IBS Fact : Evidence-based management of irritable bowel syndrome

Barium enema in irritable bowel syndrome (IBS)

A barium enema, also known as lower GI series, or double-contrast barium enema, or lower GI tract radiography, is a diagnostic procedure that uses a form of real-time x-ray called fluoroscopy and a contrast agent called barium to produce images of the lower GI tract. Air is sometimes used as a second contrast agent to expand the bowels for better visibility, hence double-contrast barium enema.

 

What does a barium enema visualize?

This method primarily visualizes the colon, and rectum, and sometimes the appendix and a portion of the small intestine. Abnormalities that can be detected include cancerous growths, diverticula (small pouches in the colon), fistula (an abnormal passage or channel between the anal canal and the skin around the anus), inflammation of the intestinal lining (Cohn’s disease or ulcerative colitis), polyps, ulcers, and obstruction. The procedure can often provide sufficient information to avoid the more invasive colonoscopy.

 

When is a barium enema prescribed?

Common symptoms or conditions that might require a barium enema include:

 

How should I prepare for the procedure?

For the exam to be successful, your lower digestive tract must be completely empty. You will therefore need to eat a diet consisting of liquids, low-fat and low-residue foods two or three days before the exam. The night before the exam, you will be asked to drink only clear liquids and to refrain from drinking or eating anything after midnight. You may also be prescribed a laxative and an over-the-counter enema to clear your lower tract the day before the exam.

 

How is de procedure performed?

The procedure is performed on an outpatient basis, usually in the morning. Upon arrival and an explanation of the procedure you will be changed into a gown and lie down on a special table that can be tilted to obtain images from various angles. A small, soft tube will be inserted into your anus and the barium contrast liquid will be infused into your colon. This is not painful, but will make you feel somewhat uncomfortable producing an urge to defecate. You will be asked not to expulse the liquid despite the urge. The tube in your anus will also prevent the contrast liquid from being released. Depending the type of examination, air may also be infused into your colon to obtain a better contrast (double contrast barium enema). The images of your colon will show up on a screen and will be interpreted and recorded by a specialist. You will be asked to hold very still and hold your breath for a couple of seconds at a time to obtain clear images in various positions. Once the examination is complete, the barium liquid will be released through the tube in your anus, and you will be allowed to go to a restroom to expel any remaining liquid. You may also be given a laxative and an enema to remove any residual the barium from your colon. The complete examination usually takes 30 to 60 minutes.

 

What happens after the examination?

After the examination, you will be able to resume your daily routine. You may however be constipated during a couple of days and your stool may give a whitish colour. You may also need to visit the toilet more frequently to expulse any remaining barium. The images of your colon will be forwarded to your general practitioner who will discuss them with you.

 

Potential side effects.

Side effects of barium enema are very rare. The examination itself is not dangerous since no instruments are inserted into your colon. The examination does expose you to a small amount of radiation, since it is basically an X-ray of your bowels. The barium contrast liquid itself is not absorbed into your bloodstream and will therefore cause no side effects. Only in very rare cases, an allergic reaction may occur. Constipation is a more frequent side effect, and you will be required to increase your intake of liquids to prevent it. Should the constipation persist more than 2 days, you should consult your GP.

 

Interpretation of findings in suspected IBS

The barium enema may reveal the cause of your symptoms, such as an obstruction or inflammation of the colon or small bowel. This will prompt additional examinations and/or a dedicated treatment. Since IBS itself does not cause any visible changes to the bowels, absence of any abnormalities on barium enema in persons with persistent symptoms may be considered a confirmation of true IBS.

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