Esophageal Function Tests Flashcards
What is the esophagus?
muscular, tubelike structure located in the posterior mediastinum
Where does the esophagus span from and to?
spans from the posterior oropharynx to the cardia of the stomach.
What are the three functional regions of the esophagus?
upper esophageal sphincter (UES), esophageal body, and lower esophageal sphincter (LES).
What is the primary purpose of endoscopic or radiologic examination in patients with esophageal symptoms?
To rule out structural lesions such as malignancy.
What is considered after ruling out structural lesions in patients with esophageal symptoms?
Functional disorders secondary to esophageal dysmotility.
What are some indications for esophageal function tests in patients with noncardiac chest pain or heartburn?
Noncardiac chest pain or heartburn that does not improve with acid suppression and has no explanation on radiologic or endoscopic examination.
What are esophageal function tests indicated for in patients with dysphagia or odynophagia?
Nonobstructive dysphagia or odynophagia that is unexplained
Why might esophageal function tests be conducted before foregut surgery?
to evaluate esophageal peristalsis
What is one indication for localizing the lower esophageal sphincter (LES) before a specific study?
to place an impedance probe in preparation for a pH monitoring study
What is the indication for esophageal function tests after foregut surgery?
Evaluating dysphagia after foregut surgery.
What disease is esophageal function testing part of the workup for?
Scleroderma.
What is a contraindication for esophageal function tests in patients with esophageal masses?
Esophageal mass causing obstruction.
Why is abnormal nasal-oropharyngeal anatomy a contraindication for esophageal function tests?
It may preclude catheter placement.
Why are nonresponsive patients contraindicated for esophageal function tests?
Because they are unable to follow commands.
Why are patients on anticoagulation at high risk of bleeding contraindicated for esophageal function tests?
Due to the high risk of bleeding.
Esophageal motility disorders on high-resolution manometry
see pic
What is the gold standard for assessing esophageal motility?
Esophageal manometry.
What does esophageal manometry evaluate?
contractility and coordination of esophageal muscles.
How does conventional esophageal manometry work?
It uses sensors placed at fixed locations (~5 cm apart) on a catheter inserted transnasally into the esophagus, with its distal tip in the stomach.
What anatomical structures can be recognized by the pressure waveforms during manometry after a swallowing event?
The UES, esophageal body, LES, and gastric cardia.
What is high-resolution manometry (HRM)?
A manometry system that uses closely spaced sensors to create smooth contour plots of pressure points, providing a detailed image of esophageal function
esophageal pressure topography (EPT) or Clouse plots.
How long must patients fast before undergoing esophageal manometry?
Patients must fast for a minimum of 4 hours.
What does Integrated Relaxation Pressure (IRP) measure?
The average deglutitive relaxation pressure in a 4-second window beginning at UES relaxation.
What is the Distal Contractile Integral (DCI)
The product of amplitude, duration, and length of the distal esophageal contraction
What is Distal Latency in esophageal manometry?
interval between UES relaxation and the contractile deceleration point.
What are Pressurization Patterns in esophageal manometry?
Patterns of intraluminal pressure that indicate how effectively the esophagus is moving contents downward.
How does the Chicago Classification categorize esophageal motility disorders?
Into disorders of esophagogastric junction (EGJ) outflow or of peristalsis
What is the preferred diagnostic tool for evaluating esophageal motor function when other studies fail to explain symptoms?
High-resolution manometry (HRM).
What medications should patients stop before undergoing HRM to avoid interference with testing
H2-blockers, proton pump inhibitors, opioids, nitrates, and calcium channel blockers
What conditions may lead to false readings in HRM?
A history of esophageal surgery
peptic stricture,
the presence of a current hiatal hernia.
How is a catheter-based pH monitoring device inserted and positioned?
inserted transnasally with the distal pH probe placed approximately 5 cm above the lower esophageal sphincter (LES).
What is the DeMeester score used for in pH monitoring?
To quantify acid exposure and determine whether it is abnormal (scores of 14.72 or greater are considered abnormal).
What are the components of the DeMeester score?
- Percent total time pH < 4
- Percent upright time pH < 4
- Percent supine time pH < 4
- Number of reflux episodes
- Number of reflux episodes ≥ 5 minutes
- Longest reflux episode (in minutes)
What principle does impedance testing in esophageal studies rely on?
The principle of current resistance.
How is the impedance catheter placed, and how long does the procedure last?
A long flexible catheter with 6 to 8 sensors is placed transnasally for 24 hours
How does the impedance catheter detect a liquid and Air bolus?
-a rapid decrease in impedance (resistance)
-swallowed air boluses will be detected as increased impedance
What type of movement can impedance testing assess based on the direction of impedance change?
Both antegrade movement (normal peristalsis) and retrograde movement (gastroesophageal reflux).
