Three-Gas Breath Test Preparation Instructions

This test measures hydrogen, methane, and hydrogen sulfide gases in your breath. These gases are produced when intestinal microbes ferment carbohydrates. Careful preparation is essential for an accurate result.

12–24 Hours Before the Test: Strict Preparation Diet

Eat only the following:

• Baked or boiled chicken breast, turkey breast, or white fish
• Plain steamed white rice
• Eggs
• Plain water

Do not eat or drink:

• Dairy products
• Fruits or vegetables
• Beans, lentils, nuts, or seeds
• Garlic, onions, herbs, spices, or seasonings
• Butter, oils, sauces, or condiments
• Bread, pasta, cereal, oats, or other gluten-containing grains
• Alcohol, juice, soda, coffee, tea, or flavored beverages

Final 12 Hours Before the Test

• Do not eat or drink anything except plain water.
• Do not take medications or supplements that must be held, as listed below.

Day of the Test

• Do not smoke or vape.
• Do not exercise or perform strenuous physical activity.
• Do not chew gum or use mints.
• Brush your teeth 2 hours before the test, but do not swallow toothpaste.
• Plain water is allowed unless otherwise instructed.

Medications, Supplements, and Treatments to Hold

Hold for 4 Weeks (28 Days) Before the Test

All prescription antibiotics, including:

• Rifaximin (Xifaxan)
• Neomycin
• Metronidazole (Flagyl)
• Amoxicillin (Amoxil)
• Amoxicillin-clavulanate (Augmentin)
• Azithromycin (Zithromax)
• Clarithromycin (Biaxin)
• Ciprofloxacin (Cipro)
• Doxycycline (Vibramycin)
• Levofloxacin (Levaquin)
• Nitrofurantoin (Macrobid)
• Sulfamethoxazole-trimethoprim (Bactrim)
• Tetracycline
• Any other oral, injectable, or intravenous antibiotic

Herbal antimicrobials, including:

• Berberine
• Oregano oil
• Neem
• Allicin
• Garlic extract
• Grapefruit seed extract
• Olive leaf extract
• Artemisinin
• Wormwood
• Black walnut
• Uva ursi
• FC Cidal
• Dysbiocide
• Candibactin-AR
• Candibactin-BR
• MBIOTA
• Any other antimicrobial or “SIBO treatment” supplement

Colon-cleansing treatments, including:

• Colonoscopy bowel preparations
• Barium enemas
• Colonics or colonic irrigation
• Bowel cleanse kits
• Magnesium citrate bowel cleanse products

Hold for 2 Weeks (14 Days) Before the Test

All probiotics, including:

• Visbiome
• Culturelle
• Florastor
• Align
• Activia
• Yakult
• Kefir or probiotic yogurt
• Spore-based probiotics
• Saccharomyces boulardii products
• Lactobacillus products
• Bifidobacterium products
• Combination probiotic products
• Probiotic-containing digestive supplements

Hold for 7 Days Before the Test

All laxatives, stool softeners, bowel-regimen medications, and constipation medications, including:

• Polyethylene glycol 3350 (MiraLAX)
• Lactulose (Constulose)
• Senna (Senokot)
• Bisacodyl (Dulcolax)
• Docusate (Colace)
• Magnesium hydroxide (Milk of Magnesia)
• Magnesium citrate
• Magnesium oxide
• Magnesium glycinate
• Magnesium-containing constipation supplements
• Sodium phosphate enemas (Fleet Enema)
• Glycerin suppositories
• Mineral oil
• Castor oil
• Lubiprostone (Amitiza)
• Linaclotide (Linzess)
• Plecanatide (Trulance)
• Tenapanor (Ibsrela)
• Prucalopride (Motegrity)
• Colchicine
• Any other prescription or over-the-counter laxative, enema, suppository, or constipation treatment

Bulk-forming fiber supplements and dietary laxatives, including:

• Psyllium (Metamucil)
• Methylcellulose (Citrucel)
• Calcium polycarbophil (FiberCon)
• Wheat dextrin (Benefiber)
• Inulin
• Partially hydrolyzed guar gum
• Acacia fiber
• Flaxseed
• Chia seeds
• Two green kiwifruit daily
• Any fiber powder, gummy, capsule, chew, or drink supplement

Prokinetic or motility medications, including:

• Prucalopride (Motegrity)
• Metoclopramide (Reglan)
• Domperidone
• Erythromycin
• Pyridostigmine (Mestinon)
• Vibrant capsule
• Bethanechol (Urecholine)
• Tegaserod (Zelnorm)
• Any other medication or supplement used to stimulate stomach or intestinal movement

All proton-pump inhibitors (PPIs), including:

• Omeprazole (Prilosec)
• Esomeprazole (Nexium)
• Lansoprazole (Prevacid)
• Dexlansoprazole (Dexilant)
• Pantoprazole (Protonix)
• Rabeprazole (AcipHex)
• Omeprazole-sodium bicarbonate (Zegerid)

Potassium-competitive acid blockers (PCABs), including:

• Vonoprazan (Voquezna)

Hold for 24–48 Hours Before the Test

Digestive enzymes, including:

• Alpha-galactosidase (Beano)
• Lactase (Lactaid)
• FODZYME
• Fructaid
• Pancrelipase (Creon)
• Pancrelipase (Zenpep)
• Pancrelipase (Pancreaze)
• Pancrelipase (Pertzye)
• Pancrelipase (Viokace)
• Betaine hydrochloride
• Ox bile
• Broad-spectrum digestive enzyme blends

Gas-relief products and carminatives, including:

• Simethicone (Gas-X)
• Iberogast
• Peppermint oil (IBgard)
• Ginger
• Chamomile
• Fennel
• Caraway
• Any herbal tea or supplement used for gas, bloating, nausea, or digestion

Elemental diets and meal-replacement formulas

• Stop elemental diets and transition to the strict preparation diet at least 24 hours before the test.
• This includes elemental formulas, semi-elemental formulas, liquid nutrition shakes, and meal-replacement drinks.

Gastric Emptying Study Preparation Instructions

This study measures how quickly a standard meal leaves the stomach. It is used to evaluate for delayed gastric emptying (gastroparesis) or rapid gastric emptying (dumping syndrome). You will eat a small meal labeled with technetium-99m (99mTc), followed by imaging over several hours.

Fasting and Day-of-Test Instructions

• Do not eat or drink anything after midnight before the test, unless instructed otherwise.
• Do not smoke, vape, use nicotine patches, or use other nicotine products on the morning of the test.
• Do not drink coffee, tea, energy drinks, or other caffeine-containing products on the morning of the test.
• Do not chew gum or use mints.
• Plan to remain in the imaging department for the full testing period.

Diabetes and Blood Sugar Instructions

• Your fasting finger-stick blood glucose must be less than 200 mg/dL before you eat the test meal.
• Bring your morning insulin and glucose monitor to the appointment.
• Take insulin with the 99mTc-labeled test meal as directed by the imaging team.
• If your blood glucose is 200 mg/dL or higher, the study may need to be rescheduled because elevated blood sugar can slow stomach emptying and affect accuracy.

Medications, Supplements, and Treatments to Hold

Unless specifically instructed otherwise, hold the following medications and supplements for 48–72 hours before the test. Do not stop medications that are medically necessary without specific instructions from the prescribing clinician.

Prokinetic and Motility Medications

• Metoclopramide (Reglan)
• Domperidone
• Erythromycin
• Azithromycin (Zithromax)
• Prucalopride (Motegrity)
• Pyridostigmine (Mestinon)
• Bethanechol (Urecholine)
• Tegaserod (Zelnorm)
• Any other medication or supplement used to speed stomach or intestinal movement

Antiemetic and Antinausea Medications

• Ondansetron (Zofran)
• Granisetron (Sancuso)
• Palonosetron (Aloxi)
• Promethazine (Phenergan)
• Prochlorperazine (Compazine)
• Aprepitant (Emend)
• Fosaprepitant (Emend)
• Scopolamine transdermal patch (Transderm Scōp)
• Cyproheptadine (Periactin)
• Metoclopramide (Reglan)
• Trimethobenzamide (Tigan)
• Droperidol (Inapsine)
• Haloperidol (Haldol)
• Olanzapine (Zyprexa)

Over-the-Counter and Herbal Nausea Remedies

• Phosphorated carbohydrate solution (Emetrol)
• Sodium citrate (Nauzene)
• Dimenhydrinate (Dramamine)
• Meclizine (Bonine)
• Ginger or ginger root
• Fennel
• Chamomile
• Lemon balm
• Peppermint
• L-carnitine
• Coenzyme Q10 (CoQ10)
• Any over-the-counter or herbal product used for nausea, bloating, digestion, or motion sickness

