An upper gastrointestinal series, also called a barium swallow, barium study, or barium meal, is a series of
radiographs
Radiography is an imaging technology, imaging technique using X-rays, gamma rays, or similar ionizing radiation and non-ionizing radiation to view the internal form of an object. Applications of radiography include medical radiography ("diagnos ...
used to examine the
gastrointestinal tract
The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organ (biology), organs of the digestive syste ...
for abnormalities. A
contrast medium
A contrast agent (or contrast medium) is a substance used to increase the contrast of structures or fluids within the body in medical imaging. Contrast agents absorb or alter external electromagnetism or ultrasound, which is different from radiop ...
, usually a
radiocontrast agent
Radiocontrast agents are substances used to enhance the visibility of internal structures in X-ray-based imaging techniques such as computed tomography (contrast CT), projectional radiography, and fluoroscopy. Radiocontrast agents are typically io ...
such as
barium sulfate
Barium sulfate (or sulphate) is the inorganic compound with the chemical formula Ba SO4. It is a white crystalline solid that is odorless and insoluble in water. It occurs as the mineral barite, which is the main commercial source of barium an ...
mixed with water, is ingested or instilled into the gastrointestinal tract, and
X-ray
An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...
s are used to create radiographs of the regions of interest. The barium enhances the visibility of the relevant parts of the gastrointestinal tract by coating the inside wall of the tract and appearing white on the film. This in combination with other plain radiographs allows for the imaging of parts of the upper gastrointestinal tract such as the
pharynx
The pharynx (plural: pharynges) is the part of the throat behind the mouth and nasal cavity, and above the oesophagus and trachea (the tubes going down to the stomach and the lungs). It is found in vertebrates and invertebrates, though its struc ...
,
larynx
The larynx (), commonly called the voice box, is an organ in the top of the neck involved in breathing, producing sound and protecting the trachea against food aspiration. The opening of larynx into pharynx known as the laryngeal inlet is about ...
,
esophagus
The esophagus (American English) or oesophagus (British English; both ), non-technically known also as the food pipe or gullet, is an organ in vertebrates through which food passes, aided by peristaltic contractions, from the pharynx to the ...
,
stomach
The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital organ in the digestive system. The stomach i ...
, and
small intestine
The small intestine or small bowel is an organ in the gastrointestinal tract where most of the absorption of nutrients from food takes place. It lies between the stomach and large intestine, and receives bile and pancreatic juice through the p ...
such that the inside wall lining, size, shape, contour, and patency are visible to the examiner. With
fluoroscopy
Fluoroscopy () is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. In its primary application of medical imaging, a fluoroscope () allows a physician to see the internal structure and functio ...
, it is also possible to visualize the functional movement of examined organs such as
swallowing
Swallowing, sometimes called deglutition in scientific contexts, is the process in the human or animal body that allows for a substance to pass from the mouth, to the pharynx, and into the esophagus, while shutting the epiglottis. Swallowing i ...
,
peristalsis
Peristalsis ( , ) is a radially symmetrical contraction and relaxation of muscles that propagate in a wave down a tube, in an anterograde direction. Peristalsis is progression of coordinated contraction of involuntary circular muscles, which ...
, or
sphincter
A sphincter is a circular muscle that normally maintains constriction of a natural body passage or orifice and which relaxes as required by normal physiological functioning. Sphincters are found in many animals. There are over 60 types in the hum ...
closure. Depending on the organs to be examined, barium radiographs can be classified into "barium swallow", "barium meal", "barium follow-through", and "enteroclysis" ("small bowel enema"). To further enhance the quality of images, air or gas is sometimes introduced into the gastrointestinal tract in addition to barium, and this procedure is called double-contrast imaging. In this case the gas is referred to as the negative contrast medium. Traditionally the images produced with barium contrast are made with plain-film radiography, but
computed tomography
A computed tomography scan (CT scan; formerly called computed axial tomography scan or CAT scan) is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers ...
is also used in combination with barium contrast, in which case the procedure is called "
CT enterography".
Types
![Duenndarmstenose Morbus Crohn KM-Passage 004](https://upload.wikimedia.org/wikipedia/commons/a/ab/Duenndarmstenose_Morbus_Crohn_KM-Passage_004.jpg)
Various types of barium X-ray examinations are used to examine different parts of the gastrointestinal tract. These include barium swallow, barium meal, barium follow-through, and
barium enema
A lower gastrointestinal series is a medical procedure used to examine and diagnose problems with the human colon of the large intestine. Radiographs (X-ray pictures) are taken while barium sulfate, a radiocontrast agent, fills the colon via an ...
