A barium meal examination identifies the lower half of the esophagus, stomach, and duodenum using barium sulfate and imaging. It is used to investigate dyspepsia, weight changes, abdominal masses, gastrointestinal bleeding, suspected obstruction, and perforation site assessment. The patient must fast beforehand and not take antacids. Hyoscine is injected to relax the stomach while carbon dioxide is released after the patient drinks barium to distend the stomach. Images are taken of the esophagus, stomach, and duodenum from different positions to visualize the mucosal surfaces coated in barium. Abnormalities like filling defects are detected under fluoroscopy during compression views.

1. Barium Meal

2. Barium meal Identifies lower half of oesophagus, the stomach and all of duodenum. Method A)double contrast – the method of choice to demonstrate mucosal pattern B)single contrast-used in children (not necessary to demonstrate mucosal pattern) And very ill adults (only gross pathology)

3. Indications 1)Dyspepsia 2)Weight 3)Upper abdominal mass 4)Gastro intestinal haemorrhage 5)suspected upper GI obstruction 6)assessment of the site of perforation(water soluble contrast is used)

4. Contra indications 1.Complete large bowel obstruction 2.Suspected perforation (unless water soluble contrast medium used) Patient preparation 1. NPO after midnight(6 hrs) 2.abstain from-smoking, chewing gum or antacids- ->dec fluid in stomach which impairs barium coating.

5. Technique 1.Hypotonic agent Buscopan(hyoscine butyl bromide,20 mg i.v) or 0.1-0.2 mg i.v glucagon is injected intravenously -relax stomach and suspend peristalsis. A packet of effervescent granules swallowed with small amount of water- releases CO2 and gastric distension.(approx 400ml CO2) High density barium is swallowed(120 ml- 250% w/v) and double contrast views of oesophagus is obtained standing RAO.

6. Patient faces Xray table,lowered to horizontal Then turned onto left side and finally supine. Patient rolled from side to side so as barium coats mucosal surfaces properly-washes over the mucus . Sequences of films of stomach obtained—

7. When barium enters duodenum, patient is turned RAO – fills duodenum with gas, DC films are taken. Biphasic examination–Prone swallow of thin (125%w/v low density) barium given after contrast view obtained to optimize compression views of stomach and duodenum

8. Under fluoroscopic guidance, on the compression views-filling defects or abnormal collections are detected. Note:young children- main indication identify cause of vomiting eg:-pyloric Flow technique identifies-subtle mucosal abnormalities. obstruction,malrotation,and GOR.single contrast technique preferred(30% w/v Barium sulfate with no paralytic agent).

9. Note : kV range double contrast- 70-120 kV. single contrast-120-150kV . Note:If partial gastrectomy or drainage procedues (eg; pyloroplasty or gastrenterostomy), begin with prone swallow using high density barium.Reaching duodenum or Genterostomy-turned supine for DC films.DC of stomach and oesophagus follows.

12. STOMACH Surface:reticular pattern – multipleinterconnecting grooves. Divides- polygonal islands(2-4 mm)areae gastricae.distal 2/3rds. Presence- excludes diffuse atrophic gastritis >4mm sign of gastritis Fundus and body.- longitudinal folds or rugae.

13. Duodenum- Extends from pylorus to duodenojejunal flexure-cap,second part(descending horizontal,third part(ascending) and fourth part. Barium meal-cap-fine velvety reticular surface pattern by villi. Barium caught under mucosal pattern – incomplete erosive duodenitis

14. Barium caught underfold between 1 st and 2 nd part of duodenum-ulcer pic Beyond cap-mucosal folds-narrow bands across whole width. Major papilla of Vater(2 ND PART) Central fold and 2 oblique folds Minor papilla(Santorini- 2 CM PROXIMAL)

18. Frail and immobile, modification. Single contrast examination : 100%w/v barium – oesophagus, stomach and duodenum Compression applied-lower stomach and duodenum. Approximates front and back walls with thin layer in between. Protruding lesion-radiolucent filling defect Depressed-eg:ulcer --focal extra density.