Antispasmodic and Anticholinergic Medications

• Dicyclomine (Bentyl)
• Hyoscyamine (Levsin)
• Glycopyrrolate (Robinul)
• Methscopolamine (Pamine)
• Scopolamine transdermal patch (Transderm Scōp)
• Atropine
• Belladonna-containing products
• Oxybutynin (Ditropan)
• Tolterodine (Detrol)
• Solifenacin (Vesicare)
• Trospium (Sanctura)
• Fesoterodine (Toviaz)
• Darifenacin (Enablex)
• Ipratropium (Atrovent)
• Tiotropium (Spiriva)
• Benztropine (Cogentin)
• Trihexyphenidyl (Artane)
• Cyclobenzaprine (Flexeril)
• Orphenadrine (Norflex)
• Peppermint oil (IBgard)
• Buspirone (Buspar)

Antidiarrheal Medications and Bile-Acid Binders

• Loperamide (Imodium)
• Diphenoxylate-atropine (Lomotil)
• Eluxadoline (Viberzi)
• Alosetron (Lotronex)
• Bismuth subsalicylate (Pepto-Bismol)
• Colesevelam (Welchol)
• Colestipol (Colestid)
• Cholestyramine (Questran)
• Any other medication used to slow bowel movements or bind bile acids

Opioids and Cannabinoids: Discuss With Your Prescribing Provider

Opioid pain medications and cannabis products can slow stomach emptying and affect test accuracy.

Opioids are typically held for 48–72 hours before the test. However, do not stop opioid medications on your own. Contact the clinician who prescribes these medications to determine whether it is safe for you to hold them and for specific instructions on timing. Abruptly stopping opioids may cause withdrawal symptoms or uncontrolled pain.

This includes:

• Codeine
• Hydrocodone (Norco, Vicodin)
• Oxycodone (OxyContin, Percocet)
• Morphine (MS Contin)
• Hydromorphone (Dilaudid)
• Fentanyl (Duragesic)
• Methadone (Dolophine)
• Buprenorphine (Suboxone, Butrans, Belbuca)
• Tramadol (Ultram)
• Tapentadol (Nucynta)

Cannabis products are typically held for 48–72 hours before the test, including:

• Medical cannabis
• Recreational cannabis
• THC-containing products
• CBD-containing products
• Cannabis edibles, tinctures, vapes, and topical products

GLP-1 and Dual GIP/GLP-1 Medications

These medications can slow stomach emptying and may affect the study.

Hold daily formulations for 48–72 hours before the test:

• Liraglutide (Victoza, Saxenda)
• Exenatide twice daily (Byetta)
• Lixisenatide (Adlyxin)
• Oral semaglutide (Rybelsus)

Hold weekly formulations for 1–2 weeks before the test, according to the imaging facility’s protocol:

• Semaglutide (Ozempic, Wegovy)
• Tirzepatide (Mounjaro, Zepbound)
• Dulaglutide (Trulicity)
• Exenatide extended-release (Bydureon)
• Semaglutide-containing compounded products
• Tirzepatide-containing compounded products

Neuromodulators: Hold for 48 Hours Before the Test When Clinically Safe

• Amitriptyline (Elavil)
• Nortriptyline (Pamelor)
• Desipramine (Norpramin)
• Imipramine (Tofranil)
• Doxepin (Sinequan)
• Mirtazapine (Remeron)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Risperidone (Risperdal)
• Duloxetine (Cymbalta)
• Venlafaxine (Effexor)
• Desvenlafaxine (Pristiq)
• Gabapentin (Neurontin)
• Pregabalin (Lyrica)
• Topiramate (Topamax)
• Trazodone (Desyrel)
• Sertraline (Zoloft)
• Fluoxetine (Prozac)
• Escitalopram (Lexapro)
• Paroxetine (Paxil)
• Citalopram (Celexa)

Important: If you are uncertain whether a medication, supplement, over-the-counter product, or herbal product should be held, bring the product or a complete medication list to the imaging appointment. Do not discontinue seizure medications, psychiatric medications, heart medications, blood-pressure medications, anticoagulants, or other essential medications unless specifically instructed to do so.

