Upper GI series

Definition

An upper GI examination is a fluoroscopic examination (a type of x-ray imaging) of the upper gastrointestinal tract, including the esophagus, stomach, and upper small intestine (duodenum).

Purpose

An upper GI series is frequently requested when a patient experiences unexplained symptoms of abdominal pain , difficulty in swallowing (dysphagia), regurgitation, diarrhea , or weight loss . It is used to help diagnose disorders and diseases of, or related to, the upper gastrointestinal tract, including cases of hiatal hernia, diverticuli, ulcers, tumors, obstruction, enteritis, gastroesophageal reflux disease , Crohn's disease, and pulmonary aspiration .

Precautions

Patients with an obstruction or perforation in their bowel should not ingest barium (a radioactive substance used to show contrast in the images) for an upper GI, but may still be able to undergo the procedure if a water-soluble contrast medium is substituted for the barium.

Glucagon, a medication sometimes given prior to an upper GI procedure, may cause nausea and dizziness .

Description

An upper GI series takes place in a hospital or clinic setting and is performed by an x-ray technician and a radiologist. A radiologist typically is in attendance to oversee the procedure and view and interpret the fluoroscopic pictures. Before the test begins, the patient is sometimes administered an injection of glucagon, a medication which slows stomach and bowel activity, to allow the radiologist to get a clearer picture of the gastrointestinal tract. In order to further improve the clarity of the upper GI pictures, the patient may be given a cup of baking soda crystals to swallow, which distend the stomach by producing gas.

Once these preparatory steps are complete, the patient stands against an upright x-ray table, and a fluoroscopic screen is placed in front of him. The patient will be asked to drink from a cup of flavored barium sulfate, a thick and chalky-tasting liquid that allows the radiologist to see the digestive tract, while the radiologist views the esophagus, stomach, and duodenum on the fluoroscopic screen. The patient will be asked to change positions frequently in order to coat the entire surface of the gastrointestinal tract with barium. The technician or radiologist may press on the patient's abdomen in order to spread the barium. The x-ray table will also be moved several times throughout the procedure. The radiologist will ask the patient to hold his breath periodically while exposures are being taken. The entire procedure may take up to 45 minutes.

KEY TERMS

Dysphagia —An inability to swallow, or difficulty with swallowing.

Fluoroscopy —Also called radioscopy, this procedure involves the examination of internal body structures using x-rays and projecting images on a fluorescent screen.

Necrosis —Death of cells in a body tissue.

Radiologist —A doctor who specializes in an area of medicine that focuses on the use of radiation to diagnose and treat disease.

In some cases, in addition to the standard upper GI series, a doctormayrequest a detailed intestine, or small bowel, radiography and fluoroscopy series; it is also called a small bowel follow-through (SBFT). Once the preliminary upper GI series is complete, the patient will be escorted to a waiting area while the barium travels down the rest of the small intestinal path. Every 15 to 30 minutes, the patient will return to the x-ray suite for additional x rays. Once the barium has traveled down the small bowel tract, the test is complete. This procedure can take anywhere from one to four hours.

Esophageal radiography, also called a barium esophagram or a barium swallow, is a study of the esophagus only, and is usually performed as part of the upper GI series. It is commonly used to diagnose the cause of difficulty in swallowing (dysphagia) and for detecting hiatal hernia. A barium sulfate liquid, and sometimes pieces of food covered in barium or a barium tablet, are given to the patient to drink and eat while a radiologist examines the swallowing mechanism on a fluoroscopic screen. The test takes approximately 30 minutes.

Preparation

Patients must not eat, drink, or smoke for eight hours prior to undergoing an upper GI examination. Longer dietary restrictions may be required, depending on the type and diagnostic purpose of the test. Patients undergoing a small bowel follow-through exam may be asked to take laxatives the day prior to the test. Upper GI patients are typically required to wear a hospital gown, or similar attire, and to remove all jewelry, so the camera has an unobstructed view of the abdomen. Patients who are severely ill may not be able to tolerate the procedure.

QUESTIONS TO ASK YOUR DOCTOR

• What is the purpose of this examination?
• When will I know the results?
• How will I be notified of the results?
• How will the examination results help to determine the next step in management of my condition?
• What are the alternatives to this diagnostic exam?

Aftercare

No special aftercare treatment or regimen is required for an upper GI series. The patient may eat and drink as soon as the test is completed. The barium sulfate may make the patient's stool white for several days, and patients are encouraged to drink plenty of fluids in order to eliminate it from their system.

KEY TERMS

Crohn's disease —A chronic, inflammatory bowel disease usually affecting the ileum, colon, or both.

Diverticula —Pouch-like herniations through the muscular wall of an organ such as the stomach, small intestine, or colon.

Enteritis —Inflammation of the mucosal lining of the small intestine.

Gastroesophageal reflux disease —A painful, chronic condition in which stomach acid flows back into the esophagus causing heartburn and, in time, erosion of the esophageal lining.

Hiatal hernia —Protrusion of the stomach up through the diaphragm.

Risks

Because the upper GI series is an x-ray procedure, it does involve minor exposure to ionizing radiation. Unless the patient is pregnant, or multiple radiological or fluoroscopic studies are required, the small dose of radiation incurred during a single procedure poses little risk. However, multiple studies requiring fluoroscopic exposure that are conducted in a short time period have been known, on rare occasions, to cause skin death (necrosis) in some individuals. This risk can be minimized by careful monitoring and documentation of cumulative radiation doses administered to these patients.

Another risk is barium impaction, which occurs when the patient is unable to completely expel the barium contrast agent before it eventually dries and hardens. The risk of barium impaction is greatest in elderly patients and those with colon obstruction or colon motility disorder.

Results

A normal upper GI series will show a healthy, functioning, and unobstructed digestive tract.

Obstructions or inflammation, including ulcers of the esophagus, stomach, or small intestine, or irregularities in the swallowing mechanism are some of the possible abnormalities that may show up on an upper GI series. Other abnormalities may include polyps, foreign bodies, or congenital anomalies. Upper GIseries are helpful in the diagnosis of gastric (stomach) cancer .

Resources

PERIODICALS

Froehlich, F., and C. Repond, et al. “Is the Diagnostic Yield of Upper GI Endoscopy Improved by the Use of Explicit Panel-based Appropriateness Criteria?” Gastrointestinal Endoscopy 52, no. 3 (September 2000): 333-41.

Paula Anne Ford-Martin