRM among healthy Turkish volunteers, demon strating differing diagnostic criteria and providing valuable reference data for future studies. Cite this article as: Bor S, Sadeghı A, Kıpcak S, Senkaya A. Normal values in esophageal high-resolution manometry performed using 36-channel water-perfused catheter or solid-state catheter. Turk J Gastroenterol. 2025;36(8):515-522.

BACKGROUND:Exposure to COVID-19 has been shown previously to be associated with a higher risk for irritable bowel syndrome (IBS). This study aimed to better explain this relationship using mediation analysis. METHODS:This post hoc analysis of a multicenter cohort study includes 623 patients with and without COVID-19 infection. All participants completed the ROME IV criteria, gastrointestinal symptom rating scale (GSRS), and hospital anxiety and depression scale (HADS) over 1 year. Mediation analysis utilized the PROCESS macro and Baron and Kenny's method for parametric and nonparametric mediating variables, respectively. KEY RESULTS:The impact of COVID-19 on the development of post-COVID-19 IBS is completely mediated by dyspnea at baseline (adjusted OR = 3.561, p = 0.012), severity of acid regurgitation at 1 month [indirect effect, log-odds metric = 0.090, 95% CI (0.006-0.180)], hunger pains at 1 [indirect effect, log-odds metric = 0.094, 95% CI (0.024-0.178)], and 6 months [indirect effect, log-odds metric = 0.074, 95% CI (0.003-0.150)], depression at 6 [indirect effect, log-odds metric = 0.106, 95% CI (0.009-0.225)] and 12 months [indirect effect, log-odds metric = 0.146, 95% CI (0.016-0.311)] as well as borborygmus [indirect effect, log-odds metric = 0.095, 95% CI (0.009-0.203)], abdominal distention [indirect effect, log-odds metric = 0.162, 95% CI (0.047-0.303)], and increased flatus [indirect effect, log-odds metric = 0.110, 95% CI (0.005-0.234)] at 12 months. CONCLUSIONS AND INFERENCES:Our findings provide evidence for psychological and clinical mediators between COVID-19 and post-COVID-19 IBS, which may be promising targets for interventions tailored for treating or preventing depression. The presence of specific GI symptoms at COVID-19 onset and their persistence should increase awareness of a potential new onset of IBS diagnosis.

The diagnosis and management of laryngopharyngeal reflux (LPR) remain challenging due to complex pathophysiological interactions, including autonomic nerve dysfunction and impaired esophageal motility. The lack of definitive diagnostic tools, insufficient exclusion of alternative causes, and variability in study design and methodology often lead to inconsistent treatment responses and suboptimal outcomes. Functional laryngeal disorders and hypersensitivity further complicate accurate diagnosis and management. High-resolution manometry, combined with multichannel impedance testing, has highlighted the role of esophageal dysmotility in LPR symptoms. This article focuses on the neural-mediated mechanisms and esophageal dysmotility contributing to LPR.

AIMS:The purpose of this study was to evaluate proton pump inhibitor (PPI) response rates for gastroesophageal reflux disease (GERD) phenotypes and functional heartburn (FH) according to the different diagnostic techniques. METHODS:This was a retrospective, noninterventional, single-center study, presenting real-life data. Among 1,233 patients, 510 patients agreed to respond and were evaluated via a validated questionnaire consisting of 28 questions. Patients were classified into: Group I (n=54) if the diagnosis was based only on history, Group II (n=151) if diagnosis was documented on history and upper gastrointestinal endoscopy (UGE), and Group III (n=305) if diagnosis was based on history, UGE, high-resolution manometry and intraesophageal 24-h ambulatory pH-impedance monitoring. Patients were classified into 5 phenotypes (according to the final diagnosis): erosive esophagitis (EE) (n=117), non-erosive reflux disease (NERD) (n=94), FH (n=58), reflux hypersensitivity (RH) (n=16) and Barrett esophagus (BE) (n=20). A response rate under 50% was accepted as being nonresponsive with double doses after 8 weeks of treatment. A very good response was defined as being over 80% improvement of typical symptoms. RESULTS:The response rates for heartburn and regurgitation of all the patients were 85.3% and 82.2%, respectively. The heartburn and regurgitation response rates of Group I patients were 79.6% and 70.4%; 91.4% and 85.4% for Group II; whereas 83.3% and 82.6% for Group III. The heartburn and regurgitation response rates of BE were 90% and 90%, for EE 88% and 87.2%, for NERD 85.2% and 85.1%, for RH 68.8% and 62.5% and for FH 72.4% and 74.1%. Response rates for both heartburn and regurgination were 40% in BE, 41.4% in EE, 18.8% in NERD, 24.1% in RH and 15.5% in FH. CONCLUSIONS:We demonstrated higher PPI response rates than Western populations in all the GERD patients. More than 1/3 of the patients exhibited very good response rates for both heartburn and regurgitation. The response rates of patients who were diagnosed via all the diagnostic modalities are lower than those who were diagnosed via only history and UGE.

