Barium Contrast Studies Research Articles

Esophageal Motility Disorders: How Does the Barium Swallow Correlate With Manometry?

Achalasia is defined as dysfunction of the esophageal wall myenteric plexus, which causes symptoms of dysphagia. While manometry is typically regarded as the gold standard for diagnosing and confirming achalasia, other imaging modalities such as barium swallow and upper endoscopy are often obtained initially. The barium swallow study can be a supportive or confirmatory test, whereas the upper endoscopy is typically used to rule out pseudo-achalasia. Additionally, barium swallow is an imaging modality of choice in resource-limited settings. A standardized approach for categorizing motility disorders is the Chicago Classification. This is a newer classification of achalasia based on high-resolution manometry. However, the role of barium contrast studies does not seem to have been evaluated in the context of the Chicago Classification of the three achalasia subtypes, suggesting an underappreciated role of fluoroscopy in the diagnostic evaluation of achalasia subtypes.

Celiac Disease and Intussusception: A Common Association in Children.

In young childhood, intestinal intussusception (IS) is the most common cause of small bowel obstruction. A lead point such as Meckel diverticulum, polyps, tumors, enlarged lymph nodes, cystic fibrosis, and Schoenlein-Henoch purpura are recognized causes. Association between celiac disease (CD) and IS has been well recognized in adults but rarely in children. Data on causes and outcome of intussusception among Saudi children are lacking in the literature. Our objectives were to characterize the pattern of IS among Saudi children and investigate the frequency, clinical presentation, and outcome of intussusception among children with CD. We searched the hospital's picture archiving and communications system for abdominal imaging studies (ultrasound, magnetic resonance imaging, computed tomography scan, and barium contrast studies), performed between 2008 and 2019, using "intussusception" as a search key word. The hospital medical records of the identified cases of intussusception (aged 0-14 years) were then retrospectively reviewed to collect demographic, clinical, laboratory and imaging findings, management, and outcome. During the study period, 57 cases were identified as confirmed IS (31 boys, median age 1.95 years, range 0.33-11 years). Abdominal ultrasound was the diagnostic imaging study in 93%. An underlying cause (secondary IS) could be identified in 19 (33.3%) cases: CD in 6, malignancy and Henoch-Schoenlein purpura, 5 each, and Meckel diverticulum in 3; the remaining 38 (66.6%) cases of IS were idiopathic (primary IS). The presence of hypoalbuminemia and abdominal distension were significantly associated with secondary IS as compared with primary IS ( P < 0.001, P = 0.006, respectively). All of the 6 cases of IS associated with CD resolved spontaneously, but 3 were recurrent. Secondary causes contributed to a large proportion of IS in our study cohort (33%) as compared with 5% to 10% in the literature. Celiac disease is an underrecognized cause of IS among children. A child with IS and hypoalbuminemia, anemia, or chronic diarrhea needs to be investigated for CD to avoid unnecessary surgery.

Frequency of Gastrointestinal Diseases Diagnosed on Barium Contrast Studies

Barium is a non-invasive, low-cost imaging technology. Gastrointestinal (GIT) symptoms are common and have significant economic and social implications. Objective: To determine the frequency of gastrointestinal diseases diagnosed on barium contrast studies. Methods:This research includes 125 participants suffering from Gastrointestinal Diseases. The research was carried out at a secondary care private sector hospital in Gujranwala, Pakistan. The information was gathered between January and April of 2022. All patients who were recommended for barium examinations and those who had never surgery before were included in the study. Images were obtained for research objectives immediately after barium was taken orally. SPSS version 20 was used to enter and evaluate data. Results: Out of 125 Patients about 62(49.6%) were male and 63(50.4%) were female. The age ranges from (13-88 years) with a mean age of 48 years. The patients diagnose on barium study shows 11(8.8%) gastric ulcer, 7(5.6%) patients Achalasia, 19(15.2%) Diverticula, 10(8.0%) esophageal stricture, 13(10.4%) esophagitis, 5(4.0%) GERD, 7(5.6%) pyloric stenosis, 5(4.0%) SMA syndrome, 2(1.6%) others, and 46(36.8%) patients had normal radiological findings. Conclusion: Barium studies are a sensitive and reliable approach to identifying gastrointestinal problems. The barium studies should reclaim their place as a primary diagnostic tool by complementing endoscopy to provide physicians with information regarding the nature of the lesion

