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Tests
Tests and endoscopy
A test is worth doing when its answer will change what we do. This page lists the tests available in my practice, what each one tells us, and when I advise it. Endoscopy and the motility tests are done at Arka Anugraha Hospital, and I perform the endoscopic procedures myself.
Endoscopy
- Upper GI endoscopy: a ten-minute camera examination of the food pipe, stomach and duodenum, for reflux that does not settle, swallowing difficulty, anaemia or warning signs.
- Colonoscopy: an examination of the whole large intestine, for bleeding, a change in bowel habit, screening and follow-up.
- Polyp removal: polyps found during colonoscopy are removed in the same sitting and examined in the laboratory. See colon polyps.
- Biopsy and H. pylori testing: small tissue samples taken during endoscopy confirm inflammation, infection and coeliac disease. H. pylori can also be checked with a breath or stool test.
Motility and function tests
These measure how the gut moves and senses, which a camera does not show.
- Oesophageal manometry: measures the muscles of the food pipe during swallowing. Used for swallowing difficulty and before reflux surgery.
- 24-hour pH monitoring: records how much acid reaches the food pipe over a day and night. Used to prove reflux.
- Hydrogen and methane breath tests: detect bacterial overgrowth in the small intestine and intolerance to lactose or fructose.
- Anorectal manometry: measures the muscles and sensation of the rectum and anus. Used for constipation that does not respond to treatment, and for leakage.
Liver assessment
- Liver function panels: blood tests for liver enzymes, bilirubin and proteins, with tests for hepatitis B and C and other causes where needed.
- FibroScan: a ten-minute scan that measures liver stiffness and fat, to find out whether the liver is scarred.
- Ultrasound: shows liver fat, gallstones, the bile ducts and the other abdominal organs.
Functional and root-cause testing
These tests look for contributors to long-standing symptoms. I read each one together with your history, examination and standard tests, and order it only when the result would change the plan.
- Stool analysis: checks for infection, parasites, inflammation and how well food is being digested.
- Microbiome testing: a stool test that reads the DNA of gut bacteria to show which are present and how varied they are. I use it in selected patients, after standard tests, to help set priorities for food and treatment.
- Urine organic acids test (OAT): a urine test that measures by-products of metabolism, including some made by gut microbes. I use it in selected patients with long-standing symptoms, and read it together with the history and standard tests.
- Nutrient and metabolic panels: vitamin B12, vitamin D, iron, magnesium, blood sugar, insulin and cholesterol patterns.
- Hormone panels: thyroid, stress and sex hormones, where symptoms point to them.
- Mycotoxin and toxin panels: used in selected people with a relevant exposure history and symptoms that other tests have not explained.
- Heart rate variability (HRV): a short recording that reflects the balance between the stress and rest branches of the nervous system. It guides breathing and biofeedback work.
At the hospital
- Laboratory: blood, stool and urine tests, and tissue reporting.
- Imaging: ultrasound, CT and MRI scans, arranged as needed.
- Pre-surgical assessment: heart, lung and anaesthesia checks before an operation.
How do I decide which tests you need?
Your story first
The pattern of symptoms, your past reports and an examination narrow the possibilities more than any single test.
Warning signs change the order
Bleeding, weight loss, anaemia, difficulty swallowing or symptoms that begin later in life call for endoscopy early.
One question per test
Each test is chosen to answer a specific question: is there inflammation, is reflux present, is the muscle coordinated, is the liver scarred.
No repeat tests without a reason
Bring your earlier reports. A good recent test rarely needs repeating.
Questions patients ask me about tests
Do I need to see you before booking a test?
For most tests, yes. A short consultation makes sure the right test is done, with the right preparation. If another doctor has already advised a test, bring the referral note.
Which tests need fasting?
Upper GI endoscopy, manometry, the pH study, breath tests and FibroScan need a fast of between three and twelve hours. Colonoscopy needs bowel preparation. Each test page gives the details, and you receive written instructions.
Will I be sedated for endoscopy?
You can choose a throat spray alone or light sedation for upper GI endoscopy. Colonoscopy is done under sedation. Manometry, the pH study and breath tests need none.
Who performs the endoscopy?
I do. The doctor who examines you is the doctor who has heard your history and will plan your treatment.
Can all my tests be done on the same day?
Often several can be combined, for example manometry with placement of the pH tube. Tests that need different preparation are scheduled on separate days.