Double Contrast Barium Meal Examinations Research Articles

Oral peppermint oil is a useful antispasmodic for double‐contrast barium meal examination

Intraluminally administered peppermint oil (PO) is reportedly a safe and useful antispasmodic for gastroscopy, colonoscopy and double-contrast barium enema. The aim of this study was to examine the efficacy of oral PO for double-contrast barium meal examination (DCBM) without other antispasmodics. Two hundred and five randomly chosen subjects (PO group) and 215 sex- and age-matched controls were enrolled. All participants underwent DCBM. The PO group was orally administered PO and a barium suspension mixture at the start of DCBM. Radiographs were blindly evaluated for spasm and overlapping with barium-filled duodenal loops (scored 0-3, indicating none to severe). The quality of barium coating of the mucosa and overall diagnostic quality (scored 0-3, indicating not acceptable to excellent) were also evaluated. There was no significant difference in subject acceptance between PO group and controls, and no adverse effects in either group. Scores for spasm at the esophagus, lower stomach and duodenal bulb were significantly lower in the PO than in the control group (P < 0.001). Scores for overlapping at the lower stomach and duodenal bulb were significantly lower in the PO than in the control group (P < 0.05, P < 0.01, respectively). Scores for overall diagnostic quality at the esophagus, lower stomach and duodenal bulb were significantly higher in the PO than in the control group (P < 0.001). Oral PO reduces spasm of the esophagus, lower stomach and duodenal bulb, inhibits barium flow to the distal duodenum, and improves diagnostic quality without other antispasmodics. Oral PO is a safe, easy to use and effective antispasmodic for DCBM.

Dose reduction of hyoscine- N-butylbromide for double-contrast barium meal examinations — A prospective randomized study

A search of the literature suggests that the conventional 20 mg dose of intravenous hyoscine-N-butylbromide (HBB) for smooth muscle relaxation in double-contrast barium meal (DCBM) studies is largely empirical. This study analysed the merits of three different doses (5 mg, 10 mg, 20 mg) in the performance of routine DCBMs. One hundred and twenty DCBM examinations were prospectively and randomly allocated to receive one of three doses. Three parameters were measured for each examination: gastroduodenal distension, delay in gastric emptying and gastric antrum overlapping with barium-filled duodenal loops. Almost half the examinations using 5 mg produced undesirable duodenal-gastric overlay. Unacceptable early flooding of the duodenal bulb with barium was seen mostly with doses of 5 mg and 10 mg. Overall, the best results were obtained with 20 mg. The continued use of 20 mg HBB in routine DCBMs is recommended.

Barium meals in the elderly—a quality reassurance

The consecutive double contrast barium meal examinations of 100 elderly patients (aged over 65 years) and a group of 33 younger adult patients were analysed by two observers for technical quality and pathological abnormalities. Technical quality declined with patient age, especially in those over 75 years, but was sufficient to enable diagnosis of abnormalities in 60% of the elderly group. It is concluded that, in the majority of elderly patients, the technical quality of double contrast barium meal examinations is sufficiently high to offer considerable diagnostic utility.

Morning or afternoon barium meal? Diurnal variation and the effectiveness of gastric mucosal coating during double-contrast studies

The radiographs of 60 patients having double-contrast barium meal examinations were analysed by a linear analogue technique to assess variation in the quality of mucosal coating between morning and afternoon studies. No significant difference (P greater than 0.5) was found between morning and afternoon gastric mucosal coating. Factors that could in theory contribute to a diurnal variation are discussed. We conclude that afternoon DCBMs can be confidently booked and performed, in the knowledge that their diagnostic quality is not impaired.

DO YOUNG PATIENTS WITH DYSPEPSIA NEED INVESTIGATION?

During 1986, 1386 patients with simple dyspepsia were referred by general practitioners for endoscopy (686) or double-contrast barium meal examination (700) at Leicester General Hospital. 618 (45%) were under the age of 45 years. Abnormal findings were more common in older than younger dyspeptic patients (58% vs 40% at endoscopy, 69% vs 25% by barium meal). Malignant disorders were diagnosed in 5% at endoscopy and 3% at barium meal, but in no patient under 45 years old. The incidence of malignant disorders at endoscopy was analysed for the 6 years 1980-86. Of 707 cases identified, only 13 (1·8%) occurred in patients under 45 years old; all 13 had symptoms suggesting pathology more serious than simple dyspepsia. It can be concluded that young patients with simple dyspepsia are overinvestigated. A majority can be treated safely with antacids and/or histamine receptor type 2 antagonists.

