ASGE Esophagology: Tailoring Management from Testing to Treatment (Live and Virtual) | July 2022-Pandolfino_Diagnostic Approaches in Eso Motility Disorders

Pandolfino_Diagnostic Approaches in Eso Motility Disorders

Pdf Summary

This document discusses diagnostic approaches in esophageal motility disorders. The author emphasizes that no single test in esophagology is perfect, and a combination of clinical presentation, endoscopy, FLIP (functional luminal imaging probe), manometry, and esophagram is necessary for accurate diagnosis. The differential diagnosis for esophageal symptoms includes GERD, eosinophilic esophagitis, obstruction, motor disorder, and functional esophageal disorder, and endoscopy is essential to rule out mechanical obstruction, reflux injury, and eosinophilic esophagitis. The diagnostic algorithm for dysphagia according to the Rome IV criteria involves a series of visits to perform upper endoscopy, esophageal function testing, and follow-ups in the clinic. Different patterns seen in high-resolution manometry (HRM) are discussed, including achalasia, esophagogastric junction outflow obstruction (EGJOO), hypercontractile esophagus, and weak peristalsis. The limitations of HRM in diagnosing certain conditions are acknowledged, and additional diagnostics such as esophagram and FLIP are recommended in specific cases. The clinical use of FLIP panometry, which measures esophagogastric junction (EGJ) opening dynamics in the context of peristalsis, is described, including its association with disorders diagnosed by the Chicago Classification v4.0. Contractile patterns identified through FLIP panometry are discussed, such as normal contractile response, impaired/disordered contractile response, absent contractile response, spastic-reactive contractile response, and various types of achalasia. The clinical application of panometry and its potential use in mimicking the Chicago Classification for diagnosing esophageal disorders are explained. The document also mentions the use of in-silico models and machine learning approaches to predict surgical approaches and outcomes based on patient data.

Keywords

esophageal motility disorders

diagnostic approaches

endoscopy

FLIP

manometry

esophagram

differential diagnosis

Rome IV criteria

high-resolution manometry

FLIP panometry