Classify break resolution easily

Aug 6th, 2022
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How to classify break resolution

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hello and welcome to GI 101 my name is dr. Adriana Lazarus CO and Im a gastroenterologist at the University of Alberta in Edmonton with me in the GI 101 studios today is my co-host for GI 101 dr. Dan Sadowski Dan last week we began a discussion on the diagnosis and classification of esophageal motility disorders what are we going to cover today well I would like to build on the concepts that I introduced last week and discuss the most current thinking on esophageal motility disorders which is the Chicago classification excellent as well I should mention that todays episode is probably more appropriate for advanced learners such as residents in gastroenterology or general or thoracic surgery as we will be discussing some of the finer points of esophageal manometry as well I will be showing a fair number of motility tracings today and these may not display well on a small handheld device and you may have better visibility using a tablet or a laptop computer why dont we begin where we

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The integrated relaxation pressure (IRP) corresponds to the lowest mean 4 seconds of axial pressure from onset of UES relaxation. In this example the DCI is normal (between 450 to 8,000 mmHgscm), the DL is normal (greater than 4.5s), and the IRP is normal (less than 15mmHg using the Sierra system).
The purpose of high-resolution esophageal manometry is to measure the pressures in your esophagus when you are resting and when you swallow. These pressures will tell us if your esophagus is working normally. The most common uses for the test are to: Diagnose esophageal motility disorders (e.g., spasms and achalasia)
Based on our results, the following values should be considered normal for manometry performed with viscous swallows: 60% ineffective contractions, 10% simultaneous contractions and DEA
Normal pressure of the lower esophageal sphincter (LES) is about 15 millimeters of mercury (mm Hg). The pressure is less than 10 mm Hg when the LES relaxes to let food pass into the stomach. Abnormal results would show: Muscle spasms are present in the esophagus.
Understanding Esophageal Manometry Results A normal result means that your LES and esophageal muscles are working properly. An abnormal result suggests a problem with your esophagus or LES. Possible problems include: abnormal contractions of the muscles in your esophagus.
Esophageal manometry is done to see if the esophagus is contracting and relaxing properly. The test helps diagnose swallowing problems. During the test, the doctor can also check the LES to see if it opens and closes properly.
DCI values between 450 to 8000 mmHgscm are within normal range, though values at the upper limit of normal (5,000 to 8,000 mmHgscm) may indicate a degree of increased contractile vigor. 6, 18. Latency and peristaltic integrity should only be assessed in the context of DCI values above 450 mmHgscm.
Manometry is almost always used to confirm the diagnosis of achalasia. The test typically reveals three abnormalities in people with achalasia: high pressure in the LES at rest, failure of the LES to relax after swallowing, and an absence of useful (peristaltic) contractions in the lower esophagus.
The test measures how well the muscles at the top and bottom of your esophagus (sphincter muscles) open and close, as well as the pressure, speed and pattern of the wave of esophageal muscle contractions that moves food along.
Chicago Classification v4. 0 (CCv4. 0) is the updated classification scheme for esophageal motility disorders using metrics from high-resolution manometry (HRM). Fifty-two diverse international experts separated into seven working subgroups utilized formal validated methodologies over two-years to develop CCv4.

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