endoscopy

Endoscopy is a procedure that lets your doctor look inside your body. It uses an instrument called an endoscope, or scope for short. Scopes have a tiny camera attached to a long, thin tube. The doctor moves it through a body passageway or opening to see inside an organ. Sometimes scopes are used for surgery, such as for removing polyps from the colon.

There are many different kinds of endoscopy. Here are the names of some of them and where they look.:

• Arthroscopy: joints
• Bronchoscopy: lungs
• Colonoscopy and sigmoidoscopy: large intestine
• Cystoscopy and ureteroscopy: urinary system
• Laparoscopy: abdomen or pelvis
• Upper gastrointestinal endoscopy: esophagus and stomach

Eosinophilic esophagitis (EoE) is a chronic disease of the esophagus. Your esophagus is the muscular tube that carries food and liquids from your mouth to the stomach. If you have EoE, white blood cells called eosinophils build up in your esophagus. This causes damage and inflammation, which can cause pain, trouble swallowing, and food getting stuck in your throat.

EoE is rare. But because it is a newly recognized disease, it is being diagnosed more often. Some people who think that they have reflux (GERD) may actually have EoE.

Researchers are not certain about the exact cause of EoE. They think that it is an immune system/allergic reaction to foods or to substances in your environment, such as dust mites, animal dander, pollen, and molds. Certain genes may also play a role in EoE.

EoE can affect anyone, but it is more common in people who:

• Are male
• Have other allergic diseases, such as hay fever, eczema, asthma and food allergies
• Have family members with EoE

The most common symptoms of EoE can depend on your age.

In infants and toddlers::

• Feeding problems
• Vomiting
• Poor weight gain and growth
• Reflux that does not get better with medicines

In older children::

• Vomiting
• Abdominal pain
• Trouble swallowing, especially with solid foods
• Reflux that does not get better with medicines
• Poor appetite

In adults::

• Trouble swallowing, especially with solid foods
• Food getting stuck in the esophagus
• Reflux that does not get better with medicines
• Heartburn
• Chest pain

To find out if you have EoE, your doctor will likely:

• Ask about your symptoms and medical history. Since other conditions can have the same symptoms of EoE, it is important for your doctor to take a thorough history.
• Do an upper gastrointestinal (GI) endoscopy. An endoscope is a long, flexible tube with a light and camera at the end of it. Your doctor will run the endoscope down your esophagus and look at it. Some signs that you might have EoE include white spots, rings, narrowing, and inflammation in the esophagus. However, not everyone with EoE has those signs, and sometimes they can be signs of a different esophagus disorder.
• Do a biopsy. During the endoscopy, the doctor will take small tissue samples from your esophagus. The samples will be checked for a high number of eosinophils. This is the only way to make a diagnosis of EoE.
• Do other tests as needed. You may have blood tests to check for other conditions. If you do have EoE, you may have blood or other types of tests to check for specific allergies.

There is no cure for EoE. Treatments can manage your symptoms and prevent further damage. The two main types of treatments are medicines and diet.

Medicines used to treat EoE are:

• Steroids, which can help control inflammation. These are usually topical steroids, which you swallow either from an inhaler or as a liquid. Sometimes doctors prescribe oral steroids (pills) to treat people who have serious swallowing problems or weight loss.
• Acid suppressors such as proton pump inhibitors (PPIs), which may help with reflux symptoms and decrease inflammation.
• Monoclonal antibodies, which can reduce inflammation and may help with swallowing. They can be used in adults and children over age 12.

Dietary changes for EoE include:

• Elimination diet. If you are on an elimination diet, you stop eating and drinking certain foods and beverages for several weeks. If you are feeling better, you add the foods back to your diet one at a time. You have repeat endoscopies to see whether or not you are tolerating those foods. There are different types of elimination diets:
• With one type, you first have an allergy test. Then you stop eating and drinking the foods you are allergic to.
• For another type, you eliminate foods and drinks that commonly cause allergies, such as dairy products, egg, wheat, soy, peanuts, tree nuts and fish/shellfish.
• Elemental diet. With this diet, you stop eating and drinking all proteins. Instead, you drink an amino acid formula. Some people who do not like the taste of the formula use a feeding tube instead. If your symptoms and inflammation go away completely, you may be able to try adding foods back one at a time, to see whether you can tolerate them.

Which treatment your doctor suggests depends on different factors, including your age. Some people may use more than one kind of treatment. Researchers are still trying to understand EoE and how best to treat it.

If your treatment is not working well enough and you have narrowing of the esophagus, you may need dilation. This is a procedure to stretch the esophagus. This makes it easier for you to swallow.

Your digestive or gastrointestinal (GI) tract includes the esophagus, stomach, small intestine, large intestine or colon, rectum, and anus. Bleeding can come from any of these areas. The amount of bleeding can be so small that only a lab test can find it.

Signs of bleeding in the digestive tract depend where it is and how much bleeding there is.

