{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 2, Ep 4 of 4: Weak Pump Scleroderma Obstruction","html":"","width":"100%","height":180,"duration":850,"description":"The fourth and final Esophageal Motility episode covers the weak-body disorders on a normal IRP: ineffective motility, absent contractility, and scleroderma, then the one diagnosis you are required to distrust, outflow obstruction with an elevated IRP but peristalsis still firing. The weak-body tracings resolve into three different diseases depending on two numbers: what the body is doing and what the LES is doing. Obstruction is never a manometry diagnosis alone; it needs pattern, symptoms, and a confirmatory test.\n \nTopics covered\n\nIneffective esophageal motility: strict criteria, common pattern, rare disease\nMultiple rapid swallows: probing pump reserve before fundoplication\nAbsent contractility versus type one achalasia on the IRP\nScleroderma esophagus: failed pump plus hypotensive LES together\nTwice-daily PPI, not a Nissen, in scleroderma reflux\nElevated IRP outflow obstruction and its defensive criteria\nFLIP distensibility index and the Dallas Consensus line of 2.0\nImpostor differential: opioids, EoE, hernia, malignancy, obesity\n \n \nKey decisions\n\nThe only decision ineffective motility changes is whether the esophagus can survive a full fundoplication\nA flat multiple-rapid-swallow response predicts post-op dysphagia and sends you to a partial wrap (Toupet or Dor)\nAbsent contractility on a normal IRP means the pump is guilty and the sphincter is innocent; on an elevated IRP suspect type one achalasia\nScleroderma is the paired hit: absent contractility plus a resting LES below ten, driving Barrett in five to thirty-five percent\nOutflow obstruction requires the IRP elevated both supine and upright (upright cutoff twelve) plus elevated intrabolus pressure\nOn manometry alone, junction outflow obstruction is always inconclusive; it needs symptoms and a confirmatory timed barium or FLIP\n \n \nThis is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your understanding, and we hope you enjoyed this content.\n \n \nStudy the full chapter on...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}