PROCEDURES

At the Greater Houston Digestive Disease Consultants, we know that the prospect of having an outpatient procedure can sometimes produce anxiety and uncertainty. As a way of reducing your stress, we invite you to learn more about your scheduled procedure.

 By clicking on the appropriate link, you will learn what is involved in the procedure, why it is being performed, what can be expected and how long it might take. We hope that this information will be helpful as you and your family prepare for your procedure. Please feel free to contact us at any time and we will be happy to answer any further questions and address any concerns you may have.

Your physician has determined that colonoscopy is necessary for further evaluation or treatment of your condition. The information below has been prepared to help you better understand the procedure. It includes answers to the most frequently asked questions. If you have any additional questions or concerns, please feel free to discuss them with the endoscopy nurse or physician before the examination begins.

Colonoscopy is the endoscopic examination of the colon. Colonoscopy enables your physician to examine the lining of the colon (large bowel) for abnormalities by inserting a flexible tube that is about the thickness of your finger and has a fiber optic camera and light source into the anus and advancing it slowly into the rectum and colon.

Colonoscopy is more accurate than x-ray films for detecting inflammation, ulcers or tumors of the colon. Colonoscopy is usually performed to evaluate symptoms of persistent lower abdominal pain, chronic diarrhea, and for finding the cause of active or occult (slow, chronic) bleeding from the lower gastrointestinal tract. Colonoscopy can detect early cancer and can distinguish between benign and malignant (cancerous) conditions when biopsies (small tissues sample) of suspicious areas are obtained. Biopsies are taken for many reasons and do not necessarily mean that cancer is suspected. A cytology test, the introduction of a small brush to collect cells, may also be performed. Colonoscopy is also used to treat conditions present in the lower gastrointestinal tract. A variety of instruments can be passed through the colonoscope that allow many abnormalities to be treated directly with little or no discomfort, for example, stretching narrowed areas, removing polyps (usually benign growths), treating lower gastrointestinal bleeding. Safe and effective endoscopic control of bleeding has reduced the need for transfusions and surgery in many patients.

You must inform your physician of all prescribed and over the counter medications you are currently taking, as well as any allergies to any medications several days before to the examination. Most medications may be continued as usual, but some medications can interfere with the preparation or the examination. If you require antibiotics prior to undergoing dental procedures you should alert your physician, as you may need antibiotics prior to colonoscopy as well.

Your doctor will give you a sedative through a vein to help you relax and better tolerate any discomfort from the procedure. Colonoscopy is usually well tolerated and rarely causes much pain. There is often a feeling of pressure, bloating, or cramping at various times during the procedure. During the procedure you will be lying on your left side or on you back while the colonoscope is advanced through the rectum and colon.
The lining of the intestine is carefully examined as the instrument is withdrawn. The procedure usually takes anywhere from 15 to 60 minutes. In some cases, passage of the colonoscope through the entire colon to its junction with small intestine cannot be achieved. The physician will determine if colonoscopy is sufficient or if other types of examinations are necessary.

If it is determined by your doctor that an area of the bowel needs to be evaluated in greater detail, a forceps instrument will passed through the colonoscope to obtain a biopsy (a tissue sample from the colon lining). This specimen is then submitted to the pathology laboratory for analysis. If colonoscopy is being performed to identify sites of bleeding, the areas of bleeding may be treated through the colonoscope by injecting medication or by coagulation (sealing off bleeding vessels with heat treatment). If polyps are found, they are generally removed. None of these additional procedures typically produce pain. Remember, the biopsies are taken for many reasons and do not necessarily mean that cancer is suspected.

Polyps are abnormal growths from the lining of the colon which vary in size from a tiny dot to several inches. The majority of polyps are benign (noncancerous) but the doctor cannot always tell a benign from a malignant (cancerous) polyp by its outer appearance alone. For this reason, removed polyps are sent to the laboratory for tissue analysis. Removal of colon polyps is an important method of prevention and early detection of colon cancer. Tiny polyps may be destroyed by fulguration (burning), but larger polyps are removed by a technique called snare polypectomy. To perform this technique the doctor passes a wire loop (snare) through the colonscope and severs the attachment of the polyp from the intestinal wall by means of an electrical current. You should feel no pain during the polypectomy. There is a very small risk (0.1%) that removing a polyp will cause bleeding or result in a burn to the wall of the colon, which require emergency surgery.

