ASGE Esophagology: Tailoring Management from Testing to Treatment (Live and Virtual)

The basics of HRM- Gyawali

Pdf Summary

The document discusses the basics of HRM (High Resolution Manometry) in the field of gastroenterology. It highlights the importance of HRM in visualizing the position of catheters, identifying and rectifying curled catheters, and visualizing bolus with impedance. The document also mentions that HRM is recommended over conventional manometry.<br /><br />The Chicago Classification, specifically version 4.0, is introduced as an algorithm for identifying esophageal motor dysfunction. It provides guidelines for diagnosing conditions such as achalasia, esophagogastric junction outflow obstruction (EGJOO), distal esophageal spasm (DES), and ineffective esophageal motility (IEM).<br /><br />The document explains when to request a high resolution manometry, which includes transit symptoms that are not explained by other tests, suspected esophageal motor disorders, pH monitoring, unexplained esophageal symptoms, peristaltic performance prior to antireflux surgery, and post-fundoplication dysphagia.<br /><br />Different types of achalasia (type 1, type 2, and type 3) and EGJOO are discussed, and their diagnostic criteria are mentioned. The document also provides information on provocative maneuvers and complementary tests that can be used to improve the diagnostic yield of esophageal motility disorders.<br /><br />The document briefly mentions the use of timed upright barium swallow and the Functional Lumen Imaging Probe (FLIP) for assessing esophageal function. It also discusses the treatment options for various esophageal motor disorders, including medications, lifestyle modifications, and surgical interventions.<br /><br />Lastly, the document presents a summary of the key points discussed, emphasizing the importance of HRM and the Chicago Classification in diagnosing and characterizing esophageal motor function. It also encourages the use of adjunctive tests and maneuvers to enhance diagnostic accuracy.

Keywords

HRM

High Resolution Manometry

gastroenterology

Chicago Classification

esophageal motor dysfunction

achalasia

EGJOO

esophageal symptoms

provocative maneuvers

diagnostic accuracy