Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
An upper gastrointestinal
(GI) series (barium swallow), is a radiological test that is used to visualize the
structures of the upper digestive
system - the esophagus, stomach and duodenum. If it is desired to
see the remaining parts of the small intestine, a small bowel series
can be added to the test. These structures
are seen during the examination, and the images are also are
saved for further review on X-ray film or digital
images. The results of an upper GI series can reveal conditions such as
ulcers,
tumors, hiatal hernias, scarring, blockages, and abnormalities of the muscular
wall of the gastrointestinal tissues.
What are the risks of an upper GI series?
Any x-ray test procedure involves some risk from radiation
exposure. The radiation exposure is minimized by standard techniques
that have been assigned and approved by national and international
radiology committees and councils. Radiology technicians are
certified by national certifying boards.
Patients who are or may be pregnant should notify the requesting
practitioner and radiology staff, as there is potential risk of harm
to the fetus with any radiation exposure.
How does a patient prepare for an upper GI series, and how is
it performed?
A radiology technologist guides the patient through the upper
GI series along with a radiologist (a physician trained in
performing and interpreting x-rays). Because an upper GI series
involves interpreting images of the gastrointestinal system, it is
important that any materials or objects internally
or externally that could potentially interfere with interpretation of
the x-ray film be avoided. Therefore, prior to an upper GI series,
patients are requested not to eat or drink anything from four to
eight hours before the procedure. Patients also are asked to remove
extraneous clothing and all metallic objects such as jewelry.
A patient will be positioned behind X-ray equipment called a fluoroscope for
X-ray exposure.
The patient then is asked to swallow a liquid that contains
barium. The barium
fills and then coats the lining of the intestinal tract making the adjacent
esophagus, stomach and duodenum visible. (X-rays of the stomach and intestine
done without barium provide very little detail and information.)
X-ray images
are obtained at different angles through the chest and abdomen. The X-ray
machine (fluoroscope) produces these images by sending X-ray radiation through
the tissues of the body to a film on the opposite side of the patient's body. As
the radiation penetrates the body, it is absorbed in varying amounts by
different body tissues.
Due to differences in their composition, the different
organs and certain abnormalities and conditions all become visible on the X-ray
film, since they block the penetration of the X-ray beam to varying degrees.
After development of the film, an image of the organs is revealed. The
radiologist then examines the X-rays and can define various normal and abnormal
structures of the gastrointestinal system.
If needed, further enhancement of the different structures can be obtained by having air as well as barium in the stomach. This is accomplished by swallowing baking soda crystals.
As barium passes through the digestive system,
constipation can result,
especially in patients prone to constipation. Therefore, it generally is
advisable that patients who undergo an upper GI series
drink extra fluids after the test and consider a
laxative to relieve the bowels of the barium if the barium is
not eliminated completely within the next day or two. As it
is passing in the stool, barium has a whitish appearance that may
be apparent for several days after the test.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Gas or "intestinal gas" means different things to different people. Everyone has gas and eliminates it by belching or farting (passing it through the rectum).
GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid
contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are heartburn,
regurgitation, and nausea. Effective treatment is available for most patients with GERD.
Crohn's disease is a chronic inflammatory disease,
primarily involving the small and large intestine, but which can
affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are
common symptoms.
A hiatal hernia is an anatomical abnormality in which part of the stomach protrudes through the diaphragm and up into the chest. Causes of hiatal hernia are a larger than normal esophageal hiatus. There are two types of hiatal hernias, sliding, or para-esophageal. When symptoms of hiatal hernia appear, they are similar to GERD symptoms. Hiatal hernia treatment is generally surgery.
Though the cause of stomach cancer is unknown, risk factors for stomach cancer include diet, H. pylori infection, smoking age, gastritis, stomach surgery, family history, and pernicious anemia. Symptoms include stomach discomfort, feeling full after a small meal, nausea and vomiting, and weight loss. Treatment depends upon staging and may involve surgery, radiation therapy, or chemotherapy.
IBS (irritable bowel syndrome) is a common gastrointestinal disorder involving abnormal gut contractions (motility) characterized by abdominal pain,
bloating, mucous in stools, and irregular bowel habits with alternating diarrhea
and constipation, symptoms that tend to be chronic and to wax and wane over the
years. Treatment options include medication and lifestyle changes such as diet, exercise, and stress management to control symptoms. Also called spastic colitis, mucus colitis, nervous colon syndrome.
Esophageal cancer is a disease in which malignant cells form in the esophagus. Risk factors of cancer of the esophagus include smoking, heavy alcohol use, Barrett's esophagus, being male and being over age 60. Severe weight loss, vomiting, hoarseness, coughing up blood, painful swallowing, and pain in the throat or back are symptoms. Treatment depends upon the size, location and staging of the cancer and the health of the patient.
A peptic ulcer is an ulcer in the lining of the stomach, duodenum, or esophagus. Ulcer formation is related to Helicobacter pylori bacteria in the stomach, use of anti-inflammatory medications, and cigarette smoking.
