Diagnostic procedures
In order to reach a diagnosis for digestive and liver problems, a thorough and accurate medical history must be taken by the physician, noting the symptoms your child has experienced and any other pertinent information. A physical examination is also done to help assess the problem more completely.
Some patients need to undergo a more extensive diagnostic evaluation, which may include capsule endoscopy, breath tests, imaging tests, endoscopic procedures or a liver biopsy. These tests are described as follows:
Capsule endoscopy
Capsule endoscopy is a technology that uses a tiny wireless camera to take pictures of the digestive tract. The camera is the size of a large capsule and can either be swallowed or endoscopically placed inside the patient.
This technique is very valuable in examining the small intestine, an area that is not easily accessed by current endoscopes. Traditional endoscopy involves passing a long, flexible tube equipped with a video camera down the throat or through the rectum.
Why the test is done
Capsule endoscopy helps your doctor see inside your child's small intestine. The small intestine, located between the stomach and colon, can be difficult to reach with traditional endoscopy procedures. It can also be difficult to see on X-rays and other imaging tests.
Although it is not a substitute for a colonoscopy or an upper endoscopy, it is a safe method to find out more about your child's small intestine and to determine the best course of management.
Situations in which your doctor might recommend a capsule endoscopy procedure include:
- Gastrointestinal bleeding
- Suspected inflammatory bowel disease such as Crohn disease
- Unexplained symptoms involving the small bowel
- Further evaluation of celiac disease
- Cancer - to see if tumors are in the small intestine or other parts of the digestive tract
- Polyps
How capsule endoscopy works
As the capsule travels through your child's digestive tract, the camera takes thousands of pictures that are transmitted to a recorder worn on a belt around his waist. The images are saved on the recorder and are downloaded to a computer for the gastroenterologist to review.
The capsule records for about 8 hours. It is not necessary to collect the camera capsule because the images have been saved on the recorder. The capsule can be safely flushed down the toilet. If you do not think that the camera capsule has passed through your child's system, the hospital can take an x-ray. Remove the belt and the recorder from your child, pack them in a bag and follow your doctor's instructions for returning the equipment.
It may take a few days to a week to receive the results of the capsule endoscopy. Your doctor will then share the results with you.
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Breath tests
Hydrogen breath test
This test measures the amount of hydrogen in the breath and helps diagnose several digestive problems, including carbohydrate intolerance, bacterial overgrowth of the small intestine and rapid transit of food through the small intestine.
Normally, digestive enzymes in the stomach and upper small intestine digest carbohydrates in the food we eat. Bacteria in the lower small intestine digest the rest of the carbohydrates and produce hydrogen gas in the process. If carbohydrates are largely undigested by the time they reach the small intestine, bacteria will complete the digestive process; however, hydrogen gas being produced will cause cramps and bloating. This can happen if the carbohydrates are not digested properly, if food moves through the digestive system quickly or if large numbers of bacteria are present.
The amount of hydrogen in the breath is greater than usual when bacteria in the intestines digest carbohydrates instead of digestion being done by the normal digestive enzymes. The child is told to fast overnight, and then breath samples are obtained by having the child blow into a balloon periodically. He will be given samples of a carbohydrate (such as lactose or sorbitol) to drink. The amount of hydrogen produced in his breath will be measured at the start of the test and at intervals after carbohydrates are given.
This test helps determine if a child has trouble digesting lactose properly. Your child is given a liquid containing lactose to drink. Several blood samples are taken over a 2-hour period to measure the amount of glucose (sugar) present in the bloodstream. If lactose is digested normally, blood glucose rises. If lactose is not digested as it should be, then the blood glucose level does not change throughout the test.
This test helps diagnose the presence of Helicobacter pylori (H.pylori) in the digestive tract. Your child swallows a capsule containing urea. If H.pylori is present in the stomach, then the urea will be converted into nitrogen and carbon. The carbon changes to carbon dioxide and moves into the bloodstream, and then into the lungs where it is exhaled. Your child breathes into a balloon, and the amount of carbon in the breath is measured. A positive test, meaning carbon is present, indicates the presence of H.pylori.