Esophageal Manometry Preparation Instructions

This test evaluates how the esophagus moves food and liquid toward the stomach. It measures esophageal peristalsis, swallowing-related upper and lower esophageal sphincter function, and contraction patterns using the Chicago Classification v4.0.

Fasting and Dietary Instructions

• Do not eat or drink anything for 6–8 hours before catheter placement.
• Maintain your usual diet until the fasting period begins.
• Avoid a heavy or high-fat meal the evening before the procedure.
• Do not chew gum, use mints, smoke, or vape during the fasting period.

Medications, Supplements, and Treatments to Hold

Unless specifically instructed otherwise, hold the following medications and supplements for 48–72 hours before the procedure. These products can alter esophageal contractions or lower esophageal sphincter pressure and may affect the accuracy of the study.

Prokinetic and Motility Medications

• Metoclopramide (Reglan)
• Domperidone
• Erythromycin
• Azithromycin (Zithromax)
• Prucalopride (Motegrity)
• Pyridostigmine (Mestinon)
• Bethanechol (Urecholine)
• Tegaserod (Zelnorm)
• Any other medication or supplement used to stimulate stomach or intestinal movement

Prescription Smooth Muscle Relaxants and Spasmolytics

• Dicyclomine (Bentyl)
• Hyoscyamine (Levsin)
• Buspirone (Buspar)
• Nitroglycerin (Nitrostat)
• Isosorbide dinitrate (Isordil)
• Isosorbide mononitrate (Imdur)
• Amlodipine (Norvasc)
• Diltiazem (Cardizem)
• Nifedipine (Procardia)
• Verapamil (Calan)
• Felodipine (Plendil)
• Nicardipine (Cardene)
• Clevidipine (Cleviprex)
• Any other nitrate or calcium channel blocker

Over-the-Counter and Herbal Spasmolytics

• Peppermint oil (IBgard, Mintec)
• Iberogast
• Peppermint tea
• Fennel
• Chamomile
• Ginger
• Lemon balm
• Any over-the-counter or herbal product used for esophageal spasm, bloating, indigestion, or digestive discomfort

Opioids: Discuss With Your Prescribing Provider

Opioid pain medications can alter lower esophageal sphincter pressure and esophageal contractions. They can produce motility patterns that resemble type III achalasia, esophagogastric junction outflow obstruction, distal esophageal spasm, or hypercontractile esophagus.

Opioids are typically held for 48–72 hours before the procedure. The appropriate hold time may vary based on the specific medication, dose, formulation, and medical indication.

Do not stop opioid medications on your own. Discuss the timing of any medication hold with the clinician who prescribes your opioid medication. Abrupt discontinuation can cause withdrawal symptoms or uncontrolled pain.

This includes:

• Codeine
• Hydrocodone (Norco, Vicodin)
• Oxycodone (OxyContin, Percocet)
• Morphine (MS Contin)
• Hydromorphone (Dilaudid)
• Fentanyl (Duragesic)
• Methadone (Dolophine)
• Buprenorphine (Suboxone, Butrans, Belbuca)
• Tramadol (Ultram)
• Tapentadol (Nucynta)
• Any other short-acting or long-acting opioid pain medication

Medications to Hold the Morning of the Procedure

Hold the following on the morning of the procedure unless specifically instructed otherwise. These medications can reduce swallowing-related inhibition or weaken esophageal contraction strength.

Benzodiazepines and Sedatives

• Alprazolam (Xanax)
• Clonazepam (Klonopin)
• Diazepam (Valium)
• Lorazepam (Ativan)
• Temazepam (Restoril)
• Oxazepam (Serax)
• Chlordiazepoxide (Librium)
• Midazolam (Versed)
• Zolpidem (Ambien)
• Eszopiclone (Lunesta)
• Zaleplon (Sonata)
• Hydroxyzine (Atarax, Vistaril)
• Diphenhydramine (Benadryl)
• Doxylamine (Unisom)
• Any other sleep aid, sedative, or anti-anxiety medication

Skeletal Muscle Relaxants

• Baclofen (Lioresal)
• Cyclobenzaprine (Flexeril)
• Methocarbamol (Robaxin)
• Tizanidine (Zanaflex)
• Carisoprodol (Soma)
• Metaxalone (Skelaxin)
• Chlorzoxazone (Parafon Forte)
• Orphenadrine (Norflex)
• Any other muscle relaxant

Important: If you are uncertain whether a medication, supplement, over-the-counter product, or herbal product should be held, bring the product or a complete medication list to the appointment. Do not discontinue seizure medications, psychiatric medications, heart medications, blood-pressure medications, anticoagulants, or other essential medications unless specifically instructed to do so.

