Skip to content Skip to sidebar Skip to footer
Home / How to Read a Barium Swallow Study

How to Read a Barium Swallow Study

Post a Comment

Radiographs used to examine abnormalities of the digestive system excluding the colon

For the barium meal test in espionage, come across Canary trap.

Upper gastrointestinal serial

File:Fluoroscopy of normal barium swallow.ogg Play media

Normal barium swallow fluoroscopic paradigm, showing the ingested barium sulfate being induced downwards the oesophagus by peristalsis.
Synonyms Upper gastrointestinal report, contrast radiography of the upper gastrointestinal tract, barium swallow, barium repast
ICD-10-PCS GroupMajor.pocket-sized

An upper gastrointestinal series, besides chosen a barium swallow, barium report, or barium meal, is a series of radiographs used to examine the alimentary canal for abnormalities. A contrast medium, usually a radiocontrast amanuensis such as barium sulfate mixed with water, is ingested or instilled into the gastrointestinal tract, and Ten-rays are used to create radiographs of the regions of interest. The barium enhances the visibility of the relevant parts of the alimentary canal by coating the inside wall of the tract and appearing white on the movie. This in combination with other plain radiographs allows for the imaging of parts of the upper gastrointestinal tract such as the pharynx, larynx, esophagus, stomach, and small-scale intestine such that the inside wall lining, size, shape, profile, and patency are visible to the examiner. With fluoroscopy, it is also possible to visualize the functional move of examined organs such as swallowing, peristalsis, or sphincter closure. Depending on the organs to be examined, barium radiographs tin be classified into "barium swallow", "barium repast", "barium follow-through", and "enteroclysis" ("small bowel enema"). To further raise the quality of images, air or gas is sometimes introduced into the gastrointestinal tract in addition to barium, and this procedure is chosen double-contrast imaging. In this case the gas is referred to as the negative contrast medium. Traditionally the images produced with barium contrast are fabricated with plain-flick radiography, but computed tomography is also used in combination with barium contrast, in which case the process is called "CT enterography".[ane]

Types [edit]

Barium repast examination showing the stomach and duodenum in double dissimilarity technique with CO2 as negative contrast medium

Barium follow through showing the modest bowel

Enteroclysis in double contrast technique showing stenosis of the small intestine

Various types of barium X-ray examinations are used to examine dissimilar parts of the gastrointestinal tract. These include barium swallow, barium repast, barium follow-through, and barium enema.[ii] The barium swallow, barium repast, and barium follow-through are together also chosen an upper gastrointestinal series (or study), whereas the barium enema is chosen a lower gastrointestinal series (or study).[3] 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 through a small tube inserted into the rectum.[ii]

  • Barium swallow Ten-ray examinations are used to study the pharynx[4] and esophagus.[two]
  • Barium meal examinations are used to study the lower esophagus, tummy and duodenum.[2]
  • Barium follow through examinations are used to study the minor intestine.[2]
  • Enteroclysis, as well called pocket-size bowel enema, is a barium X-ray exam used to display individual loops of the pocket-sized intestine by intubating the jejunum and administering barium sulfate followed past methylcellulose or air.[5]
  • Barium enema examinations are used to study the large intestine and rectum and are classified as lower gastrointestinal serial.[ii]

Medical uses [edit]

Barium Ten-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, dysphagia, hiatus hernia, strictures, diverticula, pyloric stenosis, gastritis, enteritis, volvulus, varices, ulcers, tumors, and gastrointestinal dysmotility, every bit well equally to find strange bodies.[three] [half-dozen] Although barium X-ray examinations are increasingly being replaced by more mod techniques, such as computer tomography, magnetic resonance imaging, ultrasound imaging, endoscopy and sheathing endoscopy,[7] barium contrast imaging remains in common employ because information technology offers the advantages of greater affordability, wider availability,[one] [5] and better resolution in assessing superficial mucosal lesions.[7] [8]

Mechanism [edit]

Barium sulfate is swallowed, which because it is a radio opaque substance does not allow the passage of X-rays. As a upshot, areas coated by barium sulfate will appear white on an X-ray pic. The passage of barium through the gastrointestinal tract is observed past a radiologist using a fluoroscope fastened to a Boob tube monitor. The radiologist takes a serial 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 ameliorate imaging conditions and in this case the procedure is called double-dissimilarity imaging.[nine]

Process [edit]

Clinical condition and relevant medical history are reviewed prior to the studies.[x] Patient consent is required.[3]

Barium consume [edit]

