@FrontGastro_BMJ @HasanHaboubi @Dominic_S_King There are excellent BSG guidelines on Barrett's oesophagus, and manometry and pH monitoring. We are working on eosinophilic oesophagitis guidelines currently. #fgdebate

@FrontGastro_BMJ @HasanHaboubi @Dominic_S_King Thank you for participating in our debate. We hope we have demystified oesophageal manometry and reflux monitoring for you! #fgdebate

@FrontGastro_BMJ pH with impedance can be helpful here to establish aerophagia and supragastric belching if there is doubt. Showing patients their impedance tracings can help as part of the management #fgdebate

@FrontGastro_BMJ This can be demonstrated to a patient by putting e.g. a pen between the teeth and the belching will stop (as air cannot be swallowed). #fgdebate

@leicdan @DrEmmaNash Absolutely agree - very unusual to have persistent GORD on reflux monitoring with taking BD PPI#fgdebate

@ravmis81 We recommend pH/impedance testing not pH testing as more information, more reproducible and can define GORD phenotypes guiding treatment #fgdebate

@jamesbmaurice Significant co-morbidity and patient wishes more important than age in stopping Barrett's surveillance #fgdebate

@jamesbmaurice Endoscopic therapy for early cancer by EMR if remarkably safe and age should not necessarily be a limit to surveilalnce #fgdebate

@FrontGastro_BMJ Don’t’ forget other measures to try to lower oesophageal cancer risk in Barrett’s – stop smoking, avoid obesity, PPI therapy #fgdebate

@FrontGastro_BMJ This one question could have it’s own Frontline Debate. Lots of excitement about Barrett’s endotherapy but for me – in one word...Quality! #fgdebate

@jamesbmaurice @Jonathansegal85 All seem to give good long term results and safe just need an expert doing regularly #fgdebate

@jamesbmaurice @Jonathansegal85 Type 3 achalasia POEM best; types 2 and 1 responds well POEM/PD/lap myotomy - PD needs repeat but sedation, POEM ands Lap myotomy GA.

@UKGastroDr Twice daily PPI first, then consider six food elimination diet if dietician or swallowed steroid. Swallowed Steroid prior to dilatation if strictures and maintain.

@Jonathansegal85 You then have to balance this result with the recent metanalysis which showed POEM to be better at 12-months at relieving dysphagia (93.5% v 91%) but these patients were more likely to have pathologic gastro-oesophageal reflux. #fgdebate

@Jonathansegal85 Also, retreatment with PD was considered a failure, but if it were not, the PD response rate would have improved to 76% #fgdebate

@Jonathansegal85 The PD technique used a lower maximal pressure (8 PSI) compared with a traditional maximum of 12 PSI, which has been demonstrated to be efficacious without an excessive risk for perforation and might have increased response to PD #fgdebate

@Jonathansegal85 The recent RCT comparing POEM with pneumatic dilatation (PD) generated enthusiasm for POEM but there are some factors that are being addressed in the current ongoing RCT. #fgdebate

@FrontGastro_BMJ EGJ outflow obstruction and absent contractility can both be due to achalasia – adjunctive testing during HRM with rapid drink challenge or food can reveal achalasia in these conditions and should be routine. #fgdebate

@FrontGastro_BMJ EGJ outflow obstruction may be due to achalasia that does not meet diagnostic criteria, a mechanical cause (may be missed at endoscopy) or opiates. #fgdebate