What is a barium swallow test used for. How does a barium swallow help diagnose GERD. What happens during a barium swallow procedure. What are the potential side effects of a barium swallow test. How long does a typical barium swallow exam take.

Understanding the Barium Swallow Test

A barium swallow test is a valuable diagnostic tool used by medical professionals to examine the upper gastrointestinal tract. This radiological examination provides detailed images of the back of the mouth, pharynx, and esophagus, allowing doctors to identify various digestive issues, including gastroesophageal reflux disease (GERD).

During this procedure, patients swallow a barium sulfate solution, which coats the inner lining of the digestive tract. As X-rays are taken, the barium appears opaque, highlighting potential abnormalities or structural issues that may be causing symptoms.

Types of Barium Swallow Tests

There are two primary types of barium swallow tests:

• Liquid Barium Swallow: This test involves drinking a barium mixture, which can be flavored or unflavored based on patient preference.
• Modified Barium Swallow: This more comprehensive test analyzes three phases of swallowing – oral, pharyngeal, and upper esophageal.

The choice between these tests depends on the specific symptoms and concerns of the patient, as well as the doctor’s recommendation.

The Barium Swallow Procedure: What to Expect

Understanding the barium swallow procedure can help patients feel more comfortable and prepared. Here’s a breakdown of what typically occurs during the exam:

1. Patients are asked to remove any metal objects and change into a hospital gown.
2. The radiologist or technician explains the procedure and answers any questions.
3. Patients drink small amounts of the barium solution while X-rays are taken.
4. The radiologist may ask patients to move into different positions to capture various angles.
5. The entire process usually takes between 30 to 60 minutes.

Is special preparation required for a barium swallow test? Typically, patients are advised to fast for several hours before the exam to ensure clear images. Your healthcare provider will provide specific instructions based on your individual case.

Diagnosing GERD with a Barium Swallow

Gastroesophageal reflux disease (GERD) is a common digestive disorder that affects millions of people worldwide. A barium swallow test can be instrumental in diagnosing this condition by revealing several key factors:

• Esophageal strictures or narrowing
• Hiatal hernias
• Abnormal esophageal motility
• Presence of reflux

Can a barium swallow definitively diagnose GERD? While a barium swallow can provide valuable information, it is often used in conjunction with other diagnostic tools such as endoscopy or pH monitoring for a comprehensive evaluation of GERD symptoms.

Potential Side Effects and Precautions

As with any medical procedure, it’s important to be aware of potential side effects associated with a barium swallow test:

• Constipation or fecal impaction
• Temporary changes in stool color
• Abdominal discomfort or bloating
• Radiation exposure (minimal but cumulative)

To minimize these effects, patients are advised to drink plenty of fluids and consume high-fiber foods following the procedure. In some cases, a doctor may prescribe a laxative to help expel the barium from the body.

Are there any contraindications for a barium swallow test? Patients who are pregnant, have known allergies to barium, or have suspected gastrointestinal perforation should inform their healthcare provider before undergoing this test.

Comparing Barium Swallow to Other Diagnostic Tests

While a barium swallow is a valuable diagnostic tool, it’s not the only option available for evaluating digestive issues. Let’s compare it to some other common tests:

Barium Swallow vs. Endoscopy

An endoscopy involves inserting a small camera into the esophagus and stomach, providing direct visualization of the digestive tract. Unlike a barium swallow, it allows for tissue sampling if necessary. However, a barium swallow is generally less invasive and may be more suitable for initial evaluations.

Barium Swallow vs. pH Monitoring

pH monitoring measures the acidity levels in the esophagus over an extended period, typically 24 hours. This test is particularly useful for confirming GERD diagnoses but doesn’t provide the structural information that a barium swallow can offer.

How do doctors determine which test is most appropriate? The choice of diagnostic test depends on the patient’s symptoms, medical history, and the specific information the doctor is seeking to obtain.

Interpreting Barium Swallow Results

After a barium swallow test, patients often wonder about the timeline for receiving results. Typically, a radiologist will review the images and provide a report to the referring physician within a few days. The doctor will then discuss the findings with the patient and recommend any necessary follow-up actions or treatments.

What specific information can be gleaned from a barium swallow test? The results may reveal:

• Structural abnormalities in the esophagus or stomach
• Signs of inflammation or ulceration
• Presence of tumors or growths
• Swallowing difficulties or abnormalities
• Evidence of reflux or regurgitation

It’s important to note that while a barium swallow can provide valuable insights, it may not always offer a definitive diagnosis. In some cases, additional tests or procedures may be necessary to confirm or rule out certain conditions.

