Category: Diagnonistic Test

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Percutaneous Transhepatic Cholangiography (PTCA)

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Definition:

Percutaneous transhepatic cholangiography (PTHC or PTC) is a radiologic technique used to visualize the anatomy of the biliary tract. A contrast medium is injected into a bile duct in the liver, after which X-rays are taken. It allows access to the biliary tree in cases where endoscopic retrograde cholangiopancreatography (ERCP) has been unsuccessful. Initially reported in 1937, the procedure became popular after a 1952 report in the English-language literature.

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It is an x-ray test that can help show whether there is a blockage in the liver or the bile ducts that drain it. Since the liver and its drainage system do not normally show up on x-rays, the doctor doing the x-ray needs to inject a special dye directly into the drainage system of the liver. This dye, which is visible on x-rays, should then spread out to fill the whole drainage system. If it does not, that means there is a blockage. This type of blockage might result from a gallstone or a cancer in the liver.

It is predominatly now performed as a therapeutic technique. There are less invasive means of imaging the biliary tree including transabdominal ultrasound, MRCP, computed tomography and endoscopic ultrasound. If the biliary system is obstructed, PTC may be used to drain bile until a more permanent solution for the obstruction is performed (e.g. surgery). Additionally, self expanding metal stents can be placed across malignant biliary strictures to allow palliative drainage. Percutaneous placement of metal stents can be utilised when therapeutic ERCP has been unsuccessful, anatomy is altered precluding endoscopic access to the duodenum, or where there has been separation of the segmental biliary drainage of the liver, allowing more selective placement of metal stents. It is generally accepted that percutanous biliary procedures have higher complication rates than therapeutic ERCP. Complications encountered include infection, bleeding and bile leaks.
Why the test is performed?
Bile is a by-product of protein metabolism. It is created in the liver and excreted into the intestines via the bile ducts. If bile cannot be removed from the body, it collects in the blood and is seen as a yellow discoloration of the skin and eyes (jaundice).

Also, the pancreas creates digestive fluids which drain via a common bile duct into the intestine, and thus obstruction can prevent the drainage of the fluids and may cause pancreatitis (inflammation of the pancreas).

A PTCA test can help identify whether a blockage is causing the jaundice and pancreatitis.

How do you prepare for the test?
Tell your doctor if you have ever had an allergic reaction to lidocaine or the numbing medicine used at the dentist’s office. Also tell your doctor if you could be pregnant. If you have diabetes and take insulin, discuss this with your doctor before the test.

Most people need to have a blood test done some time before the procedure, to make sure they are not at high risk for bleeding complications. If you take aspirin, nonsteroidal anti-inflammatory drugs, or other medicines that affect blood clotting, talk with your doctor. It may be necessary to stop or adjust the dose of these medicines before your test.

You will be told not to eat anything on the morning of the test so that your stomach is empty. This is a safety measure in the unlikely case you have a complication, such as bleeding, that might require repair surgery.

What happens when the test is performed?
You lie on a table wearing a hospital gown. An IV (intravenous) line is inserted into a vein in case you need medicines or fluid during the procedure. An area over your right ribcage is cleaned with an antibacterial soap. Then the radiologist may take a picture of your abdomen with an overhead camera. Medicine is injected through a small needle to numb the skin and the tissue underneath the skin in the area where the dye is to be injected. You may feel some brief stinging from the numbing medicine.

A separate needle is then inserted between two of your ribs on your right side. A small amount of xray dye is injected, and some pictures are taken that are visible on a video screen. Your doctor adjusts the placement of the needle until it is clear that the dye is flowing easily through the ducts (drainage tubes) inside your liver.

Because taking the x-ray pictures sometimes requires a significant amount of time, the doctor replaces the needle with a softer plastic tube. First, the syringe holding the dye is detached from the top of the needle, leaving the needle in place. The doctor then gently pushes a thin wire through the needle and into the duct where the needle has been sitting. Next the needle is pulled out, sliding over the outside end of the wire. The wire is left with one end inside the liver to hold the position where the needle had been. A thin plastic tube similar to an IV line is slid along the wire, like a long bead on a string, until it is in the same place where the needle was. The wire is then pulled out, and the dye syringe is attached to the tube.

