DIAGNOSING
There are several tests which may be performed to help diagnose digestive disorders/diseases. The following is a list of some of the most common methods used. Please note that no assessment method is foolproof, and your physician should evaluate results in conjunction with your symptoms and medical history. Test results can also vary from day to day and can be affected by many factors; results are a snapshot of a moment in time and must be viewed in this light:
Anorectal Manometry: This test can help determine the causes of fecal incontinence, constipation, or other disorders involving the rectum and/or anal sphincter. A small tube is passed through the anus, the anal sphincter, and the rectum, where a tiny balloon is then gradually inflated. As the muscles squeeze, a machine measures the pressure to help determine areas of muscle or nerve weakness.
Antroduodenal Manometry: This test can help determine a motility disorder in the stomach and/or the first portion of the first section of the small intestine. A catheter (with a recording device attached) is placed through the nose, down the throat and into the stomach and small intestines. The device measures muscle activity and muscle contractions over a period of time. Abnormal patterns may indicate a motility disorder.
Bernstein Test (Acid Infusion Test): This test can be useful in confirming that Gastroesophageal Reflux Disease (GERD) is the cause of chest pain. During the procedure, you will be asked to lie down, and your nose and throat will be sprayed with a numbing solution. A nasogastric (NG) tube is passed through one nostril, proceeding into the esophagus and stomach. Mild hydrochloric acid is administered into the NG tube, followed by a saline solution. During the procedure, you will be asked if you have any pain or discomfort. A positive test confirms that your symptoms are caused by GERD.
Colonic Manometry: This test is used to determine the cause of motility problems, such as constipation, in the lower end of the digestive tract. A doctor places a small and flexible tube through the rectum and into the colon. The tube is connected to a device that measures the level of activity in the colon and rectum. Different-sized tubes may be used for pediatric patients.
Colonoscopy: A colonoscopy is performed to assess the large intestines and determine abnormalities. Before the procedure, the patient will be instructed to cleanse the colon by ingesting laxatives (frequently in liquid form). During the procedure, the patient will be mildly sedated while a flexible scope with a small camera is inserted into the rectum and throughout the colon. Air is pumped in through the tube to gradually inflate the colon, and images are sent to a monitor for evaluation. If polyps are present, they may be removed, and tissue samples may also be taken if abnormalities are present.
Defecography: This test involves a series of x-rays performed as the patient defecates. A barium paste (which prompts the need to empty the bowels) is inserted into the rectum, and x-rays are then taken during various stages of defecation to help determine how well the pelvic floor muscles are functioning.
Electrogastrogram (EGG): For this test, electrodes are placed on the abdomen and stomach to monitor and record electrical activity or rhythm in the stomach. An irregular pattern may indicate improper function of the stomach muscles.
Esophageal Manometry: This test is typically used when one is experiencing difficulties or pain when swallowing to determine whether the esophageal sphincter and muscles are working properly and are moving food/liquids down into the stomach. It is similar to the antroduodenal manometry in that a tube is passed through the nose and into the stomach. A machine records the pressure and muscle contraction strength/patterns at various points to assess proper functioning.
Esophageal pH Test: This test is used to measure the pH or amount of acid that flows into the stomach during a 24-hour period. A small probe is inserted into one nostril and positioned near the lower esophagus. The probe is plugged into a monitor, which is typically attached to your belt or placed over your shoulder.
Gastric Emptying Breath Test (GEBT): This test measures the rate at which food moves from the stomach into the small intestines. The patient fasts overnight and is then given a non-radioactive food containing a specific type of carbon that can be measured through a series of breath samples given at regular intervals.
Gastric Emptying Study/Scintigraphy (GES): This test is considered the “gold standard” by which to diagnose gastroparesis. The patient ingests a small amount of radioactive material that has been added to foods and/or liquids. Using a gamma camera, a nuclear medical technician traces that material as it passes through the stomach and enters the intestines. Images of the substance’s progression are taken at regular intervals.
“Sitz”/Radio-opaque Markers Test: This test is sometimes used to assess colonic motility/transit times. The patient ingests one or more capsules containing markers (rings), and as the markers pass through the colon, x-rays are taken to determine their progress. Delayed passage of the markers through the lower GI tract may indicate a problem with colonic motility. It can also indicate possible mechanical obstructions in places where markers are retained.
Tensilon Provocative Testing: This test is performed in conjunction with esophageal manometry to identify an esophageal cause of noncardiac chest pain.
Upper Gastrointestinal Endoscopy: This procedure is used to get a visual of your esophagus, stomach, and duodenum. Once the patient is sedated, the doctor places a long, thin, flexible tube with a camera attached which is maneuvered down the esophagus and into the stomach. The doctor is able to get a more accurate picture of inflammation, stomach contractions, blockages, bezoars and/or undigested food.
Upper GI Series/Barium: For this procedure, the patient is instructed to drink a chalky liquid (Barium) and then must undergo a series of x-rays. This liquid can sometimes highlight undigested food, blockages and tumors.
Wireless Capsule Monitoring/Smart Pill: This is an ingestible electronic device in capsule form that measures pressure, pH level and temperature as it travels through the digestive tract. This information is then sent to a receiver, downloaded and analyzed by a technician. Doctors use this information to evaluate progress through the digestive tract.
Wireless pH Test: The wireless pH test is used to monitor reflux activity within a 48-hour period. During the test, the physician will perform an endoscopy to place a small chip in the lower esophagus. The chip records the level of acid activity at the site and transmits the information to a wireless device that you wear around a belt. The recording device is sent to your physician, who downloads the data to determine your reflux activity.