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"Is there a decent alternative to a colonoscopy for a 28-year-old male? "
A couple days after returning from Hawaii in Sept 2012, I experienced a sharp pain in my abdomen on the right side, which woke me up. The pain subsided immediately, and I fell back asleep. Since then I'd noticed my bowel habits become more irregular, and would experience off and on mild stomach discomfort on the right side. It was not really painful just a discomforting feeling. I went to see an MD who did blood tests and checked it out. The blood test showed slightly elevated lipase (only by 4 or 5 points). He performed an abdominal ultrasound and found nothing abnormal. Referred me to a GI specialist. The GI specialist felt around, asked me a couple questions and recommended a colonoscopy.
A colonoscopy is the gold standard when it comes to diagnosing problems of the lower intestinal tract. The procedure involves a prep period the evening before the procedure, when laxatives are consumed in order to clear out the intestines. While this can be a bit uncomfortable, it is necessary in order for the gastroenterologist to get a good view during the procedure. The procedure itself is almost always done under conscious sedation with the use of IV medication to help the patient relax and treat any discomfort; in this setting most patients may not even recall the procedure being done. In the proper hands, the procedure is very safe with a low complication rate. If you have concerns, I recommend speaking with your gastroenterologist. There are other ways of investigating the GI tract as well. Imaging studies such as CT scan or MRI can show inflammatory changes or structural disease, but do not allow for direct visualization of the intestinal mucosa or biopsy of any abnormal areas. A flexible sigmoidoscopy also involves the use of a scope inserted into the rectum, and while the procedure does not involve an extensive prep, it is usually done after an enema. With this procedure, only the last portion of the intestine is visualized and not the entire colon. The gastroenterologist likely recommended the colonoscopy to rule out any disease involving the mucosal lining of the intestine that could be causing your pain and change in bowel movements. If you have any further questions regarding the need for the procedure or the possibility of proceeding with your work-up via a different method, it is advised that you discuss this further with your gastroenterologist.
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