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Barium Enema

Barium enema

Definition

A barium enema, also known as a lower GI (gastrointestinal) exam, is a diagnostic test using x-ray examination to view the large intestine (colon and rectum). There are two types of this test: the single-contrast technique, in which barium sulfate solution is injected into the rectum to gain a profile view of the large intestine; and the double-contrast (or air contrast) technique, in which air and barium sulfate are injected into the rectum.

Purpose

A barium enema may be performed to assist in diagnosing or detecting:

  • colon or rectal cancer (colorectal cancer)
  • inflammatory diseases such as ulcerative colitis
  • polyps (small benign growths in the tissue lining of the colon and rectum)
  • diverticula (pouches pushing out from the colon)
  • structural changes in the large intestine

The double-contrast barium enema is more accurate than the single-contrast technique for detecting small polyps or tumors, early inflammatory disease, and bleeding caused by ulcers because it gives a better view of the intestinal walls.

The decision to perform a barium enema is based on the patient's history of altered bowel habits. These alterations may include diarrhea , constipation, lower abdominal pain, blood, mucus or pus in the stool. It is also recommended that this exam be used every five to 10 years beginning at age 50 to screen healthy people for colon cancer , the second most deadly type of cancer in the United States. Those who have a close relative with colon cancer or who have had a precancerous polyp are considered to be at an increased risk for the disease and should be screened more frequently to detect abnormalities.

Precautions

Although the barium enema is an effective screening method and may lead to a timely diagnosis of a variety gastrointestinal diseases, the test may not detect all abnormalities present in the colon and rectum. In addition, the barium enema visualizes only the large intestine; the small intestine may also require examination with an upper GI series to rule out abnormalities in that area of the digestive tract. Another drawback is that intestinal gas may hinder the accuracy of test results.

As of 2001, numerous studies have shown that a colonoscopy performed by an experienced gastroenterologist is a more accurate initial diagnostic tool for detecting early signs of colorectal cancer than a barium enema. Colonoscopy allows a physician to examine the entire colon and rectum for polyps. In addition, if abnormalities such as polyps are observed during the procedure, these often-precancerous growths may be removed during the procedure and later examined (biopsy ). One additional difference between a barium enema and a colonoscopy is that a colonoscopy almost always involves conscious sedation, while the barium enema is an unsedated procedure. Some physicians use flexible sigmoidoscopy (proctosigmoidoscopy) plus a barium enema instead of colonoscopy. However, sigmoidoscopy only visualizes the rectum and the portion of the colon immediately above it (sigmoid colon) and does not allow the physician to remove polyps but only to obtain tissue or stool samples.

Description

To begin a barium enema, the patient lies flat on his or her back on a tilting radiographic table in order to have x rays of the abdomen taken. After being assisted to a different position, a well-lubricated rectal tube is inserted through the anus. This tube allows the physician or assistant to slowly administer the barium sulfate into the intestine. While this filling process is closely monitored, it is important for the patient to keep the anus tightly contracted against the rectal tube to help maintain its position and prevent the barium from leaking. This step is important because the test may be inaccurate if the barium leaks. A rectal balloon may also be inflated to help retain the barium. The table may be tilted or the patient moved to different positions to aid in the filling process.

As the barium fills the intestine, x rays of the abdomen are taken to distinguish significant findings. There are many ways to perform a barium enema. One way is that shortly after filling, the rectal tube is removed and the patient expels as much of the barium as possible. Upon completing this expulsion, an additional x ray is taken, and a double-contrast enema exam may follow. If this procedure is done immediately, a thin film of barium will remain in the intestine, and air is then slowly injected to expand the bowel lumen (space in the intestine). Sometimes no x rays will be taken until after the air is injected. The entire test takes about 20-30 minutes.

Preparation

In order to conduct the most accurate barium enema test, the large intestine must be empty. Thus, patients must follow a prescribed diet and bowel preparation instructions prior to the test. This preparation commonly includes restricted intake of dairy products and a liquid diet for 24 hours prior to the test, in addition to drinking large amounts of water or clear liquids 12-24 hours before the test. Patients may also be given laxatives and asked to give themselves a cleansing enema.

In addition to the prescribed diet and bowel preparation prior to the test, the patient can expect the following during a barium enema:

  • The patient will be well draped with a gown and secured to a tilting x-ray table.
  • As the barium or air is injected into the intestine, the patient may experience cramping pains or the urge to defecate.
  • The patient will be instructed to take slow, deep breaths through the mouth to ease any discomfort.

