Archives: FAQ

Gastroenterological check-ups are performed at pre-arranged dates at our Ljubljana subsidiary, where ambulatory examinations are performed and patients prepare for the examination by themselves at home, while it is also possible to arrange a hospital examination in Bled.

In almost a third of patients examined with gastroscopy we discover gastroesophageal reflux disease (GERD), in which proper nutrition and timely medication are very important for improving their quality of life.
Due to the increasing incidence of colon cancer, whose incidence in both genders is third among all carcinoma types, it is very important to screen for precancerous changes (polyps) in the colon. Every year more than 1,400 patients in Slovenia develop colon cancer. In more than 95 per cent it develops from a precancerous polyp, so we try to find these growths and promptly remove them. Due to these facts, colonoscopy is a recommended part of preventive health checks in subjects over age 45.

• If you suspect you have deep vein thrombosis (blockade of the deep vein system due to a clot),
• phlebitis (inflammation of the surface veins),
• leg pain, cramping,
• leg swelling (phleboedema),
• varicose veins,
• as a control check-up during or after anticoagulation treatment due to deep vein thrombosis or phlebitis.

Probably all women are familiar with gynaecological examination, except from maybe those who are coming to the exam for the first time. First, we examine the external genitalia and any changes to it. Then follows an inspection of the vagina and cervix with the mirrors. This also allows us to observe any abnormalities, especially a variety of inflammatory changes and changes in the cervix. With a wooden stick we take a smear sample – PAP-test. The mirror exam is followed by palpation of the uterus and ovaries with both hands, namely, with 2 fingers of the right hand in the vagina and the left hand played on patient’s abdomen. Generally, gynaecological examination is painlessness. Any pain is usually a sign of pathological changes. Gynaecological examination can be complemented by a vaginal ultrasound examination.

The purpose of the gynaecological examination is to determine the potential precancerous changes.

The easiest way is, of course, the home test. If you have problems that are consistent with lactose intolerance symptoms (bloating, gas, diarrhoea, etc.), try to completely avoid milk for a week. After a few days, the problems should subside. After a week, drink half a litre of milk in the morning, on an empty stomach, and observe. If you end up at the toilet, this is already an almost reliable evidence that milk has an adverse effect on you. On the next day, repeat the same test with lactose-free milk, after which you should have no problems.

Home test is the most practical and the easiest to perform, but also the least reliable. Often, it is not enough to remove from our diet just milk, because lactose can be also found in many processed food products. If during the trial diet lactose is not removed from our menu entirely, the problems do not pass and we continue to falsely believe that the symptoms are not related to lactose. On the other hand, the re-occurrence of the problems after you introduce the milk back to your diet is not unique to lactose intolerance, but it may also apply to other disorders, for example, to milk protein allergy.

Today, as a rule, we carry out several different laboratory tests to diagnose lactose intolerance.

The most widely used is the blood lactose tolerance test, for which you can make an appointment with the doctor. On an empty stomach, in the laboratory the patient ingests a test meal with lactose. Then, the patient’s blood is collected several times in a row and the increase in blood glucose is monitored. If the at a given time glucose does not increase sufficiently, this proves that lactose has not been broken down and absorbed into the blood stream. Blood lactose tolerance test is most easily accessible, but only measures your blood sugar, which is not always associated with the patient’s problems. The blood glucose levels depend on other factors as well, so can many times this lead to false-positive or false-negative results.

At Diagnostic Centre Bled we prefer to use hydrogen breath test, which is also the world’s most renowned test to confirm the diagnosis. On an empty stomach, the patient ingests the test amount of lactose, and then exhales into a special bag for 4 hours, once every half hour. The exhaled air is analysed for determining the level of hydrogen and methane. If a bacterial fermentation of lactose occurs, the resulting gases are partially excreted through the lungs and are present in the breath. Therefore, if the exhaled air contains a characteristic increase in these gases, we know that lactose has not been broken down completely.

Hydrogen breath test is the most sensitive among simple laboratory methods. Its usefulness is significant also due to the fact that it allows us to measure the actual production of gases which cause problems for the patients.
At Diagnostic Centre Bled adults can undergo an examination as self-paying clients, without a referral from their physician. For more information and making an appointment please call our appointment scheduling service.
More technologically demanding and expensive is the 13C-lactose breath test, where following the same principle, a marked increase in the exhaled CO2 is monitored.

