At the GutBiome Institute we provide traditional endoscopic procedures, as well as generation microbiome sequencing, intestinal permeability testing for leaky gut, parasitology analysis, and assessment for bacterial overgrowth – all in the privacy of your home.

 

Place of Procedure

Georgetown University Hospital
Division of Gastroenterology
3800 Reservoir Rd. NW
Washington, DC 20007
2nd floor Main Building. Room 2210

If your insurance company requires a referral, you must bring it with you. Also, please bring your insurance card(s),co-pay (if applicable) and a current picture ID with you on the day of your procedure(s).

Please Note

  • You must have a responsible adult accompany you home after the procedure. This person must pick you up in the endoscopy unit. They can check in at Room M-2210.
  • You may not take a taxi or bus home unless accompanied by a responsible adult.
  • You may not operate a motor vehicle for the remainder of the day following your procedure.

Colonoscopy Miralax Prep

Two days before your procedure purchase:

  • One bottle of Miralax (238 gm) or generic Glycolax (238 gm)
  • 4 Dulcolax laxative tablets (5 mg each)
  • 64 ounces of green juice or coconut water

24 hours before your procedure:

  • Refrigerate the green juice/coconut water.
  • Drink only clear liquids for breakfast, lunch and dinner (water, broth, apple juice, white grape juice, lemonade, coffee or tea). Do not drink any red liquids or artificial sweeteners.
  • At 3:00 pm take 2 Dulcolax laxative tablets with 8 ounces of clear liquid.
  • At 6:00 pm mix Miralax with the 64 ounce bottle of green juice/coconut water. Make sure the Miralax powder is well dissolved.
  • Drink an 8 ounce glass of the Miralax solution every 10-15 minutes until it is finished.
  • At 8:00 pm take 2 additional Dulcolax laxative tablets with 8 ounces of clear liquid.
  • Continue to drink as much clear liquid as possible until bedtime.
  • After midnight NOTHING BY MOUTH until after the procedure except for blood pressure medication which should be taken at least 4 hours before the procedure with a sip of water.

Day of your procedure:

  • Nothing to eat or drink the morning of the procedure. Do not eat hard candy or chew gum.
  • Wear comfortable clothing that is easy to remove and leave jewelry at home.
  • Please limit your visitors to 1 – 2 adults.
  • Report to Endoscopy Registration one hour prior to your scheduled procedure.Registration is located on the 2nd floor of the Main Hospital – Room M-2210
  • You will be brought to the Endoscopy Suite where you will be instructed to put on a hospital gown. A nurse will review your medical history with you (bring a list of your current medications and allergies). An intravenous line (IV) will be started in order to administer the sedation during your procedure.
  • Your heart rate, blood pressure and oxygen level will be monitored during the procedure.
  • When your procedure is finished, you will remain in the recovery room for up to one hour.
  • Dr Chutkan will discuss the results of your procedure with you and give you a written copy of the report.

Additional Information

  • If you are on blood thinners, insulin or other diabetic medications please check with your primary physician for instructions and let us know when you arrive for your procedure. You may call the Endoscopy nursing staff at 202-444-3302 or our office at 301-215-7700 if you have questions regarding your medications.
  • It is not uncommon for people to experience bloating, nausea, abdominal pain or even vomiting when drinking the bowel prep solution. If you experience any of these symptoms, take a break for 1-2 hours and then resume drinking at a slower rate.
  • If upon completion of the prep you are still passing solid stool, drink a 10 ounce bottle of citrate of Magnesium which can be obtained without a prescription.
  • Make sure you have not had anything to eat or drink for at least 6 hours prior to the procedure.

The Intestinal Permeability (IP) Assessment is a powerful, noninvasive test that measures absorption and barrier function of the gut. The small intestine functions as a digestive and absorptive organ for nutrients, as well as a powerful immune and physical barrier against excessive pathogenic bacteria, food antigens and other macromolecules.

The IP Assessment directly measures the ability of two non-metabolized sugar molecules – lactulose and mannitol – to permeate the intestinal mucosa. Your IP Assessment will include a drink containing a premeasured amount of lactulose and mannitol, which when consumed will reflect the degree of intestinal permeability through the levels of the two sugars recovered in urine samples over the next 6 hours.

After carefully following the instructions outlined in the link below, your collection of urine samples should remain in the refrigerator until shipped to Genova’s lab in the prepaid envelope provided.

