Upper GI Exam

Definition
Purpose
Description
Preparation
Aftercare
Risks
Normal results

Definition

An upper GI examination is a fluoroscopic examination (a type of x-ray imaging) of the upper gastrointestinal tract, including the pharynx (throat), esophagus, stomach, and upper small intestine (duodenum). An x-ray examination that evaluates only the pharynx and esophagus is called a barium swallow.

Purpose

An upper GI series is frequently requested when a patient experiences unexplained symptoms of abdominal pain, difficulty in swallowing (dysphagia), regurgitation (reflux), diarrhea, unexplained vomiting, blood in the stool, or unexplained weight loss. It is used to help diagnose disorders and diseases of, or related to, the upper gastrointestinal tract. Some of these conditions are: hiatal hernia, diverticula, tumors, obstruction, gastroesophageal reflux disease (GERD), pulmonary aspiration, and inflammation (e.g., ulcers, enteritis, and Crohn’s disease).

Glucagon, a medication sometimes given prior to an upper GI procedure, may cause nausea and dizziness. It is used to relax the natural movements of the stomach, which will enhance the overall study.

Description

An upper GI series takes place in a hospital or clinic setting, and is performed by an x-ray technologist and a radiologist. Before the test begins, the patient is sometimes given a glucagon injection, a medication that slows stomach and bowel activity, to provide the radiologist with a clear picture of the gastrointestinal tract. In order to further improve the upper GI picture clarity, the patient may be given a cup of fizzing baking soda crystals to swallow, which distends the esophagus and stomach by producing gas. This procedure is called a double-contrast or air-contrast upper GI.

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 or her. The patient will be asked to drink from a cup of flavored barium sulfate, a thick and chalky-tasting liquid, while the radiologist views the esophagus, stomach, and duodenum on the fluoroscopic screen. The patient will be asked to change positions frequently to coat the entire surface of the gastrointestinal tract with barium, move overlapping loops of bowel to isolate each segment, and provide multiple

views of each segment. The technician or radiologist may press on the patient’s abdomen to spread the barium throughout the folds within the lining of the stomach. The x-ray table will also be moved several times throughout the procedure. The radiologist will ask the patient to hold his or her breath periodically while exposures are taken. After the radiologist completes his or her portion of the exam, the technologist takes three to six additional films of the GI tract. The entire procedure takes approximately 15-30 minutes.

In addition to the standard upper GI series, a physician may request a detailed small bowel follow-through (SBFT), which is a timed series of films. After the preliminary upper GI series is complete, the patient will drink additional barium sulfate, and will be escorted to a waiting area while the barium moves through the small intestines. X rays are initially taken at 15-minute intervals until the barium reaches the colon (the only way to be sure the terminal ileum is fully seen is to see the colon or ileocecal valve). The interval may be increased to 30 minutes, or even one hour if the barium passes slowly. Then the radiologist will obtain additional views of the terminal ileum (the most distal segment of the small bowel, just before the colon). This procedure can take 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 (sometimes only a barium swallow is done). It is commonly used to diagnose the cause of difficulty in swallowing (dysphagia), and to detect a hiatal hernia. The patient drinks a barium sulfate liquid, and sometimes eats barium-coated food while the radiologist examines the swallowing mechanism on a fluoroscopic screen. The test takes approximately 30 minutes.

Preparation

Patients must not eat, drink, chew gum, 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

KEY TERMS

Contrast medium— Any substance that is swallowed or injected in order to increase the visibility of body structures or fluids.

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

Diverticula (singular, diverticulum)— 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 (GERD)— 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.

follow-through exam may be asked to take laxatives the day before the test. Patients are required to wear a hospital gown, or similar attire, and to remove all jewelry, to provide the camera with an unobstructed view of the abdomen.

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 can cause constipation; therefore, patients are encouraged to drink plenty of water to eliminate it from their system.

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 very rare occasions, cause skin death (necrosis) in some individuals. This risk can be minimized by careful monitoring and documentation of cumulative radiation doses.

Some patients find the barium liquid unpleasant to the taste or difficult to swallow. The radiologist may be able to provide a strawberry- or chocolate-flavored version. In addition, some patients feel gassy, bloated, or nauseated while they are being tilted on the examination table or having their abdomen pressed.

