A thin light tube (probe) with an acid sensor at its tip is inserted through the nose into the lower part of the esophagus. The probe is then taped to the face and hooked to a recorder. The probe detects and records the amount of stomach acid coming back up into the esophagus. You will be asked to keep a “Symptom Diary” that your physician will use to correlate findings with the computer recordings. You will keep track of symptoms (crying, arching, coughing, wheezing, etc), when your child eats, body position (lying down, sitting or standing) using the buttons on the recording box(if capable) and/or a paper diary. The length of testing needs to be at least 18-24 hours to be accurate. Depending on the prescribing physician, there may be a need to stop all reflux medications prior to testing. Some facilities require an overnight stay while testing, others do not. This is the gold standard in testing for reflux.
PH PROBE WITH IMPEDANCE
Same process as above as far as the placement of the probe, just a lot more technical in nature on the recording end. Adding impedance allows for measuring nonacid reflux as well as acid reflux episodes. Why is this important? Nonacid reflux can cause just as many symptoms as acid reflux. Impedance measurements will allow your doctor to see if current reflux medications are effective; if medications need to be increased; and/or if symptoms are truly reflux related or another underlying issue altogether.
BARIUM SWALLOW (UPPER GI)
The Modified Barium Swallow Study (MBSS), also known as video-fluoroscopic swallow study, is a common, standard procedure for the assessment of dysphagia (difficulty swallowing) in patients of all ages. The testing consists of the child drinking a small amount of barium or food mixed with barium while under a continuous x-ray. A speech pathologist, in conjunction with a radiologist, will closely assess the child’s swallow for any abnormalities, dysfunction, or dysphagia. Dysphagia may create a host of immediately life threatening and/or chronic lung related issues in an individual. Most concerning is aspiration, in which food or fluids enter the normally protected linings of the trachea and lungs. This can cause long term lung damage (chronic lung disease) from scarring of tissue, especially if acidic. Signs and symptoms of aspiration include apnea, wheezing, coughing, gagging, sputtering, gasping, etc. Treatment for dysphagia includes, but not limited to, thickening of feeds, feeding therapy, and possibility of nissen fundoplication/gtube (surgical intervention).
Test detects/measures pressures w/in the GI tract. There are several types of manometry to test muscle contractions of (1) esophagus, (2) antroduodenal), (3) colon, and (4) anorectal. Good test to determine motility in GI system and to help diagnose a variety of GI disorders from dysphagia to intestinal dysmotility or chronic constipation.
SCINTA SCAN (GASTRIC EMPTYING SCAN)
Also known as Scinta Scan or milk scan. This test shows how well the stomach empties. After a child drinks a liquid with radioactive isotopes, pictures are taken for an extended period of time, usually over an hour. This test is best for diagnosing Delayed Gastric Emptying (gastroparesis) or Rapid Gastric Emptying.
ULTRASOUND OF ABDOMEN
Same equipment used during pregnancy, very simple procedure. Test useful in looking at structural/anatomical abnormalities such as hernia, pyloric stenosis, etc.
EGD – SCOPES
Test requiring IV sedation that uses a small flexible scope w/camera to look at child’s esophagus, stomach, and upper part of the small intestine(duodenum). Biopsies often taken to test for the extent of erosive damage, eosinophilic disorders, celiac disease, food allergies, etc.
Flexible Sigmoidoscope or Colonoscopy
Similar scope used to view with lower part of the GI tract as well (sigmoidoscopy/colonoscopy).Biopsies often taken to test for the extent of erosive damage, eosinophilic disorders, celiac disease, food allergies, etc.
Very similar technique as described for the upper endoscopy, but scope sent down the nose to look at the airway, trachea and lungs. Test helpful in determining aspiration of liquids/reflux, damage from reflux, structural abnormalities (laryngomalacia, tracheomalacia, etc), and causes for other breathing issues. Bronchial alveolar lavage(BAL) is also most often performed at the same time to test for infection, gastric material, etc. BAL consists of a small amount of fluid squirted into the lung via the bronchoscope and then recollected or suctioned out for testing.