Upper GI Series/Small Bowel Follow-Through 

What is an upper GI series test?

An upper GI series is an imaging study that enables us to assess the contours and position of your child’s esophagus, stomach, and duodenum (the portion of the small intestine immediately beyond the stomach), as well as how well these parts of the gastrointestinal tract function (their emptying and motility). Because this imaging test provides important information about the gut’s contour, position, and function, it can be very helpful in evaluating and diagnosing children who have a persistent cough, difficulty swallowing, vomiting, abdominal pain, and possible gastroesophageal reflux (GERD), and in deciding on a treatment plan.

What is a small bowel follow through?

A small bowel follow through is an imaging study that enables us to assess the jejunum and ileum, the second and third sections of the small intestine. We use this test to evaluate children who have abdominal pain, diarrhea, and who are failing to grow properly. It is used to make the diagnosis of Crohn’s disease.

Both the upper GI series and small bowel follow through are fluoroscopy exams. This type of X-ray imaging enables us to capture a real-time, moving image of your child swallowing and digesting, much like an X-ray movie. To make this image we use a specialized X-ray machine called a fluoroscope. The fluoroscope directs an X-ray beam at the part of the body to be examined, and captures the image created as the X-rays are absorbed or scattered by the internal organs and tissues. During the exam your child will be asked to lie on a table below the X-ray machine and detector. To highlight the contours and function of the throat, esophagus, stomach, and upper portion of the small intestine we will ask your child to drink a liquid “contrast agent.” The liquid contains barium, an X-ray absorber that appears white on X-ray film. This thick, milkshake-like drink is available in a plain or chocolate flavor.

How should I help my child get ready for the test?

Your child’s stomach should be empty before the imaging test so that the doctor can obtain the clearest, most useful images.

If your child is under 6 months of age you should not feed him/her anything within two hours of the exam.

If your child is over 6 months of age you should not feed him/her anything for four hours before the exam.

On the day of the test your child should wear comfortable clothes and may be asked to change into a gown when you arrive at the fluoroscopy site.

What will happen during the test?

For the upper GI series the radiologist will ask your child to lie down on his/her side or back, then to swallow the barium drink from a bottle or cup. As the contrast passes from the mouth to the stomach to the small intestine, the radiologist will image the organs from different angles. The test takes between 5 to 30 minutes, depending on how quickly the contrast passes through your child’s system.

We can perform the small bowel series, in which we exam the lower portion of the small intestine, immediately after the completion of the upper GI series. We will ask your child to drink more contrast, and will then bring him/her back into the fluoroscopy area for additional imaging every 20 or 30 minutes as the contrast travels through the GI tract. This test may take several hours to complete.

We can also perform the small bowel series if you child has not had an upper GI series first. We will ask your child to drink a cup of contrast agent in the waiting room. We will then bring him/her back into the fluoroscopy area for imaging every 20 or 30 minutes as the contrast travels through the GI tract. This test may take several hours to complete.

How can I help my child feel comfortable about and during the test?

Young children sometimes find the fluoroscope, a large machine that passes over the X-ray table, a bit frightening. In addition, we sometimes have to immobilize children so that we can position them properly under the camera. We do this by wrapping their legs with an ace bandage. You can remain with your child in the imaging area during the exam to offer comfort and reassurance. You will be asked to wear a lead apron to protect you from unnecessary exposure to radiation. We can also arrange to have a child life specialist at your child's appointment to help your child better cope with the stress of the procedure.

Are there any risks?

Although this is an X-ray based exam, your child will be exposed to minimal doses of diagnostic radiation.

After the test

After the exam your child can immediately resume his/her normal activities. Because barium may cause constipation, make sure your child drinks extra fluid after the test. Your child’s first bowel movement may be white or gray because of the barium.

A radiologist will analyze the fluoroscopic images and will share the results with the doctor who requested the exam. Your child’s doctor will then discuss the results with you.