After the test, you will be monitored in the recovery room until most of the effects of the medication have worn off. You may experience cramping or bloating due to air introduced into your colon during the test. This should disappear quickly with passage of flatus (gas). In most circumstances, your doctor can inform you of your test results on the day of the procedure; however, the results of any biopsies or cytology samples will take several days.

Colonoscopy and polypectompy are generally safe when performed by physicians who have been specially trained and are experienced in these endoscopic procedures. One possible uncommon complication is a perforation tear through the bowel wall that could require surgery. Bleeding may occur in approximately 0.1% of patients from a biopsy site or where a polyp was removed. It can occur during the procedure or up to 7 to 10 days later. It is usually minor and stops on its own or can be controlled through the colonoscope. Blood transfusions or surgery are rarely required. Phlebitis, or the localized irritation of the vein into where medication was injected, seldom causes a tender lump that may last several weeks, but this will go away eventually. The application of heat packs or hot moist towels may help to relieve the discomfort. Other potential risks include a reaction to the sedatives used and complications from heart or lung diseases. Although complications after colonoscopy are uncommon, it is important for you to recognize early signs of any possible complication. Contact the physician who performed the colonoscopy immediately if you notice any of the following symptoms: severe abdominal pain, fever and chill, or rectal bleeding of more than one half cup. Bleeding may occur several days after polypectomy.

One of the following preparations will be recommended by your doctor based on your health conditions.
For all patients the colon must be completely clean for the procedure to be accurate and complete. Follow your doctor's instructions carefully. If you do not, the procedure may have to be canceled and the preparation repeated later. You can have as much clear liquids as you want until midnight. It is easy to become dehydrated during your preparation so it is important to drink at least 2 liters of fluid prior to starting your laxative. If you experience any problems, such as nausea or vomiting, please contact our office. A loose or watery bowel movement will occur within 1-2 hours of beginning the laxative and is expected. Results will vary with each individual. You may take your doctor approved medications in the morning. No insulin or diabetes pills should be taken prior to the procedure.
Your physican will recommend one of the following preps:

Osmo Prep Tablets

Approved for ages 55 years and under If ages 55 years old and under,

  1. Follow a clear liquid diet all day. Clear liquids include coffee, tea bouillon soup, Chicken broth, water, apple and white grape juice, lemonade, lemon lime or white Gatorade or other sports drinks that are clear. If you can see through the liquid it is ok to drink it. No red, purple, or green colored liquids should be consumed.
  2. Take 4 tablets every 15 mins with 8ounce of clear liquied from  4pm to 5pm (4:15, 4:30, 4:45, 5:oopm) to total 20 tablets.  Then 4 tablets every 15 mins with 8ounce of clear liquied from  8pm to 8:30pm (4:15, 4:30, 4:45, 5:oopm)  to total 12 more pills (8pm, 8:15, 8:30pm)
  3. Continue drinking clear liquids the entire day.
  4. Take 2 sleep anemas at 6am on day of procedure.
  5. Please do not eat anything after midnight, the night before your exam.
  6. If you are taking blood pressure medication, take it the morning of the procedure with a small sip of water.
  7. Be sure to stop all aspirin or ibuprofen 7 days prior to the procedure.  Stop Plavix 5 days prior to the procedure and Coumadine 4 days prior to the procedure. 
  8. It is extremely important to drink large amounts of clear liquids throughout the prep to prevent dehydration!
  9. Please check with your primary physician before stopping any medication.

Miralax Capsule Endoscopy Prep

  1. Follow a Clear Liquid diet the day before the exam starting at lunch (no red or dark green fluids).
  2. Take one Dulcolax (Bisacodyl) tab in the morning, one at noon and one in the evening (this medication is over the counter).
  3. Mix the 255gm Miralax (prescription) in a 64oz. bottle of Gatorade or water (no red colored fluids) and drink over about 3-4 hours starting around 6PM day before exam.
  4. Drink plenty of water throughout the day so you don’t get dehydrated.
  5. Have nothing to eat or drink after midnight before procedure.
  6. Stop any iron or sucralfate 5 days before exam as this coats the bowel wall.
  7. Avoid narcotic pain medications 1-2 days before exam as this will slow down the bowels and the capsule may not make it through in time.
  8. Please do not eat anything after midnight, the night before your exam.
  9. If you are taking blood pressure medication, take it the morning of the procedure with a small sip of water.
  10. Please check with your primary physician before stopping any medication.

