Improving diagnosis of upper gastrointestinal disorders—experts create consensus with classifications

A team of experts led by Northwestern Medicine investigators has developed a standardized approach that will improve the measurement of esophageal function to better diagnose upper gastrointestinal disorders, as detailed in a recent paper published in Gastroenterology.

"Esophageal motility diagnoses are made based on a global impression that incorporates a patient's symptoms, the endoscopic findings and the motility findings," said Dustin Carlson, MD, '15 MS, '12 GME, assistant professor of Medicine in the Division of Gastroenterology and Hepatology, and the lead author of the paper.

Functional lumen imaging probe (FLIP) panometry is a sedated procedure that utilizes a specialized catheter with sensors to measure esophageal function, specifically how well the esophagus contracts and relaxes, which can help physicians better diagnose and manage different upper gastrointestinal disorders.

The FLIP procedure stimulates peristalsis and motility in the esophagus while a patient is sedated for endoscopy, rather than requiring the patient to perform a series of swallows while awake as required during a standard esophageal manometry procedure.

In the last decade, FLIP panometry has been increasingly incorporated into esophageal motility assessments, but a standardized approach to perform and interpret the procedure has not yet been established.

In the current publication, Carlson, along with 18 FLIP panometry experts from around the U.S. and Canada, produced and assessed statements on the FLIP panometry procedure and interpretations. A total of 40 statements were selected to be included in the consensus, called the Dallas Consensus, and included FLIP panometry protocol, interpretation of esophagogastric junction opening and contractile response, and motility classification scheme.

Key points from the consensus included:

• FLIP panometry should be interpreted in the context of the clinical presentation, the accompanying esophagogastroduodenoscopy findings and other relevant complementary testing.
• A major motor disorder is unlikely in the setting of a "normal" FLIP panometry classification.
• Diminished or absent contractile response with reduced esophageal opening (i.e., nonspastic obstruction) supports the diagnosis of a disorder of esophagogastric junction outflow.

"We anticipate that this approach will help create consistent and broad implementation of a very useful technology for care of patients with esophageal diseases," Carlson said.