Diagnosis & Treatment

Common Diagnostic Procedures Performed by Dr. Ulmer:

Upper Endoscopy

What is an Upper Endoscopy?
A thin flexible tube with a camera is inserted in the mouth to see the esophagus, stomach, and first part of the small intestine while the child is under general anesthesia, usually as an outpatient. The test is used to diagnose eosinophilic esophagitis, gastroesophageal reflux, celiac disease, peptic ulcer disease, gastric infections, inflammatory bowel disease and other GI problems. It is also used to look for causes of poor growth, and regurgitation. Small pieces of tissue, about the size of a pinhead, are usually taken for testing under the microscope. Through this approach, the doctor is able to actually see inside the GI tract to determine possible problem areas.
Reasons why children may need an Upper Endoscopy?
  • Difficulty swallowing
  • Nausea/Vomiting
  • Weight loss
  • Diarrhea
  • Abdominal pain
  • Persistent heartburn
What happens before and after the test?
The child should not eat or drink anything after midnight on the night before the procedure unless otherwise advised by Dr. Ulmer. After the test, Dr. Ulmer may have pictures to show. At the same time, she can tell the family if there are any medicines the child should take. Once the child is drinking well, they can start eating again and go home.
After the test, if you child has any of these symptoms, notify Dr. Ulmer:
Severe abdominal pain lasting for more than an hour.

Throwing up several times - To make sure this is not a problem, have them drink small amounts of beverages like Sprite or ginger ale, and popsicles.

Bleeding - Spitting up small amounts of blood may be normal. However, if there is more than a spoonful or it lasts longer than 1 day, contact our office.

Persistent fevers (Temp equal to or greater than 101).

Sore throat - The child may have a sore throat for a day or two after the test. If this is really bad or does not go away contact our office.


What is a Colonoscopy?
A colonoscopy is a special test that allows Dr. Ulmer to look directly into the lower intestines. This test may be recommended to help find out why children have diarrhea, bloody stool, and/or abdominal pain. The procedure is performed under anesthesia and she will take a narrow bendable tube with a camera and a light to look inside. Dr. Ulmer may take very small tissue samples, the size of a pinhead. This can help explain why your child might have abdominal (stomach) pain, diarrhea, rectal bleeding or other symptoms.
Reasons why children may need a Colonoscopy?
  • Blood in the stool
  • Diarrhea
  • Abdominal pain
  • Weight loss
  • Inflammatory Bowel Disease
  • Family or personal history of polyps
What happens before and after the test?
Before the test, patients are required to perform a cleanout (with Miralax & Dulcolax) and a clear liquid diet. Specific instructions will be provided to the patient for this cleanout. This must be completed as it allows your doctor to perform the colonoscopy completely. Patients MUST not eat or drink ANYTHING after midnight on the night before the test unless otherwise advised by Dr. Ulmer.

After the test, Dr. Ulmer may have pictures to show you and your family and discuss any recommendations. Once the child is drinking well, he/she can start eating again and go home.
After the test, notify Dr. Ulmer if your child experiences...

Severe abdominal pain for more than an hour.

Excessive vomiting.

Bleeding -- Passing small amounts of blood (less than a spoonful) may be normal for 1-2 days, but if it is more than that, please contact our office.

Fevers (persistent) to 101 or greater.

Capsule Endoscopy (Pillcam)

A pill with a built-in camera, taking pictures twice per second, is swallowed, and a video of the entirety of the small bowel is produced, allowing full visualization from duodenum to ileum. This allows inspection for polyps, bleeding sites and areas of inflammation, to be identified. This procedure is generally done in the office setting.

A patient fasts for 10 hours prior to the procedure, then swallows the PillCam SB capsule with a glass of water. Images and data are acquired as the PillCam SB capsule passes through the digestive system over a 6 to 8-hour period. This information is transmitted via a sensor belt or array to the portable PillCam recorder attached to a belt worn around the patient’s waist. Once the patient swallows the capsule, they can continue with their daily activities. After six or eight hours, they return to the office with the recorder so that the more than 50,000 images can be downloaded and reviewed by Dr. Ulmer. After completion of the Pillcam study, the pill camera leaves the body through the stool naturally and need not be retrieved by the patient.

The PillCam SB is about the size of a standard vitamin (11mm x 26mm) and weighs less than four grams. In the event that a child cannot swallow the Pillcam, it can be quickly and easily placed and released into the stomach or small bowel by upper endoscopy (egd).

Rectal Suction Biopsy

A rectal suction biopsy is a procedure used to extract a tissue sample from the rectum for laboratory analysis and is most often performed under anesthesia or sedation. The rectum is the lowest six inches of the large intestine. A rectal biopsy is an important tool for determining the causes of abnormalities in the rectum such as Hirschsprung’s Disease.

Additional Testing:

Other recommended evaluations may include imaging tests performed at hospitals or imaging centers, including X-rays (upper GI series, swallowing evaluations), ultrasound, MRI (magnetic resonance imaging), CT (computerized tomography) and nuclear medicine tests.