Managing GERD: Beyond Diagnosis

Once GERD has been diagnosed, whether through a barium swallow or other means, the focus shifts to management and treatment. There are several approaches to managing GERD symptoms and preventing complications:

Lifestyle Modifications

Many patients find relief through simple lifestyle changes, such as:

• Elevating the head of the bed
• Avoiding trigger foods (e.g., spicy, fatty, or acidic foods)
• Eating smaller, more frequent meals
• Quitting smoking
• Maintaining a healthy weight

Medications

Various medications can help manage GERD symptoms:

• Antacids for quick relief of mild symptoms
• H2 blockers to reduce acid production
• Proton pump inhibitors (PPIs) for more severe cases

Surgical Interventions

In some cases, particularly when conservative treatments fail, surgical options may be considered. These can include:

• Fundoplication: A procedure to strengthen the lower esophageal sphincter
• LINX device: A ring of magnetic beads placed around the lower esophagus to prevent reflux

How do doctors determine the best treatment approach for GERD? The choice of treatment depends on the severity of symptoms, the frequency of occurrences, and the individual patient’s overall health and preferences.

The Importance of Regular Follow-up

After a GERD diagnosis and the initiation of treatment, regular follow-up appointments are crucial. These check-ins allow doctors to monitor the effectiveness of the chosen treatment plan and make adjustments as necessary. They also provide an opportunity to address any new or persistent symptoms and discuss any concerns the patient may have.

How often should patients with GERD have follow-up appointments? The frequency of follow-ups can vary depending on the severity of the condition and the chosen treatment plan. Typically, patients might have appointments every few months initially, with the interval increasing as symptoms improve and stabilize.

During these follow-up visits, doctors may:

• Review symptom diaries or logs kept by the patient
• Adjust medications or dosages as needed
• Discuss any new lifestyle modifications that might be beneficial
• Consider additional testing if symptoms persist or worsen
• Address any complications or related conditions that may have developed

Regular follow-ups not only ensure optimal management of GERD but also help in the early detection and prevention of potential complications such as Barrett’s esophagus or esophageal strictures.

Emerging Technologies in GERD Diagnosis and Management

As medical science advances, new technologies and techniques are emerging to improve the diagnosis and management of GERD. Some of these innovative approaches include:

Wireless pH Monitoring

This technique involves attaching a small capsule to the esophageal lining, which transmits pH data to a receiver worn by the patient. It allows for longer monitoring periods (up to 96 hours) and is more comfortable than traditional catheter-based systems.

Impedance-pH Testing

This advanced form of pH monitoring can detect both acid and non-acid reflux events, providing a more comprehensive picture of esophageal function.

Endoscopic Therapies

New endoscopic techniques are being developed to treat GERD without the need for invasive surgery. These include:

• Transoral Incisionless Fundoplication (TIF): A procedure that reinforces the anti-reflux barrier using an endoscopic device
• Stretta Procedure: Uses radiofrequency energy to strengthen the lower esophageal sphincter

How might these emerging technologies change the landscape of GERD diagnosis and treatment? While many of these techniques are still being studied and refined, they hold promise for more accurate diagnoses and less invasive treatment options in the future.

As research continues, it’s likely that we’ll see even more innovative approaches to managing GERD and other digestive disorders. Patients are encouraged to discuss these emerging options with their healthcare providers to stay informed about the latest developments in GERD care.

What Is A Barium Swallow? — Tampa Bay Reflux Center

If you have been diagnosed with GERD or any other digestive issue, there are several GERD diagnostic tests that your doctor can recommend, among them the barium swallow. A barium swallow test can diagnose several conditions, but we want to focus on how it can help diagnose GERD. This blog discusses what a barium swallow is, what happens during it and what to expect from a barium swallow. 

What Is A Barium Swallow?

During a barium swallow, your doctor uses X-rays to take a close look at your back of the mouth, your pharynx, and your esophagus, the tube that runs from the back of your tongue down to your stomach. It is used to diagnose gastroesophageal reflux disease (GERD), esophageal cancer, and other issues. 

Types of Barium Swallows

When preparing for your barium swallow test, you have to consider what kind of test you are getting. There are two primary barium swallow tests: a liquid barium swallow and modified barium swallow.  

A liquid barium swallow involves drinking the mixture, which can be flavored or unflavored depending on what works best for you. A modified barium swallow test analyzes three phases of swallowing: oral, pharyngeal, and upper esophageal. In contrast, a barium swallow examines how liquid travels through the esophagus and into the stomach.

What Happens During A Barium Swallow

During the procedure, you will be asked to swallow small amounts at a time as they x-ray what is going on inside your throat and esophagus. The liquid barium sulfate solution coats whatever it comes into contact with so that when an x-ray is taken, what they are looking for shows up on the X-ray. This can be helpful if there has been a history of esophageal strictures or narrowing to diagnose what’s happening in that area and what might be causing it. It may also help identify an obstruction further.

How Long Does A Barium Swallow Test Take?

