Module information
Module details
- Title
- Upper Gastrointestinal Physiology 2
- Type
- Specialist
- Module code
- S-GI-S4
- Credits
- 10
- Phase
- 3
- Requirement
- Compulsory
Aim of this module
This module will provide trainees with the opportunity to gain advanced knowledge of Upper Gastrointestinal physiology. Trainees will perform and interpret the full range of clinical diagnostic investigations of the upper gastrointestinal systems, with a particular focus on complex cases. They will contribute to delivering patient centered care within multidisciplinary settings and improve their professional practice.
Work-based content
Training activities
| # | Learning outcome | Training activity | Type | Action |
|---|---|---|---|---|
| # 1 | Learning outcome 1, 2, 5, 8 |
Training activities
Review and triage patient referrals under supervision, and determine suitability for upper gastrointestinal physiology investigations |
Type ETA | Action View |
| # 2 | Learning outcome 2, 3, 8 |
Training activities
Review and identify the characteristic features of a pH-impedance investigation, including:
|
Type ETA | Action View |
| # 3 | Learning outcome 1,4,6,7,8 |
Training activities
Perform, analyse and interpret oesophageal manometry studies on a range of patients with the following complex presentations:
|
Type ETA | Action View |
| # 4 | Learning outcome 3,5 |
Training activities
Review two complex patient cases, and make recommendations for further treatment and investigation for surgically altered oesophagus |
Type DTA | Action View |
| # 5 | Learning outcome 2,3,5,6,8 |
Training activities
Perform, analyse and interpret a range of complex pH-impedance traces for patients, choosing at least three from the following conditions:
|
Type ETA | Action View |
| # 6 | Learning outcome 3 |
Training activities
Analyse and interpret pH-impedance studies for patients with atypical reflux symptoms |
Type ETA | Action View |
| # 7 | Learning outcome 1,4,6,7 |
Training activities
Perform the following adjunctive testing during oesophageal manometry as appropriate:
|
Type ETA | Action View |
| # 8 | Learning outcome 3,4,6,7 |
Training activities
Produce accurate and concise technical/clinical reports for oesophageal manometry and pH-impedance investigations for a range of conditions |
Type ETA | Action View |
| # 9 | Learning outcome 5,6 |
Training activities
Observe procedures conducted in the following clinics, and present an overview of the techniques and cases observed to colleagues:
|
Type DTA | Action View |
| # 10 | Learning outcome 5,6,8 |
Training activities
Review and present the results of investigations for a complex patient case, making recommendations for treatment to other multidisciplinary team colleagues |
Type ETA | Action View |
Assessments
Complete 2 Case-Based Discussions
Complete 2 DOPS or OCEs
Direct Observation of Practical Skills Titles
- Perform adjunctive tests with esophageal manometry, using current guidelines.
- Insert, remove and adjust any event markers on a pH-impedance study.
- Review symptom association with reflux for a pH-impedance study.
Observed Clinical Event Titles
- Explain complex upper gastrointestinal physiology procedures to patients.
- Explain the procedure and provide support to a patient during HRM adjunctive testing.
- Discuss a complex oesophageal manometry investigation with a colleague.
- Discuss the patient’s medication regime with the patient, identifying medications that may interfere with the outcome of upper gastrointestinal physiology investigations and advise accordingly.
Learning outcomes
| # | Learning outcome |
|---|---|
| 1 | Perform high-resolution oesophageal manometry in the complex patient, including a full range of adjunctive tests as appropriate. |
| 2 | Perform combined oesophageal pH-impedance monitoring in adult patients presenting with a wide range of conditions. |
| 3 | Analyse and interpret the data producing complete reports for both high-resolution oesophageal manometry and oesophageal pH-impedance monitoring, making recommendations for subsequent management/treatment. |
| 4 | Analyse and interpret the data producing preliminary reports from high-resolution manometry (HRM), differentiating between artefact and physiological occurrences. |
| 5 | Practice professionally within the multidisciplinary team. |
| 6 | Employ effective communication skills to present information to a variety of audiences including patients, carers and healthcare professional colleagues. |
| 7 | Interpret manometric patterns in the proximal oesophagus/crycopharynx and identify abnormalities, using knowledge from the wider multidisciplinary team. |
| 8 | Identify situations where physiological measurements are affected by pharmacological interactions and the impact this may have on test results. |
Clinical experiences
Clinical experiences help you to develop insight into your practice and a greater understanding of your specialty's impact on patient care. Clinical experiences should be included in your training plan and you may be asked to help organise your experiences. Reflections and observations from your experiences may help you to advance your practice and can be used to develop evidence to demonstrate your awareness and appreciation of your specialty.
Activities
- Observe upper gastrointestinal endoscopy and barium swallow to appreciate the anatomy and physiology and role of the investigation in the patient pathway.
- Observe upper gastrointestinal surgery e.g., anti-reflux surgery or laparoscopic myotomy.
- Observe endoscopic therapy e.g., Botox, dilatations or POEM.
- Attend dietetics or enteral feeding clinics or services.
- Attend ENT clinics including transnasal endoscopy, UOS dilatation and respiratory to observe management of patients with atypical symptoms of reflux.
- Attend nuclear medicine clinics to observe how they feature in the patient pathway e.g., gastric emptying SeHCAT.
- Attend conservative treatment clinics e.g., CBT, diaphragmatic breathing, psychotherapy and hypnotherapy.
- Attend a video fluoroscopy or speech and language therapy (SALT) clinic.
Academic content (MSc in Clinical Science)
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
On successful completion of this module the trainee will be able to:
- Differentiate between benign upper gastrointestinal system conditions and critically appraise the range of investigations available.
- Critically evaluate the range of technologies and techniques used to investigate benign upper gastrointestinal system disease in complex patients and the role of additional investigations.
- Critically evaluate factors that influence confidence in investigation techniques including spectrums of normality and device error ranges, in addition to physiological artefact.
- Classify drugs used to treat upper gastrointestinal system disorders and differentiate the actions of these agents from other drugs that might confound diagnosis.
- Critically evaluate risk, safe working practices, quality assurance and infection control in the context of the investigation of complex benign upper gastrointestinal system disorders.
Indicative content
Disease and conditions
- Achalasia
- Congenital abnormalities
- Surgically altered oesophagus
- Eosinophilic oesophagitis
- Crycopharyngeal abnormalities
- Hiatus hernias
Anatomy and physiology
- Structure and function of the upper gastrointestinal tract including the action of sphincters
- Peristalsis
- Pharyngeal from oesophageal dysphagia
- Voluntary and involuntary movement
- Striated muscle within the gastrointestinal tract
Neurophysiology
- Parasympathetic and sympathetic nerves
- Intrinsic nerve plexuses
- Concept of neurotransmitters and hormones in relation to gastrointestinal 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 medication cessation
Device design and technology
- Types of manometric systems
- MII and pH sensors
- Electrode characteristics and function
- Programmable functions and monitoring devices including telemetry
- High-resolution impedance oesophageal manometry – development and benefits compared to conventional manometry
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
Module assigned to
Specialties
| Specialty code | Specialty title | Action |
|---|---|---|
| Specialty code SPS3-1-22 | Specialty title Gastrointestinal Physiology [2022] | Action View |
| Specialty code SPS3-1-23 | Specialty title Gastrointestinal Physiology [2023] | Action View |
| Specialty code SPS3-1-24 | Specialty title Gastrointestinal Physiology [2024] | Action View |