We established normal values for the HRM parameters in a representative sample of the Thai population. Our supine results still prove that the use of the CC v3.0 is preferable. HRM testing in patients measured in the upright position should be analyzed based on the normative values obtained from upright swallow studies.

The management of dyspepsia in limited-resource areas has not been established. In 2017, key opinion leaders throughout Thailand gathered to review and evaluate the current clinical evidence regarding dyspepsia and to develop consensus statements, rationales, levels of evidence, and grades of recommendation for dyspepsia management in daily clinical practice based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. This guideline is mainly focused on the following 4 topics: (1) evaluation of patients with dyspepsia, (2) management, (3) special issues (overlapping gastroesophageal reflux disease/irritable bowel syndrome and non-steroidal anti-inflammatory drug/aspirin use), and (4) long-term follow-up and management to provide guidance for physicians in Thailand and other limited-resource areas managing such patients.

Introduction: Gastroesophageal reflux plays a significant role in idiopathic pulmonary fibrosis (IPF).Given the morbidity and mortality associated with IPF, understanding the mechanisms responsible for reflux is essential if patients are to receive optimal treatment and management, especially given the lack of clear benefit of anti-reflux therapies. Our aim was to understand the inter-relationships between esophageal motility, lung mechanics and reflux (particularly proximal reflux -a prerequisite of aspiration), and pulmonary function in IPF patients. Methods:We prospectively recruited 35 IPF patients (aged 53-75yrs; 27 male) who underwent highresolution impedance manometry and 24-hr pH-impedance, together with pulmonary function assessment.Results: Twenty-two (63%) patients exhibited dysmotility, 16(73%) ineffective esophageal motility (IEM) and 6(27%) esophagogastric junction outflow obstruction. Patients with IEM had more severe pulmonary disease (%FVC:p=0.032) and more proximal reflux (p=0.074) than patients with normal motility. In patients with IEM, intra-thoracic pressure inversely correlated with the number of proximal events (r=-0.429;p=0.098). Surprisingly, inspiratory lower esophageal sphincter pressure (LESP) positively correlated with the percentage of reflux events reaching the proximal esophagus (r=0.583;p=0.018), whilst in patients with normal motility it inversely correlated with the bolus exposure time (r=-0.478;p=0.098) and number of proximal events (r=-0.542;p=0.056). %FVC in IEM patients inversely correlated with the percentage of reflux events reaching the proximal esophagus (r=-0.520;p=0.039) and inspiratory LESP (r=-0.477;p=0.062), and positively correlated with intrathoracic pressure (r=0.633;p=0.008). Conclusions:We have shown that pulmonary function is worse in patients with IEM which is associated with more proximal reflux events, the latter correlating with lower intra-thoracic pressures and higher LESPs.