Aftercare

Patients should follow several steps immediately after undergoing a barium enema, including:

  • Drinking plenty of fluids to help counteract the dehydrating effects of bowel preparation and the test.
  • Taking time to rest because a barium enema and the bowel preparation taken before it can be exhausting.
  • Administering a cleansing enema may help to eliminate any remaining barium. Light-colored stools will be prevalent for the next 24-72 hours following the test.

Risks

Although a barium enema is generally considered a safe screening test , it can cause complications in certain people. For example, patients with a rapid heart rate, severe ulcerative colitis, toxic megacolon (acute dilation of the colon that may progress to rupture), or a presumed perforation in the intestine should not undergo a barium enema. Patients with a known blocked intestine, diverticulitis, or severe bloody diarrhea may be tested with caution on the advice of a physician. Also, administering a barium enema to a pregnant woman is not advisable because of radiation exposure to the fetus.

Although the barium enema may cause minor stomach or abdominal discomfort in some people, more serious complications include:

  • severe cramping
  • nausea and vomiting
  • perforation of the colon
  • water intoxication
  • barium granulomas (inflamed nodules)
  • allergic reactions

These complications, however, are all very rare.

Normal results

When the patient undergoes a single-contrast enema, the intestine is steadily filled with barium to differentiate the colon's markings. A normal result displays uniform filling of the colon. As the barium is expelled, the intestinal walls collapse. A normal result on the x ray after the barium is expelled shows an intestinal lining with a standard, feathery appearance and no abnormalities.

The double-contrast enema expands the intestine, which is already lined with a thin layer of barium; however, the addition of air displays a detailed image of the mucosal pattern. Varying positions taken by the patientallow the barium to collect on the dependent walls of the intestine by way of gravity.

Abnormal results

A barium enema visualizes abnormalities appearing on a series of x rays, thus aiding in the diagnosis of a variety of gastrointestinal disorders and the early signs of cancer. However, most colon cancers occur in the rectosigmoid region, or upper part of the rectum and adjoining portion of the sigmoid colon, and are better detected with flexible sigmoidoscopy or colonoscopy.

Abnormal findings on a barium enema examination may include polyps, lesions or tumors, diverticulae, inflammatory disease, such as ulcerative colitis, obstructions, or hernias. Structural changes in the intestine, gastroenteritis, and the size, position, and motility of the appendix may also be apparent.

Resources

BOOKS

Fischbach, Frances Talaska. A Manual of Laboratory and Diagnostic Tests, 6th ed. Philadelphia: Lippincott Williams and Wilkins, 2000.

Pagana, Kathleen Deska, and Timothy James Pagana. Mosby's Manual of Diagnostic and Laboratory Tests. St. Louis, Mo: Mosby, 1998.

Schull, Patricia, ed. Illustrated Guide to Diagnostic Tests, 2nd ed. Springhouse, PA: Springhouse Corporation, 1998.

Segen, Joseph C., and Joseph Stauffer. "Barium Enema (lower GI series)." In The Patient's Guide To Medical Tests: Everything You Need To Know About The Tests Your Doctor Prescribes. New York, NY: Facts On File, Inc., 1998: 44-45.

PERIODICALS

Fletcher, Robert H. "The End of Barium Enemas?" The New England Journal of Medicine 342 (June 15, 2000): 1823-1824.

Winawer, Sidney J., R. H. Fletcher, L. Miller, et al. "Colorectal Cancer Screening Clinical Guidelines and Rationale." Gastroenterology 112 (1997):594-642.

Winawer, Sidney J., Edward T. Stewart, Ann Zauber et al. "AComparison of Colonoscopy and Double-Contrast Barium Enema for Surveillance After Polypectomy." The New England Journal of Medicine 342 (June 15, 2000): 1766-1772.

Zoorob, Roger, Russell Anderson, Charles Cefalu, and Modamed Sidari. "Cancer Screening Guidelines." American Family Physician 63 (March 15, 2001): 1101-1112.

ORGANIZATIONS

American Cancer Society. 1599 Clifton Road, NE, Atlanta, GA 30329-4251. Phone: 1-800-ACS-2345. <http://www.cancer.org>.

American College of Gastroenterology. 4900 B South 31st Street, Arlington, VA 22206. Phone: 703-820-7400. Health Hotline: 1-800-978-7666. <http://www.acg.gi.org>.

American College of Radiology, <http://www.acr.org>.

Beth Kapes

KEY TERMS

Barium sulfate

A barium compound used during a barium enema to block the passage of x rays during the exam.

Colonoscopy

An examination of the upper portion of the rectum performed with a colonoscope or elongated speculum.

Diverticula

A diverticulum of the colon is a sac or pouch in the colon walls which is usually asymptomatic (without symptoms) but may cause difficulty if it becomes inflamed.

