Your case suggestive of chronic heartburn and regurgitation strongly suggests GERD, while the manometry findings of low motility indicate an underlying esophageal motility disorder Surgical Considerations A standard Nissen fundoplication may not be suitable due to poor motility. But modified surgical approaches like: Partial (Toupet) fundoplication Loose two-stitch Nissen fundoplication could be considered in selected cases Other option is Proton pump inhibitors (PPIs) Prokinetics to improve motility H2 blockers as add-on therapy