Upper Gl Exam
Upper Gl Exam
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).
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.
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.
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.
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.
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.
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.
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 to handle a variety of situations are essential in doing barium studies.
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.
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.
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.
Ross, Linda, ed. Gastrointestinal Diseases and Disorders Sourcebook, Vol. 16. Detroit: Omnigraphics, 1996.
Newman, J. "Radiographic and Endoscopic Evaluation of the Upper GI Tract." Radiology Technology 69 (Jan-Feb 1998): 213-26.