.
The barium swallow, barium meal, and barium follow-through are together also called an upper gastrointestinal series (or study), whereas the barium enema is called a
lower gastrointestinal series
A lower gastrointestinal series is a medical procedure used to examine and diagnose problems with the human colon of the large intestine. Radiographs (X-ray pictures) are taken while barium sulfate, a radiocontrast agent, fills the colon via an ...
(or study).
In upper gastrointestinal series examinations, the barium sulfate is mixed with water and swallowed orally, whereas in the lower gastrointestinal series (barium enema), the barium contrast agent is administered as an
enema
An enema, also known as a clyster, is an injection of fluid into the lower bowel by way of the rectum.Cullingworth, ''A Manual of Nursing, Medical and Surgical'':155 The word enema can also refer to the liquid injected, as well as to a device ...
through a small tube inserted into the
rectum
The rectum is the final straight portion of the large intestine in humans and some other mammals, and the Gastrointestinal tract, gut in others. The adult human rectum is about long, and begins at the rectosigmoid junction (the end of the s ...
.
* Barium swallow X-ray examinations are used to study the pharynx
and esophagus.
* Barium meal examinations are used to study the lower esophagus, stomach and
duodenum
The duodenum is the first section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear, and the terms anterior intestine or proximal intestine m ...
.
* Barium follow through examinations are used to study the small intestine.
*
Enteroclysis
An upper gastrointestinal series, also called a barium swallow, barium study, or barium meal, is a series of radiographs used to examine the gastrointestinal tract for abnormalities. A contrast medium, usually a radiocontrast agent such as barium ...
, also called small bowel enema, is a barium X-ray examination used to display individual loops of the small intestine by intubating the
jejunum
The jejunum is the second part of the small intestine in humans and most higher vertebrates, including mammals, reptiles, and birds. Its lining is specialised for the absorption by enterocytes of small nutrient molecules which have been previous ...
and administering barium sulfate followed by
methylcellulose
Methyl cellulose (or methylcellulose) is a compound derived from cellulose. It is sold under a variety of trade names and is used as a thickener and emulsifier in various food and cosmetic products, and also as a bulk-forming laxative. Like cellu ...
or air.
* Barium enema examinations are used to study the large intestine and rectum and are classified as ''
lower gastrointestinal series
A lower gastrointestinal series is a medical procedure used to examine and diagnose problems with the human colon of the large intestine. Radiographs (X-ray pictures) are taken while barium sulfate, a radiocontrast agent, fills the colon via an ...
''.
Medical uses
Barium X-ray examinations are useful tools for the study of appearance and function of the parts of the gastrointestinal tract. They are used to diagnose and monitor
esophageal reflux
Gastroesophageal reflux disease (GERD) or gastro-oesophageal reflux disease (GORD) is one of the upper gastrointestinal chronic diseases where stomach content persistently and regularly flows up into the esophagus, resulting in symptoms and/ ...
,
dysphagia
Dysphagia is difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, in some contexts it is classified as a disease#Terminology, condition in its own right.
It may be a sensation that suggests difficulty in the passag ...
,
hiatus hernia
A hiatal hernia or hiatus hernia is a type of hernia in which abdominal organs (typically the stomach) slip through the diaphragm into the middle compartment of the chest. This may result in gastroesophageal reflux disease (GERD) or laryngoph ...
,
strictures,
diverticula
In medicine or biology, a diverticulum is an outpouching of a hollow (or a fluid-filled) structure in the body. Depending upon which layers of the structure are involved, diverticula are described as being either true or false.
In medicine, t ...
,
pyloric stenosis
Pyloric stenosis is a narrowing of the opening from the stomach to the first part of the small intestine (the pylorus). Symptoms include projectile vomiting without the presence of bile. This most often occurs after the baby is fed. The typical a ...
,
gastritis
Gastritis is inflammation of the lining of the stomach. It may occur as a short episode or may be of a long duration. There may be no symptoms but, when symptoms are present, the most common is upper abdominal pain (see dyspepsia). Other possi ...
