What is an upper gastrointestinal series?

An upper gastrointestinal series (UGI) is a radiographic (X-ray) examination of the upper gastrointestinal (GI) tract. The esophagus, stomach, and duodenum (first part of the small intestine) are made visible on X-ray film by a liquid suspension. This liquid suspension may be barium or a water-soluble contrast. If only the pharynx (back of mouth and throat) and esophagus (a hollow tube of muscle extending from below the tongue to the stomach) are examined with barium, the procedure is called a barium swallow.

X-rays use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film. X-rays are made by using external radiation to produce images of the body, its organs, and other internal structures for diagnostic purposes. X-rays pass through body tissues onto specially-treated plates (similar to camera film) and a “negative" type picture is made.

Fluoroscopy is often used during an upper GI series. Fluoroscopy is a study of moving body structures — similar to an X-ray “movie." A continuous X-ray beam is passed through the body part being examined, and is transmitted to a TV-like monitor so that the body part and its motion can be seen in detail. In an upper GI series, fluoroscopy allows the radiologist to see the movement of the barium through the esophagus, stomach, and duodenum as a person drinks.

Why is barium used with X-rays?

Barium is a dry, white, chalky powder that is mixed with water to make a thick, milkshake-like drink. Barium is an X-ray absorber and appears white on X-ray film. When swallowed, a barium drink coats the inside walls of the upper GI tract organs so that the swallowing motion, inside wall lining, function, size, and shape of these organs are visible on X-ray. This process shows differences that might not be seen on standard X-rays. Barium is used only for diagnostic studies of the GI tract.

The use of barium with standard X-rays contributes to the visibility of various characteristics of the esophagus, stomach, and duodenum. Some abnormalities of the upper GI tract that may be detected with an upper GI series include tumors, ulcers, hernias, diverticula (pouches), strictures (narrowing), inflammation, and swallowing difficulties.

In addition to barium, the radiologist may use a gas, such as air or a carbonated substance. You may be given a powder, tablet, or carbonated beverage that produces gas when swallowed. Alternately, you may drink the barium through a perforated straw so that you swallow air with the barium. Air or gas will appear black on X-ray film, contrasting with the barium’s white image. The use of the 2 substances, barium and gas, is called a double contrast study. The radiologist may use the water-soluble contrast if you have a perforation (tear or hole) of the bowel or esophagus, or for other reasons determined by your doctor.

The purpose of using 2 contrast substances is to achieve an enhancement of the inside wall lining of the esophagus, stomach, and duodenum. As the gas expands the organs (like blowing up a balloon), a barium coating is formed on the inner surface of the organs. This technique enhances visualization by sharpening the outline of the inner surface layer of the esophagus, stomach, and/or duodenum, and is useful in diagnosing structural and tissue abnormalities.

Other related procedures that may be used to diagnose upper GI problems are barium swallow and esophagogastroduodenoscopy (EGD).

What are the reasons for an upper GI series?

An upper GI series may be performed to diagnose structural or functional abnormalities of the esophagus, stomach, and duodenum. These abnormalities may include, but are not limited to:

• Ulcers. Ulcers may be gastric (stomach) or enteric (duodenum)

• Gastroesophageal reflux disease (GERD)

• Inflammation (esophagitis, gastritis, or duodenitis) or infection

• Benign tumors. Nonmalignant

• Cancer

• Structural problems. Such as diverticula, strictures, or polyps (growths)

• Hiatal hernia. Upward movement of the stomach, either into or alongside the esophagus

• Dysphagia. Difficulty swallowing

• Motility disorders. Difficulty moving foods through the pharynx or esophagus

• Chest and/or abdominal pain

• Unexplained vomiting and/or indigestion

• Bloody bowel movements

There may be other reasons for your doctor to recommend an upper GI series.

What are the risks of an upper GI series?

You may want to ask your doctor about the amount of radiation used during the procedure and the risks related to your particular situation. It's a good idea to keep a record of your past history of radiation exposure, such as previous scans and other types of X-rays, so that you can inform your doctor. Risks associated with radiation exposure may be related to the cumulative number of X-ray examinations and/or treatments over a long period of time.

If you're pregnant or suspect that you may be pregnant, you should notify your doctor. Radiation exposure during pregnancy may lead to birth defects.

Patients who are allergic to or sensitive to medications, contrast dyes, iodine, or latex should notify their doctor.

Constipation or fecal impaction may occur if the barium isn't completely eliminated from the body.

Contraindications for an upper GI series include, but are not limited to:

• Bowel or esophagus perforation

• Bowel obstruction or severe constipation

• Pregnancy

• Severe swallowing difficulty such that aspiration (entry of substances into the lungs) of barium is likely

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

How do I prepare for an upper GI series?

PRECAUTIONS: If you are pregnant or think you may be pregnant, you should notify your doctor. Notify the radiologist if you have had a recent barium X-ray or cholangiography procedure, as this may interfere with obtaining an optimal X-ray exposure of the upper GI series.

CLOTHING: You must completely change into a patient gown. A locker will be provided to secure your personal belongings. Please remove all piercings and leave all jewelry and valuables at home.

EAT/DRINK: The night before your exam, do not eat or drink anything after midnight until the exam is over.

Based on your medical condition, your doctor may request other specific preparation.

What happens during an upper GI series?

An upper GI series may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary, depending on your condition and your doctor’s practices.

Generally, an upper GI series follows this process:

• You'll be asked to remove any clothing, jewelry, or other objects that may interfere with the procedure.

• If you're asked to remove clothing, you'll be given a gown to wear.

• You will be positioned on an X-ray table that can tilt you from a horizontal to an upright position. You may be asked to change positions (for example, lying on your side, back, or stomach) at intervals during the procedure.

• Standard X-rays of the heart, lung, and abdomen may be performed first.

• The radiologist will ask you to take a swallow of a thickened contrast drink. The contrast is usually flavored, although it may not be very pleasant tasting.

• As you swallow the contrast, the radiologist will take single pictures, a series of X-rays, or a video (fluoroscopy) to observe the contrast moving through the pharynx.

• If you're having a procedure with barium, you'll be given a thinner barium drink to swallow. X-rays and/or fluoroscopy will be used to observe the barium’s passage down the esophagus. You may also be asked to swallow a barium tablet, which can help to visualize certain structural problems of the esophagus.

• The radiologist may press on your abdomen during the examination to help visualize the stomach and aid in coating of the stomach wall.

• If you're having a double contrast study, you may be asked to swallow a powder, tablet, or carbonated beverage. Alternately, you may be asked to drink the barium through a perforated straw. Because the gas that's produced will expand and enhance the visualization of the inner surface of the upper GI organs, it will be important not to burp.

• Once all required X-rays have been taken, you'll be assisted from the table.

What happens after an upper GI series?

You may resume your normal diet and activities after an upper GI series, unless your doctor advises you differently.

Barium may cause constipation or possible impaction after the procedure if it isn't completely eliminated from your body. You may be advised to drink plenty of fluids and eat foods high in fiber to expel the barium from the body. You may be given a laxative to help expel the barium.

Since barium isn't absorbed into the body but passes through your entire gastrointestinal tract, your bowel movements may be lighter in color until all of the barium has been excreted.

Notify your doctor to report any of the following:

• Difficulty with bowel movements or inability to have a bowel movement

• Pain and/or distention of the abdomen

• Stools that are smaller in diameter than normal

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.