Quantifies acid and non-acid reflux, bolus clearance, mean nocturnal baseline impedance (MNBI), and symptom association probability (SAP) under Lyon Consensus 2.0.
Fasting & Ingestion: Strict NPO for 4 to 6 hours prior to catheter placement. Resume normal eating, drinking, and daily activities once positioned.

• Dietary Guidance: Consume standard, uninhibited daily meals and typical personal triggers during recording to capture true reflux events.

• Hold Schedule (If Testing OFF Therapy for Baseline Diagnosis):

  • Hold 7 to 14 Days (Minimum 7 Days): Proton Pump Inhibitors (PPIs)—Omeprazole, Esomeprazole, Pantoprazole, Lansoprazole, Dexlansoprazole, Rabeprazole; Potassium-Competitive Acid Blockers (PCABs)—Vonoprazan (Voquezna).

  • Hold 48 Hours: Histamine-2 Receptor Antagonists (H2RAs)—Famotidine, Cimetidine; Promotility agents.

  • Hold 24 Hours: Antacids, Alginates & Mucosal Protectants—Sodium Alginate (Gaviscon Advance), Bismuth Subsalicylate (Pepto-Bismol), Calcium Carbonate (Tums), Apple Cider Vinegar, Aloe Vera Juice, Slippery Elm, White Rice Water.

• Note on ON-Therapy Testing: If ordered to evaluate refractory symptoms despite optimal medical therapy, continue all prescribed acid suppression without pause.

Wireless pH Capsule Preparation Instructions

This test measures the amount of acid exposure in the esophagus over 48–96 hours. During an upper endoscopy, a small wireless capsule is attached to the lining of the esophagus. The capsule sends information to a receiver that you will carry during the recording period.

Fasting and Day-of-Procedure Instructions

• Do not eat or drink anything after midnight before your procedure unless instructed otherwise.
• Follow all instructions provided for sedated endoscopy, including medication and transportation instructions.
• You must have a responsible adult available to take you home after sedation.
• Do not have an MRI for 30 days after capsule placement or until you have confirmed that the capsule has passed.

During the Recording Period

To obtain accurate results, continue your usual daily activities, meals, and sleep routine.

• Eat your normal, unrestricted diet.
• Do not follow a reflux-protective, low-acid, low-fat, or otherwise restricted diet during the study.
• Do not intentionally avoid foods or activities that usually bring on your symptoms.
• Record meals, sleep periods, body position, and symptoms as instructed.
• Keep the receiver with you as directed throughout the study.

Acid-Reducing Medications, Supplements, and Remedies to Hold

This study is being performed OFF acid-suppressing treatment to measure your baseline acid exposure. Unless specifically instructed otherwise, follow the medication hold schedule below.

Hold for 7–14 Days Before the Procedure

All proton-pump inhibitors (PPIs), including:

• Omeprazole (Prilosec)
• Esomeprazole (Nexium)
• Lansoprazole (Prevacid)
• Dexlansoprazole (Dexilant)
• Pantoprazole (Protonix)
• Rabeprazole (AcipHex)
• Omeprazole-sodium bicarbonate (Zegerid)
• Any prescription, over-the-counter, combination, or compounded PPI product

Potassium-competitive acid blockers (PCABs), including:

• Vonoprazan (Voquezna)

Hold for 48 Hours Before the Procedure

All histamine-2 receptor antagonists (H2RAs), including:

• Famotidine (Pepcid)
• Cimetidine (Tagamet)
• Nizatidine (Axid)
• Any prescription or over-the-counter H2RA product

Hold for 24 Hours Before the Procedure

Over-the-counter antacids, including:

• Calcium carbonate (Tums)
• Calcium carbonate/magnesium hydroxide (Rolaids)
• Aluminum hydroxide/magnesium hydroxide/simethicone (Maalox)
• Aluminum hydroxide/magnesium hydroxide (Mylanta)
• Magnesium hydroxide/aluminum hydroxide (Gaviscon)
• Sodium bicarbonate (Alka-Seltzer)
• Sodium bicarbonate (Baking soda)
• Any chewable, liquid, powder, or effervescent antacid product

Alginates, including:

• Sodium alginate (Gaviscon Advance)
• Alginate-containing reflux products
• Any raft-forming reflux or heartburn product

Bismuth-containing products, including:

• Bismuth subsalicylate (Pepto-Bismol)
• Any bismuth-containing stomach-relief product

Home remedies and herbal products used for reflux or indigestion, including:

• Apple cider vinegar
• Aloe vera
• Slippery elm
• Marshmallow root
• Licorice or deglycyrrhizinated licorice (DGL)
• Ginger
• Chamomile
• Fennel
• Peppermint
• Iberogast
• Digestive bitters
• Any herbal tea, supplement, or home remedy used for heartburn, reflux, indigestion, nausea, bloating, or stomach discomfort

Important: Do not stop anticoagulants, antiplatelet medications, insulin, diabetes medications, seizure medications, heart medications, blood-pressure medications, or other essential medications unless you receive specific instructions to do so. If you are uncertain whether a medication, supplement, or over-the-counter product should be held, contact the endoscopy or GI office before your procedure.

Measures luminal cross-sectional area (CSA), distensibility index (DI), and compliance of the gastroesophageal junction or pylorus during sedated endoscopy.

• Fasting & Ingestion: Strict NPO from midnight prior.

• Hold 48 to 72 Hours Prior:

  • Smooth Muscle Relaxants: Nitrates, Calcium Channel Blockers, Dicyclomine, Hyoscyamine, Buspirone, Peppermint Oil (IBgard).

  • Motility Modulators & Prokinetics: Metoclopramide, Domperidone, Erythromycin, Prucalopride.

  • Opioids: All narcotic analgesics (suppress compliance and induce secondary spasm).

 EGD with  Small-Bowel Aspirate Culture (SIBO, SIFO Testing)

This procedure obtains a sterile fluid sample during upper endoscopy for quantitative bacterial culture and fungal isolation, including Candida species.

Fasting Instructions

• Do not eat or drink anything for 8–12 hours before the procedure.
• Follow all additional instructions provided for sedated endoscopy, including transportation requirements.

Medications, Supplements, and Treatments to Hold

Hold for 4 Weeks (28 Days) Before the Procedure

Prescription antibiotics, including:

• Rifaximin (Xifaxan)
• Neomycin
• Metronidazole (Flagyl)
• Amoxicillin (Amoxil)
• Amoxicillin-clavulanate (Augmentin)
• Azithromycin (Zithromax)
• Clarithromycin (Biaxin)
• Ciprofloxacin (Cipro)
• Levofloxacin (Levaquin)
• Doxycycline (Vibramycin)
• Tetracycline
• Trimethoprim-sulfamethoxazole (Bactrim)
• Nitrofurantoin (Macrobid)
• Any other oral, injected, or intravenous antibiotic

Herbal antimicrobials, including:

• Berberine
• Oregano oil
• Neem
• Allicin
• Garlic extract
• Grapefruit seed extract
• Olive leaf extract
• Artemisinin
• Wormwood
• Black walnut
• Uva ursi
• Candibactin-AR
• Candibactin-BR
• Dysbiocide
• FC Cidal
• Any other antimicrobial or “SIBO treatment” supplement

Hold for 2–4 Weeks Before the Procedure

Systemic and oral antifungal medications, including:

• Fluconazole (Diflucan)
• Itraconazole (Sporanox)
• Voriconazole (Vfend)
• Posaconazole (Noxafil)
• Isavuconazonium (Cresemba)
• Nystatin (Mycostatin)
• Amphotericin B
• Ketoconazole (Nizoral)
• Clotrimazole (Mycelex)
• Miconazole (Monistat)
• Any other oral or systemic antifungal medication

Hold for 2 Weeks (14 Days) Before the Procedure

All probiotics, including:

• Visbiome
• Culturelle
• Align
• Florastor
• Saccharomyces boulardii (Florastor)
• Spore-based probiotics
• Lactobacillus products
• Bifidobacterium products
• Combination probiotic products
• Probiotic-containing digestive supplements
• Probiotic yogurt, kefir, and other probiotic foods

