Tests to Diagnose Gastrointestinal Autonomic Neuropathy

In many cases, a doctor can identify the source of a patient's digestive disturbance based on reported symptoms and a physical exam. However, special tests may be necessary to confirm a diagnosis of gastrointestinal autonomic neuropathy or rule out other medical conditions. For instance, the symptoms of gastroparesis may mimic a peptic ulcer or even a cancerous tumor in the gastrointestinal system. Getting the diagnosis right means getting proper therapy as soon as possible.

Some tests your doctor may order include:

Upper endoscopy. Open wide! A doctor inserts a slender, flexible tube with a video camera on the tube's business end into the mouth and guides it down the esophagus. If you can't even brush your molars without gagging, don't worry. Before the procedure, which takes only 10 or 15 minutes, your doctor will either spray your throat with a local anesthetic or give you a sedative. The camera sends images to a video monitor, allowing the doctor to scan the esophagus, stomach, and duodenum for anything that might be causing gastrointestinal problems, including tumors, ulcers, or inflammation. Endoscopes can also take a biopsy if any tissue looks suspicious. A doctor may also use this test if he or she suspects you may have a bezoar.

Colonoscopy and sigmoidoscopy. Kind of like an endoscopy, with one key difference: the scope enters the body at the other end of the digestive tract. If a patient has severe or worsening constipation, persistent diarrhea, unexplained pain in the abdomen, or any other gut abnormalities, a doctor may order one of these tests. A colonoscopy examines the inside of the entire colon; a sigmoidoscopy only offers a view of the lower third of the intestines. To ensure that these scopes take clear pictures, your intestines must be empty and squeaky clean. That means no solid food for a day or two before the exam, though you are allowed to sip broth and drink all the juice you like right up until the night before the test. On the day before the exam you'll take laxatives and give yourself enemas to flush the contents of your intestines. (Plan on spending the day within a very short walk of a bathroom.) Right before the exam, you will be given a sedative and pain reliever. During the procedure, the doctor may take biopsies with tiny forceps or remove polyps (little nubbins in the colon that can turn cancerous).

Esophageal motility testing. If you're having difficulty swallowing, your doctor may use this exam to determine whether the muscles in your esophagus have suffered nerve damage. The procedure involves slipping a slender tube called a catheter into one nostril, then guiding it into the esophagus. The tip of the catheter is equipped with sensors that record pressure inside the esophagus, then send the information to a recorder. The test can also measure how well the LES is working.

Gastric emptying study. Your doctor may order this test if you have symptoms of gastroparesis. Although you may not have much of an appetite, you will be asked to eat a small meal (such as a scrambled egg) that has been laced with radioactive material. The doctor then places a special scanner over your stomach that traces the movement of the radioactive material, measuring how long it takes to empty into the intestines. The gastric emptying study is considered the gold standard for confirming the diagnosis of gastroparesis.

Gastroduodenal manometry. Although this test isn't commonly performed or universally available, your doctor may order it. The physician inserts a small plastic tube through the nose, down the esophagus, and into your stomach and small intestine. The tube measures muscle contractions in the gut and sends the information to a computer. Doctors use this test to learn whether muscle contractions in the stomach are strong enough to mash food and move it down the pipe, and whether muscles in the stomach and intestines are working in a coordinated manner. A related test may be used in cases of bowel incontinence to measure the strength of anal muscles.

Electrogastrogram. Didn't Buck Rogers use an electrogastrogram to fight the Martians? Although it sounds like a ray gun or some other science-fiction gadget, an electrogastrogram is actually a new medical imaging tool (similar to an electrocardiogram) that measures the strength and rhythm of electrical signals traveling between the brain and the stomach muscles. You'll be relieved to know that no tubes down the throat are needed; this device senses muscle activity with electrodes taped to the abdomen. Stomach contractions normally have a steady pace and speed up after a meal; an electrogastrogram study showing that your belly muscles move slowly, or not at all, offers strong evidence of gastroparesis.

Other tests, which may be more familiar to you than the ones we've covered here, are on the next page.

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This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.