In recent years there is also the possibility of genetic testing, but is more suitable for research purposes. Several genetic variants have been identified and associated with primary lactose intolerance. Such genes can be determined with rather expensive laboratory blood tests of blood or other body tissues. The disadvantage of these tests lays in the fact that they do not prove or disprove that a disturbed digestion of lactose is really causing problems to the patient, as this is largely dependent on other factors, for example, the composition of intestinal microflora.

If an endoscopic examination of the upper gastrointestinal tract (gastroscopy) is indicated due to the patient’s symptoms, we may also take a sample of the lining of the small intestine and, under specific conditions, sent it to the laboratory, where they will be able to directly determine the activity of the enzyme lactase. If the latter is reduced, the patient cannot digest lactose properly.

In the case of lactose intolerance, the ingested lactose cannot break down completely and remains in the lumen of the small intestine. It binds a lot of water and the intestinal contents travel forward into the colon. A part of undigested lactose is excreted, but the other part is decomposed by the bacteria of our normal intestinal flora. During this process, gases (CO2, hydrogen and methane) and short chain fatty acids are produced. The latter are partly used in the intestinal cells. 5-10% of the ingested lactose is excreted with the faeces. Since lactose binds much water, the faeces can be liquid, and some of the produced fatty acids irritate the intestinal mucosa, which results in diarrhoea and possibly leads to unpleasant burning skin inflammation at the rectum.

The activity of lactase in humans declines within a few years after the cessation of breast-feeding. In environments where lactose intolerance is common, the first symptoms emerge already at the age 2-7, while elsewhere the decrease in lactase activity may be delayed until the age 20.

Despite the disrupted decomposition of lactose, some people do not exhibit any symptoms. It appears that this is in part connected to the bacteria species in the large intestine. Different bacteria produce various acids, which may irritate the intestinal mucosa to varying degrees. Also, different bacteria produce a variety of different gases.

The main symptoms of lactose intolerance are, bloating, gases, flatulence, gurgling, increased urinary frequency, liquid stool, and pains, which depend on the sensitivity of an individual’s gut.

The amount of ingested lactose affects the severity of the symptoms.

Avoiding lactose is of course necessary only when unpleasant symptoms ensue because of it. The fact is that the ingestion of lactose does not cause any long-term health damage or dangerous acute consequences even in those people who are unable to digest it.

In case of suspected celiac disease, we first need to test blood for specific antibodies; sometimes, the test can be ordered by personal physician, but mostly a referral must be issued for an examination by a specialist gastroenterologist. By means of a detailed interview with the patient, the specialist assesses the possibility for celiac disease or other related disorders, and orders appropriate laboratory tests. Mostly, you will have to wait a week or two for the test results. If the levels of antibodies in blood are too high, the test is followed by a gastroscopy, during which samples of duodenal mucosa are taken and later histologically examined. Characteristic changes observed in the microscopic sample confirm the diagnosis of celiac disease. At the follow-up examination by gastroenterologist (and possibly by a nutritionist) you discuss any additional tests and the appropriate diet. The success of the diet is evaluated in a few months with laboratory test, and after a year or two with a control gastroscopy as well.

The trial diet is not suitable for diagnosing celiac disease; the diet affects the changes which are characteristic for celiac disease, which blurs the results and renders the diagnosis of celiac disease impossible. Before the tests must be at least 3 months normally consume gluten.

A referral for an examination can be also to our Centre, to the gastroenterological clinic or the dispensary for food intolerances.

Unfortunately, the road to review referrals and quite complicated, waiting times very long, so we also offer self-paid orientation checks tailored specifically diagnosing celiac disease, which are described in detail in the next section directed self-payment reviews for celiac disease.

Information and appointments:
Emal: info@dc-bled.si or
Email: alergologija@dc-bled.si

In addition to celiac disease, gluten or bread products can cause other problems.

Particularly in children, allergy to wheat is common, but it has different immunological basis and requires a different diet as well as presenting with different complications than celiac disease.

Nowadays, there is much talk also about gluten sensitivity, which is an inherent problem associated with the direct toxic effects of gluten in the intestines and the activation of natural immune mechanisms. Since we have begun to encounter celiac disease more frequently in everyday life, many people without the disease began to use gluten-free products and some noticed that after a diet without morning cereal, bread and pasta they feel much better. It is remarkable, however, that tests have not confirmed any wheat allergy or celiac disease in these individuals.