Aim:This systematic review evaluated the effectiveness of proton pump inhibitors (PPIs) in improving manometric parameters in patients with gastroesophageal reflux disease (GERD) diagnosed with Ineffective esophageal motility (IEM). Background:IEM represents the most common esophageal motility disorder among patients with GERD. To date, no treatment has conclusively demonstrated efficacy in restoring esophageal motor function in these individuals. Methods:This systematic review was performed according to the PRISMA guidelines. We conducted comprehensive searches of electronic databases, including PubMed, Embase, and Scopus, until January 2024 to identify relevant randomized and non-randomized controlled trials. Criteria for study inclusion were based on the population, intervention, comparison, and outcome framework. Results:A total of 9 studies met the inclusion criteria, comprising eight non-randomized controlled trials (non-RCTs) and one randomized controlled trial (RCT). Out of 305 recruited patients with a diagnosis of GERD, 185 patients matched the diagnosis of IEM with manometric studies before and after a PPI treatment. PPIs used in the studies included omeprazole, pantoprazole, lansoprazole, and rabeprazole. The duration of treatment ranged from four to twenty-four weeks. Except for one study, there was no statistically significant improvement in manometric parameters following PPI treatment. Conclusion:Evidence from included studies indicates that although PPIs are effective in healing esophagitis, they do not consistently improve esophageal motility, irrespective of the PPI type, dosage, or treatment duration.

BACKGROUND/AIMS:Idiopathic achalasia is a rare esophageal motility disorder of unknown etiology. Although its neuromuscular aspects are well described, little is known about the role of the esophageal epithelium. This study aimed to evaluate the activation status of key cell signaling pathways and assess esophageal epithelial barrier function in achalasia patients. MATERIALS AND METHODS:Biopsy samples from 37 achalasia patients and 15 healthy volunteers (HVs) were analyzed. Tissue resistance and permeability were measured using a mini-Ussing chamber system. Gene expression related to epithelial integrity and signaling was assessed via quantitative reverse transcription polymerase chain reaction, and corresponding protein levels were evaluated using enzyme-linked immunosorbent assay (ELISA) and multiplex ELISA. RESULTS:No significant differences were observed in epithelial resistance (achalasia: 187.3 ± 25.6 Ω vs. HVs: 166.8 ± 20.1 Ω, P = .18) or permeability (achalasia: 35.76 ± 5.4 pmol vs. HVs: 36.9 ± 4.7 pmol, P = .67) between the 2 groups. Thirty-two genes involved in key sig naling pathways were found to be significantly deregulated (P < .05), and 6 key signaling proteins (Akt (Ser473), c-Jun (Ser63), Erk1/2 (Th202/Tyr204), Thr185/Tyr187), IκB-α (Ser32/Ser36), MEK1 (Ser217/Ser221), mTOR (Ser2448)) were downregulated at the protein level (P < .05). CONCLUSION:The findings reveal that major signaling pathways, including MAPK, PI3K/AKT/mTOR, and JAK/STAT, are significantly sup pressed in the esophageal epithelium of achalasia patients, despite preserved epithelial barrier integrity. These molecular alterations may represent a previously unrecognized component of achalasia pathogenesis. Furthermore, the preserved barrier function suggests that endoscopic therapies such as peroral endoscopic myotomy may not exacerbate reflux-related epithelial injury in these patients.   Cite this article as:Kipcak S, Ergun P, Gunel NS, Bor S. Epithelial barrier function and altered cell signaling pathways in the esophageal epithelium of achalasia patients. Turk J Gastroenterol. 2026;37(2):170-178.

