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 on 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

Esophagus disorders are problems with how your esophagus works. The esophagus is the tube that carries food from your mouth to your stomach. You usually don't notice it unless you swallow something too big, hot, or cold. You might also notice it if something is wrong. When that happens, you might feel pain or have trouble swallowing (dysphagia).

The cause depends on the type of disorder. Some run in families. Others are linked to allergic reactions to food or substances in your environment. Sometimes, the cause is unknown.

You may be more likely to develop an esophagus disorder if you:

• Are overweight or have obesity
• Are pregnant
• Take certain medicines
• Have had radiation treatmentt to your neck or chest
• Smoke or are around secondhand smoke

The most common esophagus problem is gastroesophageal reflux disease (GERD). This happens when the muscle at the bottom of your esophagus doesn't close properly. Stomach acid can move back up and irritate the esophagus.

Other esophagus disorders include:

• Heartburn is a burning feeling in your chest or throat. It is often caused by acid reflux.
• Barrett's Esophagus happens when the lining of your esophagus changes. It is often caused by chronic (long-term) GERD.
• Achalasia is a problem where the lower muscle in your esophagus doesn't relax like it should.
• Esophageal Spasms are muscle contractions that cause chest pain or swallowing problems.
• Eosinophilic Esophagitis (EoE) is a rare condition where certain white blood cells (eosinophils) build up in the esophagus, causing swelling, pain, and trouble swallowing.
• Esophageal Cancer is a type of cancer that starts in the tissues of the esophagus.

Symptoms can be different for each condition but may include:

• Pain in your chest, abdomen (belly), or back
• A cough or sore throat that doesn't go away
• Trouble swallowing or feeling like food is stuck
• A hoarse voice or wheezing
• Heartburn or a burning feeling in your stomach
• Tasting acid or food in the back of your mouth
• Food or liquid coming back up into your mouth (regurgitation)
• Losing weight without trying

Get medical help right away if you have chest pain with shortness of breath, or pain in your jaw or arm. These could be signs of a heart problem.

Your health care provider will ask about your symptoms and medical history. They may order one or more tests, such as:

• Upper gastrointestinal (GI) endoscopy. This test uses a tiny camera to look inside your esophagus and stomach.
• Biopsy. This test takes a small tissue sample to check.
• Barium swallow. This test uses imaging to see how you swallow.
• Esophageal manometry. This test checks how well your esophagus moves food to your stomach.
• Esophageal pH test. This test measures how often acid backs up into your esophagus and how long the acid stays there.

Treatment depends on what's causing the problem and your overall health. Some esophagus disorders get better with over-the-counter medicines, diet changes, or lifestyle changes. Others may need prescription medicine or surgery.

Without treatment, some disorders may lead to other problems, such as pneumonia, from food entering the windpipe. GERD, Barrett's esophagus, and achalasia can also raise your risk for esophageal cancer.

You can help prevent or reduce symptoms by:

• Not smoking and limiting alcohol
• Eating smaller meals
• Avoiding eating close to bedtime
• Wearing loose-fitting clothes
• Sleeping on your left side or raising the head of your bed
• Maintaining a healthy weight

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Sometimes, after eating a large meal or lying down too soon after eating, you might feel acid coming up into your throat. This is called gastroesophageal reflux (GER). It happens when the muscle at the end of your esophagus (the tube that carries food from your mouth to your stomach) doesn't close properly. Stomach contents can then move back up and irritate the esophagus.

Having reflux occasionally is common. But if you have symptoms two or more times a week or if they cause damage to the lining of your esophagus, you may have gastroesophageal reflux disease (GERD). GERD is a chronic (long-lasting) condition that can cause discomfort and, over time, lead to other health problems.

Anyone can have GERD, including infants and children.

GERD can happen when the muscle at the bottom of your esophagus becomes weak or relaxes at the wrong time. You are more likely to have GERD if you:

• Are overweight or have obesity
• Are pregnant
• Smoke or are around secondhand smoke
• Have a hiatal hernia (when part of the stomach pushes up into the chest)

Certain foods, drinks, or medicines can also make GERD worse.