Hold for 7–14 Days Before the Procedure

All proton-pump inhibitors (PPIs), including:

• Omeprazole (Prilosec)
• Esomeprazole (Nexium)
• Lansoprazole (Prevacid)
• Dexlansoprazole (Dexilant)
• Pantoprazole (Protonix)
• Rabeprazole (AcipHex)
• Omeprazole-sodium bicarbonate (Zegerid)
• Any prescription, over-the-counter, combination, or compounded PPI product

Potassium-competitive acid blockers (PCABs), including:

• Vonoprazan (Voquezna)

Hold for 7 Days Before the Procedure

Motility medications and prokinetics, including:

• Prucalopride (Motegrity)
• Metoclopramide (Reglan)
• Erythromycin
• Azithromycin (Zithromax)
• Domperidone
• Pyridostigmine (Mestinon)
• Bethanechol (Urecholine)
• Tegaserod (Zelnorm)
• Any other medication or supplement used to stimulate stomach or intestinal movement

Hold for 24–48 Hours Before the Procedure

Elemental diets and nutritional formulas, including:

• Elemental formulas
• Semi-elemental formulas
• Liquid nutrition shakes
• Meal-replacement drinks

Digestive enzymes, including:

• Alpha-galactosidase (Beano)
• Lactase (Lactaid)
• FODZYME
• Fructaid
• Pancrelipase (Creon)
• Pancrelipase (Zenpep)
• Pancrelipase (Pancreaze)
• Pancrelipase (Pertzye)
• Pancrelipase (Viokace)
• Betaine hydrochloride
• Ox bile
• Broad-spectrum digestive enzyme blends

Gas-relief products and carminatives, including:

• Simethicone (Gas-X)
• Iberogast
• Peppermint oil (IBgard)
• Ginger
• Chamomile
• Fennel
• Caraway
• Lemon balm
• Any herbal tea or supplement used for gas, bloating, nausea, or digestion

Important: Do not stop anticoagulants, antiplatelet medications, insulin, diabetes medications, seizure medications, heart medications, blood-pressure medications, or other essential medications unless you receive specific instructions to do so.

EGD With Duodenal Biopsies for Disaccharidase Activity Preparation

This procedure obtains small-bowel biopsies during upper endoscopy to measure digestive enzyme activity, including lactase, sucrase, maltase, and palatinase/isomaltase. It may help evaluate for congenital or acquired disaccharidase deficiency, including congenital sucrase-isomaltase deficiency (CSID).

Fasting Instructions

• Do not eat or drink anything for 6–8 hours before the procedure.
• Follow all additional instructions provided for sedated endoscopy, including transportation requirements.

Dietary Instructions Before the Procedure

• Maintain your usual carbohydrate intake for 2–3 weeks before the procedure.
• Do not begin a zero-carbohydrate, ketogenic, or carnivore diet before testing.
• Do not substantially restrict carbohydrates unless specifically instructed to do so.

Medications, Supplements, and Treatments to Hold

Hold for 48–72 Hours Before the Procedure

Digestive enzyme supplements, including:

• Sacrosidase (Sucraid)
• Lactase (Lactaid)
• Alpha-galactosidase (Beano)
• Pancrelipase (Creon)
• Pancrelipase (Zenpep)
• Pancrelipase (Pancreaze)
• Pancrelipase (Pertzye)
• Pancrelipase (Viokace)
• FODZYME
• Fructaid
• Starchway
• Betaine hydrochloride
• Ox bile
• Broad-spectrum digestive enzyme blends
• Any enzyme powder, capsule, chew, liquid, or digestive support supplement

Hold for 24 Hours Before the Procedure

Products that coat or adhere to the intestinal lining, including:

• Sucralfate (Carafate)
• Bismuth subsalicylate (Pepto-Bismol)
• Sodium alginate (Gaviscon Advance)
• Alginate-containing reflux products
• Aloe vera
• Slippery elm
• Marshmallow root
• Licorice or deglycyrrhizinated licorice (DGL)
• Any coating agent, mucosal protectant, or herbal digestive product

Important: Do not stop anticoagulants, antiplatelet medications, insulin, diabetes medications, seizure medications, heart medications, blood-pressure medications, or other essential medications unless you receive specific instructions to do so.

