Achalasia: Physician Practices and Knowledge in Türkiye

Area of Science:

• Gastroenterology
• Esophageal Motility Disorders

Background:

• Achalasia is a rare esophageal motility disorder often underrecognized due to nonspecific symptoms and limited physician awareness.
• Diagnostic delays for achalasia are common despite advancements in diagnostic tools.
• Previous studies in Türkiye were primarily single-center or review-based, lacking a nationwide assessment of physician-related factors.

Purpose of the Study:

• To evaluate physician knowledge, diagnostic practices, and access to high-resolution esophageal manometry (HREM).
• To identify factors influencing diagnostic delay for achalasia nationwide in Türkiye.
• To provide the first nationwide dataset on achalasia-focused physician practices.

Main Methods:

• A web-based survey was distributed to 4216 physicians, with 675 responses analyzed (16.0% response rate).
• The 32-item questionnaire assessed demographics, achalasia knowledge, diagnostic/referral practices, HREM accessibility, and training.
• Participants represented various physician levels and specialties, including primary care, secondary, tertiary, and university hospital physicians, predominantly in internal medicine.

Main Results:

• Male physicians showed higher knowledge and diagnostic recognition compared to females.
• Gastroenterologists demonstrated superior diagnostic accuracy, but easy HREM access was limited to 9.1% of respondents.
• Physicians in tertiary hospitals exhibited higher knowledge and diagnostic accuracy, while training participation and treatment familiarity did not vary by hospital type.

Conclusions:

• Variations in physician knowledge and practices across specialties, hospital types, and gender contribute to delayed achalasia recognition.
• Significant gaps in practical competence, HREM familiarity, and diagnostic resource access necessitate targeted education and interventions.
• Enhancing diagnostic infrastructure and HREM accessibility is vital for earlier achalasia diagnosis and improved patient outcomes.