Barium Meal

Barium meal

 Identifies lower half of oesophagus, the

stomach and all of duodenum.

 Method
 A)double contrast – the method of choice to
demonstrate mucosal pattern
 B)single contrast-used in children (not
necessary to demonstrate mucosal pattern)
 And very ill adults (only gross pathology)
Indications

 1)Dyspepsia
 2)Weight
 3)Upper abdominal mass
 4)Gastro intestinal haemorrhage
 5)suspected upper GI obstruction
 6)assessment of the site of perforation(water
soluble contrast is used)
Contra indications

 1.Complete large bowel obstruction

 2.Suspected perforation (unless water
soluble contrast medium used)
 Patient preparation
 1. NPO after midnight(6 hrs)
 2.abstain from-smoking, chewing gum or
antacids-
->dec fluid in stomach which impairs barium
coating.
Technique

 1.Hypotonic agent Buscopan(hyoscine butyl

bromide,20 mg i.v) or 0.1-0.2 mg i.v glucagon
is injected intravenously -relax stomach and
suspend peristalsis.
 A packet of effervescent granules swallowed
with small amount of water- releases CO2
and gastric distension.(approx 400ml CO2)
 High density barium is swallowed(120 ml-
250% w/v) and double contrast views of
oesophagus is obtained standing RAO.
 Patient faces Xray table,lowered to horizontal
 Then turned onto left side and finally supine.


 Patient rolled from side to side so as barium

coats mucosal surfaces properly-washes
over the mucus .

 Sequences of films of stomach obtained—

 When barium enters duodenum, patient is
turned RAO – fills 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.
 Note:young children- main indication identify
cause of vomiting eg:-pyloric
 Flow technique identifies-subtle mucosal
abnormalities.
 obstruction,malrotation,and GOR.single
contrast technique preferred(30% w/v Barium
sulfate with no paralytic agent).
 Note : kV range double contrast- 70-120 kV.
 single contrast-120-150kV .
 Note:If partial gastrectomy or drainage
procedues (eg; pyloroplasty or
gastrenterostomy), begin with prone swallow
using high density barium.Reaching
duodenum or Genterostomy-turned supine
for DC films.DC of stomach and oesophagus
follows.
STOMACH

 Surface:reticular pattern –
multipleinterconnecting grooves.
 Divides- polygonal islands(2-4 mm)areae
gastricae.distal 2/3rds.
 Presence- excludes diffuse atrophic gastritis
 >4mm sign of gastritis
 Fundus and body.- longitudinal folds or
rugae.

 Duodenum-
 Extends from pylorus to duodenojejunal
flexure-cap,second part(descending
horizontal,third part(ascending) and fourth
part.
 Barium meal-cap-fine velvety reticular
surface pattern by villi.
 Barium caught under mucosal pattern –
incomplete erosive duodenitis
 Barium caught underfold between 1st and 2
nd part of duodenum-ulcer pic
 Beyond cap-mucosal folds-narrow bands
across whole width.
 Major papilla of Vater(2ND PART)
 Central fold and 2 oblique folds
 Minor papilla(Santorini- 2 CM PROXIMAL)
 Frail and immobile, modification.
 Single contrast examination:
 100%w/v barium – oesophagus, stomach and
duodenum
 Compression applied-lower stomach and
duodenum. Approximates front and back
walls with thin layer in between.
 Protruding lesion-radiolucent filling defect
 Depressed-eg:ulcer --focal extra density.