The most common symptom of GERD is heartburn. This is a burning feeling in your chest or throat. You can also have GERD without having heartburn. Other symptoms may include:

• Tasting acid or food in the back of your mouth
• A dry cough or hoarse voice
• Asthma-like symptoms
• Trouble swallowing

Get medical help right away if you have chest pain with shortness of breath, or pain in your jaw or arm. These can be signs of a heart problem.

Your health care provider will ask about your symptoms and medical history. They may recommend tests such as:

• Upper GI endoscopy to look at the esophagus and stomach lining with a tiny camera.
• Biopsy to check a small tissue sample.
• X-Ray to take pictures of the upper digestive system.
• Esophageal pH test to measure how often acid backs up the esophagus and how long the acid stays there.
• Esophageal manometry to check how well your esophagus moves food when you swallow.
• Transnasal esophagoscopy to look for damage to the esophagus by using a small tube with a camera.

Most people can manage GERD with lifestyle changes and medicine. In rare cases, surgery is needed.

Lifestyle changes can include:

• Eating smaller meals and avoiding lying down for at least 2-3 hours after eating
• Avoiding foods that trigger symptoms, such as spicy foods, chocolate, caffeine, or fatty foods
• Losing weight if needed
• Raising the head of your bed
• Quitting smoking

Medicines can include:

• Over-the-counter medicines, such as antacids
• Prescription medicines

If not treated, GERD can cause problems like inflammation of the esophagus, scarring, or changes in the tissue lining (Barrett's esophagus). It can also worsen asthma or cause chronic (long-term) cough or hoarseness.

You may be able to improve symptoms of GERD by:

• Avoiding alcohol and trigger foods
• Eating smaller meals
• Not eating close to bedtime
• Wearing loose-fitting clothes
• Sleeping on your left side or raising the head of your bed
• Maintaining a healthy weight

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

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

Anesthesia is the use of medicines, called anesthetics, to prevent pain during surgery and other medical procedures. Medicine may be given by injection, inhalation, topical lotion, spray, eye drops, or a skin patch.

Anesthesia can cause a loss of feeling, awareness, or both. Sedation may be used with anesthesia. Unlike full anesthesia, sedation doesn't make you completely unconscious, and recovery is faster. It helps reduce pain, keep you calm, and make you less aware during procedures such as minor surgeries, endoscopies, imaging, or dental work.

Levels of sedation include:

• Minimal sedation. You are awake but more relaxed.
• Moderate sedation (conscious sedation). You may feel sleepy and not remember much, but you can still respond when spoken to or touched.
• Deep sedation. You are very drowsy and may respond only to repeated or stronger stimulation.

Anesthesia may be used for:

• Minor procedures, such as filling a tooth.
• Childbirth or procedures such as colonoscopies.
• Minor and major surgeries.

In some cases, a dentist, nurse, or doctor may give you an anesthetic. In other cases, you may need an anesthesiologist. This is a doctor who specializes in giving anesthesia.

There are several different types of anesthesia:

• Local anesthesia numbs a small area like a tooth or a cut that needs stitches. You are awake during local anesthesia.
• Regional anesthesia numbs a larger area, like an arm, a leg, or everything below the waist. You may be awake during the procedure, or you may be given sedation. It may be used during childbirth, a Cesarean delivery (C-section), or minor surgeries.
• General anesthesia affects your whole body. It feels like a deep sleep, but you do not feel anything. It is used during major surgeries, such as heart surgery, brain surgery, back surgery, and organ transplants.
• Monitored sedation makes you relaxed or sleepy. You may be able to talk, depending on the level of sedation, and you probably won't remember the procedure. It may be used for a colonoscopy or dental work.

Your overall health, medical history, the procedure you're having, and other factors will help determine the type of anesthesia you receive.

Anesthesia is generally safe. But there can be risks, especially with general anesthesia, including:

• Heart rhythm problem (arrhythmia).
• Breathing problems.
• An allergic reaction to the anesthesia.
• Temporary confusion (delirium), which can last several days in some people over the age of 60, or briefly in children after waking up from anesthesia.
• Awareness when someone is under general anesthesia. This usually means that the person hears sounds. But sometimes they can feel pain. This is rare.

Talk to your health care provider about the benefits and risks of anesthesia.