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dc.contributor.authorSanagapalli, Santosh
dc.date.accessioned2021-04-12T02:58:17Z
dc.date.available2021-04-12T02:58:17Z
dc.date.issued2021en_AU
dc.identifier.urihttps://hdl.handle.net/2123/24896
dc.descriptionIncluded publicationsen_AU
dc.description.abstractBackground and aims High-resolution manometry is the reference standard test for the diagnosis of oesophageal motility disorders. Yet diagnosis is imperfect, with both suboptimal sensitivity and specificity in some settings. One reason may be the standard manometric protocol whereby motility is assessed using small volume water swallows whilst supine, which is inherently not reflective of normal swallowing behaviour. This thesis examines the utility of assessing oesophageal function in a more realistic fashion while ingesting larger volumes of liquid and solids; hypothesising that this would lead to more clinically meaningful results. I aimed to evaluate the utility of such “provocative testing” during manometry in differentiating gastro-oesophageal reflux disease phenotypes, improving the diagnostic yield for achalasia and determining the functional relevance of manometric oesophagogastric junction outflow obstruction. The barium swallow, and in particular the timed barium swallow, is a useful complementary investigation that provides valuable information regarding bolus flow as well as oesophageal contractility during ingestion of larger volumes of liquid. This thesis also aimed to compare its diagnostic yield over the standard manometric protocol in achalasia, and to examine whether novel metrics of emptying on timed barium swallow would improve its correlation with symptoms. Key findings In Barrett’s oesophagus, motility was poor when challenged with the more representative workload of provocative testing, a finding not seen in other GORD phenotypes. Second, use of provocative testing with timed barium swallow increases the diagnostic yield for achalasia compared to manometry with small volume water swallows alone. Such extra cases respond favourably to sphincter-disrupting therapy. Third, measurement of the percentage reduction in oesophageal stasis on timed barium swallow following therapy correlates closely with symptomatic response, unlike other metrics of oesophageal emptying. Fourth, manometric findings from provocative testing can be used to differentiate clinically relevant from spurious cases of oesophagogastric junction outflow obstruction with a high degree of accuracy, whereas findings from small volume water swallows and barium oesophagography do not.en_AU
dc.language.isoenen_AU
dc.subjectachalasiaen_AU
dc.subjecthigh-resolution manometryen_AU
dc.subjectoesophageal motilityen_AU
dc.subjectBarrett'sen_AU
dc.subjectrapid drink challengeen_AU
dc.subjectsolid swallowsen_AU
dc.titleAdvances in the manometric and radiographic assessment of oesophageal motility disordersen_AU
dc.typeThesis
dc.type.thesisDoctor of Philosophyen_AU
dc.rights.otherThe author retains copyright of this thesis. It may only be used for the purposes of research and study. It must not be used for any other purposes and may not be transmitted or shared with others without prior permission.en_AU
usyd.facultySeS faculties schools::Faculty of Medicine and Health::Concord Clinical Schoolen_AU
usyd.degreeDoctor of Philosophy Ph.D.en_AU
usyd.awardinginstThe University of Sydneyen_AU
usyd.advisorLEONG, RUPERT


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