Gastric volvulus is a rare and life-threatening abdominal pain

Gastric volvulus is a rare and life-threatening abdominal pain condition resulting from the stomach twisting on its own longitudinal (organo-axial) or transverse (mesentero-axial) axis. Gastric volvulus can be primary or secondary. Secondary is most commonly related to para-esophageal hernia. Gastric volvulus can have an acute or chronic presentation, the acute form presents abdominal pain with a risk of gastric ischemia with subsequent perforation. Diagnosis is made by imaging studies such as barium contrast studies in the upper digestive tract or abdominal and chest computed tomography (CT). CT of the abdomen and thorax is very useful in the diagnosis as it can demonstrate the abnormal position and gastric torsion The goal in the definitive treatment of gastric volvulus is resolution of gastric obstruction and prevention of recurrence. Performing volvulus reduction, repair of the concomitant cause (para-esophageal hernia), fundoplication and/or gastropexy to the anterior abdominal wall. Gastropexy is considered safe and effective in elderly patients with high surgical risk.

A Newborn with Barium Sulphate Aspiration Following Barium Contrast Study for Esophageal Atresia: A Case Report

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THE RADIOGRAPHIC AND ENDOSCOPIC ANATOMY AND DIGESTIVE MECHANISMS OF CAPTIVE AFRICAN PENGUINS (SPHENISCUS DEMERSUS).

The anatomy of the avian gastrointestinal (GI) tract is uniquely suited to each species' dietary requirements. African penguins (Spheniscus demersus) are charismatic and popular exhibit animals. As their prevalence grows, there is a need to understand their unique digestive tract to diagnose abnormalities. Reference material specific to the digestive tract of piscivores is scant, and knowledge of the GI tract of a healthy penguin is based on information from other birds. The purpose of this study is to determine the normal gross anatomy, transit time, and histopathologic structures of the penguin GI tract. Twelve clinically healthy penguins were selected for this study from the colony at the Maryland Zoo in Baltimore, which, at the time of this study, consisted of 55 birds. All penguins underwent a barium contrast study, and radiographic images were obtained until the entire GI tract was empty. Approximately 2 wk later, each penguin was anesthetized, and an endoscopic evaluation of the anterior GI tract was performed. Time from barium administration to defecation ranged from 17 to 70 min, and on average, barium clearance was 17.6 hr (range, 5-36 hr). Fluid from the ventriculus had an average pH of 2.75 and contained a mixed bacterial population. Koilin presence and thickness appreciated on endoscopy did not correspond with the thickness determined on histopathology. The results of this study provide a comparative baseline to use during diagnostic workups and help guide treatment decisions.

Superior mesenteric artery syndrome after severe head trauma

Abstract Superior mesenteric artery syndrome (SMAS) is a very rare manifestation of duodenal obstruction with the incidence of 0.013–0.3% in adult population, but there are only few reports in the literature concerning children. SMAS can be related to a rapid loss of intraabdominal fat by severe, debilitating illnesses such as malignancy, burn, spinal cord injury, anorexia. As a result, compression of the third duodenal portion by the aorta and the overlying superior mesenteric artery occurs, when the angle formed by these two structures becomes smaller. We present a case of a 17-year-old boy who suffered a severe head trauma during a car accident. He had prolonged confinement in the supine position because of ongoing coma. The SMAS developed due to a progressive weight lost. Upper gastrointestinal Barium contrast study, fibroesophagogastroduodenoscopy (FEGDS), abdomen computed tomography scan (CT) were not specific and only, magnetic resonance imaging (MRI) findings suggested diagnosis of SMAS. As there was no response to the conservative treatment, surgical intervention of duodenojejunostomy was performed. The postoperative period was successful.