,
enteritis
Enteritis is inflammation of the small intestine. It is most commonly caused by food or drink contaminated with pathogenic microbes,Dugdale, David C., IIII, and George F Longretc"Enteritis" MedlinePlus Medical Encyclopedia, 18 October 2008. Access ...
,
volvulus
A volvulus is when a loop of intestine twists around itself and the mesentery that supports it, resulting in a bowel obstruction. Symptoms include abdominal pain, abdominal bloating, vomiting, constipation, and bloody stool. Onset of symptoms ma ...
,
varices
A varix (pl. varices) is an abnormally dilated vessel with a tortuous course. Varices usually occur in the venous system, but may also occur in arterial or lymphatic vessels.
Examples of varices include:
* Varicose veins, large tortuous veins usua ...
,
ulcer
An ulcer is a discontinuity or break in a bodily membrane that impedes normal function of the affected organ. According to Robbins's pathology, "ulcer is the breach of the continuity of skin, epithelium or mucous membrane caused by sloughing o ...
s,
tumor
A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...
s, and gastrointestinal dysmotility, as well as to detect
foreign bodies
A foreign body (FB) is any object originating outside the body of an organism. In machinery, it can mean any unwanted intruding object.
Most references to foreign bodies involve propulsion through natural orifices into hollow organs.
Foreign bo ...
.
Although barium X-ray examinations are increasingly being replaced by more modern techniques, such as
computer tomography
A computed tomography scan (CT scan; formerly called computed axial tomography scan or CAT scan) is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers ...
,
magnetic resonance imaging
Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio wave ...
,
ultrasound imaging
Medical ultrasound includes diagnostic techniques (mainly medical imaging, imaging techniques) using ultrasound, as well as therapeutic ultrasound, therapeutic applications of ultrasound. In diagnosis, it is used to create an image of internal ...
,
endoscopy
An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are insert ...
and
capsule endoscopy
Capsule endoscopy is a medical procedure used to record internal images of the gastrointestinal tract for use in disease diagnosis. Newer developments are also able to take biopsies and release medication at specific locations of the entire ...
,
barium contrast imaging remains in common use because it offers the advantages of greater affordability, wider availability,
and better resolution in assessing superficial mucosal lesions.
Mechanism
Barium sulfate is swallowed, which because it is a
radio opaque
Radiodensity (or radiopacity) is opacity to the radio wave and X-ray portion of the electromagnetic spectrum: that is, the relative inability of those kinds of electromagnetic radiation to pass through a particular material. Radiolucency or hypod ...
substance does not allow the passage of X-rays. As a result, areas coated by barium sulfate will appear white on an X-ray film. The passage of barium through the gastrointestinal tract is observed by a radiologist using a
fluoroscope
Fluoroscopy () is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. In its primary application of medical imaging, a fluoroscope () allows a physician to see the internal structure and function ...
attached to a TV monitor. The radiologist takes a series of individual X-ray images at timed intervals depending on the areas to be studied. Sometimes medication which produces gas in the gastrointestinal tract is administered together with the Barium sulfate. This gas distends the gastrointestinal lumen, providing better imaging conditions and in this case the procedure is called double-contrast imaging.
Procedure
Clinical status and relevant medical history are reviewed prior to the studies.
Patient consent is required.
Barium swallow
A barium swallow study is also known as a barium esophagram and needs little if any preparations for the study of the larynx, pharynx, and esophagus when studied alone.
Amongst the uses of barium swallow are: persistent
dysphagia
Dysphagia is difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, in some contexts it is classified as a disease#Terminology, condition in its own right.
It may be a sensation that suggests difficulty in the passag ...
and
odynophagia
Odynophagia is pain when swallowing. The pain may be felt in the mouth or throat and can occur with or without difficulty swallowing. The pain may be described as an ache, burning sensation, or occasionally a stabbing pain that radiates to the b ...
despite negative
esophagogastroduodenoscopy
Esophagogastroduodenoscopy (EGD) or oesophagogastroduodenoscopy (OGD), also called by various other names, is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract down to the duodenum. It is considered ...
(OGDS) findings, failed OGDS,
esophageal motility disorder
An esophageal motility disorder (EMD) is any medical disorder causing difficulty in swallowing, regurgitation of food and a spasm-type pain which can be brought on by an allergic reaction to certain foods. The most prominent one is dysphagia.
Es ...