Signs of bleeding in the upper digestive tract include:

• Bright red blood in vomit
• Vomit that looks like coffee grounds
• Black or tarry stool
• Dark blood mixed with stool

Signs of bleeding in the lower digestive tract include:

• Black or tarry stool
• Dark blood mixed with stool
• Stool mixed or coated with bright red blood

GI bleeding is not a disease, but a symptom of a disease. There are many possible causes of GI bleeding, including hemorrhoids, peptic ulcers, tears or inflammation in the esophagus, diverticulosis and diverticulitis, ulcerative colitis and Crohn's disease, colonic polyps, or cancer in the colon, stomach or esophagus.

The test used most often to look for the cause of GI bleeding is called endoscopy. It uses a flexible instrument inserted through the mouth or rectum to view the inside of the GI tract. A type of endoscopy called colonoscopy looks at the large intestine.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

The esophagus is the muscular tube that carries food and liquids from your mouth to the stomach. You may not be aware of your esophagus until you swallow something too large, too hot, or too cold. You may also notice it when something is wrong. You may feel pain or have trouble swallowing.

The most common problem with the esophagus is GERD (gastroesophageal reflux disease). With GERD, a muscle at the end of your esophagus does not close properly. This allows stomach contents to leak back, or reflux, into the esophagus and irritate it. Over time, GERD can cause damage to the esophagus.

Other problems include heartburn, cancer, and eosinophilic esophagitis. Doctors may use various tests to make a diagnosis. These include imaging tests, an upper endoscopy, and a biopsy.

Treatment depends on the problem. Some problems get better with over-the-counter medicines or changes in diet. Others may need prescription medicines or surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

A hiatal hernia is a condition in which the upper part of your stomach bulges through an opening in your diaphragm. Your diaphragm is the thin muscle that separates your chest from your abdomen. Your diaphragm helps keep acid from coming up into your esophagus. When you have a hiatal hernia, it's easier for the acid to come up. This leaking of acid from your stomach into your esophagus is called GERD (gastroesophageal reflux disease). GERD may cause symptoms such as :

• Heartburn
• Problems swallowing
• A dry cough
• Bad breath
• Nausea and/or vomiting
• Breathing problems
• The wearing away of your teeth

Often, the cause of a hiatal hernia is unknown. It may have to do with weakness in the surrounding muscles. Sometimes the cause is an injury or a birth defect. Your risk of getting a hiatal hernia goes up as you age; they are common in people over age 50. You are also at higher risk if you have obesity or smoke.

People usually find out that they have a hiatal hernia when they are getting tests for GERD, heartburn, chest pain, or abdominal pain. The tests may be a chest x-ray, an x-ray with a barium swallow, or an upper endoscopy.

You don't need treatment if your hiatal hernia does not cause any symptoms or problems. If you do have symptoms, some lifestyle changes may help. They include eating small meals, avoiding certain foods, not smoking or drinking alcohol, and losing weight. Your health care provider may recommend antacids or other medicines. If these don't help, you may need surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Your small intestine is part of your digestive system. It is a long tube that connects your stomach to your large intestine. Intestinal cancer is rare, but eating a high-fat diet or having Crohn's disease, celiac disease, or a history of colonic polyps can increase your risk.

Possible signs of small intestine cancer include:

• Abdominal pain
• Weight loss for no reason
• Blood in the stool
• A lump in the abdomen

Imaging tests that create pictures of the small intestine and the area around it can help diagnose intestinal cancer and show whether it has spread.

Surgery is the most common treatment. Additional options include chemotherapy, radiation therapy, or a combination.

NIH: National Cancer Institute

A peptic ulcer is a sore in the lining of your stomach or your duodenum, the first part of your small intestine. A burning stomach pain is the most common symptom. The pain:

• Starts between meals or during the night
• Briefly stops if you eat or take antacids
• Lasts for minutes to hours
• Comes and goes for several days or weeks

Peptic ulcers happen when the acids that help you digest food damage the walls of the stomach or duodenum. The most common cause is infection with a bacterium called Helicobacter pylori. Another cause is the long-term use of nonsteroidal anti-inflammatory medicines (NSAIDs) such as aspirin and ibuprofen. Stress and spicy foods do not cause ulcers, but can make them worse.

To see if you have an H. pylori infection, your doctor will test your blood, breath, or stool. Your doctor also may look inside your stomach and duodenum by doing an endoscopy or x-ray.

Peptic ulcers will get worse if not treated. Treatment may include medicines to reduce stomach acids or antibiotics to kill H. pylori. Antacids and milk can't heal peptic ulcers. Not smoking and avoiding alcohol can help. You may need surgery if your ulcers don't heal.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

The stomach is an organ between the esophagus and the small intestine. It mixes food with stomach acid and helps digest protein. Stomach cancer mostly affects older people - two-thirds of people who have it are over age 65. Your risk of getting it is also higher if you:

• Have had a Helicobacter pylori infection
• Have had stomach inflammation
• Are a man
• Eat lots of salted, smoked, or pickled foods
• Smoke cigarettes
• Have a family history of stomach cancer

It is hard to diagnose stomach cancer in its early stages. Indigestion and stomach discomfort can be symptoms of early cancer, but other problems can cause the same symptoms. In advanced cases, there may be blood in your stool, vomiting, unexplained weight loss, jaundice, or trouble swallowing. Doctors diagnose stomach cancer with a physical exam, blood and imaging tests, an endoscopy, and a biopsy.

