Common Procedures

The following procedures can be used to diagnose pediatric inflammatory bowel disease, to check how well a treatment is working and to follow the progress of your child’s Pedi IBD.

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Lab Tests

Lab tests, including blood tests and stool samples, are the most frequently ordered tests. Lab tests may be needed on a regular basis depending on what treatment your child is getting.

Blood tests can be used to look for:

  • low blood counts
  • whether or not your child’s body is taking in the right nutrition
  • inflammation
  • if a treatment is working

Common blood tests include:

  • CBC – Complete Blood Panel to look for anemia and infection
  • ESR – Erythrocyte Sedimentation Rate to look for inflammation
  • Retic Count – to measure how many red blood cells the body is making
  • C Reactive Protein – to look for signs of severe inflammation
  • Comprehensive Metabolic Panel – checks liver, kidney, sugar and protein levels

Stool samples are used to look for:

  • bacteria that causes inflammation
  • blood loss that you don’t know about
  • inflammation

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X-rays are used to:

  • help your healthcare provider decide if your child has IBD
  • find where the disease is in your child’s digestive tract
  • discover parts of the intestine that are swollen or narrow
  • look for fistulas

The most common x-rays are:

  • Upper GI series with small bowel follow-through

This procedure gives doctors information about your child’s esophagus, stomach and small intestine. For this test, your child will drink barium, a thick chalky liquid that is used to coat the lining of the small intestine, before X-rays are taken. The barium shows up white on x-ray film, marking areas of inflammation in the intestine. If these tests show Crohn’s disease, more x rays of both your child’s upper and lower digestive tract may be needed to see how much of the GI tract is affected by the disease. The procedure is not uncomfortable.

An upper GI series takes about 1 to 2 hours and can cause your child to be slightly constipated or have gray/white stools for a few days after the procedure.

Preparation for the test:
Your child’s stomach and small intestine must be empty for the X-rays to be clear, so the night before the test, he or she will not be able to eat or drink anything after midnight. Your doctor may give you other specific instructions.

  • Lower GI series

This procedure gives doctors information about your child’s large intestine including the colon and the rectum. For this test, your child will have a barium enema where barium, a thick chalky liquid used to coat the lining of the large intestine which the pediatric radiologist will put into your child’s rectum.

Your child may be asked to change their position while the X-rays are being taken so that the radiologist can get different views of the colon.

Your child may be uncomfortable during the lower GI series because the barium can cause a feeling of fullness or the urge to go to the bathroom. Once the procedure is finished, your child will be able to go to the bathroom and the discomfort will be over.

Lower GI Series takes about 1-2 hours and may cause your child to be a little constipated or have gray/white stools for a few days after the procedure.

Preparation for this test:
Your child’s colon must be empty for the X-rays to be clear. To prepare for the procedure you may have to restrict your child’s diet for a few days before the test and

  • allow them to drink liquids and eat non dairy foods for two days before
  •  allow only clear liquids the day before
  • nothing after midnight the night before

A liquid diet means fat-free bouillon or broth, gelatin, strained fruit juice, water, plain coffee, plain tea, or diet soda. To make sure your child’s colon is empty, you may have to give your child a laxative or an enema before the procedure. Your doctor may give you other specific instructions.

  • Abdominal CT scan is an X-ray that provides 3 dimensional pictures of the intestine and other abdominal organs.

Endoscopy gives the doctor more information about your child’s IBD by using a lighted scope to see inside areas of the intestine.

Your child may be given a mild sedative to make them comfortable during an endoscopy. This will also let the doctor do the procedure as quickly and as safely as possible.

The four types of endoscopy your child’s doctor can order are:

  • upper endoscopy (or EGD)
  • colonoscopy (or lower endoscopy)
  • flexible sigmoidoscopy
  • capsule endoscopy

Upper endoscopy (or EGD)

A tube is passed in through the mouth and then into the stomach and small intestine.  This gives the doctor information about the esophagus, stomach and duodenum, which is the first part of the small intestine. Small areas of the intestine lining, or biopsies, can be taken during this test to be examined under a microscope.

Colonoscopy (or lower endoscopy)
A tube is passed into the rectum and moved through the colon allowing the doctor to see and, if needed, biopsy the entire large intestine and the end of the small intestine. The most uncomfortable part of this procedure happens the day before when your child will need to drink an unpleasant tasting cleansing liquid. This will cause them to have many bowel movements to clean out their colon so that the scope will be able to pass through easily.

Flexible sigmoidoscopy
A flexible scope is passed into the rectum and examines the very end of the intestine, the rectum and the sigmoid colon. This test is usually done when your child has already been diagnosed with Pedi IBD.

Video capsule endoscopy
Your child will swallow a video capsule or mini camera about the size of a vitamin or jellybean. After the capsule is swallowed the doctor can look at parts of your child’s small intestine that cannot be easily seen in an upper endoscopy. Your child will be awake for this procedure.

You will receive specific instructions from your healthcare provider for any test that is scheduled. You may find it helpful to use the Procedures Log provided here to keep track of when and what procedure your child has.

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