Many gastrointestinal issues in children can be diagnosed through careful history taking and physical examination, together with parental observation and discussion. However, if during the initial consultation I identify any red flags, or your child has a more complicated issue, it may be necessary to perform one or more investigations to assist in providing a diagnosis.
Investigations may begin with collecting urine or faecal samples, or taking blood tests. Other common gastrointestinal investigations include:
An upper endoscopy is a procedure which uses a long thin camera (called an endoscope) to look at the upper part of your child’s gastrointestinal tract. This includes the oesophagus (the swallowing tube), the stomach and the duodenum (the first part of the small intestines).
The procedure is commonly used to help diagnose conditions such coeliac disease and gastro-oesophageal reflux disease.
Your child will need to follow a strict diet and may need to take certain medications before the procedure, to make sure that their stomach is empty. If your child is currently on regular medication, your doctor may also advise you to stop this before the procedure.
For more information take a look at the following video:
A lower endoscopy (or colonoscopy) is a procedure which uses a long thin camera (called an endoscope) to look inside the colon – the lower part of your child’s gastrointestinal tract.
The main reasons children need a colonoscopy are to find a cause for abdominal (stomach) pain, diarrhoea or bleeding from the bowel.
Your child will need to follow a strict diet and may need to take certain medications before the procedure, to make sure that their stomach and intestines are completely empty. If your child is currently on regular medication, your doctor may also advise you to stop this before the procedure.
For more information please download the following information sheet:
Or take a look at the following video:
A wireless capsule endoscopy is used to identify or confirm a number of conditions, including: food allergies and intolerances, Crohn’s disease, Meckel’s diverticulum, infantile myofibromatosis and intestinal tumors. The procedure uses a small video capsule to take photographs of the inside of the of the oesophagus, stomach and small intestine.
For a capsule endoscopy, the intestines are first cleared of residual food and bacterial debris with the use of laxatives and/or purges, such as Senokot, Piccolax or Movicol. It may also be necessary to eat a low fibre diet for a few days leading up to your procedure.
At the start of the procedure the patient will swallow a large capsule (slightly larger than a large vitamin pill). The capsule contains one or two video chips (cameras), a light bulb, a battery and a radio transmitter. As the capsule travels through the oesophagus, stomach and small intestine, it takes a series of rapid photographs. These photographs are transmitted to a small external receiver that is worn around the waist.
At the end of the procedure, approximately eight hours later, the photographs are downloaded from the receiver onto a computer, and the images are reviewed by a physician. The capsule is excreted naturally by the patient and flushed down the toilet. There is no need to retrieve the capsule!
An oesophageal pH study is a safe and reliable diagnostic test for detecting reflux.
Reflux is the term used to describe the involuntary return of undigested food, milk etc. from the stomach into the oesophagus. As stomach contents are usually acidic this can irritate the lining of the oesophagus, causing inflammation and pain which may be similar to that described as heartburn.
Prior to the procedure the patient may need to stop taking certain medications, such as Omeprazole, Lansoprazole, Ranitidine and Domperidone for a few days. The patient will also need to be ‘nil by mouth’ on the day of admission.
The procedure involves a small probe being passed through the nose into the lower part of the oesophagus (similar to that of some feeding tubes). Passing the probe does not take long but some children find it upsetting.
When the probe is in the correct position your child may resume normal activity. The probe should not feel uncomfortable but some children take a little while to get used to the presence of the probe.
The probe is removed after 24hrs (occasionally less) and analysis and results can usually be given before discharge. If acid reflux is diagnosed it is usually successfully treated by using a combination of medicines which help to reduce the level of stomach acid and aid stomach emptying.
You may need to ring the ward on the morning of admission to ensure that a bed is available. Alternatively you may be offered to take your child home after the initial procedure and return the following day for the probe to be taken out.
The hydrogen breath test is a non-invasive, safe test used to diagnose bacterial overgrowth, sugar intolerances, such as lactose or fructose intolerance, and other causes of toddler diarrhoea.
Prior to the procedure your child must be kept ‘nil by mouth’ (apart from water) for a minimum of four hours. No food or drink, apart from water, is allowed during the test.
If it is thought that your child has sugar intolerance (and might not be absorbing all the sugar in certain foods), we will do a ‘sugar challenge’. By measuring the amount of breath hydrogen that your child expires over a three hour period we are able to tell if all the sugar has been absorbed.
If your child has abdominal pain or diarrhoea without sugar intolerance we will give a sweet tasting drink containing Lactulose which is not absorbed by the gut. By measuring breath hydrogen over three hours we can tell how quickly the Lactulose moves through the bowel.
Your child will be asked to blow into a small hand held monitor (or if unable to do this a face mask will be placed gently over the face and nose) before taking the sugary tasting drink. Breath samples are then taken every 30 minutes for three hours.
The results of the test will be given to you when you next visit the outpatients department.