Diverticulitis

A condition of the diverticulum of the intestinal tract, especially in the colon, in which inflammation may cause pain and distended sacs extending from the colon.

Sigmoidoscopy

A visual examination of the rectum and sigmoid colon using an instrument called a sigmoidoscope.

Ulcerative colitis

An ulceration or erosion of the mucosa (lining) of the colon.

QUESTIONS TO ASK THE DOCTOR

  • How long will the test take?
  • Will the test be painful?
  • Is barium safe?
  • Can I take my usual medications the day before the test?
  • How many days will the barium be in my system?
  • When will I get the test results?

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"Barium Enema." Gale Encyclopedia of Cancer. . Encyclopedia.com. 30 Apr. 2017 <http://www.encyclopedia.com>.

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"Barium Enema." Gale Encyclopedia of Cancer. . Retrieved April 30, 2017 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/barium-enema

Barium Enema

Barium Enema

Definition

A barium enema, also known as a lower GI (gastrointestinal) exam, is a test that uses x-ray examination to view the large intestine. There are two types of this test: the single-contrast technique where barium sulfate is injected into the rectum in order to gain a profile view of the large intestine; and the double-contrast (or "air contrast") technique where air is inserted into the rectum.

Purpose

A barium enema may be performed for a variety of reasons, including to aid in the diagnosis of colon and rectal cancer (or colorectal cancer ), and inflammatory disease. Detection of polyps (a benign growth in the tissue lining of the colon and rectum), diverticula (a pouch pushing out from the colon), and structural changes in the large intestine can also be established with this test. The double-contrast barium enema is the best method for detecting small tumors (such as polyps), early inflammatory disease, and bleeding caused by ulcers.

The decision to perform a barium enema is based on a person's history of altered bowel habits. These can include diarrhea, constipation, any lower abdominal pain they are currently exhibiting, blood, mucus, or pus in their stools. It is also recommended that this exam be used every five to 10 years to screen healthy people for colorectal cancer, the second most deadly type of tumor in the United States. Those who have a close relative with colorectal cancer or have had a precancerous polyp are considered to be at an increased risk for the disease and should be screened more frequently to look for abnormalities.

Precautions

While barium enema is an effective screening method in the detection of symptoms and may lead to a timely diagnosis of several diseases, it is not the only method to do this. As of 1997, some studies have shown that the colonoscopy procedure performed by experienced gastroenterologists is a more accurate initial diagnostic tool for detecting early signs of colorectal cancer. A colonoscopy is the most accurate way for the physician to examine the entire colon and rectum for polyps. If abnormalities are seen at this time the procedure is accompanied by a biopsy. Some physicians use sigmoidoscopy plus a barium enema instead of colonoscopy.

KEY TERMS

Barium sulfate A barium compound used during a barium enema to block the passage of x rays during the exam.

Bowel lumen The space within the intestine.

Colonoscopy An examination of the upper portion of the rectum performed with a colonoscope or elongated speculum.

Diverticula A diverticulum of the colon is a sac or pouch in the colon walls which is usually asymptomatic (without symptoms) but may cause difficulty if it becomes inflamed.

Diverticulitis A condition of the diverticulum of the intestinal tract, especially in the colon, where inflammation may cause distended sacs extending from the colon and pain.

Ulcerative colitis An ulceration or erosion of the mucosa of the colon.

Proctosigmoidoscopy A visual examination of the rectum and sigmoid colon using a sigmoidoscope.

Description

To begin a barium enema, the patient will lie with their back down on a tilting radiographic table in order to have x rays of the abdomen taken. After being assisted to a different position, a well-lubricated rectal tube is inserted through the anus. This tube allows the physician or assistant to slowly administer the barium into the intestine. While this filling process is closely monitored, it is important for the patient to keep the anus tightly contracted against the rectal tube to help maintain its position and prevent the barium from leaking. This step is emphasized to the patient due to the inaccuracy that may be caused if the barium leaks. A rectal balloon may also be inflated to help retain the barium. The table may be tilted or the patient moved to a different position to aid in the filling process.

As the barium fills the intestine, x rays of the abdomen are taken to distinguish significant findings.There are many ways to perform a barium enema. One way is that shortly after filling, the rectal tube is removed and the patient expels as much of the barium as possible. Upon completing this, an additional x ray is taken, and a double-contrast enema may follow. If this is done immediately, a thin film of barium will remain in the intestine, and air is then slowly injected to expand the bowel lumen. Sometimes no x rays will be taken until after the air is injected.

