Diagnostic Tests and Treatments :: Nationwide Children's Hospital

Diagnostic Tests and Treatments

Most every parent that hears the news their child needs a test or treatment, is likely to find out every single thing they possibly can about the procedure. This can be a feat within itself, as many of the terms used will be words you will likely not be familiar with. We've compiled a list of the most common words having to do with the tests and treatments.

Use the links below for definitions on each term.

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Anorectal manometry (anal manometry): In infants and children with stooling problems, anorectal manometry is used to test for the normal relaxation of the muscles which help to control bowel movements. These muscles are known as sphincters. Normally these muscles are closed to keep stool in the rectum and open when it is time to have a bowel movement. Anorectal manometry can also test for how the child senses distention or streching of the rectum. A tube with a balloon on its end is inserted into the rectum. The balloon is slowly inflated to simulate stool in the rectum. As the balloon is inflated the muscles should open. The tube is connected to a computer which will measure how well this happens.



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Antroduodenal manometry: The antrum is the lower part of the stomach and the duodenum is the first part of the small intestine, which is connected to the stomach.  Antroduodenal manometry is used to study how the stomach and the first part of the small intestine are working. It can be used to measure both the strength and coordination of muscle contractions of the stomach and small intestine. To do this test, a small flexible tube (catheter) is passed through the nose, down the esophagus, through the stomach, and into the small intestine. The tube is passed after the child is sedated, but the manometry test itself is done after the child wakes up, often the next day. If the child has a gastrostomy tube, the catheter will be passed through the gastrostomy instead of through the nose.  



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Banding of varices: Varices are large, dilated veins that develop in the esophagus (swallowing tube) when there is elevated pressure in the portal vein, the large vein that enters the liver. This elevated pressure can occur under several circumstances including severe liver disease and thrombosis (clotting) of the portal vein. Sometimes these varices can bleed or be at high risk of bleeding. One way to control this is to put a “band” on the vein so that it clots and then will not bleed. The bands are placed using an endoscope. This is done while your child is asleep under anesthesia. A fiberoptic tube (endoscope) is passed through the mouth and into the esophagus. There is a light and video chip on the end of the endoscope that sends images to a screen. A special device, called a bander, is attached to the tip of the endoscope.  Once a varix is identified, a band can be placed around the vein. Bands can be placed on several different varices at the same session. It often requires several sessions, each scheduled several weeks apart, to take care of all the varices.



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Botox® injection of anal sphincter: Botox® is the brand name of a toxin produced by the bacterium Clostridium botulinum (botulinum toxin). When a small amount is injected into a muscle, it causes the muscle to relax. Your child’s doctor may recommend Botox® injection of the anal sphincter under selected circumstances, such as when the child is having difficulty with stooling specifically because of problems with relaxation of the muscles that make up the anal sphincter. The injection is done while the child is asleep under anesthesia. The effect on the muscle is not permanent but can last for many weeks to months.



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Breath testing: Hydrogen breath testing is used to evaluate several different gastrointestinal problems including intolerance of various sugars (such as lactose intolerance) and overgrowth of bacteria in the small intestine. Bacteria in the intestinal tract can produce hydrogen when they are exposed to unabsorbed sugars. This hydrogen gets into the bloodstream, is taken to the lungs, and then removed from the body in the breath. To do this test, the child is asked to blow into a bag (to get a baseline reading). Then they are given a measured amount of a specific sugar to drink.  At intervals after this, the child blows into a bag. The hydrogen in their breath will be measured. The test takes about 4 hours.



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C-13 for helicobacter: Helicobacter pylori (H.pylori) is a bacteria that can infect the stomach and cause irritation or inflammation. In some cases it can cause ulcers in the stomach or small intestine. One test that can be used to look for infection with H. pylori is a C-13 breath test (other tests include a stool test and an upper endoscopy). For the breath test, your child will be asked to blow into a bag (to get a baseline reading). They are then given a special drink and then after a short time will be asked to blow into a bag.



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Capsule endoscopy: Capsule endoscopy (PillCam®) allows for visualization of the lining of the small intestine in areas of the intestine which cannot be seen with standard endoscopy. This can be helpful in the evaluation of a number of problems, such as identifying a source of bleeding in the small intestine, further evaluation of inflammatory bowel disease, or looking for polyps or other lesions in the small intestine. The capsule is about the size of a large vitamin pill and contains a light and video chip that sends images to a computer. Many can swallow the capsule. For those who cannot, the capsule can be placed in the small intestine using endoscopy; in this case, the child is asleep under anesthesia when the capsule is placed. The capsule travels through the intestinal tract taking pictures for 8 hours. These pictures are captured by a receiver that the child wears on a belt. The capsule will ultimately be passed harmlessly in the stool and is discarded.  Pictures are downloaded from the receiver and then reviewed by the doctor.