A few patients are allergic to barium and other contrast materials. Patients should inform the radiologist of any known allergies.

Normal results

A normal upper GI series shows a healthy, normally functioning, and unobstructed digestive tract. Hiatal hernia, obstructions, inflammation (including ulcers or polyps of the esophagus, stomach, or small intestine), or irregularities in the swallowing mechanism are just a few of the possible abnormalities that may appear on an upper GI series. Additionally, abnormal peristalsis, or digestive movements of the esophagus, stomach, and small intestine can often be visualized on the fluoroscopic part of the exam, and in the interpretation of the SBFT.

Resources

BOOKS

Brant, William E., and Clyde A. Helms. Fundamentals of Diagnostic Radiology, 3rd ed. Philadelphia: Lippincott Williams and Wilkins, 2006.

PERIODICALS

Nandurkar, S., G. R. Locke, III, J. A. Murray, et al. “Rates of Endoscopy and Endoscopic Findings among People with Frequent Symptoms of Gastroesophageal Reflux in the Community.” American Journal of Gastroenterology 100 (July 2005): 1459–1465.

“Patient Page: Upper GI Series.” Radiologic Technology 77 (May-June 2006): 415–416.

ORGANIZATIONS

American College of Gastroenterology (ACG). P.O. Box 342260, Bethesda, MD 20827-2260. (301) 263-9000. http://www.acg.gi.org/ (accessed April 14, 2008).

American College of Radiology (ACR). 1891 Preston White Drive, Reston, VA 20191. (703) 648-8900. http://www.acr.org/ (accessed April 14, 2008).

Radiological Society of North America (RSNA). 820 Jorie Blvd., Oak Brook, IL 60523-2251. (630) 571-2670. http://www.rsna.org/ (accessed April 14, 2008).

OTHER

Kefalas, Costas H. Commonly Performed Radiographic Tests in Gastroenterology. http://www.acg.gi.org/patients/gihealth/raphic.asp [cited January 14, 2008; accessed April 14, 2008].

Radiological Society of North America (RSNA). Upper Gastrointestinal (GI) Tract X-ray (Radiography). http://www.radiologyinfo.org/en/info.cfm?pg=uppergi&bhcp=1 [cited January 14, 2008; accessed April 14, 2008].

Sawyer, Michael A. J., and Tarak H. Patel. “Gastroesophageal Reflux.” eMedicine, December 15, 2005 [cited January 14, 2008]. http://www.emedicine.com/radio/topic300.htm (accessed April 14, 2008).

Debra Novograd, BS, RT(R)(M)

Lee A. Shratter, MD

Rebecca Frey, PhD

Upper GI exam

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 unexplained weight loss. It is used to help diagnose disorders and diseases of, or related to, the upper gastrointestinal tract, including cases of hiatal hernia, diverticula, ulcers, tumors, obstruction, enteritis, gastroesophageal reflux disease, Crohn's disease , abdominal pain, and pulmonary aspiration.

Precautions

Because of the risks of radiation exposure to the fetus, pregnant women are advised to avoid this procedure. In addition, children having to undergo this exam must be shielded with lead, when possible. Patients with an obstruction or perforation in their bowel should not ingest barium (a radiopaque substance used to visualize the GI tract) 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. It is used to relax the natural movements of the stomach, which will enhance the overall study.

Description

An upper GI series takes place in a hospital or clinic setting and is performed by an x-ray technologist and a radiologist. 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 fizzing 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, to move overlapping loops of bowel to isolate each segment, and to obtain multiple views of each segment. The technician or radiologist may press on the patient's abdomen in order to spread the barium thought the folds within the lining of the stomach. 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. After the radiologist completes his or her portion of the exam, the technologist will take several additional films of the GI tract. The entire procedure takes approximately 30 minutes.

In addition to the standard upper GI series, a doctor may request a detailed small bowel follow-through (SBFT), which is a timed series of films. After the preliminary upper GI series is complete, the patient will be given some additional barium sulfate to drink, and escorted to a waiting area while the barium moves through the small intestines. X rays are taken at 15-minute intervals until the barium reaches the colon (the only way to be sure the terminal ileum is fully seen is to see the colon or ileocecal valve). Then the radiologist will obtain additional views of the terminal ileum (the most distal segment of the small bowel, just before the colon). This procedure can take 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 (though sometimes only a barium swallow is done). 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 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 required to wear a hospital gown, or similar attire, and to remove all jewelry, so the camera has an unobstructed view of the abdomen.