Preparation

In order to conduct the most accurate barium enema test, the patient must follow a prescribed diet and bowel preparation instructions prior to the test. This preparation commonly includes restricted intake of diary products and a liquid diet for 24 hours prior to the test, in addition to drinking large amounts of water or clear liquids 12-24 hours before the test. Patients may also be given laxatives, and asked to give themselves a cleansing enema.

In addition to the prescribed diet and bowel preparation prior to the test, the patient can expect the following during a barium enema:

  • They will be well draped with a gown as they are secured to a tilting x-ray table.
  • As the barium or air is injected into the intestine, they may experience cramping pains or the urge to defecate.
  • The patient will be instructed to take slow, deep breaths through the mouth to ease any discomfort.

Aftercare

Patients should follow several steps immediately after undergoing a barium enema, including:

  • Drink plenty of fluids to help counteract the dehydrating effects of bowel preparation and the test.
  • Take time to rest. A barium enema and the bowel preparation taken before it can be exhausting.
  • A cleansing enema may be given to eliminate any remaining barium. Lightly colored stools will be prevalent for the next 24-72 hours following the test.

Risks

While a barium enema is considered a safe screening test used on a routine basis, it can cause complications in certain people. The following indications should be kept in mind before a barium enema is performed:

  • Those who have a rapid heart rate, severe ulcerative colitis, toxic megacolon, or a presumed perforation in the intestine should not undergo a barium enema.
  • The test can be cautiously performed if the patient has a blocked intestine, ulcerative colitis, diverticulitis, or severe bloody diarrhea.
  • Complications that may be caused by the test include perforation of the colon, water intoxication, barium granulomas (inflamed nodules), and allergic reaction. These are all very rare.

Normal results

When the patient undergoes a single-contrast enema, their intestine is steadily filled with barium to differentiate the colon's markings. A normal result displays uniform filling of the colon. As the barium is expelled, the intestinal walls collapse. A normal result on the x ray after defecation will show the intestinal lining as having a standard, feathery appearance.

Accordingly, the double-contrast enema expands the intestine which is already lined with a thin layer of barium, but with air to display a detailed image of the mucosal pattern. Varying positions taken by the patient allow the barium to collect on the dependent walls of the intestine by way of gravity.

Abnormal results

A barium enema allows abnormalities to appear on an x ray that may aid in the diagnosis of several different conditions. Although most colon cancers occur in the rectosigmoid region, or upper part of the rectum and adjoining portion of the sigmoid colon, and are better detected with a different test called a proctosigmoidoscopy, an enema can identify other early signs of cancer.

Identification of polyps, diverticulosis, inflammatory disease, such as diverticulitis and ulcerative colitis is attainable through a barium x ray. Structural changes in the intestine, gastroenteritis, and some cases of acute appendicitis may also be apparent by viewing this x ray.

Resources

ORGANIZATIONS

American Cancer Society. 1599 Clifton Rd., NE, Atlanta, GA 30329-4251. (800) 227-2345. http://www.cancer.org.

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"Barium Enema." Gale Encyclopedia of Medicine, 3rd ed.. . Encyclopedia.com. 30 Apr. 2017 <http://www.encyclopedia.com>.

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"Barium Enema." Gale Encyclopedia of Medicine, 3rd ed.. . Retrieved April 30, 2017 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/barium-enema-0

Barium Enema

Barium enema

Definition

A barium enema, also known as a lower GI (gastrointestinal) exam, is a test that uses x-ray examination to view the large intestine. There are two types of tests: the single-contrast technique, where barium sulfate is injected into the rectum to gain a profile view of the large intestine, and the double-contrast (or "air contrast") technique, where air and barium are inserted into the rectum.


Purpose

A barium enema may be performed for a variety of reasons. One reason may be to help in the diagnosis of colon and rectal cancer (or colorectal cancer), and inflammatory disease. Detection of polyps (benign growths in the tissue lining the colon and rectum), diverticula (pouches pushing out from the colon), and structural changes in the large intestine can also be confirmed by the barium enema. The double-contrast barium enema is the best method for detecting small tumors (such as polyps), early inflammatory disease, and bleeding caused by ulcers.

A doctor's decision to perform a barium enema is based on a patient's history of altered bowel habits. These can include diarrhea, constipation, lower abdominal pain, or patient reports of blood, mucus, or pus in the stools. It is recommended that healthy people have a colorectal cancer screening colonoscopy every five to 10 years, because this form of cancer is the second most deadly type in the United States. Those who have a close relative with colorectal cancer, or who have had a precancerous polyp, are considered to be at an increased risk for the disease and should be screened more frequently by their doctor for possible abnormalities.


