Anyone ever get an Upper GI

I have one scheduled in a week and a half and I'm a tad nervous. I'll be under for it which also makes me nervous. Any tips or experiences to share? Also any funny ways I can mess with the doctor doing it? While I won't do these I have already thought about swallowing four marbles and labeling them 1, 2, 3, and 5. Also swallowing something that says "We've been trying to contact you about your vehicles extended warranty".

I’ve had tons of these, super easy, I read some places do it differently, but basically they give you an iv, take you back, lay on your left side, hook up monitors, and give you a bite block and then your out, wake up in recovery 15 minutes later. If they dilate it can be sore, and if they biopsy it’ll be a little sore, goes away a day or so later.

Enjoy the nap!

I've had 3 or 4 these, with biopsies, due to digestive issues. They're very easy and I've never experienced any pain or soreness. I always go out for breakfast after the procedure, and have never had any problems. Like @M82a1 said, once I roll onto my left side, I don't remember a thing until I wake up 10 minutes later. A couple of times, in the prep area, they've had me remove my shirt and put a gown on, opening in the front. The other times, they had me remove my shirt before I lied down in the procedure room and just left me shirtless during the procedure. This allows them to hook up the heart monitors.

Yes, I've had several. Two of the times I had both the upper GI (endoscopy) and a colonoscopy at the same time. Well probably not exactly at the same, but separately while I was out. The visual that I kept having is the scene from the movie Idiocracy, where the "doctor" has two probe-looking things, one in each hand, and he says, "Here, put this one in your mouth and this one in you butt." Then he says, "No, wait.." and switches hands. Once, I did ask one of the Docs if the probes would meet and see each other. He gave me a wry smile and said simply , No."

Mine was fairly easy, didn't stop me from stressing about it. Got called back, ugly exam gown. With only underwear under it. Confirmed details again, IV, waited. Spoke to the CRNA, laid on my left side, wheeled back, confirmed stuff again, mouth guard (which reminded me of a gag and kinda relaxed me). Doctor came in, confirmed everything, anesthesia was injected, felt kinda burning like pre workout.

Barely woke up in recovery, went back to sleep, work up again later and my wife came in. Got dressed, spoke to the doctor, and wheeled out.

What sucks is it was a good nap so that ruined my sleep that night. Gotta repeat it in a few months.

I had one done a few years ago in conjunction with my colonoscopy. I choose to be sedated so they blocked my mouth open and before anything and then poof, I woke up with nothing out of normal except being thirsty and groggy.

Unsure what kind of upper GI you mean. Others seem to be talking endoscopy but...

Had one 20-some years ago (planar) then one more recently as a CT. You can't eat for the evening before, they give you the barium solution to drink, then in about an hour they start taking radiographs. No sedation.

Yep, I got scoped. No food after midnight, nothing after 4AM.

If you’re going to be sedated, this will be a walk in the park.

We doctors are dead serious about the NPO thing, however.

I have had 2

@Iris1858 don't worry I took it seriously too. I did not want to have to reschedule it and extend my stress again.

About 10 years ago my ENT sent me for a barium swallow and based on those results sent me to the gastro doc for a throat scope. The throat scope was no big deal and they put me out for it. The swallow was OK and they recommended an enema the next day to assist with the barium expulsion. My wife was more than happy to help with that.

My next one is in a couple weeks. I'm hoping that mentally it'll be easier. I'm just glad I remember waking up and talking to the doctor after.

Have to get the upper endoscopy every 3 years due to Barrett's Esophagus. It's kinda getting to feel routine, now.

@timberwolf421 this will be my second so its still pretty stressful to me. What helps me is I'm afraid of heights but I climb water towers so I know exposure therapy as a concept works for me.

Upper GI test

The preparation is not much fun. For me, it involves a cleanse—nothing but water and clear gelatin for three days and an Evac U Kit to clean everything out. The good news is that the test is easier. It involves drinking different solutions of chalky stuff while X-rays are taken of your esophagus, stomach, and duodenum. I even looked up the big words for you.

Sedation? I have upper and lower GI tests and Barium enema with contrast tests, and a colonoscopy to remove polyps often. None of them comes with sedation. It is not necessary.

Just follow the directions during the test. Take it seriously.

I know I have had them, but I was out for the actual procedure. Throat's a bit raspy for a bit afterwards.

