Posted By Posting
Mar 20, 2010
momma bear
What tests/trials are ordered when?
I'm looking for a brief overview of what tests/modifications are ordered when. I'm trying to make a typical gastroenterology "road map" of sorts to judge what would be our next steps. Small or large tests, trials, modifications, or labs with just a one or two line explanation of when they're done based on your own research or experience would be really helpful to place myself in the GI city and see where we've gone and where we can go. We went down this road with our older child, but this one has different docs and some different complications and I don't know how much has changed with time, how much with their different histories, and how much with the docs so that's why I'm trying to get a general feel for how things are handled now. Thanks for the help!
Mar 21, 2010
emibug
Kathryn, Pager Volunteer and mommy to Emily Mia 02/04/07. 3 years old with GERD. 30mg Prevacid and Pepcid AC. Mylanta needed for flares. Failed prilosec med switch. Tried and failed many med weans but GERD and pain are well controlled. Functional constipation. Reoccurring SBBO. Suspected IBD or autoimmune disease. Resolved issues: MSPI, CSID (acquired), Stage 2 kidney reflux, Chronic diarrhea.
Audrey Meadow 06/20/08. born 34/35 weeks. Still b/f and eats everything! ftt and chronic constipation.
this is by no means a concrete list and anybody is free to correct me but from my research and dealing with this first hand a course of treatment can go like this:

- changing formulas or thickening formulas
- removing milk and or soy
- adding in a H2 blocker like zantac or axid
- ordering a Upper GI barium swallow study (and/or a small bowel follow through)
- ordering a Swallow Study Series if swallow and aspiration from above is suspected.
- ordering a Ph Probe or Impedance Probe study
- adding in a PPI like prevacid or prilosec (can be done at any point prior)
- ordering a "Milk scan" if DGE is suspected.
- ordering meds to promote gastric emptying like reglan or eythromaycin
- ordering a Upper Endoscopy if no response to meds, order biopsies to be taken
- ordering a KUB xray if Constipation is suspected
- ordering a Colonoscopy if Lower GI issues are suspected to be causing upper GI issues, biopsies are ordered
- consultation with a ENT doctor if constant ear infections or breathing is a problem
- consultation with a Pulmonolgist if lungs or aspiration is concerned
- consultation with an Allergist if allergies or EE are a concern.
- consultation with GI and surgeon on Nissan Fundo. and or G-Tube (usually as last resort)

if you are able to elaborate on some of the complications or issues your little one faces I am almost sure there is someone here i can help you get in touch with if you need some further guidance. Many of us have been through A LOT of stuff in addition to reflux!
I really hope this helps!
Mar 21, 2010
jeddsmommy
Jessica, Mommy to Jedd, severe reflux, severe food and oral aversions, Finally G tube free!!! VSD repair 4-24-07 (open heart surgery), hypospadias, repaired 3 times and Ear tubes Visit Jedd at his CB site: www.caringbridge.org/visit/jedd
Here is Jedd's order of tests he was put through as well as a surgery for a feeding tube. Each child's will probably be different as some DRs will do testing more quickly than others.

Shortly after birth at around 2 weeks of age the Ped switched us to a hypoallergenic formula, Alimentum.

Around age 3 weeks the Ped put him on Zantac, this did nothing at all for his pain.

By age 10 weeks or so we moved to a PPI, yes we suffered that long with Zantac....Remember, Jedd wasn't eating anything the longer we went after birth due to his heart defect, we saw little issues here and there, but as long as his intake hovered around 9 ounce per day, we saw NO issues. We just had a baby who would scream while his tummy growled. :(

NG tube placed due to FTT and a DX of a CHD, specifically a VSD.

Upper GI, this was to check for structural anomalies. It was followed through to check for malrotation.

EDG (scope) with biopsies, VERY easy and quick test to take pictures as well of the upper GI tract into his Duodinum.

G tube surgically placed, this was done to remove his NG out of his nose to aide in orally eating since he was tube dependent for 100% of his nutrition.

GES, to check for Delayed Gastric Emptying, it was done os liquids.

At this point we moved testing out of our state as some of the tests our fantastic GI and I agreed we needed done were not offered at home. We were approved to get treatment at one of THE best GI Motility Centers in the Nation. We were all very pleased.