More dye is injected through the plastic tube, and pictures are taken with the video camera as the dye spreads inside the liver. If there is no blockage, the dye drains out of the liver through the bile ducts and begins to show up on the x-ray in the area of your small intestine. Once all of the needed pictures have been taken, the plastic tube is pulled out, and a small bandage is placed over your side. The whole test usually takes less than an hour.

Risk Factors:
It is possible to have serious bleeding from this test. In some cases, blood leaks to the outside surface of the liver and causes a buildup of blood there. In other cases, blood can leak directly into the liver’s drainage system, in which case it might start showing up in your intestine, causing a bloody bowel movement. It is less likely that you could develop an infection after the test. The only soreness you are likely to have is at the skin surface where the needle went in. This should last for only a day or two.

In rare cases, the dye used in the test can damage your kidneys. This kidney effect is almost always temporary, but some people have permanent damage.

As with all x-rays, there is a small exposure to radiation. In large amounts, exposure to radiation can cause cancers or (in pregnant women) birth defects. The amount of radiation from the video x-ray in this test is very small-too small to be likely to cause any harm. (The people performing the test on you will wear lead shields, since they would otherwise be exposed to this radiation over and over, which could be more of a danger.)

Must you do anything special after the test is over?
Call your doctor right away if you have pain in your right abdomen or shoulder, fever, dizziness, or a change in your stool color to black or red.

How long is it before the result of the test is known?
You may be told a few early results of your test as soon as the test is done. It takes a day or two for the radiologist to review the x-rays more thoroughly and to give your doctor a full report.

RESULTS:-

Normal Result:-The bile ducts are normal in size and appearance for the age of the patient.

Abnormal Results:-The results may show that the ducts are enlarged, which may indicate the ducts are blocked. The blockage may be caused by infection, scarring, or stones. It may also indicate cancer in the bile ducts, liver, pancreas, or region of the gallbladder.

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*Blocked bile ducts
*Cholangitis (infection in common bile duct)
Special considerations:-
A PTCA may be done if an endoscopic retrograde cholangiopancreatography ( ERCP) cannot be performed or has failed in the past.

An MRCP (magnetic resonance cholangiopancreatography) is a newer, non-invasive imaging method, based on MRI, which provides similar views of the bile ducts.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/percutaneous-transhepatic-cholangiography.shtml
http://en.wikipedia.org/wiki/Percutaneous_transhepatic_cholangiography
http://www.healthline.com/adamcontent/percutaneous-transhepatic-cholangiogram

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Rapid Detection of Infectious Diseases.

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Only a few minutes and a simple, ready-to-use diagnostic test kit are needed to determine an individual’s infectious disease status.
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In about the middle of the 20th century, mass vaccination programs and the widespread availability of antibiotics significantly reduced the threat of infectious diseases in Canada and many other regions of the world. Indeed, a concerted worldwide effort led to eradication of the smallpox virus, the cause of the most serious infectious disease in the western world during the 17th and 18th centuries , and the incidence of other diseases, such as the common childhood ailments measles, mumps, and pertussis, have been reduced by similar vaccination programs . Despite these advances, however, infectious diseases remain the world’s leading cause of premature death, accounting for about 17 million deaths in 1995.

To further control communicable diseases, global efforts must overcome ongoing challenges provided by the evolution of infectious agents. Among the more significant evolutionary changes in the past 25 years are the increased prevalence of antibiotic resistance in infectious bacteria (e.g., methicillin resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococci (VRE))  and the emergence of about 30 new infectious agents (e.g., human immunodeficiency virus (HIV), hepatitis C virus (HCV), and the ebola virus) . Moreover, rapid evolutionary changes create new appearances for some infectious agents (e.g., the influenza virus and HIV), allowing them to circumvent the defensive mechanisms of our immune systems.

