Digestive Disorder Diagnostics

If your child is experiencing digestive disorders, his or her doctor will take a thorough medical history, noting the symptoms your child has experienced, as well as any other pertinent information. A physical examination is also done to help assess the problem more completely. Some patients need to undergo a more extensive diagnostic evaluation, which may include laboratory tests, imaging tests and/or endoscopic procedures. These tests may include any, or a combination of, the following:

Laboratory Tests

CHOC Children’s Laboratory Services is one of the only dedicated pediatric labs in Southern California. We specialize in providing children with the most pleasant lab experience possible—even when it comes to having blood drawn. All of our phlebotomists (people specially trained to draw blood) have at least two years of experience working with children before coming to CHOC and attend a very special four-week training course upon being hired to work with our patients.

We pride ourselves on processing blood, urine and stool tests as quickly and efficiently as possible using the very latest equipment and expert staff. Physicians connected to our computer network are often able to get routine results within 60 minutes.

Many of our gastroenterology patients will undergo laboratory tests, including:

  • Blood tests. Blood is often drawn to evaluate whether your child is anemic, has an infection or has an illness caused by inflammation or irritation. Learn more about blood tests at CHOC.
  • Stool culture. A stool culture checks for the presence of abnormal bacteria or blood in the digestive tract that may cause diarrhea, infection and other problems. A small sample of stool is collected and sent to the laboratory. Some results may take several days, especially when looking for a bacteria. Learn more about stool tests.
  • Urine analysis and culture. Urine analysis is done to help assess for urinary tract infections.

Imaging Tests

At CHOC Children’s, we offer a wide range of imaging services using the most advanced imaging equipment available. In addition, our imaging machines are carefully calibrated to provide the highest quality images using the lowest doses of radiation possible. Some of the more common imaging studies for gastroenterology patients include:

  • Abdominal X-ray. A simple study that will give the health care provider an idea of how the internal organs look.
  • Barium meal. During this test, the patient eats a meal containing barium (a metallic, chalky liquid used to coat the inside of organs so that they will show up on an X-ray), allowing the radiologist to watch the stomach as it digests the meal. The amount of time it takes for the barium meal to be digested and leave the stomach gives the doctor an idea of how well the stomach is working and helps to detect emptying problems that may not show up on the liquid barium X-ray.
  • Cholangiography. X-ray examination of the bile ducts using an intravenous (IV) dye (contrast).
  • Colorectal transit study. This test shows how well food moves through the colon. The patient swallows capsules containing small markers that are visible on X-ray. The patient follows a high-fiber diet during the course of the test, and the movement of the markers through the colon is monitored with abdominal X-rays taken several times three to seven days after the capsule is swallowed.
  • Computed tomography scan (CT or CAT scan). This diagnostic imaging procedure uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general X-rays.
  • Hepatobiliary (HIDA) scan. A low radioactive isotope (technetium) is injected into the child’s vein. The liver and intestine are scanned by a nuclear medicine machine. If the isotope passes through the liver into the intestine, the bile ducts are open and the child does not have biliary atresia.
  • Lower GI (gastrointestinal) series (also called barium enema). A lower GI series is a procedure that examines the rectum, the large intestine, and the lower part of the small intestine. Barium is given into the rectum as an enema. An X-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and other problems.
  • Magnetic resonance cholangiopancreatography (MRCP). This test uses magnetic resonance imaging (MRI) to view the bile ducts. The machine uses radio waves and magnets to scan internal tissues and organs.
  • Magnetic resonance imaging (MRI). MRI is a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. The patient lies on a bed that moves into the cylindrical MRI machine. The machine takes a series of pictures of the inside of the body using a magnetic field and radio waves. The computer enhances the pictures produced. The test is painless, and does not involve exposure to radiation. Because the MRI machine is like a tunnel, some people are claustrophobic or unable to hold still during the test, and may be given a sedative to help them relax. Metal objects cannot be present in the MRI room, so people with pacemakers or metal clips or rods inside the body cannot have this test done. All jewelry must be removed before the procedure.
  • Meckel’s scan. A substance called technetium is injected into your child’s bloodstream though an intravenous (IV) line. The technetium can be seen on an X-ray in areas of the body where stomach tissue exists, such as the Meckel’s diverticulum in the lower abdomen.
  • Oropharyngeal motility (swallowing) study. This is a study in which the patient is given small amounts of a liquid containing barium to drink with a bottle, spoon, or cup. A series of X-rays is taken to evaluate what happens as the liquid is swallowed.
  • Radioisotope gastric-emptying scan. During this test, the patient eats food containing a radioisotope, which is a slightly radioactive substance that will show up on a scan. The dosage of radiation from the radioisotope is very small and not harmful, but allows the radiologist to see the food in the stomach and how quickly it leaves the stomach, while the patient lies under a machine.
  • Ultrasound. Ultrasound is a diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels. Gel is applied to the area of the body being studied, such as the abdomen, and a wand called a transducer is placed on the skin. The transducer sends sound waves into the body that bounce off organs and return to the ultrasound machine, producing an image on the monitor. A picture or videotape of the test is also made so it can be reviewed in the future.
  • Upper GI (gastrointestinal) series (also called barium swallow). Upper GI series is a diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine). Barium is swallowed and X-rays are then taken to evaluate the digestive organs.

