disorder of esophagus, stomach, small intestine,large intestine

1. DIAGNOSTIC TESTS FOR GI
DISORDERS
Presented by- POOJA TUMMA
POST GRADUATION IN DIETETICS

2. DISORDERS OF OEASOPHAGUS

3. 1) Gastroesophageal reflux disease (GERD)
Gastroesophageal reflux disease (GERD) is defined
as symptoms produced by the abnormal reflux
of gastric contents into the esophagus or beyond,
into the oral cavity (including larynx) or lung.
Symptoms-
Acid regurgitation, heartburn
Epigastric fullness, epigastric pressure,
epigastric pain, dyspepsia, nausea, bloating, belching
Chronic cough, bronchospasm, wheezing,
hoarseness, sore throat, asthma, laryngitis, dental erosions

4. DIAGNOSTIC TESTS
1)Ambulatory pH monitoring
This test measures how much acid is in stomach
over 24 hours. The doctor will thread a long,
thin, flexible tube called a catheter through the
nose and down the esophagus. Then the patient
makes to wear a small device to track how
much acid comes into the esophagus from your
stomach. The doctor might also attach a small
device that looks like a capsule to the wall of
the esophagus. It measures acid and sends
signals to a small device which is weared. It
will fall off esophagus and pass through stool
about 2 days later.

5. 2)Endoscopy
 An upper GI endoscopy procedure helps to
evaluate the overall anatomy and identify any
structural problems or complications from the disease.
 This test confirms the presence of acid reflux
disease and is useful determining the extent of
damage to the esophagus.
 The doctor will put a long, thin tube and
tiny camera into the digestive tract to look
for damage. It will thread through the nose and
down the esophagus.
 The tube can also be used for a biopsy if the
doctor wants to take out a small sample of tissue to test.

6. 3) Esophageal Manometry
to evaluate the lower esophageal sphincter
and the muscle of the body of the esophagus.
 can identify weakness in the lower
esophageal sphincter that allows stomach
acid and contents to back up into the esophagus.
 It also may identify abnormalities in the
functioning of the muscle of the esophageal
body that may add to the problem of reflux.
 During the manometry test, a thin,
pressure-sensitive tube is passed through the nose,
along the back of the throat, down the esophagus,
and into the stomach

7. 4) Barium X-ray
A special X-ray called a barium swallow radiograph
can help doctors see whether liquid is
refluxing into the esophagus.
It can also show whether the esophagus
is irritated or whether there are other
abnormalities in the esophagus or the stomach
that can make it easier for someone to reflux.
With this test, the person drinks a special
solution (barium, a kind of chalky liquid);
this liquid then shows up on the X-rays

8. 2) Esophagitis
• Esophagitis (or oesophagitis) is an inflammation of the esophagus, that can be
painful and can make swallowing difficult
Symptoms of esophagitis include:
Heartburn, acid reflux, or unpleasant taste in mouth
Sore throat or hoarseness
Mouth sores
Nausea, vomiting, or indigestion
Chest pain, in the middle of the chest, often radiating
to the back, usually associated with swallowing or soon after a meal
Bad breath (halitosis)
Excessive belching

9. 1)Barium X-ray
• For this test, you drink a solution containing a compound called barium or take a
pill coated with barium. Barium coats the lining of the esophagus and stomach and
makes the organs visible. These images can help identify narrowing of the
esophagus, other structural changes, a hiatal hernia, tumors or other abnormalities
that could be causing symptoms

10. 2)Endoscopy
Doctors guide a long, thin tube equipped with a tiny camera (endoscope) down your
throat and into the esophagus. Using this instrument, your doctor can look for any
unusual appearance of the esophagus and remove small tissue samples for testing.
The esophagus may look different depending on the cause of the inflammation, such
as drug-induced or reflux esophagitis. You'll be lightly sedated during this test.