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 can cause constipation; therefore patients are encouraged to drink plenty of water in order to eliminate it from their system.

Complications

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 very 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.

Results

A normal upper GI series shows a healthy, normally functioning, and unobstructed digestive tract. Hiatal hernia, obstructions, inflammation, including ulcers, polyps of the esophagus, stomach, or small intestine, or irregularities in the swallowing mechanism are just a few of the possible abnormalities that may show up on an upper GI series. Additionally, abnormal peristalsis, or digestive movements of the stomach and intestines can often be visualized on the fluoroscopic part of the exam, and in the interpretation of the SBFT.

Health care team roles

The radiologist and technologist are a team, in the compliance and completion of an optimal upper GI study. The well-prepared technologist will promote efficiency of the radiologist's portion of the exam. Having all supplies available, and being ready for anything, is essential in doing barium studies.

Patient education

The technologist, and to some degree the radiologist, can ease a patient through this exam by giving the patient a brief overview of what he or she will need to do and what to expect while having this exam. Although the exam is painless and simple, there will still be some concern by the patient who is unfamiliar with the procedure. Keeping the positioning directions simple makes it easy for the patient to comply, and creates for a positive experience for all concerned.

KEY TERMS

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

Diverticula —Pouchline 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 lining of esophagus.

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

Training

The technologist will have had a minimum of two years training in radiologic technology , and extensive experience in barium studies, as this is one area that a student radiographer will show early competence in. The technologist is also fully educated on the anatomy and physiology of the gastrointestinal tract, and must demonstrate this on written exams, as well as a clinical evaluation prior to completing the program.

Resources

BOOKS

Ross, Linda, ed. Gastrointestinal Diseases and Disorders Sourcebook, Vol. 16. Detroit: Omnigraphics, 1996.

PERIODICALS

Newman, J. "Radiographic and Endoscopic Evaluation of the Upper GI Tract." Radiology Technology 69 (Jan-Feb 1998): 213-26.

Debra Novograd, B.S.,R.T.(R)(M)

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

Because of the risks of radiation exposure to the fetus, pregnant women are advised to avoid this procedure. 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 throughoutthe 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.

In some cases, in addition to the standard upper GI series, a doctor may request 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.

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.

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.

Normal results

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

Abnormal results

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 GI series are helpful in the diagnosis of gastric (stomach) cancer.

Resources

BOOKS

Fischbach, F., ed. A Manual of Laboratory & Diagnostic Tests, 6th Ed. Philadelphia, PA: Lippincott Williams and Wilkins, 1999.

Rosen, P., ed. Emergency Medicine Concepts and Clinical Practice, 4th ed. St. Louis, MO: Mosby-Year Book, Inc., 1999.

Varricchio, C., ed. A Cancer Source Book for Nurses. Sudbury, MA: Jones and Bartlett Publishers, 1997.

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.

Newman, J. "Radiographic and Endoscopic Evaluation of the Upper GI Tract." Radiology Technology 69, no. 3 (January-February 1998): 213-26.

Paula Anne Ford-Martin

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.

QUESTIONS TO ASK THE 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?

Upper gastrointestinal endoscopy

Definition

Upper gastrointestinal endoscopy is a procedure that allows the doctor to visually examine the upper portions of the gastrointestinal tract, using a flexible tool called an endoscope. The endoscope has a light source and projects an image on a video screen. An endoscope may also be used to assist with other diagnostic exams and procedures. For instance, an ultrasound probe can be placed on the end of the endoscope to evaluate how deeply a tumor has penetrated the esophagus or wall of the stomach. An endoscope may be used to assist with placement of a permanent feeding tube or to treat a bleeding ulcer.

Purpose

An upper gastrointestinal endoscopy aids in the investigation of the source of pain, difficulty swallowing, bleeding or other symptoms of an upper abdominal problem. During an endoscopy the doctor can obtain samples of tissue for biopsy , to check for the presence of cancer cells or the bacteria responsible for most stomach ulcers. Various instruments can be passed through the endo-scope to treat problems, such as controlling bleeding due to an ulcer. The procedure may be performed on patients who have had stomach surgery to assess for cancer or the return of an ulcer. It may also be used to monitor patients at high risk for upper gastrointestinal cancers .

