24 Hour Ph Test
Colonscopy
Endoscopic Ultrasound
Gastroscopy
Oesophageal Manometry
Endoscopic Retrograde Cholangio (ERCP)
24 Hour pH Test
What is a 24-hour pH study?It is a test to measure the amount of acid reflux that occurs over 24 hour period. Acid reflux is a condition when the acidic content of the stomach comes up into the food pipe or oesophagus. It is also known as oesophageal pH testing or 24-hour pH impedance testing.
When is it advised?This test is commonly used in diagnosing GERD or to determine the cause of various symptoms, including heartburn, hoarseness or voice changes, difficulty swallowing, a sensation of a lump in the throat, persistent cough or throat clearing. The procedure may also be performed to assess the effectiveness of ongoing treatment for reflux.
How to prepare for the test?
- Do not eat or drink for four to six hours before the oesophageal pH testing. You can eat normally after the catheter is placed.
- You should not take any antacids 24 hours before the test.
- You must inform the doctor if you are pregnant, have allergies, are on insulin or have a heart or lung condition or any other disease.
- There is no need for anaesthesia or sedation.
- A gel will be applied to the nose and throat to make you comfortable during the procedure.
- It starts by measuring the distance between your nose to the stomach’s opening with the help of a manometry catheter.
- The doctor will put the testing catheter’s end into your nose, and you will be asked to swallow sips of water. The doctor will then gently push the catheter into the opening of your stomach.
- Once the catheter is placed, the other end is secured to your face with the help of tape and wrapped over your ear.
- There is a small smartphone-like monitor which you will wear on a belt. It is a small data recorder that picks up information from the catheter inside your body.
- After the catheter is inserted, you can go back to your normal eating and drinking pattern. The tube will not cause any hindrance in breathing, eating, drinking and talking. You can leave the centre after the procedure.
- The procedure takes 10 to 20 minutes. You will be advised to return to the Bangalore Gastro Centre after 24 hours. The doctor then analyses the data of your test record and observes the change in acid levels throughout the 24 hours.
- As it involves no sedative or anaesthesia, you can go home directly without any help.
- You will be advised to return to Bangalore Gastro Centre after 24 hours.
- The doctor then analyses the data of your test records and observes the change in acid levels throughout the 24 hours.
Colonoscopy
WHAT IS COLONOSCOPY?Colonoscopy is a medical test to observe any abnormality in the large intestine, specifically the rectum and colon. Colonoscopy can detect irritated and swollen tissue, polyp, ulcer and cancer. It is done with the help of an endoscope, a flexible tube, about the thickness of a (little) finger. It has a light and a camera at one end.
WHEN IS COLONOSCOPY ADVISED?This examination is used for the diagnostic purpose of colorectal diseases, and it is advised by a doctor when there is the presence of one or more of the following symptoms:
- changes in your bowel activity such as chronic constipation and chronic diarrhoea
- bleeding from the anus
- unexplained weight loss
- pain in the abdomen
- a family history of bowel cancer
- any existing condition such as Crohn’s disease or colitis.
- Dietary changes– You need to be on a liquid diet but limit milk, tea, and coffee. You should not eat solid food for one day before the test.
- Empty the colon – Your doctor will normally recommend a laxative to take the night before your examination. If the rectum and colon fail to empty, there may be a need for enema to completely empty the colon. It is to be given either the night before the procedure or a few hours before it. Enemas are not the primary means to empty the colon.
- Adjusting the medication- You must inform the doctor if you are taking any medicine for diabetes. There may be a need to change the dose of your medication because you will need to fast before the examination. If you are on a blood thinner, such as antiplatelet medicines (for example, clopidogrel or aspirin) or anticoagulant drugs (for example, warfarin), please tell your doctor, as you may need to stop those medicines temporarily before your procedure. If you are taking any other regular medicines (over the counter or homoeopathic medicines, or any herbal) inform it before the procedure.
- Inform your doctor if you have any allergic conditions.
- Consent will be taken. It means taking your permission for the test means you agree to have a colonoscopy and you are aware of what it involves. If you opt to go ahead, you will be requested to sign a consent form
- You will be asked to take off your jewellery during the examination. This is due to wearing any metal for the technique is not allowed, especially if polyp removal is going to happen. You need to change into a gown before the test. Once you are ready, the doctor will go ahead with the examination.
