An Upper GI (short for Gastrointestinal) is primarily an examination of the stomach, with sections of the esophagus and duodenum (the first section of the small intestine) as needed. Like most studies of the digestive system done in radiology, an Upper GI normally uses Barium, a thick, chalky fluid, as a "contrast medium" in order to make the stomach and other items of interest more visible on x-rays. Unlike other GI studies however, an Upper GI is also normally done as what is known as a "double contrast" study. All double contrast means in this case is that air or gas is somehow introduced into the stomach to help make it show up better. This is done because the stomach is basically a collapsible hollow bag, and if all that was in the stomach during the study was the barium, the Radiologist overseeing the study would not be able to see all that he or she might need to see. How the air is put into the stomach will be explained in a minute (I promise that it doesn't hurt), but let's take things in order.

Since it is necessary for your stomach to be empty when you come in for your exam, you will be told not to eat or drink anything after midnight of the night before. Many places will also tell you not to smoke either, as smoking will cause some of the same reactions in the stomach as eating will. A few facilities will even go as far as to have you follow the same preparation as for an IVP (for an example of that preparation, please refer to the IVP page on this site). When you report for your exam, the technologist will be doing your study will escort you to a changing room, and ask you to remove everything from the waist up. If you are wearing pants or a skirt with zippers and snaps near the waist line, you may be asked to remove them also since they may show up over the stomach or duodenum. You will then be shown to the flouro (short for fluoroscopy) room where your exam will be done.

You will probably start your examination in a standing position, though this depends on what your physical condition at the time of your study is, as well as what they will be looking for. If a "normal" Upper GI is being done, you will then be hand one or two cups with water and some alka-seltzer like crystals in them, and asked to swallow the contents as quickly as you can. Personally, the time I had to have one these exams, I just pretended that I was doing a shot of liquor and it went down fairly easily (I wasn't real fond of the taste though). These crystals will react in the water to fill your stomach with a harmless gas, that in return will cause your stomach to expand to full size, allowing the supervising doctor to see everything with relative ease. You may find that you feel as if you need to burp. Do not! If you burp, then all the gas will escape and the radiologist will not be able to see everything! You will then be hand a cup of barium and told to drink it while the radiologist and the technologist watch under flouro as the barium flows down your esophagus to the stomach. After you have drunk enough barium for the first part of the exam, the table, and you, will be lowered till you are laying down, and the radiologist will ask you to roll yourself over several times. This will coat the inside of your stomach with the barium almost as if it was paint. The radiologist will then continue to watch the barium move through your stomach under flouro, asking you to move to various positions to allow different parts of the stomach to be seen better, and occasionally asking you to drink some more barium as needed. Once he or she is satisfied that they have seen everything they need, the technologist will take several regular x-rays to complete the exam.

Under some circumstances, such as the suspicion that you may have a perforation of the esophagus or stomach for example, the facility doing your study may elect to use a "water soluble contrast" instead of barium. By water soluble, we refer to a class of contrast mediums very similar to the contrast used for IVP's and mylograms. These contrast mediums, unlike barium, will be absorbed by the blood stream and then eliminated from the body by the kidneys if, for some reason, they leak out of the digestive system. They do taste somewhat bitter, and they do not always show up as clearly as barium, but for some conditions, they are far safer. It should also be noted that they do not coat the walls of the stomach the way barium will, so many radiologists will skip giving you the gas producing crystals if they are going to use a water soluble contrast. In addition to this, I feel I should also mention that I have been told that water soluble contrast studies do not show certain problems clearly. So it you have one, and it proves to be negative, you may need to come back at a later date and have the exam done again with barium.

Finally, when you leave after your exam, you will probably feel rather full. This is normal, and, if you think about it, to be expected. After all, you just drank several cups of a thick liquid about the consistency of a milkshake, so it stands to reason that you would be full. You will be instructed by the technologist before leaving to make sure you drink plenty of water and other fluids. This will help the barium pass through you fairly quickly and easily. Be warned though that your stools for the rest of the day, and possibly the next day will be a white to grayish white color as a result of all the barium you drank. Do not worry, it will pass and your stools will return to their normal color and consistency in a day or two.

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