Dyspepsia (indigestion) is a functional disease in which the gastrointestinal organs, primarily the stomach and first part of the small intestine, function abnormally. It is a chronic disease in which the symptoms fluctuate infrequency and intensity. Symptoms of dyspepsia include upper abdominal pain, belching, nausea, vomiting, abdominal bloating, early satiety, and abdominal distention (swelling). These symptoms are most often provoked by eating.
Scleroderma is an autoimmune disease of the connective tissue. It is characterized by the formation of scar tissue (fibrosis) in the skin and organs of the body, leading to thickness and firmness of involved areas. Scleroderma is also referred to as systemic sclerosis, and the cause is unknown. Treatment of scleroderma is directed toward the individual features that are most troubling to the patient.
The inflammatory bowel diseases (IBD) are Crohn's disease (CD) and ulcerative colitis (UC). The intestinal complications of Crohn's disease and ulcerative colitis differ because of the characteristically dissimilar behaviors of the intestinal inflammation in these two diseases.
Dysphagia or difficulty in swallowing, swallowing problems. Dysphagia is due to problems in nerve or muscle control. It is common, for example, after a stroke. Dysphagia compromises nutrition and hydration and may lead to aspiration pneumonia and dehydration.
Esophagitis is caused by an infection or irritation of the esophagus. Infections that cause esophagitis include candida yeast infection of the esophagus as well as herpes.
Gastritis is an inflammation of the stomach lining. Causes of gastritis include drinking too much alcohol, medications such as NSAIDs, ibuprofen, aspirin, H. pylori infection, severe infections, burns, anemia, and autoimmune disorders. Gastritis is diagnosed with endoscopy, blood tests, or stool tests. Treatment depends upon the cause of gastritis.
Barrett's esophagus occurs as a complication of chronic gastroesophageal reflux disease (GERD), primarily in white males. GERD refers to the reflux of acidic fluid from the stomach into the esophagus (the swallowing tube), and is classically associated with heartburn.
Achalasia is a disease of the esophagus that mainly affects young adults. Abnormal function of nerves and muscles of the esophagus causes difficulty swallowing and sometimes chest pain.
Gastroparesis is a medical condition in which the muscle of the stomach is paralyzed by a disease of either the stomach muscle itself or the nerves controlling the muscle. As a consequence, food and secretions do not empty normally from the stomach. Gastroparesis symptoms are nausea and vomiting; abdominal bloating, and pain can result.
Schatzki (Schatzki's) ring, is a narrow ring of tissue located just above the junction of the esophagus and stomach. The cause of Schatzki ring is not clearly known, however, some doctors believe they are caused by long term acid reflux. The symptoms of a Schatzki ring is primarily poorly chewed food that stays in chunks becoming stuck in the esophagus. Diagnosis of Schatzki's ring is barium x-ray or endoscopy. Treatment is generally a procedure to stretch or fracture the rings.
Abdominal adhesions (scar tissue) bands of scar tissue that form between abdominal organs and tissues. Symptoms of abdominal adhesions are pelvic or abdominal pain. Abdominal adhesions on the intestines can cause bowel obstruction, which is a medical emergency. Treatment for abdominal adhesions is generally surgery to cut the adhesions away from the internal tissues and organs. There is no way to prevent abdominal adhesions.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Acid backing up into the larynx (voice box), it causes reflux laryngitis. Irritation of the lining of the esophagus, larynx, and throat can lead to esophagitis, sinusitis, strictures, hoarseness, throat clearing, swallowing problems, asthma, chronic cough, and more. Typical symptoms of reflux laryngitis include heartburn, hoarseness, or a sensation of a foreign body in the throat. Reflux laryngitis can be treated with OTC medication, prescription medication, and lifestyle changes.
Duodenal diverticula (extramural or intramural), or duodenal diverticulum, is a pouch that is attached to the first part of the small intestine (duodenum). The cause of extramural diverticula is not clear, however, it may be congenital. Complications caused by duodenal diverticulum include rupture, gallstones, or pancreatitis. Extramural duodenal diverticula has no symptoms. Treatment is generally surgery.
Ulcerative colitis (UC) and Crohn's disease (CD) are known as the
inflammatory bowel diseases (IBD). The precise cause of IBD remains unknown.
These diseases are believed to be caused by a combination of genetic and
non-genetic, or environmental factors (for example, infections) that interact
with the body's immune (defense) system. When the intestinal immune system does
not function properly, many white blood cells accumulate in the inner lining (mucosa)
of the gut. The white cells then release chemicals that lead to tissue injury
(inflammation). This inflammation of the mucosa can cause diarrhea, which is the
most common symptom of ulcerative colitis and Crohn's disease, with or without the intestinal complications.
What are the intestinal complications of IBD?
The intestinal complications of IBD occur when the intestinal inflammation is
severe, extends beyond the inner lining (m...
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