Precautions

Patients with a history of heart and lung disease and those with blood-clotting problems require special precautions. For instance, a patient with artificial heart valves or a history of infection of the lining of the heart will need antibiotics to prevent infection. Patients with an intestinal perforation, or puncture in the gastrointestinal tract, should not have an upper gastrointestinal endoscopy. Patients must be able to cooperate during the procedure. Those who are not able to cooperate are not good candidates for an endoscopy.

Description

An endoscopy may take place in the physician's office or in a hospital. An intravenous (IV) line will be started in a vein in the arm. Through the IV line, the patient generally receives a sedative and a pain-killer if needed. The medication will help the patient feel relaxed and drowsy. A local anesthetic is usually sprayed into the throat to prevent a gag reflex. Dentures are removed. A mouthpiece will help to keep the mouth open. Patients are positioned onto their sides. The doctor slowly advances the lubricated endoscope down the throat, into the stomach. Air will be passed through the endoscope to make it easier for the doctor to see the lining of the gastrointestinal tract. The endoscope will be repositioned to see different parts of the stomach and the small intestine. The exam usually takes less than an hour. The patient is able to breathe independently during the exam. In some cases a biopsy may be taken. Biopsy forceps or a brush used to secure cells are passed through the endoscope. The tissue sample is taken and then removed through the endoscope.

Preparation

The doctor should be informed of any allergies as well as all the medications that the patient is currently taking. The doctor may instruct the patient not to take certain medications, like aspirin and anti-inflammatory drugs that interfere with clotting, for a period of time prior to the procedure. The patient should not eat or drink anything for at least eight hours prior to the endoscopy. The doctor should be informed if the patient has had heart valves replaced or a history of an inflammation of the inside lining of the heart, so that appropriate antibiotics can be administered to prevent any chance of infection. Risks and benefits of the procedure will be explained to the patient. The patient will be asked to sign a consent form.

Aftercare

The patient will be monitored for an hour or two after the procedure, while the effects of the medication wear off. Due to the sedative, the patients will need to arrange for someone to drive them home after the procedure.

Patients may feel bloated due to the air that is introduced into the stomach during the procedure, and may have a sore throat for a couple of days. Patient should contact the doctor if they develop difficulty swallowing, chest pain, severe abdominal pain, throat soreness that becomes more severe or rectal bleeding.

Risks

Endoscopy is usually considered safe when performed by a specially trained physician. As with any invasive procedure it is not risk-free. Complications include bleeding and perforation (puncturing a hole in the lining of the gastrointestinal tract). Scopes are cleaned and disinfected between patients so any risk of transmitting infectious disease from one patient to another by the endoscope would be negligible.

Normal results

A pale reddish pink lining with no abnormal-looking masses or ulcerations is considered a normal result.

Abnormal results

Evidence of an ulcer or other lesion would be considered an abnormal result. If the biopsy determines the presence of cancer cells, a diagnosis of cancer is made. The appearance of the lesion, including its size or if there are multiple lesions, often helps with staging and treatment plans. An ultrasound probe attached to the endo-scope also may help with staging.

Resources

BOOKS

Fauci, Anthony S. Harrison's Principles of Internal Medicine, 14th edition. New York, NY: The McGraw-Hill Companies, 2000.

Pfenninger, John L. Procedures for Primary Care Physicians, 2nd edition. St. Louis, MO: Mosby-Year Book, Inc, 2000.

Schull, Patricia. Illustrated Guide to Diagnostic Tests. Spring-house, PA: Springhouse Corporation, 1997.

ORGANIZATIONS

Society of American Gastrointestinal Endoscopic Surgeons (SAGES). 2716 Ocean Park Boulevard, Suite 3000, Santa Monica, CA 90405. (310) 314-2404. <http:www.sages.org> 28 June 2001.

American Gastroenterological Association. 7910 Woodmont Ave., Seventh Floor, Bethesda, MD 20814. (301) 654-2055. <http:www.gastro> 28 June 2001.

Debra Wood, R.N.

KEY TERMS

Biopsy

—Removal of a tissue sample for examination under a microscope to check for cancer cells.

Duodenum

—The first portion of the small intestine.