A standard barium swallow exam takes about 30-60 minutes to complete. In some cases, the test might be longer if there is a need to repeat swallows for what they are looking for to show up on an x-ray. It can also take more time depending on what else may be happening during your exam that could require additional images or testing, such as endoscopy or capsule studies.

Barium Swallow Side Effects

Constipation or fecal impaction may occur if the barium is not completely expelled from the body after the procedure. For your body to eliminate the barium, drink plenty of fluids and consume foods high in fiber. Your doctor might prescribe a laxative if that doesn’t work.

Your bowel movements might appear lighter in color after your procedure. This occurs because the body cannot absorb the barium. You will see that the color of your stool returns to normal as soon as all the barium has been eliminated.

If you experience any of the following, consult your physician as soon as possible:

• It is difficult for you to have a bowel movement.

• Your abdomen hurts or feels bloated.

• There is a decrease in diameter in your stools.

Barium swallows also expose patients to radiation, as do all X-ray procedures. Radiation-related complications accumulate over time and are associated with the number of X-ray exams and treatments a person undergoes. Before your barium swallow, it may be helpful to provide your doctor with a record of past radiation procedures.

A barium swallow is a helpful GERD diagnostic test. At Tampa Bay Reflux Center, we can perform your barium swallow to uncover your reflux issues. You can schedule your test today.

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Barium Swallow Vs.

Endoscopy: What’s the Difference?

Two procedures used to examine the upper gastrointestinal (GI) tract are a barium swallow and an endoscopy. While they are related in their goal of helping your doctor assess areas and structures in your digestive tract that cannot be viewed externally, they are very different processes. A barium swallow enables your physician to diagnose relatively simple medical conditions solely through the use of X-rays. More difficult-to-diagnose procedures may require endoscopy, which is an invasive procedure requiring the insertion of a small camera into the upper GI.

What Is an Endoscopy?

An endoscopy allows surgeons to see problems inside your body without having to make surgical incisions. In the case of an upper GI endoscopy, a specialized flexible tube with a light and camera attached to it is inserted through your mouth and down into your GI tract. The scope allows your doctor to see interior structures in much greater detail than an X-ray. Attached to the scope are forceps and scissors, which allow the removal of tissue for further examination and biopsy if appropriate.

EGD Vs. Endoscopy

What is the difference between EGD and endoscopy? An endoscopy is another term for an EGD procedure. You will sometimes see endoscopies referred to as EGDs. EGD is another name for the same procedure. EGD stands for esophagogastroduodenoscopy.

What Is an Endoscopy Used to Diagnose?

Your doctor may order an endoscopy if you have

Symptoms such as:

• Bleeding in the digestive tract
• Abdominal pain
• Nausea and vomiting
• Swallowing problems
• Weight loss

Conditions such as:

• Stomach ulcer
• Gastroesophageal reflux disease or GERD (acid reflux) and heartburn
• Tumors (cancerous and noncancerous)
• Infections, inflammation, or allergic conditions of the esophagus (esophagitis, gastritis, and duodenitis)
• Hiatal hernia
• Swallowing disorders
• Gastrointestinal disorders (celiac disease or Crohn’s disease)

What Is a Barium Swallow?

A barium swallow is an X-ray procedure in which you swallow a chalky, white substance called barium that is typically a thick drink with the consistency of a milkshake. This exam is used to provide images of your GI tract. This includes your pharynx (the back of your mouth and throat), esophagus (the tube that starts behind your tongue and runs down to your stomach), stomach, and the first part of your small intestine, which is called the duodenum.

The barium coats the surface of your upper GI tract and appears white on X-rays. The procedure produces detailed images of the linings of the tract and can provide insight into the motion of your swallowing.

Barium Swallow Vs. Esophagram

Barium swallows are also known as esophagram procedures. Esophagrams are the X-ray images produced by a barium swallow test.  

What is a Barium Swallow Used to Diagnose?

A barium swallow can help diagnose a number of conditions, including:

• Cancerous and noncancerous tumors
• Inflammation
• Blockages
• Ulcers
• Gastroesophageal reflux disease (GERD)
• Hiatal hernia
• Muscle disorders that cause spasms or problems with swallowing.

Should I Get a Barium Swallow or an Endoscopy for Upper GI Problems?

The main advantage of a barium swallow is that it is less invasive because it’s a special type of X-ray. While many patients report that swallowing the barium is unpleasant, no instruments are inserted into the body. An endoscopy is a more invasive procedure, but it enables a doctor to immediately see the structures or areas of interest and to take actions such as removing tissue for biopsy.

Your physician’s decision to perform a barium swallow or an endoscopy will depend on several factors, including the nature of your symptoms, the potential diagnosis, and your comfort level with the procedures. In some cases, if a barium swallow proves insufficient for diagnosis, an endoscopy might still be required. Be sure to speak with your doctor about your diagnostic and treatment options.