11. 3)Laboratory tests
Small tissue samples removed (biopsy) during an endoscopic exam are sent to the
lab for testing. Depending on the suspected cause of the disorder, tests may be used
to:
Diagnose a bacterial, viral or fungal infection
Determine the concentration of allergy-related
white blood cells (eosinophils)
Identify abnormal cells that would indicate
esophageal cancer or precancerous changes

12. Disorders of Stomach
1. Peptic ulcer
2. Gastritis
Infection with Helicobacter pylori is the etiologic factor in both
diseases.

13. Symptoms
• Burning pain in the upper abdominal wall lining
• Acid reflux or heart burn
• Feeling of satiatment while eating
• Weight loss
• Bloating or burping
• Nausea and vomiting

14. Diagnostic test
Endoscopic Tests
During upper intestinal endoscopy, gastric juice or biopsy specimens of gastric
mucosa can be easily obtained for direct tests of H.pylori infection, such as
histology, culture, and polymerase chain reaction (PCR), and for indirect tests,
such as urease testing.
• Direct Endoscopic Tests
• Indirect Endoscopic Tests

15.  Histology
• Histology can reveal the presence of bacteria as well as the type of
inflammation.
• Many stains have been used to detect H. pylori, for example, Warthine Starry,
Hp silver stain
• In a histological section, H. pylori is recognised by its appearance as a short,
curved or spiral bacillus resting on the epithelial surface or in the mucus
layer; it is also found deep in the gastric pits.
• The average time for a histological diagnosis is 2-3 days, However, this
increases when multiple biopsies are taken, which also increases the
processing costs of the biopsies and the overall costs of the diagnosis.

16.  Culture
• Helicobacter can be cultured from gastric biopsies.
• The colonies are identified by a Gram stain and biochemical tests.
• The biopsies can be kept in a transport medium (Stuart’s transport medium) for
24 h at 4 C.
• Helicobacter are isolated on agar (Columbia or brain heart infusion), generally
with added antibiotics and albumin
• The plates are incubated for at least 5 days at 37 C.
• culture has a high specificity (100%), the sensitivity is often lower
• Culture tends to be done only in research centres particularly dedicated to H.
pylori infection

17.  Molecular testing
Polymerase Chain Reaction
• PCR has been used extensively for the diagnosis of H. pylori from gastric
biopsy specimens, saliva etc.
• PCR yields information on the presence of potential virulence markers in the
strain, which might have implications for the development of severe disease
or efficacy of eradication.
• This is a very sensitive and specific diagnostic method, but it is expensive, is
performed only in reference laboratories, and is subject to error if not done
with careful attention to technique.

18.  Fluorescent in situ hybridization
• Fluorescent in situ hybridization (FISH) is a new method used on histological
preparations that allows detection of a specific bacterial factor or feature, such
as clarithromycin resistance, in addition to H. pylori.

19.  Indirect Endoscopic Test
Urease test
• Urease testing is an indirect method for detecting H pylori in gastric mucosal
biopsy specimens. H pylori possesses a potent urease; if urease is present,
the organism converts urea to ammonia, increasing the pH of the medium. If
a pH colour indicator is added, a subsequent colour change indirectly
documents the presence of H.pylori.
• Many commercial urease tests are available, including gel-based tests
(CLOtest, HpFast) paper-based tests (PyloriTek, ProntoDry HpOne) and
liquid-based tests (CPtest, EndoscHp)
• In comparison to histology, and PCR, urease tests are more rapid, much
cheaper and have comparable sensitivity and specificity.

20.  Serological test
• There are three main formats for these tests
• Enzyme-linked immunosorbent assay (ELISA) test
• Latex agglutination tests
• Western blotting
• Antibodies against the important proteins of H. pylori, cagA and vacA, can be
detected using above serological test

21.  Stool antigen test
• The SAT uses an enzyme immunoassay (EIA) to detect the presence of
antigens against H. pylori in stool samples.
• The most widely used test in the assay uses polyclonal anti-H. pylori-capture
antibodies absorbed to microwells.
• This polyclonal antibody test has been extensively evaluated in the diagnosis
of H. pylori infection
• It is a reliable method to diagnose an active infection and to confirm an
effective treatment of infection
• This test checks for the presence of blood in the stool, another sign of bleeding
in the stomach.