Actually, I have a GI consult in August for one. (VA liver doctor wants it, but I'm having it done out here for logistical reasons.)

Strangest was the day they did a "fore and aft." (Colostomy/upper GI in the same session) The afore mentioned liver doc wanted me to have both, but I had the colostomy about a month before I talked with her. (Also, outside the VA, same reason)

@DocTemplar

Strangest was the day they did a "fore and aft." (Colostomy/upper GI in the same session) The afore mentioned liver doc wanted me to have both, but I had the colostomy about a month before I talked with her. (Also, outside the VA, same reason)

I usually have my upper and lower GI tests done on the same appointment.

Drink the chalk then have an ice cold bag of barium pumped up my arse and a photo shoot.

Do I ever have to go after the lower GI test. After pooping it out in the parking lot I linger in the washroom for a bit after it. They used to give me an enema after the test. Not anymore. Cut backs.

There are different methods for doing GI tests One method is endoscopy tests, which involves a camera on a tube and relies on visual detection. For upper GI, the tube snakes up through the nose and down the throat or it goes in the mouth. into the stomach and to the start of the small intestines, or a colonoscopy, which does pretty much the same thing at the other end.

I have the GI tests done with X-rays and fluoroscopy. They involve drinking barium or having it given as an enema while the X Rays are done. They involve swallowing and moving into different positions while being X-rayed. The lower GI with contrast involves being flooded with barium chalk to coat the inside of the bowel and intestines. The table tilts in all directions and ends up with me upside down. After this, I am given a bath to wash the grey chalky stuff off. I am covered in it. then back on the table. I am puffed up like a balloon, and the X-rays are done. I do this test naked. These tests have become an annual event. My little sister started having them done last year. We share some good and bad things.

Our specialist prefers this method.

It has worked well for me and detected some serious stuff before really bad stuff happened.

I prefer it over the Roto-Rooter. That snakes up me to harvest the polyp garden. One at least is big enough to make a track in my poop so that treat is booked. It will be a relief to have it out.

A couple of times, things went wrong. on the Lower GI with contrast test, one time the machine had a problem and I had to wait with a but full of grey gunk. The other time they had me deflated and the barium drained out, I was waiting for the nozzle to be removed and to be released from the table. Then had to do the whole dam thing over because some of the images were bad. It takes a little over an hour when everything goes right. Now I say "Please don't drain me till you're sure the images are all good" while I am being secured to the table after the bath.

@Bad_Princess mine is just an endoscopy so the only prep is not eating after midnight.

@XR171

mine is just an endoscopy so the only prep is not eating after midnight.

I wish I had that easy prep. Endoscopy would not help to show what is going on with my and Little Sister's conditions.

I call it IBS+. It is not fun.

Just to clarify Upper GI Endoscopy can be performed by 2 methods : 1. Transnasal (TNE) 2.Transoral ( OGD or Gastroscopy).

Unlike the US The UK uses Conscious Sedation(also known as Twilight sedation) as the name suggest you are conscious and never unconscious.

In the UK Transoral Endoscopy is more common but recently TNE is being promoted extensively in Endoscopy units.

Transnasal endoscopy is a medical examination where a flexible, thin tube with a camera (an endoscope) is passed through the nose to visualize the esophagus, stomach, and upper part of the small intestine. It's an alternative to traditional oral endoscopy (gastroscopy), often preferred because it can be more comfortable and doesn't typically require sedation.

Key aspects of transnasal endoscopy:

• Procedure: A slim endoscope is inserted through a nostril and gently guided down the back of the throat into the esophagus.
• Purpose: It helps doctors visualize the lining of the upper digestive tract, allowing for the detection of abnormalities like ulcers, inflammation, or cancer ,infection ,the presence of bacteria that can cause ulcers, gastritis and gastric cancer (helicobacter pylori), cause of anaemia, coeliac disease (inability to digest gluten)as well as patients who's symptoms include : pain in your upper tummy (abdomen), difficulty swallowing, recurring indigestion or heartburn, being sick (vomiting) and bleeding.
• Benefits:
  • Patient comfort: Many patients find the procedure more comfortable than traditional gastroscopy.
  • Reduced gagging: The endoscope passing through the nose is less likely to trigger the gag reflex compared to oral endoscopy
  • No sedation: Transnasal endoscopy is often performed without sedation, allowing patients to remain awake and communicate during the procedure.
• Applications: It can be used to investigate various symptoms like indigestion, heartburn, stomach pain, difficulty swallowing, and blood in stools.
• Complications: Complications are rare, but may include a sore nose or nosebleed bleeding (1 in 5,000 people), infection, a tear in the oesophagus, stomach or intestine (1 in 10,000 people). If this happens to you, you might need to have a blood transfusion, stay or come into hospital, or have surgery to treat the problem. There is also a risk of chest infection due to aspiration, which is when fluid from the stomach goes into the lungs. If you get a chest infection, you will need antibiotics. This is a small risk. You might be allergic to the local anaesthetic spray. You should contact your nursing team before your procedure if you know you are allergic to lidocaine, lignocaine or phenylephrine.

Your doctor or specialist nurse will discuss the possible complications with you before you sign the consent form.

• Recovery: Since it doesn't typically involve sedation, recovery is generally faster.

How it differs from traditional oral endoscopy:

Route:

Transnasal endoscopy involves passing the endoscope through the nose, while oral endoscopy involves passing it through the mouth.

Comfort:

Transnasal endoscopy is often considered more comfortable, especially for patients prone to gagging.

Sedation:

Transnasal endoscopy often doesn't require sedation, whereas traditional oral endoscopy may require it

What happens during a TNE.

A nurse will take you to the procedure room. You might be asked to remove your dentures, if you have them.

We spray a local anaesthetic into your nose 3 to 4 times. We do this about 10 minutes before the examination. The spray numbs your upper airways and makes the nostrils larger. This helps when the endoscope tube is being put in. We do not use any sedation or general anaesthetic.

We ask you to lie down on your left-hand side on the bed. The endoscope tube will be gently put through your nose. If there is too much saliva in your mouth, it will be cleared with a sucker.

The endoscope tube used for a TNE is thinner than your little finger. It will not get in the way of your breathing at any time, as it passes down your oesophagus and not your windpipe. You can breathe and talk normally during the procedure.

A nurse will stay with you during the examination. You can ask to stop the procedure at any time by saying so or raising your hand.

The endoscopist might pass some air down the endoscope to get a clearer view. This might make you feel slightly bloated, but it should not be painful.

The procedure usually lasts 5 to 15 minutes. When it's finished, the endoscope will be removed quickly and painlessly.

Taking a tissue sample (biopsy)

Sometimes a small tissue sample (a biopsy) will be taken for analysis in the laboratory. The tissue is removed through the endoscope using tiny forceps (scissors). Sometimes this can be uncomfortable, but the discomfort should pass quickly. You'll probably only feel a tugging sensation.

Photographs might be taken, but that does not mean there is something wrong.

After a TNE

After the procedure, you'll be taken to the recovery area. When your nurses are sure there is no bleeding or discomfort, you'll be able to leave hospital (discharged). This waiting time is usually 10 to 15 minutes.

The results of the procedure will be discussed with you on the day. One of the following will happen.

You might be discharged back to your GP.

You might need a follow-up appointment in clinic, which you will be sent a letter for.

The clinical team might review your results and discuss your care. You and your GP will receive a letter about the next steps of your treatment 4 to 6 weeks after your procedure.

A copy of the report and a discharge information sheet will also be given to you.

After you leave hospital .

You can do your usual day-to-day activities and eat and drink once the local anaesthetic spray has worn off.

Transoral endoscopy

This procedure is like a TNE, but the endoscopy tube is put through your mouth, not your nose. A Transoral endoscopys is less comfortable than a transnasal endoscopy, due to the size (Diameter) of the endoscope which can increase gagging during the procedure. This is why most people want sedation.

Transoral endoscopy can be performed by spraying a local anaesthetic orally , initially in the mouth and then into the throat to prevent the gagging, however being awake and losing the sensation when swallowing can be terrifying and cause the patient to panic. Often patient feel that they are unable to breathe resulting in the procedure being abandoned in favour for sedation. Unlike transnasal you are unable to talk/speak during the procedure .

Recovery: Since it involve sedation, recovery is generally longer. Sedation affects different people differently some take much longer to recovery this may be due to ethnicity, medical conditions, age and sex.

@Bad_Princess I have EOE so they pretty much just have to look at my esophagus without doing much else.

