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New Developments in Gastroenterology at West Herts High Resolution oesophageal manometry and 24 hour pH studies

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

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New Developments in Gastroenterology at West Herts High Resolution oesophageal manometry and 24 hour pH studies

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  1. New Developments in Gastroenterology at West HertsHigh Resolution oesophageal manometry and 24 hour pH studies Dr Mark Fullard Consultant Gastroenterologist

  2. 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.

  3. Pharynx Upper Esophageal Sphincter Epiglottis Lower Esophageal Sphincter Esophageal Body Stomach

  4. Measures Upper oesophageal sphincter pressure and relaxation Lower oesophageal sphincter pressure and relaxation Motor function of oesophageal body Pass catheter through nose into oesophagus and stomach Pressure sensors along catheter measure function of oesophagus in response to swallows of water What is oesophageal manometry?

  5. How is it done? • Conventional manometry • 5-8 pressure sensors along catheter

  6. How is it done? • High Resolution Manometry • 36 circumferential pressure sensors placed along catheter

  7. Digitrapper pH 100 1 or 4 channel 24 h pH recorder Digitrapper pH 400 1 channel 4 channels + LES perfusion port What is pH study?

  8. UES For ENT positionning: Proximal pH sensor is placed approx. 1 cm above UES pH sensor approx. 2-3 cm below UES 15 cm between sensors Single channel pH Catheter Two channels pH Catheter pH sensor 5cm above proximal LES border LES

  9. Manometry Dysphagia with normal OGD Unexplained non cardiac chest pain For patients considered for anti-reflux 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 anti-reflux surgery Indications for procedures

  10. ‘The old system’ • 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

  11. 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 GI colleagues Surgeons Respiratory ENT GPs ‘The New System’

  12. Case study • 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

  13. Patient Normal study Diagnosis = Achalasia No relaxation of LOS on swallowing LOS relaxes on swallowing Simultaneous, non-propagated weak swallow Well propagated swallow

  14. Summary • New Service • Useful applications • Local service been repatriated from London teaching hospitals • Less travelling for patients • Quicker service • One of the increasing number of centres doing high resolution manometry as a routine

  15. Summary • Happy to receive referrals • Will see in clinic first • Happy to discuss over phone or by e-mail mark.fullard@whht.nhs.uk Tel – 01442 287060

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