Half-Lytely Prep

  1. In the morning, prepare your Half Lytely solution and refrigerate. Have clear liquids all day. Clear liquids include coffee, tea, bouillon soup, chicken broth, water, white grape juice, apple juice and any clear sports drink. You may also make lemon jell-o. No red, purple, or green colored products.
  2. At 12 noon take all four time-released Bisacodyl tablets provided in the prep kit box.
  3. Continue drinking clear liquids all day.
  4. At 6:00 pm begin drinking Half-Lytely as instructed 8 oz. Every 10-15 minutes until the bottle is empty. Rapidly drinking a glassful is better than sipping an ounce or two at a time.
    A. You will have consumed several glassfuls before having the first loose, water bowel movement.
    B. Initially, you may feel slightly bloated, but will become more comfortable as you continue to have bowel movements.
  5. Please do not eat anything after midnight, the night before your exam.
  6. In the morning when you first get up give yourself a sleep enema, if you tend to be constipated, you may need to do a second one an hour prior to leaving your home, or you may take it along with you.
  7. If you are taking blood pressure medication, take it the morning of the procedure with a small sip of water.
  8. Be sure to stop all aspirin or ibuprofen 7 days prior to the procedure.  Stop Plavix 5 days prior to the procedure and Coumadine 4 days prior to the procedure. 
  9. Please check with your primary physician before stopping any medication.

Movie Prep

  1. Have clear liquids all day
  2.  At 12 noon 2 time-released Bisacodyl tablets followed with 3 8ounce glasses of liquid.
  3. Continue drinking clear liquids all day.
  4. At 6:00 pm mix one packet of A and one Packet of B TOGETHER IN THE CPNTAINER, mix with water up to the line on the container and drink one 8ounce glass every ten to fifteen minutes until gone.
  5. At 8pm repeat step 4 which is second packets of A and B
  6. Continue to drink clear liquid until bedtime.
  7. Please do not eat anything after midnight, the night before your exam.
  8. In the morning when you first get up give yourself a sleep enema, if you tend to be constipated, you may need to do a second one an hour prior to leaving your home, or you may take it along with you.
  9. If you are taking blood pressure medication, take it the morning of the procedure with a small sip of water.
  10. Be sure to stop all aspirin or ibuprofen 7 days prior to the procedure.  Stop Plavix 5 days prior to the procedure and Coumadine 4 days prior to the procedure.
  11. Please check with your primary physician before stopping any medication.

 

Your physician has determined that EGD is necessary for the further evaluation or treatment of your condition. Below you will find answers to questions most frequently asked by patients. If you have additional questions or concerns, please feel free to discuss them with the endoscopy nurse or physician before the examination begins.

EGD (also known as Upper GI Endoscopy or Panendoscopy) is a procedure that enables your physician to examine the lining of the upper part of your gastrointestinal tract, or the esophagus, stomach and duodenum (first portion of the small intestine) using a thin flexible tube with its own fiber optic camera and light source. EGD is usually performed to evaluate symptoms of persistent upper abdominal pain, nausea, vomiting, or difficulty swallowing. It is also performed to determine the cause of bleeding from the upper gastrointestinal tract. EGD is more accurate than x-ray films for detecting inflammation, ulcers or tumors of the esophagus, stomach and duodenum. EGD can detect early cancer and can distinguish between benign and malignant (cancerous) conditions when biopsies (small tissue samples) of suspicious areas are obtained. Biopsies are taken for many reasons and do not necessarily mean that cancer is suspected. A cytology test (introduction of a small brush to collect cells) may also be performed. EGD is also used to treat conditions present in the upper gastrointestinal tract. A variety of instruments can be passed through the endoscope that allow many abnormalities to be treated directly with little or no discomfort, for example, stretching narrowed areas, removing polyps (usually benign growths) or swallowed objects, or treating upper gastrointestinal bleeding. Safe and effective endoscopic control of bleeding has eliminated the need for transfusions and surgery in many patients.