,
globus pharyngis
Globus pharyngis or globus sensation is the persistent but painless sensation of having a pill, food bolus, or some other sort of obstruction in the throat when there is none. Swallowing is typically performed normally, so it is not a true case o ...
, assessment of
tracheoesophageal fistula
A tracheoesophageal fistula (TEF, or TOF; see spelling differences) is an abnormal connection (fistula) between the esophagus and the trachea. TEF is a common congenital abnormality, but when occurring late in life is usually the sequela of surgica ...
, and timed barium swallow to monitor the progress of
esophageal achalasia
Esophageal achalasia, often referred to simply as achalasia, is a failure of smooth muscle fibers to relax, which can cause the lower esophageal sphincter to remain closed. Without a modifier, "achalasia" usually refers to achalasia of the esopha ...
therapy.
Barium sulfate suspension
Barium sulfate suspension, often simply called barium, is a contrast agent used during X-rays. Specifically it is used to improve visualization of the gastrointestinal tract (esophagus, stomach, intestines) on plain X-ray or computed tomograph ...
such as 100 ml or more of E-Z HD 200 to 250% concentration and Baritop 100% can be used. Water-soluble contrast agent such as Gastrografin (
diatrizoate
Diatrizoate, also known as amidotrizoate, is a contrast agent used during X-ray imaging. This includes visualizing veins, the urinary system, spleen, and joints, as well as computer tomography (CT scan). It is given by mouth, injection into a vei ...
) and Conray (
Iotalamic acid
Iotalamic acid, sold under the brand name Conray, is an iodine-containing radiocontrast agent. It is available in form of its salts, sodium iotalamate and meglumine iotalamate. It can be given intravenously or intravesically (into the urinary b ...
) is used instead of barium if oesophageal perforation is suspected. Low osmolar contrast medium with concentration of 300 mg/ml is used instead of gastrografin if there is risk of
aspiration or there is tracheoesophageal fistula.
A thick barium mixture is swallowed in supine position and fluoroscopic images of the swallowing process are made. Then several swallows of a thin barium mixture are taken and the passage is recorded by fluoroscopy and standard radiographs. The procedure is repeated several times with the examination table tilted at various angles. A total of 350–450 mL of barium is swallowed during the process.
Normally, 90% of ingested fluid should have passed into the stomach after 15 seconds.
Right anterior oblique (RAO) view is to see the oesophagus clearly, away from overlapping spine.
AP (anterior-posterior) view is also done to visualise the
gastroesophageal junction
The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital organ in the digestive system. The stomach i ...
.
AP and lateral views are also done to visualise the
hypopharynx
The pharynx (plural: pharynges) is the part of the throat behind the mouth and nasal cavity, and above the oesophagus and trachea (the tubes going down to the stomach and the lungs). It is found in vertebrates and invertebrates, though its struct ...
during swallowing at a frame rate of 3–4 per second. Left posterior oblique (LPO) position is used to identify hernias, mucosal rings, and varices.
Barium meal
Intravenous injection of Buscopan (
Hyoscine butylbromide
Hyoscine butylbromide, also known as scopolamine butylbromide and sold under the brandname Buscopan among others, is an anticholinergic medication used to treat crampy abdominal pain, esophageal spasms, renal colic, and bladder spasms. It is a ...
) 20 mg or
glucagon
Glucagon is a peptide hormone, produced by alpha cells of the pancreas. It raises concentration of glucose and fatty acids in the bloodstream, and is considered to be the main catabolic hormone of the body. It is also used as a Glucagon (medicati ...
0.3 mg is used to distend the stomach and slow down the emptying of the contrast into the duodenum.
Right anterior oblique (RAO) view is used to demonstrate antrum and greater curve of stomach. Supine position is to demonstrate antrum and body of stomach. Left anterior oblique (LAO) view is used to see the lesser curve of stomach en face. This position is also used to check for gastroesophageal reflux when patient is asked to cough or swallow (water siphon test). Left lateral tilted with head up 45 degrees is used to demonstrate the fundus of the stomach.
To demonstrate the duodenal loop, the subject can lie down in prone position on a compression pad to prevent excessive barium flowing into the duodenal loop. Anterior view of duodenal loop can be seen at RAO position.
Duodenal cap can be visualised by taking images when subject lie down in prone position, RAO, supine, and then LAO positions or it can be seen on erect position with RAO and steep LAO views.
