Some factors influencing the roentgen visualization of the mucosal pattern of the gastromestinal tract.

Abstract

Historical Review (1, 2a) Within the years immediately following the discovery of x-rays, the possibility of visualizing the stomach and intestines by the use of radiopaque media had been realized and explored. Since the introduction of barium sulfate, it has remained the single important intestinal contrast material. The earliest observations concerned the movements and motility of the gastrointestinal tract, mostly in animals, with little attention to morphological detail. In man, because of inability to obtain satisfactory radiographs, the study of disease became one of “symptom-complexes,” wherein the mobility, shape, and peristaltic activity of the stomach and intestines, observed fluoroscopically, determined the diagnosis. Toward the end of the first decade of the present century, with improvement in design of transformers and the introduction of fluorescent screens, the radiopaque filled viscus could be filmed, with demonstration of its outline and of the larger defects. Shortly after this, the importance of visualizing the mucosal folds was realized, and the sedimentation method was introduced. Following ingestion of a thin bismuth solution, the patient remained in a supine or prone position for twenty minutes, after which a film was exposed. Soon afterward it was found that, with the use of a small amount of medium carefully distributed over the gastric wall by positioning, the entire mucosal pattern could be outlined. In 1921, Akerlund (3) introduced his thin-layer compression technic for the demonstration of duodenal cap lesions. Pressure correctly applied displaced all excess medium and left only the mucosal outline and any associated defects. This method was adapted for the visualization of the mucous membrane of the stomach during fluoroscopy. Repeated attempts have been made to improve the quality of the pattern by using different media or adjuvants to the standard media. Among these are buttermilk, tragacanth, acacia, honey, and more recently mucin (4), oil (5), gelatine (6), saline (7), and colloidal aluminum hydroxide (8). During the past decade, attention has been directed to the particle size of the medium itself, and several investigators (2b, 8–11) have claimed to have obtained improved mucosal studies with the use of barium sulfate of small particle size. To our knowledge, there have been no detailed investigations relating the state of individual resting gastric function, such as pH, mucin production, and motility, to the mucosal pattern as obtained on films or at fluoroscopy, nor has there been any correlation between the type of stomach (asthenic, hypersthenic, etc.) and the excellence of mucosal detail obtained. Experimental Procedures and Results The materials used in the present studies were as follows:2 1. Barium sulfate, U.S.P. 2. Barium sulfate micropowder, 3. linckrodt 4. Barium sulfate, 1.05 μ.