It is necessary to have a completely empty stomach for a safe and thorough examination. You should eat nothing solid for approximately 6 hours before the procedure. You may however, drink water or clear liquids up to 2 hours before procedure. Several days before the examination you should notify the physician of any prescribed or over the counter medications you take regularly, any heart or lung conditions, any major diseases, and whether you have any drug allergies. If you require antibiotics prior to undergoing dental procedures you should alert your physician, as you may need antibiotics prior to colonoscopy as well.

Your physician will review with you why EGD is being performed, potential complications from EGD, and alternative diagnostics or therapeutic tests that are available. A local anesthetic may be applied to your throat and an intravenous sedative will be given to make you more comfortable during the test.  Some patients may also receive antibiotics before the procedure. Most patients remember or feel very little of the examination and many patients fall asleep during the test. The test begins with you lying comfortably on your left side. The endoscope is then passed through the mouth, esophagus and stomach into the duodenum. The instrument does not interfere with breathing. Air is introduced through the instrument and may cause temporary bloating during and after the procedure. The test usually lasts between 5 and 15 minutes.

After the test, you will be monitored in the recovery room until most of the effects of the medication have worn off. Your throat may be a little sore for a while and you may feel bloated right after the procedure because of air introduced into your stomach during the test. In most circumstances, your doctor can inform you of your test results on the day of the procedure; however, the results of any biopsies or cytology samples will take several days.

EGD is a generally safe procedure. Complications can occur but are rare when the test is performed by a physician with special training and experience in this procedure. Bleeding may occur in approximately 0.1% from a biopsy site or where a polyp was removed. It is usually minimal and rarely requires blood transfusion or surgery. Phlebitis, or localized irritation of the vein into where medication was injected, may cause a tender lump that could last several weeks, but this will go away eventually. The application of heat packs or hot moist towels may help relieve the discomfort. Other potential risks include a reaction to the sedatives used and complications from heart or lung diseases. Major complications, such as perforation, a tear that may require surgery for repair, are very uncommon (less than 1%).
Although complications after EGD are uncommon, it is important for you to recognize early signs of any possible complication. If you begin to run a fever after the test, begin to have trouble swallowing, or have increasing throat, chest or abdominal pain, contact your doctor immediately.

 

Your physician has determined that ERCP is necessary for the further evaluation and treatment of your condition. Below you will find answers to questions most frequently asked by patients about to undergo the ECRP procedure. If you have any additional questions or concerns, please feel free to discuss them with the endoscopy nurse or your physician before the examination begins.

ERCP is a specialized technique used to study the ducts (drainage routes) of the gallbladder, pancreas and liver. An endoscope, or flexible thin tube that allows the physician to see inside the bowels, is passed through the mouth, esophagus, and stomach into the duodenum (the first part of the small intestine). After the common opening to the ducts from the liver and pancreas is visually identified, a narrow plastic tube is passed through the endoscope into the ducts. Dye is then injected gently into the ducts and x-ray films are taken. ERCP is used to diagnose and treat many diseases of the pancreas, bile duct, liver and gallbladder. Structural abnormalities suspected by symptoms, physical examination, laboratory tests or x-rays can be shown in detail and biopsies of abnormal tissues can be taken if necessary. ERCP can make the important distinction between whether jaundice (yellow discoloration of the eyes and skin) is caused by diseases that are treated medically such as hepatitis, or structural diseases such as gallstones, tumors or strictures (obstructing scar tissue) that are treated surgically or endoscopically. In patients who are not jaundiced but have pain or laboratory abnormalities suggesting biliary or pancreatic diseases, ERCP may also provide important information. ERCP can determine whether or not surgery is necessary and is helpful in providing the anatomic detail the surgeon needs to plan an operation. The information provided by ERCP is far more detailed than that provided by standard x-rays or CT scans. Diagnostic ERCP is the first step in therapeutic ERCP. Several conditions of the biliary or pancreatic ducts can be treated (cured or improved) by ERCP techniques that can open the end of the bile duct, extract stones, and place stents (plastic drainage tubes) across obstructed ducts to improve their damage.

