science

Upper gastrointestinal series

Upper gastrointestinal series is a science topic covered in the lgStudy science library. This page brings together a partial reference excerpt, illustrations, worked examples, real-world applications and a short study plan, so you can understand Upper gastrointestinal series rather than just read about it. In short: An upper gastrointestinal series, also called a barium swallow, barium study, or barium meal, is a series of radiographs used to examine the gastrointestinal tract for abnormalities. A contrast medium, usually a radiocontrast agent such as barium sulfate mixed with water, is ingested or instilled into the gastrointestinal tract, and X-rays are used to create radiographs of the regions of interest.

Key takeaways

Upper gastrointestinal series belongs to science; place it in that map before memorising details.
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Connect Upper gastrointestinal series to a quantity you can measure, compute or draw — that is where exam questions come from.
Reproduce the core statement of Upper gastrointestinal series from memory before moving on to harder problems.

Reference excerpt

An upper gastrointestinal series, also called a barium swallow, barium study, or barium meal, is a series of radiographs used to examine the gastrointestinal tract for abnormalities. A contrast medium, usually a radiocontrast agent such as barium sulfate mixed with water, is ingested or instilled into the gastrointestinal tract, and X-rays are used to create radiographs of the regions of interest. The barium enhances the visibility of the relevant parts of the gastrointestinal tract by coating the inside wall of the tract and appearing white on the film. This in combination with other plain radiographs allows for the imaging of parts of the upper gastrointestinal tract such as the pharynx, larynx, esophagus, stomach, and small intestine such that the inside wall lining, size, shape, contour, and patency are visible to the examiner. With fluoroscopy, it is also possible to visualize the functional movement of examined organs such as swallowing, peristalsis, or sphincter closure. Depending on the organs to be examined, barium radiographs can be classified into "barium swallow", "barium meal", "barium follow-through", and "enteroclysis" ("small bowel enema"). To further enhance the quality of images, air or gas is sometimes introduced into the gastrointestinal tract in addition to barium, and this procedure is called double-contrast imaging. In this case the gas is referred to as the negative contrast medium. Traditionally the images produced with barium contrast are made with plain-film radiography, but computed tomography is also used in combination with barium contrast, in which case the procedure is called "CT enterography".

Types

Various types of barium X-ray examinations are used to examine different parts of the gastrointestinal tract. These include barium swallow, barium meal, barium follow-through, and barium enema. The barium swallow, barium meal, and barium follow-through are together also called an upper gastrointestinal series (or study), whereas the barium enema is called a lower gastrointestinal series (or study). In upper gastrointestinal series examinations, the barium sulfate is mixed with water and swallowed orally, whereas in the lower gastrointestinal series (barium enema), the barium contrast agent is administered as an enema through a small tube inserted into the rectum.

Barium swallow X-ray examinations are used to study the pharynx and esophagus. Barium meal examinations are used to study the lower esophagus, stomach and duodenum. Barium follow-through examinations are used to study the small intestine. Enteroclysis, also called small bowel enema, is a barium X-ray examination used to display individual loops of the small intestine by intubating the jejunum and administering barium sulfate followed by methylcellulose or air. Barium enema examinations are used to study the large intestine and rectum and are classified as lower gastrointestinal series.

Medical uses Barium X-ray examinations are useful tools for the study of appearance and function of the parts of the gastrointestinal tract. They are used to diagnose and monitor esophageal reflux, dysphagia, hiatus hernia, strictures, diverticula, pyloric stenosis, gastritis, enteritis, volvulus, varices, ulcers, tumors, and gastrointestinal dysmotility, as well as to detect foreign bodies. Although barium X-ray examinations are increasingly being replaced by more modern techniques, such as computer tomography, magnetic resonance imaging, ultrasound imaging, endoscopy and capsule endoscopy, barium contrast imaging remains in common use because it offers the advantages of greater affordability, wider availability, and better resolution in assessing superficial mucosal lesions.

Mechanism Barium sulfate is swallowed and is a radio opaque substance that does not allow the passage of X-rays. As a result, areas coated by barium sulfate will appear white on an X-ray film. The passage of barium sulfate through the gastrointestinal tract is observed by a radiologist using a fluoroscope attached to a TV monitor. The radiologist takes a series of individual X-ray images at timed intervals depending on the areas to be studied. Sometimes medication which produces gas in the gastrointestinal tract is administered together with the Barium sulfate. This gas distends the gastrointestinal lumen, providing better imaging conditions and in this case the procedure is called double-contrast imaging.

