Updates on diagnostic modalities for esophageal dysphagia

Abstract

Esophageal dysphagia is a common symptom in adults. Fluoroscopic contrast studies, endoscopy, and esophageal manometry have been used in the diagnosis of esophageal dysphagia for many years. The diagnostic yield has been improved with new test protocols that highlight abnormal bolus transit in the esophagus and outflow obstruction, as well as new high‐definition and high‐resolution technical advances in equipment. Functional luminal impedance planimetry and the addition of impedance to high‐resolution esophageal manometry have also allowed the assessment of new parameters to better understand esophageal structure and function. In this concise review, we describe the role and utility of various diagnostic modalities in the assessment of patients with esophageal dysphagia.

Impedance Planimetry and the Changing Paradigm of Esophageal Dysphagia

“…With no objective data, this could mean separate trips for high resolution manometry, pH study, extending the PPI trial, or additional radiographic work-up. 2 This is a time consuming and costly endeavor both in direct and indirect cost to the patient, as well as multiple sedations or often traumatic awake procedures.…”

“…1 Should an esophageal motility disorder be expected following initial endoscopy, the current gold standard is the use of high resolution manometry (HRM) to assess integrated relaxation pressure (IRP) and primary peristalsis. 2 However, the trans-nasal approach for catheter placement during manometry testing is associated with patient discomfort, cost, and can be inconclusive. 3 High resolution impedance planimetry (HRIP) is a new mechanism for enhancing and possibly hastening the process of diagnosis and treatment.…”