diagnosing gastrointestinal disorders in kids
comprehensive diagnostic testing
Diagnosing a gastrointestinal condition can be difficult and sometimes frustrating, in part because many of these conditions have similar symptoms. Our physicians are highly knowledgeable about diagnosing pediatric gastrointestinal disorders, and skilled in interpreting test results. Our team schedules diagnostic tests and provides test results as quickly and efficiently as possible, with the goal of beginning treatment in a timely manner. We want your child to feel better soon!
Dayton Children’s offers comprehensive testing for gastrointestinal disorders, including the tests listed below. Our pediatric nurses and other staff work closely with parents to make sure kids are as comfortable and relaxed as possible before, during and after these tests. Below are some simple descriptions of some of the tests we might perform. Our specialists will be sure to discuss these tests with you ahead of time to ensure you know what will be happening and how to prepare.
24-hour pH probe study (requires an overnight hospital stay)
This test is used to detect gastroesophageal reflux and the number of reflux episodes. A thin, flexible tube is placed through the nose into the esophagus. The tip rests just above the esophageal sphincter, the muscle at the bottom of the esophagus that opens to allow swallowed food and beverages to pass into the stomach, to monitor fluid and acid levels in the esophagus and to detect any reflux.
anorectal and esophageal manometry
There are two small muscles in the anus (opening where bowel movements come out) which help to control bowel movements. These muscles are normally closed to prevent leaking of stool. To have a bowel movement, these muscles must open at the same time. An anorectal manometry is a test to tell how well these muscles are working.
During the test a tube with a balloon on the end will be inserted into the child’s rectum, the final portion of the large intestine which ends at the anus. The balloon will be blown up to different sizes, and pressure readings done by the computer. The computer will record how the rectum is working. An older child will be asked to tell the nurse what they are feeling during the test. The child will also be asked to squeeze their bottoms shut, and to push the balloon out. This tell us how their bodies control their bowel movements.
Antroduodenal manometry tests the ability of the antrum (the end of the stomach) and duodenum (first part of the small intestine) to move digested foods. For this test, a thin catheter with sensors is placed, generally at the same time as an upper endoscopy, through the nostril, down the esophagus and into the stomach and first part of the small intestine. Measurements of pressure and relaxation are taken for analysis of the motility (movement) of the stomach and duodenum.
This is a special X-ray that can show the refluxing of liquid into the esophagus, any irritation in the esophagus, and abnormalities in the upper digestive tract. For the test, your child must swallow a small amount of a chalky liquid (barium). This liquid appears on the X-ray and shows the swallowing process.
water-soluble contrast enema
A water-soluble contrast enema is an x-ray test that looks at the structure of the large intestine (colon). An enema solution made of a water-soluble contrast material is given to your child to outline the large bowel. During the test, a small flexible tube will be placed into your child’s rectum, the final portion of the large intestine which ends at the anus (where bowel movements come out). This tube is attached to the enema solution which will flow into the large bowel. The x-ray will be taken before and after your child goes to the bathroom. This test is similar to a barium enema, but the water-soluble contrast is more easily expelled than barium.
breath hydrogen tests
A breath hydrogen helps to diagnose abnormal digestion of sugars or the presence of infection by measuring the amount of hydrogen in the breath in after the ingestion of sugars or substances to detect infection. A breath sample will be collected by blowing into a balloon-type bag (a face mask will be used for a small child). The hydrogen levels will be higher than usual when bacteria in the intestines are digesting carbohydrates rather than the normal digestive enzymes, or if an infection is present.
During this test a small wireless camera will take photos of your child’s digestive tract, especially in the long length of the small intestine that is beyond what can be seen in an upper endoscopy or colonoscopy. The camera is a large capsule and can either be swallowed or placed endoscopically with a small medical instrument inside the patient. This test is useful to the physician because it allows them to see parts of the small intestine that cannot be seen by other endoscopes.