What Are the Main Differences Between a Barium Swallow Vs. Endoscopy

Endoscopies and barium swallows are distinguished by the way they’re conducted and the degree of information they provide. There are other significant differences between the two as well.

Sedation

Patients undergoing a barium swallow rarely require sedation. As is typical of X-rays, you remain awake during the procedure. On the other hand, an endoscopy usually requires some degree of sedation. Few of us have the patience to lie still while our physician is manipulating a scope inside our body. Moderate to heavy sedation is typical, to reduce irritation and anxiety during the procedure. Heavy sedation leads to the temporary loss of consciousness (sleep state). You will have no memory of the procedure on waking.

Degree of Invasiveness

The main advantage of a barium swallow is that it is less invasive because it is a special type of X-ray. While many patients report that swallowing the barium is unpleasant, no instruments are inserted into the body. An endoscopy is a more invasive procedure, but it enables a doctor to immediately see the structures or areas of interest and to take actions such as removing tissue for biopsy.

Side Effects

Both barium swallow and endoscopy are typically outpatient procedures, meaning you can go home the same day. Each has side effects that are generally mild. These include constipation with a barium swallow and a sore throat with an endoscopy. In both procedures, the side effects tend to resolve on their own with proper aftercare such as hydrating and eating high-fiber foods after a barium swallow and eating soft foods after an endoscopy.

Learn More About Barium Swallow and Endoscopy Procedures from Baptist Health

Baptist Health provides safe and efficient inpatient and outpatient diagnostic imaging, including endoscopies and barium swallow X-rays. As one of the area’s most advanced diagnostic imaging centers, our services are fully integrated with our excellent medical care. In this way, we work together to detect the earliest signs of disease or injury and provide expert treatment.

If you need diagnostic imaging, you can count on the compassionate and skilled team at Baptist Health to be with you every step of the way. From helping you prepare for your tests to listening carefully to your questions and clearly explaining everything you need to know, you’ll appreciate our careful attention and support.

To schedule an appointment, contact your Baptist Health primary care provider.

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methods and methods of diagnostics, where to get examined

Stomach is an organ of the gastrointestinal tract where food is digested. In gastroenterological practice, a large number of various diseases of the stomach are distinguished. Some of them can be dangerous and lead to the development of complications. That is why it is so important to conduct instrumental and laboratory examinations of the stomach, prescribed by a specialist. They will allow timely detection of the disease, clarifying its stage with maximum reliability and prescribing effective treatment.

If you find any abnormalities in the work of the gastrointestinal tract, you should contact a gastroenterologist. It is this specialist who can recommend undergoing an examination of the stomach both to establish or clarify the diagnosis, and for preventive purposes. It is usually prescribed if the patient has the following symptoms:

• pain behind the sternum or in the epigastric region;
• increased gas formation;
• colonic bleeding;
• pain, fullness or heaviness in the stomach after eating;
• frequent heartburn;
• vomiting containing blood;
• sour-tasting belching;
• frequent nausea or vomiting of food taken the day before;
• digestive or swallowing disorder;
• feeling of a foreign body in the esophagus;
• changes in appetite (when the desire to eat is reduced or absent for a long time, and also in cases where a person is constantly tormented by the feeling of hunger).

Indications for the appointment of a medical examination of the stomach may be various diseases. Hardware diagnostic tools help to identify the cause of the disease and find out how effective the treatment is. Various procedures for examining the stomach are carried out with:

• the presence of polyps and other neoplasms on the gastric mucosa;
• gastritis;
• hernia;
• peptic ulcer;
• reflux disease;
• oncological diseases;
• inflammatory processes of any etiology in the pancreas, in the duodenum and stomach;
• portal hypertensive gastropathy;
• esophageal achalasia;
• cholelithiasis.

In order to clarify the diagnosis or control the ongoing treatment, a gastroenterologist prescribes various types of instrumental and laboratory tests.

Methods for diagnosing pathologies of the stomach

Statistics say that approximately 95% of the population in one way or another needs regular monitoring by a gastroenterologist. But you should not be afraid of this. The current level of diagnosis of stomach diseases in Russia is high. Many clinics have high-tech equipment that allows for high-precision diagnostics, and qualified gastroenterologists who will explain what kind of gastric examination you need and how to start preparing for it.

Instrumental methods for examining the stomach

Instrumental methods of examination of the stomach are the main link in the diagnosis of diseases of the digestive system. They cannot replace each other. Each of these methods of examining the stomach is prescribed on the basis of the existing clinical picture and makes it possible to assess the morphological and structural features of the digestive organ.