Evaluates total and segmental transit time to distinguish normal transit, colonic inertia, and functional pelvic outlet obstruction.

• Fasting & Ingestion: Ingest Sitzmarks capsule (24 radiopaque markers) on Day 1 at a set morning time. Obtain an abdominal KUB radiograph on Day 5 (120 hours post-ingestion).

• Dietary Guidance: Maintain habitual daily fiber and fluid intake; do not fast.

• Hold Schedule (Hold Starting 3 to 5 Days BEFORE Ingestion and Continuously Throughout All 5 Days of the Study):

  • All Laxatives: PEG 3350 (Miralax), Senna, Bisacodyl, Milk of Magnesia, Magnesium Citrate, Docusate Sodium (Colace).

  • Dietary Laxatives & Supplemental Fibers: Psyllium (Metamucil), Methylcellulose (Citrucel), Calcium Polycarbophil (FiberCon), Flaxseed, Two Green Kiwifruit daily.

  • Secretagogues & Prokinetics: Linaclotide (Linzess), Plecanatide (Trulance), Lubiprostone (Amitiza), Tenapanor (Ibsrella), Prucalopride (Motegrity), Pyridostigmine (Mestinon), Vibrating Capsule (Vibrant), Colchicine.

  • Suppositories & Enemas: All bisacodyl, glycerin suppositories, and Fleet enemas.

  • Antidiarrheals & Spasmolytics: Loperamide, Lomotil, Viberzi, Lotronex, Dicyclomine, Hyoscyamine, Peppermint Oil.

Assesses resting/squeeze anal sphincter pressures, the rectoanal inhibitory reflex (RAIR), sensory thresholds, and pelvic floor coordination during evacuation under the London Classification.

• Fasting & Bowel Prep: Light liquid meal up to 2 hours prior. Clear the rectal ampulla using 1 to 2 Fleet saline enemas administered at home 2 hours before the examination.

• Hold 24 to 48 Hours Prior:

  • Laxatives & Stool Softeners: PEG 3350, Senna, Bisacodyl, Milk of Magnesia, Magnesium Citrate, Docusate Sodium.

  • Secretagogues & Prokinetics: Linaclotide, Plecanatide, Lubiprostone, Tenapanor, Prucalopride.

  • Antidiarrheals & Binders: Loperamide, Lomotil, Viberzi, Lotronex, Colesevelam, Colestipol, Cholestyramine.

• Hold Morning of Test: Centrally acting skeletal muscle relaxants (Baclofen, Flexeril), topical rectal lidocaine, or nitroglycerin ointments (artificially lower resting internal sphincter tone).

Visualizes dynamic pelvic organ support, rectal evacuation dynamics, internal intussusception, rectocele, enterocele, and dyssynergic pelvic floor contraction.

• Fasting & Bowel Prep: Clear liquid diet or light meal up to 2 hours prior. Administer a single Fleet saline enema 2 hours prior if required by imaging facility protocol.

• Hold 24 to 48 Hours Prior: Active osmotic or stimulant laxatives (Miralax, high-dose Senna, Magnesium Citrate) that induce loose, unformed liquid stool and risk premature contrast loss.

• Hold Morning of Test: Skeletal muscle relaxants.

Neuromuscular operant conditioning targeting paradoxical puborectalis contraction (dyssynergic defecation) and sensory threshold normalization.

• Preparation & Patient Protocol:

  • No Day-of Enemas: Do not administer Fleet enemas or suppositories immediately prior to sessions; mucosal liquid residue triggers urgency reflexes and interferes with probe contact.

  • Attire: Loose clothing to accommodate diaphragmatic breathing exercises.

• Dietary Guidance: Maintain consistent soluble fiber (25 to 35 g daily) and hydration (1.5 to 2 L daily) to target Bristol Stool Form Type 4.

• Medications to Continue vs. Hold:

  • Continue Baseline Stool Softeners: Continue scheduled osmotic laxatives (Miralax) or secretagogues (Linzess, Trulance). Retraining requires soft-formed stool to practice normal expulsion biomechanics without impaction.

  • Hold Morning of Session: Acute fast-acting stimulants (Bisacodyl, high-dose Senna, Magnesium Citrate) to prevent urgent incontinence; muscle relaxants and high-dose benzodiazepines that blunt cortical voluntary motor control.