Living With Crohns Disease

This was one of the coolest tests I’ve ever had to do in my history of living with Crohns disease. The capsule endoscopy is a newer and more sophisticated procedure that makes it easier on patients and less time-consuming for doctors to get a glimpse of the upper portion of the gastrointestinal tract.

Preparation for the procedure is less disruptive than the way one would normally get ready for an endoscopy, with no food taken by mouth within 12-24 hours of the scheduled test.

The procedure involves swallowing a pill containing a small camera. The pill is only slightly larger than the size of a single shelled peanut, and can be easily swallowed by anyone used to taking medication by mouth.

Once the pill has been swallowed, the patient is given a device that can receive signals from the camera inside the pill. The receiver is held in a pouch that straps around the waist.

As the pill travels through the esophagus, stomach, and small bowel, it periodically takes photographs (or in the newest devices, video) and transmits them to the device the patient is wearing, which stores the information.

During this time the patient is able to resume normal activity and can drive and walk around, but must be conscious of the somewhat heavy pack they are wearing.

In 4-8 hours, the patient returns to the doctor’s office and the receiver is returned so that the images captured by the pill camera can be uploaded to the doctor’s system for viewing.

After the test is over, the pill is simply passed in the stool. The patient doesn’t need to worry about keeping it, finding it, or being in pain, as it should pass untraced.

An endoscopy is a procedure in which a camera is inserted into the mouth and down the esophagus into the stomach, and then the duodenum, the first portion of the small bowel.

Patients undergoing endoscopy are instructed to prep for the exam by not eating for several hours before the procedure.

Before the endoscopy begins, the patient is given an IV through which a sedative can be administered. This is done just before the procedure starts, and renders the patient unable to recognize or feel the presence of an obtrusive object during the exam.

The patient’s mouth is held open with a plastic guard and a spray is applied to the mouth and throat to numb the area and thus deactivate the patient’s gag reflex.

A thin tube containing a fiber-optic camera is used to investigate the path of the gastrointestinal system extending from the mouth through the anterior small intestine. The medical doctor looks for any problems including ulceration, scarring, tumors, and other damaged tissue.

Often after an Upper GI Series, your doctor will order a test called a Small Bowel Follow-Through. You don’t really have to do anything extra to take this test except wait.

The waiting period is required so that the barium contrast you drank during the Upper GI has a chance to continue traveling through your gastrointestinal tract. It may take a couple of hours for it to fully coat the small bowel, and you’ll be called in periodically for test x-rays so they can gauge how far it has gone.

While I’m waiting, I find it’s better to walk around - or at least stand - than to sit still. I don’t know if it helps, but sometimes I jump up and down in place because I think the gravitational force may help get things moving along down there. That’s not educated medical advice, but having gone through enough of these tests I’m ready to offer any tip I can to help out others having to undergo them.

When the contrast has made it to a point where the test x-ray reveals is sufficient, the doctor will call you back in and proceed taking x-ray images of your abdomen. You may be asked to turn from side to side and angle your body in different ways so that images can be captured.

One final word of advice: barium can tend to be constipating, and if you’re living with crohns disease you know how quickly you can be surprised with bowel… er… “conditions”… from one end of the spectrum to the other - so after you undergo this test make sure to drink lots of fluids to keep things moving inside. I know I sound like your mommy, but I’m just trying to be helpful and give you fair warning.

As tests go, the Upper GI isn’t all that bad. It’s an x-ray examination that will allow the doctors to see the function and condition of your digestive tract from the mouth and esophagus through the stomach and to the first portion of the small bowel, the duodenum.

For certain versions of the exam you may be asked to begin drinking barium before you arrive, but most often the only preparation taken by the patient is that nothing can be eaten after midnight on the night before the test.

Upon arrival at the testing site, you will be given a gown to wear and asked to remove your exterior clothing and all objects except for usually your socks and undergarments. There is a mild risk of exposure to radiation, but these levels are very low, and unless you are pregnant they are considered to be acceptable for the average human being.

When you begin the test, you may first be asked to swallow a small mouthful of granules that are mixed with water just before they’re given to you. As the water is added, they begin to fizz like an Alka-seltzer tablet, and when swallowed will make you feel as if you have to belch. The technician will ask you to hold it in, because this concoction is filling your stomach with gas that will stretch it out and allow it to be more easily viewed by x-ray.

Next comes the fun part.

Barium is a radioactive element used in radiological testing because it coats the lining of the gastrointestinal tract and makes your insides easier to see. In this form, it’s called contrast and makes your digestive system look white on the x-ray machine.

Barium contrast is a thick, white liquid. Some describe it as “milky,” but I’ll tell you it’s more like drinking liquid chalk, as if you ground up a bunch of sidewalk chalk and added a little water to it. It does have the consistency of a very smooth, thick milkshake, but it definitely tastes nothing like milk. Sometimes they flavor it with a hint of artificial berry or a similar essence to make it more bearable. It doesn’t taste bad, but it doesn’t taste good either.

I’ve had to drink it so many times I’m used to it by now; I can chug it because I know what to expect and I realize that the quicker it goes down the quicker the test is over with. Usually they ask you to drink two big cups of it, one slightly thicker than the other.

As you start drinking, the doctor will take some pictures of your esophageal function, and then more when it gets to the stomach and again as the stomach says “what the heck is this stuff?!” and starts letting it out into the small intestine. Once you have it all down, the test for you is basically over, unless you are also having a small bowel follow-through.