INTRODUCTION:Abdominal distension is an objective visible sign of increased abdominal girth. Bloating is a feeling of abdominal fullness and discomfort. Bloating may be associated or not with abdominal distension. Bloating and abdominal distension are among the most commonly reported gastrointestinal symptoms and may be associated with both organic and functional disorders. Nevertheless, specific consensus and recommendations on diagnosis, underlying mechanisms, assessment and management of functional bloating and abdominal distension are still lacking. The aim of this European consensus, then, is to provide expert opinions and recommendations on the epidemiology, diagnosis, pathophysiology and treatment of functional bloating and abdominal distension. METHODS:A multidisciplinary team of experts in the field, including European specialists and national societies, participated in the development of this consensus. Relevant questions were formulated and addressed through a literature review and statements were developed and voted using a Delphi process. RESULTS:Functional bloating and abdominal distension are common and frequently overlap with other disorders of gut-brain interaction. Diagnosis is made according to the Rome IV criteria after the exclusion of organic disease, based on the physical examination and assessment of the patient's medical history and alarming signs. In the absence of alarming signs or any relevant finding, clinical laboratory, imaging or endoscopic tests are unnecessary. The pathophysiology of functional bloating and abdominal distension is multifactorial and involves visceral hypersensitivity, abdomino-phrenic dyssynergia, intestinal dysmotility and dysbiosis. Treatment may include dietary modifications (e.g. lactose-limiting diet and low FODMAP diet), probiotics, antispasmodics (e.g., otilonium bromide, peppermint oil), rifaximin, secretagogues (e.g., linaclotide), neuromodulators (e.g., serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, buspirone), and plethysmography-based biofeedback. Moreover, cognitive behaviour therapy and hypnotherapy can be used in case of functional bloating associated with irritable bowel syndrome. CONCLUSION:This consensus provides an evidence-based framework for the evaluation and treatment of patients with functional bloating and abdominal distension.

Extraesophageal reflux is a complex clinical entity, classically presenting with laryngopharyngeal symptoms including chronic cough and vocal changes, but it is also implicated in conditions such as subglottic stenosis and lung injury. Diagnosis is challenging, in large part due to the oftentimes vague presenting symptoms with multiple possible etiologies, as well as limited consistency of currently available diagnostic tests. Furthermore, effective medical treatment is limited, and acid suppression therapy such as proton pump inhibitors has shown low to mixed efficacy in relieving signs and symptoms of reflux outside the esophagus. In this review, we will address laryngopharyngeal reflux and its diagnosis based on symptoms and exam findings, and diagnostic tools such as impedance monitoring and salivary pepsin testing. A summary of the use and limitations of acid-suppressing therapies for extraesophageal reflux and the rationale for targeting pepsin as a nonacid component of reflux will be presented. Finally, the current literature on the potential role of reflux in subglottic stenosis and lessons learned regarding reflux in the lung transplant surgery field in higher risk patient populations will be discussed.

Proton pump inhibitors (PPIs) one of the most prescribed drugs worldwide, inhibit acid secretion in the stomach by irreversible hydrogen/potassium adenosine triphosphatase (H+/K+ ATPase) blocking. Currently conventional PPIs in markets are mainly in racemic forms (containing both R- and S- forms). It has been suggested that the beneficial effects of racemic PPIs mostly depend on one of the enantiomers, and a drug containing pure enantiomers might be superior to racemic PPIs. Enantiomers are mirror image stereoisomers of a molecule. In this article, we aim to analyze the comparative studies of the enantiomers of PPIs with non-racemic counter-parts and to assess whether enantiomers, as suggested by certain studies and primarily promoted by some pharmaceutical companies, demonstrate superior efficacy.

Antispasmodics are commonly used to treat irritable bowel syndrome (IBS) symptoms. They are generally regarded as safe.However, some have been found to be ineffective or not cost-effective. Marked discrepancies in the availability and formulation of antispasmodic agents across countries—ranging from the limitation to only fundamental compounds in regions such as the United States to the marketing of diverse combination products elsewhere—have generated considerable ambiguity and debate within the field. Meta-analyses show varying results on the efficacy of antispasmodics, indicating the need for further analysis. This article aims to evaluate the effectiveness of antispasmodic drugs in relieving symptoms in IBS patients. We conclude that most drugs are considered safe and effective, with pinaverium, otilonium, and peppermint oil having meta-analyses supporting their efficacy. However, there is a lack of high-quality data for drugs like alverine, trimebutine, and cimetropium, and some drugs, such as simeticone or combinations of spasmolytic agents and simeticone, have insufficient research data. Clinicians should prioritize evidence-based medicine when selecting antispasmodic agents. Cite this article as: Bor S, Özen H, Akyüz F, et al. Expert opinion on the efficacy and safety of antispasmodics with a focus on irritable bowel syndrome. Turk J Gastroenterol. 2025;36(Supp 2):S1-S38.