There he was given: Impendance Probe, This is the next generation PH probe test, most hospitals are moving to this type of probe as it can tell the difference between acidic and non acidic reflux.

GES, done on solids this time. We were actually the first according to the tech to put solids through a G tube and do this test. Kinda neat, esp. since I was proud to be a blended diet tube feeding Momma.

An Antro-Duodinal Manometry test on his GI tract. This is the Gold Standard for kids who are suspect to have DGE. This test is "normally" only done on kids who have G tubes or GI tubes or a separate G and J tube site placed in their body.

However, on the rare occasions, the probes "can" be placed through the nose and down the stomach and into the small intestines. They don't like to do this and really won't do it unless they really have to do so. Our old ST, her DD had one done this way, but NOT at the hospital we went to.

This test monitors for between 8-12 hours, the contractions of the stomach and the small intestines through the duodinum to see if they are contract, if they are contract enough and if they are contract together in order to move food through the GI tract.

Some where along the line he saw an ENT for repeated EI and had tubes placed, this was a fabulous decision and he has yet to have another one.

Jedd have also been seen and evaluated by Early Intervention for ST, OT, and PT. He qualified for OT for feeding and ST for speech. He was also seen at our local feeding clinic for Feeding Aversion and at our local clinic as well for therapies and at the next closest Feeding Clinic in Richmond VA. They have an inpatient program for tube weaning and complete food refusal.

Like I said, at the start, GIs will do testing in different orders.

Mar 22, 2010
momma bear
What tests/trials are ordered when?
Thank you!! Please keep the answers coming! Let me see if I can remember everything. Went to the doc complaining of throwing up frequently, often 1.5 hrs after eating. Few bowel movements with lots of straining. Turning blue and red in the arms and legs. Congestion which worsened with feeding. Formula changes with pedi Food thickened with rice cereal Prevacid and Lactulose started Didn't grow for 2 months Referred and started GI visits Formula & meds changed Back where he should be on growth chart Sweat test done - OK Upper GI done - OK MSPI diagnosed Modified Barium Swallow Study showed increased congestion with feeding and food resting on the vocal chords Speech therapy started. Dysphagia diagnosed. Therapy was no help with aspiration or congestion. FEES Study showed aspiration and concerning anatomy Direct bronchoscopy with laryngoscopy showed a laryngeal cleft and minor laryngomalacia Referral to Pulmonology put in, as well as to aero-digestive clinic. Follow-up with GI coming up. G-tube mentioned as a possibility by pedi and ST, but currently not being done since he's gaining and not sick. Another test mentioned as a possibility, which I'm guessing was the antro-duodinal manometry test mentioned by Jedd's Mom, but based on her description it seems unlikely. Repair surgery for the cleft in the larynx being considered. Reflux needs to be completely under control. My inclination is ph probe (or the newer version mentioned above) and DGE testing and reassessing the allergy diagnosis with the new info. That's just my gut, though, so I am trying to see what's realistic. The baby's been through a lot of testing and is going to have a lot more on another, unrelated, issue so I don't want to put him through more than necessary, nor do I want to frustrate his doctors, but I do want to make sure we do what is beneficial for diagnosis or treatment. Our older one, who shares no genetic history with our little one, had Zantac, Reglan, some other drug, formula changes, an Upper GI, flexible sigmiodoscopy w/ biopsies, and whatever the upper GI version of that scope with biopsies is called. She had a high eosiniphil count and was referred to Allergy & Immunology and diagnosed with 2 major allergies. Her reflux worsened around age 3-4 and has declined but continues to this day. No one's mentioned the more invasive procedures within the GI realm so far for the little guy, so I wasn't sure what the current course of doing things is.
Mar 22, 2010
momma bear
What tests/trials are ordered when?
Thank you!! Please keep the answers coming! Let me see if I can remember everything. Went to the doc complaining of throwing up frequently, often 1.5 hrs after eating. Few bowel movements with lots of straining. Turning blue and red in the arms and legs. Congestion which worsened with feeding. Formula changes with pedi Food thickened with rice cereal Prevacid and Lactulose started Didn't grow for 2 months Referred and started GI visits Formula & meds changed Back where he should be on growth chart Sweat test done - OK Upper GI done - OK MSPI diagnosed Modified Barium Swallow Study showed increased congestion with feeding and food resting on the vocal chords Speech therapy started. Dysphagia diagnosed. Therapy was no help with aspiration or congestion. FEES Study showed aspiration and concerning anatomy Direct bronchoscopy with laryngoscopy showed a laryngeal cleft and minor laryngomalacia Referral to Pulmonology put in, as well as to aero-digestive clinic. Follow-up with GI coming up. G-tube mentioned as a possibility by pedi and ST, but currently not being done since he's gaining and not sick. Another test mentioned as a possibility, which I'm guessing was the antro-duodinal manometry test mentioned by Jedd's Mom, but based on her description it seems unlikely. Repair surgery for the cleft in the larynx being considered. Reflux needs to be completely under control. My inclination is ph probe (or the newer version mentioned above) and DGE testing and reassessing the allergy diagnosis with the new info. That's just my gut, though, so I am trying to see what's realistic. The baby's been through a lot of testing and is going to have a lot more on another, unrelated, issue so I don't want to put him through more than necessary, nor do I want to frustrate his doctors, but I do want to make sure we do what is beneficial for diagnosis or treatment. Our older one, who shares no genetic history with our little one, had Zantac, Reglan, some other drug, formula changes, an Upper GI, flexible sigmiodoscopy w/ biopsies, and whatever the upper GI version of that scope with biopsies is called. She had a high eosiniphil count and was referred to Allergy & Immunology and diagnosed with 2 major allergies. Her reflux worsened around age 3-4 and has declined but continues to this day. No one's mentioned the more invasive procedures within the GI realm so far for the little guy, so I wasn't sure what the current course of doing things is.
Mar 22, 2010
momma bear
Whoah! Apparently I double posted and forgot about this forum's lack of line breaks.