A barium swallow report is too known as a barium esophagram and needs lilliputian if any preparations for the study of the larynx, pharynx, and esophagus when studied alone.[11] [12] A thick barium mixture is swallowed in supine position and fluoroscopic images of the swallowing process are made. Then several swallows of a sparse 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 full of 350-450 mL of barium is swallowed during the procedure.[13] [14] Normally, 90% of ingested fluid should have passed into the stomach after xv seconds.[xv]

Barium repast and barium follow-through [edit]

For barium meal or barium follow-through examinations, a 6-hour flow of fasting is observed prior to the studies.[10] Barium is administered orally, sometimes mixed with diatrizoic acid to reduce transit time in the bowel. Metoclopramide is sometimes also added to the mixture to heighten gastric elimination. X-ray images are so taken in a supine position at intervals of 20–30 minutes. Real-time fluoroscopy is used to assess bowel motion. The radiologist may press or palpate the belly during images to separate abdominal loops. The total fourth dimension necessary for the test depends on the speed of bowel motility or transit fourth dimension and may vary between ane and 3 hours.[16] [xiv]

600 ml of 0.5% methylcellulose can be given orally, after barium meal is given can improve the images of small bowel follow-through by reducing the fourth dimension taken for barium to pass through the small-scale intestines, and increment the transparency of the dissimilarity-filled small bowels.[17] Other methods to reduce transit fourth dimension are: ice cold normal saline is added later on the administration of barium saline mixture, administration of intravenous metoclopramide, addition of gastrografin,[xviii] and a dry repast.[19]

Enteroclysis [edit]

In this procedure continuous infusion of contrast into the bowel also every bit IV contrast injection accept identify. Therefore, at that place will exist more than pregnant small bowel distension compared to CT enterography which could cause discomfort for the patient.[20]

For small bowel examinations, in addition to fasting for 8 hours prior to examination, a laxative may besides be necessary for bowel grooming and cleansing.[12] Enteroclysis involves the continued infusion of 500 to thou mL of thin barium sulfate suspension into the intestine through a duodenal tube. So methylcellulose is instilled through the tube. Barium and methylcellulose fill the intestinal loops which can be viewed continuously using fluoroscopy, or viewed every bit standard radiographs taken at frequent intervals. The technique is a double-dissimilarity procedure that allows detailed imaging of the entire small intestine. However, the procedure may accept 6 hours or longer to complete and is quite uncomfortable to undergo.[21]

Interpretation of results [edit]

  • Enteroclysis has shown to exist very accurate in diagnosing pocket-size bowel diseases, with a sensitivity of 93.ane% and specificity of 96.nine%. It permits detection of lesion which may not be seen with other imaging techniques.[seven] At that place is no pregnant difference in terms of detection of clinically significant findings, sensitivity or specificity betwixt enteroclysis and CT enterography.[i] Enteroclysis compares favorably with wireless capsule endoscopy and double-airship endoscopy in the diagnosis of mucosal abnormalities of the pocket-sized bowel.[22]
  • The interpretation of standard barium swallow examinations for assessing dysphagia is operator and interpreter dependent. It has poor sensitivity for subtle abnormalities only is more than sensitive in detecting esophageal webs and rings than gastroscopy.[4] The best initial evaluation of suspected oropharyngeal dysphagia is a barium study.[23] Barium swallow studies remain the main investigation of dysphagia.[24] Barium studies may find pharyngeal tumors that are difficult to visualize endoscopically.[25]
  • Barium follow through examinations are the most commonly used imaging technique in assessing patients with Crohn'due south disease, although CT and magnetic resonance imaging are widely accustomed equally being superior.[ane] All the same Barium examinations remain superior in the depiction of mucosal abnormalities.[22] The features of Crohn's illness are well described past barium follow-through examinations, actualization as a typical "cobblestone blueprint", but no information is obtained regarding extraluminal disease.[26] Radiographic imaging in Crohn's disease provides clinicians with objective evaluations of small bowel regions that are not attainable to standard endoscopic techniques.[27] Because of its length and circuitous loops, the small-scale intestine is the virtually difficult function of the alimentary canal to evaluate. Almost 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 hurting, diarrhoea and in particular diseases manifesting mucosal abnormalities such as coeliac and Crohn'southward disease.[24]
  • Barium swallow studies are better than endoscopy at demonstrating the anatomic findings in gastroesophageal reflux disease after anti-reflux surgery.[28]
  • Barium fluoroscopic examinations have some advantages over computed tomography and magnetic resonance techniques, such equally higher spatial resolution and the ability to examine bowel peristalsis and distension in existent time.[29]
  • Many infections and parasitic infestations produce patterns of the luminal surface, which are all-time seen on Barium examinations. Sure parasites are seen every bit filling defects outlined by Barium and Barium examinations play an important office in the diagnosis of intestinal infections and infestations as compared to other techniques.[30] Barium studies testify tapeworms and roundworms as thin, linear filling defects of the bowel.[31] Because roundworms have a developed comestible tract, barium may outline the parasites' intestinal tracts on delayed images. In Strongyloidiasis barium studies show intestinal wall oedema, thickening of intestinal folds with flattening, and atrophy of the overlying mucosa.[31] Schistosomiasis caused past infection with flatworms have an advent resembling colitis ulcerosa, with inflammatory polyps, ulcers, fibrosis, wall thickening, loss of haustration, and stenosis in Barium X-rays.[31] Anisakiasis is demonstrated by Barium X-rays as bowel wall oedema, thickening, ulceration, or stricture due to inflammation. Sometimes worms are seen equally long, thread-like, linear filling defects up to 30 cm long.[31] In Typhlitis Barium studies show oedema, ulceration, and inflammation of bowel wall resulting in wall thickening.[31] In pseudomembranous colitis, barium studies show pancolitis with thumb printing and shaggy margins every bit well equally plaque-like eccentric, nodular or polypoid appearance.[31]
  • Barium studies and computer tomography are the most common tools used to diagnose gastrointestinal lymphoma. Barium dissimilarity is more than sensitive in the demonstration of subtle mucosa and sub-mucosa abnormalities but reckoner tomography is the method of pick for determining the extent of disease and staging every bit well as related complications such equally fistulation and perforation. Submucosal nodules or masses class a bull'southward-eye or target appearance on barium studies.[32]