Learn more about imaging at CHOC Children’s.

Endoscopic Procedures

Endoscopic procedures are invasive procedures that allow doctors to look inside a child’s gastrointestinal system. Although most procedures require sedation, they are typically outpatient and do not require an overnight stay in the hospital.

  • Colonoscopy (lower endoscopy). Colonoscopy is a procedure that allows the doctor to view the entire length of the large intestine (colon), and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the rectum up into the colon. The colonoscope allows the doctor to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered. Learn more about colonoscopy.
  • Endoscopic retrograde cholangiopancreatography (ERCP). ERCP is a procedure that allows the doctor to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. The procedure combines X-ray and the use of an endoscope, a long, flexible, lighted tube. The scope is guided through the patient’s mouth and throat, then through the esophagus, stomach, and duodenum (the first part of the small intestine). The doctor can examine the inside of these organs and detect any abnormalities. A tube is then passed through the scope, and a dye is injected that will allow the internal organs to appear on an X-ray.
  • Esophagogastroduodenoscopy (EGD or upper endoscopy). An EGD a procedure that allows the doctor to examine the inside of the esophagus, stomach, and duodenum with an endoscope, which is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the doctor to view the inside of this area of the body, as well as to insert instruments through the scope for the removal of a sample of tissue for biopsy (if necessary). Learn more about endoscopy.
  • Sigmoidoscopy. A sigmoidoscopy is a diagnostic procedure that allows the doctor to examine the inside of a portion of the large intestine, and is helpful in identifying the causes of diarrhea, abdominal pain, constipation, abnormal growths, and bleeding. A short, flexible, lighted tube, called a sigmoidoscope, is inserted into the intestine through the rectum. The scope blows air into the intestine to inflate it and make viewing the inside easier.

Other Diagnostic Tests and Procedures

  • Anorectal manometry. This test helps determine the strength of the muscles in the rectum and anus. These muscles normally tighten to hold in a bowel movement and relax when a bowel movement is passed. Anorectal manometry is helpful in evaluating anorectal malformations and Hirschsprung’s disease, among other problems. A small tube is placed into the rectum to measure the pressures exerted by the sphincter muscles that ring the canal.
  • Antroduodenal manometry. This test measures how your child’s stomach and intestines move.
  • Bravo pH capsule study. The BRAVO® capsule is a wireless method to measure the amount of acid from the stomach that goes into the esophagus (acid reflux).
  • Capsule endoscopy. A capsule endoscopy helps doctors examine the small intestine, because traditional procedures, such as an upper endoscopy or colonoscopy, cannot reach this part of the bowel. This procedure is helpful in identifying causes of bleeding, detecting polyps, inflammatory bowel disease, ulcers, and tumors of the small intestine. A sensor device is placed on a patient’s abdomen and a PillCam is swallowed. The PillCam passes naturally through the digestive tract while transmitting video images to a data recorder. The data recorder is secured to a patient’s waist by a belt for eight hours. Images of the small bowel are downloaded onto a computer from the data recorder. The images are reviewed by a doctor on a computer screen. Normally, the PillCam passes through the colon and is eliminated in the stool within 24 hours.
  • Colonic manometry. This test measures contractions in the colon. It provides an understanding of the underlying movement in the colon.
  • Dilation of esophageal strictures. Doctors treat strictures by passing a blunt instrument (called a dilator) through the esophagus from above to stretch them open.
  • Esophageal manometry. This test helps determine the strength of the muscles in the esophagus. It is useful in evaluating gastroesophageal reflux and swallowing abnormalities. A small tube is guided into the nostril, then passed into the throat, and finally into the esophagus. The pressure the esophageal muscles produce at rest is then measured.
  • Gastric emptying studies. Gastric emptying is a test that measures the time it takes for food to empty from the stomach and enter the small intestine.
  • Gastric manometry. This test measures electrical and muscular activity in the stomach. The doctor passes a thin tube down the patient’s throat into the stomach. This tube contains a wire that takes measurements of the electrical and muscular activity of the stomach as it digests foods and liquids. This helps show how the stomach is working, and if there is any delay in digestion.
  • Lactose breath hydrogen test. This test is done to determine if your child is intolerant to lactose, a sugar present in milk and milk products. Learn more about lactose breath hydrogen tests.
  • Liver biopsy. A liver biopsy is a procedure in which tissue samples from the liver are removed for examination under a microscope to look for signs of damage or disease. It is used to diagnose many liver conditions. During a liver biopsy, tissue samples are removed with a special needle to determine if cancer or other abnormal cells are present, or to determine how well the liver is working. Learn more about liver biopsy.
  • pH-Impedance study. An impedance study with pH monitoring determines if contents from the stomach are coming up into the esophagus (food tube), by evaluating acid and non-acid gastroesophageal reflux. This is one of the best possible tests for diagnosing gastroesophageal reflux disease.
  • Rectal suction biopsy.