- This test will be performed under anaesthesia or an injection of painkillers. This medication makes you relaxed and sometimes drowsy.
- A nurse will be there throughout the procedure for consolation.
- The total time for the test is only 30 minutes.
- The endoscope will then be introduced into your colon through the anus. Air will be pushed into the large bowel to make the lining easier to see. You may experience slightly bloated and an urge to go to the toilet, but as the bowel is empty, you will not be able.
- The endoscopist can remove the polyps if present. You will not feel it.
Endoscopic Ultrasound (EUS)
What is endoscopic ultrasound or EUS?
Endoscopic ultrasound or EUS combines endoscopy with an internal ultrasound scan. It is a low-risk diagnostic procedure to evaluate gastrointestinal (GI) and lung diseases. Usually, an endoscope is inserted into the upper GI tract via the mouth to the stomach. The rectum can also be the route for examination. EUS also allows the doctor to take tissue or fluid or samples for biopsy from the internal organs for analysis and plan further treatment.
When is EUS performed?EUS is done for the evaluation of certain diseases like:- Lymphoma
- Cancer of oesophagus or stomach, lung, pancreas, colon, ampullary, and rectal cancers
- Pancreatitis and pancreatic cysts
- Bile duct stones
- Barrett’s oesophagus
- Sarcoidosis
- Neuroendocrine tumours
- To determine the severity or stage of cancer
- Fasting for at least six hours before the test is advised. It is to make sure the stomach is empty.
- Sometimes, EUS is done through the rectum, and then the rectum has to be prepared. You will be given a laxative or an enema to keep the bowel empty and clear. You have to follow a liquid diet for one day before the procedure.
- Certain medications like blood thinners need to be stopped temporarily. Before the procedure, the doctor will even modify the dose of other drugs like anti-diabetic or anti-hypertensive drugs.
- You need to sign the consent form. The doctor will explain everything before the test.
- An IV will be injected into your vein to administer sedatives and fluid. It makes you tired or sleepy and relaxed.
- The doctor will numb your throat with the help of local anaesthesia.
- The EUS endoscope is gently pushed via your mouth into the stomach. It is not a painful procedure. It will not make breathing or swallowing difficult.
- If necessary, the doctor may take a sample for biopsy.
- The doctor will observe the images on a monitor.
- You may go home after the test and rest at home, once your procedure is over and the action of the sedative ends.
- The total time taken during this procedure is approximately 30- 45 minutes.
- There may be some discomfort from the air pushed into the stomach.
- You may also experience a sore throat which may last for one or two days.
- After the procedure, you will be taken for monitoring to the recovery area for approximately one hour.
- The gastroenterologist will discuss the procedure results with you before you leave.
Gastroscopy
WHAT IS GASTROSCOPY?A gastroscopy is a diagnostic procedure to view inside the upper gastrointestinal tract with the help of a thin, flexible tube fitted with a camera. Sometimes it is also referred to as upper gastrointestinal endoscopy.
HOW IS GASTROSCOPY DONE?An endoscopy trained doctor or gastroenterologist performs gastroscopy. A thin and flexible tube known as a gastroscope passed through your mouth, down your oesophagus (food pipe) and into your stomach. It has a light at one end. It will help look at the lining of these structures. If needed, biopsies (small tissue samples) are taken for analysis. The removal of tissue for biopsies will not cause any pain. You might feel a little tugging sensation.
WHY IS GASTROSCOPY DONE?Gastroscopy helps investigate the cause of problems like stomach aches or difficulty in swallowing (dysphagia). It helps establish the diagnosis of various diseases such as stomach ulcers or GERD (reflux disease). It also helps in treating conditions like a blockage in the oesophagus or bleeding ulcers or non-cancerous growths (polyps), or small cancerous tumours. When gastroscopy is used for treating disease, it is called therapeutics gastroscopy.Gastroscopy is usually advised when one or more of the following symptoms are present:
- Bloody vomit or regurgitation of blood
- Difficulty in swallowing
- Vomiting
- Pain in the upper abdomen (tummy)
- Recurrent indigestion
- Inflammation
- Ulcers
- The presence of bacteria called Helicobacter pylori which cause ulcers, gastritis and gastric cancer
- Infection
- Cancer of the stomach
- Celiac disease
- You must not drink or eat anything for at least 6 hours before the procedure. To make sure the gastroscopy has a clear view, the stomach must be empty.