Corrosive injuries of the upper gastrointestinal tract: A pictorial review of the imaging features.

Corrosive ingestion is a common form of poisoning. Corrosive agents cause severe damage to the gastrointestinal (GI) tract. The most severe forms of injury can lead to mortality; however, the major concern with this type of injury is life-long morbidity. Upper GI endoscopy is the test of choice for assessing severity in the acute phase of the disease. The long-term management is based on the site, length, number, location, and tightness of the stricture. This information is best provided by the barium contrast studies. In this pictorial review, a spectrum of findings in patients with corrosive injuries of the esophagus and stomach is illustrated. The role of various imaging modalities including barium studies, endoscopic ultrasound, computed tomography, and magnetic resonance imaging is discussed.

Up-to-date overview of imaging techniques in the diagnosis and management of inflammatory bowel diseases.

Radiological examination occupies a significant role, complementary to endoscopic studies, in the diagnostic process of inflammatory bowel disease (IBD). Both ulcerative colitis and Crohn’s disease, due to multiple remissions and relapses, require repetitive examinations to evaluate the disease extent, severity, and response to pharmacological treatment. Whereas the use of barium contrast studies is progressively reduced, plain radiography confirms its utility as a first-line imaging tool for acute abdomen. Computed tomography remains an easily accessible and effective method to demonstrate disease activity and extraintestinal manifestations. However, the related radiation exposure reduces its applicability to urgent situations. Ultrasound and magnetic resonance, with the great advantage of avoiding ionising radiation, are highly recommended to present the complications of IBD. Use of oral and intravenous contrast in computed tomography enterography and magnetic resonance enterography demonstrates IBD involvement in the small intestine wall, which is difficult to assess in other radiological and endoscopic examinations.

Is color Doppler a reliable method for the diagnosis of malrotation?

The gold standard for the diagnosis of malrotation is barium contrast study of the upper gastrointestinal system (UGCS), while color Doppler ultrasonography (CDUS) is another method used in the diagnosis. We investigated the value of CDUS for the diagnosis of malrotation in this study. UGCS images, CDUS images, plain abdominal images, demographic data, and symptoms of 82 patients who were investigated for presumed malrotation during a 7-year period were evaluated, retrospectively. All patients underwent CDUS, and 18% of these patients were diagnosed with malrotation as the superior mesenteric vein was seen to be on the left of the superior mesenteric artery. We found that 16% of the 75 patients who underwent UGCS were diagnosed with malrotation. The sensitivity and specificity of CDUS in the diagnosis of malrotation was found to be 93.8 and 100%, respectively. The respective values for UGCS were 91.7 and 98.4%. Current data in the literature and our results underline that UGCS may yield false-positive and false-negative results. Although CDUS was found to be a reliable method for the diagnosis of malrotation in our study, the limitations of UGCS are also recognized for CDUS. Prospective studies are needed to determine the more valuable method.

Submitted, Not Presented: Clinical Vignettes/Case Reports - Small Intestine/Unclassified.

