Esophageal Testing

Question 1

Suggest HRM for eval of motility disorder in patients w/ obstructive esophageal symptoms w/o mechanical cause

Answer 1

conditional, very low evidence

Question 2

Recommend HRM over conventional line tracing manometry to diagnose motility disorders w/ obstructive symptoms

Answer 2

strong, moderate evidence

Question 3

Suggest inclusion of barium tablet w/ barium esophageal during eval of obstructive symptoms

Answer 3

conditional, very low evidence

Question 4

Suggest FLIP to complement HRM for diagnosis of motility disorders in patients w/ obstructive symptoms and borderline HRM findings

Answer 4

conditional, low evidence

Question 5

Suggest the EGJ and gastric cardia anatomy be inspected endoscopically and/or radiographically to assess for mechanical abnormalities in patients w/ esophageal symptoms after anti reflux surgery

Answer 5

conditional, very low evidence

Question 6

Suggest ambulatory reflux monitor (even over not definitive EGD) for conclusive GERD diagnosis

Answer 6

conditional, very low evidence

Question 7

Suggest ambulatory reflux monitor OFF PPI therapy (even over not definitive EGD) for conclusive GERD diagnosis

Answer 7

conditional, low evidence

Question 8

Suggest prolonged wireless pH monitor over 24-hr catheter-based monitor for diagnosis or CERD in adults w/ infrequent or day-to-day variation in esophageal symptoms

Answer 8

conditional, very low evidence

Question 9

Suggest ambulatory pH impedance monitoring on PPI therapy over EGD or pH monitor alone to diagnose persisting GERD in adults w/ typical esophageal reflux symptoms and previous confirmation of GERD

Answer 9

conditional, very low evidence

Question 10

Suggest for patients w/ esophageal symptoms being evaluated for anti reflux surgery, abnormal acid exposure time be considered a predictor of treatment outcome; reflux symptoms association and mean nocturnal baseline impedance provide adjunctive value

Answer 10

conditional, very low evidence