Certain procedures are needed to determine the cause of the symptoms of GORD and the extent of the disease, and thereby decide on the optimal treatment. It is essential to evaluate the disease to determine whether operation is needed, and whether the patient will benefit from the procedure. It must also be determined which type of operation will be of the most benefit to the patient.
The following examinations may have to be performed:
The oesophagus and stomach are examined using a long pliable tubular instrument called a gastroscope. The gastroscope may be of the fibre-optic type or the more modern version viz a video gastroscope. The video gastroscope projects the image on to a screen. A video recording or a computer may be coupled to the video gastroscope to store the visual material of the examination on either a video or digitally. Special digital video printers may be used to reproduce the images.
A Gastroscopy is usually performed in an well equipped unit or centre. The modern gastroscope is computer coupled with digital intensification. A central processing unit controls the camera function of the gastroscope.
Preparation for gastroscopy:
The patient is instructed not to drink or eat or smoke from 22.00 on the night prior to the procedure. No antacids or stomach medication are to be taken for a 24 hour period prior to the procedure.
Before the examination is performed, the patient completes an information form in which all the previous medical history is provided. Consent for the procedure and permission for the administration of sedation is signed for.
The procedure is performed with the patient lying on his left side on an examination couch. The examination is usually carried out under conscious sedation.
An oxymeter is attached to the patient's finger to determine the oxygen concentration of the blood as well as the pulse rate during the procedure.
It is common to spray the back of the throat with a local anaesthetic spray. The gastroscope is then placed in the back of the throat. The patient is instructed to swallow and during this swallo the gastroscope is advanced into the oesophagus, and the oesophagus, stomach and the first portion of the duodenum are examined.
During the gastroscopy biopsies may be taken from any suspicious looking area. The biopsymaterial is sent to a pathological laboratory for histological examination by a histopathologist.
The biopsies are taken via a special biopsy forceps which is passed through a channel in the gastroscope.
Trained staff assists with the procedure
Die biopsietang word deur die gastroskoop geplaas om ‘n biopsie te neem vir ontleding.
Conscious sedation
The procedure can be performed under conscious sedation. It is comparable to light anaesthesia without actually falling asleep, which makes the examination easier to perform. A short term memory loss occurs for the period of the examination. An intra-venous drip is usually put up to allow any necessary drugs to be injected during the procedure to achieve adequate sedation.
After the examination antidotes are injected to convert the effects of the conscious sedation.
After gastroscopy:
After a gastroscopy with conscious sedation, the following instructions must be obeyed;
No food or fluids for the first hour after the examination.
The throat is occasionally anaesthetised and choking can occur.
For the rest of the day:
This examination is performed in an X-Ray department by a radiologist. The patient swallows a Barium solution ( a fluid which is visible on X-ray). X-Ray pictures are taken during the examination of the oesophagus and stomach. In some cases the images may be recorded on a video tape.
The dynamic function of the oesophagus and its anatomy are recorded during the examination. Complicated hiatus hernias, anatomical abnormalities or recurrence of hiatus hernia are often also an indication for this procedure. The examination often provides additional information to that gleaned from the gastroscopy.
Barium can occasionally cause constipation and a light purgative may be taken after the examination, if indicated.
The X-ray image of a Barium Swallow
A chest X-ray showing a hernial sac filled with barium behind the heart shadow.
This examination is performed to determine the muscle strength of theoesophagus as well as the force with which the valve contracts and relaxes. The examination also determines the pressures which occur when the oesophagus contracts. The length of the oesophagus, hiatus hernia and inferior valve or sphincter can also be measured. Abnormal oesophageal contractions and abnormalities can also be identified.
The data which is obtained during oesophageal manometry is fed into a computer. Several graphs and data tables are created which provide information regarding the upper and lower oesophageal sphincters as well as the pressures. This data is used to make the further diagnosis and treatment of GORD.
The data is fed into a Computer and analysed. The manometric catheter contains sensors which measure pressures in the oesophagus and the valve. Several catheters may be used. Shown above is a "solid state" catheter with electronic sensors which are very accurate.
The examination is performed by passing a narrow tube through the nose, which has been lightly anaesthetised. The patient swallows as the tube is advanced until it is resting in the stomach. The tube is then coupled to a sensor which registers the pressures in various parts of the area examined and the data is fed into the computer. The examination is performed in the consulting rooms and takes about 40 minutes. After the examination normal daily activities can be resumed.
Die ondersoek word uitgevoer om te bepaal of daar suur teruglek vanaf die maag na die slukderm . Die ondersoek word gewoonlik na die esofageale manometrie uitgevoer aangesien die klep se posisie bepaal moet word. Die pHmetrie ondersoek strek oor 'n 24 uur tydperk.
Die ondersoek bestaan daaruit dat 'n dun plastiekbedekte draadjie ('n elektrode) deur die neus geplaas word tot in die slukderm bokant die aansluiting tussen die slukderm en die maag. Die elektrode word gekonnekteer aan 'n klein digitale opnemer wat met 'n battery werk.
Die pH word bepaal en gestoor deur hierdie mobiele reke-naartjie.’n Spesiale kateter of elektrode sensor word in die slukderm geplaas wat die pH meet.
Die pH metrie ondersoek meet die pH onder in die slukderm en word grafies voorgestel en ontleed volgens sekere parameters. Simptoomkorrelasie word ook uitgevoer.
Points to take note of during the 24 hour Ph measurement procedure
The following should be avoided:
The actual performance of the examination.
The time is indicated on asmall screen on the apparatus.
A form is given to the patient. The symptoms which the patient experiences must be noted along with the time at which they occurred. The notation of the time when the symptoms occurred is needed to correlate the symptoms with the pH in the oesophagus.
After 24 hours the patient reports to the consulting rooms, where the electrode is removed, and the information is fed into the computer. An analysis of the examination is done. Several graphs are created to help evaluate the degree of reflux.
Other investigations
In some cases it may be necessary to perform additional examinations to evaluate a specific problem.
We will be duty bound to inform you if such is the case.