Nav: Home

New guidelines set standard on test to diagnose acid reflux, heartburn and other diseases

December 04, 2003

New consensus guidelines will help to set the standards for physicians using esophageal manometry to accurately identify esophageal diseases such as gastroesophageal reflux disease, heartburn, problems with swallowing or non-heart related chest pain coming from the esophagus.

FINDING & IMPLICATIONS:
Although a test called esophageal manometry has provided the best diagnostic tool for healthcare professionals to diagnose suspected diseases of the esophagus, there are no uniform standards to guide physicians as to the best way to perform the procedure or to interpret the results. In fact, a lack of standardized training and multiple ways to perform the test have made it difficult or impossible to share data between physicians.

Now, new consensus guidelines will help to set the standards for physicians using esophageal manometry to accurately identify esophageal diseases such as gastroesophageal reflux disease, heartburn, problems with swallowing or non-heart related chest pain coming from the esophagus. The paper is published in the December issue of Neurogastroenterology and Motility.

"This is the first paper to provide a detailed standardized description of how esophageal manometry should be administered. It will help clinical practitioners to perform a standardized and reproducible test that can be interpreted across the board by other doctors," said Dr. Jeffrey L. Conklin, Medical Director of the Esophageal Center at Cedars-Sinai Medical Center in Los Angeles.

BACKGROUND:
The esophagus is a muscular tube that connects the throat with the stomach. Its synchronized contractions push what is swallowed into the stomach. At the upper and lower ends of the esophagus are two short areas of specialized muscle called the upper and lower esophageal sphincters. When at rest, the muscles of the upper and lower esophageal sphincters are closed and prevent anything from passing through them. For example, the upper sphincter prevents food or liquid within the esophagus from backing up into the throat, while the lower esophageal sphincter protects the lower esophagus from stomach acid and bile by opening only when food or liquid is swallowed.

When a person is afflicted with esophageal problems such as acid reflux, heartburn, swallowing problems or chest pain, doctors use esophageal manometry to determine how well the muscle of the esophagus works. The information can then help them to identify and treat the problem.

During the procedure, a thin, flexible plastic catheter with very small openings that are located at varying positions along the tube is placed down the esophagus through the patient's nostril. These openings sense the pressure in various parts of the esophagus when the muscle is at rest and during swallowing. The pressures are then transmitted to a computer analyzer where they are recorded. The doctor then analyzes the various wave patterns and determines whether they are abnormal.

"Although esophageal manometry has been around for at least two decades, most gastroenterologists continue to see it in somewhat mystical terms. This is because few practitioners are sufficiently trained in the principles and practice of manometry, and because performance of the test was never adequately standardized. Our goal was to give clinicians some background about the principles of esophageal manometry, and to give them a detailed standard approach to performing and reporting the test," said Dr. Conklin.

METHODS:
In the paper, Dr. Conklin and his colleagues describe how the esophagus works in varying disease states, the proper way to study it using esophageal manometry, and also identify the abnormalities that cause diseases of the esophagus. These include achalasia, where the nerves are damaged; esophageal spasms; non-cardiac chest pain; a condition called scleroderma, or chronic autoimmune disease of the connective tissue; and hiatal hernia, which occurs when a part of the stomach slides above the diaphragm, the thin muscle separating the stomach from the chest.

LEAD INVESTIGATORS:
Jeffrey L. Conklin, M.D., Medical Director of the Esophageal Center at Cedars-Sinai Medical Center

J.A. Murray, M.D., Director of the Esophageal Unit at the Mayo Clinic, Rochester MN

R.E. Clouse, M.D., Professor of Medicine, Washington University School of Medicine, Saint Louis. MO.
-end-


Cedars-Sinai Medical Center

Related Chest Pain Articles:

CT angiography appears better at predicting future risk for patients with chest pain
An analysis of diagnostic test results from a trial comparing anatomic with functional testing as an initial diagnostic strategy for patients with chest pain found that CT angiography better predicted the risk for future cardiac events than did measures of exercise tolerance or restricted blood flow to the heart muscle.
High-sensitivity assay gives more reassurance to chest pain patients
For some time now, patients in Sweden's emergency clinics complaining of chest pain have been evaluated using the 'high-sensitivity troponin T' assay.
Chest pain: New tool helps doctors decide when tests are needed
Study published in JAMA Cardiology suggests stress testing may not always be necessary for those with non-urgent chest pain.
Rule could take one-third of chest pain patients off emergency department heart monitors
Ottawa researchers have validated a rule that could safely take a third of chest pain patients in the emergency department off of heart monitors, according to a study published in the Canadian Medical Association Journal.
LifePoint health furthers commitment to chest pain care
Thirty-five LifePoint Health® facilities earned Chest Pain Center Accreditation in 2016, bringing the total number of accredited facilities to 63, as part of a system-wide collaboration between LifePoint Health® (NASDAQ: LPNT) and the American College of Cardiology.
More Chest Pain News and Chest Pain Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Anthropomorphic
Do animals grieve? Do they have language or consciousness? For a long time, scientists resisted the urge to look for human qualities in animals. This hour, TED speakers explore how that is changing. Guests include biological anthropologist Barbara King, dolphin researcher Denise Herzing, primatologist Frans de Waal, and ecologist Carl Safina.
Now Playing: Science for the People

#534 Bacteria are Coming for Your OJ
What makes breakfast, breakfast? Well, according to every movie and TV show we've ever seen, a big glass of orange juice is basically required. But our morning grapefruit might be in danger. Why? Citrus greening, a bacteria carried by a bug, has infected 90% of the citrus groves in Florida. It's coming for your OJ. We'll talk with University of Maryland plant virologist Anne Simon about ways to stop the citrus killer, and with science writer and journalist Maryn McKenna about why throwing antibiotics at the problem is probably not the solution. Related links: A Review of the Citrus Greening...