At first it seemed that avoiding gluten was just a fad, but today we know that gluten can indeed cause a wide range of problems which tend to be less pronounced than in celiac disease. Patients describe the discomfort, the feeling of bloating and heaviness in the abdomen, fatigue after meals, deconcentration of attention and ‘foggy’ mind, malaise, etc. These symptoms have not yet been explained in detail, nor are we able to predict the course of the disorder since there are no simple diagnostic tests yet. In search for the diagnosis, we mostly rely on trial diets and different gluten levels in diet, but of course, prior to that we first eliminate the possibility for celiac disease. According to preliminary estimates, up to 6% of people are supposedly suffering from this type of gluten intolerance. Our experience shows that, unlike celiac disease, this type of gluten intolerance eventually subsides, and dietary restrictions are usually not as strict either.

After all, we all know that exaggerated consumption of white bread, pasta and pastries triggers a variety of adverse metabolic changes which negatively affect our health. In this case, the only solution is to change the diet, and not so much to avoid gluten.

A celiac disease patient’s diet requires a strict life-long suspension of all foods containing gluten, i.e. wheat, spelt, Khorasan wheat, rye, barley, and sometimes also oats. The ingested gluten triggers an immune response within the body, which gradually leads to the damage of the intestinal mucosa. This causes digestive disturbances when ingesting heavy foods, which is reflected in the form of bloating, diarrhoea and other problems. Therefore, most of often, the patients do not experience problems immediately after the consumption of a meal containing gluten, but rather after greasy food, milk, etc.

It takes a several-month lasting gluten-free diet without any “misdemeanour” for the mucous membrane to heal and the symptoms to subside. Already an amount greater 10 mg – this means a pinch of flour – can have a harmful impact. Since small amounts of gluten are often present in many other processed foods, gluten-free diet is particularly complex for the patient. Without the fear of dietary transgression, the patients can only consume unprocessed products which are naturally gluten-free (fruits, vegetables, milk, meat, etc.), otherwise only those products are safe, where it is clearly stated that they do not contain traces of gluten, meaning, that they are produced in a way where the product does not come into contact with wheat. Most of these products have been made by specific manufacturers who, under strict supervision, manufacture only gluten-free products – bread, pastry and pasta from other cereals which pose no risk for patients with celiac disease: corn, buckwheat, millet, rice, quinoa, etc.

With a life-long gluten-free diet, celiac disease is completely curable and patients are at no more at risk for complications than healthy people.

But untreated celiac disease can cause a variety of complications, which are by the time of occurrence divided into short, medium and long term effects.

Short-term complications include bloating, gas, flatulence, weight loss, hair loss, skin inflammation, burning tongue sensation, general fatigue, etc., since the food is digested poorly, as a result of damage to the lining of the gastrointestinal tract.

The medium-term complications arise due to the lack of absorption of nutrients from food. We are talking mostly about anaemia due to iron deficiency, or vitamin B group deficiency, not so much about osteoporosis, etc.

The long-term complications, which pose the most danger to patients with celiac disease, are various autoimmune and cancerous disorders. Neither type is very common, but in patients with celiac these diseases occur significantly more than in healthy people. It is estimated that the mortality of patients with celiac disease is 1.3-times higher than that of the average population.

In those suffering from celiac disease, the most common autoimmune diseases are the autoimmune inflammation of the thyroid, vitiligo, diabetes mellitus, systemic connective tissue diseases, autoimmune hepatitis, etc.

Cancer often affects the digestive tract, so after the age of 40 it is also important to perform preventive endoscopic examinations (gastroscopy, colonoscopy). Due to the constant stimulation of the immune system in untreated celiac disease, a lymphoma often develops, particularly the enteropathy-associated T-cell lymphoma in the small intestine (EATL).

We suspect celiac disease in patients with vague indigestion problems, diarrhoea or increased urinary frequency, bloating and gases, or sometimes with atypical abdominal pain. We can also observe fatigue, oral ulcers, itchy blister rash on the skin (dermatitis herpetiformis), nervous system disorders, depression, etc.

Sometimes, the patients do not exhibit any particular problems, but celiac disease is still suspected, mainly due to related disorders; anaemia, or iron deficiency, is especially suggestive of celiac disease, and so are early osteoporosis, various autoimmune diseases, such as non-insulin-dependent diabetes mellitus of type 1, alopecia areata, vitiligo, various rheumatic disorders etc..