Patients undergoing laparoscopic anti-reflux surgery (LARS) often experience improved quality of life and reduced gastroesophageal reflux disease (GERD) symptoms. This study aimed to assess the impact of LARS on epithelial remodeling and repair in the esophageal mucosa. Upper gastrointestinal (GI) endoscopy was performed once on healthy controls (HC) and twice on GERD patients before and approximately 6 month after surgery, with esophageal biopsies collected. The expressions of E-cadherin (ECAD), Occludin (OCLN), Claudin 1 (CLDN1), Claudin 4 (CLDN4), Zonula Occludens -1 (ZO-1), and ZO-2 were analyzed in the biopsies, and dilated intercellular spaces (DIS) were examined under light microscopy. The study included 22 GERD patients who were underwent for LARS, and 20 HCs. All patients had pathological reflux episodes. In the Post-LARS group, TEER increased significantly compared to Pre-LARS and HC (p < 0.05), while mucosal permeability decreased (p < 0.05). A significant negative correlation was found between TEER and permeability (p = 0.0002). DIS remained dilated in both Pre- and Post-LARS patients compared to HC (p < 0.05). Gene expression analysis revealed significant increases in ZO-1, OCLN, and ZO-2 Post-LARS (p < 0.05). LARS improves mucosal integrity by enhancing TEER and reducing permeability in GERD patients, although DIS remains unchanged. The upregulation of tight junction genes such as ZO-1 and OCLN Post-LARS suggests that surgical intervention may support epithelial barrier restoration. DIS remains dilated after LARS; this might be reason that it is not an early marker in GERD pathogenesis. These findings enhance our understanding of GERD nature and may inform future target therapeutic strategies.

BACKGROUND:The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has highlighted the potential exacerbation of gastrointestinal symptoms in patients with disorders of gut-brain interaction (DGBIs). However, the distinct symptom trajectories and psychological burden in patients with post-COVID-19 DGBIs compared with patients with pre-existing irritable bowel syndrome (IBS)/functional dyspepsia (FD) and non-DGBI controls remain poorly understood. OBJECTIVES:To examine the long-term gastrointestinal symptom progression and psychological comorbidities in patients with post-COVID-19 DGBI, patients with pre-existing IBS/FD and non-DGBI controls. METHODS:This post hoc analysis of a prospective multicenter cohort study reviewed patient charts for demographic data and medical history. Participants completed the Gastrointestinal Symptom Rating Scale at four time points: baseline, 1, 6, and 12 months, and the Hospital Anxiety and Depression Scale at 6 and 12 months. The cohort was divided into three groups: (1) post-COVID-19 DGBIs (2) non-DGBI, and (3) pre-existing IBS/FD, with the post-COVID-19 DGBIs group compared to the latter two control groups. RESULTS:Among 599 eligible patients, 27 (4.5%) were identified as post-COVID-19 DGBI. This group experienced worsening abdominal pain, hunger pain, heartburn, and acid regurgitation, unlike symptom improvement or stability in non-DGBI controls (p < 0.001 for all symptoms, except hunger pain, p = 0.001). While patients with pre-existing IBS/FD improved in most gastrointestinal symptoms but worsened in constipation and incomplete evacuation, patients with post-COVID-19 DGBI exhibited consistent symptom deterioration across multiple gastrointestinal domains. Anxiety and depression remained unchanged in patients with post-COVID-19 DGBI, contrasting with significant reductions in controls (non-DGBI: p = 0.003 and p = 0.057; pre-existing IBS/FD: p = 0.019 and p = 0.007, respectively). CONCLUSIONS:COVID-19 infection is associated with the development of newly diagnosed DGBIs and distinct symptom trajectories when compared with patients with pre-existing IBS/FD. Patients with post-COVID-19 DGBI experience progressive gastrointestinal symptom deterioration and persistent psychological distress, underscoring the need for tailored management strategies for this unique subgroup.

BACKGROUND:Prokinetics are a class of pharmacological drugs designed to improve gastrointestinal (GI) motility, either regionally or across the whole gut. Each drug has its merits and drawbacks, and based on current evidence as high-quality studies are limited, we have no clear recommendation on one class or other. However, there remains a large unmet need for both regionally selective and/or globally acting prokinetic drugs that work primarily intraluminally and are safe and without systemic side effects.PURPOSE:Here, we describe the strengths and weaknesses of six classes of prokinetic drugs, including their pharmacokinetic properties, efficacy, safety and tolerability and potential indications.

