What is an upper GI series?

An upper GI series is a procedure in which a doctor uses real-time X-rays called fluoroscopy and a chalky liquid contrast material called barium to view your upper GI (gastrointestinal) tract. The barium will make your upper GI tract (the esophagus, stomach and the first part of small intestine or duodenum) more visible on an x-ray. Fluoroscopy (real-time X-rays) makes it possible to see internal organs in motion. When the upper GI tract is coated with barium, the radiologist is able to view and assess the anatomy and function of the esophagus, stomach and duodenum.

Upper GI series is safe, noninvasive, and may be used to help accurately diagnose pain, acid reflux, blood in the stool and other symptoms.

The two types of upper GI series are:

• a standard barium upper GI series, which uses only barium
• a double-contrast upper GI series, which uses both air and barium for a clearer view of your stomach lining

You will be instructed on how to prepare. Your stomach must be empty, so you will likely be told not to eat or drink anything (including oral medications) or chew gum after midnight the night before. Tell your doctor if there’s a possibility you are pregnant and discuss any recent illnesses, medical conditions, medications you’re taking and allergies, especially to contrast materials. Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown.

Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation.

Why do doctors use upper GI series?

An upper GI series can help a doctor find the cause of:

• nausea and vomiting
• pain in the chest and abdomen
• difficulty swallowing
• unexplained weight loss
• reflux (a backward flow of partially digested food and digestive juices)
• unexplained vomiting
• severe indigestion
• blood in the stool (indicating internal GI bleeding)

An upper GI series can also detect:

• abnormal growths such as cancer
• inflammation of the esophagus, stomach and duodenum
• abnormalities of the muscular wall of GI tract
• anatomical problems such as intestinal malrotation (a twisting of a baby’s intestine)
• esophageal varices
• gastroesophageal reflux
• a hiatal hernia
• scars or strictures
• blockages
• ulcers

What is upper GI and small bowel series?

An upper GI and small bowel series is a set of x-rays taken to examine the esophagus, stomach, and the small intestine.

How long does an upper GI series take?

The upper GI series procedure usually takes about 2 hours. The upper GI series procedure can take up to 5 hours if the barium moves slowly through your small intestine.

Upper GI series vs Endoscopy

Endoscopy is a procedure that lets your doctor look inside your body using an instrument called an endoscope or scope for short. Endoscope has a tiny camera attached to a long, thin tube. The doctor moves it through a body passageway or opening to see inside an organ. Sometimes endoscopes are used for surgery, such as for removing polyps from the colon.

Upper GI series vs Barium swallow

With upper GI series, your doctor can view your esophagus, stomach and the first part of small intestine or duodenum. Whereas a barium swallow on examines the pharynx, esophagus and the upper part of your stomach.

Upper GI series prep

To prepare for an upper GI series, don’t eat, drink, smoke, or chew gum. You should talk with your doctor about any medical conditions you have and all prescribed and over-the-counter medicines, vitamins, and supplements you take.

In order to see your upper GI tract clearly, your doctor will most likely ask you not to eat, drink, smoke, or chew gum during the 8 hours before the upper GI series.

Doctors don’t recommend x-rays for pregnant women because x-rays may harm the fetus. Tell your doctor if you are, or may be, pregnant. Your doctor may suggest a different procedure.

A doctor may recommend an upper GI series for your child when the benefits of the procedure outweigh the relatively small risk of x-rays. Talk with your child’s doctor about safety measures used to lower your child’s exposure to x-rays during the procedure.

Upper GI series procedure

An x-ray technician and a radiologist perform an upper GI series at a hospital or an outpatient center. You do not need anesthesia . The upper GI series procedure usually takes about 2 hours. The upper GI series procedure can take up to 5 hours if the barium moves slowly through your small intestine.

You may get an injection of a medicine that slows muscle movement in the small intestine. This makes it easier to see the structures of your organs on the x-rays.

Before the x-rays are taken, you must drink 16 to 20 ounces (480 to 600 milliliters) of a milkshake-like drink. The drink contains a substance called barium, which shows up well on x-rays.

For the upper GI series procedure, you’ll be asked to stand or sit in front of an x-ray machine and drink barium, which coats the lining of your upper GI tract. You will then lie on the x-ray table, and the radiologist will watch the barium move through your GI tract on the x-ray and fluoroscopy. The technician may press on your abdomen or ask you to change position several times to evenly coat your upper GI tract with the barium.