Intestinal Permeability (IP) Assessment Kit Instructions: https://www.gdx.net/core/domestic-kit-instructions/Intestinal-Permeability-Instructions.pdf

Common FAQ’s

What is intestinal permeability? 

The small intestine functions as a selective barrier to toxins and large molecules, such as incompletely digested food particles. This test checks for an increase in intestinal permeability, which can indicate compromised barrier function of the small intestine, and is also known as “leaky gut”. Leaky gut is common in disorders such as inflammatory bowel disease, food allergies, autoimmune disease, chronic skin disorders and chronic inflammation.

What causes an increase in intestinal permeability?

Abnormal intestinal permeability can be caused by a number of different things, though the most common causes include:
• Intestinal infection
• Ingestion of allergenic foods or toxic chemicals

  • Overall poor diet
  • Deficient secretory IgA
  • Trauma and stressful lifestyle
  • NSAIDs
  • Antibiotics

Does the test need to be performed in a doctor’s office?

No, you may do the test yourself in the comfort of your home. Please be sure to carefully review and follow the instructions provided with the testing kit to ensure accurate results.

Must I fast before the test?

You must fast for 8 hours before beginning the test. We highly recommend you do the test first thing in the morning upon waking.

The test is taken over the course of 6 hours. Is fasting required throughout the entire duration?

Fasting is not required during the entire duration of the testing. However, do not eat or drink for two hours after taking the test drink. At two hours, drink a glass of water, then at least a cup of water every hour until you finish your test. You may eat and drink as usual two hours after taking the test drink.

Are there certain foods I should avoid throughout the duration of the test?

Yes, you must avoid certain foods or beverages, especially those containing fructose (fruit sugar), during the test. These include:
• Fruits, fruit juices, jams, jellies, etc.
• Soft drinks and foods sweetened with high fructose corn syrup
• Any dairy products
• Dietetic chocolate
• Honey and other sweeteners
• Mushrooms, beans (legumes including peanuts), celery
• Chewing gum

What is the turnaround time for the IP Assessment?

Once your samples have been received at the Genova Diagnostic lab, allow an additional 7-10 days for our office to receive the results of your IP Assessment. If you do not have a follow-up appointment scheduled, you can set up a phone consultation to discuss your results.

An easy 1-2-3 step process to understanding your gut bacteria, the uBiome Gut Kit gives you a comprehensive breakdown of your microbiome based on research from the NIH Human Microbiome Project. You’ll learn how your gut microbiota compares with other people, find out how well your gut bacteria metabolizes carbohydrates and over 100 other functions, and enhance the scientific research of the microbiome.

Additionally, analyzing the families of bacteria growing in your gut can provide us with valuable insight into your symptoms. We use this test in our practice to confirm abnormalities in the microbiome that we think may be responsible for your health conditions.  

Once you have registered your kit, you will collect a tiny stool sample with the swab provided, place the swab in the vial provided, then shake for a minute to transfer the bacteria. Discard the swab and close the vial tightly to shake for another minute. Then simply enclose your sample in the prepaid envelope and drop in the mail.

uBiome Gut Kit Instructions: http://ubiome.com/pages/faq#collect

Common FAQ’s

May I perform this test at home?

Yes, in fact uBiome created this test to be taken on your own at home.

How do I collect my sample?

All instructions for the kit are available online, once you activate your kit. To activate your kit, go to app.ubiome.com and follow the instructions there. You’ll find helpful information, like how long to swab for and what to do with your sample, before sending it in to uBiome.

I need a new sample tube – can I order another?

Your testing kit comes with a spare tube and swab, so any mistake can be remedied by using the spare included. If you still need a replacement, email support@ubiome.com to request your replacement.

Can my child take part in this test?

Yes, children can have their microbiome sequenced with parental permission. For kids under 18, a parent or guardian will need to sign a consent form, confirming they would like their child’s sample processed. Kids over 13 will also need to give their assent (non-binding approval) to make sure they understand what microbiome sequencing involves. (See the full consent forms at https://register.ubiome.com/images/forms/consents_combined.pdf.)

When and how will I get my results?

You’ll receive your results directly from uBiome via e-mail 4-6 weeks after submitting your sample. The results are password protected via the specific password you set up when you registered your kit with uBiome so we will not have access to your results. We ask that you send your kit ID number to admin@digestivecenterforwellness.com the day you register your kit online so that we have access to your results and can discuss them with you in detail. If you do not have a follow-up appointment scheduled, you can set up a phone consultation to discuss your results.

