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.

Outlines

00:00

🔍 Introduction to Upper GI Imaging

Dr. Kristoff Walt introduces himself as a radiologist at the Ley Clinic in Boston and explains the purpose of an upper gastrointestinal (GI) exam. This x-ray examination focuses on the initial part of the digestive system, including the mouth, throat, esophagus, stomach, and duodenum. The preparation for the test involves fasting to ensure the stomach is empty, and avoiding medications, chewing gum, and smoking. The examination uses fluoroscopy, a real-time X-ray imaging technique, to observe the movement of contrast material through the upper GI tract. Patients are given barium, which coats the inner surfaces of the organs, enhancing visibility on X-rays. The presentation also mentions the use of baking soda to produce gas, which helps in examining the GI tract lining. The exam is recommended for symptoms like difficulty swallowing, chest pain, and reflux, and can diagnose conditions such as swallowing disorders, inflammation, hernias, ulcers, and tumors.

05:01

📸 Case Studies in Upper GI Imaging

The second paragraph delves into specific case studies demonstrated through upper GI exam images. It describes an image of a patient's throat with barium, highlighting a Zener diverticulum, an abnormal pouch where food can get trapped, leading to bad breath or aspiration. Another image shows a patient's esophagus during a spasm, causing a 'corkscrew' effect and difficulty in food passage. A normal stomach image is contrasted with one showing erosive gastritis, characterized by multiple ulcers visible as white puddles of barium. The paragraph concludes with a case of duodenal cancer causing a blockage, visible as barium backup into the stomach. The speaker encourages further learning about upper GI exams through a provided website and thanks the audience for their attention.

Keywords

💡Radiologist

A radiologist is a medical doctor who specializes in diagnosing and treating diseases using medical imaging techniques such as X-rays, MRI, and CT scans. In the context of the video, Kristoff Walt identifies himself as a radiologist at the Ley clinic, emphasizing the importance of his expertise in interpreting the imaging of the upper GI tract.

💡Upper GI Exam

An upper GI exam is an X-ray examination of the upper gastrointestinal tract, which includes the esophagus, stomach, and duodenum. The video presentation focuses on explaining this procedure, highlighting its role in diagnosing various conditions affecting these areas. The script mentions that this exam can be limited to the throat and esophagus, known as a barium swallow.

💡Fluoroscopy

Fluoroscopy is a special form of X-ray that provides live radiographic images. It is used during an upper GI exam to observe the movement of contrast material through the digestive tract in real-time. The radiologist uses this technique to assess the function and anatomy of the GI tract, as described in the script where the radiologist watches the passage of contrast.

💡Barium

Barium is a substance used as a contrast agent in X-ray imaging. It is ingested by the patient and coats the lining of the digestive tract, making it visible on X-rays. The script explains that barium 'sticks to the inner surface of your internal organs like paint to a wall,' which helps the radiologist to view and assess the anatomy and function of the digestive tract.

💡Baking Soda Crystals

Baking soda crystals are sometimes given to patients before an upper GI exam to produce gas inside the patient. This gas helps to distend the upper GI tract, allowing for a clearer view of its lining. The script mentions that 'some patients are also given baking soda crystals which produce some gas inside the patient,' enhancing the visualization of the GI tract during the exam.

💡Zenker Diverticulum

A Zenker diverticulum is an abnormal outpouching of the pharyngeal wall, which can cause food to become trapped, leading to symptoms like bad breath or aspiration. The video script provides an example of an image where 'some of the barium gets caught in an abnormal outpouching of the hind wall of the throat called a Zenker diverticulum,' illustrating a condition that can be identified through an upper GI exam.

💡Esophageal Spasms

Esophageal spasms are involuntary, uncoordinated contractions of the esophagus muscles that can make it difficult for food to pass through. The script describes a scenario where 'the esophagus...goes into a spasm which looks like a corkscrew and makes it difficult for more barium to pass downward,' which is a condition that can be visualized and diagnosed using an upper GI exam.

💡Erosive Gastritis

Erosive gastritis is a condition characterized by the presence of multiple ulcers or erosions in the stomach lining, often caused by excessive stomach acid or the use of certain medications. The video script mentions an image where 'the small image at the bottom shows the many little ulcers in the stomach,' which is a direct result of erosive gastritis and can be identified through an upper GI exam.

💡Duodenal Blockage

A duodenal blockage refers to an obstruction in the duodenum, which is the first part of the small intestine. The script describes a case where 'a tight blockage in the duodenum causes barium to back up into the stomach,' due to a cancerous growth. This is a serious condition that can be diagnosed using an upper GI exam, and may require surgical intervention.

💡Radiologyinfo.org

Radiologyinfo.org is a website mentioned in the script as a resource for patients to learn more about various radiological exams, including upper GI exams. It is an example of how the video script directs viewers to additional educational resources for a more comprehensive understanding of medical imaging procedures.

Highlights

Introduction to upper GI tract imaging by Kristoff Walt and Dr. Frank Schulz.

Explanation of an upper GI exam as an x-ray examination of the digestive system's beginning.

Description of a barium swallow as a specific type of upper GI exam focused on the throat and esophagus.

Schematic drawing highlighting the parts of the upper GI tract that can be evaluated.

Enlarged view detailing the stomach and the first part of the small intestine (duodenum).

Preparation instructions for an upper GI exam, including fasting and avoiding medications, gum, and smoking.

Use of fluoroscopy in upper GI exams to provide live radiographic images.

Process of patients drinking oral contrast liquid containing barium for x-ray visibility.

