Kicking off #ACG2021 with the #esophagus! @RenaYadlapati on "taming the tube!"
@AmCollegeGastro #VaxxedNMasked
@AmCollegeGastro #VaxxedNMasked
Candida esophagitis. Some pill and liquid retention.
Obstructive symptoms without mechanical cause ▶️ HRM (+/- TBE/FLIP)
Need to test supine AND upright
❓Is LES relaxation adequate? ▶️ IRP
If > 15, not relaxing adequately, concern for #achalasia-like process
If > 15, not relaxing adequately, concern for #achalasia-like process
100% failed peristalsis
IRP 10.5 (upper limit of normal)
Absent contractility? Type I achalasia?
IRP 10.5 (upper limit of normal)
Absent contractility? Type I achalasia?
Type I: classic
Type II: often precursor to TI. Panesophageal pressurization
Treatment: LES-directed therapy– POEM, LHM, pneumatic dilation
Type III spastic achalasia
Treatment: stop opioids; tailored POEM
Type II: often precursor to TI. Panesophageal pressurization
Treatment: LES-directed therapy– POEM, LHM, pneumatic dilation
Type III spastic achalasia
Treatment: stop opioids; tailored POEM
Inconclusive #achalasia? Time to reach for other tools (TBE, FLIP).
🐦
Elevated IRP but evidence of intact peristalsis? Could be EGJOO 🧇
Need symptoms PLUS findings
Disorders of peristalsis
HCE can be a response to #GERD
Both HCE and DES are only relevant if there are associated symptoms. May be response to #GERD or opioid use.
LES relaxes normally, normal IRL, 100% failed peristalsis
Can be seen in connective tissue disorders or #GERD
Can be seen in connective tissue disorders or #GERD
Ineffective esophageal motility
💎s from @RenaYadlapati on "taming the tube"
"Don't look at your patient in a vaccum. Look for symptoms and other findings."
"Don't look at your patient in a vaccum. Look for symptoms and other findings."
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