Sorry!

Since I'm posting again, I'll just repost the whole thing with breaks now.

Thank you!! Please keep the answers coming! Let me see if I can remember everything.

Went to the doc complaining of throwing up frequently, often 1.5 hrs after eating.

Few bowel movements with lots of straining.

Turning blue and red in the arms and legs.

Congestion which worsened with feeding.

Formula changes with pedi

Food thickened with rice cereal

Prevacid and Lactulose started

Didn't grow for 2 months

Referred and started GI visits

Formula & meds changed

Back where he should be on growth chart

Sweat test done - OK

Upper GI done - OK

MSPI diagnosed

Modified Barium Swallow Study showed increased congestion with feeding and food resting on the vocal chords

Speech therapy started. Dysphagia diagnosed. Therapy was no help with aspiration or congestion.

FEES Study showed aspiration and concerning anatomy

Direct bronchoscopy with laryngoscopy showed a laryngeal cleft and minor laryngomalacia

Referral to Pulmonology put in, as well as to aero-digestive clinic.

Follow-up with GI coming up.

G-tube mentioned as a possibility by pedi and ST, but currently not being done since he's gaining and not sick. Another test mentioned as a possibility, which I'm guessing was the antro-duodinal manometry test mentioned by Jedd's Mom, but based on her description it seems unlikely. Repair surgery for the cleft in the larynx being considered. Reflux needs to be completely under control.

My inclination is ph probe (or the newer version mentioned above) and DGE testing and reassessing the allergy diagnosis with the new info. That's just my gut, though, so I am trying to see what's realistic. The baby's been through a lot of testing and is going to have a lot more on another, unrelated, issue so I don't want to put him through more than necessary, nor do I want to frustrate his doctors, but I do want to make sure we do what is beneficial for diagnosis or treatment.

Our older one, who shares no genetic history with our little one, had Zantac, Reglan, some other drug, formula changes, an Upper GI, flexible sigmiodoscopy w/ biopsies, and whatever the upper GI version of that scope with biopsies is called. She had a high eosiniphil count and was referred to Allergy & Immunology and diagnosed with 2 major allergies. Her reflux worsened around age 3-4 and has declined but continues to this day. No one's mentioned the more invasive procedures within the GI realm so far for the little guy, so I wasn't sure what the current course of doing things is.

Check with your
doctor first!