Total mucosal coating of the stomach is done by asking the subject to roll to the right side into a complete circle until RAO position. Arae gastriae in the antrum (fine reticular network of grooves) is visible if good coating is achieved.
Small bowel follow-through
Indications to do this procedure are: unexplained chronic abdominal pain with weight loss, unexplained diarrhea, anemia which is caused by gastrointestinal bleeding or dependent on
blood transfusion
Blood transfusion is the process of transferring blood products into a person's circulation intravenously. Transfusions are used for various medical conditions to replace lost components of the blood. Early transfusions used whole blood, but mo ...
where the cause cannot be explained despite OGDS or colonoscopy investigations, partial obstruction of bowel/small bowel adhesive obstruction suspected, and unexplained
malabsorption
Malabsorption is a state arising from abnormality in absorption of food nutrients across the gastrointestinal (GI) tract. Impairment can be of single or multiple nutrients depending on the abnormality. This may lead to malnutrition and a variety ...
of nutrients.
For barium follow-through examinations, a 6-hour period of fasting is observed prior to the study.
Barium is administered orally, sometimes mixed with
diatrizoic acid
Diatrizoate, also known as amidotrizoate, is a contrast agent used during X-ray imaging. This includes visualizing veins, the urinary system, spleen, and joints, as well as computer tomography (CT scan). It is given by mouth, injection into a vei ...
(gastrografin) to reduce transit time in the bowel. Intravenous
metoclopramide
Metoclopramide is a medication used for stomach and esophageal problems. It is commonly used to treat and prevent nausea and vomiting, to help with emptying of the stomach in people with delayed stomach emptying, and to help with gastroesoph ...
is sometimes also added to the mixture to enhance gastric emptying.
[ 600 ml of 0.5% methylcellulose can be given orally, after barium meal is given, to improve the images of small bowel follow-through by reducing the time taken for barium to pass through the small intestines, and increase the transparency of the contrast-filled small bowels. Other methods to reduce transit time are to add ice cold normal saline after the administration of barium saline mixture or to give a dry meal.
X-ray images are then taken in a supine position at intervals of 20–30 minutes. Real-time fluoroscopy is used to assess bowel motility. The radiologist may press or palpate the abdomen during images to separate intestinal loops. The total time necessary for the test depends on the speed of bowel motility or transit time and may vary between 1 and 3 hours.]
Enteroclysis
Enteroclysis is also known as small bowel enema. It has been largely replaced by magnetic resonance enterography/enteroclysis and computed tomography enterography/enteroclysis.
In addition to fasting for 8 hours prior to examination, a laxative
Laxatives, purgatives, or aperients are substances that loosen stools and increase bowel movements. They are used to treat and prevent constipation.
Laxatives vary as to how they work and the side effects they may have. Certain stimulant, lubri ...
may also be necessary for bowel preparation and cleansing. The main aim of this study is to distend the proximal bowel through infusion of large amount of barium suspension. Otherwise, the distension of distal small bowel is generally similar with small bowel follow-through. Therefore, there is a need to pass a tube through the nose into the jejunum
The jejunum is the second part of the small intestine in humans and most higher vertebrates, including mammals, reptiles, and birds. Its lining is specialised for the absorption by enterocytes of small nutrient molecules which have been previous ...
(nasojejunal tube) to administer large amount of contrast. This can be unpleasant to the subject, requires more staff, longer procedural time, and higher radiation dose when compared to small bowel follow through. The indications for enteroclysis are generally similar to small bowel follow-through. Barium suspensions such as diluted E-Z Paque 70% and Baritop 100% can be used. After that, 600 ml of 0.5% methylcellulose is administered after 500 ml of 70% barium suspension is given. Bilbao-Dotter tube and Silk tube can be used to administer barium suspension. The subject should be fasted overnight, any antispasmodic
An antispasmodic (synonym: spasmolytic) is a pharmaceutical drug or other agent that suppresses muscle spasms.
Smooth muscle spasm
One type of antispasmodics is used for smooth muscle relaxation, especially in tubular organs of the gastrointesti ...
drugs should be stopped one day before the examination, and Tetracaine
Tetracaine, also known as amethocaine, is an ester local anesthetic used to numb the eyes, nose, or throat. It may also be applied to the skin before starting an intravenous (injection) to decrease pain from the procedure. Typically it is applied ...
lozenges can be used 30 minutes before the procedure to numb the throat for nasojejunal tube insertion.
