Norm of Upper Gastrointestinal (UGI) Series
Mucosa is smooth and regular and free of lesions, polyps, narrowing, or filling defects. Barium fills smoothly and does not leak into the abdominal cavity. The passage of barium progresses at a normal rate, and there is no reflux into the esophagus (indicating hiatal hernia or incompetent cardiac sphincter). Gastric folds measure approximately 5 mm in the antrum and body of the stomach and are slightly wider near the fundus than near the esophagus.
Usage of Upper Gastrointestinal (UGI) Series
Investigation of abnormal gastrointestinal symptoms; evaluation for leaks after gastric bypass surgery; allows fluoroscopic visualization of the esophagus, stomach, and duodenum; helps evaluate organ size, lumen size, outline, and position of the examined areas; and detection of strictures, scarring, varices, ulcers, tumors, hiatal hernia, or inflammation of the upper gastrointestinal tract.
Description of Upper Gastrointestinal (UGI) Series
Upper gastrointestinal (UGI) series involves examining the upper gastrointestinal tract under fluoroscopy after the client drinks barium sulfate. Barium sulfate is a chalky substance of “milkshake” consistency that has radiopaque properties. Films of specific portions of the tract are taken as the barium passes through and outlines the structures. Barium-swallow studies of the esophagus with or without a small bowel series may be performed with this test. (See Barium swallow; Small bowel series.)
Professional Considerations of Upper Gastrointestinal (UGI) Series
Consent form NOT required.
Aspiration of contrast material, bowel obstruction, constipation.
Suspected ileus, obstruction, or gastrointestinal perforation.
During pregnancy, risks of cumulative radiation exposure to the fetus from this and other previous or future imaging studies must be weighed against the benefits of the procedure. Although formal limits for client exposure are relative to this risk: benefit comparison, the United States Nuclear Regulatory Commission requires that the cumulative dose equivalent to an embryo/ fetus from occupational exposure not exceed 0.5 rem (5 mSv). Radiation dosage to the fetus is proportional to the distance of the anatomy studied from the abdomen and decreases as pregnancy progresses. For pregnant clients, consult the radiologist/ radiology department to obtain estimated fetal radiation exposure from this procedure.
- Notify the physician before preparation if the client is pregnant.
- When it is possible, medications that affect the motility of the gastrointestinal tract should be withheld for 24 hours before the study.
- If this test is to be followed by a small bowel series for a bowel cleansing routine, see also Small bowel series.
- The client should disrobe and put on a gown. All jewelry and metal objects should be removed.
- Obtain 8 ounces of barium sulfate solution.
- See Client and Family Teaching.
- The client is positioned supine on the fluoroscopic tilt table and strapped into place. The hydraulic table is then moved into a vertical position.
- Baseline fluoroscopic radiographs are taken of the area to be studied.
- The client is then given 8 ounces of barium sulfate solution and is instructed to drink portions of it at specified intervals as the table is tilted to various angles.
- Initial films are taken of the esophagus as the barium travels downward.
- Stomach films are taken as barium mixed with air enters the stomach. The lower esophagus is examined for reflux of the barium from the stomach or for free-flowing barium between the stomach and the esophagus, both conditions indicating hiatal hernia.
- As the client finishes ingesting the barium, the filled stomach and the emptying of the barium into the duodenum are radiographed from several angles. Gastric folds are examined for thickening, indicated by a rugal pattern that is not obliterated by filling of the stomach with barium sulfate.
- The test takes less than 1 hour.
- Resume previous diet.
- See Client and Family Teaching.
Client and Family Teaching
- Fast from food and fluids, and do not chew gum or smoke overnight before the study.
- A laxative or suppository may be prescribed to be taken the night before the study.
- If this test is to be followed by a small bowel series, bring something to read, if desired, because the procedure time may increase to 4–6 hours.
- After swallowing a chalky barium solution, you will be asked to move to several positions and at times to hold your breath while the radiographs are taken.
- Drink 6–8 glasses of water or other fluids each day for 2 days after the test to help pass the barium through the gastrointestinal system.
- Observe stools for passage of barium for 1–3 days. This will make the stools look chalky white.
- Call the physician if unable to defecate. A mild laxative may be prescribed prophylactically, or cathartics or enemas may be prescribed as needed if pending impaction is suspected.
Factors That Affect Results
- The client must be able to cooperate in swallowing the barium sulfate.
- Helicobacter pylori infection should be suspected if isolated thickened gastric folds are found.
- Routine use of this procedure for morbid obesity as part of presurgery evaluation is controversial.