Among close relatives of those suffering from celiac disease, this disorder is up to 10 times more frequent (about 1 out of 10 relatives gets sick), so in such cases we opt for the prevention or examination already at the slightest suspicion of the disease.

One option is stress echocardiography. This is an ultrasound observation of the heart function changes under exercise stress.

Disturbed blood flow in the heart muscle may be shown by scintigraphy of the heart and cardiac catheterization.

A 24-hour ECG measurement can reveal arrhythmias during physical exertion, but the said the examination is not standardized.

In very rare cases it can lead to severe heart failure, severe heart arrhythmias or a heart attack.

Prior to the exercise test, we record an ECG at rest. Then the patient starts exercising by walking on a treadmill. Every three minutes the workload is increased to a higher level (speed and incline of the treadmill). During the test we constantly monitor the ECG and measure the blood pressure at every stage. Both variables continue to be measured for approximately 6 minutes after the end of the test.
We abandon the test if any of the following occurs:

• changes in the ECG graph or a heart rhythm disorder,
• characteristic chest pain (angina pectoris)
• an excessive elevation of blood pressure,
• drop in blood pressure during the exercise,
• difficulty breathing, dizziness,
• muscular fatigue,
• maximal heart rate regardless of age.

The purpose of the stress test is to achieve maximum heart rate and the estimated workload depending on the age, weight and gender of the tested subject, because only in this case we can conclude in a relatively reliable manner that no serious heart disease is present.

In the examples below exercise stress testing should not be carried out:

• a fresh heart attack – at least 2 weeks must pass,
• in severely high blood pressure at rest,
• in fresh thrombosis or embolism (fresh vessel blockage caused by blood clots),
• in severe heart failure.

• Any atherosclerosis of heart vessels, and consequently, coronary heart disease, which presents itself with angina pectoris (Angina pectoris is the main symptom of the disease in heart vessel disease. Angina is experienced as a pressure, or a pressuring chest pain under the sternum, which spreads into the left shoulder or arm, or also as a crushing pain in the xiphoid or neck. This kind of pain may occur during physical exertion and subsides after the cessation of strain.).
• Hypertension during cycloergometry.
• Arrhythmias during cycloergometry.
• We assess the effectiveness of medications used to treat high blood pressure or coronary artery disease.
• We estimate the degree of possible load after myocardial infarction or cardiac surgery.

Exercise stress test is performed to measure fitness of the patient and the corresponding cardiovascular changes (ergometry).

ECG recording during exercise is obtained in the same manner as the basic ECG at rest. The only difference is that the subject is physically active now. For this purpose we utilize a treadmill. The intensity of the performed work on the treadmill is measured in metabolic equivalents (METs).

The hydrogen breath test is a simple, reliable and does not cause discomfort to the patient.

After proper preparation, the subject drinks a certain amount of a test sugar on an empty stomach.

Ingestion of sugar can lead to abdominal bloating or passing stools.

Every half hour in the next 4-5 hours the patient exhales into a plastic bag. The exhaled air is analysed for hydrogen and methane content. If the concentrations of both gases increase significantly, the test is positive.

50% of people are infected with the bacteria Helicobacter pylori, but it does not cause problems to everyone. If a specialist gastroenterologist by means of gastroscopy discovers abnormalities which may relate to Helicobacter pylori infection, an antibiotic treatment is prescribed. After the antibiotic treatment, the success of the bacteria eradication has to be assessed. This can be done with another gastroscopy. If abnormalities were not so severe as to require a second gastroscopy, the presence of HP bacteria can also be determined with the breath test.

The breath test is accurate, reliable, simple and harmless. It is also suitable for children and pregnant women as well. On an empty stomach, the patient drinks a glass of orange juice with a harmless test substance added to it. The bacteria break down the substance into CO2, which is eventually exhaled. The patient is asked to exhale into a plastic bag before the test and 30 minutes after the test, while a special device measures the amount of tagged CO2 in the exhaled air. The greater the difference between both samples, the more it is likely that the bacterium is still present in the stomach.

An important advantage of the breath test is that a control gastroscopy is no longer needed to assess the success of antibiotic treatment. Breath test is more reliable than blood test, because it indicates the actual presence of the bacteria. The positive antigen blood test only proves that the patient was once infected with this bacterium, but the infection may be already gone.