Hemangiomas of the small bowel are a rare phenomenon and usually present with gastrointestinal bleeding. They are defined as masses of capillaries and blood-filled endothelial-line spaces that rarely manifest in the small intestines. Most of them are symptomatic until they present with bleeding and anemia; and less commonly can cause intestinal obstruction, intussusception or perforation. Intestinal bleeding can be acute with severe, life threatening blood loss, or chronic with anemia. Initial work up includes upper and lower gastrointestinal endoscopy, barium contrast study and computed tomography (CT) scans. Further evaluation includes video capsule endoscopy, and deep enteroscopy. We present a case of a 59 year-old male with dizziness, fatigue and melena. He endorsed a history of blood in stools for the past eight months. The patient was not taking NSAIDs or on anticoagulation medications. In the two days before admission, his episodes of black stools have considerably increased. Recent GI work up included a normal esophagogastroduodenoscopy (EGD), anterograde enteroscopy to proximal ileum showing no acute pathology, colonoscopy which revealed small nonbleeding diverticula in the sigmoid colon, and video capsule endoscopy which showed evidence of bleeding in the mid-small bowel. The patient's vitals were stable and he was not orthostatic. Physical exam was unremarkable, rectal exam showed melena, laboratory studies revealed a drop of 2 grams of hemoglobin to 9 g/dL. Repeat video capsule endoscopy again showed evidence of active bleeding in mid-small bowel with an area of questionable ulceration versus ulcerated mass. CT enterography was unremarkable with no evidence of abnormal mass. The patient underwent antegrade single balloon enteroscopy which revealed a single 1-2 cm. vascular lesion suspicious for hemangioma that was actively oozing from a punctuate lesion on the surface. To control bleeding, initially a Gold Probe was employed that slowed but did not stop bleeding. An argon beam coagulator, set at 20 watts, was then use with complete control of bleeding. This area was tattooed proximally with a sclerotherapy needle using india ink. The patient's hemoglobin stabilized and melena resolved after procedure and he was discharged home. This case illustrates successful endoscopic therapy of an actively bleeding hemangioma at the time of deep enteroscopy with the single balloon enteroscope.

Primary Myopathic Chronic Intestinal Pseudo-Obstruction in a Maltese Dog

An 11-year-old castrated male Maltese had vomiting, diarrhea, and abdominal distension for over two weeks and weight loss for several months. Clinical laboratory studies were not remarkable. Abdominal radiographs showed severe dilated intestine with a gravel sign. Colon was empty with normal diameter in the pneumocolon study. On ultrasonographs, most small bowel loops were dilated without normal peristalsis and showed abnormal thin wall. Barium contrast study revealed remarkably delayed gastric emptying and transit time up to 6th day. On exploratory laparotomy, there were no mechanical obstruction and extra-intestinal abnormalities except severe dilated small intestine. Chronic fibrosing lymphohistiocytic leiomyositis with atrophy of tunica muscularis in the small intestines and colon was identified through full thickness biopsy and histopathology. Therefore, primary myopathic chronic intestinal pseudoobstruction was diagnosed. This dog is survival with symptomatic treatments for eight months.

Aberrant right retroesophageal subclavian artery causing esophageal compression.

Key Clinical MessageDysphagia lusoria is present in 0.2–2.5% of the population representing the most common anomaly of the aortic arch (De Araújo et al., 2015, Int. J. Surg. Case Rep., 7, 32). It usually presents in infants, but can present at any age. Symptoms include cough, dysphagia, thoracic pain, and pulmonary infection. Barium contrast studies, CT, and MR angiography are useful studies for evaluating the condition. Dietary modification and PPI therapy are the first-line treatments with surgical intervention reserved for those with ongoing symptoms (Janssen et al., 2000, Am. J. Gastroenterol., 95, 1411).

Gastric Diverticuli as a Cause of Obscure Gastrointestinal Bleeding

Introduction: Gastric diverticuli are a rare but life-threatening source of obscure gastrointestinal bleeding. Their insidious and sometimes catastrophic presentation underlies the need for increased awareness and prompt management. A 75-year-old white male presented with symptoms of pre-syncope and dyspnea on exertion after multiple episodes of melena. He denied hematemesis, abdominal pain, dysphagia, or NSAID use. His co-morbidities included hypertension, diabetes mellitus, and atrial fibrillation. On admission, he was hemodynamically unstable with a tachycardia of 120 beats/minute and systolic BP of 60 mm of Hg. His physical examination was remarkable for melena on digital rectal examination. Laboratory tests revealed a Hb of 6.2, INR of 5.7, and an elevated BUN of 71. He was administered intravenous fluids, large-volume blood and plasma transfusions, and started on a pantoprazole infusion. On transfer to the ICU, he underwent an emergent upper endoscopy (EGD) with a large amount of retained blood and no obvious source of bleeding seen. The fundus was not adequately visualized due to an inability to clear the blood clots. An emergent Nuclear Medicine bleeding scan did not reveal active blood loss. He remained transfusiondependent and subsequently underwent a second EGD. This revealed the presence of a gastric fundal diverticulum (Figure 1 a,b), about 1 cm in diameter, with no other source of bleeding identified. The patient was referred for surgical evaluation; however, his clinical status gradually improved and he was discharged to the medical floor. Due to an often dramatic and potentially fatal presentation, gastrointestinal bleeding secondary to gastric diverticuli (GD) requires a high index of suspicion. Some reports have indicated vague symptoms of burning sub sternal pain or nonspecific abdominal discomfort preceding the presentation; however, patients are mostly symptom free. Prevalence ranges from 0.04% on barium contrast studies to 0.01-0.11% on endoscopy. Surgical resection is advocated in the presence of persistent symptoms or with complications such as persistent bleeding or a perforation.Figure 1