Diagnostic strategy in suspected duodenal ulcer disease. A questionnaire study.

In a questionnaire study of 89 Danish gastroenterologists the current diagnostic strategy in patients suspected of having duodenal ulcer disease was elucidated. A case summary concerning a patient with upper abdominal pain was presented. It was assumed that the patient had had a double-contrast barium meal examination or an upper gastrointestinal endoscopy performed. If the X-ray had revealed a deformity of the duodenal bulb, 30% of the gastroenterologists would offer the patient specific medical treatment (H2-blocking agent etc.), but a significantly higher number of gastroenterologists, 45%, (p less than 0.05) would offer specific medical treatment if a deformity was revealed at endoscopy. There was also a significant difference (p less than 0.01) between those who would offer specific treatment if X-ray (84%) or if endoscopy (100%) had revealed an ulcer. Considerable variation was found among experts in their decisions on the basis of X-ray and endoscopy in patients with suspected duodenal ulcer disease. Gastroenterologists generally rely more on endoscopic than on radiographic findings.

A comparison of paralysing agents in double-contrast barium meal examinations

One hundred and fourteen patients attending for barium meal examination were randomly allocated to receive Buscopan (hyoscine N-butylbromide, Boehringer Ingelheim; 20 mg) or glucagon (0.5 mg) as paralysing agents, or sterile water as control. The radiographs were analysed with regard to (a) gastric and duodenal distension and coating and (b) early or delayed filling of the duodenum with barium, in order to assess claims that paralysing agents influence radiographic quality. It was found that both duodenal distension and coating were better with Buscopan and glucagon than with water but there was no difference between Buscopan and glucagon in producing these effects. Relaxants produced no significant effect on distension or coating of the stomach. Glucagon prolonged the time of some examinations but gave better visualisation of the stomach, which was less frequently obscured by contrast in the duodenum.

Double contrast barium meal examination: A comparison of two high density barium preparations, E-Z-HD and X-Opaque

A clinical trial comparing E-Z-HD and X-Opaque, both high density, low viscosity barium preparations designed for use in double contrast barium meal examinations, found no significant difference in their performance.

Deceptive duodenal deformity

In the investigation of the site of origin of mass lesions in the abdomen, the duodenal loop is a useful landmark (Whalen et al., 1972). The direction of displacement of the duodenum is useful in determining the site of origin of mass lesions in this region. Two patients are presented in whom the duodenum was seen at double contrast barium meal examination. In both cases the duodenal impression was subsequently demonstrated to be due to a normal right kidney.

Metoclopramide in double contrast barium meals

A prospective controlled trial was carried out to evaluate the usefulness of the administration of Metoclopramide (Primperan) prior to double contrast barium meal examinations. The results indicated that this did not significantly alter the quality of the examination.

Double contrast barium meal examination — A comparison of techniques for introducing gas

A comparison made between five techniques for introducing additional gas to the stomach for double contrast barium examination showed effervescent tablets to be associated with significant improvement in gastric mucosal coating with significantly less bubble formation. A proprietary effervescent health salt on the other hand was associated with significantly greater bubble formation.

Technique of the double contrast barium meal with examples of correlation with endoscopy

The technique of double contrast barium meal examination is presented. This requires a liquid barium of low viscosity and high concentration. Transient gastric atony is required to prevent entry of barium into overlying small bowel, but this must not be too prolonged or the duodenal cap and loop will not be shown. Moderate duodenal relaxation gives views comparable to hypotonic duodenography, but it does preclude follow-through examination of the small bowel as the transit time becomes greatly prolonged. The surface pattern of the stomach showing areae gastricae can be routinely demonstrated, and thus becomes the criterion of an adequate examination. Small gastric carcinomas of the order of 2–3 cm can be demonstrated, benign and malignant disease can be distinguished and the surface changes in such conditions as chronic erosive gastritis and Menetriere's disease can be visualised as well as the small ‘ulcers' following endoscopic biopsies.