It is necessary to have a completely empty stomach for a safe and comprehensive examination. You must fast for at least 4-6 hours before the procedure. An allergy to drugs containing iodine (contrast material or ñdyeî) is not a contraindication to ERCP, but it should be discussed with your physician before the procedure. The physician performing the procedure should be informed of any prescription or over the counter medications you take regularly, any heart or lung conditions, any other major diseases, and whether you have any drug allergies.

Your physician will discuss why ERCP is being performed, potential complications from ERCP, and alternative diagnostic or therapeutic tests that are available. A local anesthetic may be applied to your throat and an intravenous sedative will be given to make you more comfortable during the test.  Most patients remember or feel very little of the examination. Some patients may also receive antibiotics before the procedure. The test begins with you lying face down with your head to the right on an x-ray table. The endoscope is passed through the mouth, esophagus and stomach into the duodenum. The instrument does not interfere with breathing. Air is introduced through the instrument and may cause temporary bloating during and after the procedure. The injection of contrast materials, or dye, into the ducts rarely causes discomfort. The duration of the test varies anywhere from 15 minutes to 2 hours.

ERCP is generally a well-tolerated procedure when performed by physicians who have special training and experience in this technique. Phlebitis, or localized irritation of the vein into which medications were given, may cause a tender lump that could last several weeks. The application of heat packs or hot moist towels may ease the discomfort. Major complications requiring hospitalization can occur but are uncommon (less than 1%) during diagnostic ERCP. Complications include serious pancreatitis, infections, bowel perforation and bleeding. Another potential risk of ERCP is an adverse reaction to the sedative used. The risks of the procedure vary with the indications for the test, what is found during the procedure, what therapeutic intervention is undertaken, and the presence of other major medical problems, such as heart or lung diseases. Your physician will discuss with you what the likelihood of your experiencing any complications before undergoing the test. It must be realized that stones in the bile ducts can also lead to pain, serious pancreatitis and infection if left untreated in some patients. If therapeutic ERCP is performed (cutting an opening in the bile duct, stone removal, dilation of a stricture, stent or drain placement, etc), the possibility of complications is higher than with diagnostic ERCP. Complications again included pancreatitis (3-7%), bleeding requiring a transfusion (3-5%), and bowel perforation (1-2%). These risks must be balanced against the potential benefits of the procedure and the risks of alternative surgical treatment of the condition. Often these complications can be managed without surgery, but occasionally require corrective surgery.

If you are having ERCP as an outpatient, you will be kept under observation several hours until most of the effects of the medications have worn off. Evidence of any complications of the procedure will be looked for and hospitalization may be advised if further observation or treatment is necessary. You may experience bloating or pass gas due to the air introduced during the procedure. You may resume your usual diet unless instructed otherwise.

 

48 Hour pH probe is a procedure that enables your physician to detect the presence of acid reflux into the esophagus. It is done by passing a thin flexible tube into the esophagus and sending you home for 48 hours. Below you will find answers to questions most frequently asked by patients about to undergo the 48 Hour pH probe. If you have any additional questions or concerns, please feel free to discuss them with the nurse or your physician before the examination begins.

48 Hour pH probe is usually performed to evaluate symptoms of chest pain, difficult to treat gastroesophageal reflux disease or to determine if surgery for gastroesophageal reflux disease is necessary. It may also determine if there is a relationship between a variety of symptoms and acid reflux.

It is necessary to have a completely empty stomach for a safe and thorough examination. You should have nothing to eat or drink, including water, for approximately 2-6 hours before the procedure. Your doctor may require that you stop stomach medications 3 days before the examination.

The test begins with you sitting up comfortably. A lubricated thin flexible catheter is passed through the nose into the esophagus. The catheter does not interfere with breathing. The catheter will be taped in place to your noise and you will be sent home after proper placement confirmation. There will be a small recording device you may attach to your belt. You will be given a diary for you to record time of meals, sleep and any symptoms you may have (heartburn, chest pain or tightness, knot in throat, etc.). After 48 hours, you will return to the hospital, turn in your diary, and the catheter will be removed. The data will be analyzed and you will be contacted by the office several days later with your results.