The filling of the small intestines can be viewed continuously using fluoroscopy
Fluoroscopy () is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. In its primary application of medical imaging, a fluoroscope () allows a physician to see the internal structure and functio ...
, or viewed as standard radiographs taken at frequent intervals. The technique is a double-contrast procedure that allows detailed imaging of the entire small intestine. However, the procedure may take 6 hours or longer to complete and is quite uncomfortable to undergo.
Interpretation of results
* Enteroclysis has shown to be very accurate in diagnosing small bowel diseases, with a sensitivity of 93.1% and specificity of 96.9%. It permits detection of lesion which may not be seen with other imaging techniques. There is no significant difference in terms of detection of clinically significant findings, sensitivity or specificity between enteroclysis and CT enterography. Enteroclysis compares favorably with wireless capsule endoscopy and double-balloon endoscopy in the diagnosis of mucosal abnormalities of the small bowel.
* The interpretation of standard barium swallow examinations for assessing dysphagia is operator and interpreter dependent. It has poor sensitivity for subtle abnormalities but is more sensitive in detecting esophageal webs and rings than gastroscopy
Esophagogastroduodenoscopy (EGD) or oesophagogastroduodenoscopy (OGD), also called by various other names, is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract down to the duodenum. It is considered ...
. The best initial evaluation of suspected oropharyngeal dysphagia is a barium study. Barium swallow studies remain the main investigation of dysphagia
Dysphagia is difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, in some contexts it is classified as a disease#Terminology, condition in its own right.
It may be a sensation that suggests difficulty in the passag ...
. Barium studies may detect pharyngeal tumors that are difficult to visualize endoscopically.
* Barium follow through examinations are the most commonly used imaging technique in assessing patients with Crohn's disease
Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract. Symptoms often include abdominal pain, diarrhea (which may be bloody if inflammation is severe), fever, abdominal distension ...
, although CT and magnetic resonance imaging
Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio wave ...
are widely accepted as being superior. However Barium examinations remain superior in the depiction of mucosal abnormalities. The features of Crohn's disease
Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract. Symptoms often include abdominal pain, diarrhea (which may be bloody if inflammation is severe), fever, abdominal distension ...
are well described by barium follow-through examinations, appearing as a typical "cobblestone pattern", but no information is obtained regarding extraluminal disease. Radiographic imaging in Crohn's disease provides clinicians with objective evaluations of small bowel regions that are not accessible to standard endoscopic techniques. Because of its length and complex loops, the small intestine is the most difficult part of the gastrointestinal tract to evaluate. Most endoscopic techniques are limited to the examination of proximal or distal segments, hence Barium follow through remains in most centres the test of choice for the investigation of abdominal pain, diarrhoea and in particular diseases manifesting mucosal abnormalities such as coeliac and Crohn's disease.
* Barium swallow studies are better than endoscopy at demonstrating the anatomic findings in gastroesophageal reflux disease
Gastroesophageal reflux disease (GERD) or gastro-oesophageal reflux disease (GORD) is one of the upper gastrointestinal chronic diseases where stomach content persistently and regularly flows up into the esophagus, resulting in symptoms and/ ...
after anti-reflux surgery.
* Barium fluoroscopic examinations have some advantages over computed tomography and magnetic resonance techniques, such as higher spatial resolution and the ability to examine bowel peristalsis and distension in real time.
* Many infections and parasitic infestations produce patterns of the luminal surface, which are best seen on Barium examinations. Certain parasites are seen as filling defects outlined by Barium and Barium examinations play an important role in the diagnosis of intestinal infections and infestations as compared to other techniques. Barium studies show tapeworms
Cestoda is a class of parasitic worms in the flatworm phylum (Platyhelminthes). Most of the species—and the best-known—are those in the subclass Eucestoda; they are ribbon-like worms as adults, known as tapeworms. Their bodies consist of man ...
and roundworms
The nematodes ( or grc-gre, Νηματώδη; la, Nematoda) or roundworms constitute the phylum Nematoda (also called Nemathelminthes), with plant-parasitic nematodes also known as eelworms. They are a diverse animal phylum inhabiting a broa ...