Adverse furnishings [edit]

Barium in the lungs resulting from aspiration during a barium swallow

  • Radiographic examinations involve radiation exposure in the form of Ten-rays.[26]
  • Although barium ions are toxic, their use is generally regarded equally safety because the small amounts of barium ions available in solution and captivated by the alimentary canal are deemed to be negligible; even so, isolated cases of barium encephalopathy have been described following absorption of barium from the abdominal tract.[33]
  • Constipation and abdominal pain may occur afterward barium meals.[33]
  • The formation of baroliths, which may need to be removed surgically, is a complication of the use of barium sulfate.[33]
  • Barium sulfate may cause serious peritoneal irritation.
  • Leakage of barium sulfate into the abdominal crenel may occur in people with duodenal ulcers or other perforations and may lead to peritonitis, adhesion, and granulomas; information technology is associated with a high mortality rate.[12] Leakage of barium into the mediastinum or peritoneal cavity may lead to endotoxic shock, which is often fatal; as a result, the use of barium as a contrast agent is contraindicated when at that place is a suspicion or possibility of compromise of bowel wall integrity.[33]
  • Aspiration or inhalation of barium sulfate into the lungs during oral application can lead to serious respiratory complications leading to fatal aspiration pneumonia or asphyxiation.[33]
  • Hypersensitivity and allergic reactions are rare but some additives contained in barium preparations may induce allowed reactions.[33]

Complete gastrointestinal obstacle is a contraindication for barium studies.[sixteen]

History [edit]

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 equally early on as 1898. Barium sulfate as a dissimilarity medium in medical practice was introduced largely every bit a result of the works of Krause a managing director of the Bonn Polyclinic, now the medical faculty of the University of Bonn and his colleagues Bachem and Gunther. In a paper read in 1910 at the radiological congress they advocated for the utilize of barium sulfate as an opaque dissimilarity medium in medicine.[34]

References [edit]

