ASGE Annual Postgraduate Course Endoscopy 2022: Breakthrough to Excellence

Vaezi_HRM FLIP PH Monitoring
Pdf Summary
The document provides an overview of HRM (High-resolution Manometry), Flip (EndoFlip System), and pH monitoring and how and when they are used in diagnosing esophageal disorders. It is written by Michael F. Vaezi, MD, PhD, MSc, a Professor of Medicine and Otolaryngology at Vanderbilt University Medical Center.<br /><br />The document highlights the importance of the esophagus as a barrier for gastroesophageal reflux disease (GERD) and for the transfer of food. It also discusses various esophageal syndromes, both symptomatic and those with esophageal injury, such as reflux esophagitis, reflux stricture, Barrett's esophagus, and adenocarcinoma. It mentions established associations between GERD and conditions like reflux cough, reflux laryngitis, reflux asthma, and reflux dental erosions, as well as proposed associations with sinusitis, pulmonary fibrosis, pharyngitis, and recurrent otitis media.<br /><br />The document provides a timeline of reflux testing, from the early 20th century to the present day, highlighting key milestones in the development of ambulatory esophageal pH testing. It also mentions the current design of the FDA-approved MI (manometry) wireless impedance device for esophageal reflux testing.<br /><br />Indications for esophageal reflux testing are discussed, including incomplete or lack of response to therapy and prior to anti-reflux intervention. The document also covers dysphagia, difficulty swallowing, and differentiating between oropharyngeal and esophageal dysphagia. Various diagnostic methods are mentioned, such as endoscopy, barium swallow, and manometry (including HRM and impedance).<br /><br />The document concludes with a discussion of esophageal dysphagia, especially in the context of severe chest pain, regurgitation, chronic heartburn, respiratory symptoms, and weight loss. It mentions conditions such as mechanical obstruction, motor dysfunction, esophageal (Schatzki') rings, diffuse esophageal spasm, peptic stricture, malignancy, achalasia, and scleroderma.<br /><br />Overall, the document serves as an introduction to the use of HRM, Flip, and pH monitoring in diagnosing and understanding various esophageal disorders and their associated symptoms.
Keywords
HRM
Flip
pH monitoring
esophageal disorders
GERD
reflux testing
dysphagia
esophageal dysphagia
endoscopy
barium swallow