Advances in the Diagnosis and Evaluation of Disabling Physical Health Conditions (2023) / Chapter Skim
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8 Techniques for Digestive System Disorders
8 Techniques for Digestive System Disorders
Pages 181-220
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From page 181... ...
, which can include Crohn's disease and ulcerative colitis, as well as short bowel syndrome, malabsorptive syndrome/malabsorption, achalasia and other chronic gastro intestinal motility disorders, chronic anemia, liver disease, cirrhosis, chronic pancreatitis, uncontrolled diarrhea, and fecal incontinence. Common techniques for diagnosing digestive disorders include clinical assessments, imaging techniques, scoring systems for measuring the severity of the disease process and quality-of-life measures, colonoscopy, upper GI endoscopy, capsule endoscopy, endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, and, in some cases, laparoscopy or open surgery.
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From page 182... ...
The improved ability to identify digestive disease, including cancerous lesions, in the early stages can have a positive effect on prognosis and health outcomes. This chapter provides information about select new and improved diagnostic and evaluative techniques in gastroenterology that have been introduced since 1990.
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From page 183... ...
. These techniques are categorized into those that assess anatomical or physiologic functions and those that assess functional performance or capacity at both the body function level and the activity BOX 8-1 Selected New or Improved Digestive Diagnostic and Evaluative Techniques Since 1990 Assesses Anatomical or Physiologic Functions Imaging Tests • Multidetector computed tomography scan • Magnetic resonance and computed tomography enterography • Positron emission tomography and computed tomography scan • Magnetic resonance defecography • Magnetic resonance cholangiopancreatography • Transient elastography • Virtual colonoscopy Endoscopic Tests • Endoscopic ultrasound • Esophagogastroduodenoscopy Additional Tests/Assessments High-resolution manometry • Scoring systems for mortality risk and disability • Genetic testing Assesses Functional Performance or Capacity • Inflammatory Bowel Disease Disability Index • IBD Disk • GI-PROMIS • Short Health Scale • Eckardt Symptom Score • Northwestern Esophageal Quality of Life Scale • Adult Eosinophilic Oesophagitis Quality of Life
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From page 184... ...
dysfunction, inflammatory bowel disease, short bowel syndrome, and malnutrition. They may also lead to complications, such as obstruction, or be accompanied by manifestations in other body systems." The Cumulative List of Medical Diagnostic or Evaluative Techniques does not include any tests for gastroenterological conditions, presently.
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From page 185... ...
(b) Although CT imaging has the advantage of simultaneous detection of the extent of mural and extramural disease, advances in MDCT have allowed mucosal assessment by virtual endoscopy, and virtual colonoscopy can be used to detect colon cancer and colon polyps.
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From page 186... ...
The requested information for MRE and CTE related to diagnosis is as follows: (a) In addition to evaluating patients with Crohn's disease, both proce dures can be used to monitor the progression of IBD and sometimes response to treatment.
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From page 187... ...
Positron Emission Tomography and Computed Tomography Scan As described in Chapter 3, positron emission tomography (PET) and computer tomography (CT)
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. The requested information related to PET–CT and diagnostic and prognostic ability is as follows: (a)
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From page 189... ...
A small amount of radioactive sugar substance is injected through an IV, which allows the scanner to detect where the cancer might be and produce images. A technician who special izes in these scans will complete the test, and then the results will be read by a radiologist or nuclear medicine specialist.
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From page 190... ...
. Given its good temporal resolution, high soft-tissue contrast, and lack of radiation exposure, MRD is the preferred imaging approach for pelvic floor dysfunction (Nikjooy et al., 2015)
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From page 191... ...
is a medical imaging technique that which uses magnetic resonance to visualize the biliary tree and pancreatic ducts by non-invasive means to evaluate a wide range of pancreatobiliary diseases. The requested information related to MRCP and diagnostic ability is outlined below: (a)
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From page 192... ...
. Transient Elastography Transient elastography is a non-invasive method proposed for the assessment of hepatic fibrosis in chronic liver disease.
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(g) The range of outcomes for transient elastography testing is typically provided in liver stiffness measurements and controlled attenuation parameters (CAPs)
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From page 194... ...
However, virtual colonoscopy does not detect other mucosal pathologies such as inflammatory bowel disease or mucosal vascular pathologies. The requested information on virtual colonoscopy for diagnosis is below: (a)
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The disadvantages of CT colonography include exposure to low-dose ionizing radiation, which may increase the risk of malignancy. Finally, if a polyp is detected on a virtual colonoscopy, the patient will undergo a stan dard colonoscopy to remove the polyp (which entails repeat bowel prep, additional cost in time away from work, and costs associated with another procedure)
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The requested information for use of EUS for diagnosis is as follows: (a) EUS is used to evaluate abnormalities and malignancies detected at a prior endoscopy or found on imaging tests such as a CT scan.