After the exam it is advisable to increase your fluid intake to facilitate the discharge of barium contrast, which thickens the consistency of stool. However, can resume your normal activities right away. Please, attend the examination dressed in loose, comfortable clothes that are easy to take off and put on. We also kindly request that you leave the jewellery at home.

In the X-ray examination of the digestive tract we use a milky drink which contains barium. Barium is not absorbed from the intestines into the body, rather it passes through the digestive tract and is eventually excreted naturally. Since barium absorbs X-rays, it leaves an image on the X-ray screen or film, and from multiple sequential images we obtain a film projection of the digestive system in one plane. It provides useful information about the position of the examined organ, possible abnormal growths, strictures or flow obstructions.

In this way, we are able to perform X-ray imaging of the stomach, oesophagus and duodenum in only about 15 to 20 minutes.

You will need to stay at the Diagnostic Centre for at least one day after the procedure. In the event that you came from another hospital, an ambulance will take you back. Please, inform us about any severe abdominal pain (not just cramps), vomiting, hypothermia, and bloody or tarry stools. To determine whether an irritation of the pancreas or other complications have occurred, we will perform a blood test on the day after the procedure. We will instruct you when and what to drink and eat, normally this is possible on the next morning after ERCP.

Good results with minimal complications are achieved in close collaboration of a well-tuned team, consisting of an experienced endoscopist, endoscopy nurse and a radiologist. At Diagnostic Centre Bled, this examination is performed by gastroenterologists, expert endoscopists with a long-standing practice and experience with a number of diagnostic and endoscopic surgeries.

ERCP (endoscopic retrograde cholangio pancreatography) is the examination of biliary and pancreatic ducts.

Here we present the basic principles for understanding the procedure – how it is performed, to which purpose it serves and what are the possible side effects. The text cannot provide answers to all of your questions, so if you require additional clarification, please ask your personal physician, or the doctor who conducts the examination.

Although complications are possible, they are extremely rare

The pain in throat may linger for another day or two. To relieve the pain, you can take some lozenges for sore throat. Sometimes it is necessary to take a painkiller.

Other possible complications are: 

• allergic reaction to the medication which you received during the procedure (local anaesthetic, sedative)
• bleeding in the passage between the oesophagus and stomach, due to bloating (the complication is tackled endoscopically)
• transient occurrence of fever in the afternoon,
• a puncture in the wall by the endoscope, which may require surgery.

In the case the following symptoms ensue after the examination, immediately contact your personal physician or emergency doctor: severe pain in the chest or abdomen, stiff abdomen, blood in vomit or black sticky mud, dizziness, loss of consciousness, fever and/or hypothermia.

You may feel mild bloating due to air and water, and a slight pain in your throat. These problems subside quickly. For at least one hour after the procedure it is not recommended to ingest food or liquid.

Your doctor will discuss with you the examination results and further procedures. You will receive a written report after the examination, in exceptional cases it will be sent by post in a few days.

Prior to the examination of your upper digestive tract, your pharynx will be numbed with a local anaesthetic. In order to protect the endoscope against biting, we will insert a mouthpiece in your mouth. While you are lying on your left side, the doctor will introduce the endoscope. You can breathe normally throughout the procedure, and you will not feel pain.

Most patients undergoing the procedure perceive it as mildly uncomfortable, while others even fall asleep. The procedure lasts 15-45 minutes.

In most cases, no medication is needed for examining the rectum. For this procedure you will be also positioned on your left side, and it will take from 10 to 30 minutes.

If after a careful medical assessment, clinical examinations, laboratory tests and other ultrasound or endoscopic procedure, there is a suspicion of certain disease of the oesophagus, stomach, rectum, biliary ducts or pancreas, we arrange for EUS, which may be useful as a complementary or a final diagnostic test.

Most often it is used for:

• identifying bile duct stones (especially in the presence of problems which are similar to those before a gallstone surgery)
• identifying pancreatic diseases (when abnormal lab test or abnormal abdominal organ ultrasound indicators are present)
• identifying different thickenings of the gastrointestinal wall, which may have surfaced during the previous endoscopic examinations (gastroscopy, colonoscopy). EUS allows us to assess the nature, size and distribution of these changes and possibilities for surgical removal.

While gastroscopy enables an exact examination of the inner lining of the digestive tract, EUS makes it possible to look deeper and to obtain images of the entire thickness of the intestinal wall.

It is used to examine the upper digestive tract (oesophagus, stomach, duodenum), or the lower digestive tract (the last part of the colon – rectum). An examination of some organs surrounding the gastrointestinal organs is also possible (liver, pancreas, bile ducts, gallbladder …).

