barIum swallow vs EGD

[brownbook]

I have a developmentally disabled 5 year old pediatric patient with vague symptoms "he just seems to be in pain....isn't sleeping well.... definitely not his usual self....usually pretty easy going...." etc. All test come up "negative" but parents and Dr's are leaning towards this is a GI issue?

I have only had with him a few times. I heard the Dr's are planning a barium swallow and a motility test.

I think I get the motility test. He is a little flaccid, weak muscles, is able to walk but unsteady gait. Has been on fiber supplements since age 1.

I just wondered why not do an EGD? I don't really know what information a barium swallow provides vs, or instead of, an EGD?

[KatieMI, BSN, MSN, RN]

Barium swallow gives info about esophageal motility, takes only a few minutes, can be repeated immediately if first shot went wrong and do not require any anesthesia. Motility tests - there are several of them, so we do not know which one is planned - may require anesthesia (and so PACU stay), take up to 24 hours and more expensive. So the doctor decided to do swallow first and if it comes definite enough for reflux (or absolutely negative) he'll change plans accordingly. EGD always requires anesthesia, and gives no info about motility. In 5 y/o with recent symptoms it would be pretty pointless to do unless there is strong suspicion of foreign body, which will be seen on swallow, directly or indirectly. Reflux esophagitis takes a few months at least to develop.

[brownbook]

WOW.....thanks so much. I honestly didn't know what a motility test entailed. I assumed (and you know what that means) it would be a simpler procedure than the barium swallow. For some reason I think of barium swallows as being.....??.....more complex...??.....than what they are.

I did You Tube barium swallow yesterday so I really get your point. Now off to You Tube, or Google, to find out about motility tests.

I had worked in a large clinic that a Peds GI came to frequently. It seemed he did a lot of EGD's and colonoscopies so my first thought was why not an EGD.

[KatieMI, BSN, MSN, RN]

My pleasure

[brownbook]

OKAY......I looked up motility studies.....manometer studies.....??? (if I understood they are the same thing)....then there was also one where it seems the probe went further, into the small intestines?

All really fascinating way more complex than I ever imagined.

I wondered how they might do some of what I saw on You Tube with a developmentally delayed child though! But this was just my quick.....10 minutes....looking at different sites on the Internet. I am sure there are variations, improvements, within the different procedures.

Have you been involved with these? Have you helped with a pediatric or disabled patient?