BARIUM GI STUDIES

BARIUM GI STUDIES-Upper GI and Barium Enema:

Gastric Ulcer
(red arrow)

These studies are done with an Xray machine called a Flouroscope which provides a real time Xray image of the patient’s abdomen on a television screen placed on a stand next to the patient’s table. Most fluoroscopes also have spot film capability. When a button on the flouroscope console is pushed, an xray picture is taken of the image on the flouroscope screen.

Esophogram ,Upper GI

Indications: Abdominal Pain, gastroesophageal reflux, gastric or duodenal ulcer, pain before or after eating, weight loss.

Preparation: Nothing by mouth after midnight before the UGI examination. No smoking, no chewing gum before examination. The stomach must be completely empty to be examined properly. Smoking and Gum chewing causes fluid accumulation in the stomach. No breakfast, no coffee, nothing by mouth before the exam.

Terminal ileum showing crohn's disease

The Upper GI Exam is completely painless. The patient is started off in the upright position and given carbonated fizzy granules called E-Z-Gas which makes CO2 gas in the stomach immediately after swallowing. The patient is then given a cup of high density barium, usually lemon or strawberry flavor depending on the source. Don’t be surprised at how heavy the cup is. Barium is inert but very heavy.

Procedure: The patient drinks the Barium while the radiologist operates the flouroscope xray machine observing the flow of Barium through the esophagus, stomach duodenum and small bowel. The radiologist usually takes permanent xray images along the way which are stored in the patient’s xray folder.

Findings typically seen on an UGI:

Esophageal Diverticulum, stricture, ulceration, cancer, hiatus hernia, Gastroesophageal Reflux, infection, small bowel obstruction.

Allergy:

Barium is completely inert, not absorbed and not allergenic. However, some people are allergic to the flavoring in the Barium mixture and I have very rarely seen a case of hives and itching from the Strawberry flavor in patients who are allergic to Strawberries.

Precaution:

Barium UGI is not a good idea if there is a colonic obstruction because the Barium tends to turn into a solid bolus in the colon just before the obstructing lesion. This may be difficult to remove later. Also Barium is not a good idea if a CT SCAN is planned for the patient, since the Barium stays in the colon for a few days and makes it impossible to obtain a good quality CAT SCAN of the abdomen because the barium is too radio-dense for the CAT Scanner.

Constipation:

After the UGI Barium Exam, make sure you drink a lot of fluids and take a laxative to flush out the Barium from the Colon. The barium sometimes tends to solidify and turn into "cement" if fluid intake is reduced. This leads to a very uncomfortable constipation.

Swallowing Study:

Stroke patients who choke after eating may benefit from this procedure. A speech therapist and radiologist are both in attendance while various thin and thick mixtures are given to the patient while the swallowing mechanism is observed on xray flouroscopy and stored on videotape. This gives valuable information on how to best feed the patient while avoiding tracheal aspiration.

BARIUM ENEMA (BE):
Patient preparation:

The colon should be as clean as possible by having the patient take a strong laxative the night before the barium enema test and cleansing enemas in the morning before the barium enema test. If there is any residual stool present in the colon at the time of the barium enema test, the small bits of stool may be mistaken for colon polyps and the BE test may need to be repeated. Drugs: 1 mg IV glucagon may be given to the patient just prior to the introduction of the barium into the rectum to relax the colon and reduce abdominal cramping.

This BE test can be uncomfortable because an enema tube with a retention balloon is inserted into the rectum and liquid Barium allowed to flow from an enema bag into the colon. There is a single contrast or full column technique, and an air-contrast technique. The single contrast is faster and easier to tolerate.

The radiologist is in attendance observing the flouroscopic image while the barium column fills the colon. Spot xray films are taken by the radiologist. The radiologist then leaves the examining room and larger overhead xrays of the abdomen are taken by the technologist. The enema tube is remove. The patient is instructed to evacuate the colon into the toilet, and a post-evacuation xray film of the abdomen is taken. The films are checked with the radiologist and if no further xrays are needed, the study is ended and the patient is returned to home.

Findings typically seen on Barium Enema:

Diverticuli, Diverticulitis, polyps, masses, obstruction, ulceration, cancer, and infection.

Possible Risks and Complications: A rare complication is perforation of the colon and leakage of Barium into the peritoneal cavity. If this possibility is a consideration, then a water-soluble form of Contrast material called Gastrograffin is used instead of Barium.

Next test after a BE:

Colonoscopy by the gasteroenterologist is usually done to confirm abnormal findings on the BE and to perform colonoscopic biopsy of any polyps or masses found in the colon.