48 Hour pH probe is a generally safe procedure. Complications can occur but are rare when the test is performed by a physician with special training and experience in this procedure. Perforation (a tear that might require surgery for repair) is very uncommon (less than 0.1%). It is important for you to recognize early signs of any possible complication. If you begin to run a fever after the test, begin to have trouble swallowing, or have increasing throat, chest or abdominal pain, contact your doctor immediately.


Your physician has determined that flexible sigmoidoscopy is necessary for the further evaluation or treatment of your condition. Below you will find answers to questions most frequently asked by patients about to undergo flexible sigmoidoscopy. If you have any additional questions or concerns, please feel free to discuss them with the nurse or your physician before the examination begins.

Flexible sigmoidoscopy is a procedure that enables your physician to examine the lining of the rectum and a portion of the colon (large bowel) by inserting a flexible tube that is about the thickness of your finger into your anus and advancing it slowly into the rectum and lower part of the colon.

The rectum and lower colon must be completely empty of waste material for the procedure to be safe, accurate and complete. Your physician will give you detailed instructions regarding the cleansing routine to be used. In general, preparation consists of two enemas prior to the procedure. In some circumstances, for example, if you have acute diarrhea or colitis, your physician may advise you to forgo any special preparation before the examination.

You should inform your physician of all current prescribed and over the counter medications, as well as any allergies to medications several days prior to the examination. Most medications can be continued as usual. If you require antibiotics prior to undergoing dental procedures you should alert your physician, as you may need antibiotics prior to sigmoidoscopy as well.

Flexible sigmoidoscopy is usually well tolerated and rarely causes much pain. There is often a feeling of pressure, bloating, or cramping at various times during the procedure. During the procedure you will be lying on your left side while the sigmoidoscope is advanced through the rectum and colon. The lining of the intestine is carefully examined as the instrument is withdrawn. The procedure usually takes anywhere from 5 to 15 minutes.

If the doctor sees an area that needs further evaluation a biopsy, or sample of the colon lining, may be obtained and submitted to a laboratory for greater analysis. If polyps (growths from the lining of the colon which vary in size) are found, they can be biopsied, but usually are not removed at the time of the sigmoidoscopy. There are many types of polyps and they vary in size. Certain benign polyps, known as "adenomas" are potentially precancerous and should be removed, while other "hyperplastic" polyps may not require removal. Your doctor will likely request that you have a colonoscopy, a complete examination of the colon, to remove any large polyp that is found, or any small polyp that is determined to be adenomatous after biopsy analysis.

After sigmoidoscopy, the physician will explain the results to you. You may have some mild cramping or bloating sensation because of the air that has been passed into the colon during the examination. This will disappear quickly with the passage of gas. You should be able to eat and resume your normal activities after leaving your doctor's office or the hospital.

Flexible sigmoidoscopy and biopsy are generally safe and well tolerated when performed by physicians who have had special training and experience in these endoscopic procedures. While possible complications after flexible sigmoidoscopy are rare, it is important for you to recognize early signs of any possible complication. Contact your physician immediately if you notice any: severe abdominal pain, fever and chills, or rectal bleeding of more than one half cup. It is important to note that some rectal bleeding can occur even several days after the biopsy.

Helicobacter pylori (H.pylori) is a bacteria which lives only in the lining of the stomach and is one of the most common chronic infections in humans. The importance of H. pylori was not recognized until 1982, when an Australian physician, Dr. Barry Marshall, discovered that the germ was almost always present in patients with gastritis (inflammation of the stomach) and ulcers. Doctors now believe that H. pylori is associated with most stomach ulcers and almost all duodenal ulcers. Below you will find answers to questions most frequently asked by patients. If you have any additional questions or concerns, please feel free to discuss them with the nurse or your physician.

H. pylori does not always cause ulcers to form but almost always produces inflammation of the stomach lining. Some people with H. pylori infection do not have any symptoms, but many report nausea, gas, bloating, and burning stomach pain. The symptoms occur twice as often in people with H. pylori compared to those who are not infected.

H. pylori infection occurs throughout the world, in every part of society, and in every age group. About 30% of the United States population has the infection, which is more common with advancing age (50% will have it by age 60) and is rare in children. Once infected with H. pylori, a person usually continues to carry the germ unless certain medications are used to cure the infection.

