Gastroenterological functional diagnostics includes various methods of research, with the help of which functional disorders of the esophagus, stomach, small and large intestine are examined. In this case, the spectrum of individual procedures, as a rule, is not widely described.
Functional disorders of the esophagus are usually characterized by a feeling of food stuck (dysphagia) during swallowing or pain in the thoracic region, not caused by heart or lung diseases. In such patients, the pressure of the musculature of the esophagus and the upper and lower sphincters during the swallowing act is measured for the diagnostics using manometry. Typically, manometry is used before surgery on the lower sphincter of the esophagus. For examination, the measuring probe is inserted through the nose into the esophagus. Thus, the study compared with gastroscopy is much less unpleasant and can be performed by patients who are conscious.
Anal sphincter manometry
Measurement of the anal sphincter pressure can be administered to patients with a functional disruption of the sphincter of the anus or when certain operations on the large intestine are necessary.
Measurement of acidity in the esophagus and in the stomach is necessary, for example, in patients with gastroesophageal reflux. In addition, such examination can be conducted for patients with complaints, despite the medication being received. For pH-metry, a flexible probe with a pencil thickness is inserted through the nose into the esophagus and left there for 24 hours. The study can also be conducted on an outpatient basis, while patients can eat and drink.
Under certain conditions, some patients get measurement for 96 hours. In such cases, a small capsule is implanted under the control of endoscopy in the lower part of the esophagus (Bravo capsule). The measurement data are transferred to a recording device located on the patient’s body. The capsule detaches itself from the esophagus after a few days and is excreted along with the feces.
In some of our patients who have turned to our clinic for non-specific digestive disorders, we do not get results explaining these disorders when conducting standard methods of investigation, such as ultrasound examination or colonoscopy. If there are additional signs indicating intolerance to certain food, you can perform respiratory tests to determine if lactose or fructose is intolerant. In isolated cases with the help of a breath test can detect the pathological colonization of the small intestine by bacteria.
Depending on the type of test, the patient should, after a certain time, exhale into a tube after taking milk sugar (lactose), fruit sugar (fructose) or sugar (glucose). In the exhaled air, the hydrogen content is measured.
Oral glucose tolerance test (OGTT)
OGTT serves to determine or exclude diabetes mellitus.
In this case, after determining the concentration of blood glucose on an empty stomach, 200 ml of water is diluted with 75 g of glucose dissolved in it and after two hours, glucose in the blood is again determined. At a rate of ≥ 200 mg/100 ml, there is diabetes mellitus.
In this case, a combined treatment is required, often with the patient’s compliance with a new lifestyle (weight loss, increased mobility, etc.), diets and, if necessary, medication intake.
Iron absorption test
When the iron absorption test is performed, the ability of the small intestine to sufficiently absorb iron obtained with food is examined. This test is worthwhile in those cases when an insufficient level of iron in the blood is detected and the possible reason for this is a disorder of the assimilation of iron in the intestine. Most often, iron deficiency is a consequence of loss of blood.
In practical terms, the test is conducted as follows: after a 12-hour fasting period, blood is taken to determine the level of iron on an empty stomach. After this, the patient needs to take 200 mg of iron in a tablet form, with a sip of water. Accordingly, after 2 and 4 hours, a second blood sample is taken.
If there is a low level of iron in the blood and when taking the iron preparation there is a significant increase, then in this case it is a significant insufficiency, but the intestinal absorption index is not impaired. If the increase in the concentration of iron does not occur, then there is a violation of absorption of the iron and the cause is determined.
Video capsule endoscopy (VCE)
When carrying out this method, a device consisting of a light source, a video camera and a transmitter, in shape and size corresponding to the capsule with the medicine, is swallowed by drinking water. Before this, 8 flat antennas on the abdomen are glued in a certain position, similar to the way that many patients who got Holter monitoring ECG are aware.
The camera transmits for 10 to 12 hours of high-resolution photos of the gastrointestinal tract to a portable recording device. After you return the device from these images, you can compose a video. The capsule is an expensive disposable device, which after isolation in a few days is naturally released into the garbage after the test. In addition, the battery is discharged.
This method is suitable only for assessing the mucosa of the small intestine, especially if there is a suspicion of bleeding in this localization. It cannot be a substitute for cancer screening in the form of colonoscopy (endoscopy of the large intestine) or gastroscopy.