Esophageal Function Tests

Question 1

What is the esophagus?

Answer 1

muscular, tubelike structure located in the posterior mediastinum

Question 2

Where does the esophagus span from and to?

Answer 2

spans from the posterior oropharynx to the cardia of the stomach.

Question 3

What are the three functional regions of the esophagus?

Answer 3

upper esophageal sphincter (UES), esophageal body, and lower esophageal sphincter (LES).

Question 4

What is the primary purpose of endoscopic or radiologic examination in patients with esophageal symptoms?

Answer 4

To rule out structural lesions such as malignancy.

Question 5

What is considered after ruling out structural lesions in patients with esophageal symptoms?

Answer 5

Functional disorders secondary to esophageal dysmotility.

Question 6

What are some indications for esophageal function tests in patients with noncardiac chest pain or heartburn?

Answer 6

Noncardiac chest pain or heartburn that does not improve with acid suppression and has no explanation on radiologic or endoscopic examination.

Question 7

What are esophageal function tests indicated for in patients with dysphagia or odynophagia?

Answer 7

Nonobstructive dysphagia or odynophagia that is unexplained

Question 8

Why might esophageal function tests be conducted before foregut surgery?

Answer 8

to evaluate esophageal peristalsis

Question 9

What is one indication for localizing the lower esophageal sphincter (LES) before a specific study?

Answer 9

to place an impedance probe in preparation for a pH monitoring study

Question 10

What is the indication for esophageal function tests after foregut surgery?

Answer 10

Evaluating dysphagia after foregut surgery.

Question 11

What disease is esophageal function testing part of the workup for?

Answer 11

Scleroderma.

Question 12

What is a contraindication for esophageal function tests in patients with esophageal masses?

Answer 12

Esophageal mass causing obstruction.

Question 13

Why is abnormal nasal-oropharyngeal anatomy a contraindication for esophageal function tests?

Answer 13

It may preclude catheter placement.

Question 14

Why are nonresponsive patients contraindicated for esophageal function tests?

Answer 14

Because they are unable to follow commands.

Question 15

Why are patients on anticoagulation at high risk of bleeding contraindicated for esophageal function tests?

Answer 15

Due to the high risk of bleeding.

Question 16

Esophageal motility disorders on high-resolution manometry

Answer 16

see pic

Question 17

What is the gold standard for assessing esophageal motility?

Answer 17

Esophageal manometry.

Question 18

What does esophageal manometry evaluate?

Answer 18

contractility and coordination of esophageal muscles.

Question 19

How does conventional esophageal manometry work?

Answer 19

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.

Question 20

What anatomical structures can be recognized by the pressure waveforms during manometry after a swallowing event?

Answer 20

The UES, esophageal body, LES, and gastric cardia.

Question 21

What is high-resolution manometry (HRM)?

Answer 21

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.

Question 22

How long must patients fast before undergoing esophageal manometry?

Answer 22

Patients must fast for a minimum of 4 hours.

Question 23

What does Integrated Relaxation Pressure (IRP) measure?

Answer 23

The average deglutitive relaxation pressure in a 4-second window beginning at UES relaxation.

Question 24

What is the Distal Contractile Integral (DCI)

Answer 24

The product of amplitude, duration, and length of the distal esophageal contraction

Question 25

What is Distal Latency in esophageal manometry?

Answer 25

interval between UES relaxation and the contractile deceleration point.

Question 26

What are Pressurization Patterns in esophageal manometry?

Answer 26

Patterns of intraluminal pressure that indicate how effectively the esophagus is moving contents downward.

Question 27

How does the Chicago Classification categorize esophageal motility disorders?

Answer 27

Into disorders of esophagogastric junction (EGJ) outflow or of peristalsis

Question 28

What is the preferred diagnostic tool for evaluating esophageal motor function when other studies fail to explain symptoms?

Answer 28

High-resolution manometry (HRM).

Question 29

What medications should patients stop before undergoing HRM to avoid interference with testing

Answer 29

H2-blockers, proton pump inhibitors, opioids, nitrates, and calcium channel blockers

Question 30

What conditions may lead to false readings in HRM?

Answer 30

A history of esophageal surgery peptic stricture, the presence of a current hiatal hernia.

Question 31

How is a catheter-based pH monitoring device inserted and positioned?

Answer 31

inserted transnasally with the distal pH probe placed approximately 5 cm above the lower esophageal sphincter (LES).

Question 32

What is the DeMeester score used for in pH monitoring?

Answer 32

To quantify acid exposure and determine whether it is abnormal (scores of 14.72 or greater are considered abnormal).

Question 33

What are the components of the DeMeester score?

Answer 33

1. Percent total time pH < 4 2. Percent upright time pH < 4 3. Percent supine time pH < 4 4. Number of reflux episodes 5. Number of reflux episodes ≥ 5 minutes 6. Longest reflux episode (in minutes)

Question 34

What principle does impedance testing in esophageal studies rely on?

Answer 34

The principle of current resistance.

Question 35

How is the impedance catheter placed, and how long does the procedure last?

Answer 35

A long flexible catheter with 6 to 8 sensors is placed transnasally for 24 hours

Question 36

How does the impedance catheter detect a liquid and Air bolus?

Answer 36

-a rapid decrease in impedance (resistance) -swallowed air boluses will be detected as increased impedance

Question 37

What type of movement can impedance testing assess based on the direction of impedance change?

Answer 37

Both antegrade movement (normal peristalsis) and retrograde movement (gastroesophageal reflux).