A gastric emptying scan is an imaging test. It measures how quickly food travels from the stomach into the small bowel (intestine). During the test, you’re given a meal to eat that contains a small amount of radioactive substance (tracer). Then scans of the stomach are done. The tracer shows up clearly on the scans and tracks the movement of the food through your stomach. This test is most often needed if you have symptoms that suggest a motility problem. Motility refers to the movement of the muscles in the digestive tract. The test takes about 5 hours.

Before the Test

With a gastric emptying scan, a machine called a scanner is used to take pictures of your stomach.

• Let your doctor know of any medications you’re taking. This includes vitamins, herbs, and over-the-counter medications. Certain medications may need to be stopped for a time in the days before the test.
• Don’t eat or drink anything starting from 6 hours before the test.
• Follow any other instructions given by your doctor.

During the Test

A gastric emptying scan takes place in a hospital. It is performed by a technologist trained in nuclear medicine or radiology.

• You’ll be given a meal to eat. This can be a solid food, such as eggs, or a liquid, such as water. Both the food and drink contain a small amount of tracer. The tracer has no flavor. If you’re allergic to the food to be given, another type of food is used instead.
• After you finish the meal, you’ll be asked to lie on your back on an exam table.
• Pictures of your stomach are then taken with a machine called a scanner. You must lie still during this process. The scanner uses technology that can detect the amount of tracer in the stomach. As food is emptied from the stomach, the amount of tracer decreases. This allows the technologist to measure the rate at which food is leaving the stomach.
• More pictures of your stomach are taken at different times. This usually occurs after 1, 2, and 4 hours of eating the meal. You can leave the room between the times the pictures are taken. But do not eat or drink anything or perform any strenuous activities during this period.
• Once the last set of pictures has been taken, the test is complete.

After the Test

You can go home shortly after the test. A nuclear medicine doctor or radiologist will go over the test results with your doctor. Your doctor will then review the test results with you. This is likely within a few days of the test.

Your doctor recommends that you have esophageal dilation (also called dilatation). This procedure is used to widen a narrowed section of the esophagus. This is the tube that leads from the throat to the stomach. Narrowing, or stricture, of the esophagus can cause problems. These include trouble swallowing. This sheet explains what to expect with esophageal dilation.

Why Esophageal Dilation Is Needed

A balloon dilator may be used to widen a stricture in the esophagus.

Several problems can be treated with esophageal dilation. They include:

• Peptic stricture. This is caused by reflux esophagitis. With this problem, the esophagus is irritated by acid reflux. This occurs when acid from the stomach flows back up into the esophagus. Stomach acid damages the lining of the esophagus. This leads to a buildup of scar tissue. As a result, the esophagus is narrowed.
• Schatzki’s ring. This is an abnormal ring of tissue. It forms where the esophagus meets the stomach. It can cause trouble swallowing. It can also cause food to become stuck in the esophagus. The cause of this condition is not known.
• Achalasia. This problem prevents food and liquids from moving into the stomach from the esophagus. The lower esophageal sphincter (LES) is a muscular ring. It relaxes (opens) during swallowing. With achalasia, it does not relax. Also with this problem, peristalsis does not work well. This is the normal action of the esophagus that moves food into the stomach.

Before You Have Esophageal Dilation

• Tell your doctor about any medications you take. This includes supplements. Be sure to mention aspirin or any blood thinners you’re taking. And let your doctor know if you need to take antibiotics before dental procedures. You may need to take them before esophageal dilation as well.
• Tell your doctor about any health conditions you have, such as heart or lung disease. Also mention any allergies to medications.
• You’ll need to have an empty stomach for the procedure. Be sure to follow your doctor’s instructions for not eating and drinking before the procedure.
• Arrange to have a family member or friend drive you home after the procedure.

During the Procedure

• You may be given local anesthesia to numb your throat. You’ll also likely be given anesthesia (conscious sedation) to relax you. The procedure takes about 15 minutes.
• An endoscope (scope) is used. This is a narrow tube with a tiny light and camera at the end. The scope is inserted through your mouth and into your esophagus. It allows the doctor to see inside the esophagus. Fluoroscopy may also be used. This imaging technique creates a continuous x-ray image on a monitor throughout the procedure.
• Next, special instruments are carefully guided through the mouth and down into the esophagus. They widen the stricture and are then removed. Different types of instruments are used. The type used depends on the width and cause of the stricture. Types include:
  • Balloon dilator. A tiny deflated balloon is inserted into the stricture using an endoscope. The balloon is slowly inflated. It’s deflated when the stricture is widened enough. Balloon dilators are used to treat a wide range of strictures. They can also be used to stretch the LES in cases of achalasia.
  • Guided wire dilator. A thin wire is eased down the esophagus. A small tube that’s wider on one end is guided down the wire into the stricture to stretch it. These dilators are used to treat all kinds of strictures.
  • Bougies. These are weighted, cone-shaped tubes. Starting with smaller cones, your doctor uses increasingly larger cones until the stricture is stretched the right amount. Bougies are often used to treat strictures that are simple (short, straight, and not very narrow).

