ASGE Esophagology: Tailoring Management from Testing to Treatment (On-Demand)

The basics of HRM- Gyawali

Pdf Summary

The document discusses the basics of high-resolution manometry (HRM) and the Chicago Classification, which is an algorithm used to identify esophageal motor dysfunction. HRM is considered the gold standard for assessing esophageal motor function. It allows for real-time visualization of the catheter position, identification and correction of curled catheters, and visualization of bolus movement. The Chicago Classification v4.0, published in 2021, provides criteria for diagnosing esophagogastric junction outflow obstruction (EGJOO) and ineffective esophageal motility (IEM). It also emphasizes the importance of clinical relevance in interpreting these findings.<br /><br />The document highlights the indications for requesting HRM, including transit symptoms that are unexplained by other tests, suspected esophageal motor disorders, evaluation before antireflux surgery, and unexplained esophageal symptoms. It also discusses the different types of achalasia and EGJOO.<br /><br />Additional topics covered include the use of adjunctive provocative maneuvers and complementary tests to improve diagnostic accuracy, the management of esophageal motor disorders such as achalasia and spastic motor disorders, the use of supportive testing such as barium studies and functional lumen imaging probe (FLIP), and the importance of considering underlying conditions like hiatus hernia.<br /><br />The document ends with a summary of the key points discussed, highlighting the significance of HRM and the Chicago Classification in assessing esophageal motor function and diagnosing esophageal motor disorders. It also emphasizes the importance of clinical relevance and the use of adjunctive tests to enhance diagnostic accuracy.

Keywords

high-resolution manometry

Chicago Classification

esophageal motor dysfunction

gold standard

clinical relevance

transit symptoms

achalasia

diagnostic accuracy

spastic motor disorders

hiatus hernia