Gastroenterology and hepatology
Investigation of oesophageal disorders
Which oesophageal test answers which question after gastroscopy, how to read high-resolution manometry (IRP, DCI, distal latency) under Chicago 4.0, ambulatory pH and pH-impedance under Lyon 2.0, barium swallow and timed barium oesophagram, nuclear transit studies and FLIP, with worked results.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Gastroscopy comes first for dysphagia, alarm features and PPI failure, with biopsies for eosinophilic oesophagitis. The physiological tests below answer the questions gastroscopy can't.
- Manometry asks "how does the oesophagus move?" pH or pH-impedance monitoring asks "is there too much reflux, and does it cause the symptoms?" Barium shows anatomy and emptying.
- Chicago 4.0 (2021) remains the current manometry classification in 2026, and Lyon 2.0 (2024) the reflux criteria.
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Sources
- Yadlapati R et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0. Neurogastroenterol Motil 2021;33:e14058International High Resolution Manometry Working Group (Neurogastroenterology and Motility), 4.0 (2021); still current in 2026
- Gyawali CP et al. Updates to the modern diagnosis of GERD: Lyon consensus 2.0. Gut 2024;73:361-71Lyon Consensus Group (Gut), 2.0 (2024)
- Katz PO et al. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol 2022;117:27-56American College of Gastroenterology, 2022
- Carlson DA et al. A standardized approach to performing and interpreting functional lumen imaging probe panometry for esophageal motility disorders: the Dallas Consensus. Gastroenterology 2025Gastroenterology, 2025
- Vaezi MF et al. ACG Clinical Guidelines: Diagnosis and Management of Achalasia. Am J Gastroenterol 2020;115:1393-411American College of Gastroenterology, 2020
- Therapeutic Guidelines: Gastrointestinal. Gastro-oesophageal reflux disease; DysphagiaAU/NZTherapeutic Guidelines Limited, Current online edition
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback