Office TestingDescription of Our Office Services and Procedures
FibroScan is a non-invasive, pain-free test to measure the “stiffness” of the liver. It is a faster, easier, and less expensive alternative to painful biopsies and is a similar procedure to an ultrasound. A technician will place a probe on your side, near where the liver is located. The probe sends a painless vibration through your body into your liver. The probe measures how long it takes the vibration to travel through the liver. The faster the vibration travels through the liver, the stiffer the liver is. The liver’s stiffness helps your physician determine the best course of treatment for you. The stiffer the liver, the more likely you have scarring, and the more rigorous treatment required.
The test will only take 10-15 minutes in most instances, and you will not be permitted to have anything to eat or drink for 3 hours prior to the test.
We offer several different infusions at North Shore: REMICADE® (infliximab), Entyvio, and iron. You are welcome to bring books or portable electronic devices to your infusion appointments since you will be here for several hours. All three of these infusions are offered at our conveniently located Westlake on an out-patient basis.
REMICADE® is a medication used to treat Crohn’s disease, ulcerative colitis, and rheumatoid arthritis. REMICADE® helps decrease inflammation associated with inflammatory bowel disease (IBD) and rheumatoid arthritis. For Crohn’s disease, REMICADE® can help in decreasing symptoms and achieving remission in patients who have not adequately responded to other medical therapies.
Prior to your infusion, please be sure to disclose to your physician all medications you are currently taking, and be sure to notify your doctor if you have had any of the following (from REMICADE® website):
- Infections (like TB, blood infections, pneumonia)—fever, tiredness, cough, flu, or warm, red or painful skin or any open sores. REMICADE® can make you more likely to get an infection or make any infection that you have worse.
- Lymphoma, or any other cancers in adults and children.
- Skin cancer—any changes in or growths on your skin.
- Heart failure—new or worsening symptoms, such as shortness of breath, swelling of your ankles or feet, or sudden weight gain.
- Reactivation of HBV—feeling unwell, poor appetite, tiredness, fever, skin rash and/or joint pain.
- Liver injury—jaundice (yellow skin and eyes), dark brown urine, right-sided abdominal pain, fever, or severe tiredness.
- Blood disorders—fever that doesn’t go away, bruising, bleeding or severe paleness.
- Nervous system disorders—numbness, weakness, tingling, changes in your vision or seizures.
- Allergic reactions during or after the infusion—hives, difficulty breathing, chest pain, high or low blood pressure, swelling of face and hands, and fever or chills.
- Lupus-like syndrome—chest discomfort or pain that does not go away, shortness of breath, joint pain, rash on the cheeks or arms that gets worse in the sun.
- Psoriasis—new or worsening psoriasis such as red scaly patches or raised bumps on the skin that are filled with pus.
Any of these conditions can lead to complications if you receive REMICADE® infusions.
During the infusion, one of our nurses will set you up with an IV drip which contains your proper dosage of REMICADE®. As with all medications, allergic reactions, while rare, may occur during administration of your infusion. At North Shore, we are equipped to deal with these reactions should they occur.
REMICADE® infusions generally last 3 hours.
For more information, please visit https://www.remicade.com/
Entyvio is a new option that works to block important contributors to the chronic inflammation that is a well-known symptom of ulcerative colitis and Crohn’s disease. To ensure Entyvio is safe for you, tell your physician if you have:
- an active or recent infection
- tuberculosis (or if you have close contact with someone who has tuberculosis)
- signs of infection such as fever, cough, or flu symptoms
- open sores or skin wounds
- weak immune system (caused by disease or by using certain medicine)
- received any recent vaccines or are scheduled to receive a vaccine.
Entyvio is given intravenously, and requires approximately 2 hours. Your physician will determine how often your infusions are required, but typically after beginning your treatment, regular injections are scheduled every 8 weeks. It is important to keep in mind that it may take several weeks or even several treatments for your symptoms to improve, and you need to communicate any changing symptoms you experience throughout your treatment with your physician.
For more information, please visit https://www.entyvio.com/
IV iron may be necessary to treat iron deficiency (anemia) in patients who do not absorb iron well in the gastrointestinal tract, patients with severe iron deficiency or chronic blood loss, patients who are receiving supplemental erythropoietin, a hormone that stimulates blood production, or patients who cannot tolerate oral iron. Iron deficiency symptoms include:
- difficulty breathing
- fast heartbeat
- feeling cold, mainly in your hands and feet
- infections which are caused by problems with the immune system
IV iron is delivered into your vein through a needle and may take up to several hours. Your doctor may recommend several rounds of infusion based on your iron levels. Side effects are minimal with IV iron, but be sure to report any changes or abnormalities you experience to your doctor.
Hydrogen and H. Pylori Breath Testing
At North Shore Gastroenterology, we offer several breath tests to determine various intolerances and infections. Hydrogen Breath Tests are used to detect Lactose and Fructose Intolerance as well as bacterial overgrowth in the intestine. We also offer a Breath Test for the detection of Helicobacter Pylori (H. Pylori), which is a bacterial infection in the stomach or duodenum (the first part of the small intestine). All of these forms of breath testing are non-invasive, convenient ways to detect these potential digestive issues.
Hydrogen Breath Testing
The Lactose Hydrogen Breath Test is used to detect Lactose Intolerance, the failure to digest lactose, the sugar found in milk. This occurs when the body has a lack of lactase, one of the enzymes produced by the small intestine that is important to the digestion of lactose. Symptoms of Lactose Intolerance include gas, bloating, cramping, or diarrhea after the consumption of dairy products.
The Fructose Hydrogen Breath Test is used to detect Fructose Intolerance. This is caused by the absence of enzymes capable of digesting fructose. It is often diagnosed at a very early age. In addition to digestive issues, some people may also experience symptoms such as fatigue, headaches, brain fog, and mood changes.
Small amounts of bacteria in the intestine are normal. However, significant increases in bacteria can lead to improper absorption of nutrients. Bacterial overgrowth can result from taking certain medications or from slow passage of food through the bowels. Symptoms of bacterial overgrowth can include bloating, gas, diarrhea, and abdominal pain.
After a baseline breath sample has been taken, you may be asked to drink a carbohydrate solution (typically lactulose or glucose). You will be asked to blow into a device designed to measure the levels of hydrogen when you exhale at different time intervals. The test will take approximately three hours.
Pylori Breath Testing
The H. Pylori Breath Test is a safe and easy test used to identify an active H. Pylori infection. If left untreated, H. Pylori can cause gastric ulcers or gastritis (irritation of the stomach lining). Accurate and early detection of H. Pylori can prevent the development of more severe gastrointestinal issues.
After an initial breath sample is taken, you will drink a solution containing Pranactin-Citric. The test will take approximately 20 minutes. Your breath samples will be collected in order to test for urease (an enzyme that breaks urea down into carbon dioxide and ammonia) which is associated with H. Pylori bacteria in the stomach.
Capsule Endoscopy (Pill Cam)
Capsule Endoscopy is a way to record images of the digestive tract without the use of a scope. The capsule is small, comparable to the size of a vitamin, and contains a tiny camera. This device allows your physician to see the parts of your digestive tract that are not reachable in a colonoscopy or EGD, mainly the small intestine. The capsule takes thousands of pictures that it transmits to the recorder for the physician to view. It is important that at least 12 hours prior to taking the capsule that you have no food or water, allowing for the clearest possible images to be taken.
The day before your procedure you will be able to eat a light breakfast and lunch. At 12 noon you will start a clear liquid diet. You will have to drink a small amount of laxative that afternoon to help clean the small bowel. The day of your procedure you will report to the office. You will swallow the capsule pill and be given a recorder to carry with you for 8 hours. 2 hours after ingesting the capsule you will be able to have full liquids, and in 4 hours you will be able to eat a light lunch. You will be able to leave the office with your recorder, we recommend that you refrain from strenuous exercise but are able to resume your normal activities. You will return to the office after 8 hours to return the recorder. The capsule passes naturally in your stool in a day or two.
Video capsule endoscopy is generally safe and well tolerated. But it should not be used if you are known to have intestinal obstructions or narrowing (strictures).
Smart Pill (Pressure Cam)
SmartPill is an ingestible capsule that measures pressure, pH and temperature as it travels through the gastrointestinal (GI) tract to assess GI motility. It is used to evaluate motility disorders like gastroparesis (a condition in which the contents of the stomach empty too slowly) and chronic constipation.