Colonic manometry tests the ability of the colon (large intestine) to move stool. For this test, a thin catheter with sensors is placed, in conjunction with a colonoscopy, in the colon. Measurements of pressure and relaxation are then taken for analysis of the motility (movement) of the colon.
colonoscopy with biopsies
Using an endoscope (or colonoscope), a long, thin tube inserted through the anus and attached to a video monitor, allows the doctor see inflammation, bleeding, or ulcers on the wall of the colon and last part of the small intestine (ileum).
Esophageal manometry tests the ability of the esophagus to move foods and beverages to the stomach. For this test, a thin catheter with sensors is inserted through the nostril, down into the esophagus, and ending in the stomach, and measurements of pressure and relaxation are taken for analysis.
A flexible sigmoidoscopy is a test that lets the doctor look at the lining of the rectum and lower portion of the large intestine. A flexible tube is passed through the rectum into the large bowel. The doctor can look at the lining of the rectum and large intestine and may take tissue samples to look at under a microscope. This test does not usually hurt but the child may feel some pressure or cramping.
gastric emptying scan
A gastric emptying scan is a radiology test that measures how fast the stomach is able to pass its contents on into the small intestine. It is performed by having a child swallow liquids or foods containing a tracer and then measuring how fast the tracer leaves the stomach.
hepatobiliary (HIDA) scan
A hepatobiliary scan is a radiology test that checks how the gallbladder works. It is often used for complaints of abdominal (stomach) pain. Your child will require one or two injections of medicine for the hepatobiliary scan. This will help the liver, gallbladder and small intestine show up better on the x-ray pictures.
imaging studies ( X-ray, ultrasound, computed tomography (CT) and nuclear medicine)
Your child’s gastroenterologist may order a number of different imaging studies to determine what might be the issue. These can include tests such as the barium swallow and upper GI study.
Your doctor might order blood tests to look for signs of the inflammation that often accompanies diseases such as inflammatory bowel disease, and to check for anemia and for other causes of symptoms, like infection. Stool tests might also be done to check for the presence of blood, infection, inflammation, or evidence that food is not being absorbed normally.
A biopsy is a test that's performed to examine tissue or cells from a part of the body. It can be done by cutting or scraping a small piece of the tissue or by withdrawing a sample of tissue with a needle and syringe. In a liver biopsy a small portion of the liver will be removed through a needle and will be sent to the laboratory for further testing.
modified barium swallowing study
A modified barium swallowing study is a study performed by a radiologist and a speeth therapist to evaluate swallowing to make sure that the child can swallow foods or beverages without having them go into the lungs (aspirate).
sitz marker study
A Sitz marker study is most often used with patients who are suffering from chronic constipation. This test will require swallowing a capsule which contains 24 special barium rings or “markers” inside of it. These markers show up on an x-ray and help see how quickly they move through your child’s intestines.
suction rectal biopsy
A rectal biopsy is the removal of several small pieces of tissue from the rectum. This is often done to determine if there are nerve cells present that are needed for your child to have normal bowel movements. The rectal biopsy is generally done in the clinic or at the bedside. Your child remains awake for the test and it is not painful.
upper endoscopy with biopsies
In this test, which is also called esophagogastroduodenoscopy (EGD), doctors directly look at the esophagus, stomach, and the first portion of the small intestines using a tiny fiber-optic camera. During the procedure, doctors may also biopsy (take a small sample of) the lining of the esophagus to evaluate for other problems and see what is causing other complications.
upper GI study
An upper GI series is a study that involves swallowing contrast material while X-rays are taken of the top part of the digestive system including the esophagus, stomach and small intestine. This allows the doctor to see how a child swallows. Upper GI studies are used to evaluate things like difficulty swallowing and vomiting. An upper GI isn't painful, but some kids don't like to drink the contrast material, which sometimes can be flavored to make it more appealing.
wireless capsule pH probe study
This test is used to detect acid in the esophagus that results from gastroesophageal reflux. The acid is detected using a sensor in a small capsule that is attached to the lining of the lower esophagus in conjunction with an upper endoscopy. The sensor then sends measurements to a detector worn near the chest for 48 hours. The capsule then eventually falls off the esophagus and comes out in the stool.