Investigating the gut

The investigating the gut chapter examines investigations used to diagnosis diseases of the gastrointestinal tract. The investigations need to be used in the appropriate settings as there are risks associated with some, such as the radiation used in scans. Investigating the gut includes the defaecating proctogram to explore the rectum as well as ultrasounds of the abdomen or endoanal. There are also investigations such as computer tomography, virtual colonoscopy, and magnetic resonance imaging. Simple X-rays can be used to examine the abdomen or monitor gut transit, and barium studies can be taken orally or via the anus. These investigations can be used to diagnose changes within the gastrointestinal tract, such as a colorectal cancer or a stricture. Succinct explorations on the different investigations used to examine the gastrointestinal tract, detailed within this chapter can be reviewed when necessary within clinical practice by the nurse.

PS01.073: HIATAL HERNIA—DIAGNOSIS AND RELEVANCE—THE CONUNDRUM CONTINUES….

Background Upper GI endoscopy and barium swallow are the commonly used diagnostic modalities and Oesophageal manometry of late has contributed to the diagnosis of hiatal hernias. It is known that there exist considerable limitations within each modality in the diagnosis of this seemingly common condition. Aims To assess the correlation between the commonly used investigations of Upper GI Endoscopy and Barium studies and selective use of Esophageal physiology studies in the diagnosis of hiatal hernias. Methods 92 patients who had both an Upper GI endoscopy and Barium swallow in a University hospital formed the study population. There was a subgroup of 29 patients who also underwent a manometry and pH study as a part of their workup. A mix of endoscopists (Physicians, GPs, Surgeons, Supervised trainees and Nurses) performed the upper GI endoscopies. The barium studies were performed by specialist radiographers based on a standard protocol. GI physiology studies were performed by a single GI physiologist with over 25 years of experience. Correlation was performed in varied combinations based on the presence/absence and the size of hernias on different investigations. Results 74% (68) of patients were diagnosed to have a hiatal hernia on endoscopy whereas only 55% of the same group had a hiatal hernia on Barium studies. Of the 29 patients who had all the 3 investigations a hiatal hernia was diagnosed in 82% on endoscopy, 34% on Barium swallow and 48% on High resolution manometry. Only 21% of patients had correlation between all 3 studies. 62 percent had correlation between any 2 modalities and 17% did not have any correlation between any of the diagnostic modalities. The correlation in-between studies was greater for the moderate to large hernias and least for the small/absent hernias. Conclusion There exists considerable variation between the commonly performed procedures for this relatively presumed common condition. There is a greater observed tendency to diagnose a hiatal hernias on endoscopies and less on barium swallows based on the above study. The gold standard for the diagnosis is debatable, considering known limitations based on criteria for diagnosis, dynamic of the Oesophagogastric junction and operator variability. Disclosure All authors have declared no conflicts of interest.