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📘 Chicago Classification v4.0 updates HRM interpretation with stricter criteria & mandatory clinical correlation.
🔄 Supine + upright swallows required.
🚫 EGJOO now needs ↑IRP in both positions + abnormal confirmatory test.
⚡ Achalasia (Types I–III) must include symptoms & supportive tests (TBE/EndoFLIP).
🔥 DES & Jackhammer diagnosed only when manometry + symptoms align.
#GastroAGI #AGA #ChicagoClassification #Esophagus #Motility #HRM
⚠ Ultra-processed foods (UPFs) & Early Death
A global study shows a 2.7% rise in mortality for every 10% increase in UPF intake.
🍔 Countries with highest UPF intake (US/UK >50%) see up to 14% premature deaths linked to UPFs.
📉 Experts call for taxes, better labeling & healthier food access.
🔪 Two-Stage Hepatectomy (TSH)
A key option for initially irresectable colorectal liver metastases.
🩺 Stage-1: Debulk tumors + allow liver regeneration.
🩸 Stage-2: Remove remaining disease after FLR hypertrophy.
✅ Feasible in ~80%, offering long-term survival & potential cure.
🧪 Autoantibodies & MASLD Outcomes
ANA (17%) and ASMA (25%) are common in MASLD.
Their presence signals worse prognosis:
⚠️ ~4× higher risk of liver decompensation
⚠️ >2× higher mortality
Autoantibodies act as markers of immune activation and predict
progression to cACLD.
➡️ Useful for risk stratification & closer monitoring.
📏 FLIP Panometry Update – Dallas Consensus
🔬 Experts standardized 40 guidelines for performing & interpreting FLIP to reduce variability.
✅ A normal FLIP reliably rules out major motor disorders.
⚠️ ↓EGJ opening + weak contractions = EGJ outflow obstruction.
A major step toward uniform global practice.
🔥 HbA1c & Infected Pancreatic Necrosis (IPN)
⚠️ HbA1c ≥6.5% = 4× higher IPN risk in acute necrotizing pancreatitis.
🩸 Hyperglycemia drives immune dysfunction, bacterial translocation & severe inflammation.
📌 Early HbA1c testing + strict glucose control is essential.
How is hepatic fibrosis assessed & staged?
🔆 Radiotherapy in HCC: Y90 vs SBRT
• Y90: Injected microspheres → heterogeneous dose, 2–3 mm penetration, radiation over days (t½ ~64h).
• SBRT: External beam → uniform, precise high dose in minutes.
• Y90’s slow delivery ↓ biological effect per Gy; ~400 Gy Y90 ≈ 40–50 Gy SBRT.
