Diagnosis

• Pictures that show the inside of your child’s belly or pelvic area can help the team learn more about your child’s condition. When possible, we choose methods that use low or no radiation, such as ultrasound and MRI (magnetic resonance imaging).
• Some children might need an upper gastrointestinal (GI) (PDF) X-ray series with a small bowel follow-through or a CT (computed tomography) scan.

• One of the best ways to tell what’s happening on the lining inside your child’s intestine is for the doctor to look at it. Doctors do this by inserting a thin, flexible, lighted tube (endoscope) through your child’s mouth or anus.
• The tube has a tiny camera on it that’s connected to a computer and a TV screen. Using this camera, doctors can look for swelling, redness, ulcers and bleeding. They can even take a tiny sample (biopsy) of the intestine for testing.
• Your child might have one or more of these types of endoscopy:
  • Upper endoscopy. The doctor puts the endoscope through your child’s mouth to look at their stomach and the first part of their small intestine.
  • Sigmoidoscopy. The doctor puts the endoscope through your child’s anus to look at only their lower colon (large intestine).
  • Colonoscopy. The doctor puts the endoscope through your child’s anus to look at their whole colon.
  • Balloon endoscopy. This special form of endoscopy (through either the mouth or the anus) lets the doctor see your child’s whole small intestine.
  • Endoscopic retrograde cholangiopancreatography (ERCP). The doctor puts the endoscope through your child’s mouth to look at the tubes that drain the liver, gallbladder and pancreas.
• Before these procedures, we give your child medicine that makes them fall asleep (anesthesia). They will not feel any pain and will not be able to move around during the procedure.
• Capsule endoscopy. Sometimes, doctors ask children to swallow a pill-like device that carries a tiny camera (capsule endoscopy). (The doctor might also place the capsule in your child’s digestive tract using an endoscope.) This device takes pictures of the intestine. It passes out of your child's body in stool. Doctors view the pictures on a computer. This lets them see parts of the intestine they cannot see using a regular endoscope.

• Blood tests. Blood tests are done to check for anemia, which can be a sign of heavy internal bleeding in the gut. Blood tests are also done to check for high levels of white blood cells and platelets, which can be signs of inflammation. Blood protein levels can tell the team if your child isn’t eating enough protein, isn’t absorbing enough protein or is losing too much protein because of inflammation. Other tests look for substances in the blood that are signs of inflammation (C-reactive protein test, sedimentation rate).
• Breath tolerance tests. These tests check how well your child’s intestines digest and absorb sugar. It may also be used to check for bacterial overgrowth in the intestines.
• Tests on a stool (feces) sample. These tests look for blood or signs of infection. Certain stool tests can tell the team if your child has active inflammation.

During a liver biopsy, the doctor takes a small sample of the liver. Later, they examine the sample under a microscope to look for signs that help them make a diagnosis. All children get sedation under the careful watch of a pediatric anesthesiologist for this biopsy.

Manometry studies allow your child’s doctor to measure the pressure or contractions all along the digestive tract, from the mouth to the anus. Depending on what kind of study is being done, your child may need to stay in the hospital for two or three days. Your child may be sedated to ensure that the test is as safe and comfortable as possible. Seattle Children’s is the only program in the Northwest to offer a complete range of manometry studies for children. Read more about our Motility Program.

Doctors often perform pH probe monitoring along with gastrointestinal endoscopy. During this test, a healthcare provider inserts a small wire into the lower part of the tube that carries food to the stomach (esophagus). The wire carries a device that measures the amount of acid going into the area.