Function of barium in adhering to internal organs to enhance x-ray imaging.

Administration of baking soda crystals to produce gas and distend the upper GI tract for better imaging.

Indications for an upper GI exam, including difficulty swallowing, chest pain, and reflux symptoms.

Diagnostic capabilities of upper GI exams in identifying swallowing disorders and inflammation.

Examples of conditions visible on upper GI exams, such as hiatal hernias, ulcers, and tumors.

Presentation of example images from upper GI exams, showing various pathological conditions.

Image analysis of a Zener diverticulum, an abnormal outpouching in the throat.

Demonstration of esophageal spasm causing difficulty in food passage through a radiographic movie.

Radiographic image of a normal stomach with barium coating and gas from baking soda.

Identification of erosive gastritis through the presence of ulcers in the stomach lining.

Case of a duodenal blockage caused by cancer, visible through barium backup in the stomach.

Recommendation for learning more about upper GI exams via www.radiologyinfo.org.

Transcripts

hello my name is Kristoff Walt and I'm a

radiologist at the Ley clinic in Boston

my colleague Dr Frank Schulz and myself

have prepared the following short

presentation to explain Imaging of the

upper GI

tract an upper GI exam is an x-ray

examination of the beginning of the

digestive system when the exam is

limited to the throat and esophagus only

we call it a barium

swallow this is a schematic drawing

highlighting the various parts of the

upper ey tract we can evaluate with this

test as I said before we image the mouth

and throat esophagus and stomach here's

enlarged view of the stomach and the

first part of the small intestine which

is also known as the Dum which we can

also evaluate on an upper GI

exam you may wonder how best to prepare

for this test to ensure the best

possible image quality your stomach must

be empty of food you will likely be

asked not to eat or drink anything

including any medications taken by mouth

especially and aets also please refrain

from chewing gum and smoking after

midnight on the day of the

examination upper GI exams use a special

form of X-ray called

fluoroscopy fluoroscopy provides live

radiographic images while switched on

the radiologist shown here sitting

behind a protective screen uses the

equipment to watch the passage of

contrast through the upper G tract and

to observe internal organs in

motion before or during the exam

patients are asked to drink an oral

contrast liquid most commonly containing

a substance called

barium an X-ray camera can see barium

inside a patient from the outside after

drinking it barium sticks to the inner

surface of your internal organs like

paint to a wall and makes them invisible

to the X-ray eye the radiologist can now

View and assess anatomy and function of

the digestive tract some patients are

also given baking soda crystals which

produce some gas inside the patient

distending the upper GI tract using both

contrast and the gas helps to see the

lining of the GI tract

better your doctor may ask you to

undergo an upper GI exam if you have

symptoms such as difficulty swallow

flowing chest and abdominal pain reflux

which is a backward flow of partially

digested food and digestive juices and

other symptoms an upper GI exam helps to

evaluate digestive function and can

diagnose many diseases of the upper GI

tract here are some examples swallowing

disorders inflammation of the esophagus

stomach and duodenum hial hernias ulcers

tumors and other things the following

slides contains some example images from

upper GI exams showing some of the

conditions we can see on these

exams this is an image of a patient's

throat seen from the side for

orientation the spine is labeled barium

seen here in black is passing through

the throat shown by the Green Arrow and

some of the barium gets caught in an

abnormal outpouching of the hind wall of

the throat called a zener

diverticulum this this second image

shows that most of the Barum has passed

into the

esophagus while some got stuck in the

zener

diverticulum in patients with this

condition food can get stuck in this

little pouch and cause bad breath or

accidentally spill out into the

neighborhood such as the breathing

tube here you see a short Loop of a

movie of a patient whose esophagus is

giving trouble the image shows a view

into the patient from the side the p

patient is actually swallowing barium

contrast the black column in this image

is barium passing through the esophagus

as the camera is filming it the

esophagus which is basically a tube

mostly made up of muscle is first moving

the barium downward just fine but then

at some point goes into a spasm which

looks like a cork screw and makes it

difficult for Mor barium to pass

downward when the spasm occurs the

patient has a sensation that food or in

this case barium is getting

stuck this is a radiographic picture of

a normal stomach the stomach lining is

coated with barium the stomach is filled

with gas from baking soda crystals you

can see the body which is the main part

of the stomach marked by the letter b

and the exit of the stomach the

so-called antrum marked by the letter A

little black arroe heads point to normal

folds of the lining of the stomach the

first part of the stomach called the

fundus marked by the letter F is filled

here with dense white

barium this is an image of a patient

with erosive gastritis this condition

can be caused by taking common

over-the-counter anti-inflammatory

painkiller type pills chronic

inflammation of the stomach lining and

too much acid in the stomach can result

in the development of many little erss

shown here on images from an upper GI

exam the small image at the bottom shows

the many little ulcers in the stomach

barium which looks white on these images

pools in the little ulcer craters which

are shallow grooves in the lining of the

stomach the dark ring arout eat little

white barium puddle on this image is

caused by swelling of the inflamed

stomach lining surrounding the alcer

crater this patient has developed a

tight blockage in the duodenum the

duodenum normally looks like a tube tube

and is the first part of the human small

bowel in this patient the blockage

causes barium to back up into the

stomach the reason is a cancer of the

duodenum marked here with a red C which

wraps around the duodenum squeezing it

tightly which is illustrated by the

green arrows if the cancer has not yet

spread this patient may need an

operation to remove the cancer and

restore passage for food and liquid

if you would like to learn more about

upper GI exams please visit www.

radiologyinfo.org and I thank you for

your

attention