Upper GI Barium X-ray (barium and gas)

What it is

The oesophagus, stomach, and first part of the small bowel are invisible on an ordinary abdominal film. Barium changes that: it is dense enough to stop x-rays, so wherever it goes it shows up white, and a radiologist watching by fluoroscopy can see swallowing happen in real time rather than as a still picture. The double-contrast technique adds a second ingredient — crystals that release gas in the stomach, much like a dissolving antacid tablet. The barium clings to the lining while the gas stretches the walls apart, and the result is a fine outline of the surface itself, where an ulcer crater or a change in the folds can be spotted. This code also includes the scout films taken of the abdomen before any contrast is swallowed, and delayed images taken later once the barium has travelled onward.

Why it is done

• To investigate difficulty or pain on swallowing, and to watch how the swallow itself is coordinated
• To look for an ulcer, a narrowing, or a growth in the stomach or the first part of the small bowel
• To assess reflux of stomach contents back up the oesophagus, and hernias at the junction between the two
• To examine the anatomy after stomach or oesophageal surgery
• To answer a structural question in someone for whom an endoscopy is not the preferred first step

What to expect

Nothing to eat or drink after midnight is the usual instruction, since food in the stomach hides everything. The barium is thick and chalky, sometimes flavoured; the gas crystals produce a strong urge to belch, which patients are asked to resist because the gas is the point. The table tilts and the patient is asked to roll into several positions so the barium coats all surfaces, and the radiologist may press on the abdomen with a paddle to spread it. The imaging portion is usually finished within about twenty minutes, with delayed pictures taken after a wait. Barium turns the stool pale for a couple of days afterwards and can be constipating; extra fluids are commonly recommended.

Questions worth asking

• Is this the double-contrast study with scout and delayed films, or the simpler single-contrast one? They are different codes.
• Is the barium and the gas-producing agent billed as a supply charge on top of the procedure?
• Is the radiologist's supervision and interpretation a separate bill from the facility's charge for the room and equipment?
• If an endoscopy is likely to follow anyway, is it worth pricing both before starting with this one?
• If the small bowel is followed further along on the same visit, does that add another code?