BARIUM MEAL

BARIUM MEAL

A barium meal is a diagnostic test used to detect abnormalities of the oesophagus, stomach, and small bowel using X-ray imaging. X-rays can only highlight bone and other radio-opaque tissues and would not usually enable visualization of soft tissue. However, infusion of the contrast medium barium sulfate, a radiopaque salt, coats the lining of the digestive tract, allowing accurate X-ray imaging of this part of the abdomen. The images are fluoroscopic and can be viewed in real-time and on plates.

Indications

• Dyspepsia/reflux / Upper abdomen pain/ Nausea/ Weight loss
• Fullness or distension
• Peptic ulceration (defects in mucosa extending through muscular mucosae)
• Gastritis (Inflammation of the stomach)
• Polyps
• Upper abdominal mass
• Gastrointestinal haemorrhage
• Pyloric / cardiac stenosis
•  Hernia (Slipping off the upper portion of the stomach through the oesophagal hiatu
• Partial bowel obstruction
• Assessment of perforation site (What type of contrast to use?)

Contra-indications

• Complete bowel obstruction
• Complete significant bowel obstruction
• Suspected perforation (unless water-soluble contrast medium is used)
• Patient preparation
• NPO after midnight (6 hrs.)
• Abstain from smoking, chewing gum, or antacids

Barium meal contrast media & patient preparation

• High-density, low-viscosity barium
• Nil orally for 6 hours prior
• Explanation of procedure
• Physical & psychological preparation
• No smoking (>gastric motility)
• Check for contra-indications to the pharmacological agents (What is the contraindication for Buscopan?)

Barium Meal Investigation

• Can perform double (CO₂ & Barium) or single contrast examinations
• Single contrast examinations are used in paediatrics & grossly ill patients
• Double-contrast examinations - demonstrate the mucosal pattern
• Equipment should contain the ability to perform spot film images.

 Technique

• The patient faces the X-ray table, lowered to horizontal
• Then turned onto the left side and finally supine
• Patient rolled from side to side so that barium coats mucosal surfaces properly- washes over the mucus
• Sequences of films of the stomach obtained
• When barium enters the duodenum, the patient is turned RAO – fills the duodenum with gas, DC films are taken
• Biphasic examination–Prone swallow of thin (125%w/v low density) barium given after contrast view obtained to optimize compression views of stomach and duodenum
• Under fluoroscopic guidance, on the compression views-filling defects or abnormal collections, are detected.

Barium meal - Typical film series

 RAO- Stomach and C-loop of the duodenum with the duodenal bulb in profile

PA (Prone) - Duodenal loop + duodenal with body and pylorus filled with barium

Right lateral - Retro gastric space

AP (supine) - Entire stomach and duodenum + Fundus of a stomach filled with barium

LPO - Duodenum Bulb without superimposition with the pylorus + Fundus of Stomach filled with barium

Other films may be taken LAO - Lesser curve

Prone, RAO, LAO, Supine, Erect Duodenal Cap series