as thin, linear filling defects of the bowel. Because roundworms have a developed alimentary tract, barium may outline the parasites' intestinal tracts on delayed images. In Strongyloidiasis
Strongyloidiasis is a human parasitic disease caused by the nematode called ''Strongyloides stercoralis'', or sometimes the closely related ''S. fülleborni''. These helminths belong to a group of nematodes called roundworms. These intestinal worm ...
barium studies show intestinal wall oedema, thickening of intestinal folds with flattening, and atrophy of the overlying mucosa. Schistosomiasis
Schistosomiasis, also known as snail fever, bilharzia, and Katayama fever, is a disease caused by parasitic flatworms called schistosomes. The urinary tract or the intestines may be infected. Symptoms include abdominal pain, diarrhea, bloody s ...
caused by infection with flatworms
The flatworms, flat worms, Platyhelminthes, or platyhelminths (from the Greek πλατύ, ''platy'', meaning "flat" and ἕλμινς (root: ἑλμινθ-), ''helminth-'', meaning "worm") are a phylum of relatively simple bilaterian, unsegment ...
have an appearance resembling colitis ulcerosa
Ulcerative colitis (UC) is a long-term condition that results in inflammation and ulcers of the colon and rectum. The primary symptoms of active disease are abdominal pain and diarrhea mixed with blood (hematochezia). Weight loss, fever, and a ...
, with inflammatory polyps, ulcers, fibrosis, wall thickening, loss of haustration, and stenosis in Barium X-rays. Anisakiasis
''Anisakis'' (a·nuh·saa·keez)
is a genus of parasitic nematodes that have life cycles involving fish and marine mammals. They are infective to humans and cause anisakiasis. People who produce immunoglobulin E in response to this parasite may ...
is demonstrated by Barium X-rays as bowel wall oedema, thickening, ulceration, or stricture due to inflammation. Sometimes worms are seen as long, thread-like, linear filling defects up to 30 cm long. In Typhlitis
Neutropenic enterocolitis is inflammation of the cecum (part of the large intestine) that may be associated with infection. It is particularly associated with neutropenia, a low level of neutrophil, neutrophil granulocytes (the most common form of ...
Barium studies show oedema, ulceration, and inflammation of bowel wall resulting in wall thickening. In pseudomembranous colitis
Colitis is swelling or inflammation of the large intestine ( colon). Colitis may be acute and self-limited or long-term. It broadly fits into the category of digestive diseases.
In a medical context, the label ''colitis'' (without qualification) ...
, barium studies show pancolitis
Pancolitis, in its most general sense, refers to inflammation of the entire colon. This can be caused by a variety of things. Pancolitis or universal colitis is frequently used in a more specific fashion to denote a very severe form of ulcerativ ...
with thumb printing and shaggy margins as well as plaque-like eccentric, nodular or polypoid appearance.
* Barium studies and computer tomography are the most common tools used to diagnose gastrointestinal lymphoma
Lymphoma is a group of blood and lymph tumors that develop from lymphocytes (a type of white blood cell). In current usage the name usually refers to just the cancerous versions rather than all such tumours. Signs and symptoms may include enlar ...
. Barium contrast is more sensitive in the demonstration of subtle mucosa and sub-mucosa abnormalities but computer tomography is the method of choice for determining the extent of disease and staging
Staging may refer to:
Computing
* Staging (cloud computing), a process used to assemble, test, and review a new solution before it is moved into production and the existing solution is decommissioned
* Staging (data), intermediately storing data ...
as well as related complications such as fistulation
A fistula (plural: fistulas or fistulae ; from Latin ''fistula'', "tube, pipe") in anatomy is an abnormal connection between two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other hollow org ...
and perforation
A perforation is a small hole in a thin material or web. There is usually more than one perforation in an organized fashion, where all of the holes collectively are called a ''perforation''. The process of creating perforations is called perfor ...
. Submucosal nodules or masses form a bull's-eye or target appearance on barium studies.
Adverse effects
* Radiographic examinations involve radiation exposure
Radiation is a moving form of energy, classified into ionizing and non-ionizing type. Ionizing radiation is further categorized into electromagnetic radiation (without matter) and particulate radiation (with matter). Electromagnetic radiation con ...
in the form of X-rays.