Superior mesenteric artery syndrome following surgery for adolescent idiopathic scoliosis

Superior mesenteric artery (SMA) syndrome is a rare but potentially fatal complication following spinal fusion for scoliosis. The aims of our study were to identify clinical features and evaluate their importance in SMA syndrome following posterior spinal fusion (PSF) in adolescent idiopathic scoliosis (AIS) patients and to recommend a simple approach for the recognition and management of SMA syndrome. This is an IRB-approved study. Three patients in our series and 11 patients from other published case reports who underwent PSF for adolescent idiopathic scoliosis were included in our study. Patient demographics, clinical presentation, investigations, and management were recorded and analyzed. In this combined series of 14 patients (mean age 14.8 years), the main presenting clinical features included vomiting of any kind (92.9%), abdominal pain/tenderness (57.1%), abdominal distension (42.9%), bilious vomiting (35.7%), and hypoactive bowel sounds (28.6%). Most patients presented within 2 weeks of surgery (71.4%). In total, 50% of patients presented with both vomiting (of any kind) and abdominal tenderness. The number of presenting symptoms appeared to be directly related to the severity of SMA syndrome. Our second patient had intermittent vomiting on postoperative day (POD) 3, which was initially considered as insignificant; she was discharged on POD 9 and readmitted for recurrent vomiting, during which SMA syndrome was diagnosed. Our first patient presented in the classical manner. Our third patient had bilious vomiting after discharge that started on POD 13 and increased in frequency until readmission on POD 27. Vomiting and abdominal pain are nonspecific symptoms following PSF; differentiating between SMA syndrome and postoperative ileus can be challenging. The highest index of suspicion applies to patients who present within the first week with symptoms of vomiting and abdominal pain. We propose an algorithm for the management of SMA syndrome, which includes a focused clinical assessment to evaluate for intestinal obstruction, followed by an abdominal radiography and barium contrast study if clinical assessment is positive. An early referral to general surgery should be considered especially for high-risk patients (BMI<5% percentile, sagittal kyphosis). Early diagnosis of SMA syndrome allows for early intervention, reducing the likelihood of future complications and need for surgery.

Anastomotic stenosis of the descending colon caused by barium granuloma formation following barium peritonitis: report of a case

Anastomotic stricture reportedly often recurs following barium peritonitis, regardless of whether the anastomotic diameter is initially sufficient. However, the causes of repetitive stricture have not been clarified. We report a case that suggests the pathophysiology of recurrent anastomotic strictures following barium peritonitis. The patient was a 39-year-old Japanese man with idiopathic perforation of the descending colon after undergoing an upper gastrointestinal barium contrast study. After emergency peritoneal lavage and diverting colostomy, created using the perforated region, the patient recovered uneventfully and 3 months later, the colostomy was closed and the perforated colon was resected. However, 7 months after colostomy closure, abdominal distention gradually developed, and colonoscopy revealed an anastomotic stricture. The patient was referred to our hospital where he underwent resection of the anastomotic stricture. The surgical specimen exhibited barium granulomas not only in the subserosa of the entire specimen, but also in the submucosa and lamina propria localized in the anastomotic site. These findings suggest that barium was embedded in the submucosa and lamina propria with manipulation of the stapled anastomosis and that the barium trapped in the anastomotic site caused persistent inflammation, resulting in an anastomotic stricture.

