Transcript New Developments in Gastroenterology at West Herts High

New Developments in
Gastroenterology at West Herts
High Resolution oesophageal manometry
and 24 hour pH studies
Dr Mark Fullard
Consultant Gastroenterologist
Background
• Trained in South East Thames Region
• Research at St George’s Hospital, London
• MD 2008
– ‘Studies in Gastro-oesophageal reflux disease with special
emphasis on disease progression’
• Appointed as consultant at West Herts April 2008
• Special interest in oesophageal disease and oesophageal
physiology.
Pharynx
Epiglottis
Upper Esophageal Sphincter
Esophageal Body
Lower Esophageal Sphincter
Stomach
What is oesophageal manometry?
• Pass catheter through • Measures
•
nose into oesophagus
and stomach
Pressure sensors
along catheter
measure function of
oesophagus in
response to swallows
of water
– Upper oesophageal
sphincter pressure and
relaxation
– Lower oesophageal
sphincter pressure and
relaxation
– Motor function of
oesophageal body
How is it done?
• Conventional manometry
– 5-8 pressure sensors along
catheter
How is it done?
• High Resolution Manometry
– 36 circumferential pressure sensors placed along
catheter
What is pH study?
Digitrapper pH 100
1 or 4 channel
24 h pH recorder
Digitrapper pH 400
1 channel
4 channels
+ LES perfusion port
UES
pH sensor
approx. 2-3 cm
below UES
Single channel
pH Catheter
15 cm
between
sensors
pH sensor
5cm above proximal LES border
LES
For ENT positionning:
Proximal pH sensor
is placed approx. 1 cm
above UES
Two channels
pH Catheter
Indications for procedures
• Manometry
– Dysphagia with normal
OGD
– Unexplained non
cardiac chest pain
– For patients
considered for antireflux surgery
– Prior to a pH study
• 24 Hr pH study
– Patients with
symptoms of reflux
not responding to PPI
– Patients with normal
OGD and symptoms
that may be due to
reflux
– Patients being
considered for antireflux surgery
‘The old system’
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Referred to St Mark’s, UCL
Travel to London
Waiting time recently up to 4 months
West Herts physicians and surgeons combined
sent about 80 in last year
‘The New System’
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Done by me
HHGH
Tuesday pm
Doing 3 patients per
week
• Expect to do 80-100 per
year
• Aim to do within 6 weeks
• Started 2 weeks ago
• Take referrals from
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GI colleagues
Surgeons
Respiratory
ENT
GPs
Case study
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Second patient
28 year old man
Two years intermittent dysphagia to solids and liquids
OGD normal
Barium swallow
– ‘No mucosal lesion, tertiary contractions, abnormal lower
oesophagus, not achalasia’
• Had high resolution manometry within 2 weeks of
referral
Patient
Normal study
Diagnosis = Achalasia
No relaxation of LOS on swallowing
LOS relaxes on swallowing
Simultaneous, non-propagated weak swallow
Well propagated swallow
Summary
• New Service
• Useful applications
• Local service been repatriated from London
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teaching hospitals
Less travelling for patients
Quicker service
One of the increasing number of centres doing
high resolution manometry as a routine
Summary
• Happy to receive referrals
– Will see in clinic first
• Happy to discuss over phone or by e-mail
[email protected]
Tel – 01442 287060