UPPER
GASTROINTESTINAL TRACT
This test is usually done to be sure
you don't have an ulcer in your stomach or duodenum (the first part
of your intestine). You will be asked to swallow barium and X-rays
will be taken of the eosophagus, stomach and duodenum. The entire test usually
takes no more than fifteen minutes. A mild laxative such as Milk of Magnesia may
be taken after the test to purge the barium since it can occasionally lead to
severe constipation.
BARIUM ENEMA
(LOWER GI TRACT)
This test can provide a great deal of
information to your doctor. Of course, colon cancer and polyps can be
detected but it also can show diverticulitis, a redundant colon, a
lax colon, or strictures and other less common conditions. Except
when looking specifically for colon cancer or polyps, a barium enema provides much more information than a colonoscopy. The test is
performed by inserting a small tube into the rectum and a balloon is
filled with air so it cannot be easily expelled. Barium is then
instilled through the tube and the entire colon is filled. When an
"air contrast barium enema" is done, air is also instilled for better
definition. The test should take only ten to fifteen minutes and you
will experience mild cramping and a moderate urge to have a bowel
movement.
ENDOSCOPY
UPPER
PANENDOSCOPY
In order to do this test, you must
fast overnight. An IV will be inserted into a vein so that sedative
medication can be given. After you are asleep, a thin tube that can
send a picture to a television screen will be placed into your mouth
and then into the eosophagus. Since you will be asleep you will not
gag or vomit. The doctor doing the test will be able to see your
esophagus, stomach and upper small intestine. Biopsies can be done if
necessary (you have no pain nerves here so it won't hurt and you
won't be sore afterward). This is by far the best test to look for
ulcers, esophagitis, gastritis, etc., but it is alsoexpensive and
relative invasive so your doctor will order it only in highly
selected cases. If your friends have told you "horror stories" about
their endoscopies, I can assure you that the test was not properly
done. The only uncomfortable part should be the IV. The sedation time
is usually five to ten minutes, the endoscopy takes five to fifteen
minutes.
COLONOSCOPY
This test is the best test to look
for cancer and polyps and will discover over 95% of these lesions
(barium enemas will miss 15%-20%). If a polyp is found, it can be
removed at the same time; this is painless since you have no pain
nerves in the lining of your colon. Biopsies can also be done if a
mass is found or if colitis (inflammation) is suspected. When pain is
the primary symptom, this is not the best test to do since a barium
enema will provide more information about the shape and function of
the colon. As with the upper panendoscopy, an IV is placed so that
sedation can be given. The test generally takes thirty to sixty
minutes and the waking up time is twenty to thirty minutes. This is
not a painful test if done properly! The only time this test is
painful is if the doctor doesn't give you enough sedation. The colon
must be very clean to do the test and therefor harsh laxatives must
be given beforehand to purge completely.
FLEXIBLE
SIGMOIDOSCOPY
This is like a colonoscopy but the
tube that is inserted is much shorter and only enemas are needed to
prepare the colon. It is often done in your physician's office and
doesn't require an IV or sedation. It can quickly tell your doctor if
your have inflammation of your colon or if bleeding is coming from
the lower part of the colon. Biopsies can be done (again, this
painless). The test should take only five to ten minutes in
experienced hands and generally you will only feel some gas and
moderate cramping. In women who have had a hysterectomy the test is
more uncomfortable due to adhesions (scar tissue) around the bowel.
Some patients with IBS are more sensitive to bowel distention and
stretching and can be momentarily more uncomfortable.
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CAT SCAN
This is a fairly expensive test that
takes multiple x-rays of the abdomen from different angles, then a
computer puts them all together to develop a cross-sectional view of
different "slices" of the abdomen. Usually you will be asked to drink
thin barium before the test and IV contrast (iodine based) will be
given. If you are allergic to iodine, several medicines can be taken
for three days before the test and a low iodine contrast material
will be given IV. You will be moved through a short tunnel-like
structure (about three feet long). The test takes between ten to
thirty minutes and is painless.
