Gastroenterology
Diagnosis of oesophageal motility disorders
Dr. Rehan Haidry, a Consultant Gastroenterologist and Clinical Lead for Endoscopy at Cleveland Clinic London, discusses an innovative solution to advance diagnosis and management of gastrointestinal motility disorders.
Gastrointestinal motility disorders, such as achalasia and gastroparesis, disrupt the normal functioning of the upper digestive tract, leading to symptoms like difficulty swallowing (dysphagia), chest pain, regurgitation, heartburn, early satiety, nausea, and vomiting. These disorders are often challenging to diagnose accurately, as their symptoms can overlap with more common conditions like gastro-oesophageal reflux disease (GORD) and functional dyspepsia (FD). Consequently, patients may undergo numerous inconclusive endoscopies and wait years for a definitive diagnosis.1 Gastroparesis is a condition where the
stomach muscles fail to contract properly, causing delayed gastric emptying. Symptoms include nausea, vomiting, bloating, and abdominal pain. It can significantly impact quality of life and is often associated with diabetes.2
of gastroparesis varies widely, with studies reporting rates from 13.8 to 267.7 per 100,000 adults. The condition is more common in women and often presents with a cluster of symptoms, making diagnosis challenging. Achalasia is a rare disorder affecting about 1 in every 100,000 people, characterised by the
inability of the lower oesophageal sphincter (LES) to relax, leading to difficulty swallowing and regurgitation of food.3
The exact cause
of achalasia is unknown, but it may involve complex interactions between genetic predispositions, immune system dysregulation, and environmental factors such as infections.3 Gastrointestinal symptoms are broad and
therefore patients often undergo a series of investigations over many months before a diagnosis can be made. Typically, the primary investigation is a gastroscopy to assess the upper gastrointestinal tract. However, this is simply to exclude an
The prevalence
alternative cause for the symptoms. The diagnosis of a motility disorder will require referral for additional specialist tests such as barium swallow, scintigraphy, and manometry that cannot be completed at the index endoscopy. On the contrary, the Endoflip 300 system is the first device that could provide real-time assessment of gastrointestinal motility at the time of endoscopy to aid the diagnosis. Delays in the diagnosis of gastrointestinal
motility disorders remain a significant challenge in clinical practice. These conditions often
present with nonspecific symptoms like dysphagia, vomiting, or chronic nausea, which can overlap with other gastrointestinal issues, leading to misdiagnosis or prolonged diagnostic journeys.
Compounding this issue are lengthy waiting lists for specialised diagnostic tests, such as high-resolution manometry and gastric emptying studies, which are essential for accurate diagnosis and management. These delays can result in disease progression, poorer patient outcomes, and reduced quality of life. Early access to specialised diagnostic tools and multidisciplinary care is crucial to improving timely diagnoses and optimising treatment strategies for these complex disorders.
Next generation diagnostic tool The Endoflip 300 system, developed by Medtronic, represents a significant advancement in the diagnosis and management of these disorders. This next-generation diagnostic tool has recently received CE-Mark approval, allowing it to be used across Europe. The system measures pressure and dimensions in the oesophagus and pylorus, providing valuable insights that can expedite accurate diagnosis and improve patient outcomes.1 One of the key advantages of the system is its ability to be performed under sedation in approximately five minutes, making it a convenient and well-tolerated method for assessment. The device uses a balloon catheter filled with conductive fluid that enables real-time assessment of the geometry and function of the gastrointestinal tract. Endoflip provides estimates on the luminal diameter, distensibility, and pressure. Essentially, the balloon assesses how a hollow organ like the oesophagus is able to respond to changes in volume or pressure. A real-time topography is also reported that allows visualisation of the organ geometry and how both the pressure and diameter of the organ are distributed across the area of measurement. This real-time topography allows for more
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