Upper GI Exam Health Article

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.