* Although barium ions are toxic, their use is generally regarded as safe because the small amounts of barium ions available in solution and absorbed by the gastrointestinal tract are deemed to be negligible; however, isolated cases of barium encephalopathy
Encephalopathy (; from grc, ἐνκέφαλος "brain" + πάθος "suffering") means any disorder or disease of the brain, especially chronic degenerative conditions. In modern usage, encephalopathy does not refer to a single disease, but r ...
have been described following absorption of barium from the intestinal tract.
* Constipation
Constipation is a bowel dysfunction that makes bowel movements infrequent or hard to pass. The stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement ...
and abdominal pain may occur after barium meals.
* The formation of baroliths, which may need to be removed surgically, is a complication of the use of barium sulfate.
* Barium sulfate may cause serious peritoneal
The peritoneum is the serous membrane forming the lining of the abdominal cavity or coelom in amniotes and some invertebrates, such as annelids. It covers most of the intra-abdominal (or coelomic) organs, and is composed of a layer of mesothe ...
irritation.
* Leakage of barium sulfate into the abdominal cavity may occur in people with duodenal ulcers or other perforations and may lead to peritonitis
Peritonitis is inflammation of the localized or generalized peritoneum, the lining of the inner wall of the abdomen and cover of the abdominal organs. Symptoms may include severe pain, swelling of the abdomen, fever, or weight loss. One part or ...
, adhesion
Adhesion is the tendency of dissimilar particles or surfaces to cling to one another ( cohesion refers to the tendency of similar or identical particles/surfaces to cling to one another).
The forces that cause adhesion and cohesion can be ...
, and granulomas
A granuloma is an aggregation of macrophages that forms in response to chronic inflammation. This occurs when the immune system attempts to isolate foreign substances that it is otherwise unable to eliminate. Such substances include infectious ...
; it is associated with a high mortality rate. Leakage of barium into the mediastinum
The mediastinum (from ) is the central compartment of the thoracic cavity. Surrounded by loose connective tissue, it is an undelineated region that contains a group of structures within the thorax, namely the heart and its vessels, the esophagu ...
or peritoneal cavity
The peritoneal cavity is a potential space between the parietal peritoneum (the peritoneum that surrounds the abdominal wall) and visceral peritoneum (the peritoneum that surrounds the internal organs). The parietal and visceral peritonea are lay ...
may lead to endotoxic shock
Lipopolysaccharides (LPS) are large molecules consisting of a lipid and a polysaccharide that are bacterial toxins. They are composed of an O-antigen, an outer core, and an inner core all joined by a covalent bond, and are found in the outer ...
, which is often fatal; as a result, the use of barium as a contrast agent is contraindicated when there is a suspicion or possibility of compromise of bowel wall integrity.
* Aspiration or inhalation of barium sulfate into the lungs during oral application can lead to serious respiratory complications leading to fatal aspiration pneumonia
Aspiration pneumonia is a type of lung infection that is due to a relatively large amount of material from the stomach or mouth entering the lungs. Signs and symptoms often include fever and cough of relatively rapid onset. Complications may inclu ...
or asphyxiation
Asphyxia or asphyxiation is a condition of deficient supply of oxygen to the body which arises from abnormal breathing. Asphyxia causes generalized hypoxia, which affects primarily the tissues and organs. There are many circumstances that can i ...
.
* Hypersensitivity and allergic reactions
Allergies, also known as allergic diseases, refer a number of conditions caused by the hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include hay fever, food allergies, atopic derma ...
are rare but some additives contained in barium preparations may induce immune reactions.
Complete gastrointestinal obstruction is a contraindication for barium studies.
History
Barium sulfate as a contrast medium was evolved from the prior use of bismuth preparations which were too toxic. The use of bismuth preparations had been described as early as 1898. Barium sulfate as a contrast medium in medical practice was introduced largely as a result of the works of Krause a director of the Bonn Polyclinic, now the medical faculty of the University of Bonn
The Rhenish Friedrich Wilhelm University of Bonn (german: Rheinische Friedrich-Wilhelms-Universität Bonn) is a public research university located in Bonn, North Rhine-Westphalia, Germany. It was founded in its present form as the ( en, Rhine U ...
and his colleagues Bachem and Gunther. In a paper read in 1910 at the radiological congress they advocated for the use of barium sulfate as an opaque contrast medium in medicine.
References
{{Digestive system procedures
Diagnostic gastroenterology
Digestive system imaging
Fluoroscopy
Projectional radiography
Barium