The journey from diagnosis to treatment should be straightforward, with as little burden on the patient as possible.  Unfortunately, this is not always the case. It can often take around a year for gastroenterology outpatients to get the correct testing, diagnosis and consequently the right treatment for their symptoms – and often at expense to […]

A 66-year-old lady presented with epigastric pain, heartburn, regurgitation, belching, high dysphagia and odynophagia.  Her OGD showed a hiatus hernia and barium swallows – tertiary contraction and reflux. Initially high resolution manometry was carried out with a further 24-hour pH-impedance test due to HRM results. High Resolution Manometry HRM results showed the following: These results

The patient was a 53-year-old lady presenting with a cough, LUQ pain and occasional dysphagia.  She had previously undergone high-resolution manometry which showed ‘normal oesophageal motility’ based on Chicago Classification.  Her previous 24-hour pH-impedance showed mainly pathological postprandial reflux.  A 24-hour pH-impedance reflux monitoring test on PPIs was carried out.  The patient was taking 80

A 16-year-old boy presented with IBS-like symptoms of chronic abdominal pain and diarrhoea.  A clinical diagnosis of small intestinal bacterial overgrowth (SIBO) was made. Hydrogen Breath Test A hydrogen breath test was carried out using 75g of glucose, the patient had followed a restricted diet the previous day and fasted overnight.  Methane levels in the

A 61-year-old patient presented with chest pain, heartburn, regurgitation and mid/low dysphagia.  AN OGD showed mild gastritis and there was no hiatus hernia visible. High resolution manometry and 24-hour pH/impedance reflux monitoring was carried out. High Resolution Manometry HRM results showed the following: These results based on the Chicago Classification indicated Type II Achalasia (with

A 44-year-old lady presented with stomach pain, heartburn, regurgitation, belching and mid/low dysphagia.  She had previously undergone a gastric sleeve procedure in 2015 which was followed by a gastric bypass in 2018. High resolution manometry and 24-hour pH/impedance reflux monitoring was carried out. High Resolution Manometry HRM results were as follows: These results based on

This 27-year-old patient presented with postprandial epigastric/stomach pain and a high level of dysphagia.  Her OGD was normal with MBI = 14 and Lupus A.  Stationary high- resolution manometry with impedance was carried out. High-Resolution Manometry HRM results were as follows: These results based on the Chicago Classification showed that the patient exhibited normal oesophageal

A 20-year-old lady presented with heartburn, belching and persistent hiccups.  High resolution manometry and 24-hour pH/impedance reflux monitoring were carried out. High Resolution Manometry HRM results were as follows: These results based on the Chicago Classification showed that the patient exhibited normal oesophageal motility. 24-hour pH-Impedance Reflux Monitoring Off PPI The pH-impedance reflux monitoring gave

Do you have patients with recurrent belching that cannot be explained by physiological changes?  If so, the patient may be suffering from supragastric belching, a behavioural condition which may benefit from oesophageal biofeedback therapy. So, firstly let’s look at this condition and how it manifests itself. As we are all aware, belching is normal!  It

The diagnosis of patients with dysphagia can be challenging and often results in their symptoms being attributed to functional dysphagia which is a psychological condition. With testing, typically high-resolution manometry and impedance=pH, careful analysis can prove that the dysphagia is not psychological and therefore treatment options for the patient need to be changed. Initially, the