A negative test, meaning no carbon is detected, indicates no H.pylori is present.
Back to top Imaging tests:
A procedure that examines the rectum, the large intestine, and the lower part of the small intestine. A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray) is given into the rectum as an enema. An x-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and other problems. Find more information about a barium enema here.
Oropharyngeal motility (swallowing) study
Your child is given small amounts of a liquid containing barium to drink with a bottle, spoon, or cup. Barium shows up well on x-ray. A series of x-rays are taken to evaluate what happens as your child swallows the liquid.
Upper GI (gastrointestinal) series
A diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine). A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray) is swallowed. X-rays are then taken to evaluate the digestive organs. Find more information about an upper GI series here.
Back to top Endoscopic procedures
Esophagogastroduodenoscopy (EGD)
Esophagogastroduodenoscopy (also called upper endoscopy) is a procedure that allows the physician to look at the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube called an endoscope is guided into the mouth and throat, then into the esophagus, stomach, and duodenum.
The endoscope allows the physician to view the inside of this area of the body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy (if necessary).
Colonoscopy
Colonoscopy is a procedure that allows the physician to view the entire length of the large intestine, and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding.
The colonoscope allows the physician to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered.
Manometry procedures:
Anorectal manometry
This test helps determine the strength of the muscles in the rectum and anus. These muscles normally tighten to hold in a bowel movement and relax when a bowel movement is passed. Anorectal manometry is helpful in evaluating anorectal malformations and Hirschsprung's disease, among other problems. A small tube is placed into the rectum, and the pressures inside the anus and rectum are measured.
Esophageal manometry
This test helps determine the strength of the muscles in the esophagus. It is useful in evaluating gastroesophageal reflux and swallowing abnormalities. A small tube is guided into the nostril, then passed into the throat and finally into the esophagus. The pressure the esophageal muscles produce at rest is then measured.
Colonic manometry
This test helps determine the the strength of the muscle contractions in the large intestine. It is useful in helping doctors understand the reasons for symptoms in a number of digestive disorders. The tube is placed using a colonoscopy probe and measurements of muscle contractions are taken in various parts of the large intestine.
Antroduodenal manometry:
This test helps determine the strength of the lower part of the stomach, the first portion of the small intestine, and the muscle that connects them (pyloric sphincter). The pyloric sphincter acts as a gateway between the stomach and small intestine, which should open and close based on food in the stomach. Abnormalities in the strength or coordination of the contractions may cause improper digestion and result in symptoms including anorexia, nausea, gagging, vomiting, abdominal distention, abdominal pain, diarrhea, and constipation. A small tube will be placed down the nose, down the throat into the stomach and finally into the small intestine.
pH Monitoring:
An esophageal pH monitor measures the acidity inside of the esophagus. It is helpful in evaluating gastroesophageal reflux disease (GERD). A thin plastic tube is placed into a nostril, guided down the throat and then into the esophagus. The tube stops just above the lower esophageal sphincter, which is at the connection between the esophagus and the stomach. At the end of the tube inside the esophagus is a sensor that measures pH, or acidity.
The other end of the tube outside the body is connected to a monitor that records the pH levels for a 12 to 24 hour period. Normal activity is encouraged during the study, and a diary is kept of symptoms experienced or activity that might be suspicious for reflux, such as gagging or coughing. The pH readings are evaluated and compared to the child's activity for that time period.
Back to top Biopsy procedure:
Liver biopsy
A liver biopsy helps diagnose liver diseases. A small sample of liver tissue is obtained with a special biopsy needle and examined for abnormalities. Children are sometimes given medication to minimize their anxiety during the procedure. A small area of skin over the liver is numbed with a local anesthetic. The anesthetic is then injected deeper under the skin to numb the area that the biopsy needle will pass through and reduce the discomfort of the test.
The biopsy needle is quickly inserted through the skin and into the liver and then withdrawn. Sometimes, an ultrasound of the liver is done at the same time to help the physician know exactly where to obtain the tissue samples. After a liver biopsy, a healthcare professional will observe the child for bleeding problems for a few hours. Pain medications will be given, if needed.
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