A detailed analysis of all intestinal parasites from all seven continents (including protozoa, trematodes, tapeworms, and nematodes), PCI’s Comprehensive Stool Analysis provides a detailed summary of findings based on the collection of stool samples. Also included is an analysis of bio-indicators, such as red and white blood cells, mucus, fatty acid crystals, starch granules, undigested tissue, and beneficial bacteria.

To perform the test, carefully follow the detailed instructions for your Comprehensive Stool Analysis kit (link below). You’ll collect two samples of soft stool specimens passed two to three days apart, or when you are experiencing the most symptoms. If your symptoms are cyclical (sometimes they are worse and then better) it is more important to take your specimens when you are feeling worse than following the general 2-3 days apart guideline. You’ll then mail your samples to PCI’s lab, storing them in a cool space (refrigeration is not necessary) until dropping in your mailbox.

PCI Comprehensive Stool Analysis Instructions: http://www.parasitetesting.com/files/Instructions%20for%20CSA%20test.pdf

Common FAQ’s

How do I know if I have a parasite?

It’s best to confirm the presence of a parasite through detailed stool testing. Parasites may cause the following symptoms, although these symptoms are nonspecific in nature and therefore not sufficient to make a diagnosis of parasitic infestation:

  • Abdominal pain
  • Diarrhea
  • Nausea or vomiting
  • Gas or bloating
  • Dysentery (loose stools containing blood and mucus)
  • Rash or itching around the rectum or genitals
  • Stomach pain or tenderness
  • Fatigue

What causes parasites?

Parasites may be caused by the following factors:

  • Contaminated drinking water
  • Skin contact with contaminated water
  • Contaminated food
  • Insects
  • People and pets
  • Soil containing parasite larvae

I thought parasites were more common in developing countries. Can I get a parasitic infection in the US?

Yes, because of modern trade, foreign travel, poor farming practices and other reasons, those residing in the US are still at risk of parasitic infections.

I’m concerned about my pet having parasites. Can I test them, as well?

Yes! You can use the same tests for your pets as you do for humans.

How long does it take to receive the results?

After about 7 days, we will receive the results of your Comprehensive Stool Analysis from the PCI lab. If you do not have a follow-up appointment scheduled, you can set up a phone consultation to discuss your results.

The Small Intestine Bacteria Overgrowth (SIBO) Breath Test is a non-invasive, easy to use gastrointestinal test that detects bacterial overgrowth in the small intestine. SIBO is a common gastrointestinal disorder that often underlies chronic gastrointestinal symptoms of maldigestion and malabsorption – including bloating, gas, diarrhea, irregularity, and abdominal pain. Some common causes of SIBO include a decrease in the production of hydrochloric acid from acid suppressing drugs; antibiotic use; and motility disorders where the intestinal contents are slowed down, leading to stasis and bacterial overgrowth.

To perform the test, follow the detailed instructions included in your kit. You will collect one breath sample; then, following the collection schedule provided in your test kit, you’ll collect five more breath samples after consuming the provided drink over the course of two hours. Once you’ve followed through with the instructions and completed the test, you’ll ship your samples to Genova’s lab in the prepaid envelope provided.

SIBO Breath Test Kit Instructions: https://www.gdx.net/core/domestic-kit-instructions/Bacterial-Overgrowth-Instructions.pdf

SIBO Breath Test Instructional Video: https://www.youtube.com/watch?v=Jjmltfh34PA&feature=youtu.be

Common FAQ’s

What is SIBO?

SIBO, or small intestinal bacterial overgrowth, is a change in the balance between helpful and pathogenic bacteria in the small intestine, with under-representation of “good” bacteria and overgrowth of “bad”. SIBO may interfere with the absorption of nutrients or digestion of food, and cause inflammation, which may damage the cells lining the interior walls of the small intestine. This damage may lead to the intestinal barrier becoming permeable, as well as further complications, including immune reactions that cause food allergies or sensitivities, general inflammation and autoimmune diseases.

What causes SIBO?

Though usually complex, the cause of SIBO includes the following:

  • Low stomach acid
  • Antibiotic use
  • Poor diet
  • Motility disorders
  • Partial bowel obstruction

Are there certain foods I shouldn’t consume before the test?

Yes, about 7 days prior to the test avoid the use of stool softeners or bulking agents, laxatives, and antacids containing aluminum or magnesium hydroxide.