H. pylori appears to be passed from person-to-person. It is more common in spouses of infected patients than in the general population. It is also common in places where sanitation is poor and where crowded living conditions exist. It is not clear exactly how a person gets H. pylori, but it may be through swallowing infected food or water. H. pylori is not found naturally in animals, so pets do not seem important in the spread of the infection. Careful personal hygiene (through hand washing, use of separate personal items such as eating utensils, glassware, etc.) probably is the best way to reduce person-to-person spread of H. pylori.

There are several very accurate ways to determine the presence of H. pylori:

  1. Blood test can be used to determine the presence of antibodies to the bacteria. These tests tell if a person has ever had the infection but do not tell if the infection is active.
  2. A biopsy of the stomach can be used to determine the presence of H. pylori. A biopsy is obtained during an examination of the stomach with a flexible scope. The biopsy is examined by a pathologist under a microscope to look for the presence of H. pylori, or more easily by a Rapid Urease Test such as the CLOtest. This slide test checks for the presences of an enzyme (urease) produced by H. pylori. A simple color change in the CLOtest confirms that H. pylori is active in the stomach.
  3. The PYtest C Urea breath test (i.e., the PYtest) can determine the presence of H. pylori without the use of a scope. It is safe, accurate, easy to perform, and much less expensive than a scope and biopsy for diagnosis.

The PYtest capsule contains sugar beads coated with small amounts of a chemical called urea. Urea is naturally found in the human body and the amount in the capsule is much smaller than the head of a pin. The urea in the PYtest has been “labeled” with a naturally occurring radioactive tracer called carbon-14 so it can be detected after it is taken into the body.

After the capsule is swallowed, it takes about three minutes to dissolve in the stomach. If the C-urea comes into contact with H. pylori, it is immediately broken down into C-carbon dioxide and ammonia. The carbon dioxide enters the bloodstream and is exhaled by the patient.
Ten minutes after ingesting the capsule, a breath sample is collected in a balloon. The breath sample is then analyzed; if enough of the C is present it can be concluded that the patient has H. pylori.

If H. pylori is not present, the C-urea simply washes through the stomach and is passed in the urine.

There have been no reported adverse reactions to the PYtest capsule. Although the PYtest does contain a tiny amount of radiation, it is no more than an average person receives every day (background radiation).

Do not eat or drink anything after midnight before the procedure.
No escort is required because this test does not use anesthesia.
Wear comfortable clothing; you will be at the office for 3 to 4 hours.
No smoking and do not brush your teeth the morning of the exam.
No mechanical bowel cleansing or antibiotic use one month prior to exam.
Eat a low lactose, low carbohydrate, low fiber dinner and avoid any fruit the day prior to the exam.

 

Causing the death of 55,000 patients per year colon cancer is the #2 cancer killer in the United States.  Almost all colon cancers start out as a polyp on the inside wall (lumen) of the colon. Polyps begin as small wart-like bumps the size of an unground peppercorn. Over a period of 5-10 years, some of these polyps continue to grow to be 1-2 inches in diameter. At any time a microscopic size cancer (adenocarcinoma) may develop somewhere on the polyp. This usually occurs in polyps greater than 1 cm in diameter. Once a cancer develops in the polyp, it will eventually spread throughout the polyp, into the wall of the colon, then through the wall into surrounding tissues, lymph nodes, and possibly to the liver and/or lungs.

It is unknown what percentage of polyps become cancer; however, it is known that approximately 40% of adults over the age of 50 have polyps and about 5% of the population will eventually develop colon cancer. This leads to the estimation that 10 – 15% of patients with polyps will eventually develop colon cancer.

The factors involved in what causes polyps or what causes polyps to be malignant (cancerous) are also unknown. Much of the risk has been determined to be genetic. Some weak evidence exists that you are more likely to develop colon cancer if you are overweight, smoke, drink excessively, don’t exercise, and eat a diet that is high in animal fats and low in fiber, fresh fruits, and vegetables. Some supplements that have been proposed to lower the risk of colon cancer (but none proven) include calcium (1200 mg/d), fiber supplements, vitamin E (200-400 IU/d). vitamin C (500 – 1000 mg/d), folic acid (400 mgm/d) and NSAID/aspirin use.

