What is a Small Bowel Series?
A small bowel series is an x-ray examination of the small intestine that uses a special form of x-ray called fluoroscopy and an orally ingested contrast material called barium.
An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging.
Fluoroscopy makes it possible to see internal organs in motion. When the small bowel is coated with barium, the radiologist is able to view and assess the anatomy and function of it.
In the small bowel series, x-rays are taken at timed increments, to see the barium as it moves through the small bowel.
What are some common uses of the procedure?
- An upper GI examination helps evaluate digestive function and to detect:
- hiatal hernias
- abnormalities of the muscular wall of GI tissues
- The procedure is also used to help diagnose symptoms such as:
- chest and abdominal pain
- reflux (a backward flow of partially digested food and digestive juices)
- unexplained vomiting
- severe indigestion
- blood in the stool (indicating internal GI bleeding)
How should I prepare?
Clear liquids only for 24 hours prior to the exam. Nothing to drink after midnight.
- List of appropriate clear liquids and some prohibited items are listed as well:
- Coffee and tea – sugar is fine and small amount of creamer
- Fruit and vegetable JUICES – strain to remove fibers/solids
DO NOT drink TOMATO juice.
- Broths – must be semi-clear – chicken, beef or veggie
NO tomato soup and no solids in the soup.
- Soft Drinks – Coke, Sprite, ginger ale, 7-up, etc. are allowed.
- Gatorade, Crystal Light, Kool-aide, Propel, etc. are allowed.
- Jello without any added fruit is allowed – DO NOT eat the red or purple version.
- Popsicles are allowed – DO NOT eat the red or purple version.
- Hard candies are allowed – DO NOT eat the red or purple version.
DO NOT consume CREAMY SOUPS or drink DRINK MILK, PROTEIN SHAKES, SLIM-FAST, BOOST, etc.
Bowel prep – Over the counter laxative of your choice taken the early evening prior to the exam. Take per package instructions.
You should inform your physician of any medications you are taking and if you have any allergies, especially to barium or iodinated contrast materials. Also inform your doctor about recent illnesses or other medical conditions.
Women should always inform their physician or 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. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby.
You may be asked to remove some or all of your clothes and to wear a gown during the exam. You may also be asked to remove jewelry, eye glasses and any metal objects or clothing that might interfere with the x-ray images.
What does the x-ray equipment look like?
The equipment used for this examination consists of a radiographic table, an x-ray tube and a television-like monitor that is located in the examining room or in a nearby room. When used for viewing images in real time (called fluoroscopy), the image intensifier (which converts x-rays into a video image) is suspended over a table on which the patient lies. When used for taking still pictures, the image is captured electronically.
How does the procedure work?
X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on a special digital image recording plate.
Fluoroscopy uses a continuous x-ray beam to create a sequence of images that are projected onto a fluorescent screen, or television-like monitor. When used with a contrast material, which clearly defines the area being examined by making it appear bright white, this special x-ray technique makes it possible for the physician to view internal organs in motion. Still images are also captured and stored electronically on a computer.
Until recently, x-ray images were maintained as hard film copy (much like a photographic negative). Today, most images are digital files that are stored electronically. These stored images are easily accessible and are sometimes compared to current x-ray images for diagnosis and disease management.
How is the procedure performed?
This examination is usually performed on an outpatient basis and is often scheduled in the morning to reduce the patient’s fasting time.
A radiologic technologist and a radiologist, a physician specifically trained to supervise and interpret radiology examinations, guide the patient through the small bowel series.
The patient will be asked to drink some liquid barium, which resembles a light-colored milkshake. Then the patient will be asked to lie down on the table and x-rays will be taken 15 minutes after drinking, 30 minutes, 60 minutes and then hourly until the barium travels through the entire small bowel. At one point, the patient’s abdomen may be compressed to help spread the barium, to see certain anatomy better.
The patient may want to bring something to read since there is so much time between each x-ray that is taken. The patient may also be asked to lie on their right side or walk around in order to help the barium go faster.
The patient will be asked to hold very still and may be asked to keep from breathing for a few seconds while the x-ray picture is taken to reduce the possibility of a blurred image.
When the examination is complete, you will be asked to wait until the radiologist determines that all the necessary images have been obtained. This exam is completed in 2 to 8 hours, depending on how quickly the barium moves through the body.
What will I experience during and after the procedure?
Occasionally, patients find the thick consistency of the barium unpleasant and difficult to swallow. The liquid barium has a chalky taste that may be masked somewhat by added flavors such as strawberry or chocolate.
Having pressure applied to the abdomen can be uncomfortable for some patients. The examination may also make you feel bloated.
After the examination, you can resume a regular diet and take orally administered medications unless told otherwise by your doctor.
The barium may color your stools gray or white for 48 to 72 hours after the procedure. Sometimes the barium can cause temporary constipation, which is usually treated by an over-the-counter laxative. Drinking large quantities of fluids for several days following the test can also help. If you are unable to have a bowel movement or if your bowel habits undergo any significant changes following the exam, you should contact your physician.
Who interprets the results and how do I get them?
A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will discuss the results with you. Your doctor should receive the report within 24 to 48 hours of the exam.
What are the benefits vs. risks?
- A Small Bowel Series is an extremely safe, noninvasive procedure.
- The results of the Small Bowel Series usually lead to accurate evaluation of the small bowel.
- Because barium is not absorbed into the blood, allergic reactions are extremely rare.
- No radiation remains in a patient’s body after an x-ray examination.
- X-rays usually have no side effects in the diagnostic range.
- There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk.
- The effective radiation dose from this procedure is about 6 mSv, which is about the same as the average person receives from background radiation in two years.
- 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.
- 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.
- Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant.
What are the limitations of Upper Gastrointestinal (GI) Tract Radiography?
Mild irritation of the lining of the small bowel is difficult to detect, as well as ulcers smaller than ¼ 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.