Diagnostic Accuracy of Tests in Pediatric Gastroesophageal Reflux Disease

To systematically review the literature evaluating the diagnostic accuracy of commonly used diagnostic tests over conventional history taking and physical examination in children ≤ 18 months and >18 months suspected of gastroesophageal reflux disease (GERD). We searched Medline, Embase, and the Cochrane database for studies assessing the diagnostic accuracy of pH-metry, pH-impedance, esophagogastroscopy, barium contrast study, scintigraphy, and empirical treatment as diagnostic tools. Quality was assessed according to Quality Assessment of Studies of Diagnostic Accuracy Included in Systematic Reviews criteria. Of the 2178 studies found, 6 studies were included, containing 408 participants (age 1 month-13.6 years) and 145 controls (age 1 month-16.9 years). Studies included children with GERD symptoms; 1 included an atypical presentation. In all the studies, the diagnostic accuracy of pH-metry was investigated, and in 2 studies esophagogastroscopy was investigated as well. Sensitivity and specificity were calculated in 3 studies. The range of reported sensitivity and specificity was broad and unreliable because of poor methodological quality according to Quality Assessment of Studies of Diagnostic Accuracy Included in Systematic Reviews criteria and inadequate study design. Diagnostic accuracy of tests in children suspected of GERD remains unclear and implications for practice are hard to give. There is an urgent need of well-designed randomized controlled trials where the effect of treatment according to specific signs and symptoms will be compared with the effect of treatment based on the results of additional diagnostic tests, for patient relevant outcomes.

Gastroesophageal Reflux

Gastroesophageal Reflux

Management of gastroesfophageal reflux associated with malrotation in children

Aim Children being investigated for gastroesophageal reflux (GOR) have a high incidence of malrotation. Current literature suggests these patients should be managed with a combined antireflux and Ladd's procedure. We review our experience, the largest series to date, of performing an elective Ladd's procedure as the first-line intervention. Method Retrospective case note review of 20 children with significant symptoms of GOR and an incidental finding of malrotation. Children presenting immediately with bilious vomiting were excluded. All patients underwent a Ladd's procedure as their sole primary operative intervention. Results Median age at operation was 7 months (21 days-12 years). Fifteen patients (75%) had evidence of reflux on barium contrast study. All children were followed up for at least 6 months. Eighteen (90%) had resolution or significant improvement of their symptoms postsurgery. Only 3 have not managed to tolerate a full oral diet, all unrelated to GOR. None of our series required an antireflux procedure. Conclusion In children with debilitating vomiting necessitating surgical management, a contrast study is imperative in the work up. The high incidence of GOR and the significant improvement after correction of malrotation show the relationship between delayed gastric emptying and GOR. We suggest that when an abnormally placed duodenojejunal flexure is found, a Ladd's procedure alone is sufficient and may obviate the need for a more invasive antireflux procedure.

Superior mesenteric artery syndrome in a 16-year-old with bilious emesis

Superior mesenteric artery (SMA) syndrome describes vascular compression of the third portion of the duodenum and presents with nausea, postprandial vomiting, and epigastric abdominal pain. The syndrome is rare and may be missed if appropriate radiologic studies are not performed or the clinical presentation is atypical. The clinical contexts in which SMA syndrome develops usually involve rapid weight loss, alterations in spine anatomy, or external increases in abdominal pressure. Diagnostic methods for identifying duodenal obstruction by the SMA include upper gastrointestinal barium contrast studies, computed tomography scans, or angiography of the aorta with either contrast or magnetic resonance angiography. Medical therapy relies upon nutritional rehabilitation with either jejunal tube feedings or parenteral nutrition until weight gain results in relief of the obstruction. In instances where this approach fails, surgical correction is necessary, most often with laparoscopic duodenojejunostomy.