Modern instrumental methods for examining the stomach include:

1. Gastroscopy, or esophagogastroduodenoscopy (EGDS), is an examination of the stomach with a special flexible instrument, with a fiber optic thread inside and a micro-lens at the end of the instrument, an endoscope. EGDS is prescribed before a planned operation, with significant weight loss and any symptoms of diseases of the stomach or intestines (nausea, severe heartburn, pain, belching, feeling of heaviness in the stomach, etc.). Contraindications to its implementation are:

   • severe respiratory failure;
   • cardiac arrhythmias;
   • hypertensive crisis;
   • stroke;
   • hypertensive crisis;
   • mental disorders.

   The doctor always tells all patients how to prepare for such an examination of the stomach, since the reliability and informativeness of the results depend on this. The patient should:

   • refuse to eat 10 hours before the examination;
   • do not smoke or take capsules or tablets before the procedure;
   • remove tie, glasses and dentures for the duration of the procedure.

   Gastroscopy takes 5 to 10 minutes. The patient is asked to lie on the left side. A mouthpiece is inserted into the mouth, and an endoscope is inserted into the throat. The doctor asks to make a swallowing movement and, controlling the endoscope, makes an examination.

   Please note!
   Do not be afraid of pain during gastroscopy. When using new equipment and special anesthetics, discomfort is minimized.

   No other types of gastric diagnostics will provide so much information for making a diagnosis and choosing a treatment method. Only EGDS allows you to examine in detail the inner surface of the organ, make a digital video recording of the process and conduct the necessary additional studies (biopsy and determination of the acidity of gastric juice). The results of a gastroscopic examination with a detailed description of age-related or pathological changes seen during the examination are issued to the patient on the same day. Often, EGDS is prescribed in conjunction with colonoscopy , or fibrocolonoscopy (FCS) , a similar procedure, but designed to look at the bowel.

2. Fluoroscopy of the stomach is a visualization of an organ on the screen of X-ray equipment used to study the condition of the mucous membranes and diagnose disorders in their functioning. Indications for its implementation are:

   • weight loss;
   • belching;
   • blood in stool;
   • heartburn;
   • swallowing disorder.

   Attention!
   Do not confuse fluoroscopy with radiography! Radiography involves the creation of x-ray images for their subsequent study. Digital fluoroscopy is the most informative method for examining an organ in real time and in motion. The procedure is fast and does not require taking multiple pictures. In addition, the radiation exposure itself in fluoroscopic devices is hundreds of times lower.

   There are contraindications for gastric fluoroscopy. It is not recommended to carry it out with intestinal obstruction, a through violation of the stomach wall, pregnancy and the patient is allergic to drugs that contain barium.

   The preparation for this gastric examination is very simple. The patient needs to exclude legumes, milk, pastries, fruits, vegetables from the diet for several days and refrain from eating on the evening before the procedure.

   Before the start of the fluoroscopy, the patient receives a contrast agent – a suspension with barium sulfate (approximately 0.250 ml). This substance envelops the gastric mucosa, delays x-rays, providing a clear image of the organ on the screen. After this, the patient is asked to take different poses and pictures are taken. The procedure does not cause any discomfort.

   Important to know!
   After the test is completed, you may experience mild nausea and white stools for 2-3 days. Do not worry! So the body removes barium sulfate.

   The results of fluoroscopy allow you to quickly and accurately diagnose various diseases of the stomach – gastritis, hernia, malignant tumors, stomach and duodenal ulcers.

3. Ultrasound examination of the stomach , – a method based on the ability of tissues to reflect sound waves with a frequency of more than 20 kHz. Such a study is prescribed extremely rarely and mainly for children. Why? Ultrasound of the stomach (namely the stomach) is an uninformative procedure in comparison, for example, with gastroscopy. With echography, it is impossible to see the pathology as a whole, it is impossible to simultaneously perform a biopsy, to track the nature of the changes. But in view of the fact that other types of hardware studies can cause discomfort to children, they begin with an ultrasound of the stomach – solely to confirm the suspicions of a gastroenterologist. A definitive diagnosis cannot be made after this examination. As a primary diagnosis, it is sometimes prescribed for adults who are timid about other types of research.

   Ultrasound of the stomach is recommended if you suffer from increased gas formation, pain in the stomach, there are problems with digestion of food or suspicion of gastritis, ulcers, polyps or oncological neoplasms.

   When prescribing an ultrasound of the stomach, the doctor always specifies what kind of preparation is required during the examination, because the accuracy of the results depends on it. Approximately 3 days in advance, patients should exclude fiber (fruits, vegetables), dairy products, legumes, sodas and pickles, bread from the menu. Do not eat, drink or smoke in the morning before the procedure. Usually, this study is performed (not always) as part of an ultrasound of all abdominal organs.

   Ultrasound takes 7-15 minutes. The patient lies on the couch and a special gel is applied to his stomach. The doctor moves the sensor over the skin and receives an image on the monitor. In some cases, after the examination on an empty stomach, the patient needs to drink 0.5 liters of water and undergo the procedure again. Ultrasound does not cause any discomfort.