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Colonic manometry: Colonic manometry is used to study how the colon is working. A manometry catheter is placed in the colon (large intestine). The catheter is a thin, flexible tube that is used to measure how the muscles and nerves of the colon are working. The catheter is either placed by colonoscopy or in interventional radiology. The catheter is attached to a computer that records the strength and coordination of muscle contractions in the colon.



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Colonoscopy: A colonoscopy is a test that allows the doctor to look directly at the lining of the large intestine (colon) using a long flexible tube that has a light and video chip at the end (colonoscope). Prior to this test the child must take medication that will clean stool out of the colon. The colonoscopy is done while the child is asleep under anesthesia. The colonoscope is passed through the anus, into the rectum and then around the remainder of the colon. Frequently, tiny samples of cells (biopsies) are taken to look for inflammation, infection, or other problems.



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Double balloon enteroscopy: Double balloon enteroscopy is a new endoscopic technique that allows for direct visualization of the entire small intestine with the ability to obtain biopsies if abnormal areas are found, to remove polyps, or to treat a bleeding site. This is done while the child is asleep under anesthesia. A special flexible fiber optic tube (endoscope) is passed through the mouth, down the esophagus, through the stomach and into the duodenum which is the start of the small intestine. From there, using a novel technique with two small balloons attached to the endoscope, the endoscope is carefully advanced through the small intestine.



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Esophageal dilatation: Sometimes a child or adolescent can develop a stricture (narrowing) in the esophagus (swallowing tube) that requires dilatation (stretching) to allow for easy passage of food and liquids. There are several ways of dilating the esophagus. One method is to use a series of flexible dilators of increasing thickness called bougies. These are passed down through the esophagus one at a time starting with a thin bougie that can pass through the narrowed area; as the size of the bougie increases, it stretches the strictured area. A second method is using a balloon dilator.  This may be done in Interventional Radiology by one of the radiologists. Under x-ray guidance, a catheter with a balloon is placed through the area of narrowing; the balloon is then inflated which stretches the stricture.



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Esophageal manometry: Esophageal manometry is used to study how the esophagus (swallowing tube) is working. The child is awake for this test. A small tube (catheter) is passed through the nose and into the esophagus. The child is then asked to swallow both with and without sips of water to drink. The catheter is attached to a computer that records the strength and coordination of muscle contractions in the esophagus that occur with these swallows. The catheter needs to be moved during the study to test different areas of the esophagus.



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Foreign body removal: A child or adolescent may swallow a coin, toy, large piece of food that is not chewed well, or other object. If this gets stuck in the esophagus, it must be taken out. To do this, an endoscope (fiber optic tube) is passed through the mouth and into the esophagus. Various tools (graspers and baskets) are available that can be passed through the endoscope and then used to grab the object and pull it out of the esophagus. If the object gets through the esophagus and into the stomach, with time it will usually pass through the rest of the intestinal tract and come out in the stool. For this reason, foreign bodies in the stomach only need to be removed by endoscopy if they are causing symptoms (such as abdominal pain or vomiting) or if the object has remained in the stomach for a prolonged time.



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Motility testing: Motility testing is performed to evaluate how well different parts of the GI tract are working. These tests include anorectal manometry, antroduodenal manometry, esophageal manometry, and colonic manometry.



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Pancreatic function testing (not ERCP): A number of tests are available to see how well the pancreas is making the enzymes that break down food. These include simple stool tests. Sometimes it is important to measure the amount of the enzymes that gets into the small intestine. This is done at the time of an upper endoscopy (see below). After the child is asleep, under anesthesia, they are given a medication through an IV that stimulates the pancreas. This causes fluid from the pancreas to empty out into the first part of the small intestine (duodenum). This fluid is suctioned out through the endoscope and collected in a container. It is then sent to a laboratory where the amount of enzymes in the fluid is measured.



