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Cameron > Esophageal Function Tests > Flashcards

Esophageal Function Tests Flashcards

1
Q

Achalasia presentation

A

Dysphagia to solids/liquids

Associated weight loss

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2
Q

Gold standard test for achalasia

A

High-res esophageal manometry

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3
Q

Manometry - integrated relaxation pressure

A

Nadir pressure over 4 seconds when EGJ relaxation is expected within a 10-second window after UES relaxation

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4
Q

Manometry - distal contractile integral

A

Assessment of the strength of esophageal smooth muscle contraction

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5
Q

Manometry - distal latency

A

Measure of the timing of esophageal peristalsis

UES relaxation to the contractile deceleration point

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6
Q

Type I achalasia manometry

A

Absent peristalsis, IRP of 10mmHg

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7
Q

Type II achalasia manometry

A

Absent peristalsis with at least 20% of swallows with panesophageal pressurization regardless of IRP

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8
Q

Type III (spastic) achalasia manometry

A

Premature or spastic distal esophageal contractions in at least 20% of swallows

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9
Q

Achalasia standard treatment

A

Distal esophageal myotomy with partial fundoplication

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10
Q

Results of myotomy for achalasia

A

80% (type I)
95% (type II)
60% (type III)

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11
Q

POEM how-to

A

Submucosal tunnel in esophagus approx 10cm proximal to GEJ

Myotomy of circular muscle layers distal extended to 2cm into the cardia

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12
Q

Major downside of POEM for achalasia

A

GERD (up to 40%) since patients don’t have simultaneous reflux procedure

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13
Q

Esophageal junction outflow obstruction

A

Diagnosis based on IRP with exclusion of achalasia

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14
Q

Causes of EJOO

A
  • Anatomic abnormality at the cardia (hiatal hernia, disease of esophageal wall)
  • Idiopathic with normal anatomy
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15
Q

Achalasia contrast esophagram

A

Bird’s beak

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16
Q

Management of non-anatomic EJOO

A

Invasive interventions only in patients with persistent symptoms and associated weight loss
(significant number of patients report spontaneous resolution over time)

17
Q

Diffuse esophageal spasm

A
  • <10% of esophageal motility disorders
  • Uncoordinated contractions of esophagus
  • Manometry usually necessary for diagnosis
18
Q

DES symptoms

A

Chest pain, dysphagia, or both

19
Q

Distal latency DES

A

Associated with onset of inhibitory myenteric neuron activity after contractions, shorter in patients with DES

20
Q

DES dx guidelines

A

Normal IRP at LES

Distal latency <4.5s in 20% of wet swallows

21
Q

Medical treatment of DES

A

Nitrates, sildenafil, TCAs (for noncardiac chest pain)
Diazepam/lorazepam next line
May consider PPI for concomitant GERD

22
Q

Surgical treatment of DES

A

Laparoscopic or thoracoscopic extended myotomy can be effected in well-selected patients with refractory DES

23
Q

Hypercontractile “nutcracker” esophagus vs. DES

A

Peristaltic contractions propagate normally, LES relaxes appropriately

24
Q

Manometry of nutcracker esophagus

A

DCI >8000mmHg s cm in >20% of swallows

25
Q

Medial treatment of nutcracker esophagus

A

Diltiazem lowers distal peristaltic pressures

Nitrates/sildenafil/TCAs for noncardiac chest pain

26
Q

Ineffective esophageal motility

A

DCI <450mmHg s cm in 50% of swallows

27
Q

Absent esophageal motility manometry

A

DCI < 100

28
Q

GERD epidemiology

A

20% of US population

Patient-reported: pathologic-confirmed: 70%

29
Q

GERD evaluation

A

1) Trial of PPI

2) If recurrence, upper endoscopy with esophageal bx

30
Q

Endoscopic findings considered confirmatory for GERD

A

High-grade esophagitis (Grade C or D)
Barrett’s metaplasia
Peptic stricture

31
Q

GERD non-confirmatory endoscopic findings

A

Grade B esophagitis: adequate evidence of initiation of medical management
Further testing warranted prior to lifetime PPI

32
Q

Demeester score cutoff

A

14.72 (greater -> abnormal)

33
Q

Measured parameters during 24-hour esophageal pH monitoring

A
  • 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)
34
Q

Benefit of esophageal impedance monitoring

A

Evaluation of acid and bile reflux using low AC voltage

35
Q

Type 1 EGJ morphology

A

No separation between LES and CD

36
Q

Type 2 EGJ morphology

A

Less than 3cm separation between LES and CD

37
Q

Type 3 EGJ morphology

A

Greater than 3cm separation between LES and CD

38
Q

Mechanically defective LES

A

Any one of:

  • Pressure <6 mmHg
  • Total length <2cm
  • Abdominal length <1cm

Cameron (1 decks)

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