If you are having an air-contrast or double-contrast upper GI study, you will swallow gas-forming crystals such as baking-soda crystals (similar to Alka-Seltzer) that mix with the barium coating your stomach. Gas forms when the crystals and barium mix. The gas expands your stomach, which lets the radiologist see more details of your upper GI tract lining. The technician will then take additional x-rays.

On occasion, some patients are given other forms of orally ingested contrast, usually containing iodine. These alternative contrast materials may be used if the patient has recently undergone surgery on the GI tract, or has allergies to other contrast materials. The radiologist will determine which type of contrast material will be used.

Children usually drink barium contrast material without any objection. If a child will not drink the contrast, the radiologist may need to pass a small tube into the stomach to complete the examination.

Very young children may be placed on a special rotating platform to help turn them into slanted positions. This allows the radiologist to see all the organs. Older children will be asked to hold very still and may be asked to hold their breath for a few seconds while the x-ray pictures are taken.

Older children may undergo a double-contrast upper GI series. The patient will swallow baking-soda crystals that create gas in the stomach while additional x-rays are taken.

What should I expect after an upper GI series?

After an upper GI series, you can expect the following:

• You may have cramping in your abdomen and bloating during the first hour after the procedure.
• You may resume most normal activities after leaving the hospital or outpatient center.
• For several days, your stools may be white or light colored from the barium in your GI tract.
• A health care professional will give you instructions on how to care for yourself after the procedure. The instructions will explain how to flush the remaining barium from your GI tract. You should follow all instructions.

A specialist will read the x-rays and send a report of the findings to your doctor.

Upper GI series results

Normal Results

A normal result shows that the esophagus, stomach, and small intestine are normal in size, shape, and movement.

Normal value ranges may vary depending on the lab doing the test. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean

Abnormal results in the esophagus may indicate the following problems:

• Achalasia
• Diverticula
• Esophageal cancer
• Esophageal narrowing (stricture) – benign
• Hiatal hernia
• Ulcers

Abnormal results in the stomach may indicate the following problems:

• Gastric cancer
• Gastric ulcer – benign
• Gastritis
• Polyps (a tumor that is usually noncancerous and grows on the mucus membrane)
• Pyloric stenosis (narrowing)

Abnormal results in the small intestine may indicate the following problems:

• Malabsorption syndrome
• Swelling and irritation of the small intestines
• Tumors
• Ulcers

The upper GI series test may also be done for the following conditons:

• Annular pancreas
• Duodenal ulcer
• Gastroesophageal reflux disease
• Gastroparesis
• Intestinal obstruction
• Lower esophageal ring
• Primary or idiopathic intestinal pseudo-obstruction

Upper GI series limitations

Mild irritation of the lining of the stomach or esophagus is difficult to detect, as well as ulcers smaller than 1/4 inch in diameter. The test will detect larger ulcers. It can also suggest the presence of underlying infection with the bacterium, Helicobacter pylori, the most common cause of ulcers; but additional noninvasive tests such as a blood test or breath test may be required to confirm this infection. Finally, biopsies of any abnormal areas cannot be performed with this test.

Upper GI series risks

You are exposed to a low level of radiation during this test, which carries a very small risk of cancer. X-rays are monitored and regulated to provide the minimum amount of radiation exposure needed to produce the image. Most experts feel that the risk is low compared with the benefits.

Pregnant women should not have this test in most cases. Children are more sensitive to the risks of x-rays.

Barium may cause constipation. Talk to your provider if the barium has not passed through your system by 2 or 3 days after the exam.

The risks of an upper GI series include:

• Constipation from the barium—the most common complication of an upper GI series
• An allergic reaction to the barium or flavoring in the barium. Occasional patients may be allergic to the flavoring added to some brands of barium. If you have experienced allergic reactions after eating chocolate, certain berries or citrus fruit, be sure to tell your physician or the technologist before the procedure.
• Intestinal obstruction. There is a slight chance that some barium could be retained, leading to a blockage of the digestive system. Therefore, patients who have a known obstruction in the GI tract should not undergo this examination.

If you have any of the following symptoms after an upper GI series, seek medical attention right away:

• fever
• no bowel movement within 2 days after the procedure
• inability to pass gas
• severe pain in your abdomen.