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Information About Common Tests
| UPPER GI X-RAY
SERIES (Barium Swallow): |
| Used to assess for sturctural problems such as
hiatal hernia, pyloric stenosis, and malrotation.
The child must drink a chalky substance called barium, which shows up white on the X ray.
The most important reason for doing a barium swallow is to make
sure there is normal anatomy, and not some other anatomic cause predisposing to
gastroesophageal reflux. |
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UPPER
GI ENDOSCOPY & ESOPHAGEAL BIOPSY:
Useful to detect esophagitis and gastric and duodenal inflammation. For endoscopy,
the child is
sedated, and a
flexible plastic tube with a tiny camera on the end is inserted through the mouth,
down
the throat, and into the esophagus and stomach. During this test, which takes about
15 minutes to do,
the esophageal and stomach walls are carefully inspected for signs of inflammation.
Biopsies are pinhead-sized pieces of the surface tissue layer. They are inspected
under the microscope.
Results
from the endoscopy are immediate: hiatal hernias, ulcers, and inflammation are
readily identified. Biopsy results generally take a few days to get. |
Endoscopic Grading in Gastroesophageal Reflux
Disease
| Stage |
Description |
| Grade 0 |
Normal Mucosa with no abnormalities |
| Grade 1 |
Erythema or hpyeremia of the esophageal mucosa |
| Grade 2 |
Superficial ulceration or erosions involving
less than 10% of the last 5 cm of the esophageal squamous mucosal surface. |
| Grade 3 |
Superficial ulceration or erosions involving
greater than 10% through 50% of the last 5 cm of the esophageal squamous mucosal surface. |
| Grade 4 |
Deep ulceration anywhere in the esophagus or
confluent erosion of more than 50% of the last 5cm of the esophageal squamous mucosal
surface. |
| ESOPHAGEAL MANOMETRY:
|
| Delineates mechanisms of reflux and may help
guide therapy. |
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| GASTRIC EMPTYING
STUDY: |
| This test measures the time it takes for food to
leave the stomach. It is a useful screening
test,
especially when the results are normal. It is the same test as a milk scan, but
measurements are focused on the rate that a meal leaves the
stomach instead of detecting
refluxed material in the lungs. Many children find this
test bothersome, because they must lie still under a camera for several minutes at a time.
This test can be done at the same time as a scintiscan if necessary. |
| SCINTISCANS(Milk
Scans): |
| This test done over the lungs
may detect aspiration. The child drinks formula with a tiny,
harmless
amount of radioactivity in it. Then the child must lie quietly on a hard table under
a large metal disc
that is a camera which measures the movement of the radioactivity. If the child is
inhaling formula, radioactivity shows up in the lungs. Neither pH monitoring nor
scintiscanning is very sensitive for proving that reflux is causing lung problems, but
they are worthwile studies in some children with persistent symptoms. |
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| PROLONGED
INTRAESOPHAGEAL pH MONITORING: (24 hour pH
probe) |
| **The most sensitive test for occult
reflux.. This may document the incidents of
reflux
immediately precede breathing
difficulties, wheezing, or coughing episodes. To do
this
study, a thick plastic tube is passed through a nostril and into the esophagus. It
is
taped
securely to the nose, and attached to a portable recording device. After a day of
recording, the results are analyzed. Since everybody has some reflux, often it is
especially important to record the child's symptoms and activities in a diary, so that
associations can be made between the episodes of reflux and the symptoms. |
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