  1. ^ a b c d Potato, KP; McLaughlin, PD; O'Connor, OJ; Maher, MM (Mar 2014). "Imaging the small bowel". Current Opinion in Gastroenterology. thirty (two): 134–xl. doi:10.1097/mog.0000000000000038. PMID 24419291. S2CID 41111179.
  2. ^ a b c d e f British Medical Association (2013). BMA Illustrated Medical Dictionary. Dorling Kindersley Ltd. ISBN978-i-4093-4966-two.
  3. ^ a b c Daniels, Rick (2010). Delmar'southward guide to laboratory and diagnostic tests (2d ed.). Clifton Park, NY: Delmar/Cengage Learning. ISBN978-1-4180-2067-5.
  4. ^ a b Kuo, P; Holloway, RH; Nguyen, NQ (May 2012). "Current and future techniques in the evaluation of dysphagia". Journal of Gastroenterology and Hepatology. 27 (5): 873–81. doi:10.1111/j.1440-1746.2012.07097.x. PMID 22369033. S2CID 5409505.
  5. ^ a b Levine, MS; Rubesin, SE; Laufer, I (Nov 2008). "Pattern approach for diseases of mesenteric small-scale bowel on barium studies". Radiology. 249 (2): 445–60. doi:10.1148/radiol.2491071336. PMID 18812557. S2CID 15473369.
  6. ^ Boland, Giles W (2013). Gastrointestinal imaging: the requisites (4th ed.). Philadelphia: Elsevier/Saunders. ISBN978-0-323-10199-8.
  7. ^ a b c Markova, I; Kluchova, K; Zboril, R; Mashlan, M; Herman, Thou (Jun 2010). "Pocket-size bowel imaging - yet a radiologic arroyo?". Biomedical Papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia. 154 (2): 123–32. doi:10.5507/bp.2010.019. PMID 20668493.
  8. ^ Sinha, Rakesh; Rawat, Sudarshan (2011-10-01). "Grooming the Next Generation in Luminal Gastrointestinal Radiology". American Journal of Roentgenology. 197 (iv): W780. doi:10.2214/ajr.eleven.6870. ISSN 0361-803X. PMID 21940553.
  9. ^ M.D, Steven R. Peikin (2014). Gastrointestinal health tertiary edition. [S.l.]: HarperCollins eastward-Books. p. 29. ISBN978-0-06-186365-3.
  10. ^ a b al.], editors, C.J. Hawkey ... [et (2012). Textbook of Clinical Gastroenterology and Hepatology (second ed.). Hoboken: John Wiley & Sons. p. 1001. ISBN978-i-118-32140-9.
  11. ^ Chen, Anthony; Tafti, Dawood; Tuma, Faiz (2021). "Barium Swallow". StatPearls. StatPearls Publishing. PMID 29630228. Retrieved 23 December 2021.
  12. ^ a b c Nightingale, Julie; Law, Robert (2012). Gastrointestinal Tract Imaging: An Prove-Based Practice Guide. Elsevier Health Sciences. ISBN978-0-7020-4549-3.
  13. ^ Chernecky, Cynthia; Berger, Barbara (2012). Laboratory Tests and Diagnostic Procedures. Elsevier Health Sciences. ISBN978-i-4557-4502-9.
  14. ^ a b Zare Mehrjardi, Mohammad (2013-07-16). Barium swallow and barium meal: techniques and interpretation. Monthly Student Meeting. Tehran, Iran. doi:ten.13140/RG.2.2.10543.33449/1.
  15. ^ Ziessman, Harvey A.; O'Malley, Janis P.; Thrall, James H. (2014). "Dysmotility Disorders". Nuclear Medicine. Elsevier. ISBN978-0-323-08299-0.
  16. ^ a b Thomas, James; Monaghan, Tanya (2014). Oxford Handbook of Clinical Examination and Practical Skills. Oxford University Printing. p. 712. ISBN978-0-nineteen-104454-0.
  17. ^ Park, Kwang Bo; Ha, Hyun Kwon; Son, Se Ho; Hwang, Jae Cheul; Ji, Eun Kyung; Kim, Nam Hyeon; Kim, Pyo Nyun; Lee, Moon Kyu; Auh, Yong Ho (1996). "Use of methylcellulose in Small-Bowel Follow-Through Examination: Comparison with Enteroclysis andConventional Series in Normal Subjects". Journal of the Korean Radiological Society (in Korean). 35 (iii): 351. doi:ten.3348/jkrs.1996.35.3.351. ISSN 0301-2867.
  18. ^ Nolan, D J (1981-08-01). "Barium examination of the pocket-sized intestine". Gut. 22 (8): 682–694. doi:ten.1136/gut.22.8.682. ISSN 0017-5749. PMC1420062. PMID 7026379.