   Ultrasound results are available immediately after completion of the examination. They suggest what causes discomfort, as many factors are assessed:

   • position and size of the organ in sections — normally they are “oval or rounded annular formations with an echo-negative rim and an echo-positive center”;
   • outer serous membrane – normal “hyperechoic”;
   • the size of the muscular membrane – “20-25 mm, hypoechoic character”;
   • submucosal size — “up to 3 mm, medium echogenicity”;
   • muscular lamina of the mucosa – “up to 1 mm, low hypoechogenicity”;
   • mucosal condition — “up to 1.5 mm in size, hyperechoic”;
   • wall thickness – normal “5 layers of the wall, different in echogenicity, wall thickness – from 4-6 to 6-8 mm in the proximal sections”;
   • layers of the gastric wall – “uniform”;
   • peristalsis – “primary evacuation of a glass of water – 3 minutes, complete – 20 minutes”;
   • the presence of inflammation – “absent”.

   This is interesting!
   Ultrasound is a stomach diagnostic method that does not have any harmful effects on the body. It is used even for newborns.

Laboratory diagnostics of stomach pathologies

These are examinations of biological body fluids: gastric juice, blood, feces and urine. Without instrumental methods, they will not help to make an accurate diagnosis. But they must be carried out with a full examination of the stomach, otherwise it is impossible to determine the secretory activity, the bacterial composition of the intestine, the activity of liver enzymes and other important indicators.

1. Study of gastric juice is prescribed for chronic gastritis and stomach ulcers. This examination is also carried out in conditions such as functional achlorhydria and an irritable stomach.

   Prepare for the examination by eating a light dinner no later than 8 pm the day before, and on the morning of the procedure, do not smoke, drink liquids, take medicine or eat. Gastric juice is taken using a special probe, which is gently inserted through the mouth and esophagus. After that, the probe is removed, the patient is given breakfast, and then another portion of gastric juice is taken. There is also a probeless method. It is based on the patient taking reagents, after which saliva and urine are examined for color changes.

   Probing results include description of color, volume, smell, determination of acidity of gastric juice. They allow assessing the functional and morphological state of the gastric mucosa and are the main ones for determining the secretory function of the stomach. But the results of tubeless methods provide only indicative information without quantitative characteristics of gastric secretion.

2. Blood test. Not a single comprehensive examination can do without it when diagnosing or checking any diseases of the stomach. Blood is taken for analysis in the morning on an empty stomach. The day before the procedure, you should not drink alcohol and fatty high-calorie foods, you must refrain from smoking. If the study requires sampling, for example, a stimulation test involving the use of a protein mixture, it is necessary to make sure that the patient has not had a history of allergies to certain plant and animal proteins. If a gastroenterological patient takes medications, it is necessary to find out whether they can be abandoned. If not, then at least 1 day before the study, it is necessary to reduce the dosage. It is also possible that the drugs will not distort the test results. Blood is taken in compliance with all the rules of asepsis and antisepsis.

   Based on the results of the analysis, it is possible to assess the general condition of the body, morphological tissue damage, determine the functional characteristics of the organ, determine the stage of the inflammatory process and the effectiveness of therapy.

   Today, special gastroenterological panels have been developed, which include a set of tests with blood sampling from a vein. The panel may include, for example, tests for the level and proportions of pepsinogens I and II, stimulated or basal gastrin-17, for the presence of antigens (IgG) to the bacterium Helicobacter pylori, which can lead to H. pylori-associated chronic gastritis. In addition, indications for such a study are usually the risk of peptic ulcer and various dyspeptic disorders.

   It is known that during inflammation of the pancreas, the enzyme lipase (triacylglycerolacylhydrolase) enters the blood, so if lipase can be detected in the blood in a volume of more than 78 U / l, one can speak of acute or chronic pancreatitis or a perforated stomach ulcer.

   To confirm or refute autoimmune pathologies of the stomach (chronic atrophic gastritis, pernicious anemia, etc.), blood serum is taken for antibodies (IgG, IgA, IgM) to parietal cells of the stomach, as well as for antibodies (IgG) to the internal factor of Castle and to antibodies (IgG) to saccharomycetes – baker’s yeast Saccharomyces cerevisiae (ASCA).

   Although perfect specific tumor markers for gastric cancer have not yet been found, it is known that the level of some antigens correlates with the stage of oncology. Such antigens include in particular the oncofetal carbohydrate antigens CA 72-4 and Ca 19-9. The latter is used to monitor pancreatic carcinoma together with carcinoembryonic antigen (CEA).