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PEG: Some children need a tube placed in their stomach (gastrostomy tube) to allow them to get adequate nutrition if they cannot take in enough by mouth or to allow them to take in liquids safely if they have a swallowing problem. There are several ways that these tubes can be placed. One is a Percutaneous Endoscopic Gastrostomy (PEG). With the child either asleep under anesthesia or with IV sedation, the endoscope (fiber optic tube) is passed through the esophagus (swallowing tube) and into the stomach. The stomach is then inflated with air through the endoscope. After carefully cleaning the abdomen, a place for the gastrostomy tube is identified, and at this spot a small needle is passed through the abdominal wall and into the stomach. A flexible wire is then passed through this needle and the needle is taken out. The flexible wire is grabbed using the endoscope and pulled out through the mouth. The gastrostomy tube is then attached to this flexible wire and pulled down the esophagus and then out the small opening that was made in the abdominal wall at the site of the needle puncture, leaving the bumper of the gastrostomy tube in the stomach, holding the tube in place. The entire procedure, after the child is asleep, takes only 5-10 minutes. The child will stay in the hospital overnight and usually the tube will be used for feedings the next day. The family is taught how to use and care for the tube before going home.



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pH probe/impedance: These tests are used to measure how often material refluxes from the stomach back into the esophagus (gastroesophageal reflux). The pH probe measures acid reflux. The impedance catheter measures both acid and nonacid reflux.  Your child’s doctor will decide which test will be most helpful. For both tests, a small, flexible catheter is passed through the nose and into the esophagus. The catheter is attached to a recording device. The catheter is left in place for 24 hours. During this time your child can eat and drink normally.



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Polypectomy: Polyps are relatively common in children. Many of these are juvenile polyps which are not cancerous. Some polyps occur as part of a polyposis syndrome.  As part of both the evaluation and treatment of polyps, they are removed endoscopically by polypectomy. This is done through the colonoscope if the polyps are in the colon (large intestine) which is the most common location, or through the endoscope if the polyps are in the stomach or small intestine. If the polyp is very small, it may be removed with a biopsy forcep which is passed through the endoscope or colonoscope. If the polyp is larger, the base of the polyp is grabbed by a snare which is passed through the endoscope or colonoscope. This allows the polyp to be taken off.  Whether removed by biopsy forceps or snare, the polyp is sent to pathology to be examined under a microscope to determine what type of polyp it is.



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Proctoscopy: A proctoscopy is a test that allows the doctor to look directly at the lining of the rectum using a flexible tube that has a light and video chip at the end (either a sigmoidoscope or a colonoscope that is passed through the anus and into the rectum). Sometimes, tiny samples of cells (biopsies) are taken to look for inflammation, infection, or other problems.



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Sclerosis of varices (sclerotherapy): Varices are large, dilated veins that develop in the esophagus when there is elevated pressure in the portal vein, the large vein that enters the liver. This elevated pressure can occur under several circumstances including severe liver disease and thrombosis (clotting) of the portal vein. Sometimes these varices can bleed or be at high risk of bleeding. These can be controlled either by banding (see above) or sclerosing the varices. Sclerotherapy is performed by injecting a medication into the varix that causes it to scar. If the varix is scarred, it cannot bleed. This is done while your child is asleep under anesthesia. A fiber optic tube (endoscope) is passed through the mouth and into the esophagus. A sclerotherapy needle is passed through the endoscope. Once a varix is identified, the needle is advanced into the vein and the medication injected. Several different varices can be injected at the same session. It often requires several sessions, each scheduled several weeks apart, to take care of all the varices.



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Sigmoidoscopy: A sigmoidoscopy is a test that allows the doctor to look directly at the lining of the lower end of the large intestine (rectum and sigmoid colon) using a flexible tube that has a light and video chip at the end (either a sigmoidoscope or a colonoscope). Prior to this test the child must take medications that will clean stool out of the colon. The scope is passed through the anus, into the rectum and then into the sigmoid colon. Frequently, tiny samples of cells (biopsies) are taken to look for inflammation, infection, or other problems.



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Upper endoscopy: An upper endoscopy is a test that allows your child’s doctor to examine the lining of the esophagus (swallowing tube), stomach, and duodenum (first part of the small intestine). It is done while the child is asleep under anesthesia or is sedated. A fiber optic tube (endoscope) is passed through the mouth, down the esophagus and into the stomach and then the small intestine. There is a light and video chip on the end of the endoscope that sends images to a screen. Frequently, tiny samples of cells (biopsies) are taken from the esophagus, stomach, and duodenum to look for inflammation, infection, or other problems.



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