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(BE, Lower Gastrointestinal Series, Lower GI Series, Colon X-ray)
A barium enema is a radiographic (x-ray) examination of the lower gastrointestinal (GI) tract. The large intestine, including the rectum, is made visible on x-ray film by filling the colon with a liquid suspension called barium sulfate (barium). Barium highlights certain areas in the body to create a clearer picture.
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 a barium enema. 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 a barium enema, fluoroscopy allows the radiologist to see the movement of the barium through the large intestine as it is instilled through the rectum.
Barium is a dry, white, chalky, metallic powder that is mixed with water to make barium liquid. Barium is an x-ray absorber and appears white on x-ray film. When instilled via the rectum, barium coats the inside wall of the large intestine so that the inside wall lining, size, shape, contour, and the colon’s patency 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 for the GI tract.
The use of barium with standard x-rays contributes to the visibility of various characteristics of the large intestine. Some abnormalities of the large intestine that may be detected by a barium enema include tumors, inflammation, polyps (growths), diverticula (pouches), obstructions, and changes in the intestinal structure.
After the instillation of barium into the rectum, the radiologist may also fill the large intestine with air. Air will appear black on x-ray film, contrasting with barium’s white image. The use of the two substances, barium and air, is called a double contrast study.
The purpose of using two contrast substances is to achieve an enhancement of the inside wall lining of the large intestine. As the air expands the large intestine (like blowing up a balloon), a barium coating is formed on the inner surface of the colon wall. This technique enhances visualization by sharpening the outline of the inner surface layer of the large intestine. The benefit of this technique is to show smaller surface abnormalities in the large intestine.
Other related procedures that may be used to diagnose lower GI problems include colonoscopy, abdominal x-ray, computed tomography (CT scan) of the abdomen, and abdominal ultrasound. Please see these procedures for additional information.
The large intestine, or colon, has four sections:
The rectum joins the anus, or the opening where waste matter passes out of the body.
A barium enema may be performed to diagnose structural or functional abnormalities of the large intestine, including the rectum. These abnormalities may include, but are not limited to, the following:
There may be other reasons for your physician to recommend a barium enema.
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 is 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 are 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, shellfish, or latex should notify their physician.
Constipation or fecal impaction may occur if the barium is not completely eliminated from the body.
Risks of barium enema may include, but are not limited to, the following:
Contraindications for a barium enema include, but are not limited to, the following:
There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.
Certain factors or conditions may interfere with the accuracy of a barium enema procedure. These factors include, but are not limited to, the following:
A barium enema 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, a barium enema will follow this process:
Following the examination, some barium will be expelled immediately. You will be assisted to the bathroom or given a bedpan.
You may resume your normal diet and activities after a barium enema, unless your physician advises you differently.
Barium may cause constipation or possible impaction after the procedure if it is not 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 cathartic or laxative to help expel the barium.
Since barium is not 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.
The long and rigorous bowel preparation prior to the procedure may cause fatigue afterwards. You should rest as needed.
You may experience soreness of the anus and rectum due to the bowel preparation. Your physician may recommend the application of a soothing ointment to the area.
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.
The content provided here is for informational purposes only, and was not 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.
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