Provocative testing of the esophagus and its future.
Standard tests in clinical practice commonly fail to demonstrate a clear esophageal etiology for symptoms such as heartburn, dysphagia, or chest pain. Over the years, various provocative measures have been developed to provide a better understanding of the origins of such symptoms. Some measures, such as esophageal acid infusion or changing bolus consistency, can be easily incorporated into clinical practice. Others, such as multimodal stimulation systems, are more technically demanding. They have contributed to a better understanding of esophageal physiology in health and disease. Their role in clinical decision making is still evolving. This focused review provides a summary of the esophageal nociceptive pathways and how provocative testing can be used to interrogate their integrity.
Centre for Digestive Diseases, Wingate Institute of Neurogastroenterology, Blizard Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom.|Department of Gastroenterology, University Hospitals of North Midlands, Stoke on Trent, Staffordshire, United Kingdom.
Adam D
AD
Farmer
Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi of Milan and Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico, Milan, Italy.
Marianna
M
Franchina
GIOME, College of Bioengineering, Chongqing University, Chongqing, China.|Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong SAR.
Hans
H
Gregersen
Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi of Milan and Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico, Milan, Italy.
Roberto
R
Penagini
Department of Medicine, University of Southern California, Los Angeles, California.
Anisa
A
Shaker
Department of Medicine, University of Southern California, Los Angeles, California. esoffer@usc.edu.
Edy
E
Soffer
D002637:Chest Pain / Q000175:diagnosis / Q000503:physiopathology; D003955:Diagnostic Tests, Routine / Q000379:methods* / Q000639:trends; D004947:Esophagus / Q000502:physiology*; D005544:Forecasting; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D008365:Manometry / Q000379:methods / Q000639:trends
esophagus; provocative tests; sensation; stimulation