Oesophageal Physiology Clinical Practice: A Case Study and Literature Review

Clinical oesophageal physiology is continually evolving through technological advancements, developing hybrid metrics for advanced clinical measurements, and continuously refining the diagnostic guidelines. This has currently placed oesophageal physiology investigation in specialist clinical centres and is excluded from the standard upper gastrointestinal diagnostic testing conducted in general hospitals. Therefore, patients and clinicians in a general hospital have reduced accessibility to oesophageal physiology tests, and patient referrals to specialist centres are only made when all standard oesophageal diagnostic tests are normal or cannot explain the patient's symptoms. As oesophageal physiology is not widely performed in healthcare centres, practitioners in general hospitals may not always think of the oesophageal physiology diagnostic test in their line of investigations. This clinical case study presents a patient under the care of a general hospital who required oesophageal physiology surveillance to see the development of achalasia. The oesophageal physiology primary study diagnosed ineffective oesophageal motility in the absence of reflux disease. The study did, however, capture features that raised suspicion of achalasia developing on high-resolution manometry. The current clinical guidelines do not identify the pre-achalasia state and make no recommendation or set the clinical pathway for repeating the oesophageal physiology or considering oesophageal physiology surveillance. In unwrapping the clinical features for the achalasia development, this case study not only justifies the referral for oesophageal physiology surveillance, but it also offers a learning platform to interpret results beyond the technical finding, addresses pitfalls in the diagnostic guidelines, and introduces useful supplementary tests that can be implemented into routine practice to uncover the correct diagnosis and exclude achalasia mimicking conditions.