Abstract
Barium studies can be a useful test for evaluating gastric motility disorders in patients with recurrent nausea and vomiting in the absence of gastric outlet obstruction. Decreased gastric motility (i.e., gastroparesis) may be manifested at fluoroscopy by a diminished strength, velocity, or frequency of gastric peristalsis, often associated with delayed emptying of barium from a variably dilated stomach containing undigested food. Once the diagnosis is made, symptoms of gastroparesis can often be ameliorated by treatment of the underlying cause (e.g., diabetes) and prokinetic agents (e.g., metoclopramide) to increase gastric peristalsis without need for further testing. Radiographic detection of superimposed gastric bezoars may necessitate endoscopic intervention for mechanical dissolution of bezoars. Conversely, extraintestinal causes of nausea and vomiting such as increased intracranial pressure, vestibular disorders, and pharmacologic agents (e.g., narcotics and chemotherapy) may be manifested on barium studies by a hyperirritable stomach characterized by immediate emesis of ingested barium in the absence of findings of gastric outlet obstruction or gastroparesis. The presence of a hyperirritable stomach at fluoroscopy therefore should prompt a careful search for extraintestinal causes of nausea and vomiting.
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