22. Fig. ImmunoCard Stat HpSA

23.  Intestinal bowel syndrome
• An intestinal disorder causing pain in the stomach, wind, diarrhea and
constipation.

24.  Diagnostic of IBS
• Physician can generally diagnose ibs by:
• Recognizing certain symptoms details
• Performing a physical examination
• Undertaking limited diagnostic testing

25.  Diagnostic testing
• Testing is individualized depending on factors such as family history, presence of
stress factors, symptom features, and other.
1-blood test
• CBC
2-Stool tests
• For bacterial infection, intestinal parasite,
blood in the stool
3-sigmoidoscopy / colonoscopy:
• Examination of the rectum or colon
4-Barium enema:
• Examines the large bowl, after being coated with barium, by taking x-rays.

26. 5-psychological test:
detect anxiety, depression or other psychological problem
• 6-miscellaneous other tests:
Tests purpose
Anorectal manometry To measure the function of muscles and nerves of the anus and rectum
Blood biomarker profile To distinguish IBS from other medical disorders, this test require
refinement to achieve sufficient accuracy for routine screening
evolution
Capsule endoscopy An accurate way to detect crohn’s disease or other abnormalities of the
small intestine.
Colonic transit To measure the rate of movement of contents in the colon.
H broth test To detect lactase deficiency
Lactulose/ glucose breath
test
To detect bacterial overgrowth syndrome

27.  diarrhea
• A condition in which faeces are discharged from the bowels frequently and in a
liquid form.

28.  Diagnosis for diarrhea
Medical family history: (doctor will ask)
• How long you have had diarrhea
• How much stool you have passed
• How often you have diarrhea
• How your stool looks
• Other symptoms
• Food allergy intolerance
• Current and past medical condition
• Prescription and over the counter medicines
• Recent contact with other people who are sick
• Recent travel to developing countries

29.  Several test for diagnosis of diarrhea
1-stool test:
• Examination of bacteria, blood and parasites.
2-blood tests
3-hydrogen breath test:
• To diagnose lactose intolerance by measuring amount of hydrogen in
your breath.
4-fasting test:
• To find out food intolerance or allergy
5-endoscopy

30. Test Method use
1-Initial screening test
Fecal leukocytes Wright’s stain or
methylene blue
Identify inflammatory
diarrhea
Fecal occult blood test Peroxidase reaction for
hemoglobin
Identify hemorrhagic
diarrhea
Stool alkalinization Color change after adding
NaoH to stool
Phenolphthalein laxative
ingestion
2-Infectious causes:
Stool bacterial culture Routine culture and
sensitivity
Identify shigella,
salmonella
Stool clostridium difficile
toxin assay
EIA for toxin a and b Pseudomembranous colitis
stool giardia Ag EIA for antigen Giardia lambia

31. 3-Endocrine causes:ser
Serum TSH, free thyroxine
(T4)
immunoassay hyperthyroidism
Serum calcitonin RIA Hypercalcemia-related
diarrhea
serum somatostatin RIA somatostatinoma
4-malabsorption:
lactose tolerance test lactose administration lactase deficiency
stool-reducing sugar clinical tablets carbohydrate intolerance
fecal fat stain sudan stain for globules lipid malabsorption
hydrogen breath test gas chromatography carbohydrate
malabsorption

32. 5-others:
serum ionizes calcium ion-specific electrode hypocalcemia-related
dirarhea
quantitative
immunoglobulin
nephelometry agammaglobulinemia

33. LARGE INTESTINE DISORDER
• Disease associated with large intestine are as follows:
1. Ulcerative colitis.
2. Crohn’s disease.

34. DIAGNOSIS OF ULCERATIVE COLITIS AND CROHN’S
DISEASE:
• Although Crohn’s Disease and Ulcerative Colitis are different conditions that
affect different parts of the digestive tract, doctors are likely to use the same tests
to help them establish their diagnosis.
1. Blood and stool test.
2. Endoscopy.
3. X-Rays.
4. Ultrasound.
5. MRI Scan.

