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A number of endoscopic procedures can be used to view structures in the upper part of the gastrointestinal tract. A doctor passes the endoscope down the esophagus until it reaches the part of the digestive tract to be examined or treated.

Colonoscopy

In colonoscopy, a narrow, flexible tube (colonoscope) is inserted through the anus and rectum and threaded up through the colon. As the colonoscope is slowly withdrawn, the doctor examines the lining of the colon for abnormalities such as inflammation, polyps, or tumors. A tiny camera at the end of the colonoscope displays images of the inside of the colon on a video monitor. The procedure is painless but can be uncomfortable, so a person is given a sedative to relax him or her and to reduce any discomfort. Growths such as polyps can be shaved and removed through the endoscope. Bleeding blood vessels or ulcers can also be treated through the endoscope.

Capsule Video Endoscopy

Capsule video endoscopy is a diagnostic imaging test that uses a miniature color video camera placed inside a pill-shaped capsule that a person swallows with a sip of water. The so-called edible camera travels through the intestinal tract by way of peristalsis, the natural contractions of the intestines. Along the way, the camera captures video images of the inside of the intestinal tract and transmits the images to sensors on a belt worn around the person’s abdomen. The sensors store the images on a recorder. The process takes about 8 hours. The person then returns the belt and recorder to the doctor’s office, where the doctor can download the images and view them on a computer screen to check for any abnormalities in the intestinal tract. The disposable (flushable) camera passes out of the body naturally during a bowel movement, usually within 24 hours.

Barium X-Ray Examinations

Tests using a contrast medium (dye) called barium are performed to detect abnormalities in the digestive tract. Barium is a metallic chemical that X-rays cannot pass through. When barium is mixed with water and passed into an area of the body to be examined, it allows an image of the area to show up on X-ray film. Sometimes air is introduced into the digestive tract to get a clearer image of less-visible abnormalities.

• Before an examination of the esophagus, stomach, and duodenum, barium is swallowed in a drink or ingested in a cookie or tablet.

• For an examination of the small intestine, barium is usually swallowed in a drink or ingested in a cookie or tablet. Sometimes the barium is passed into the small intestine through a tube inserted through the rectum.

• For an examination of the large intestine, barium is passed into the large intestine through a tube inserted through the rectum.

Small intestine

The inner wall of the small intestine is lined with tiny fingerlike projections called villi, which increase the surface area of the intestinal lining for digestion. The villi secrete enzymes to break down fats, proteins, and carbohydrates and enable the resulting particles to be absorbed into the bloodstream.

Celiac Disease

Celiac disease (also called celiac sprue) is a common inherited disorder in which the tiny fingerlike projections called villi that line the small intestine are damaged by the immune system after a person eats foods containing a protein called gluten. Gluten is found in grains such as wheat, barley, rye, and oats. When gluten comes in contact with the small intestine, the villi that line the intestine flatten, and the intestinal lining becomes smooth. This action reduces the surface area of the small intestine, decreasing the body’s ability to absorb nutrients.

Although the disorder is usually diagnosed in infants and very young children, adults can have celiac disease that is undiagnosed for many years. Untreated, celiac disease can cause malnutrition and other malabsorption or deficiency disorders such as anemia (from an iron deficiency; see page 610), osteoporosis (from poor calcium absorption; see page 989), seizures (see page