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Healthcare: Gastroenterology & Digestive Health

Office Based Procedures

Master
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Breath Testing

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Breath testing involves the collection of breath samples to measure specific gases in the exhaled air and may be used to diagnose several different gastrointestinal conditions. Despite similar steps for all breath testing – preparation, baseline collection of breath samples, ingestion of a meal or solution, and additional collection of breath samples – the specifics of these steps varies for each type of breath testing. 

Helicobacter pylori breath testing

Helicobacter pylori (“H.pylori”) is a common infection that can cause ulcers of the stomach and small intestine, gastritis, and less commonly, stomach cancer. Breath testing can be used to diagnose H.pylori, as well as to document that treatment has gotten rid of it. 

Breath testing for Helicobacter pylori involves fasting for 1-2 hours before the test, collecting a baseline breath sample, and then consuming about 5 ounces of specific solution. If H.pylori is present in the stomach, it will break down the test solution and radiolabeled carbon dioxide (13C) will be released into the breath. 

The test is the shortest of the various breath tests (10 to 20 minutes). 

It is important to discuss medications with your doctor before the test, as no proton pump inhibitors (omeprazole, lansoprazole, rabeprazole, dexlansoprazole, etc), antibiotics, or bismuth-containing preparations such as Pepto Bismol ®) can be used within 2 weeks of the test. 

The test solution does contain aspartame, which may cause harm to patients with phenylketonuria (PKU), a rare genetic condition in which aspartame breakdown products can cause neurologic and other problems. 

Specific sugar (fructose and lactose) breath testing

Breath testing can be used to test for malabsorption of specific sugars, namely fructose (which is most common in fruits, onions, artichokes, wheat) and lactose (which is in milk and dairy products).

Preparation includes a diet low in fiber and nonabsorbable carbohydrates (starchs and sugars) the day before the test. Fast for 12 hours prior to the test. Avoid testing until 4 weeks after completing antibiotics, probiotics, and bowel preparations for colonoscopy. 

Baseline breath samples will be collected, followed by ingestion of a fructose (25 grams) or lactose (50 grams) containing beverage. Breath samples will then be collected every 15 minutes for up to 2 to 4 hours, with measurement of hydrogen in the breath samples. Increased hydrogen indicated that the body cannot breakdown and absorb fructose or lactose normally and indicates intolerance.

Small intestinal bacterial overgrowth (SIBO) 
SIBO is a common condition involving and overgrowth of bacteria in the small intestine leading to fermentation of sugars and symptoms such as bloating, gas, pain, and diarrhea. There are many risk factors for SIBO, and some patients with irritable bowel syndrome (IBS) may have overlapping symptoms with SIBO and/or SIBO as a driving force behind their IBS symptoms. 

Preparation for breath testing for SIBO involves following a specific diet the day before the test, followed by an overnight fast. A baseline sample is collected, followed by consumption of 100 grams of glucose or 10 grams of lactulose). Breath samples are then collected every 15 minutes for 4 hours. Hydrogen and methane in the exhaled samples are measured, with increases in either potentially suggestive of excess bacteria in the small bowel fermenting the glucose drink. 

13C-Spirulina Gastric Emptying Breath Test 

The 13C-Spirulina Gastric Emptying Breath Test is a safe, FDA-approved, non-radioactive test to help diagnose delayed/slow emptying of the stomach known as gastroparesis. 

Preparation for the test involves an overnight fast. The day of the test, pre-meal breath samples are collected. Then, a special meal with Spirulina (an algae based supplement), egg, and saltine crackers is consumed which contains a compound, carbon-13 (13C), which can be detected in the breath as carbon dioxide (CO2). The better the stomach empties, the more of the meal is absorbed and the more 13C is exhaled in the breath. Post-meal breath samples are collected at 6 times over 4 hours and submitted to the lab for analysis. 
 

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Rectal balloon expulsion and rectal sensitivity testing

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Balloon expulsion and rectal sensitivity testing are used to help diagnose problems with defecation (“passage of stool”), such as constipation or fecal incontinence. In order to have a bowel movement, it is necessary to be able to feel that stool has accumulated in the rectum and for muscles involved in passage of stool to work in a coordinated fashion.  

For the expulsion test, a balloon is inserted into the rectum and an attempt is made to expel the balloon. Sensitivity testing is performed with the same balloon, using gradual inflation of the balloon to assess for hyper- (“more sensitive”) or hyposensitivity (“less sensitive”). 
 

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Video Capsule Endoscopy

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Video capsule endoscopy (VCE) is a test that involves swallowing a small capsule, or pill-like camera. The test is used to assess the small intestine, as routine upper endoscopy and colonoscopy are only able to look at the very beginning and very end of the small intestine, which measures the 20 feet long. 

Preparation for a VCE test involves fasting for 12 hours before the test, and some physicians request patients consume a laxative to clear the small intestine of food residue. The VCE can be swallowed like a pill or deployed during an upper endoscopy. The camera takes roughly 50,000 images over 8 or more hours. 

You will wear a small receiver (an electronic box) that the camera transmits pictures to during the test. At the completion of the test, the camera is not retrieved and is expelled in the stool. The images are downloaded from the receiver to a secure computer where your doctor will review the images to generate a report of the findings. 

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Hemorrhoid Clinic

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Our hemorrhoid clinic, led by a national expert in the treatment of hemorrhoids, Waqar Qureshi, MD, can treat a wide variety of hemorrhoid problems. In the clinic, exam by anoscopy is conducted on all patients. For those with clinically significant internal hemorrhoids, rubber band ligation and infrared coagulation can be used in the office to eradicate hemorrhoids. 

Rubber band ligation uses a single-use, disposable device to suction hemorrhoidal tissue into the device and deploy a rubber band around the tissue. This reduces blood flow into the hemorrhoid, causing it to shrink. After the banded tissue falls off, the area heals with scar tissue the reduces the likelihood of recurrence and prevents prolapse. 

Of note, rubber band ligation can treat one column of hemorrhoids as a time, and thus may require up to three visits to band the three columns of hemorrhoidal veins. Treatments are usually spaced two weeks apart.

Infrared coagulation (IRC) 

IRC is performed under direct visualization of the internal hemorrhoids using an anoscope. IRC can treat all three hemorrhoidal columns at the same visit, although occasional retreatment at the 2-4 week follow-up visit is required if shrinkage is inadequate or symptoms continue. 

In addition to the ability to treat all three columns of hemorrhoids at the same time, IRC may be favored in pregnant women and patients on chronic anticoagulation or antiplatelet therapies. 
 

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SmartPill Capsule

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The smart pill is a wireless capsule that measures information about pressure, pH (acidity), and temperature throughout the gastrointestinal tract. The test can be used to measure motility by assessing how quickly the SmartPill moves through different parts of the gastrointestinal tract, and may help with the diagnosis of conditions such as gastroparesis, as well as decreased motility in the small and large intestines. 

Preparation involves fasting for 8 hours before the test, and certain medications will need to be held prior to the test. After the SmartPill is swallowed, a receiver box is worn to capture information from the SmartPill as it passes through the gastrointestinal tract. After the test is complete, the box is returned to the physician’s office for interpretation.