Barium sulfate suspension, often simply called barium, is a

contrast agent 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 ...

used during

X-rays 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 Picometre, picometers to 10 Nanometre, nanometers, corresponding to frequency, ...

. Specifically it is used to improve visualization of 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 ...

(esophagus, stomach, intestines) on plain X-ray or computed tomography. It is taken by mouth or used

rectally The rectum is the final straight portion of the large intestine in humans and some other mammals, and the gut in others. The adult human rectum is about long, and begins at the rectosigmoid junction (the end of the sigmoid colon) at the le ...

. Side effects include

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 ...

diarrhea Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin wi ...

appendicitis Appendicitis is inflammation of the appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, and decreased appetite. However, approximately 40% of people do not have these typical symptoms. Severe complications of a rup ...

, and if inhaled inflammation of the lungs. It is not recommended in people with

intestinal perforation Gastrointestinal perforation, also known as ruptured bowel, is a hole in the wall of part of the gastrointestinal tract. The gastrointestinal tract includes the esophagus, stomach, small intestine, and large intestine. Symptoms include severe ab ...

bowel obstruction Bowel obstruction, also known as intestinal obstruction, is a mechanical or Ileus, functional obstruction of the Gastrointestinal tract#Lower gastrointestinal tract, intestines which prevents the normal movement of the products of digestion. Eith ...

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. The use of barium during

pregnancy Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ca ...

is safe for the baby; however, X-rays may result in harm. Barium sulfate

suspension Suspension or suspended may refer to: Science and engineering * Suspension (topology), in mathematics * Suspension (dynamical systems), in mathematics * Suspension of a ring, in mathematics * Suspension (chemistry), small solid particles suspend ...

is typically made by mixing

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 ...

powder with water. It is a

non-iodinated contrast media 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 ...

. Barium sulfate has been known since the

Middle Ages In the history of Europe, the Middle Ages or medieval period lasted approximately from the late 5th to the late 15th centuries, similar to the post-classical period of global history. It began with the fall of the Western Roman Empire a ...

. In the United States it had come into common medical use by 1910. It is on the

World Health Organization's List of Essential Medicines The WHO Model List of Essential Medicines (aka Essential Medicines List or EML), published by the World Health Organization (WHO), contains the medications considered to be most effective and safe to meet the most important needs in a health ...

. Some versions contain flavors to try to make it taste better.

Medical uses

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 ...

suspensions are provided by a radiologist or radiographer in advance of, or during a CT scan or

fluoroscopic 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 anatomy, structure and ...

study to allow for better visualization of the

, such as in upper or

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 a ...

. In

upper gastrointestinal series 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 ...

, the patient is instructed to take

nothing by mouth Nothing by mouth is a medical instruction meaning to withhold food and fluids. It is also known as nil per os (npo or NPO), a Latin phrase that translates to English as "nothing through the mouth". Variants include nil by mouth (NBM), nihil/non/nu ...

, which means to abstain from eating and drinking (

fasting Fasting is the abstention from eating and sometimes drinking. From a purely physiological context, "fasting" may refer to the metabolic status of a person who has not eaten overnight (see " Breakfast"), or to the metabolic state achieved after ...

), with the exception of drinking the barium sulfate suspension. The amount of time for this fast may vary, depending on the instructions given by the imaging facility and the area of the body to be scanned, but generally lasts for several hours prior to the scan. The patient generally skips one meal, along with abstaining from all liquids, clear or otherwise, during this time. Consumption of the barium sulfate suspension begins 90 minutes to two hours prior to the CT/Fluoroscopic scan, as instructed in the patient education provided. For a Barium Swallow or Dysphagiagram the barium is consumed after the study begins to discern if the patient has difficulties swallowing or masticating. Consumption is paced, beginning two hours before the scan is to occur, with levels marked on the provided container indicating how much is to be consumed between each of the two hours prior to the test. A small portion of the suspension is reserved for the minutes just before the test, to ensure that as much of the gastrointestinal tract as possible is coated. After the scan is complete, the patient is encouraged to eat and drink normally, with special attention to plenty of fluids. The barium sulfate is excreted through

defecation Defecation (or defaecation) follows digestion, and is a necessary process by which organisms eliminate a solid, semisolid, or liquid waste material known as feces from the digestive tract via the anus. The act has a variety of names ranging f ...

, so extra fluid intake helps prevent

, which is a possible side effect (see Johns Hopkins Medicine Health Library for an example of a possible patient education instruction sheet).

Side effects

Some patients with allergies or sensitive stomachs may choose to discuss alternatives to the barium sulfate suspension with their radiologist, but most patients find the common side effects more of an annoyance than a serious problem. Among the possible side effects, listed on MedlinePlus are

nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the ...

and

, which may begin as soon as 15 minutes after consumption begins and may persist through the day after the test is completed. Other side effects may include a feeling of weakness, pale skin, ringing in the ears, constipation, and vomiting. Patients may be strongly encouraged to avoid vomiting, as expelling a substantial quantity of the suspension may void its effect on the CT scan and produce unusable results, requiring a retest. As with most medications, if any severe side effects are experienced the patient is encouraged to contact their doctor or local poison control center immediately.

Taste and texture

Oral barium sulfate suspensions are sometimes described as having the consistency of a very thick glass of milk, or a very thin milkshake. Some patients may experience the texture as a chalky liquid, similar to calcium carbonate containing liquid antacids and with a slight medicinal taste. Dr. Roscoe Miller, in his article, "Flavoring Barium Sulfate", noted that taste thresholds vary per person, and patient toleration of the medicine also varies. The suspension is typically homogeneous, smooth, and white in color. When the suspension is stored at room temperature (some labels suggest 25 °C), "warm, thick milk" is a common description of the general weight and consistency of the drink. If the test requires the suspension to travel quickly through upper gastrointestinal tract it may be given chilled. Many preparations of barium sulfate have added flavors to make them easier to tolerate. In general, the flavor is considered unpleasant, and is dependent on the exact makeup of the drink. Artificial flavors vary per preparation, and include vanilla, banana, pineapple, lemon, and cherry, among others. Because of the ease of the actual test, the paced two-hour consumption of the barium sulfate suspension is often considered the worst part of a CT scan.

References

External links

* {{Portal bar, Medicine Radiocontrast agents Wikipedia medicine articles ready to translate World Health Organization essential medicines