Gastrointestinal (GI) Exams

What are gastrointestinal examinations?

Your digestive system is comprised of a series of organs that help process food from its entrance at your mouth to its exit at your anus. Although the organs have different functions, they are actually all one tube-like pathway, called the gastrointestinal (GI) tract. X-ray examinations of the GI tract enable healthcare providers to find problems in these organs. To diagnose gastrointestinal diseases, healthcare providers prefer a type of X-ray called fluoroscopy, which takes video images of the organs in action. There are different variations of the test, depending on which organs are being examined.

What are the different types of gastrointestinal (GI) exams?

Common GI exams include:

• Barium Swallow Test (Esophagram): An examination of the esophagus as it swallows. (Approximate time: one hour.)
• Upper GI Series: An examination of the esophagus, stomach and duodenum (upper small intestine) as they digest. (Approximate time: one to one and 1/2 hours.)
• Small Bowel Series: An examination of the small intestine (small bowel) as it digests. (Approximate time: two to four hours.)
• Barium Enema or Lower Bowel Series: An examination of the lower small intestine (ileum), colon and rectum (large bowel). (Approximate time: one to two hours.)

Why would I need a GI exam?

GI exams are given to determine the causes of mysterious gastrointestinal symptoms, including:

• Difficulty swallowing.
• Severe indigestion.
• Reflux.
• Abdominal pain.
• Diarrhea.
• Vomiting.
• Blood in your poop.

What do GI exams diagnose?

GI exams can screen for a variety of known conditions, including:

• Ulcers.
• Tumors.
• Polyps.
• Hiatal hernias.
• Diverticulosis and diverticulitis.
• Esophageal varices.
• Barrett's esophagus.
• Intestinal metaplasia.
• Dysphagia.
• GERD (chronic acid reflux).
• Laryngopharyngeal reflux.
• Gastritis.
• Enteritis.
• Gastroenteritis (stomach flu).
• Irritable bowel syndrome (IBS).
• Inflammatory bowel disease.

Where would I receive a GI exam?

Fluoroscopic gastrointestinal examinations may be performed in a physician's office, a commercial X-ray facility or a hospital.

Who performs GI exams?

All gastrointestinal examinations are performed and interpreted by registered and licensed technologists and board-certified radiologists.

How does a fluoroscopy work?

Like a standard X-ray machine, a fluoroscope is an imaging machine that takes images of the inside of your body. But instead of taking isolated snapshots, a fluoroscopy passes a continuous X-ray beam through your body, which produces continuous images on a screen in real-time. So rather than developing photographs, healthcare providers can view a video of your organs in action. This allows them to identify problems with your organ function and highlights any obstructions occurring in the GI tract. It will also reveal any abnormalities in the size, shape, or position of the organs.

Most fluoroscopy exams require a contrast agent called barium to coat the internal organs and help them show up better in images. You may be asked to drink a barium solution, or it may be delivered into your rectum by an enema. It depends on whether your healthcare provider is trying to see the upper organs or the lower organs of your gastrointestinal tract. An “upper GI test” examines your esophagus, stomach and the first part of your small intestine (duodenum). A “lower GI test” examines the lower part of your small intestine (ileum) and your large intestine, including your colon and rectum.

How should I prepare for a GI exam?

It's very important to prepare properly for a GI exam. Your healthcare provider will give you specific guidelines to follow in the days leading up to your test, depending on which kind of test you’re having. You may be asked to follow a diet, fast or take laxatives to clear out your bowels. You’ll be asked to avoid smoking and certain medications for a couple of days.

On the day of the exam, you’ll be asked to leave valuables such as jewelry and credit cards at home and to change into a hospital gown. Please let your technologist know in advance if you are pregnant or nursing, have an insulin pump, have any known allergies that might be in the contrast agent or have any difficulty lying in different positions.

What happens during a GI exam?

For an upper GI exam: You’ll begin standing on a tilting X-ray table. The X-ray technologist will secure you to the table with straps, in case you need to be tilted back during the exam. They may give you a mild sedative, if necessary.

During the test, you'll drink a contrast solution containing barium to highlight the upper organs and how they process the solution. Barium is a white, chalky substance, which is great for highlighting black and white images, but not as great for tasting. It will be sweetened and flavored for you, but it still tastes chalky.

You’ll sip thicker and thinner mixtures of the solution throughout the test at your healthcare provider’s request — usually about 12 ounces total. Other than the barium solution you have to drink, there should be little to no discomfort during the exam.

For a lower GI exam: You’ll begin by lying on your side on a tilting X-ray table set in the horizontal position. An X-ray technologist will secure you with straps and then deliver an enema of barium contrast solution. The contrast solution will fill your lower gastrointestinal tract, highlighting the lower small intestine and large intestine.

During the test, the table will be tilted at various angles to help spread the barium solution throughout your body and present different views to the fluoroscope. In some cases, the technologist may inject air into your rectum to provide further contrast on the X-rays.

The lower GI test may cause some discomfort, including gas, cramps and a strong urge to poop. After the first few X-rays are taken, you will be helped to the bathroom or given a bedpan and be asked to move your bowels to expel as much of the barium as possible. Then you will go back to the X-ray examination room for more X-rays, this time looking at the barium solution that remains on the lining of your intestine.

What should I expect after the GI exam?

• Generally, you can resume your normal activities and diet right away.
• You’ll be encouraged to drink plenty of fluids to help clear the barium out.
• You may have white poop for a few days as the chalky white barium passes through you.
• Sometimes the barium will cause temporary diarrhea or constipation, but this should resolve on its own in a day or so.

Are GI exams safe?

• Fluoroscopic exams are non-invasive and virtually risk-free. The benefits almost always outweigh the low risks.
• There is a low risk of allergic reaction to any of the substances in the contrast solution if you haven’t been exposed to them before.
• Radiation exposure from fluoroscopy is greater than it is from standard still X-rays, but it is still considered harmless. The risk would come from repeated exposure over a short period. So don't have multiple X-rays taken in a row. And as always, avoid exposure if you are pregnant.
• The risk of infection is very low with both upper and lower GI tests.
• The additional risk associated with the lower GI test, although very low, is the risk of a tear in the intestinal wall. Should this occur, surgery may be necessary.

When will I get the results of my GI exam?

The results of your gastrointestinal exam should be available to your physician within 24 hours after the test, Monday through Friday. Your health care provider will discuss the test results with you.

A note from Cleveland Clinic

Fluoroscopic gastrointestinal (GI) exams are simple, painless, and extremely helpful for getting to the root of your gastrointestinal problems. If you’re having any unexplained symptoms between the swallowing of food and the way it comes out, there's a GI test for you. Give us a couple of hours of your time to take a peek inside your digestive organs. We’ll talk you through the process, and we’ll have results to discuss with you within a day or two.