Description

To begin a barium enema, the doctor will have the patient lie with their back down on a tilting radiographic table so that x rays can of the abdomen can be taken. The film is then reviewed by a radiologist, who assesses if the colon has been adequately cleansed of stool during the prep process. After being assisted into a different position, a well-lubricated rectal tube is inserted through the anus. This tube allows the physician or the assisting health care provider to slowly administer the barium into the intestine. While this filling process is closely monitored, the patient must keep the anus tightly contracted against the rectal tube so that the position is maintained and the barium is prevented from leaking. This step is emphasized to the patient because inaccuracy may occur if the barium leaks. A rectal balloon may also be inflated to help the patient retain the barium. The table may be tilted or the patient may be moved to different positions to aid in the filling process.

As the barium fills the intestine, x rays of the abdomen are taken to distinguish significant findings. There are many ways to perform a barium enema. One way is that shortly after filling, the rectal tube is removed and the patient expels as much of the barium as possible. Alternatively, the tube will remain in place, and the barium will move through that tube. A thin film of barium remains in the intestine, and air is then slowly injected through the rectum and to expand the bowel lumen. Usually no films will be taken until after the air is injected. Multiple films are generally obtained by a radiologist; then, additional films are made by a technologist.


Preparation

To conduct the most accurate barium enema test, the patient must follow a prescribed diet and bowel preparation instructions prior to the test. This preparation commonly includes restricted intake of diary products and a liquid diet for 24 hours prior to the test, in addition to drinking large amounts of water or clear liquids 1224 hours before the test. Patients may also be given laxatives , and asked to give themselves a cleansing enema.

In addition to the prescribed diet and bowel preparation prior to the test, the patient can expect the following during a barium enema:

  • They will be well draped with a gown as they are placed on a tilting x-ray table.
  • As the barium or air is injected into the intestine, they may experience cramping pains or the urge to defecate.
  • The patient will be instructed to take slow, deep breaths through the mouth to ease any discomfort.

Aftercare

Patients should follow several steps immediately after undergoing a barium enema, including:

  • Drinking plenty of fluids to help counteract the dehydrating effects of bowel preparation and the test.
  • Taking time to rest. A barium enema and the bowel preparation taken before it can be exhausting.
  • A cleansing enema may be given to eliminate any remaining barium. Lightly colored stools will be prevalent for the next 2472 hours following the test.

Risks

While a barium enema is considered a safe screening test used on a routine basis, it can cause complications in certain people. The following indications should be kept in mind before a barium enema is performed:

  • Those who have a rapid heart rate, severe ulcerative colitis, toxic megacolon, or a presumed perforation in the intestine should not undergo a barium enema.
  • The test can be performed cautiously if the patient has a blocked intestine, ulcerative colitis, diverticulitis, or severe bloody diarrhea.
  • Complications that may be caused by the test include perforation of the colon, water intoxication, barium granulomas (inflamed nodules), and allergic reaction. However, these conditions are all very rare.

Normal results

When patients undergo single-contrast enemas, their intestines are steadily filled with barium to differentiate markings of the colon markings. Normal results display uniform filling of the colon.

As the barium is expelled, the intestinal walls collapse. A normal result on the x ray after defecation will show the intestinal lining as having a standard, feathery appearance.

The double-contrast enema expands the intestine, which is already lined with a thin layer of barium, using air to display a detailed image of the mucosal pattern. Varying positions taken by the patient allow the barium to collect on the dependent walls of the intestine by way of gravity.

A barium enema allows abnormalities to appear on an x ray that may aid in the diagnosis of several different conditions. Most colon cancers occur in the rectosigmoid region, or on the upper part of the rectum and adjoining portion of the sigmoid colon. However, they can also be detected with a proctosigmoidoscopy (usually referred to as a sigmoidoscopy ). Further, an enema can identify other early signs of cancer.

Identification of polyps, diverticulosis, and inflammatory disease (such as diverticulitis and ulcerative colitis) is attainable through a barium x ray. Some cases of acute appendicitis may also be apparent by viewing this x ray, though acute appendicitis is usually diagnosed clinically, or by CT scan.


Resources

books

periodicals

Gazelle, G. "Screening for Colorectal Cancer." Radiology 327 (May 2000)

Rubesin, S. "Double Contrast Barium Enema Examination Technique." Radiology 642 (June 2000).

organizations

American Cancer Society. 1599 Clifton Rd., NE, Atlanta, GA 30329-4251. (800) 227-2345. <http://www.cancer.org>.


Beth A. Kapes

Lee A. Shratter, M.D.

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barium enema

barium enema (bair-iŭm) n. see enema.

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