ULTRASOUND
This test is done by passing
ultrasound waves through your abdomen. Usually, the gallbladder,
liver, pancreas and kidney are examined. No radiation is involved and
the test should take no more than ten to twenty minutes. It is
painless, but some pressure is felt because the ultrasound probe must
be firmly pressed against the abdomen.
NUCLEAR
MEDICINE
GASTRIC EMPTYING
STUDY
More and more we are coming to
realize that many of the symptoms of IBS are due to motility
disturbances (i.e. contraction and relaxation of the gut). Nausea,
vomiting, abdominal fullness, and ulcer pain in the absence of an
ulcer can all be caused by stomach and upper small intestine
dysmotility (abnormal motility). For this test, you will be asked to
eat a small amount of food that has a minute amount of radioactive
material attached to it. By using extremely sensitive scanners, the
meal can be seen in the stomach and the time it takes for the stomach
to empty can be determined. If the test shows slow emptying, your
doctor can give you medicines that can normalize it. The test is
painless and takes sixty to ninety minutes to perform. The
radioactivity you receive is about the same dose as for a routine
chest X-ray and is very safe.
CHEMISTRY
This test provides a wealth of
information to your doctor. It shows how much salt and potassium
(which can be lost with diarrhea) are present, how the liver is
functioning and even give a very general picture of your
nutrition.
ANTIGLIANDIN
ANTIBODIES
Celiac sprue is a partially
understood disease that has a very insidious onset. It is caused by a
sensitivity (not an allergy) to gluten, a component of certain grains
such as wheat, barley and oats. In this disease, the cells in the
small intestine that are responsible for absorbing food lose their
ability to absorb nutrients. This results in the slow onset of
malabsorption and ultimately, malnutrition. Early symptoms can be
bloating, increasingly audible bowel sounds, loose stools, etc. Since
these may be the same symptoms that many patients with IBS
experience, the diagnosis could be falsely attributed to IBS.
A blood test has been developed to
detect this sensitivity to gluten - antigliandin antibodies. This
test is especially useful in children, but in adults it can is caused
by a sensitivity (not an allergy) to gluten, a component of certain
grains such as wheat, barley and oats. In this disease, the cells in
the small intestine that are responsible for absorbing food lose
their ability to absorb nutrients. This results in the slow onset of
malabsorption and ultimately, malnutrition. Early symptoms can be
bloating, increasingly audible bowel sounds, loose stools, etc. Since
these may be the same symptoms that many patients with IBS
experience, the diagnosis could be falsely attributed to IBS.
ANTIGIARDIA
ANTIBODIES
Giardia is a parasite that lives in
the small bowel. It can cause severe diarrhea when the infection is
acute, but chronically it can cause more subtle symptoms such as
intermittent bloating, flatulence, loose stools, etc. Blood testing
for this parasite is still being evaluated and may eventually be
useful, but currently it should not be relied upon. Testing of stool
samples for antigens (i.e. parts of the organism) has proven useful
and can even pick up cases of infection when the microscopic
examination of the stool was negative. Presently, most doctors and
labs make the diagnosis of Giardia by having specially trained
technicians look at stool specimens for the parasites. If nothing is
seen after looking for twenty minutes, then the sample is reported as
negative. Human error or low concentrations of parasites can lead to
"false-negatives", which means a test is reported as negative when
the patient really has the disease.
H. PYLORI
ANTIBODIES
In the past few years, we have come
to understand that most ulcers are actually caused or perpetuated by
a bacterium (Helicobacter Pylori) that lives in the duodenum.
Research into this area is rapidly changing our understanding of the
diseases and symptoms caused by this bacterium. At present, we know
that it can cause gastritis (irritation of the stomach lining but
with no ulceration) and should be treated. However, it can also be
present when there are no ulcers or gastritis found in patients who
have ulcer-like symptoms (non-ulcer dyspepsia). Your body develops
antibodies to H. Pylori if you are infected and these can be found by
a blood test. If you have an ulcer and a positive blood test, you
should definitely be treated for this infection. If you have ulcer
symptoms and no ulcer, most studies show no improvement over placebo
when the infection is treated. However, our knowledge is rapidly
expanding and new research could change these recommendations.
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