Endoscopy is one of the best methods to
diagnose a disease in the stomach or intestines because biopsy can be taken at the same time. Unfortunately, with the advent of video endoscopy, the cost of the test has increased to Rs.5000/- approx. Recently endoscopy has become a routine test, partly due to over enthusiasm and the patients’ willingness to undergo the test, so much so, that in a patient’s words it has been described as ‘Before you open the mouth to give the history, the endoscope is already in the stomach’.
I want to impress upon the practitioners that sometimes the final diagnosis is not found, even after doing an endoscopy only or/and endoscopic biopsy studies.
If a doctor or a patient wants to avoid endoscopy, other non-invasive investigations can be done to help arrive at a diagnosis. Some of these are as follows:
- In order to diagnose GORD (Gastro oesophageal reflux disease) wireless capsule pH monitoring of oesophagus can be done and is now available in Mumbai.
- To diagnose antral gastritis due to H pyloridis, non-invasive tests are (a) blood levels for IgM antibodies, (b) slightly more sensitive-breath test, which is fairly accurate.
- Capsule endoscopy, a non-invasive test is already available for small intestine diseases.
- For coeliac disease, blood is tested for antigliadin and tissue translutaminase antibodies.
- Very often, naked eye appearance or even biopsy cannot diagnose an inflammatory bowel disease. Therefore, blood test for ANCA and ASCA may be done. A positive ANCA is in favour of ulcerative colitis, while a positive ASCA is in favour of Crohn’s disease.
Finally, I would like to stress that the modern CT examination especially with contrast studies has helped markedly in diagnosing diseases of hollow organs like intestines. 3D CT Angiography of the colon is often as accurate as invasive endoscopy.
Recently, I saw a young man with epigastric pain radiating to both shoulders. Oesophagoscopy done in Mumbai as well as at Hyderabad, was normal. The disease was however picked up on CT scan, which I asked for. It showed a leak from the oesophagus in the mediastinum above both diaphragms.
|