After the Procedure

• You’ll be observed until your doctor says you’re ready to go home. You’ll need to have a friend or family member drive you home.
• You may have a sore throat for the rest of the day.
• You can start drinking again after the numbness in your throat goes away. You can resume eating the next day.

Risks and Possible Complications

Risks and possible complications for esophageal dilation include:

• Infection
• A tear or hole in the esophagus lining, causing bleeding and possibly requiring surgical repair
• Risks of anesthesia

Follow-up

You may need to have the procedure repeated one or more times. This depends on the cause and extent of the narrowing. Repeat procedures can allow the dilation to take place more gradually. This reduces the risks of the procedure.

If your stricture was caused by reflux esophagitis, you’ll likely need to take medication to treat that condition. Your doctor will tell you more.

You have a peptic ulcer. This is a sore in the lining of the stomach or duodenum (the first part of the small intestine). The ulcer is bleeding or at high risk of bleeding. This means that treatment is needed right away. Treatment can include medications and endoscopy or surgery. Your doctor will work with you to decide which treatments are best for you. Read on to learn more about each type of treatment.

Treatment with Medications

A bleeding peptic ulcer is a serious problem and must be treated right away.

Medications will be prescribed as part of your treatment. These can include:

• Antibiotics. These kill Helicobacter pylori (H. pylori) bacteria if they are present. (H. pylori infection is the most common cause of a peptic ulcer.)
• Proton pump inhibitors. These block your stomach from making any acid.
• H₂ blockers. These reduce the amount of acid your stomach makes.
• Bismuth subsalicylate. This helps protect the lining of your stomach and duodenum from acid.

When taking medications, be aware of the following:

• Each medication has risks and side effects. Your doctor will tell you more about these based on which medications are prescribed for you.
• Treatment with antibiotics lasts about 7 to 14 days. Other types of medications may need to be taken longer. Be sure to take all of the medications exactly as instructed. Do not stop taking the medications even if you are feeling better.
• During treatment, avoid non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen. Overuse of these drugs is another possible cause of ulcers. Using them can worsen your symptoms.
• Your doctor may also advise you to avoid cigarettes, alcohol, and caffeine. These may worsen your symptoms. They may also affect how well your ulcer heals.

Treatment with Endoscopy or Surgery

Along with medications, your treatment may include endoscopy or surgery. Here’s what to expect with either treatment:

• Before the treatment. You may be told not to eat or drink anything for at least 6 hours before the treatment. Also, you’ll have to stop taking medications such as aspirin and other NSAIDs.
• During the treatment. A needle is placed in a vein in your hand or arm. It’s attached to a tube called an intravenous (IV) line. The IV line gives you fluids. It’s also used to give medication to prevent pain. This may include a sedative or anesthesia. Depending on the medication used, you may be drowsy or asleep during the treatment. The doctor will then treat your ulcer with one of the following:
  • Endoscopy. With this procedure, a thin, flexible tube (endoscope or “scope”) is used. The scope has a tiny camera on the end. This allows the doctor to locate the ulcer. First, the throat is numbed with a spray or gargle. Then, the scope is inserted into the mouth and guided down into the stomach or duodenum. Air is used to expand the digestive tract. Once the ulcer is located, tools are passed through the scope to stop any bleeding. These may include clips or devices that use heat or electricity. In some cases, alcohol or adrenaline (epinephrine) is injected directly into the ulcer to help reduce bleeding. When the bleeding is stopped, the air is removed. The scope and any tools used are then also removed.
  • Surgery. Surgery can be done in different ways. With open surgery, an incision is made in the abdomen to reach the ulcer. This allows the surgeon to view and treat the ulcer directly. With laparoscopy, a few small incisions are made in the abdomen. A scope with a tiny camera is then inserted through one of the incisions. Pictures of the inside of the abdomen are sent to a screen. This allows the doctor to locate the ulcer. Tools are then passed through the other incisions to treat the ulcer. Nearby nerves, blood vessels, and parts of the stomach may also be treated. Once the surgery is complete, the incisions are closed. Any tools used are removed.
• After the treatment. You’ll be taken to a recovery room or intensive care unit. Nurses will monitor your condition. You’ll be moved to a hospital room when you’re stable. Medications are given to help manage pain and to relieve symptoms. Tests may be done to check for bleeding or rebleeding of the ulcer. You’ll remain in the hospital until your doctor confirms there are no issues of concern. Before leaving the hospital, make sure you have all the prescriptions and home care instructions you’ll need. Also, make sure you have a contact number for your doctor or hospital. This is in case you have problems or questions after treatment.

