Upper Gastrointestinal Series

Upper Gastrointestinal Series

(UGI, Upper GI Series, GI Series, Upper Gastrointestinal Tract X-ray)

Procedure overview

What is an upper gastrointestinal series?

An upper gastrointestinal series (UGI) is a radiographic (X-ray) examination of the upper gastrointestinal (GI) tract. The esophagus, stomach, and duodenum (first part of the small intestine) are made visible on X-ray film by a liquid suspension. This liquid suspension may be barium or a water-soluble contrast such as GastrografinTM. If only the pharynx (back of mouth and throat) and esophagus (hollow tube of muscle extending from below the tongue to the stomach) are examined with barium, the procedure is called a barium swallow. If the water-soluble contrast is used, the procedure is called a Gastrografin swallow.

X-rays use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film. X-rays are made by using external radiation to produce images of the body, its organs, and other internal structures for diagnostic purposes. X-rays pass through body tissues onto specially-treated plates (similar to camera film) and a “negative” type picture is made (the more solid a structure is, the whiter it appears on the film).

Fluoroscopy is often used during an upper GI series. Fluoroscopy is a study of moving body structures -- similar to an X-ray “movie.” A continuous X-ray beam is passed through the body part being examined, and is transmitted to a TV-like monitor so that the body part and its motion can be seen in detail. In an upper GI series, fluoroscopy allows the radiologist to see the movement of the barium through the esophagus, stomach, and duodenum as a person drinks it.

Why is barium used with X-rays?

Barium is a dry, white, chalky, metallic powder that is mixed with water to make a thick milkshake-like drink. Barium is an X-ray absorber and appears white on X-ray film. When swallowed, a barium drink coats the inside walls of the upper GI tract organs so that the swallowing motion, inside wall lining, function, size, and shape of these organs are visible on X-ray. This process shows differences that might not be seen on standard X-rays. Barium is used only for diagnostic studies of the GI tract.

The use of barium with standard X-rays contributes to the visibility of various characteristics of the esophagus, stomach, and duodenum. Some abnormalities of the upper GI tract that may be detected with an upper GI series include tumors, ulcers, hernias, diverticula (pouches), strictures (narrowing), inflammation, and swallowing difficulties.

In addition to barium, the radiologist may use a gas, such as air or a carbonated substance. You may be given a powder, tablet, or carbonated beverage that produces gas when swallowed. Alternately, you may drink the barium through a perforated straw so that you swallow air with the barium. Air or gas will appear black on X-ray film, contrasting with the barium’s white image. The use of the two substances, barium and gas, is called a double contrast study. The radiologist may use the water-soluble contrast if you have a perforation (tear or hole) of the bowel or esophagus, or for other reasons determined by your physician.

The purpose of using two contrast substances is to achieve an enhancement of the inside wall lining of the esophagus, stomach, and duodenum. As the gas expands the organs (like blowing up a balloon), a barium coating is formed on the inner surface of the organs. This technique enhances visualization by sharpening the outline of the inner surface layer of the esophagus, stomach, and/or duodenum, and is useful in diagnosing structural and tissue abnormalities.

Other related procedures that may be used to diagnose upper GI problems are barium swallow and esophagogastroduodenoscopy (EGD). Please see these procedures for additional information.


Reasons for the procedure

An upper GI series may be performed to diagnose structural or functional abnormalities of the esophagus, stomach, and duodenum. These abnormalities may include, but are not limited to:

There may be other reasons for your physician to recommend an upper GI series.

Risks of the procedure

You may want to ask your physician about the amount of radiation used during the procedure and the risks related to your particular situation. It's a good idea to keep a record of your past history of radiation exposure, such as previous scans and other types of X-rays, so that you can inform your physician. Risks associated with radiation exposure may be related to the cumulative number of X-ray examinations and/or treatments over a long period of time.

If you're pregnant or suspect that you may be pregnant, you should notify your physician. Radiation exposure during pregnancy may lead to birth defects.

Patients who are allergic to or sensitive to medications, contrast dyes, iodine, or latex should notify their physician.

Constipation or fecal impaction may occur if the barium isn't completely eliminated from the body.

Contraindications for an upper GI series include, but are not limited to:

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Before the procedure:

During the procedure

An upper GI series may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary, depending on your condition and your physician’s practices.

Generally, an upper GI series follows this process:

  1. You'll be asked to remove any clothing, jewelry, or other objects that may interfere with the procedure.
  2. If you're asked to remove clothing, you'll be given a gown to wear.
  3. You'll be positioned on an X-ray table that can tilt you from a horizontal to an upright position. You may be asked to change positions (e.g., lying on your side, back, or stomach) at intervals during the procedure.
  4. Standard X-rays of the heart, lung, and abdomen may be performed first.
  5. The radiologist will ask you to take a swallow of a thickened contrast drink. The contrast is usually flavored, although it may not be very pleasant tasting.
  6. As you swallow the contrast, the radiologist will take single pictures, a series of X-rays, or a video (fluoroscopy) to observe the contrast moving through the pharynx.
  7. If you're having a procedure with barium, you'll be given a thinner barium drink to swallow. X-rays and/or fluoroscopy will be used to observe the barium’s passage down the esophagus. You may also be asked to swallow a barium tablet, which can help visualize certain structural problems of the esophagus.
  8. The radiologist may press on your abdomen during the examination to help visualize the stomach and aid in coating of the stomach wall.
  9. If you're having a double contrast study, you may be asked to swallow a powder, tablet, or carbonated beverage. Alternately, you may be asked to drink the barium through a perforated straw. Because the gas that's produced will expand and enhance the visualization of the inner surface of the upper GI organs, it will be important not to burp.
  10. Once all required X-rays have been taken, you will be assisted from the table.

After the procedure

You may resume your normal diet and activities after an upper GI series, unless your physician advises you differently.

Barium may cause constipation or possible impaction after the procedure if it isn't completely eliminated from your body. You may be advised to drink plenty of fluids and eat foods high in fiber to expel the barium from the body. You may also be given a laxative to help expel the barium.

Since barium isn't absorbed into the body but passes through your entire gastrointestinal tract, your bowel movements may be lighter in color until all of the barium has been excreted.

Water-soluble contrast such as Gastrografin may cause nausea, vomiting, and/or diarrhea.

Notify your physician to report any of the following:

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.

Online Resources

The content provided here is for informational purposes only, and wasn't designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your physician. Please consult your physician with any questions or concerns you may have regarding your condition.

This page contains links to other websites with information about this procedure and related health conditions. We hope you find these sites helpful. But please remember we don't control or endorse the information presented on these websites, nor do these sites endorse the information contained here.

American Cancer Society

American Gastroenterological Association

National Cancer Institute (NCI)

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

National Institutes of Health (NIH)

National Library of Medicine

 

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