Upper GI Physiology (SPS322)

30 credits

Aim of this module

This module will provide the trainee with a specialised body of knowledge that will underpin and be applied in the specialist work based training in Upper Gastrointestinal Physiology. This rotation will enable trainees to perform a range of clinical diagnostic investigations undertaken to investigate disorders of the upper gastrointestinal system, interact with patients and demonstrate safe, patient-centred practice. Trainees will be expected to undertake a range of investigations, build practical skills in setting up and maintaining the equipment used, produce reports, interpret results, explain procedures to patients and gain consent, while developing and building their professional practice.

  1. Perform safe intubation of the upper gastrointestinal tract in a range of patients presenting with dysphagia, chest pain, typical and atypical gastro-oesophageal reflux symptoms, exacerbation of chest conditions (asthma, cystic fibrosis), and conditions including achalasia, Barrett’s oesophagus, scleroderma, non-cardiac chest pain, rumination, laryngopharyngeal reflux, Schatzki’s ring, oesophageal webs.
  2. Perform oesphogeal manometry (gaining experience of a range of water- based and solid state systems, including high-resolution manometry) in a range of patients presenting with conditions including achalasia, Barrett’s oesophagus, scleroderma, non-cardiac chest pain, Schatzki’s ring, oesophageal webs.
  3. Perform single and dual channel pH and combined pH and impedance monitoring in a range of adult patients presenting with a range of conditions, including gastro-oesophageal reflux, duodenogastric reflux, rumination and laryngopharyngeal reflux.
  4. Interpret the data and produce high-quality reports with respect to oesphogeal manometry and pH and impedance monitoring, being able to differentiate between artefact and physiological occurrence.
  5. Carry out routine maintenance and calibration procedures on equipment used in oesphogeal manometry and pH and impedance monitoring.
Number Work-based learning outcome Title Knowledge
1 1,2,3

Control infection risks in accordance with departmental protocols.

View
2 1,2,3

Minimise risks and hazards in compliance with health and safety policies.

View
3 1,2,3

Select suitable technology for each type of investigation, choosing and adapting the appropriate diagnostic technique, patient position, machine settings and transducer

View
4 1,2,3

Set up the equipment ready for use for each type of investigation and critique the equipment and consumables available in the investigation of upper gastrointestinal  motility disorders.

View
5 1,2,3

Obtain a suitably completed form, greet the patient, check patient identity and ensure that the patient’s identity is confirmed as correct and fully identified on each type of recording system.

View
6 1,2,3

Explain the procedure for each type of investigation to the patient and address any questions they may have relating to the procedure, including the process after the procedure and how the patient will be informed of the results.

View
7 1,2,3

Gain informed consent for each type of investigation.

View
8 1,2,3

Obtain a clinical history as appropriate for each type of investigation, allowing the patient time to describe symptoms and document full relevant history.

View
9 1,2,3

Treat patients in a way that respects their dignity, rights, privacy and confidentiality.

View
10 1,2,3

Take appropriate action to respond to the specific needs of the patient, as defined by department protocol.

View
11 1,2,3

Undertake each investigation/procedure.

View
12 2,3

Review the results from each type of investigation, taking into account artefacts, necessary adjustments of values and planned/unplanned events occurring during the test.

View
13 2,3

Compare the values/traces obtained with the normal range/values related to each type of investigation procedure.

View
14 4

Produce a clear written report of each type of investigation.

View
15 5

Carry out routine maintenance and calibration procedures on the equipment used for each type of investigation.

View
16 5

Accurately complete equipment maintenance records and ensure that calibration records and fault complete for the equipment used for each type of investigation/procedure.

View
You must complete
5 Case-based discussion(s)
5 of the following DOPS / OCEs
Assessment Title Type
Calibrate and check flow rates and transducer function according to Standard operating procedures HRM, solid state and or water perfused as appropriate. DOPS
Standard operating procedures HRM, solid state and or water perfused as appropriate. DOPS
Obtain measurements using either standard pull through technique applicable to HRM, standard solid state and water perfused manometric systems according to local and national standards. DOPS
Perform a minimum of ten test swallows and perform additional swallow assessments as per local protocol. DOPS
Safely extubate the patient and uses safe working methods to reduce cross infection. DOPS
Conduct an infection control assessment appropriate to a piece of equipment DOPS
Check patient details and accurately input patient demographics OCE
Take detailed history, including medication and confirm appropriateness of investigation. OCE
Safely intubate the oesophagus with the manometry catheter and confirm catheter correctly positioned within the stomach and oesophagus OCE
Assess the upper oesophageal sphincter function in terms or relaxation and coordination. OCE
Correlate technical data with the clinical data to produce a clinical report OCE
Explain procedure and the risks and benefits with respect to the patients comorbidities and medication to the investigation to obtain written and informed consent. OCE

Important information

The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.

Learning Outcomes

  1. Describe upper gastrointestinal (GI) anatomy, physiology and neurophysiology and apply knowledge to the pathophysiology, investigation and treatment of upper GI disorders.
  2. Explain the indications, contraindications, side effects and mode of action of drugs used to treat upper GI disorders and other common drugs that may affect the upper GI system.
  3. Discuss and critically evaluate a range of equipment including catheter design and technology used to investigate upper GI investigation.
  4. Describe and critically assess a range of techniques used in the investigation of the upper GI tract.
  5. Explain the principles with regard to safe working practice, infection control and quality assurance when undertaking upper GI investigations.
  6. Explain the indications, modes and choice of technology to investigate upper GI disease.
  7. Discuss and evaluate the techniques used to assess upper GI motility.
  8. Discuss and critically evaluate a range of extubation techniques and the potential advantages, disadvantages and complications.
  9. Discuss and justify the rationale and procedures for the investigation of benign upper GI disease in a broad patient range, e.g. paediatric, adult, elderly.

Indicative Content

Anatomy and physiology

  • Structure and function of the upper GI tract including the action of sphincters
  • Peristalsis
  • Voluntary and involuntary movement
  • Striated muscle within the GI tract

Neurophysiology

  • Parasympathetic and sympathetic nerves
  • Intrinsic nerve plexuses
  • Concept of neurotransmitters and hormones in relation to GI tract

Pathology

  • Malabsorption
  • Achalasia
  • Carcinoma
  • Acid and non-acidic reflux and its role in the exacerbation of extra- oesophageal symptoms
  • Extra-oesophageal reflux
  • Peptic ulcer disease
  • Gluten-sensitive enteropathy
  • Dysphagia
  • Autonomic neuropathy
  • Collagen disorders

Pharmacology

  • The effect of H2 receptor antagonists
  • Prokinetics
  • Proton pump inhibitors
  • pylori eradication regimen
  • Lidocaine
  • Bismuth
  • Sucralfate
  • Nitrates
  • Calcium antagonists
  • Botox
  • Management of cessation of medication

Device design and technology

  • Types of manometric systems
  • MII and pH sensors
  • Electrode characteristics and function
  • Programmable functions and monitoring devices including telemetry

Intubation technique and complications

  • Environmental requirements and considerations
  • Equipment required
  • Intubation procedures and techniques
  • Measurements and checks taken at implantation and their significance
  • Normal acceptable values for measurements
  • Documentation requirements
  • Implications of cessation of medication
  • Early and late complications and their significance

Follow-up

  • Equipment and personnel
  • Clinic design
  • Databases and patient records
  • Patient support material
  • Emergency equipment
  • Troubleshooting
  • Optimal monitoring procedures 

Paediatric considerations

  • Indications, intubation and complications

Associated regulations

  • Conduct of clinical trials
  • Ethical aspects of device implantation