Then, 24 hours before the test, limit your diet to the following foods:

  • Baked or broiled chicken, fish or turkey (salt and pepper only)
  • White bread (plain)
  • Plain steamed white rice
  • Eggs
  • Clear chicken or beef broth with no vegetable pieces

Must I fast before the test?

Yes, you must fast 12 hours before the test, though water is allowed.

When will I receive my results?

After about 10 days, our office will receive the results of your SIBO Breath Test from the Genova Diagnostics lab. If you do not have a follow-up appointment scheduled, you can set up a phone consultation to discuss your results.

Place of Procedure

Georgetown University Hospital
Division of Gastroenterology
3800 Reservoir Rd. NW
Washington, DC 20007
2nd floor Main Building. Room 2210

If your insurance company requires a referral, you must bring it with you. Also, please bring your insurance card(s),co-pay (if applicable) and a current picture ID with you on the day of your procedure(s).

Please Note

  • You must have a responsible adult accompany you home after the procedure. This person must pick you up in the endoscopy unit. They can check in at Room M-2210.
  • You may not take a taxi or bus home unless accompanied by a responsible adult.
  • You may not operate a motor vehicle for the remainder of the day following your procedure.

Endoscopy Prep Instructions

Day before your procedure:

  • Nothing by mouth after midnight the night before the procedure, except for blood pressure medication which should be taken at least 4 hours before the procedure with a sip of water. After the procedure is finished you will be able to resume your normal diet.

Day of your procedure:

  • Nothing to eat or drink the morning of the procedure. Do not eat hard candy or chew gum.
  • Wear comfortable clothing that is easy to remove and leave jewelry at home.
  • Please limit your visitors to 1 – 2 adults.
  • Report to Endoscopy Registration one hour prior to your scheduled procedure. Registration is located on the 2nd floor of the Main Hospital – Room M-2210
  • You will be brought to the Endoscopy Suite where you will be instructed to put on a hospital gown. A nurse will review your medical history with you (bring a list of your current medications and allergies). An intravenous line (IV) will be started in order to administer the sedation during your procedure.
  • Your heart rate, blood pressure and oxygen level will be monitored during the procedure.
  • When your procedure is finished, you will remain in the recovery room for up to one hour.
  • Dr Chutkan will discuss the results of your procedure with you and give you a written copy of the report.

Additional Information

  • If you are on blood thinners, insulin or other diabetic medications please check with your primary physician for instructions and let us know when you arrive for your procedure. You may call the Endoscopy nursing staff at 202-444-3302 or our office at 301-215-7700 if you have questions regarding your medications.
  • Make sure you have not had anything to eat or drink for at least 6 hours prior to the procedure.

What if physicians had a way to see inside a patient’s GI tract by having them simply swallowing a pill-sized camera? Today, more than a million patients have experienced the benefits from video capsule endoscopy (VCE). With VCE, physicians can visualize the intestines with a small, disposable capsule used to monitor and diagnose disorders of the gastrointestinal tract without sedation or invasive endoscopic procedures.
This procedure is the standard of care for small bowel evaluation, helping doctors detect the presence of inflammation and bleeding.

PillCam SB

PillCam SB is the most widely used, patient-friendly tool for directly visualizing the small bowel to detect and monitor abnormalities. This procedure is the standard of care for small bowel evaluation, helping healthcare practitioners detect the presence of lesions and what may be the source of obscure GI bleeding, Crohn’s disease and iron deficiency anemia.

With PillCam SB, physicians can visualize the entire small bowel without putting their patients through a lengthy, uncomfortable procedure or having them undergo sedation. By simply swallowing a vitamin-sized capsule, physicians may detect and monitor lesions, ulcers, tumors, and bleeding within the small bowel.

PillCamCOLON

PillCam® COLON capsule endoscopy is a minimally invasive tool for direct visualization of the colon, including identifying the occurrence of polyps. PillCam COLON is complementary to colonoscopy and may be used as an alternative for those who refuse other invasive colon exams or in some patients who have higher risk for complications from colonoscopy including patients with bleeding, or sedation risks, previous incomplete colonoscopy or for patients with inflammatory bowel disease.

PillCamESO

Initially cleared by the U.S. Food and Drug Administration in 2004, PillCam® ESO is a patient-friendly tool for visualizing the esophagus. By visualizing the esophagus, physicians can monitor and detect abnormalities including esophageal varices, Barrett’s Esophagus and esophageal cancers.

Click here for additional PillCam information

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