Barium X-Rays
(Upper and Lower GI)

What are barium x-rays?
Barium x-rays (also called upper and lower GI series) are used to diagnose abnormalities of the gastrointestinal tract, such as tumors, ulcers, and other inflammatory conditions, polyps, hernias, and strictures. With the use of barium sulfate, a metallic chemical that x-rays cannot pass through, x-rays are taken of the area under examination.

Why are barium x-rays performed?
Reasons for performing barium x-ray procedures may include the following:

  • abdominal pain
  • bleeding from the rectum
  • blood in the vomit
  • bowel movement changes
  • chronic diarrhea or constipation
  • pain or difficulty swallowing
  • unexplained weight loss
  • unusual bloating

Additional procedures are often performed in conjunction with or as a result of barium x-rays. These procedures may include endoscopic examinations (an endoscope is a thin, flexible tube that is inserted into a body cavity and, using fiberoptic technology, provides direct visualization of the inside of the cavity), CT or MRI scans, and intra-cavity ultrasound.

What are the different types of barium x-ray procedures?
There are three types of barium x-ray procedures, including the following:

barium enema

What is a barium enema?
A barium enema involves filling the large intestine with diluted barium liquid while x-ray images are being taken. Barium enemas are used to diagnose disorders of the large intestine, colon, and rectum, such as colonic tumors, polyps, and diverticula.

How is a barium enema performed?
Usually, a barium enema can be performed on an outpatient basis. The patient may be asked to do the following in preparation for a barium enema:

  • Drink clear liquids the day before the examination.
  • Take a laxative, suppository, or drug to cleanse the bowel.
  • Refrain from eating and drinking after midnight on the night before the examination.

These measures are done to empty the large intestine, as any residue (feces) can obscure the image.

Barium enemas are performed in two ways:

  • single-contrast image - when the entire large intestine is filled with barium liquid. Single-contrast images show prominent abnormalities in the large intestine.
  • double-contrast image - when a smaller quantity of thicker barium liquid is introduced to the large intestine, followed by air. Double-contrast images show smaller surface abnormalities of the large intestine, as the air prevents the barium from filling the intestine. Instead, the barium forms a film on the inner surface.

Although each hospital may have specific protocols in place, generally, a barium enema procedure follows this process:

  1. The patient is positioned on an examination table.
  2. A rectal tube is inserted in the rectum to allow the barium to flow into the intestine.
  3. The radiologist uses a machine called a fluoroscope (a devise used for the immediate showing of an x-ray image).
  4. During the procedure, the machine and examination table will move and the patient may be asked to change positions.
  5. After the procedure, a small amount of barium will be expelled by the body immediately. The remainder of the liquid is later excreted in the stool. Barium liquid may cause constipation. Following the examination, the patient may be asked to eat foods high in fiber and drink plenty of fluids to help expel the barium from the body.
  6. Additional x-rays may be made immediately after the procedure in order to obtain greater details of the area under examination. Often, additional x-rays are made after the barium has been excreted from the bowel, which is usually one or more days after the procedure.

barium small-bowel enema

What is a barium small-bowel enema?
A barium small-bowel enema is also called enteroclysis. The procedure involves filling the small intestine with barium liquid while x-ray images are being taken. Barium small-bowel enemas are used to diagnose disorders of the stomach and small intestine, such as ulcers and tumors.

How is a barium small-bowel enema performed?
Usually, a barium small-bowel enema can be performed on an outpatient basis. Patients may be asked to refrain from eating or drinking after midnight on the night before the examination. An enema or laxative may be given on the day before the test to clear feces from the colon.

Although each hospital may have specific protocols in place, generally, a barium small-bowel procedure follows this process:

  1. The patient is positioned on the examination table.
  2. The radiologist uses a machine called a fluoroscope (a devise used for the immediate showing of an x-ray image).
  3. A small tube is inserted through the mouth or nose into the stomach and small intestine. Barium is passed through the tube to the small intestine as x-ray images are taken.
  4. Following the examination, the patient may be asked to eat foods high in fiber and drink plenty of fluids to expel the barium from the body.
  5. Additional x-rays may be made immediately after the procedure in order to obtain greater details of the area under examination. Often, additional x-rays are made after the barium has been excreted from the bowel, which is usually one or more days after the procedure.

barium swallow

What is a barium swallow?
A barium swallow, also called an upper GI series, is an examination of the esophagus and stomach using barium to coat the walls of the upper digestive tract so that it may be examined under x-ray. Barium swallows are used to identify any abnormalities such as tumors, ulcers, hernias, pouches, strictures, and swallowing difficulties.

How is a barium swallow performed?
Usually, a barium swallowcan be performed on an outpatient basis. Patients may be advised not to eat or drink after midnight on the night before the examination.

Although each hospital may have specific protocols in place, generally, a barium swallow procedure follows this process:

  1. The patient is asked to drink the barium liquid and to swallow baking soda crystals. It is important not to belch, as the gas assists the radiologist in evaluation.
  2. The patient remains standing behind a machine called a fluoroscope (a devise used for the immediate showing of an x-ray image).
  3. The patient may be asked to move in different positions and to hold his/her breath while the x-rays are taken.
  4. If the small intestine is to be examined, the patient may be asked to drink additional barium and a series of x-rays are taken until the barium reaches the colon.
  5. Following the examination, barium may cause constipation. The patient may be advised to drink plenty of fluids and eat foods high in fiber to expel the barium from the body.