Sandhill文摘(11)

1、.AGA Issues Practices Guidelines for the Diagnosis and Management of GERDThe February 19th issue of the American Journal of Gastroenterology features the publication of new practice guidelines for the diagnosis and management of GERD.1These AGA medical position statements are developed under the aeg

2、is of the AGA Institute Clinical Practice and Quality Management Committee and provide preferred approaches to specific GERD diagnosis and management scenarios.A comprehensive review of the Practice Guidelines is recommended for all clinicians practicing in the GERD field. The full publication can b

3、e accessed using the citation in Footnote #1.Guidelines, which are specifically relevant to Sandhill Scientific reflux monitoring and motility testing diagnostic products are summarized as follows: (text inserts are sourced from the referenced AGA publication1)GERD DiagnosisEsophageal manometry is r

4、ecommended for preoperative evaluation, but has no role in the diagnosis of GERD. (Strong recommendation, low level of evidence) Ambulatory esophageal reflux monitoring is indicated before consideration of endoscopic or surgical therapy in patients with non-erosive disease, as part of theevaluation

5、of patients refractory to PPI therapy, and in situations when the diagnosis of GERD is in question. (Strong recommendation, low level of evidence).Ambulatory reflux monitoring is the only test that can assess reflux symptom association (strong recommendation, low level of evidence).Performed with ei

6、ther a telemetrycapsule (usually 48 h) or transnasal catheter (24 h), pH monitoringhas excellent sensitivity (77- 100%) and specificity (85 - 100 % ) inpatients with erosive esophagitis; however, the sensitivity is lowerin those with endoscopy-negative reflux symptoms ( 71 % ) whena diagnostic test

7、is more likely to be needed.Catheter-based monitoring allows for the addition ofimpedance and detection of weakly acidic or non-acid reflux.NOTE: A consensusstatement (35) in the body of the publication suggests that impedance added to pH monitoringincreases the sensitivity of reflux monitoring to c

8、lose to90 %.Optimal use of these two options is certainly debated as is whetherto test on or off therapy. As a true diagnostic test (is abnormalacid exposure present) and for evaluation before consideringsurgery in a patient with NERD an off therapy test is recommended1Guidelines for the Diagnosis a

9、nd Management ofGastroesophageal Reflux DiseasePhilip O. Katz, Lauren B. Gersonand Marcelo F. VelaAmJ Gastroenterol advance online publication, February 19, 2013; doi:10.1038/ajg.2012.444TECHNICAL TIPPreventing Error 2024This error occurs when the recorder is not shut down in the proper sequence res

10、ulting in the recorder not having adequate time to finish writing the data to the SD Card. It is similar to the error you get when you turn off your computer without properly shutting down windows so you get an error the next time you start up your computer.The proper sequence for shutting down the

11、recorder:1.Press and hold the light button. 2.While holding the light button, press the 1 button.3.Release both buttons simultaneously.4.Select Stop Recording.5.With the recorder in the Standby Mode, remove at least 1 battery.6.Extubate the patient and remove the flash card.7.The data is now ready t

12、o download.WENDYS CORNERHow do I recognize if my EFT or HRiM probe is coiled in the esophagus? And what are options to resolve the coil?It is possible during the insertion of a manometry probe that the probe bends in half or coils in the esophageal body. There are several conditions that can lead to

13、 a coil; the probe tip could get caught and turns in a hernia, at a poorly relaxing or non-relaxing LES or large diverticulum or start coiling above the UES due to a strong tongue thrust. Regardless of the cause, quick recognition and resolution of a coil will help minimize trauma to the patient.Rec

14、ognition that a probe has coiled:With an EFT or HRiM probe, normal peristalsis with a coil will present as a butterfly effect. What you may see is the antegrade peristaltic wave progressing left to right in the upper channels and then back to the left in the lower channels. It will appear as a refle

15、ction, like a mountain reflected in the surface of a lake. The patient may or may not be sensitive to this coil so going based on their response alone is not reliable.Fig. 1 Standard EFT coiled probe Fig. 2 HRiM coiled probeStraightening the probe:Regardless of why the probe started to turn, getting

16、 it to uncoil in the esophageal body is difficult as there is not much room for the probe to straighten. Moving up and down in the esophageal body does little but cause discomfort for the patient. If you completely remove the probe and offer to start the intubation again, the patient may refuse.If y

17、ou can get through the LES (see Fig. 2 above) the best and often quickest way to straighten the probe is to advance it further into the stomach, well beyond 60 cms if needed. There is more room for the probe to uncoil in the stomach and the probe wants to straighten. As the tip of the probe advances below the LES, you may feel a pop as the probe suddenly straightens out, and the patient may feel relief. Then you can pull the probe back to 60 cms and proceed with the study.If you are unable to get through the LES, the next best maneuver may be to pull back on the probe just to