GI X-ray Examinations

Fluoroscopy

Fluoroscopy is a type of X-ray that allows part of the body to be studied in motion and recorded on a video monitor. This type of X-ray is used to examine the gastrointestinal (GI) tract--which includes the esophagus, stomach, small intestine, large intestine (colon) and rectum--so that your physician can detect abnormalities in the size, shape, position or functioning of these organs.

Fluoroscopic gastrointestinal examinations may be performed in a physician's office, a commercial X-ray facility or a hospital.

These tests are usually called either upper GI or lower GI tests, depending on the organs that are to be studied.

Upper GI test

The upper GI test is used to examine the esophagus, stomach and part of the small intestine. For this test, the patient drinks a contrast solution that contains barium. The barium solution is sweetened and flavored, but does taste chalky. There will be both thick and thin mixtures of the barium solution you'll be asked to drink (usually totaling 355 - 415ml, or 12 - 14 ounces). The doctor or assistant will tell you when to take sips of the solution.

As the barium passes through the digestive tract, it provides an outline of the swallowing process as well as the esophagus, stomach and part of the small intestine. The fluoroscope is held over the part of the body being examined and transmits continuous images to the video monitor.

This test is used to diagnose hiatal hernias, ulcers, tumors, diverticulitis, esophageal varices, obstruction, narrowing, or enteritis (inflammation of the small intestine lining). It may also be used to determine the causes of swallowing problems, reflux, abdominal pain, diarrhea, unexplained vomiting or weight loss or bleeding.

Types of upper GI tests

Barium swallow (esophagography)

X-ray examination of the esophagus. Approximate time: 1 hour.

Upper GI series

X-ray examination of the stomach. Approximate time: 1 to 1-1/2 hours.

Small bowel series

X-ray examination of the small intestine (small bowel). Approximate time: 2 - 4 hours.

Lower GI test

The lower GI test is used to examine the large intestine and the rectum. For this test, barium is introduced gradually into the colon through a tube inserted into the rectum. As the barium passes through the lower intestine, it provides an outline of the intestinal wall. The fluoroscope is held over the part of the body being examined and transmits continuous images to the video monitor.

This test is used to detect polyps, tumors, diverticulitis, gastroenteritis, irritable colon, ulcerative colitis or other causes of abdominal pain, or blood, mucus or pus in the stool.

Types of lower GI tests

Air contrast barium enema (also called double contrast barium enema)

X-ray examination of the large intestine (colon). Barium and air are introduced gradually into the colon by a rectal tube. Approximate time: 1-1/2 - 2 hours.

Barium enema

X-ray examination of the large intestine (colon). Barium is introduced gradually into the colon by a rectal tube. Approximate time: 1 - 1.5 hours.

Before the upper and lower GI tests

Please be aware that correct preparation is very important for the upper and lower GI tests to be performed properly. The radiologist will tell you what you need to do to prepare for your specific GI examination.

Preparation usually includes making dietary changes (such as following a low-fiber diet for 2 to 3 days before the test), not smoking for 12 to 24 hours before the test, not taking any medications for 24 hours before the test and not eating anything for 12 hours before the test. Additional preparation for the lower GI test usually includes taking an enema or laxative the night before the test. Please follow the pretest directions carefully and ask questions if you do not understand them.

All examinations are performed and interpreted by registered and licensed technologists and board-certified radiologists.

Please tell the technologist if you have an insulin pump.

During the test

You may be given a mild sedative. You will be positioned on a tilting X-ray table by the technologist and will be secured with straps. For an upper GI test, the table usually starts in a vertical position, with the patient standing. For a lower GI test, the table usually starts in a horizontal position, with the patient lying on his or her side. The table will be tilted at various angles during the test to help spread the barium solution throughout the body so different views can be seen on the fluoroscope. During the test, the technologist may put slight pressure on your abdomen to get a clearer image on the fluoroscope.

Although the barium solution given in an upper GI test is unpleasant tasting, there is no pain and little discomfort during the procedure. The lower GI test may cause some discomfort, including cramps and a strong urge to have a bowel movement.

After the barium enema is administered in a lower GI test and a few X-rays are taken, you will be helped to the bathroom (or be given a bedpan) and you will be asked to move your bowels to expel as much of the barium as possible. Then you will go back to the X-ray examination room where more X-rays will taken of the barium solution that remains on the lining of the intestine. In some cases, air will be injected slowly into the colon (air contrast barium enema) to provide further contrast on the X-rays in order to detect abnormalities.

Are the tests safe?

There is virtually no risk with the upper and lower GI tests, unless they are repeated several times within a few months' time, when radiation then becomes a risk. Although radiation exposure is minimal, it is greater than for standard still X-rays. Fluoroscopic gastrointestinal examinations are performed by registered and licensed technologists and board-certified radiologists who carefully limit the X-ray to the specific area to be diagnosed so that surrounding parts of the body are not exposed. A lead apron may be worn during the procedure to protect the parts of the body that are not being studied.

• The risk of infection is very low with both the upper and lower GI tests.
• The additional risk associated with the lower GI test, although very low, is the risk of a tear in the intestinal wall. Should this occur, surgery may be necessary.
• If you have an existing blockage or tear in the intestinal wall, the upper and lower GI tests should not be performed.
• If you are pregnant or think you might be pregnant, you should not have these tests unless absolutely medically necessary. Talk to your doctor about other tests that can be more safely performed to diagnose your problem during pregnancy.

After the upper or lower GI test

• Generally you can resume your usual activities and normal diet immediately.
• Drink plenty of fluids.
• The barium given during the test may cause constipation, so a laxative or enema might be prescribed after the test.
• The barium enema given during the lower GI test may cause you to feel weak or dizzy.
• It is normal for your stool to have a white or light color for up to three days after the test.

When to call your doctor

After the test, call your doctor if you have:

• A temperature of 38.33°C or higher. This could be a sign of infection and should be treated right away.
• A marked change in bowel habits (such as no bowel movement in 2 to 3 days after the test. Remember it is normal for your stool to have a white or light color for up to three days after the test.
• Worsening of pain.
• Any usual rectail drainage.
• Other symptoms that cause concern.
• Questions about the test or the results.