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How is a digestive disorder diagnosed?


Diagnostic Tests and Procedures
In order to reach a diagnosis for digestive disorders, a thorough and accurate medical history will be taken by your physician, noting the symptoms you have experienced and any other pertinent information. A physical examination is also performed to help assess the problem more completely.

Some patients may need to undergo a more extensive diagnostic evaluation, which may include laboratory tests, imaging tests and/or endoscopic procedures. These tests may include any, or a combination of, the following.

Laboratory Tests

Fecal occult blood test

  • A fecal occult blood test checks for hidden (occult) blood in the stool. It involves placing a very small amount of stool on a special card, which is then tested in the physician's office or sent to a laboratory

Stool culture

  • A stool culture checks for the presence of abnormal bacteria in the digestive tract that may cause diarrhea and other problems. A small sample of stool is collected in the physician's office and sent to a laboratory. In two or three days, the test will show whether abnormal bacteria are present.

Imaging Tests

Barium beefsteak meal

  • During this test, the patient eats a meal containing barium, allowing the radiologist to watch the stomach as it digests the meal. The amount of time it takes for the barium meal to be digested and leave the stomach gives the physician an idea of how well the patient's stomach is working and helps to detect emptying problems that may not show up on the liquid barium X-ray.

Colorectal transit study

  • This test shows how well food moves through the colon. The patient swallows capsules containing small markers which are visible on an X-ray. The patient follows a high-fiber diet during the course of the test, and the movement of the markers through the colon is monitored with abdominal X-rays taken several times three to seven days after the capsule is swallowed

Computed tomography scan (also called CT or CAT scan)

  • This diagnostic imaging procedure uses a combination of X-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including bones, muscles, fat and organs. CT scans are more detailed than general X-rays.

Defecography

  • Defecography is an X-ray of the anorectal area that evaluates completeness of stool elimination, identifies anorectal abnormalities, and evaluates rectal muscle contractions and relaxation. During the examination, the patient's rectum is filled with a soft paste that is the same consistency as stool. The patient then sits on a toilet that is positioned inside an X-ray machine, and squeezes and relaxes the anus to expel the solution. The physician studies the X-rays to determine if anorectal problems occur while the patient empties the paste from the rectum.

Lower GI (gastrointestinal) series (also called barium enema)

  • A lower GI series is 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.

Upper GI (gastrointestinal) series (also called barium swallow)

  • Upper GI series is 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.

 Magnetic resonance imaging (MRI)

  • MRI is a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. The patient lies on a bed that moves into the cylindrical MRI machine. The machine takes a series of pictures of the inside of the body using a magnetic field and radio waves. The computer enhances the pictures produced. The test is painless, and does not involve exposure to radiation. Because the MRI machine is like a tunnel, some patientss may be claustrophobic or unable to hold still during the test, and may be given a sedative to help them relax. Metal objects cannot be present in the MRI room, so patients with pacemakers or metal clips or rods inside the body cannot have this test done. All jewelry must be removed before the procedure.

Oropharyngeal motility (swallowing) study

  • This is a study in which the patient is given small amounts of a liquid containing barium to drink with a bottle, spoon or cup. Barium is a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray. A series of X-rays are taken to evaluate what happens as the liquid is swallowed.

Radioisotope gastric-emptying scan

  • During this test, the patient eats food containing a radioisotope, which is a slightly radioactive substance that will show up on a scan. The dosage of radiation from the radioisotope is very small and not harmful, but allows the radiologist to see food in the stomach and how quickly the food leaves the stomach, while the patient lies under a machine.

Ultrasound

  • Ultrasound is a diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels. Gel is applied to the area of the body being studied, such as the abdomen, and a wand called a transducer is placed on the skin. The transducer sends sound waves into the body that bounce off organs and return to the ultrasound machine, producing an image on the monitor. A picture or video tape of the test is also made so it can be reviewed in the future.

Endoscopic Procedures

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. It involves inserting a colonoscope - a long, flexible, lighted tube - through the rectum into the colon. 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.

Endoscopic retrograde cholangiopancreatography (ERCP)

  • ERCP is a procedure that allows the physician to diagnose and treat problems in the liver, gallbladder, bile ducts and pancreas. The procedure combines X-ray and the use of an endoscope - a long, flexible, lighted tube. The scope is guided through the mouth and throat, then through the esophagus, stomach and duodenum. The physician can examine the inside of these organs and detect any abnormalities. A tube is then passed through the scope and a dye is injected that allows the internal organs to appear on an X-ray.

Esophagogastroduodenoscopy (also called EGD or upper endoscopy)

  • An EGD is a procedure that allows the physician to examine 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).

Sigmoidoscopy

  • A sigmoidoscopy is a diagnostic procedure that allows the physician to examine the inside of a portion of the large intestine. It is helpful in identifying the causes of diarrhea, abdominal pain, constipation, abnormal growths and bleeding. A short, flexible, lighted tube, called a sigmoidoscope, is inserted into the intestine through the rectum. The scope forces air into the intestine to inflate it and make viewing easier.

Additional Tests and 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 to measure the pressures exerted by the sphincter muscles that ring the canal.

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.

Esophageal pH monitoring

  • An esophageal pH monitor measures acidity inside of the esophagus. It is helpful in evaluating gastroesophageal reflux disease (GERD). A thin, plastic tube is placed into the nostril, guided down the throat 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 is a sensor that measures pH or acidity. The other end of the tube that is outside the body is connected to a monitor that records the pH levels for a 12 to 24 hour period. Patients are encouraged to perform normal daily activities during the study. The patient keeps a diary 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 patient's activity for that time period.

Gastric manometry

  • This test measures electrical and muscular activity in the stomach. The physician passes a thin tube down the patient's throat into the stomach. This tube contains a wire that takes measurements of the electrical and muscular activity of the stomach as it digests foods and liquids. This helps show how the stomach is working and any delays in digestion.



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