Because it is often found late, it can be hard to treat stomach cancer. Treatment options include surgery, chemotherapy, radiation or a combination.

NIH: National Cancer Institute

Your abdomen extends from below your chest to your groin. Some people call it the stomach, but your abdomen contains many other important organs. Pain in the abdomen can come from any one of them. The pain may start somewhere else, such as your chest. Severe pain doesn't always mean a serious problem. Nor does mild pain mean a problem is not serious.

Call your health care provider if mild pain lasts a week or more or if you have pain with other symptoms. Get medical help immediately if:

• You have abdominal pain that is sudden and sharp
• You also have pain in your chest, neck or shoulder
• You're vomiting blood or have blood in your stool
• Your abdomen is stiff, hard and tender to touch
• You can't move your bowels, especially if you're also vomiting

Celiac disease is a chronic (long-term) digestive and immune disorder that damages your small intestine. The damage may prevent your body from absorbing vitamins, minerals, and other nutrients from the food you eat. This can lead to malnutrition and other serious health problems

Celiac disease is triggered by eating foods that contain gluten. Gluten is a protein found in wheat, barley, rye, and other grains. It may also be in other products like vitamins and supplements, hair and skin products, toothpastes, and lip balm.

Celiac disease is different from gluten sensitivity. Both involve problems with gluten and can cause some of the same symptoms, such as abdominal (belly) pain and fatigue. But gluten sensitivity does not damage the small intestine like celiac disease does.

Wheat allergy, a type of food allergy, is also different. With both celiac disease and wheat allergy, your immune system is reacting to wheat. But with wheat allergy, you can have some different symptoms, such as itchy eyes or trouble breathing. And a wheat allergy will not cause long-term damage to the small intestine.

The exact cause of celiac disease is not known. Research suggests that celiac disease only happens in people who have certain genes and eat food that contains gluten. Researchers are studying other factors that may play a role in causing the disease.

Celiac disease is more common if you:

• Have a family member who has the disease
• Have Down syndrome, Turner syndrome, or Williams syndrome
• Are White
• Are female

The symptoms of celiac disease can be different from person to person. Sometimes the symptoms may come and go. Some people may not notice any symptoms.

Some of the possible symptoms affect your digestive system. Digestive symptoms are more common in children than in adults. The digestive symptoms include:

• Bloating (feeling fullness or swelling in your belly)
• Chronic (long-term) diarrhea or greasy, bulky, unusually bad-smelling stool (poop)
• Constipation
• Gas
• Lactose intolerance because of damage to the small intestine
• Nausea and vomiting
• Pain in the abdomen (belly)
• Weight loss in adults, or not enough weight gain in children

Some people with celiac disease have symptoms that affect other parts of the body, such as:

• Fatigue
• Depression and anxiety
• Irritability (in children)
• Dermatitis herpetiformis, an itchy rash with blisters (mainly in adults)
• Bone or joint pain
• Symptoms involving the mouth, such as canker sores or dry mouth

Over time, celiac disease can cause other health problems, especially if it is not treated. These problems can include:

• Malnutrition
• Anemia, especially iron-deficiency anemia
• Bone loss
• Nervous system problems such as headaches, balance problems, or peripheral neuropathy
• Reproductive problems, such as missed menstrual periods and miscarriages in women and infertility in men and women

If you have symptoms of celiac disease, your health care provider will look for signs that you might have celiac disease. To do this, your provider will get your medical and family history and do a physical exam.

If your provider thinks that you could have celiac disease, you will have some tests. Providers most often use blood tests and biopsies of the small intestine to diagnose celiac disease. The biopsy would be done during an upper gastrointestinal (GI) endoscopy. For this procedure, your provider uses an endoscope (a flexible tube with a camera) to see the lining of your esophagus, stomach, and small intestine. It also allows your provider to take a sample of tissue for a biopsy.

The treatment for celiac disease is following a gluten-free diet for the rest of your life. Sticking with a gluten-free diet will treat or prevent many of the symptoms and other health problems caused by celiac disease. In most cases, it can also heal damage in the small intestine and prevent more damage.

Your provider may refer you to a registered dietician (a nutrition expert) who can help you learn how to eat a healthy diet without gluten. You will also need to avoid all hidden sources of gluten, such as certain supplements, cosmetics, toothpaste, etc. Reading product labels can sometimes help you avoid gluten. If a label doesn't tell you what is in a product, check with the company that makes the product for an ingredients list. Don't just assume that a product is gluten-free if it doesn't mention it.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases