Upper gastrointestinal tract barium examination of postbulbar duodenal ulcers

OBJECTIVE: The purpose of our investigation was to review the findings on barium studies in a series of eight patients with postbulbar duodenal ulcers in order to better characterize the clinical and radiographic features of these ulcers. CONCLUSION: Our experience suggests that ulcers in the postbulbar duodenum are considerably larger than those in the duodenal bulb and that they constitute a greater percentage of all duodenal ulcers than has previously been recognized. It is important for radiologists to be familiar with the characteristic radiographic features of postbulbar ulcers because of the increased risk of serious upper gastrointestinal tract bleeding in patients with this condition.     

His角的观察在上消化道钡餐造影检查中的意义

X线钡餐造影是上消化道疾病常用的诊断方法之一．His角也称食管胃角．是由贲门上方3～4cm长的胃—食管前庭段的左侧壁与胃底形成的锐角切迹，食管-胃连接部一般是指食管下段、贲门及胃底区．包括邻近的横膈、韧带等结构，是某些上消化道疾病常见发生部位（如贲门癌等）。当此处发生病变时．组织结构上的改变可致His角改变。本文收集51例经病理确诊的胃-食管连接部病变的病例．并对其X线钡餐造影中His角的征象进行回顾性分析。     

What happens to patients after upper and lower gastrointestinal tract barium studies?

We investigated the occurrence of new constipation, diarrhea, nausea, vomiting, visible blood in stool, abdominal pain, black stools, belching, and flatus in 324 outpatients following upper or lower gastrointestinal tract barium procedures. We also evaluated the roles of age, sex, patient mobility, and types of barium enema (single- or double-contrast). At least one new symptom was reported after 51% of all examinations. Constipation was the most frequently reported single symptom after barium meal or small bowel examinations. Fifty percent of all constipation occurred following upper gastrointestinal examinations. Abdominal pain was common in patients of the seventh decade, especially following barium enema. Nausea typically followed barium swallow or upper gastrointestinal series. Belching and passage of flatus were the most frequently reported symptoms after barium enema, both single- and double-contrast. No significant relationship between the frequency of symptoms and patient age, sex, or the type of barium enema was established.     

Use of barium in evaluation of disorders of the upper gastrointestinal tract: current status

Biphasic contrast studies are generally advocated as the best current barium examination for the upper GI tract. Two recent prospective blinded trials compared the diagnostic results of a biphasic contrast examination--employing a medium-density barium suspension and glucagon--and endoscopy. Both methods appear to have nearly equal merit for the detection of peptic ulcer and gastric carcinoma. One of the trials demonstrated a relative inability of the barium examination to depict reflux esophagitis other than the severe variety, an inability that had been previously recognized. Earlier Japanese studies showed excellent results from biphasic studies in the detection of early and advanced gastric carcinoma. Because gastric carcinoma may present as a wide variety of lesions, ranging from minute alterations in mucosal relief through ulcers to masses, the values from these Japanese studies also test the sensitivity and specificity of the radiographic examination in demonstrating non-neoplastic lesions of the stomach. Ample data have shown that a radiographic examination compares favorably with endoscopy in the detection of esophageal carcinoma. The usefulness of a radiographic examination as a primary examination if disturbances of esophageal motor function are suspected is generally recognized. A state-of-the-art radiographic examination (ie, a biphasic examination, preferably with drug-induced hypotony) therefore appears to represent an appropriate initial examination in evaluation of most disorders of the upper GI tract. If this examination prompts the slightest suspicion of a malignant tumor, endoscopy should follow for the purpose of obtaining biopsy specimens. Endoscopy is not necessary if duodenal ulcers have been diagnosed by means of radiography; in typically benign gastric ulcers, radiographic follow-up without endoscopy may safely be considered. If in elderly patients multiple small gastric polyps have been detected, endoscopy is not needed. If complaints persist after negative results at radiographic examination, however, endoscopic intervention must be considered. If the complaints suggest reflux esophagitis, the clinician can choose between treatment and endoscopy. In a patient with acute upper GI bleeding, primary endoscopy may be preferred. This diagnostic approach in which endoscopy is employed as complementary to the barium examination is in most parts of the world a cost-effective one. It is also the safest possible option; although endoscopic complications are rare, their absolute number cannot be ignored if every patient had to undergo endoscopy. A biphasic approach with a medium-density barium suspension can be attempted in nearly every patient; if the patient proves unable to cooperate for an optimal double-contrast examination, a single-contrast examination can be performed with the same barium swallowed.     

Hypersensitivity reactions after barium studies of the upper and lower gastrointestinal tract

One hundred sixty-seven members of the Society of Gastrointestinal Radiologists, three major commercial suppliers of barium preparations, and the Food and Drug Administration were surveyed about the incidence of hypersensitivity reactions after the administration of barium for stomach or colon examinations. The American literature was also reviewed. Twenty-seven radiologists reported 42 reactions, the companies reported 41 reactions, and the FDA documented 11 cases. An additional 12 cases were found in the literature, giving a total of 106 reactions. Of all the cases, 61% involved the skin, 8% were respiratory in nature, 8% of the patients lost consciousness, and one patient experienced an extraordinary migraine headache. Of the 42 cases reported by the radiologists, half occurred after stomach examination and half after a barium enema examination; the single-contrast technique had been used in only nine of the cases. Glucagon had been used in 11 of the 42 cases. Hypersensitivity reactions can occur after the administration of barium products and are caused by one of the many additives. These reactions are extremely unusual.     

CT of radiatioe-indeced injury of the gastrointestinal tract spectrum of findings with barium studies correlation

Because of improvement in survival rate of patients with abdominal cancer, gastrointestinal complications following external radiation therapy are becoming more frequent. Thus, an increased number of patients are commonly investigated with imaging because of suspected radiation-induced injury of the gastrointestinal tract. This pictorial review highlights the spectrum of CT and barium study manifestations of radiation-induced injury of the gastrointestinal tract. The major role of CT in the evaluation and management of patients with radiation injury of the gastrointestinal tract is highlighted. Emphasis is placed on CT imaging signs that may help in distinguishing between radiation-induced injury and recurrent disease. Received: 19 October 1999; Accepted: 15 November 1999     

The double contrast barium meal in patients with acute upper gastrointestinal bleeding

One hundred and seven patients admitted to a small general hospital with acute upper gastrointestinal bleeding have been examined by the double contrast barium meal technique. The presumed bleeding site was identified in 75 cases (70%). Twenty-eight patients showed radiological evidence of recent or active bleeding. These were all examined within 24 h of the bleed and 18 (64%) continued to bleed or had a further bleed whereas of 79 patients who did not show radiological signs of recent or active bleeding only 10(13%) continued to bleed or had a further bleed. The radiological features of recent or active bleeding seen on the double contrast barium meal are: 1, Blood clot in an ulcer or adherent to a recently bleeding lesion. 2. An artery in the base of an ulcer. 3. Active bleeding during the course of the examination seen as a dynamic alteration or disturbance in the barium as it flows over the bleeding site.     

Double-contrast upper gastrointestinal radiography: a pattern approach for diseases of the stomach

The double-contrast upper gastrointestinal series is a valuable diagnostic test for evaluating structural and functional abnormalities of the stomach. This article will review the normal radiographic anatomy of the stomach. The principles of analyzing double-contrast images will be discussed. A pattern approach for the diagnosis of gastric abnormalities will also be presented, focusing on abnormal mucosal patterns, depressed lesions, protruded lesions, thickened folds, and gastric narrowing.     

胶囊内镜用于比格犬上消化道检查方法的建立与初步应用

目的 探索胶囊内镜用于比格犬等较大体型动物上消化道黏膜疾病实时监测的方法及可行性.方法 (1)对PillCam SB2型胶囊内镜进行简单改造,采用4号手术线一端束缚胶囊内镜的腰部做牵引线,另一端从胃管的顶端穿过,从一侧孔穿出胃管,通过拉伸将胶囊内镜顶靠在胃管的前端;(2)麻醉比格犬,胃管辅助胶囊内镜通过比格犬口咽送入食管、胃腔.(3)40％无水乙酸40 ml灌胃,胶囊内镜检查系统观察消化道黏膜变化.结果 (1)改装后的胶囊内镜在胃管的帮助下可以顺利地进入比格犬食管和胃内,并可通过拉伸牵引线将胶囊式内镜顶靠在胃管的前端部,控制胶囊内镜改变拍摄位置和角度.(2)40％无水乙酸40 ml灌胃,成功制造比格犬急性胃黏膜病变模型.(3)胶囊内镜可以清晰拍摄胃腔图像,观察胃黏膜在不同时间点出现的不同表观变化,实现对动物消化道疾病模型黏膜变化的实时监测.结论 成功建立了胶囊内镜实时监测上消化道黏膜急性病变发生发展的方法,将其初步应用于观察体型较大动物比格犬胃黏膜急性损伤过程中的表观变化是可行的.     

胃肠系统淋巴瘤的X线与CT诊断(附20例分析)

目的分析胃肠系统淋巴瘤的CT、胃肠造影表现。材料与方法回顾性分析了20例胃肠系统淋巴瘤的胃肠道造影及CT影像资料，其中男16例，女4例，年龄25～71岁。20例均行胃肠道造影检查，15例行腹部CT检查。所有病例均经病理证实。结果1．胃肠道气钡造影检查①浸润型胃8例，小肠1例；②肿块型胃5例；③溃疡型胃2例；④息肉型近端空肠1例，末端回肠及盲肠3例。2．CT表现向心性壁厚20～25mm局限性肿块，脾大，脾内低密度灶2例；淋巴结增大。结论1．气钡双重造影是诊断胃肠系统淋巴瘤的首选方法，CT检查可以补充其他器官及淋巴结情况。2．胃肠系统淋巴瘤应与其他疾病相鉴别。