Introduction

Achalasia is a primary motor disorder of the oesophagus characterised by absence of peristalsis and insufficient lower oesophageal sphincter relaxation. With new advances and developments in achalasia management, there is an increasing demand for comprehensive evidence-based guidelines to assist clinicians in achalasia patient care.

Methods
These guidelines were established in accordance with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. A systematic review of the literature was performed and the certainty in the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Recommendations were voted upon using a nominal group technique.

Results
These guidelines specifically focus on the definition of achalasia, treatment aims, diagnostic tests, medical, endoscopic and surgical therapy, management of treatment failure, follow-up and oesophageal cancer risk.

Conclusion
These multidisciplinary UEG and ESNM guidelines provide a comprehensive evidence-based framework with recommendations on the diagnosis, treatment and follow-up of adult achalasia patients.

Keywords: Dysphagia; oesophagus; manometry; myotomy; motility; esophagus

This guideline presents recommendations for the management of coeliac disease (CD) and other gluten-related disorders both in adults and children.
There has been a substantial increase in the prevalence of CD over the last 50 years and many patients remain undiagnosed. Diagnostic testing, including serology and biopsy should be performed on a glutencontaining diet.
The diagnosis of CD is based on a combination of clinical, serological and histopathological data. In a group of children the diagnosis may be made without biopsy if strict criteria are available.
The treatment for CD is primarily a gluten-free diet (GFD), which requires significant patient education, motivation, and follow-up. Slow-responsiveness occurs frequently, particularly in those diagnosed in  adulthood.
Persistent or recurring symptoms necessitate a review of the original diagnosis, exclude alternative diagnoses, confirm dietary adherence (dietary review and serology) and follow-up biopsy. In addition, evaluation to exclude complications of CD, such as refractory CD or lymphoma, should be performed. The guideline also deals with other gluten-related disorders, such as dermatitis herpetiformis, which is a cutaneous manifestation of CD characterized by granular IgA deposits in the dermal papillae. The skin lesions clear with gluten withdrawal. Also, less well-defined conditions such as non-coeliac gluten sensitivity (NCGS) and gluten-sensitive neurological manifestation, such as ataxia and have been addressed.
Newer therapeutic modalities for CD are being studied in clinical trials, but are not yet approved for use in practice.

Keywords: Coeliac disease; seronegative coeliac disease; dermatitis herpetiformis; non-coeliac gluten sensitivity; gluten ataxia; neurocoeliac; coeliac neuropathy; slow-responder coeliac; refractory coeliac disease; enteropathy associated T-cell lymphoma

ESGE suggests flexible endoscopic treatment over open surgical treatment as first-line therapy for patients with a symptomatic Zenker’s diverticulum of any size.

Weak recommendation, low quality of evidence, level of agreement 100 %.

ESGE recommends that emerging treatments for Zenker’s diverticulum, such as Zenker’s peroral endoscopic myotomy (Z-POEM) and tunneling, be considered as experimental; these treatments should be offered in a research setting only.

Strong recommendation, low quality of evidence, level of agreement 100 %.

ESGE recommends against the widespread clinical use of transoral incisionless fundoplication (TIF) as an alternative to proton pump inhibitor (PPI) therapy or antireflux surgery in the treatment of gastroesophageal reflux disease (GERD), because of the lack of data on the long-term outcomes, the inferiority of TIF to fundoplication, and its modest efficacy in only highly selected patients. TIF may have a role for patients with mild GERD who are not willing to take PPIs or undergo antireflux surgery.

Strong recommendation, moderate quality of evidence, level of agreement 92.8 %.

ESGE recommends against the use of the Medigus ultrasonic surgical endostapler (MUSE) in clinical practice because of insufficient data showing its effectiveness and safety in patients with GERD. MUSE should be used in clinical trials only.

Strong recommendation, low quality evidence, level of agreement 100 %.

ESGE recommends against the use of antireflux mucosectomy (ARMS) in routine clinical practice in the treatment of GERD because of the lack of data and its potential complications.

Strong recommendation, low quality evidence, level of agreement 100 %.

ESGE recommends endoscopic cecostomy only after conservative management with medical therapies or retrograde lavage has failed.

Strong recommendation, low quality evidence, level of agreement 93.3%.

ESGE recommends fixing the cecum to the abdominal wall at three points (using T-anchors, a double-needle suturing device, or laparoscopic fixation) to prevent leaks and infectious adverse events, whatever percutaneous endoscopic cecostomy method is used.

Strong recommendation, very low quality evidence, level of agreement 86.7%.

ESGE recommends considering endoscopic decompression of the colon in patients with Ogilvie’s syndrome that is not improving with conservative treatment.

Strong recommendation, low quality evidence, level of agreement 93.8%.

ESGE recommends prompt endoscopic decompression if the cecal diameter is > 12 cm and if the Ogilvie’s syndrome exists for a duration of longer than 4–6 days.

Strong recommendation, low quality evidence, level of agreement 87.5%.