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. Some patients need to undergo more extensive diagnostic evaluations, such as the ones listed below.

Capsule Endoscopy

Capsule endoscopy 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. 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.

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. The amount of hydrogen in the breath is greater than usual when bacteria in the intestines digest carbohydrates instead of digestion being done by normal digestive enzymes. During the test, breath samples are obtained by having your child blow into a balloon periodically.

Lactose Tolerance Test

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 two-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.

Urea Breath 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. Normally, 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.

Imaging Tests

Lower GI (gastrointestinal) Series (also called Barium Enema)

This procedure examines the rectum, the large intestine and the lower part of the small intestine. A fluid called barium is given into the rectum as an enema. An x-ray of the abdomen shows narrowed areas, blockages and other problems. Learn more about a barium enema in the Department of Medical Imaging .

Oropharyngeal Motility (swallowing) Study

Your child is given small amounts of liquid containing barium to drink, as barium shows well on an 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 first section of the small intestine. A fluid, barium, is swallowed and x-rays are then taken to evaluate the digestive organs. Learn more about an upper GI series in the Department of Medical Imaging .

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 insert instruments through the scope for the removal of a sample of tissue for biopsy.

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 potentially treat 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 . 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. Then, the pressure the esophageal muscles produce at rest is measured.

Colonic Manometry

This test helps determine the strength of muscle contractions in the large intestine. It is useful in helping doctors understand the causes of 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. A small tube is placed down the nose, down the throat into the stomach and finally into the small intestine.

Esophageal 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 with a sensor is placed into a nostril, guided down the throat and then into the esophagus. The tube stops just above the lower esophageal sphincter, and the sensor measures pH, or acidity, for a 12 to 24 hour period.

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. Sometimes, an ultrasound of the liver is done at the same time to help the physician know exactly where to obtain the tissue samples.