@RN1993 mine is transoral and as much as I don't like being sedated my gag reflex is random and weird but strong. So I'm pretty sure I wouldn't be able to do it, plus I'm out all the way in a propofol nap. Also I mentally freaked a bit when they rolled me in for my first one and I saw the scope on a table. I don't know if I could do transnasel either. I'm fine with things going in my butt, my face not so much.

For those not familiar with Eosinophilic Oesophagitis (EoE).

Eosinophilic Oesophagitis

EoE is a rare allergic condition that effects the oesophagus (food pipe), that affects approximately 34 in 100,000 people. This condition is known to be more prevalent in males and is associated with other allergic disorders such as immediate food allergy, atopic dermatitis, eczema, asthma and allergic rhinitis.

In EoE, eosinophils (a type of white blood cell) that can be found in the oesophagus (food pipe) and cause inflammation in this area. This type of white blood cell is not usually found in this location and can be raised for several reasons – for which you will have been investigated for.

For those subsequently diagnosed with EoE, if left untreated, the inflammation can lead to narrowing of the food pipe (strictures) or significant symptoms of difficulty swallowing. If a stricture occurs, it may require surgery to open the narrowing of the food pipe (dilatation). If treated effectively, then symptoms or risks of stricturing of the oesophagus can be reduced.

Symptoms

Symptoms can vary from one person to another and depend on the individual’s age. In children, EoE often present with some or all the following symptoms:

• feeding aversion or difficulties
• poor growth
• vomiting
• reflux
• abdominal pain or distension
• lengthy mealtimes
• avoiding difficult textures (meat and bread)
• food impaction or difficulty swallowing

The medical word for this type of swallowing difficulty is dysphagia, patients with EoE often report the feeling of food travelling more slowly down when swallowed or getting stuck (usually) in the chest, often intermittent but sometimes with every swallow. The sensation of food sticking can range from mild, making eating difficult/uncomfortable to severe and very distressing. It can occur without pain or with significant pain.

Unfortunately, in this condition, symptoms do not always correlate with disease activity and therefore cannot be used alone to diagnose EOE or to guide if the condition is in remission. Repeat endoscopies are often required following a treatment change or for surveillance.

Diagnosis

EoE can only be diagnosed by taking a tissue sample (biopsy) from the oesophagus (food pipe) during an upper gastro-intestinal endoscopy (camera test). The gastroenterologist (gut doctor) will take a minimum of 6 biopsies at varying sites down the oesophagus (food pipe). The tissue samples taken, are then analysed to count the number of eosinophils (type of white blood cell) present; this is referred to as the eosinophil count. This procedure is usually performed under sedation.

If the eosinophil count is greater than 15 per high power field a standardised area under the microscope ( around 0.3mm2), with some other associated changes, the diagnosis of EoE is made.

Currently there is not a less invasive technique for the diagnosis of this condition.

Causes of Eosinophilic Oesophagitis

The cause of EoE is not fully understood, although it is found to be triggered by certain food proteins. Atopic conditions such as eczema, rhinitis and asthma are more common in EoE compared to the general population. It is not yet known if atopy is a predisposing factor in EoE.

This type of allergy is non-IgE mediated or delayed in nature and although we know it involved the immune system, the full understanding of this type of allergy is ongoing. Unlike IgE-mediated or immediate allergies; allergy tests such as skin prick tests (SPT) or specific IgE blood tests (sIgE) are unhelpful to guide food exclusions in this condition.

There are six food proteins that are common triggers in EoE, these include, milk, egg, wheat and gluten containing grains, soya, seafood and nuts or seeds (peanut and tree nut), however this does not mean that in all cases, all of these foods will need to be excluded long term.

Treatment

EoE is a chronic (long term) condition were symptoms will wax and wane. Currently there is no cure for this condition, although there are treatments that are successful to keep it under control. Your consultant gastroenterologist will discuss these treatment options with you in detail and help you make an informed decision about which treatment would be best suited to you.

There are three main treatments used in EoE, each aim to improve symptoms and reduce the inflammation in the oesophagus (food pipe). The three treatment options are discussed below:

1.Proton Pump Inhibitors (PPI’s)

PPI medications are often used to treat symptoms of acid reflux or heartburn, and although EoE is not caused by reflux, these medications can also be helpful.