Amaç: Dünya genelinde yaklaşık %1’lik bir prevelansa sahip olan çölyak hastalığı, ülkemizde de sık görülmekte ancak tanıda gözden kaçabilmektedir. Asemptomatik çölyak hastalığının yetişkin bireylerde daha sık görülmesi de tanıyı zorlaştırmaktadır. Bu nedenle çölyak hastalığının farkındalığını arttırmak ve hastalığının farkında olmayan bireylerin tanı almasını sağlamak amacıyla Ege Üniversitesi Tıp Fakültesi bünyesinde bir anket ve bilgilendirme çalışması düzenlenmiştir. Gereç ve Yöntem: Çalışmamızda yaklaşık 550 tıp fakültesi öğrencisine ayrıntılı çölyak semptom anketi uygulanmış ve semptom pozitifliği belirlenen 110 birey Ege Üniversitesi Tıp Fakültesi Gastroenteroloji Kliniği’ne davet edilmiştir. Bulgular: Davetler sonucunda yalnızca 36 kişi kliniğimize ziyaret gerçekleştirmiştir. Bu ziyaretler esnasında hastaların anemnezleri sonrası serumlarında çölyak antikorları incelenmiştir. Çalışma sonucunda çölyak ilişkili klinik bulgular ve riskler göstermelerine rağmen hiçbir hastada çölyak serolojisine rastlanmamıştır. Bu kişilerin ilerleyen dönemlerde semptom pozitifliği devam etmesi durumunda tekrar kliniğe davet edilmeleri planlanmıştır. Ayrıca bu kişilerin çölyak dışı gluten intoleranslarının olabileceği düşünülmüştür. Sonuç: Ülkemizde tıp fakültesi öğrencileri arasında ilk defa gerçekleştirilen çölyak semptom taraması çalışmasının, ilerleyen dönemlerde merkez kampüs kapsamında genişletilerek tekrarlanması planlanmaktadır. Bunların dışında, yapılan bu çalışma ile tıp fakültesi öğrencilerinin sahip olduğu birçok hastalık ve tıbbi şikâyetin sıklıklarına yönelik veriler elde edilmiştir.

BACKGROUND Currently, the primary treatment for gastroesophageal reflux is acid suppression with proton pump inhibitors, but they are not a cure, and some patients don’t respond well or refuse long-term use. Therefore, alternative therapies are needed to understand the disease and develop better treatments. Laparoscopic anti-reflux surgery (LARS) can resolve symptoms of these patients and plays a significant role in evaluating esophageal healing after preventing harmful effects. Successful LARS improves typical gastroesophageal reflux symptoms in most patients, mainly by reducing the exposure time to gastric contents in the esophagus. Amelioration of the inflammatory response and a recovery response in the esophageal epithelium is expected following the cessation of the noxious attack. AIM To explore the role of inflammatory biomolecules in LARS and assess the time required for esophageal epithelial recovery. METHODS Of 22 patients with LARS (pre- and post/5.8 ± 3.8 months after LARS) and 25 healthy controls (HCs) were included. All subjects underwent 24-h multichannel intraluminal impedance-pH monitoring and upper gastrointestinal endoscopy, during which esophageal biopsy samples were collected using endoscopic techniques. Inflammatory molecules in esophageal biopsies were investigated by reverse transcription-polymerase chain reaction and multiplex-enzyme-linked immunosorbent assay. RESULTS Post-LARS samples showed significant increases in proinflammatory cytokines [interleukin (IL)-1β, interferon-γ, C-X-C chemokine ligand 2 (CXCL2)], anti-inflammatory cytokines [CC chemokine ligand (CCL) 11, CCL13, CCL17, CCL26, CCL1, CCL7, CCL8, CCL24, IL-4, IL-10], and homeostatic cytokines (CCL27, CCL20, CCL19, CCL23, CCL25, CXCL12, migration inhibitory factor) compared to both HCs and pre-LARS samples. CCL17 and CCL21 levels were higher in pre-LARS than in HCs (P < 0.05). The mRNA expression levels of AKT1, fibroblast growth factor 2, HRAS, and mitogen-activated protein kinase 4 were significantly decreased post-LARS vs pre-LARS. CCL2 and epidermal growth factor gene levels were significantly increased in the pre-LARS compared to the HCs (P < 0.05). CONCLUSION The presence of proinflammatory proteins post-LARS suggests ongoing inflammation in the epithelium. Elevated homeostatic cytokine levels indicate cell balance is maintained for about 6 months after LARS. The anti-inflammatory response post-LARS shows suppression of inflammatory damage and ongoing postoperative recovery.