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Upper GI Tract Endoscopy

This test is designed to take a look inside your upper gastrointestinal tract with telescope to show what's going on there.

An endoscope is a fiberoptic instrument that enables doctors to have a close look at the GI mucosa (the lining of your bowel). This instrument also makes it possible for the physician to obtain tissue samples from the gastrointestinal mucosa, a procedure called mucosal biopsy, which serves for microscopic examination of the intestine. An upper endoscope can scan the esophagus, stomach and duodenum and is helpful for diagnosing upper GI disorders, such as a peptic ulcer, reflux esophagitis, and gastritis. Additionally, a tissue biopsy at the time of an upper endoscopy can be used for diagnosis of gastritis caused by helicobacter infection and/or celiac disease. An upper endoscopy with the use of ultrasonic devices (endoscopic ultrasound) may be used to diagnose diseases of the biliary tract (including gall stones) and/or the pancreas (such as chronic pancreatitis). Indications for an upper endoscopy include upper abdominal pain, fullness, diarrhea and distension.

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Colonoscopy

Colonoscopy is essential part of colon cancer screening after age 50. It may need to be done in some instances in IBS patients.

A colonoscope is an endoscope that scan colon and can be used to diagnose inflammatory bowel disease, a colonic polyp or colon cancer. The indication for colonoscopy is lower abdominal pain, diarrhea or blood in the stool.

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Video Capsule Endoscopy

Pillcam ® is a very small camera that can fit into a pill size capsule and can record images of the entire stomach and the small bowel. The Pillcam® is ingested similar to a regular pill. The name of this test is Video Capsule Endoscopy and is currently being performed in many centers throughout the world. The camera inside the capsule is equipped with a light source that will be used to illuminate the inside of the bowel during the image capture. The images that are captured by the camera will be transmitted through a wireless technology to a small pager like device that is worn around your belt. Thus, there is no need to retrieve the capsule to obtain the images. The Pillcam® capsule is disposable and the battery inside the capsule wears out after a few hours of use. The Pillcam® capsule records 2 images per second for 8 hours continuously (almost 50,000 images). After completion of the test (8 hours) the images will be downloaded from the device into the physician’s desk-top computer for viewing. Playing these images on the computer create a near continuous motion picture like a movie. This procedure does not require prior bowel cleansing or preparation and during the test you can go back to your daily routine. In addition, this test is painless and minimally invasive with very few complications. However, there are some limitations to this test. First of all this test only is designed to diagnose lesions in the stomach and small bowel. This is due to the fact that large bowel always contains fecal material and the test is done without any pre-procedure bowel cleansing. Not to mention that the large bowel is easily accessible to colonoscopy. Additionally, there is no way to control the camera’s views or speed of passage through various part of the GI tracts, as the main force for forward movement of the Pillcam® capsule is gastrointestinal motility. Therefore, there could be a great variation in the speed of the passage of the camera and speed of recording of the images by the camera. Lastly, the lack of therapeutic capabilities on the device can mandate further endoscopic intervention for obtaining tissue or treatment of the lesions that are located using the Pillcam®. Overall, this useful test is becoming increasingly popular because of ease of use and minimal invasiveness. The test is currently being used to diagnose several gastrointestinal disorders including celiac disease, small bowel Crohn’s disease and benign or malignant tumors of the small bowel. This is particularly important because this part of the bowel is less accessible to conventional endoscopic examination. Currently, this test is not indicated to be performed routinely in patients with IBS. However, those with chronic abdominal pain in whom the diagnosis of small bowel Crohn’s disease or celiac disease are likely may benefit from this diagnostic capability of this test.

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Blood Tests

Is anemia common in IBS?

Blood tests can detect anemia as a culprit of organic GI disorders. Data from blood tests also can help in the diagnosis of malabsorption, inflammatory bowel disease and celiac disease. Nowadays, we also can perform some genetic tests for celiac disease using blood samples.

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Barium Enema or Virtual Colonoscopy

An x-ray based test to check on colon.

A barium enema or virtual colonoscopy (a type of CAT scan of the colon) are alternatives to a colonoscopy. Virtual colonoscopy or CT colography are newer techniques in which the colon image is reconstructed into a three-dimensional picture and can be used to visualize colonic abnormalities.

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Stool Tests

Is this all due to a parasite in my gut?

Stool tests can be used to detect an intestinal parasite. In addition, stool test can detect microscopic blood that can not be seen with naked eyes (occult blood). The presence of occult blood in the stool may suggest the presence of colon cancer, polyps or ulcers. Stool tests also can be used for diagnosis of pancreatic insufficiency.

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Breath Tests

This test checks your breath for special gas for diagnosis of some conditions.

Currently the most common use of breath test is for diagnosis of lactose intolerance and Bacterial overgrowth. During a Breath Test, the patient is provided with a standard amount of lactose. When an individual with reduced ability to digest lactose is exposed to a large amount of this sugar, the enzyme is easily overwhelmed. As a result, the undigested sugar travels through the small intestine and reaches the large bowel, where bacteria consumes the sugar and produce a significant amount of gases, including hydrogen. Hydrogen is an odorless gas that is absorbed in the blood stream and is eventually excreted through the lungs in our exhaled breath. During a Breath Test, the amount of hydrogen in breath is measured. If this amount is high, it means that there is not enough lactase in the intestine and the patient has lactase deficiency or lactose intolerance.

Breath test can also be used for diagnosis of bacterial overgrowth. In this test, a large amount of other sugar named Lactulose (do not confuse this term with milk sugar or lactose) is given to the patient orally. Since the human GI tract is devoid of any enzymes to break down Lactulose, this sugar escapes digestion and absorption in the human intestine. In the case of bacterial overgrowth, the bacteria in the small bowel digest the Lactulose and release the hydrogen gas while the sugar is still in the small bowel. In this case we would see a rise in breath hydrogen, after less than an hour of the consumption of a load of Lactulose.

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Need for Follow-up

I lost 15 pound recently. Is this part of the IBS package?

Many physicians believe that the best approach for diagnosing IBS is by monitoring the patient over a period of time with periodic clinical exams and simple lab tests. This will rule out the possibility of an organic GI problem and lead to early detection of abnormalities.

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