3. Urinalysis. Complete urinalysis is prescribed for diarrhea, vomiting, ascites (fluid accumulation in the abdominal cavity) and malignant neoplasms. It should be noted that in uncomplicated peptic ulcer, urinalysis results do not show any significant changes. On the eve of the procedure, you should not take diuretics and eat any products that change the color of urine (carrots, beets, etc.). Only morning urine on an empty stomach is taken for analysis. Before this, hygiene procedures of the external genital organs should be carried out. A small amount of urine (the first 1-2 seconds) is released into the toilet, and the next portion in a volume of 50 ml is collected in a sterile container.

   The results of the analysis indicate the physico-chemical characteristics of urine (specific gravity, acidity, color, transparency) and check the urinary sediment for the presence of some inclusions (protein, blood cells, glucose, hemoglobin, etc. ).

4. Examination of feces. It is prescribed for any symptoms of diseases of the digestive system. In order for the results to be informative, the patient must exclude fish and meat foods from the diet for 3 days before the procedure, as well as not take medications containing iodine, iron and bromine. For analysis, take a small amount of feces immediately after sleep. Send it for research in a sterile container.

   The results always indicate the presence of blood and mucus in the feces, evaluate its color, smell, consistency and other physico-chemical characteristics. Explicit and especially latent bleeding are observed in peptic ulcer disease in 10-15% of cases. But most often bleeding is fixed with a duodenal ulcer. In acute blood loss, the feces are tarry.

Basics. Gastrointestinal X-ray examination of the esophagus. X-ray anatomy. Anomalies and development options. +

X-RAY EXAMINATION OF THE ESOPHAGUS

X-ray contrast examination of the esophagus reveals most of the diseases of the esophagus, morphological changes and a number of primary disorders of its motility. The main indications for radiopaque examination of the esophagus are dysphagia and undefined pain in the chest .

barium suspension of various consistencies is mainly used as contrast agents or, if indicated, other contrast agents. The standard barium slurry is 50% aqueous suspension (100 g barium sulfate powder and 100 ml water), homogeneity and fine dispersion, which is ensured by thorough mixing with mechanical mixers or by boiling. By adjusting the water content, it is possible to obtain a barium suspension of various consistency: liquid, thicker or barium paste in accordance with certain diagnostic tasks:

Liquid barium suspension normally passes freely through the esophagus and almost does not stick to the walls. Its delay in the lumen, not associated with a deep breath, indicates an organic narrowing, or a violation of the propulsive ability of the esophagus. Therefore, a liquid barium suspension is used to determine the patency of the esophagus and the state of its tone.

Standard barium suspension has the consistency of thin sour cream, has good adhesive properties, its movement through the esophagus is provided by peristalsis, so this suspension can be used to study both the morphology and motor activity of the esophagus. With semi-tight filling or under conditions of pneumorelief, a standard barium suspension makes it possible to detect small changes in the contours and the inner surface, and when the esophagus collapses, it lingers in the furrows between the folds and contributes to obtaining their direct image. To better identify the relief of the mucous membrane, yodolipol and mineral oils are added to the barium suspension.

Thick barium suspension or paste, unevenly contrasts the esophagus, sticks to the walls and stays in the lumen for a long time, and also causes changes in the configuration of the esophagus and a gross increase in its motility. At the same time, subtle anatomical changes cannot be detected, it is difficult to study the relief of the mucous membrane, and in the presence of persistent narrowing of the lumen, such a barium suspension can interfere with a full-fledged study. A thick barium suspension is usually used to fill the pharynx and upper esophagus tightly to provide better visualization of these sections in the absence of severe constriction or impaired swallowing.

Barium gelatin capsules , barium sulfate tablets, or other contrast agents are used to determine the level of narrowing in the esophagus due to a tumor, foreign body, or spasm. At the same time, the contrast agent lingers over the narrowing for a long time, and after the capsule or tablet is dissolved, the narrowed area usually passes.

Water-soluble contrast agents based on diatrizoates (gastrografin, urographin) are rarely used for examination of the esophagus due to the low intensity of their shadow, rapid passage through the esophagus and low adhesive properties. They are indicated for obturation of the esophagus or its perforation.

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If bleeding from the esophagus is suspected (Mallory-Weiss syndrome, tumor), hydrogen peroxide is added to barium glow.

To examine the laryngopharynx and upper esophagus, tantalum powder is also used, which is administered by inhalation or insufflation, and using a catheter, it can also contrast the lower esophagus. Tantalum, as an inert substance, does not have a harmful effect on the body and lingers for a long time on the surface of the mucous membrane, which allows for a thorough study of the walls and contours.

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For double esophageal contrast barium suspension is used together with air, oxygen, mineral oils or water . There are many ways to obtain an image of a pneumorelief : rapid swallowing of a liquid barium suspension in large sips, taking a contrast agent through a perforated tube, using gas-generating mixtures, introducing air through a probe, in particular under conditions of artificial hypotension. All these methods make it possible to obtain a satisfactory picture of the pneumorelief, however, if necessary, to determine the degree of extensibility of the walls of the esophagus in areas of narrowing or compression, it is more effective to use effervescent mixtures or introducing air through a probe. For the same purpose, successive swallowing of a barium suspension and pure water is used.

