“The real voyage of discovery consists not in seeking new landscapes, but in having new eyes.”
Marcel Proust [1]
In early modern history, the Age of Discovery represents a period from approximately the late 15th century to the 17th century, during which seafarers from several European countries explored previously isolated regions, reshaping the world’s perspective and challenging traditional views. Today, we reflect on this era with ambivalence; however, progress and innovation are impossible without courage, curiosity, endurance, optimism, and a commitment to excellence.
From Naval History to Visceral Medicine!
In the past two decades, diagnostic and therapeutic options in neurogastroenterology – especially for motility disorders – have significantly evolved. Remarkable progress has been achieved in treating esophageal motility disorders such as achalasia through peroral endoscopic myotomy (POEM), a major advancement within the concept of natural orifice transluminal endoscopic surgery [2‒4]. Third-space endoscopy, which prepares a submucosal tunnel to reach the target structure (e.g., a hypercontractile segment in hypercontractile esophageal motility disorders), allows us to perform highly individualized interventions and provides a new, direct view of these diseases (chapter 4) [5]. The introduction of Endoflip technology has further facilitated the performance of POEM in both the esophagus and stomach, enabling tailored therapy.
In addition to these developments, numerous other innovations have broadened the spectrum of diagnostics and treatments available for managing motility disorders in 2025. Establishing a neurogastroenterology unit is essential for the optimal management of these disorders. Thomas Frieling discusses the foundational principles of setting up such a unit: “Building a Neurogastroenterology Unit: Where, Why, and How?” [6]. Sandra Nagl, Alana Ebigbo, and Helmut Messmann describe advancements in esophageal function testing and complementary techniques, such as impedance measurements with EndoFLIP, which assesses mechanical properties and distensibility rather than solely contractile patterns and bolus transit [7].
Besides pharmacological and endoscopic interventions, surgical procedures remain primary therapeutic options, particularly for types I and II achalasia. The initial open surgical technique has since evolved to the laparoscopic Heller myotomy (LHM) and, more recently, the robotic Heller myotomy. Patrick S. Plum, Stefan Niebisch, and Ines Gockel provide an overview of the current state-of-the-art surgery for achalasia, its challenges, and potential future directions [8].
Felix Gundling and Georg Pistorius illustrate the challenges of selecting the optimal therapy for a young female patient with type 3 achalasia refractory to both anterior and posterior POEM [5]. The prevalence of fecal incontinence is estimated at 1.5% in the general population, though it is likely underreported. The condition’s etiology is multifactorial, often involving underlying motility disturbances, such as weakened anal sphincters [9, 10]. Christian Pehl discusses etiology, diagnostic approaches, and conservative treatment [11].
Birgit Bittorf and Klaus Matzel review both historical and current surgical treatment options for optimizing the management of fecal incontinence [12]. Considering the ongoing demographic changes in developed countries, understanding the age-dependency of motility disorders and their pathophysiological mechanisms, especially those involving neurodegeneration, is increasingly important. Robert Patejdl provides a comprehensive overview of gastrointestinal motility function and dysfunction in elderly patients, discussing the effects of aging [13].
Gastroesophageal reflux disease is another common motility disorder, affecting up to 30% of the global population. Its pathophysiology is multifactorial, including ineffective esophageal motility and clearance. Mark Fox provides an update on diagnostic and conservative management approaches for gastroesophageal reflux disease, addressing the treatment of “difficult patients” with refractory symptoms [14‒16]. At what point should a surgeon intervene? This question is explored by Jessica Leers and Marika Ebner [17].
Wolfgang Breithaupt and Benjamin Babic [18] describe the “Scylla and Charybdis” of impaired gastric motility, focusing on the surgical approach to gastroparesis – a condition affecting around 200,000 patients in Germany – and Dumping Syndrome, a classic complication of gastric surgery [19]. This special issue concludes with a contribution from Ernst Eypasch and Christian Albus, who examine psychosomatic disorders that may present as motility disorders [20].
