Findings on Functional Lumen Imaging Probe (FLIP) Can Guide Treatment in Symptomatic Patients With Elevated Basal Lower Esophageal Sphincter Pressure (LES) But Normal LES Relaxation on High Resolution Manometry (HRM): A Case Series

The finding of elevated basal lower esophageal sphincter (LES) pressure but normal integrated relaxation pressure (IRP) on high resolution manometry (HRM) can be due to multiple etiologies. In the absence of a structural cause, esophageal dysmotility should be considered, and functional lumen imaging probe (FLIP) can provide additional information about LES function not captured on HRM. We report the clinical outcomes of three patients from a single center with nonobstructive dysphagia without narcotic use, achalasia or previous foregut surgery who demonstrated a hypertensive LES on HRM with no CCv4.0 diagnosis but had abnormal FLIP findings with LES targeted endoscopic interventions leading to symptomatic improvement. This case series underscores the potential need for additional diagnostic testing in patients presenting with dysphagia who lack a definitive manometric diagnosis on HRM, specifically highlighting the complementary role of FLIP in the evaluation of these patients.