- You must inform the doctor regarding any regular medication which you are taking. If you are on anticoagulant medication /blood-thinning medications, antiplatelet medication (medicine that prevents blood clots), or medicines for pain, high blood pressure, or diabetes, please let the doctor know beforehand. You should temporarily stop medicine like anta acids at least two weeks before the test.
- The doctor will inform you of everything regarding gastroscopy. You can ask before the test if you have any questions or queries.
- Consent (asking for your permission)- We want to take in your decisions about your treatment and care. If you are willing to go ahead, you will be requested to sign a consent form. That implies you agree to have the treatment and understand what it involves.
- A gastroscopy usually takes less than 15 minutes. Sometimes, when used to treat a condition, it may take longer.
- There is no need for hospital admissions as it is done in the outpatient department.
- It is done under local anaesthesia, which will be sprayed on your throat to numb that area.
- But if there is a requirement for sedatives, they can also be given. If sedatives are used, you may feel slightly drowsy but aware and awake.
- You will be placed on your left side. A nurse will be present throughout the procedure to assist the doctor and your reassurance.
- The doctor will place the endoscope in the throat and ask you to swallow the first part of the tube. It will cause a gagging and retching sensation, which is a natural reflex when the endoscope touches the back of the mouth.
- It will then slowly guide down your food pipe and into your stomach.
- The procedure may be unpleasant or uncomfortable, but it is not usually painful.
- If a biopsy is taken, then you may feel a tugging sensation.
- A tear (perforation) of the lining of your food pipe, stomach or duodenum
- A reaction to sedative may be a problem associated with breathing, heart rate and blood pressure
- Internal bleeding
Oesophageal Manometry
What is oesophageal manometry?Oesophageal manometry is a test that helps assess the problem involving the food pipe or oesophagus and lower oesophageal sphincter (LES). The oesophagus is a muscular tube that connects your throat with the stomach. LES is a valve in the lower oesophagus that prevents the backflow of gastric acid into the food pipe.This test also helps identify the cause, leading to problems like heartburn and difficulty in swallowing.The oesophagus contracts to push food downwards into the stomach while eating and swallowing food. The manometry helps measure the oesophageal muscle’s contraction, force, and coordination when food passes through the oesophagus into the stomach.During oesophagal manometry, a flexible, thin tube called a catheter with pressure sensors is gently pushed through your nose, down your food pipe and into the stomach.
When is it advised?The people who suffer from the following symptoms are requested to have this test done:
- Difficulty in swallowing
- Reflux or heartburn
- Chest pain that is not related to heart
- Nausea after eating
- Before anti-reflux surgery
- Achalasia – A condition that occurs when your lower oesophageal sphincter muscle does not relax properly and causes difficulty swallowing and food regurgitation into the throat.
- Diffuse oesophageal spasm – A rare condition characterized by forceful, multiple, poorly coordinated muscles leading to improper contractions of your oesophagus.
- You might need to avoid taking food and drink before Oesophageal manometry.
- Our senior GI physiologist will give you specific instructions.
- The doctor may ask about your medication history, as you might have to stop some medicines before the test.
- The doctor will also enquire about your health conditions related to the heart or lungs or any allergies.
- However, you should not discontinue any medication without talking with the doctor who advised the test.
- You will be asked to sit up during the test.
- The doctor will spray some numbing spray on your throat and nose during the test.
- A tiny catheter is passed through your nose into the oesophagus. It doesn’t cause any interference with your breathing. However, you may experience irritation in the nose and the eye. The catheter is connected to a computer.
- Once your catheter is placed, you have to take a few sips of water. The pressure, pattern, and speed of oesophageal muscle contraction are recorded.
- During the procedure, you’ll be requested to breathe smoothly and slowly. It will be best if you remain as still as possible. You have to swallow only when the examiner directs you.
- While the catheter is taking the measurements, it can be gently moved by the examiner up or down.
- The catheter then is slowly taken out.
- The whole procedure lasts for approximately 30- 40 minutes.
