In-Office Testing - Eastern Pennsylvania Gastrointestinal and Liver Specialists

Anorectal manometry is a test of the muscles around the anal opening, as well as the reflexes and sensation or feeling inside the rectum. Patients with constipation or stool leakage may have this test. Learn More.

A flexible sigmoidoscopy is a procedure used to examine the inside of the rectum and a portion of the colon (i.e. large intestines). This is done by inserting a flexible tube that contains a video camera through the anus that is then advanced into the rectum and the colon.

Esophageal manometry is a test to measure the motor action of the lower esophageal sphincter (LES) ad esophageal body. A catheter is used to measure esophageal pressure and records the duration and sequence of contractions in the esophagus.
The manometry test is commonly given to people who have:
– Difficulty swallowing
– Pain when swallowing
– Heartburn
– Chest pain

How is the Test Performed?

A thin catheter is passed through your nose and into your stomach, and then the tube is pulled slowly back into the esophagus.

Pressure measurements may be taken at intervals along the catheter. The outer end of the catheter is attached to an instrument called a transducer that will record the pressure.

The transducer records the high pressure zone of the lower esophageal sphincter (LES), the sphincter muscle that acts as a valve to prevent reflux of gastric acid into the esophagus.

When the catheter is in the esophagus, you will be asked to swallow. The swallowing wave will be recorded.

While the tube is in place, other studies of your esophagus may be done. The catheter is removed after the tests are completed.

This information will help you understand your FibroScan^® results.
FibroScan is a specialized ultrasound machine for your liver. It measures fibrosis (scarring) and steatosis (fatty change) in your liver. Fatty change is when fat builds up in your liver cells.
FibroScan will help your healthcare provider learn more about your liver disease. It can be used alone or with other tests (such as blood tests, imaging scans, or biopsies) that also measure scarring or fatty change in your liver.

Your FibroScan Results
Date: __________FibroScan steatosis result (CAP score): __________ decibels per meter (dB/m) – Steatosis grade: _________FibroScan fibrosis result: __________ kilopascals (kPa) – Fibrosis score: _______________

Your healthcare provider will talk with you about your results during your appointment. If you have questions, call your doctor’s office. You can reach them Monday through Friday from 9:00 am to 5:00 pm at 212-639-7336.
The rest of this resource explains your FibroScan results in more detail, including how your healthcare provider uses your results to determine your steatosis grade and fibrosis score. You can read the sections below if you’d like to learn more.

Your CAP score is a measurement of fatty change in your liver. Your healthcare provider will use your CAP score to find out your steatosis grade.
The CAP score is measured in decibels per meter (dB/m). It ranges from 100 to 400 dB/m. The table below shows ranges of CAP scores and the matching steatosis grade and amount of fatty change.

CAP Score	Steatosis Grade	Amount of Liver with Fatty Change
238 to 260 dB/m	S1	11 to 33%
260 to 290 dB/m	S2	34 to 66%
Higher than 290 dB/m	S3	67% or more

Your fibrosis result is a measurement of the amount of scarring in your liver. FibroScan measures scarring by measuring the stiffness of your liver.
The fibrosis result is measured in kilopascals (kPa) It’s normally between 2 and 6 kPa. The highest possible result is 75 kPa. Many people with liver disease(s) have a result that’s higher than the normal range.
Your healthcare provider will use your FibroScan fibrosis result and your medical history to determine your fibrosis score.
– Fibrosis score F0 to F1: No liver scarring or mild liver scarring
– Fibrosis score F2: Moderate liver scarring
– Fibrosis score F3: Severe liver scarring
– Fibrosis score F4: Advanced liver scarring (cirrhosis)

The table below shows liver diseases, ranges of fibrosis results, and the matching fibrosis score. The ranges of fibrosis results in the table are estimates. This means that your actual fibrosis score (the score that your healthcare provider tells you) may not match the fibrosis score in the table. If you have more than one liver disease, you may not be able to use the table.
To use the table, find the liver disease that you have on the left side of the table. Read across the row from left to right until you find the range that includes your fibrosis result. Then, look at the top of that column to see the fibrosis score.

	F0 to F1	F2	F3	F4
Hepatitis B	2 to 7 kPa	8 to 9 kPa	8 to 11kPa	18 kPa or higher
Hepatitis C	2 to 7 kPa	8 to 9 kPa	9 to 14 kPa	14 kPa or higher
HIV/HCV Coinfection	2 to 7 kPa	7 to 11 kPa	11 to 14 kPa	14 kPa or higher
Cholestatic Disease	2 to 7 kPa	7 to 9 kPa	9 to 17 kPa	17 kPa or higher
Non-alcoholic Fatty Liver Disease (NAFLD or NASH)	2 to 7 kPa	7.5 to 10 kPa	10 to 14 kPa	14 kPa or higher
Alcohol Related Disease	2 to 7 kPa	7 to 11 kPa	11 to 19 kPa	19 kPa or higher

Your fibrosis result may be over-estimated (your liver may have less scarring than what your fibrosis result says) if you have:
– Liver inflammation. This can be caused by a recent liver illness or drinking alcohol.
– Benign (not cancerous) or cancerous tumors in your liver.
– Liver congestion (when your liver is too full of blood or other fluids). This is usually caused by heart
failure.

Your FibroScan results may also be less accurate if you have:
– A body mass index (BMI) higher than 30 (obesity)
– A build-up of fluid in your abdomen (ascites)
– Too little bile flowing out of your liver (biliary obstruction)

A hydrogen breath test is used as a diagnostic tool for small intestine bacterial overgrowth (SIBO) and carbohydrate malabsorption, such as lactose and fructose. The test is a simple non-invasive test and it is performed after a short period of fasting with dietary restrictions prior to the test. The test may last up to three hours with samples taken every 30 to 6o minutes in our office setting.
The breath samples that are taken are analyzed in a machine which are then placed on a graft and interpreted by your medical provider. The provider will give direction based on the results of your breath test.