2.Dietary manipulations

Note: Do not start an exclusion diet unless advised by your gastroenterologist or allergy dietitian

Exclusion diets

As mentioned above we know that EoE can be triggered by certain food proteins; the main triggers being milk, egg, wheat and gluten, soya, fish and shellfish, and nuts (peanut and treenut). Dietary treatment of EoE requires careful avoidance of one to six (or more foods) and repeated endoscopies to determine which food protein is the trigger, so that a long-term plan can be reached.

We use a ‘step-up’ approach, usually starting with a one or two food exclusion diet (FED), usually milk plus or minus gluten, then 4FED (milk, egg, gluten, soya) and then 6FED (milk , egg, gluten, soya, seafood and nuts or seeds).

During this process, careful attention to nutrition with the help of a dietitian, expert in EoE, is needed is essential as these diets can have a high success rate, but they can be difficult to adhere to in the long term.

Elemental diet

In rare cases we may suggest an elemental diet (completely liquid using a specialised formula). We only recommend this treatment if no response is seen with a 6-food exclusion, and no other triggers have been identified. An alternative would be management with medications. Very rarely used on adults , its mainly for children.

This specialised formula can be difficult to drink in adequate volumes due to its poor taste. If so, a nasal gastric tube (NGT), a tube inserted from nose to stomach, maybe required to enable you or children to consume enough to meet their nutritional requirements.

Also, the negative impact on the quality of life when abstaining from all kind of normal eating, for example social and emotional impact on the patient and their family must be considered.

3.Topical swallowed steroid

There are two topical steroids that are used to treat EoE - budesonide and fluticasone. Both these steroids are swallowed and provide a protective coat for the oesophagus (food pipe). You could think of it like putting cream on eczema.

Budesonide

Budesonide is available in many forms, but for EoE it is given orally (by mouth) so it can coat inflamed tissue in the food pipe, similar to putting cream on inflamed skin. However, for younger children it is not readily available in a suitable form, so you to make the medicine into a sloppy mixture for your child to swallow. When it is made into this mixture it is called oral viscous budesonide (OVB). Our allergy nurse will be able to provide a separate information sheet which explains all about OVB.

For children over the age of 18, there is also a melt-in-the-mouth (oro-dispersible) budesonide tablet that you dissolve on the tip of the tongue. n.

Fluticasone

Is a type of medication that is commonly used to help control symptoms of asthma. This is administered via an asthma style pump (inhaler), which is instead squirted into the cheek and then swallowed, rather than inhaled.

Whichever medication is used to treat the EoE (OVB or fluticasone), once administered the medication should not be washed off (by brushing teeth, eating or drinking) for as long as possible (but at least 30-60 minutes). It is often a good idea to take this just before going to bed. We will monitor for side-effects, but these treatments are considered safe and effective. Some can suffer from oral thrush (candidiasis), due to this medication.

@XR171

I have EOE so they pretty much just have to look at my esophagus without doing much else.

I had an upper GI nasal endoscopy once. I coughed up blood at school after a hard hit playing floor hockey. Knocked the wind out of me. They took me to the hospital. I think I was 14 or 15.

I had some numbing stuff up my nose and gargled it, then in it went up my nose and down my throat. I just had to sit still, swallow when I was told to. I watched it on the screen. It was not all that bad. I did not feel anything.

Sedation was used as a threat. Canada eh. Lol.

The blood was from a nosebleed. It ran back while I was out of it, lying on my back. So there was nothing wrong. It just looked scary.

@Bad_Princess I could possibly do transnasel as I don't think it would trigger my gag reflex, hopefully. I just really don't like the missing time that happens with sedation.

But I'm also really sensitive to bad tastes so if the numbing solution tasted bad I'd probably throw up. It's quite lame.

@XR171. I have never met any patients that have vomited after ingesting . In the UK patients are given a drink containing simeticone (e.g. InfacolTM) to reduce bubbles in the stomach, and receive a nasal spray of phenylephrine and lidocaine, to reduce nasal congestion and provide local anaesthetic in the nose. This results in little to no gagging thus eliminating the need for sedation.

@RN1993 Interesting, but my gag reflex remains strong and set on random. If it tasted bad to me I would vomit. Makes certain medications impossible for me, sensory issues.

No joke next week I am being admitted so they can start at both ends and meet in the middle both upper and lower are “tortured”

I've not had the lower yet, probably will sooner rather than later because my mom's side are polyp factories. But I am going to try and make a joke when I wake up asking if they used the wrong scope because it tasted like ass.