- You can return to all your normal activities after the test.
- The gastroenterologist will identify the cause of oesophageal symptoms and explain the test result.
- During the test, you might have some discomfort, sore throat, a small amount of nosebleed, and a stuffy nose.
- Otherwise, oesophageal manometry is safe and rarely causes complications.
Endoscopic Retrograde Cholangio (ERCP)
What is an endoscopic retrograde cholangiopancreatography?An endoscopic retrograde cholangiopancreatography or ERCP is a procedure that combines X-ray and camera examination or endoscopy. It enables the doctor to examine and treat diseases of the hepatobiliary system (liver, gall bladder, pancreas, pancreatic and bile ducts).
Why is an ERCP performed?ERCP is done to find out and treat the bile or pancreatic ducts blockage. Blockage can be due to any of the following causes:
- Stones
- Strictures (narrowing of the bile ducts)
- Leakage of fluid from bile or pancreatic duct
- Growths or cancers of the bile ducts and pancreas
- You must inform the doctor if you have any allergic reactions to dyes, iodine, medicine, tape, latex or anaesthesia.
- You should not eat or drink anything at least 8 hours before the test. You may have to follow a special diet for one or two days before the procedure.
- You must inform your healthcare provider if you are pregnant.
- You must inform your healthcare provider of any medicines and herbal supplements you are taking.
- You must also inform the doctor about taking any blood-thinning medicines or having a history of bleeding disorders. You may have to stop these medicines before the procedure temporarily.
- Your healthcare provider may give you medication before the procedure if you have a heart-related disorder.
- You will be given a sedative, but you may be awake or wholly asleep and feel nothing.
- Our experienced Gastroenterologist will talk with you in detail and answer your questions.
- ERCP carries some risks, and it is only performed when the doctors have cautiously balanced the risks of doing this test compared with any other operations or tests and the dangers of doing nothing.
- Before the test starts, a nurse will connect monitors to one of your fingers to record your oxygen levels, blood pressure, pulse, and heart rhythm.
- You may be given a local anaesthetic spray on your throat to help to numb the throat.
- You will lay on your left side, and a mouth guard will be placed in your mouth. It will enable the endoscope to get pushed through your mouth.
- Oxygen will be administered to you throughout the procedure.
- You will be given painkillers and intravenous sedation through a needle in the back of your arm or hand. You will be able to hear and answer according to the instructions given to you. These medicines will make you drowsy and relaxed but will not put you to sleep.
- A nurse will monitor you during the entire procedure.
- Once you are sleepy, a flexible tube about the width of a finger, with a tiny camera on the end of it, called a duodenoscope, will be inserted through your mouth, down your throat, into the stomach, and then into the first part of the small intestine called the duodenum.
- The doctor will gently insert a fine wire through the endoscope into the bile ducts and inject a special dye. Multiple X-rays of various parts of your pancreatic or biliary system will be taken.
- If the test is being performed for treatment purposes like removing stones from the biliary system or pancreatic duct, a small cut or sphincterotomy may be made in the lower part of the bile duct to allow a thin tube to pass through. It also permits a small basket or balloon to be inserted to grip a stone, and in future, if any stones get into the bile duct, they will easily pass into the intestine.
- Your doctor may take a few samples from the bile ducts with the help of forceps or a small brush. A plastic or metal tube called a stent may be inserted to aid the drainage of bile or pancreatic juice.
- The actual procedure lasts between 30 minutes to one hour and 30 minutes.
- The doctor will administer painkillers and sedation before and during your test to make you comfortable. This procedure is generally carried out under conscious sedation.
- You may feel cramping abdominal pain during or after the examination from the air that we pushed to inflate your duodenum.
- You may also feel short periods of pain and discomfort from certain parts of the procedure, which should soon disappear between 30 minutes to one hour and 30 minutes.
- You will need to stay in the endoscopy unit until you are fully awake, which usually takes one hour.
- You can eat your regular diet once you are fully awake most of the time. However, you may be asked to fast for 6 hours or more afterwards, depending on your treatment.
- You can continue taking your usual medications unless the doctor suggests otherwise.
- If you have been requested to stop any medicines before the test, the doctor will advise when to resume them before leaving the endoscopy unit.
- The consultant doctor will talk you through the results of the procedure.