The best way to detect colon cancer is to undergo periodic screening on order to detect polyps before they become malignant. Whenever a polyp is detected, the patient should have a complete colonoscopy to look for any other polyps and remove all of them. Taking into consideration risk and cost, the best way to do this (given our current knowledge and understanding, which will certainly change in the future with new studies and technology) is to undergo a complete colonoscopy at age 50 and every 10 years after that until age 80. Some patients are at higher risk due to family history of colon cancer or polyps and need more frequent exams beginning at age 40 or earlier. Please let us know if you have a history of colon cancer or polyps in the family. Once polyps are detected, you should have a colonoscopy every 3-5 years to detect new polyps.

If your insurance does not pay for screening colonoscopies and you do not have an acceptable reason (to the insurance company) for colonoscopy (such as rectal bleeding, diarrhea, a change in bowel movement, etc.) then the next best choice is to either pay out of pocket or undergo a barium enema/ flexible sigmoidoscopy every 5 years.

Eating a healthy diet, exercising, not smoking, limiting alcohol consumption to no more than 2 drinks per day, and avoiding obesity is a good way to prevent heart disease, strokes, and many cancers. However, the most effective method of preventing colon cancer is regular screening. Please consider undergoing these tests, not only for yourself, but your loved ones as well.

 

Capsule endoscopy with PillCamTM SB video capsule will provide your doctor with pictures of your small intestine. Most patients find the test to be comfortable. Below you will find answers to questions most frequently asked by patients scheduled to undergo Small Bowel Capsule Endoscopy. If you have any additional questions or concerns, please feel free to discuss them with the nurse or your physician.

Capsule endoscopy with PillCamTM SB video capsule enables your doctor to examine your entire small intestine. Your doctor will have you ingest a vitamin-pill sized video capsule, which has its own camera and light source. During the 8 hour exam, you are free to move about. While the video capsule travels through your body, it sends images to a data recorder you will wear on a waist belt. Afterwards your doctor will view the images on a video monitor.

Capsule endoscopy helps your doctor determine the cause for recurrent or persistent symptoms such as abdominal pain, diarrhea, bleeding or anemia. In certain chronic gastrointestinal diseases, this method can also help to evaluate the extent to which your small intestine is involved, or monitor the effect of treatment. Your doctor might use capsule endoscopy to obtain motility data such as gastric or small bowel passage time.

Preparation instructions will be given to you before the examination. An empty stomach allows optimal viewing, so you should start a liquid diet after lunch the day prior to the examination. You should have nothing to eat or drink, including water, for approximately ten hour before a small bowel examination. Your doctor will tell you when to start fasting. It is important that you discuss with your doctor in advance any prescription or over the counter medications you take regularly as you may need to adjust your usual dose before the examination. Also, alert your doctor of the presence of a pacemaker or other implanted electromedical device, previous abdominal surgery, swallowing problem or previous history of obstructions in the bowel.

The doctor or nurse will prepare you for the examination by applying a sensor array to your abdomen with adhesive sleeves. The capsule endoscope is ingested with water and passes naturally through your digestive tract while transmitting video images to a data recorder worn on a belt for approximately eight hours. You will be able to eat four hours after the capsule ingestion unless your doctor instructs you otherwise.

At the end of the procedure, you will need to go back to your doctor to return the data recorder and sensor array. The images acquired during your exam will then be downloaded for your doctor to review. You should not have a Magnetic Resonance Imaging (MRI) examination or be near an MRI machine after ingesting the capsule until it is excreted.

After you return the equipment, your doctor will process the information from the data recorder and will view a color video of the pictures taken from the capsule. After the doctor has examined the video, you will be contacted with the results.

The capsule is disposable and passes naturally with your bowel movement. You should not feel any pain or discomfort.

Complications from capsule endoscopy rarely occur, especially when doctors who are specially trained and experienced in this procedure perform the test. One potential risk could be retention of the capsule. Although complications after capsule endoscopy are uncommon, it is important for you to recognize early signs of any possible complication. Contact the physician who performed the procedure immediately if you notice any of the following symptoms: fever, trouble swallowing or increasing chest or abdominal pain.

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