Esophageal X-Ray Procedure

The esophageal X-ray is part of the upper gastrointestinal examination and should only be done after careful examination of the stomach, duodenum, and early jejunum. This order of X-ray examination eliminates the possibility of missing pathological changes in these organs by filling them with too much barium suspension.

Examination starts with examination of the patient’s medical history, outpatient record , anamnesis, gastric juice and blood tests. In all cases, examination of the esophagus is preceded by a plain chest and abdominal fluoroscopy , in which the condition of the spine, cartilaginous larynx, shadow strips related to the esophagus, median shadow, lung fields and pleura, diaphragm and gas bubble of the stomach are assessed. In this case, it is possible to detect the presence of air and fluid in the lumen of the esophagus, diverticula or hernia of the esophageal opening of the diaphragm, an increase in the lymph nodes of the mediastinum, the state of the gas bubble of the stomach.

Then proceed directly to the study of the esophagus in a vertical position in direct projection – with the help of one or two sips of barium suspension, the act of swallowing is assessed and the patency of the esophagus is determined, and then the stomach and duodenum are studied in the usual way. For the study, 200 ml of a suspension of barium sulfate is needed.

This is followed by a detailed x-ray examination of the esophagus . In the absence of complaints, it is sufficient to examine the patient in an upright position, using a liquid barium suspension. The act of swallowing, the displacement of the esophagus, the shape and width of its lumen, the state of the contours, the nature of the collapse of the walls are consistently studied. Be sure to evaluate the condition of the pneumorelief and the function of the cardia.

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In order to assess esophageal motility and determine mucosal relief , the patient is given one or two teaspoons of a standard barium suspension (creamy consistency). First, a study is carried out in of the right oblique projection , while the left wall of the esophagus goes to the anterior contour, and the right wall to the back. Then the patient takes a large sip of barium suspension and a deep breath – estimated state of the cardia . Then the patient takes the next sip and a study is carried out in the second oblique projection in order not to miss small changes in contours, compression, curvature, etc. It is necessary to pay attention to fluid or air retention in the lumen, the presence of spastic contractions. The state of the esophagus and sphincters is fixed on one or two survey radiographs.

If there are any abnormalities for detailed motor study if hiatal hernia is suspected or cardia insufficiency, it is necessary to continue the study in a horizontal position in oblique projections using a standard barium suspension. The esophageal-gastric junction is studied during quiet breathing, as well as at the time of deep inspiration and expiration. The duration of the passage of a suspension of barium through the esophagus is determined: the time of its complete emptying after taking 15 ml of the suspension is on average 3 minutes. The revealed changes are recorded on sighting and survey radiographs.

To clarify the nature of movement disorders, as well as in the differential diagnosis of spasm and organic narrowing of the esophagus, pharmacological tests are used . Cholinergic preparations (acetylcholine) increase the tone of the muscles of the esophagus and increase the peristalsis of the esophagus. Their use in achalasia causes strong and painful contractions of the esophagus, on which the differential diagnosis of this type of pathology and organic narrowing of the distal esophagus is based. Cholinolytic drugs (atropine, metacin buscopan) have a pronounced antispasmodic effect, reduce the muscle tone of the esophagus, significantly weaken peristalsis, relieve spasms. These drugs are used to clarify the nature of movement disorders in various parts of the esophagus, the prevalence of the tumor process, in the diagnosis of varicose veins of the esophagus.

Tomographic examination of the esophagus is performed in the position on the right side, arms above the head, the patient’s legs are placed so that he lies strictly sideways. First cut – median , diaphragmation is carried out in the area of ​​hepatic dullness, back muscles. Three cuts are usually made – the median and 1 cm above and below. For tomography, 2 tablespoons of barium suspension are used, tomograms are made 7 seconds after swallowing the contrast mixture. Parietography (against the background of pneumomediastinum), CT and angiography are also used to study the esophagus.

Throat x-ray . 9 is used to examine the pharynx0003 relaxation pharyngography . The indication for relaxation pharyngography is dysphagia, the causes of which cannot be established using conventional examination of the esophagus. For the study, either an ordinary barium suspension is used, or barium and yodolipol are used in half (1 – 2 sips). Relaxation is achieved through premedication. There are several methods:

1. Intravenous atropine 1.0 – 0.1% to weaken peristalsis and calcium chloride 10.0 – 10% to prolong the action of atropine. The study is carried out after 10 minutes. This method is the most efficient.

2. Intramuscularly injected metacin 3 – 4 ml, the study is carried out after 30 – 40 minutes.