Endoscope

—A thin, flexible, lighted tube that is passed down the throat and enables the doctor to view the esophagus, stomach lining and duodenum.

Perforation

—Puncture or tear.

Staging

—Determination of how advanced the cancer is.

Ultrasound

—The study of internal organs using high-frequency sound waves.

QUESTIONS TO ASK THE DOCTOR

• Did you see any abnormalities?
• How soon will you know the results of the biopsy (if one was done)?
• When can I resume any medications that were stopped?
• What future care will I need?
• Which problems should prompt me to call you?

Upper GI exam

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 unexplained weight loss. It is used to help diagnose disorders and diseases of, or related to, the upper gastrointestinal tract. Some of these conditions are: hiatal hernia, diverticula, tumors, obstruction, gastroesophageal reflux disease, pulmonary aspiration, and inflammation (e.g., ulcers, enteritis, and Crohn's disease).

Glucagon, a medication sometimes given prior to an upper GI procedure, may cause nausea and dizziness. It is used to relax the natural movements of the stomach, which will enhance the overall study.

Description

An upper GI series takes place in a hospital or clinic setting, and is performed by an x ray technologist and a radiologist. Before the test begins, the patient is sometimes given a glucagon injection, a medication that slows stomach and bowel activity, to provide the radiologist with a clear picture of the gastrointestinal tract. In order to further improve the upper GI picture clarity, the patient may be given a cup of fizzing crystals to swallow, which distends the esophagus and 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 or her. The patient will be asked to drink from a cup of flavored barium sulfate, a thick and chalky-tasting liquid, while the radiologist views the esophagus, stomach, and duodenum on the fluoroscopic screen. The patient will be asked to change positions frequently to coat the entire surface of the gastrointestinal tract with barium, move overlapping loops of bowel to isolate each segment, and provide multiple views of each segment. The technician or radiologist may press on the patient's abdomen to spread the barium throughout the folds within the lining of the stomach. The x ray table will also be moved several times throughout the procedure. The radiologist will ask the patient to hold his or her breath periodically while exposures are taken. After the radiologist completes his or her portion of the exam, the technologist takes three to six additional films of the GI tract. The entire procedure takes approximately 15–30 minutes.

In addition to the standard upper GI series, a physician may request a detailed small bowel follow-through (SBFT), which is a timed series of films. After the preliminary upper GI series is complete, the patient will drink additional barium sulfate, and will be escorted to a waiting area while the barium moves through the small intestines. X rays are initially taken at 15-minute intervals until the barium reaches the colon (the only way to be sure the terminal ileum is fully seen is to see the colon or ileocecal valve). The interval may be increased to 30 minutes, or even one hour if the barium passes slowly. Then the radiologist will obtain additional views of the terminal ileum (the most distal segment of the small bowel, just before the colon). This procedure can take 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 (sometimes only a barium swallow is done). It is commonly used to diagnose the cause of difficulty in swallowing (dysphagia), and to detect a hiatal hernia. The patient drinks a barium sulfate liquid, and sometimes eats barium-coated food while the 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 before to the test. Patients are required to wear a hospital gown, or similar attire, and to remove all jewelry, to provide the camera with an unobstructed view of the abdomen.

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 can cause constipation; therefore patients are encouraged to drink plenty of water to eliminate it from their system.

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 very rare occasions, to cause skin death (necrosis) in some individuals. This risk can be minimized by careful monitoring and documentation of cumulative radiation doses.

Normal results

A normal upper GI series shows a healthy, normally functioning, and unobstructed digestive tract. Hiatal hernia, obstructions, inflammation (including ulcers or polyps of the esophagus, stomach, or small intestine), or irregularities in the swallowing mechanism are just a few of the possible abnormalities that may appear on an upper GI series. Additionally, abnormal peristalsis, or digestive movements of the esophagus, stomach, and small intestine can often be visualized on the fluoroscopic part of the exam, and in the interpretation of the SBFT.

Resources

books

Ross, Linda, ed. Gastrointestinal Diseases and Disorders Sourcebook, Vol. 16. Detroit: Omnigraphics, 1996.

periodicals

Newman, J. "Radiographic and Endoscopic Evaluation of the Upper GI Tract." Radiology Technology 69 (January/February 1998): 213-26.

Debra Novograd, B.S., R.T.(R)(M) Lee A. Shratter, M.D.