  19. ^ Nijhawan, Sandeep; Kumpawat, Saket; Mallikarjun, P; Bansal, Rp; Singla, Dinesh; Ashdhir, Prachis; Mathur, Amit; Rai, Ramesh Roop (2008). "Barium meal follow through with pneumocolon: Screening exam for chronic bowel hurting". Globe Journal of Gastroenterology. xiv (43): 6694–6698. doi:10.3748/wjg.14.6694. ISSN 1007-9327. PMC2773312. PMID 19034973.
  20. ^ https://acsearch.acr.org/docs/69470/Narrative/
  21. ^ al.], Rene A. Solar day ... [et (2009). Brunner & Suddarth'due south textbook of Canadian medical-surgical nursing (2nd Canadian ed.). Philadelphia: Lippincott Williams & Wilkins. ISBN978-0-7817-9989-8.
  22. ^ a b Maglinte, DD; Kohli, MD; Romano, Southward; Lappas, JC (Sep 2009). "Air (CO2) double-contrast barium enteroclysis". Radiology. 252 (3): 633–41. doi:10.1148/radiol.2523081972. PMID 19717748.
  23. ^ Grant, PD; Morgan, DE; Scholz, FJ; Catechism, CL (Jan–Feb 2009). "Pharyngeal dysphagia: what the radiologist needs to know". Current Bug in Diagnostic Radiology. 38 (1): 17–32. doi:10.1067/j.cpradiol.2007.08.009. PMID 19041038.
  24. ^ a b Robinson, C; Punwani, S; Taylor, South (December 2009). "Imaging the gastrointestinal tract in 2008". Clinical Medicine. ix (half dozen): 609–12. doi:10.7861/clinmedicine.9-6-609. PMC4952308. PMID 20095312.
  25. ^ Brant, [edited by] William E.; Helms, Clyde A. (2007). Fundamentals of diagnostic radiology (3rd ed.). Philadelphia: Lippincott Williams & Wilkins. pp. 811. ISBN978-0-7817-6135-two.
  26. ^ a b Dambha, F; Tanner, J; Carroll, N (Jun 2014). "Diagnostic imaging in Crohn's disease: what is the new gold standard?". Best Exercise & Enquiry. Clinical Gastroenterology. 28 (three): 421–36. doi:x.1016/j.bpg.2014.04.010. PMID 24913382.
  27. ^ Deepak, P; Bruining, DH (Aug 2014). "Radiographical evaluation of ulcerative colitis". Gastroenterology Report. 2 (3): 169–77. doi:10.1093/gastro/gou026. PMC4124269. PMID 24843072.
  28. ^ Baker, ME; Einstein, DM (Mar 2014). "Barium esophagram: does it accept a role in gastroesophageal reflux affliction?". Gastroenterology Clinics of Due north America. 43 (1): 47–68. doi:10.1016/j.gtc.2013.11.008. PMID 24503359.
  29. ^ Fidler, JL; Fletcher, JG; Bruining, DH; Trenkner, SW (Jul 2013). "Current status of CT, magnetic resonance, and barium in inflammatory bowel disease". Seminars in Roentgenology. 48 (3): 234–44. doi:ten.1053/j.ro.2013.03.004. PMID 23796374.
  30. ^ Sinha, R; Rajesh, A; Rawat, S; Rajiah, P; Ramachandran, I (May 2012). "Infections and infestations of the alimentary canal. Part one: bacterial, viral and fungal infections". Clinical Radiology. 67 (5): 484–94. doi:x.1016/j.crad.2011.10.021. PMID 22257535.
  31. ^ a b c d e f Sinha, R; Rajesh, A; Rawat, S; Rajiah, P; Ramachandran, I (May 2012). "Infections and infestations of the gastrointestinal tract. Part two: parasitic and other infections". Clinical Radiology. 67 (five): 495–504. doi:10.1016/j.crad.2011.10.022. PMID 22169349.
  32. ^ Engin, G; Korman, U (Sep 2011). "Gastrointestinal lymphoma: a spectrum of fluoroscopic and CT findings". Diagnostic and Interventional Radiology (Ankara, Turkey). 17 (3): 255–65. doi:ten.4261/1305-3825.dir.3332-ten.three. PMID 20725903. S2CID 6475386.
  33. ^ a b c d e f Baert, Henrik S. Thomsen ; Judith A.West. Webb (ed.). With contributions past P. Aspelin ... Foreword by A.50. (2009). Contrast media : prophylactic issues and ESUR guidelines ; with 24 tables (ii., rev. ed.). Berlin: Springer. ISBN978-3-540-72783-five.
  34. ^ Schott, G. D. (sixteen Baronial 2012). "Some Observations on the History of the Employ of Barium Salts in Medicine". Medical History. 18 (i): nine–21. doi:10.1017/S0025727300019190. PMC1081520. PMID 4618587.

hilliardableavoing.blogspot.com

Source: https://en.wikipedia.org/wiki/Upper_gastrointestinal_series

Post a Comment for "How to Read a Barium Swallow Study"