Another obstacle for the control of communicable diseases arises when the role of an infectious agent in a disease goes unnoticed. The significance of this point was demonstrated in the 1980s when the bacterium Helicobacter pylori was finally recognized as a causative factor of duodenal ulcers and other gastric diseases . As a result of the H. pylori discovery, many gastric diseases are now effectively treated with antibiotics, and it is possible that new therapeutic directions will be stimulated by a recent proposal, which implicates chronic infections as a cause of several well-Known diseases (e.g., atneroscierosis and Alzheimer’s Disease).

For infectious diseases, an unambiguous diagnosis obtained in a timely fashion is extremely important, not only from a personal viewpoint (i.e., the initiation of an appropriate treatment), but also from a public health perspective (i.e., the prevention of disease transmission from one individual to another).

To a large extent, evidence for the presence of an infectious agent, and thus the diagnosis of infectious disease status, is provided by the results of one or more diagnostic tests. In addition to providing an accurate result, an ideal rapid diagnostic test should be easy to perform while yielding a definite result within a reasonable length of time ([less than]30 min to be considered as a rapid test).

For these reasons, most rapid diagnostic tests for infectious diseases are based on the highly selective, noncovalent interactions between an antibody and an antigen. Antibodies are proteins produced by the immune system in response to the entry of a foreign entity, such as an infectious agent. Because antibodies specifically bind to a distinct site (or epitope) in a protein or another macromolecule (i.e., the antigen) associated with the infectious agent, the unique group of antibodies generated during each infection is an excellent diagnostic marker for disease. This immunoassay approach can be limited by the time required for antibody levels to increase to detectable levels after infection (e.g., antibodies for HIV are detectable on average 25 days post infection).

Immunoassays in various forms (e.g., enzyme immunoassays) are increasingly employed in clinical laboratories; however, the rapid test format is the most recent innovation in an industry undergoing substantial growth. In rapid tests, membrane immobilized antigens are used to capture the antibodies generated against the infectious agent. The specificity of a test towards a particular disease relies on the highly specific antigen-antibody interaction, and the appropriate choice of an antigen captures only the disease specific antibodies on the rapid test membrane. The appropriate antigen can be obtained from the infectious agent, produced by recombinant methods, or mimicked by synthetic peptides.

Antibodies captured by the membrane-immobilized antigen are detected using a colour reagent (e.g., protein A-colloidal gold or anti-human IgG antibodies conjugated to coloured particles), and a positive test typically is signified by the appearance of a coloured dot or line on the test membrane. If no disease antibodies are present in the sample, the colour reagent is not trapped on the membrane, and a negative result is obtained. A control dot or line often is included to verify that the colour reagent is functioning properly. While the rapid test format with visual interpretation provides only a qualitative result, a positive/negative result is sufficient in many diagnostic applications, including infectious disease diagnosis.

An immediate result provided by a rapid test is particularly advantageous when knowledge of a communicable disease is needed quickly (e.g., emergency surgery) or when a patient is apprehensive about the disease and might not make a second visit to a medical facility to receive the test result. The latter is a significant problem; about 30% of patients tested for HIV in publicly funded clinics in the United States during 1995 did not return , and a large cost is incurred by tracking them down to deliver the result of a laboratory test and to arrange a confirmatory test when a positive first result is obtained. The simplicity of the rapid test format allows the test to be used wherever an infectious disease has a high prevalence, or in remote clinical settings where patients must travel significant distances to get to the test centre.

The timeline from the initial idea to sales of an approved rapid diagnostic test is about five years. Over this period, research is undertaken to validate the concept; the optimum parameters are established for the immunoassay in the rapid test format, and in-house evaluation is conducted. The safety and effectiveness of the test is then established by independent clinical trials at several different locations before applications are submitted for regulatory approval by Health Canada and agencies in other countries, such as the Food and Drug Administration (FDA) in the United States. In April 1998, Health Canada granted its first approval for a rapid HIV test to MedMira Laboratories Inc.

