# Achalasia: Physician Practices and Knowledge in Türkiye

## TL;DR

This study explores how Turkish physicians diagnose and manage achalasia, a rare esophageal disorder, revealing gaps in knowledge and access to diagnostic tools.

## Contribution

The study presents the first nationwide assessment of physician practices and knowledge regarding achalasia in Türkiye.

## Key findings

- Physicians in tertiary hospitals showed higher knowledge and diagnostic accuracy compared to others.
- Male physicians demonstrated better diagnostic recognition than female physicians.
- Only 9.1% of physicians reported easy access to high-resolution esophageal manometry.

## Abstract

Achalasia is a rare esophageal motility disorder often underrecognized due to nonspecific symptoms and limited physician awareness. Although diagnostic tools have advanced, delays remain common. Previous studies in Türkiye were mainly single-center or review-based, with no nationwide assessment of physician-related factors. This study evaluated physician knowledge, diagnostic practices, high-resolution esophageal manometry (HREM) access, and factors influencing diagnostic delay, providing the first nationwide achalasia-focused dataset.

A web-based survey was conducted among 4216 physicians; 675 responses (16.0%) were analyzed. The 32-item questionnaire included demographics, achalasia knowledge, diagnostic/referral practices, HREM accessibility, and training. Participants included 12.3% primary care physicians, 26.4% secondary-level, 26.2% tertiary training/research, and 35.1% university hospital physicians. Overall, 89.6% practiced internal medicine, 9.8% surgical sciences, and 0.6% basic medical sciences.

Male physicians demonstrated higher knowledge (60.8% vs. 39.2%; P < .001) and diagnostic recognition, whereas females reported more self-perceived deficiencies (P < .001). Gastroenterologists had superior diagnostic accuracy (P < .001), but easy HREM access was limited (9.1%). Physicians in tertiary hospitals showed higher knowledge and diagnostic accuracy (P = .025 and P = .040). Participation in training programs and treatment familiarity did not vary by hospital type (P = .437 and P = .512).

Variations in physician knowledge and diagnostic practices across specialties, hospital types, and gender may contribute to delayed achalasia recognition. Persistent gaps in practical competence, HREM familiarity, and access to diagnostic resources highlight the need for targeted education and structured interventions. Improving diagnostic infrastructure and HREM access may enable earlier diagnosis and enhance outcomes.