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BARIUM MEALS
Shuja Tahir, FRCSEd

INV-17

It is the contrast medium radiological visualization of the stomach and duodenum. It is also called upper gastro-intestinal (UGI) examination. It may be a single or double contrast study. These x-rays also help in the diagnosis of pancreatic and splenic lesions indirectly by showing the distortion of gastric shadow. It is an extremely useful investigation. It helps to examine the fourth part of duodenum and proximal loops of jejunum. It also helps to visualize the functional sphincteric problems of cardiac and pyloric sphincters. The barium x-ray studies are performed under fluoroscopic control and spot films are exposed whenever a lesion is spotted or suspected. Immediate film shows lower esophagus and the whole of the gastric shadow. Different views are exposed to have adequate view of all sides of the stomach. Half an hour later films reveal stomach emptying capacity. INDICATIONS 1. 2. 3. 4. 5. 6. Duodenal ulcer Gastric ulcer Pyloric stenosis Carcinoma stomach Hiatus hernia Pancreatic tumours

7. Pseudocyst of pancreas 8. Splenic lesions such as cysts, haematomas and rupture 9. Haemetemesis and melaena 10. Diverticulae of upper gastro-intestinal tract 11. Congenital lesions of upper gastrointestinal tract (UGT) 12. Mesenteric cysts CONTRA INDICATIONS SUSPECTED GASTRIC PERFORATION The barium sulphate solution may lead to anaphylactic shock in cases of gastric perforation when barium sulphate enters the peritoneal cavity. It should not be tried when perforation is suspected. ACUTE INFLAMMATORY DISEASES OF SMALL GUT Barium meals should not be performed in diseases such as typhoid. It may deteriorate the acute inflammatory process. Sometimes it may even lead to perforation, peritonitis and fatal consequences. SUSPECTED INTESTINAL OBSTRUCTION The partial or subacute obstruction may change into complete and acute obstruction. The acute emergency may require immediate surgery which may be hazardous in the presence of
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BARIUM MEALS

barium solution in the intestine. PREPARATION The patient is kept fasting for twelve hours before the investigation to keep the stomach empty. The patient should have soft and low residue diet two three days prior to the examination to keep the colon free of gas and faeces.

abnormalities, if present are seen. This x-ray film is compared with the post contrast medium film.

Barium meals showing rounded collection of barium (En face benign ulcer)

The patient is given 200-300 mls of barium sulphate solution to drink after it is thoroughly mixed. The patient sits in erect position. Fluoroscopy is performed and spot x-ray pictures of abdomen are taken in three positions. 1. Standing 2. Lying 3. Lying with foot end raised These films show the gastric anatomy reasonably well.
Barium meals showing benign ulcer along the lesser curve of the stomach

PROCEDURE A plain x-ray of upper abdomen is exposed to see the soft tissue shadows of liver, spleen, kidneys and psoas muscles. Radio-opaque shadows and calcifications at various areas are seen if present. Bony shadows with its
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Any herniation at the oesophageal end (Hiatus hernia) if present can also be identified or excluded. The interior of stomach cannot be adequately examined by these films. Smaller ulcers and lesions may be missed. In difficult cases or in cases with smaller lesions, double contrast
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barium studies should be performed.

Screening studies must be performed and whenever a small ulcer or lesion is spotted, x-ray picture is exposed. The x-ray films are exposed to show the pyloric end of the stomach and the first and second part of the duodenum. Another x-ray film is exposed 30-40 minutes after the swallowing of barium solution. Ideally the stomach should be empty by then. In cases of pyloric obstruction, persistent gastric dilatation is seen in these films and in delayed films depending upon the size of obstruction. The late films are also be exposed to see the presence of dye in the small gut, the large gut and ileo caecal junction (caecum and ascending colon). These films also show abnormalities present in the distal part of gastro-intestinal tract. REFERENCES
1. Peter Armstrong. Martin L. Wastie. Gastrointestinal tract IN Diagnostic Imaging. 3rd edition Blackwell Scientific publications London, 1992, pp 157-66 Philip W. Ballinger. Stomach and Duodenum: In Radiologic positions and procedures. Fifth edition, vol., three. The C.V. Mosby Company, Toronto, 1982 pp 636-663

Barium meals showing malignant ulcer (mucosal folds do not reach the ulcer crater)

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Barium meals showing gastric outlet obstruction. Carcinoma is causing narrowing of the antrum

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