MedMira is a publicly traded (CDNX: MIR) Canadian medical biotechnology company at the leading edge of rapid diagnostic test development. The company has expanded considerably since the early 1990s when it was established in Nova Scotia’s Annapolis Valley. At present, MedMira has over 45 employees and a corporate office in Toronto, ON. Separate locations for research and manufacturing are located in the Halifax Regional Municipality. In July 1999, MedMira Laboratories received International Organization of Standards ISO9001 registration designed around Health Canada’s ISO 13485 essentials for the manufacture of medical devices, and a system of product manufacturing compliant with the U.S. FDA current Good Manufacturing Practices (cGMP) was established and implemented at MedMira in April 1999.

In addition to the HIV test, which is able to detect HIV-1, HIV-2, and the rare group O variant of HIV-1, MedMira also has developed rapid tests for other infectious agents, including H. pylori, hepatitis B virus (HBV), HCV, and a HIV/HCV combination. The MedMira rapid tests meet the approval requirements in several countries and the approval process is underway in others. For example, the H. pylori test was granted U.S. FDA 510(k) clearance last year, and the U.S. FDA/PMA committee and the Chinese State Drug Administration (SDA) have accepted the MedMira HIV test for review. The MedMira test kits are marketed worldwide.

While the acute effects of infectious diseases are widely known, a connection between infectious agents and cancer has been established for HBV/HCV (liver cancer) , H. pylori (gastric cancer) , and human papillomaviruses (HPV) (cervical cancer) . Currently, rapid tests for infectious diseases identify certain underlying risk factors for cancer, but in the future, rapid test methodology will be available to detect markers associated with other forms of cancer.

Diagnostic tests are an integral part of modern health care. The availability of rapid diagnostic tests demonstrates that the complex interactions between molecules such as antigens and antibodies (and up-to-date science) can be utilized to provide a reliable diagnostic test in a simple format. Ongoing research is needed to keep rapid test methodology current with the evolution of infectious agents, and to expand the rapid test approach to the diagnosis of other diseases. Because of the simple format and reasonable cost, rapid test methodology holds the promise of bringing more efficient and effective diagnostic testing to both developed and undeveloped countries around the world.

Sources:http://www.allbusiness.com/north-america/canada/791219-1.html

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Anoscopy

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Definition:
An anoscopy is a procedure that enables a physician to view the anus, anal canal, and lower rectum using a speculum.A tube called an anoscope is used to look at the inside of your anus and rectum. Doctors use anoscopy to diagnose hemorrhoids, anal fissures (tears in the lining of the anus), and some cancers.

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How the test is performed:
First, the health care provider performs a digital rectal exam by inserting a lubricated, gloved finger into the rectum to determine if anything will block the insertion of the scope.

He or she then inserts a lubricated metal or plastic anoscope a few inches into the rectum. This enlarges the rectum to allow the health care provider to view the entire anal canal using a light. A specimen for biopsy can be taken if needed. As the scope is slowly removed, the lining of the anal canal is carefully inspected.

How to prepare for the test:
Before the test, you might want to empty your bladder or have a bowel movement to make yourself more comfortable.
You will be asked to defecate to clear your rectum of stool before the procedure. A laxative, enema, or other preparation may be administered to help clear your rectum.

Infants and children:
A child’s age and experience determine which steps are appropriate to help prepare him or her for this procedure. For specific recommendations, refer to the following topics:

*Infant test or procedure preparation (birth to 1 year)
*Toddler test or procedure preparation (1 to 3 years)
*Preschooler test or procedure preparation (3 to 6 years)
*Schoolage test or procedure preparation (6 to 12 years)
*Adolescent test or procedure preparation (12 to 18 years)

What happens when the test is performed?
This test is usually done in a doctor’s office. You need to remove your underwear. Depending on what the doctor prefers, you either lie on your side on top of an examining table, with your knees bent up to your chest, or bend forward over the table. The anoscope is 3 to 4 inches long and the width of an average-to-large bowel movement. The doctor coats the anoscope with a lubricant and then gently pushes it into your anus and rectum. The doctor may ask you to “bear down” or push as if you were going to have a bowel movement, and then relax. This helps the doctor insert the anoscope more easily and identify any bulges along the lining of the rectum.

By shining a light into this tube, your doctor has a clear view of the lining of your lower rectum and anus. When the test is finished, the anoscope then is pulled out slowly.

You will feel pressure during the examination, and the anoscope will make you feel as if you are about to have a bowel movement. Do not be alarmed by this sensation; it is normal. Most patients do not feel pain from anoscopy.

How the test will feel:
There will be some pressure during the procedure, and you may feel the need to defecate. If biopsies are taken, you may feel a pinch.

Risk Factors:
There are no significant risks from anoscopy. Sometimes, especially if you have hemorrhoids, you may have a small amount of bleeding after the anoscope is pulled out.

Must you do anything special after the test is over?
You can return to your normal activities immediately after the test.

How long is it before the result of the test is known?
Your doctor can tell you about your anoscopy exam right away.

You may click to see:->Common Anorectal Conditions:

Resources:
https://www.health.harvard.edu/fhg/diagnostics/anoscopy.shtml
http://www.healthscout.com/ency/1/003890.html

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Fecal Occult Blood Test

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Alternative Names: Guaiac smear test; Fecal occult blood test – guaiac smear; Stool occult blood test – guaiac smear

Definition
The stool guaiac test finds hidden (occult) blood in the stool (bowel movement). It is the most common form of fecal occult blood test (FOBT) in use today.…..click & see

click & see the pictures

 

This test detects blood in your stool, which can be a sign of bleeding anywhere from your nose and mouth to your rectum, such as from an ulcer, a polyp, or cancer. If you’re over 50, you should have this test annually during the years when you don’t have either a colonoscopy or sigmoidoscopy to screen for colon cancer. Keep in mind, however, that both colonoscopy and sigmoidoscopy are better at detecting cancer than a fecal occult blood test.

How the Test is Performed
If the test is performed in an office or hospital, stool may be collected by a doctor during an examination.
If the test is performed at home, a stool sample from three consecutive bowel movements is collected, smeared on a card, and mailed to a laboratory for processing. In order to ensure the accuracy of the guaiac test, follow the manufacturer’s instructions on how to collect the stool.

There are many ways to collect the samples. You can catch the stool on plastic wrap that is loosely placed over the toilet bowl and held in place by the toilet seat. Then put the sample in a clean container. One test kit supplies a special toilet tissue that you use to collect the sample, then put the sample in a clean container. Do not take stool samples from the toilet bowl water, because this can cause errors.

For infants and young children wearing diapers, you can line the diaper with plastic wrap. The plastic wrap is positioned so that it keeps the stool away from any urine. Mixing of urine and stool can spoil the sample.

Laboratory procedures may vary. In one type of test, a small sample of stool is placed on a paper card and a drop or two of testing solution is added. A color change indicates the presence of blood in the stool.
How do you prepare for the test?
Do not eat red meat, any blood-containing food, cantaloupe, uncooked broccoli, turnip, radish, or horseradish for 3 days prior to the test.

You may need to stop taking medicines that can interfere with the test. These include vitamin C and aspirin. Check with your health care provider regarding medication changes that may be necessary. Never stop or decrease any medication without consulting your health care provider.

For several days before taking the samples, you must avoid medicines that can interfere with the results. These include NSAIDs and blood thinners  which can cause minor stomach bleeding, thereby giving an abnormal test result. If you have hemorrhoids, wait until they stop bleeding before doing the test. Women shouldn’t collect stool samples near the time of menstruation. Finally, avoid using toilet bowl cleaners for several days before the test, because these chemicals can affect the results if they come in contact with your stool sample.

For several days before the test, you also need to avoid foods and vitamins that can affect the test result. Foods to avoid include red meat (the blood it contains can turn your test positive), radishes, turnips, cabbage, cauliflower, horseradish, uncooked broccoli, and cantaloupe (all of which contain a chemical that can turn the test positive), and citrus fruits and vitamin C supplements (which can turn the test falsely negative).
What happens when the test is performed?
If one of the traditional tests is used, you collect three stool samples, ideally on three different days. Some kits include tissue paper that you can lay on the surface of the toilet bowl water to help keep the stool sample from sinking. As an alternative, you can pass your bowel movement into a disposable container. Once you’ve had a bowel movement, obtain a very small sample of the stool using the thin wooden sticks in your kit and smear it on a card from your kit. Then fold over the card to protect your sample.When you have all three samples, mail the cards to the clinic or lab in the plastic-lined envelope given to you.Make sure that your name is written on each card.

In the lab, the cards are treated with a chemical that produces a blue color when blood is present in the sample. This test works fine no matter how long it took your samples to reach the lab.

If you have the flush pad test, you drop the pad into the toilet bowl after you’ve had a bowel movement, for three consecutive days. The pads change color when blood is present in the toilet bowl. You can flush the toilet to dispose of the pads, but-if blood is detected-should contact your doctor.

How the Test Will Feel
There is no discomfort when the test is done at home, because this test only involves normal bowel functions. If stool is collected during an exam, there may be some discomfort in the anal canal and rectum.

Why the Test is Performed: This test is a screening test to detect blood in the digestive tract.

Risk Factors: No risk. But there can be false-positive and false-negative results. Using the right collection technique, avoiding certain drugs, and observing food restrictions can reduce errors.

RESULTS:
Normal Results : –
A negative test result means that there is NO blood in the stool.

What Abnormal Results Mean:-
Abnormal results may indicate:

*Angiodysplasia of the GI tract
*Colon cancer or other gastrointestinal (GI) tumors
*Colon polyps
*Esophageal varices and portal hypertensive gastropathy
*Esophagitis
*Gastritis
*GI infections
*GI trauma or bleeding from recent GI surgery
*Hemorrhoids
*Inflammatory bowel disease
*Peptic ulcer

Stool guaiac testing is sometimes used to screen for colon cancer, but it is not a reliable test for this purpose, and other screening methods should be used.

Additional non-GI related causes of positive guaiac test may include:

*Nose bleed
*Coughing up blood
Abnormal tests require follow-up with your doctor.
How long is it before the result of the test is known?
With the flush pad method, results are available immediately.With the more traditional methods, testing is performed in only a few minutes once the lab receives your sample. Some clinics or labs do this testing in batches and wait to process the test until samples have been received from several people. You should hear from your doctor’s office within a week after the lab has received your specimen. If your test is positive, it means you have blood in your stool, and your doctor will recommend some additional testing to find out the cause.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/fecal-occult-blood-test.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/003393.htm

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Barium Swallow (Upper Gastrointestinal Series or “Upper GI Series”)

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Definition:A barium swallow, or upper GI series, is an x-ray test used to examine the upper digestive tract (the esophagus, stomach, and small intestine). Because these organs are normally not visible on x-rays, you need to swallow barium, a liquid that does show up on x-rays. The barium temporarily coats the lining of the esophagus, stomach, and intestine, making the outline of these organs visible on the xray pictures. This test is useful for diagnosing cancers, ulcers, problems that cause narrowing of the esophagus, some causes of inflammation in the intestine, and some swallowing problems.

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An upper gastrointestinal (UGI) series looks at the upper and middle sections of the gastrointestinal tract. The test uses barium contrast material, fluoroscopy, and X-ray. Before the test, you drink a mix of barium (barium contrast material) and water. The barium is often combined with gas-making crystals. Your doctor watches the movement of the barium through your esophagus, stomach, and the first part of the small intestine (duodenum) on a video screen. Several X-ray pictures are taken at different times and from different views.

A small bowel follow-through may be done immediately after a UGI to look at the rest of the small intestine. If just the throat and esophagus are looked at, it is called an esophagram (or barium swallow).

Upper endoscopy is done instead of a UGI in certain cases. Endoscopy uses a thin, flexible tube (endoscope) to look at the lining of the esophagus, stomach, and upper small intestine (duodenum).

Why It Is Done:-
An upper gastrointestinal (UGI) series is done to:

1.Find the cause of gastrointestinal symptoms, such as difficulty swallowing, vomiting, burping up food, belly pain (including a burning or gnawing pain in the center of the stomach), or indigestion. These may be caused by conditions such as hiatal hernia.

*Find narrow spots (strictures) in the upper intestinal tract, ulcers, tumors, polyps, or pyloric stenosis.

*Find inflamed areas of the intestine, malabsorption syndrome, or problems with the squeezing motion that moves food through the intestines (motility disorders).

*Find swallowed objects.

Generally, a UGI series is not used if you do not have symptoms of a gastrointestinal problem. A UGI series is done most often for people who have:

1.A hard time swallowing.
2.A history of Crohn’s disease.
3.A possible blocked intestine (obstruction).
4.Belly pain that is relieved or gets worse while eating.
5.Severe heartburn or heartburn that occurs often.

How To Prepare for the Test:-
Tell your doctor and the x-ray technicians if you :

1.Are taking any medicine.

2.Are allergic to any medicines, barium, or any other X-ray contrast material.

3.Are or might be pregnant. This test is not done during pregnancy because of the risk of radiation to the developing baby (fetus).

4.You may be asked to eat a low-fiber diet for 2 or 3 days before the test. You may also be asked to stop eating for 12 hours before the test. Your doctor will tell you if you need to stop taking certain medicines before the test.

The evening before the test, you may be asked to take a laxative to help clean out your intestines. If your stomach cannot empty well on its own, you may have a special tube put through your nose and down into your stomach just before the test begins. A gentle suction on the tube will drain the stomach contents.

If you are having the small bowel follow-through after the UGI series, you will need to wait between X-rays. The entire small bowel follow-through exam takes up to 6 hours, so bring along a book to read or some other quiet activity.

You may be asked to sign a consent form. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form (What is a PDF document?) .
How It Is Done
A UGI series is usually done in your doctor’s office, clinic, or X-ray department of a hospital. You do not need to stay overnight in the hospital. The test is done by a radiologist and a radiology technologist.

You will need to take off your clothes and put on a hospital gown. You will need to take out any dentures and take off any jewelry. You may not smoke or chew gum during the test, since the stomach will respond by making more gastric juices and this will slow the movement of the barium through the intestines.

You might also be asked to swallow some tablets that “fizz,” causing air-bubbles to be released in your stomach. This might make you feel like burping, but try not to. You will get better pictures if you can keep yourself from burping.

The x-ray technician may ask you to stand or lie in different positions over the next few minutes, to help spread around the liquid you have swallowed. Most often, the x-ray pictures are taken while you lie on your back on a table. The x-ray machine or the table is moved a few times so it can take pictures of all of the internal structures. You are asked to hold your breath for each picture so that your breathing movement does not blur the image.

You will lie on your back on an X-ray table. The table is tilted to bring you to an upright position with the X-ray machine in front of you. Straps may be used to keep you safely on the table. The technologist will make sure you are comfortable during changes in table position.

You will have one X-ray taken before you drink the barium mix. Then you will take small swallows repeatedly during the series of X-rays that follow. The radiologist will tell you when and how much to drink. By the end of the test, you may have swallowed 1cup to 2.5cups of the barium mixture. See a picture of a barium swallow test.

The radiologist watches the barium pass through your gastrointestinal tract using fluoroscopy and X-ray pictures. The table is tilted at different positions and you may change positions to help spread the barium. Some gentle pressure is put on your belly with a belt or by the technologist’s gloved hand. You may be asked to cough so that the radiologist can see how that changes the barium flow. See an image of a barium swallow.

If you are having an air-contrast study, you will sip the barium liquid through a straw with a hole in it or take pills that make gas in your stomach. The air or gas that you take in helps show the lining of the stomach and intestines in greater detail.

If you are also having a small bowel study, the radiologist watches as the barium passes through your small intestine into your large intestine. X-ray pictures are taken every 30 minutes.

The UGI series 30 to 40 minutes. The UGI series with a small bowel study takes 2 to 6 hours. In some cases, you may be asked to return after 24 hours to have more X-ray pictures taken.

When the UGI series is done, you may eat and drink whatever you like, unless your doctor tells you not to.

You may be given a laxative or enema to flush the barium out of your intestines after the test to prevent constipation. Drink a lot of fluids for a few days to flush out the barium.

How It Feels
The barium liquid is thick and chalky, and some people find it hard to swallow. A sweet flavor, like chocolate or strawberry, is used to make it easier to drink. Some people do not like it when the X-ray table tilts. You may find that pressure on your belly is uncomfortable. After the test, many people feel bloated and a little nauseated.

For 1 to 3 days after the test, your stool (feces) will look white from the barium. Call your doctor if you are not able to have a bowel movement in 2 to 3 days after the test. If the barium stays in your intestine, it can harden and cause a blockage. If you become constipated, you may need to use a laxative to pass a stool.

Risk Factors:
There are no significant risks.

Barium does not move into the blood, so allergic reactions are very rare.

Some people gag while drinking the barium fluid. In rare cases, a person may choke and inhale (aspirate) some of the liquid into the lungs.

There is a small chance that the barium will block the intestine or leak into the belly through a perforated ulcer. A special type of contrast material (Gastrografin) can be used if you have a blockage or an ulcer.

There is always a small chance of damage to cells or tissue from being exposed to any radiation, even the low level of radioactive tracer used for this test.


How long is it before the result of the test is known?
It takes the x-ray department 30 minutes to an hour to develop the pictures from your barium swallow, and it will take additional time for a doctor to examine the x-rays and to decide how they look. Typically you can get the results within a day or two.

Must you do anything special after the test is over
After the test, you can eat normally and do your normal activities. You should drink more water than usual to help clear out the barium and to prevent constipation, which might be a side effect of the test. Your stool may appear light in color for a couple of days.

Results:-
An upper gastrointestinal (UGI) series looks at the upper and middle sections of the gastrointestinal tract. Results are usually ready in 1 to 3 days.

Upper gastrointestinal (UGI) series  Normal: The esophagus, stomach, and small intestine all look normal.

Abnormal: A narrowing (stricture), inflammation, a mass, a hiatal hernia, or enlarged veins (varices) may be seen. Spasms of the esophagus or a backward flow (reflux) of barium from the stomach may occur.

The UGI series may show a stomach (gastric) or intestinal (duodenal) ulcer, a tumor, or something pushing on the intestines from outside the gastrointestinal tract. Narrowing of the opening between the stomach and the small intestine (pyloric stenosis) may be seen.

The small bowel follow-through may show inflammation or changes in the lining that may explain poor absorption of food. This may be caused by Crohn’s disease or celiac disease.

What Affects the Test
Reasons you may not be able to have the test or why the results may not be helpful include:
*Eating before or during the test.
*Too much air in the small intestine.

ABOUT THE TEST:
*A gastrointestinal (GI) motility study may be done if the squeezing motions of the small intestine are not normal during the UGI series and small bowel follow-through. The movement of the barium through the lower intestinal tract is recorded every few hours for up to 24 hours. A barium enema or colonoscopy may be needed to confirm the diagnosis.

*Upper endoscopy is done instead of a UGI test in certain cases. Endoscopy uses a thin, flexible tube (endoscope) to look at the lining of the esophagus, stomach, and upper small intestine (duodenum). For more information, see the medical test Upper Gastrointestinal Endoscopy.

*The UGI series test:

*Cannot show irritation of the stomach lining (gastritis) or esophagus (esophagitis) or ulcers that are smaller than about 0.25in. in diameter.

*Cannot show an infection with the bacteria Helicobacter pylori, which may be a cause of stomach ulcers.

*A biopsy cannot be done during the UGI if a problem is found.

Sources:
http://www.webmd.com/digestive-disorders/upper-gastrointestinal-ugi-series?page=4
https://www.health.harvard.edu/fhg/diagnostics/barium-swallow.shtml

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