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(j) One of the limitations of EUS and tissue sampling is that it can be difficult to confidently exclude a malignancy due to mimicking from chronic pancreatitis (Mallery and Van Dam, 2000)
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From page 198... ...
Additional Techniques In addition to imaging tests and types of endoscopies, there are other techniques, such as high-resolution manometry, prognostic scoring systems, and genetic testing, that clinicians use to evaluate a patient's gastrointestinal tract and diagnose disorders of the digestive system.
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One study found that HRM provided superior diagnostic accuracy compared with conventional manometry (Carlson et al., 2015)
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. Scoring Systems for Mortality Risk and Associated Disability Table 8-1 summarizes two new and improved instruments that are widely used by medical professionals for characterizing disease progression and determining prognosis the risk of death in the near future for patients with liver disease.
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From page 201... ...
the severity of liver disease in women. significantly with the degree of liver functional impairment 201
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The requested information for genetic testing's use as a diagnostic technique is as follows: (a) Current genetics tests are available for the following GI disorders: colon cancer, gastric cancer, pancreatic cancer, pancreatic endocrine tumors, pancreatitis, inflammatory bowel disease, celiac disease, metabolic liver disease, and hyperbilirubinemias (Goodman and Chung, 2016)
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From page 203... ...
(g) The range of outcomes for genetic testing usually includes whether or not a person has an identified gene that plays a role in that par ticular disease process or has a mutation in a certain gene.
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and can help to direct care and improve clinical outcomes. Table 8-2 provides examples of measures created to assess symptoms and functioning in patients with specific digestive disorders, including inflammatory bowel disease and other digestive system conditions.
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However, predictive models still need to be rigorously tested in various cohorts and settings to truly determine whether they can be beneficial. Novel Biomarkers In addition to numerous efforts using AI and ML, novel serum biomarkers for chronic liver disease are also being explored in various cohorts to spot the presence of early disease or identify patients with a high risk of disease progression.
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From page 206... ...
IBD Disk 10-item questionnaire Abdominal Designed for use during that is an adaptation pain; regulating the clinical visit to (Ghosh et al., of IBD-DI. Includes defecation; give immediate visual 2017; Le Berre domains of joint interpersonal representation of patientet al., 2020; pain, abdominal interactions; reported IBD-related Paulides et al., pain, regulation of education and disability.
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From page 207... ...
be cumbersome Studies have to calculate in demonstrated clinical practice its use as an outcome measure in clinical trials and prospective epidemiological studies. 2017 Overall score Unknown Self-administered The tool lacks calculated as sum in clinical assessment of of 10 components, practice.
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From page 208... ...
inflammatory bowel extensive questions disease on health-related about specific symptoms quality of life. The four and activities.
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From page 209... ...
reliable measure of patients health related QoL. with varying demographics.
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2018: Taft et al., 2011) NOTE: EoE = eosinophilic esophagitis; GERD = gastroenterological reflux disease; GI = gastrointestinal; IBD = inflammatory bowel disease; QoL = quality of life; SD = standard deviation.
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. Each item related QoL in in initial study is coded 0–4, with clinical settings.
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From page 212... ...
For example, for the noninvasive identification of patients with significant NASH and liver fibrosis, a score using transient elastography was developed recently to identify those patients at increased risk of disease progression. A model using liver stiffness measurement by vibration-controlled transient elastography, controlled attenuation parameter, and aspartate aminotransferase had the best predictive properties for NAFLD and associated injury (Newsome et al., 2020)
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2020. FDG–PET/CT as the superior imaging modality for inflammatory bowel disease.
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2017. Development of the IBD Disk: A visual self administered tool for assessing disability in inflammatory bowel diseases.
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2005. Virtual colonoscopy for colorectal cancer screening: Current status.
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symptom scales in subjects with inflammatory bowel diseases. American Journal of Gastroenterology 113(1)
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2013. The Short Health Scale: A valid and reliable measure of health related quality of life in English speaking inflammatory bowel disease patients.
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2012. Development of the first disability index for inflammatory bowel disease based on the international classification of functioning, disability and health.
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2021. Machine learning modeling from omics data as prospective tool for improvement of inflammatory bowel disease diagnosis and clinical classifications.
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