Medications for rheumatoid arthritis can be hard on your stomach. Between heartburn, acid reflux, gas, GERD and other gastrointestinal shenanigans, chances are that sooner or later your doctor will suggest you get scoped. Even if you have the sound gastrointestinal constitution of a camel, there comes a time in your life where it just makes good sense to screen for other health conditions, such as colon cancer. Colonoscopies and endoscopies aren’t the most fun at the best of times, but can be more difficult with RA - today’s post looks at how to work around these challenges. I spoke to Dr. Cindy Haines, who gave me excellent tips for further research. Also thanks to Hanna T. Hanna of Main Drug Mart in Toronto for information regarding colonoscopy prep.
Let’s start at the top.
Endoscopy is a name for the type of procedure that looks inside the body using a flexible tube (or endoscope) with a light and a TV camera on one end and an eye piece on the other end. When laypeople talk about this, they usually mean what’s called an upper endoscopy, in which a doctor examines the esophagus, stomach and top part of the small intestine, looking for abnormalities or damage. Your doctor may order an upper endoscopies if you have acid reflux, stomach pains or as a way to diagnose GERD.
During an upper endoscopy, a small brace placed between the teeth to keep the mouth open and the endoscope is threaded through this brace into your stomach. The tube is 1/3 of an inch wide or less (8-11 mm). Before you panic, it’s important to know that you’ll receive sedation through an IV before the procedure and probably not remember what happened. The procedure itself lasts no more than 30 minutes. Preparing for an upper endoscopy usually involves fasting for about 12 hours.
If you have RA in your jaw joints, opening your mouth may be difficult. Having your mouth open for up to 30 minutes, even though you’re sedated, might strain your jaws, potentially causing a longer-term flare or pain. The good news is that there are options.
An alternative to the regular upper endoscopy is one where the doctor uses a smaller caliber scope, inserting it through the nose instead of the mouth. This eliminates the need for your mouth to be open for an extended time and reduces strain on the jaw joints. Another, significantly more high-tech, option is wireless capsule endoscopy or the “video pill.” This is the stuff of science fiction, my friends
In a capsule endoscopy, you swallow a capsule the size of a large pill. Within the pill is a small camera that takes pictures of your gastrointestinal system as it travels through your G.I. tract, transmitting it to a data recorder you wear for about 8 hours. These pictures become a sort of movie of your insides (see video here). It can be especially helpful to investigate the small intestine which can’t be reached by upper endoscopy or colonoscopy. Preparing for a capsule endoscopy also requires fasting and you might need to do a bowel prep/cleansing (see colonoscopy below).
If your RA affects your neck joints you may be concerned about the staff placing you in positions that can strain on your neck. This can be especially risky if RA has made your top neck joint unstable. Discuss this issue with your rheumatologist to get their input on ways to protect your neck during sedation or anesthesia.
A colonoscopy is a test that examines your large intestine or colon and your rectum for abnormalities. The US Preventive Services Task Force recommends starting regular colon cancer screening starting at age 50. If you have symptoms of something strange possibly going on in your colon, such as bleeding, your doctor may suggest you do a colonoscopy before the age of 50.
The procedure itself is much like an upper endoscopy, except it’s for the other end of your body. You’ll be sedated for this procedure and most don’t feel the examination or remember anything about it afterwards. While you are sleeping, a scope will be gently inserted through your anus and up into your colon. The doctor will examine your large intestine for abnormalities and if any are found, may snip a small piece of tissue biopsy.
In order to get a good look at your colon it needs to be empty. Before the procedure, you take a combination of laxatives and enemas and are usually told to not eat solid food or one or more days. The preparation comes in different forms - each specialist or lab has their preferred solution. It is usually a variant of mixing a powder or liquid with water and drinking quite a lot of it at set times the day before the procedure. This will give you a pretty severe case of diarrhea. If you have high levels of pain, fatigue or difficulty moving, having a prolonged case of diarrhea can be very challenging. Are there alternatives to colonoscopy?
The US Preventive Services Task Force (USPSTF) has developed colorectal cancer screening guidelines that include different tests at different intervals. Recommendations for timing of tests are general and your specific situation may warrant more frequent tests.
High-sensitivity fecal occult blood test. In this test, you take samples of your stool three days in a row and return the samples to your healthcare provider. The test checks for hidden blood, which may be an indication of abnormal growths and should be done every year.
Flexible sigmoidoscopy. In this test, a flexible tube (a sigmoidoscope) is used to look at the rectum and lower part of the colon. The USPSTF recommends this test be done every five years. Preparation for this usually involves sticking to clear fluids for a couple of days and an enema before the procedure.
The USPSTF recommends a colonoscopy be done every 10 years. An alternative to the regular colonoscopy is a “virtual colonoscopy,” which takes images of your colon using a CT scanner. For this test, you may have to clear your colon using laxatives the day before.
You may be able to use a sort of “pyramid” of tests, starting with the fecal occult blood test and moving up to more invasive tests in case specific concerns or risk factors are present. Make sure you discuss the pros and cons of each test with your doctor.
If you have concerns about different kinds of scopes and want to explore alternatives, make sure you have an appointment with the specialist before scheduling the procedure. Research the options and write a list of your questions and concerns. This will help ensure that your doctor fully understands your limitations, including caution when positioning, fatigue, pain and medications. An open dialogue will assist the specialist in thinking outside the box when planning your care.
This is the second post in a series on preventative health care for people living with RA. See the previous post on Pap tests and mammograms. The coming weeks will look at bone density tests and stress tests for heart health.
Lene is the author of the aard-winning blog The Seated View.