Your Radiologist Explains: Upper Gastrointestinal (GI) Examination

Summary

Dr. Kristoff Walt from Ley Clinic in Boston presents an overview of upper GI tract imaging. The upper GI exam, including barium swallow for throat and esophagus, uses fluoroscopy to capture live X-ray images. Patients consume barium to coat the digestive tract, enhancing visibility. The procedure helps diagnose conditions like swallowing disorders, inflammation, ulcers, and tumors. For an upper GI exam, patients must fast, and may also ingest baking soda to produce gas, aiding in the examination of the stomach and duodenum. The presentation includes examples of conditions detected through this imaging technique.

Takeaways

• 📚 An upper GI exam is an x-ray examination of the beginning of the digestive system, including the mouth, throat, esophagus, stomach, and the first part of the small intestine (duodenum).
• 🔍 A barium swallow is a type of upper GI exam that focuses on the throat and esophagus, using barium as a contrast agent to enhance visibility on x-rays.
• 🍽 Preparation for an upper GI exam involves fasting to ensure the stomach is empty, and avoiding medications, chewing gum, and smoking after midnight before the test.
• 👨‍⚕️ Fluoroscopy, a special form of X-ray, is used during the exam to provide live images of the contrast material as it passes through the upper GI tract.
• 💡 Barium, when ingested, coats the inner surface of the digestive tract, making the organs visible on x-ray and highlighting any abnormalities.
• 🌬️ Some patients are also given baking soda to produce gas, which helps to distend the upper GI tract and improve the visibility of its lining.
• 🩺 An upper GI exam is recommended for symptoms such as difficulty swallowing, chest or abdominal pain, and reflux, and can diagnose conditions like swallowing disorders, inflammation, hernias, ulcers, and tumors.
• 👀 The exam can reveal specific conditions through images, such as Zenker's diverticulum, a pouch in the throat where food can get stuck, or spasms in the esophagus that impede the passage of food.
• 🔎 Radiographic images can show the normal anatomy of the stomach and duodenum, as well as abnormalities like erosive gastritis, which appears as small ulcers in the stomach lining.
• 🏥 If a blockage is found, such as a cancer in the duodenum, it may require surgical intervention to remove the obstruction and restore the passage for food and liquid.

Q & A

What is an upper GI exam and what does it evaluate?

An upper GI exam is an X-ray examination of the beginning of the digestive system. It evaluates the mouth, throat, esophagus, stomach, and the first part of the small intestine (duodenum).

What is a barium swallow, and how is it different from an upper GI exam?

A barium swallow is a more limited exam focusing solely on the throat and esophagus, while an upper GI exam evaluates the entire upper digestive system, including the stomach and part of the small intestine.

How should a patient prepare for an upper GI exam?

To ensure optimal image quality, the patient’s stomach must be empty. Patients are advised to refrain from eating, drinking, taking oral medications, chewing gum, and smoking after midnight on the day of the exam.

What type of X-ray technology is used during an upper GI exam?

Fluoroscopy, a special form of X-ray that provides live radiographic images, is used during an upper GI exam. It allows the radiologist to observe the passage of contrast through the digestive tract in real-time.

Why is barium used during the exam, and what role does it play?

Barium is used as a contrast agent. After a patient drinks it, barium coats the inner surface of the digestive organs, making them visible on the X-ray. This allows the radiologist to assess the anatomy and function of the upper GI tract.

What are some of the symptoms that might prompt a doctor to recommend an upper GI exam?

Doctors may recommend an upper GI exam if a patient experiences symptoms like difficulty swallowing, chest or abdominal pain, acid reflux, or other signs of digestive dysfunction.

What conditions can be diagnosed through an upper GI exam?

An upper GI exam can diagnose a range of conditions, including swallowing disorders, inflammation of the esophagus or stomach, hiatal hernias, ulcers, tumors, and other digestive issues.

What is a Zenker diverticulum, and how does it appear on an upper GI exam?

A Zenker diverticulum is an abnormal outpouching of the hind wall of the throat. On an upper GI exam, barium can become trapped in this pouch, which may cause symptoms like bad breath or food spilling into the airway.

What happens when the esophagus goes into spasm during the swallowing process?

When the esophagus goes into a spasm, it can take on a corkscrew shape, making it difficult for food or liquid (such as barium) to pass downward. This can give the patient the sensation of food being stuck.

How does erosive gastritis appear on an upper GI exam, and what can cause it?

Erosive gastritis appears as multiple small ulcers in the stomach lining, where barium pools in the ulcer craters. It can be caused by chronic inflammation, too much stomach acid, or taking over-the-counter anti-inflammatory pills.