The procedure is performed with a thin, flexible tube, called an endoscope, which is inserted under eye guidance through the mouth or anus to the place of interest. Then the ultrasound device is switched on, which generates ultrasonic waves, by means of which an image of the examined tissue or organ is obtained.

The exam is performed by a gastroenterologist – endoscopist, who is a highly qualified specialist for performing such procedures.

After normal procedure: approximately 1 hour to rest, and clearing the air from your colon after the procedure. In so far as the colonoscopy proceeded without complications or major interventions, the patient may start ingesting lighter meals.

Major surgeries (electroresections of polyps …) require a 24-hour hospitalization for safety reasons. During this time you may only drink fluids. For the next 7 days at home you may only ingest light, overcooked food (potatoes, pasta …) and unlimited amounts of fluids. It is recommended to rest (avoid major sporting activities, or lifting loads that weigh more than 3 kg).

If the procedure is followed by abdominal pain, stiff abdomen, fever, a larger amount of blood in the stool (1/2 dl) when you are already at home, you should immediately notify your physician or emergency doctor.

A flexible tube, the colonoscope, is inserted through the rectum and travels all the way to the end of the colon and examines a short segment of the small intestine. During the examination, which may be occasionally painful, patient’s discomfort can be eased by breaking winds from the large intestine – flatulence is encouraged in this situation. In abdominal surgery patients and gynaecological patients, the procedure is expected to be more demanding due to scar tissue. The examination takes about half an hour.

The indications for the colon examination are any unfounded bleeding of unknown origin, or blood trace in the stool, unexplained anaemia, disrupted rhythm of discharge, sudden constipation, alternating diarrhoea and constipation, unexplained abdominal pain, gurgling, bloating, weight loss, or hereditary predisposition for developing intestinal cancer …

We will notify you about test results and prescribe treatment (if necessary). The numbness in the larynx lasts on average for half an hour, during which time you should not drink and eat. Slight pain in the throat will pass by itself, as well as the abdominal tension or cramps. If prior to the examination you were given a sedative, you may not drive the car that day. Your doctor will receive the histology report in a few days.

In the case the examination or surgery is followed by the following symptoms, you must immediately consult your doctor:

• severe chest pain behind the sternum or in the abdomen, stiff abdomen,
• blood in vomit or black sticky mud, dizziness, collapse,
• fever and/or hypothermia.

Complications are extremely rare in gastroscopy. Perforation may occur – a puncture in the wall of digestive system (by endoscope or after polypectomy), which requires surgery. Bleeding may mainly occur after the removal of a polyp, but it usually stops spontaneously; other interventions are seldom needed. Other complications occur even more rarely.

Prior to the procedure, your pharynx will be numbed with a local anaesthetic. In order to protect the endoscope against biting, we will insert a mouthpiece in your mouth. While you are lying on your left side, the doctor will introduce the endoscope. To better see the examined tissue, air will be blown through the endoscope tube, which may cause a sensation of abdominal fullness. You can breathe normally throughout the procedure, and you will not feel pain, but irritable feeling in your pharynx and retching may occur. The procedure usually takes 5-10 minutes.

Biopsy: Using tiny biopsy forceps we take a tissue sample for further testing, or remove a tiny polyp. The tissue sample is then examined under a microscope (histology) to determine the precise nature of the abnormalities. The procedure is painless, there are virtually no complications.

Polypectomy: it is the removal of a polyp. It is done by introducing a snare through the endoscope tube, tightening the snare around the polyp and cutting it off by passing electric current through the snare loop to cut through the polyp completely. The removed polyp is retrieved for histological examination. The procedure is painless. It is performed only by prior arrangement, which ensures that a patient can stay at the Centre for a one-day observation. Other endoscopic procedures include: haemostasis of ulcers or ruptured blood vessels, vasodilation, removal of foreign bodies.

Oesophago-gastro-duodenoscopy (gastroscopy for short) enables a doctor to directly view the interiors of the upper gastrointestinal tract. Thin and flexible optical instrument (gastroscope) is introduced through the mouth. First, oesophagus is examined and then follows the inspection of stomach and duodenum. Endoscopic examination of the upper digestive system is by far more accurate than a contrast X-ray examination. Gastroscopy will be conducted by a qualified doctor, specialist gastroenterologist.