36. MALABSORPTION SYNDROME
• Malabsorption is the pathological state of impaired nutrient absorption in the
gastrointestinal tract.
• Malabsorption can affect macronutrient , micronutrient or both causing excessive
fecal excretion , nutrient deficiencies and GI symptoms.
• It leads to following conditions:
1. Steatorrhea.
2. Lactose intolerance.
3. Celiac disease.

37. 1.STEATORRHEA (fatty stool).
• The excretion of abnormal quantities of fat with the feaces owing to reduced
absorption of fat by the intestine.
• DIAGNOSIS OF STEATORRHEA OR FECAL FAT.
1. Sudan III dye test.
2. Plasma carotene test.

38. SUDAN III DYE TEST
1. Sudan III is a red fat-soluble dye that is
utilized in the identification of the presence
of lipids, triglycerides and lipoproteins.
2. Sudan III reacts with the lipids
or triglycerides to stain red in colour .
3. The fat globules will stain red with
Sudan III dye since it is a lipid and contains triglycerides.
4.The oil will form a layer or globules above
the water and appear as a red layer above the
water in the test tube.

39. PLASMA CAROTENE TEST:
1. Carotene is the fat soluble precursor of vitamin A.
2. Absorption of carotenoids in the intestine depends on the presence of dietary
fat , disturbance in the absorption of lipids in the intestine can result in
decreasing levels of serum carotenoids

40. 2.LACTOSE INTOLERANCE
• The inability to digest lactose, a component of milk and some other dairy
products. The basis for lactose intolerance is the lack of an enzyme called lactase
in the small intestine.
• DIAGNOSIS:
1. Lactose tolerance test.
2. Hydrogen breath test.
3. Stool acidity test

41. LACTOSE INTOLERANCE TEST
1. 50 gm of lactose dissolved in 400 ml of water is orally administered
2. 2 hours after drinking the liquid, the blood sample is drawn to measure the
amount of glucose in the bloodstream.
3. If the glucose level doesn't rise, it means that body isn't properly digesting and
absorbing the lactose-filled drink.

42. HYDROGEN BREATH TEST:
1. This test also requires to drink a liquid
that contains high levels of lactose.
2. The amount of hydrogen in breath
at regular intervals is measured.
3. Normally, very little hydrogen
is detectable. Larger than normal amounts
of exhaled hydrogen measured during
a breath test indicate that person is not fully
digesting and absorbing lactose.

43. STOOL ACIDITY TEST
1. For infants and children who can't undergo other tests, a stool
acidity test may be used.
2. The fermenting of undigested lactose creates lactic acid and other
acids that can be detected in a stool sample.

44. CELIAC DISEASE:
• A disease in which the small intestine is hypersensitive to gluten, leading to
difficulty in digesting food.
1. Serology testing.
2. Genetic testing.

45. SEROLOGICAL TESTING:
There are several serologic (blood) tests
available that screen for celiac disease
antibodies, but the most commonly used
is called a (tTG-IgA) transglutaminase test.
• The tTG-IgA test is an enzyme-linked
immunosorbent assay (ELISA) test.
• People with celiac disease who eat gluten
have higher than normal levels of these
antibodies in their blood.

46. GENETIC TESTING:
• Human leukocyte antigens (HLA-DQ2 and HLA-DQ8) can be used to identify
celiac disease.
• People with celiac disease carry one or both of the HLA DQ2 and DQ8 genes.

47. Reference:
• Nutrition in the prevention and treatment of disease
Edited by ANN M. COULSTON, CAROL J. BOUSHEY- SECOND EDITION
• Clinical laboratory medicine
Clinic al application of laboratory data- RICHARD RAVEL
• Clinical biochemistry
7th edition- GEOFFREY BECKETT, SIMON WALKER
• Practical clinical biochemistry- volume 1
ALAN H GOWENLOCK, MAURICE BELL

48. THANK YOU!