ASGE Annual Postgraduate Course Endoscopy 2022 (On-Demand): Breakthrough to Excellence-Vaezi

Vaezi_HRM FLIP PH Monitoring

Pdf Summary

This document discusses HRM (high-resolution manometry), Flip (endoFlip system), and pH monitoring, and when and how to use them in the evaluation of esophageal function and 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 begins by explaining the importance of the esophagus in preventing gastroesophageal reflux disease (GERD) and facilitating food transfer. It then describes various esophageal syndromes, including typical reflux syndrome, reflux chest pain syndrome, and syndromes with esophageal injury such as reflux esophagitis, reflux stricture, Barrett's esophagus, and adenocarcinoma. Proposed associations between GERD and extra-esophageal symptoms such as reflux cough, reflux laryngitis, reflux asthma, reflux dental erosions, sinusitis, pulmonary fibrosis, pharyngitis, and recurrent otitis media are also mentioned.<br /><br />The document outlines different treatment options for GERD, including PPIs (proton pump inhibitors), H2RAs (histamine-2 receptor antagonists), antacids, lifestyle modifications, and PPI trials. It then presents a timeline of reflux testing, starting from the 1910s until now, and highlights the development and FDA approval of wireless impedance monitoring on December 23, 2019.<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 then goes on to explain the different methods of testing, such as supine meal testing, ambulatory esophageal pH monitoring, and the use of the endoFlip system for assessing esophageal function.<br /><br />Dysphagia, or difficulty swallowing, is explored, and the various causes of oropharyngeal and esophageal dysphagia are discussed. Diagnostic modalities such as endoscopy, barium swallow, and manometry (including high-resolution manometry) are mentioned. The document also highlights the role of the endoFlip system in assessing severe chest pain, regurgitation, and other related symptoms.<br /><br />Overall, this document provides a comprehensive overview of HRM, Flip, and pH monitoring in the evaluation of esophageal function and disorders.

Keywords

HRM

high-resolution manometry

Flip

endoFlip system

pH monitoring

esophageal function

esophageal disorders

GERD

reflux testing

esophageal syndromes