Patients with gastroesophageal reflux disease (GERD) may present with concomitant gas-related symptom (GRS) such as supragastric or gastric belching, and aerophagia. Identifying these patients is crucial, as their therapeutic pathway differs substantially from that of patients with "pure" reflux disease. Proceeding directly to antireflux surgery in the presence of untreated air-associated symptoms can lead to catastrophic postoperative outcomes. These partly behavioral disorders can often be effectively managed through targeted speech therapy. Following successful therapy, patients may either experience complete resolution of their symptoms or become suitable candidates for surgical treatment of GERD. As of today, there is very scarce literature on this subject.

Inclusion Criteria:

• Age 18 years and older
• Initial presentation at our reflux center with reflux symptoms, with or without concomitant air-related symptoms such as belching, bloating, or abdominal distension
• Confirmed air-related pathology based on characteristic clinical findings and/or diagnostic evidence from impedance, manometry, or videofluoroscopic swallow study (VFSS)
• Verbal informed consent as documented by the investigator

Exclusion Criteria:

• Age under 18 years
• Pregnancy
• Exclusion of GERD
• Preoperative presence of a hiatal hernia with migration of >20% of stomach in the chest
• Revisional surgery (after other procedures for reflux or at the hiatus)

The retrospective patients are identified through the upper gastrointestinal surgery data base of our institution. All patients who meet the inclusion criteria by having received the intervention which is subject to be studied will be contacted and recruited for the study. There is no participant payment or compensation for enrolment in the study.