Procedure Clinical status and relevant medical history are reviewed prior to the studies. Patient consent is required.

Barium swallow A barium swallow study is also known as a barium esophagram and needs little if any preparations for the study of the larynx, pharynx, and esophagus when studied alone. Amongst the uses of barium swallow are: persistent dysphagia and odynophagia despite negative esophagogastroduodenoscopy (OGDS) findings, failed OGDS, esophageal motility disorder, globus pharyngeus, assessment of tracheoesophageal fistula, and timed barium swallow to monitor the progress of esophageal achalasia therapy. Barium sulfate suspension such as 100 ml or more of E-Z HD 200 to 250% concentration and Baritop 100% can be used. Water-soluble contrast agent such as Gastrografin (diatrizoate) and Conray (Iotalamic acid) is used instead of barium if oesophageal perforation is suspected. Low osmolar contrast medium with concentration of 300 mg/ml is used instead of gastrografin if there is risk of aspiration or there is tracheoesophageal fistula. A thick barium mixture is swallowed in supine position and fluoroscopic images of the swallowing process are made. Then several swallows of a thin barium mixture are taken and the passage is recorded by fluoroscopy and standard radiographs. The procedure is repeated several times with the examination table tilted at various angles. A total of 350–450 mL of barium is swallowed during the process. Normally, 90% of ingested fluid should have passed into the stomach after 15 seconds. Right anterior oblique (RAO) view is to see the oesophagus clearly, away from overlapping spine. AP (anterior-posterior) view is also done to visualise the gastroesophageal junction. AP and lateral views are also done to visualise the hypopharynx during swallowing at a frame rate of 3–4 per second. Left posterior oblique (LPO) position is used to identify hernias, mucosal rings, and varices.

… excerpt ends here. Continue reading the full article.

Illustrations

Upper gastrointestinal series: Zenker's diverticulum as seen in a barium swallow examination — Zenker's diverticulum as seen in a barium swallow examination

Worked examples

Example 1 — a first encounter with Upper gastrointestinal series

Start with the simplest possible case. Write down what Upper gastrointestinal series claims or describes in one sentence, then invent the smallest concrete situation in which that sentence is true. In science, the smallest case is usually a single object, a single equation or a single measurement. Check that every symbol or term in your sentence has a meaning in that case.

Example 2 — changing one variable

Take the situation from Example 1 and change exactly one quantity: double it, halve it, or set it to zero. Predict what should happen to Upper gastrointestinal series before you calculate. Comparing your prediction with the result is the fastest way to find out whether you understand the idea or only the words.

Example 3 — an exam-style question

Typical questions about Upper gastrointestinal series ask you to (a) state it precisely, (b) apply it to given data, and (c) explain a limitation. Practise writing all three answers in under five minutes; the third part is what separates a full-mark answer from an average one.

Applications of Upper gastrointestinal series

In research: Upper gastrointestinal series appears in science research whenever the underlying quantities have to be modelled precisely. Papers usually cite it as a starting assumption and then explore where it breaks down.
In technology and industry: Engineering practice reuses Upper gastrointestinal series in design rules, simulations and safety margins. Knowing the idea lets you read a specification sheet and understand why the numbers look the way they do.
In the classroom: Upper gastrointestinal series is common in secondary-school and first-year university syllabi. It links to neighbouring topics Barium, Diagnostic gastroenterology, Digestive system imaging, so understanding it makes those chapters shorter.
In everyday life: Look for Upper gastrointestinal series outside the textbook — in sport, cooking, traffic, electronics or the sky above you. An example you found yourself is remembered far longer than one you were given.

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How to study Upper gastrointestinal series in 20 minutes

Read the reference excerpt below once, without taking notes.
Close the page and write down what Upper gastrointestinal series means in your own words.
Compare your version with the excerpt and mark what you missed.
Work through the three examples above with pen and paper.
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Frequently asked questions

What is Upper gastrointestinal series in simple terms?

Why does Upper gastrointestinal series matter?

Because it connects several science ideas at once: it gives you a definition you can apply, a quantity you can calculate, and a way to check whether a result is plausible.

How should I study Upper gastrointestinal series?

Read the excerpt, restate it from memory, then work through the examples and applications listed on this page. The five-step study plan above takes about twenty minutes.

What does this page cover?

It gives you a compact reference excerpt plus original lgStudy explanations, examples, applications and study material on Upper gastrointestinal series.