Risks and Possible Complications of Endoscopy or Surgery

For endoscopy:

• Bleeding
• Perforation (a hole) in the upper digestive tract, which includes the esophagus, stomach, and duodenum
• Risks of sedative or anesthesia used

For surgery:

• Bleeding
• Infection
• Damage to nearby organs and blood vessels
• Long-term digestive problems such as irregular bowel movements
• Risks of anesthesia
• Death

Follow-up

Keep all follow-up appointments with your doctor. These are needed to check your health and recovery progress.

A liver transplant is major surgery. During a liver transplant, your sick liver is removed. It’s replaced with a healthy donor liver. This sheet tells you more about what to expect.

Before Transplant Surgery

If you have been on a waiting list, you will receive a call from the transplant coordinator once a donor liver is found. When you arrive at the transplant center or hospital, your health and condition will be reviewed. A current or recent illness, changes in liver health, or problems with the new liver could cause the surgery to be postponed. This can be frustrating. Remember that the best decision has been made for your health. Once surgery is scheduled:

• Prepare for the transplant as you have been instructed.
• Begin anti-rejection medication as prescribed (see “What Is Organ Rejection” below).
• Call the transplant center if you develop a cold or other illness during the preparation time. This can affect whether the transplant can be done.

During Transplant Surgery

A liver transplant can take 4-12 hours. You will be given anesthesia (medication that prevents pain and makes you sleep during surgery). The sick liver is removed from your body and replaced with the new liver. Blood vessels and bile ducts are then attached to the new liver.

After Surgery

You will stay in the hospital for about 7-14 days or longer. For a time after surgery, you will recover in the ICU (intensive care unit). During this time, you may be on a machine to help you breathe (ventilation). Skilled nurses and doctors will monitor your health and liver function. Tests will be done to check that the new liver is working right. These may include ultrasound tests, a liver biopsy, and blood tests. In some cases, a “second look” surgery is done before you are sent home.

Caring for Yourself at Home

You will be given instructions on how to care for yourself and your new liver. While recovering from surgery, you will need to be watched for signs of a problem. Possible problems include organ rejection, infection, and complications from the surgery or from medications.

What Is Organ Rejection?

The immune system protects the body from germs. It also protects against foreign materials (such as a splinter) that enter the body and could cause an infection. When an organ is transplanted, the immune system thinks the new organ is an invader. As a result, the immune system fights the new organ. This process is called rejection. Anti-rejection medication suppresses the immune system to keep this from happening. Talk to your healthcare provider about this medication and what risks these medications pose. Be sure that all other doctors and healthcare providers know that you are on anti-rejection medication.

During a liver transplant, your sick liver is removed. It’s replaced with a healthy donor liver. This sheet helps you understand the process leading up to your transplant.

Why You Need a Liver Transplant

Your doctor can tell you more about why now is the right time to begin preparing for a transplant. It may be because the liver is not working as it should. Or, it may be that you have a health condition that would be improved by a liver transplant.

Your Transplant Evaluation

Before you are put on the transplant list, a transplant evaluation is done. This takes place at the transplant center. It takes 2-3 days, and is done outpatient (you go home at night). Your health is assessed. Tests, such as blood tests and imaging tests, are done. You and your family will also learn more about transplantation. The transplant coordinator and the rest of the transplant team will talk to you about:

• Benefits and risks of liver transplantation.
• Medications needed after the transplant.
• The possibility of organ rejection.
• Health insurance and financial issues.
• Options for organ donation.
• The process of waiting for an organ.
• What to expect during surgery.
• Care after surgery.
• The emotional aspects of transplant for you and your family.
• Travel plans for the time of transplantation surgery.

Where Your New Liver Will Come From

• In most cases, the new liver comes from a donor who has just died (cadaver donor). A donated liver is screened for disease before the transplant is done. It’s also checked to make sure it’s a match with your blood type.
• Transplants can also be done from living donors, often family members who match your blood type. The liver is the only organ in the body that can regenerate. So the portion of the liver removed from the living donor grows back after the transplant. The transplanted liver also grows to full size after the transplant. A living donation transplant can be scheduled ahead of time. It may be able to be done sooner than if you go on the waiting list for a non-living donor.

Waiting for a Transplant

Getting a liver transplant can be a long process. It could be months or even years before a donor liver is found for you. Here’s what will happen during this time:

• Your name is added to a national waiting list. This list is ranked by how sick people are. Very sick people are higher on the list than people who don’t need a transplant right away.
• Follow instructions for how to stay in contact with the transplant center. The transplant center maintains your status on the waiting list. If your liver disease gets worse or another health problem develops, tell the transplant center right away. These events could change your status on the list.