Question

Barium will become almost hard if it cannot pass thru the gut; so you would not want to use Barium in this type of patient, but only Gastorgraffin which is a contrast medium.

Remember that one has taken Barium, you need to flush it out with increased fluids to follow and this person is not able to take them at this time.

Hope that this makes it easy for you to understand.

I can personally verify and testify to barium hardening and setting up in the gut if not completely passed w/in 2 days. It can set up like "white bricks" w/in 3-4 days and THEY are NOT fun to pass w/a healthy gut!!

I ALWAYS have to not only drink LOTS of liquids, especially water, but also take Milk of Magnesia the day of and after the SBFT as well as the day after the SBFT in order to pass the barium comfortably. Most people don't have to go to that much extreme but I do. LOTS of liquids just doesn't cut the mustard for me. My easiest SBFT was at Mayo Clinic in 1999 when they added a little Reglan to the barium. I don't know if they still do that or not or if they added it just to mine because I told them the difficult time I have passing the barium in a timely manner.

I have a partial obstruction at an old resection site and Mayo Clinic this past April didn't even mention a SBFT, they ordered a CT Enterography instead. They use the lighter weight Gastrofin and I had no problems w/passing that.

Mayo has also been comparing MRI vs CT enterographies and so far are finding the CTE superior to the MRE except for the rectal area according to the person I talked to.

Another nice thing about gastrograffin is that it is a great osmotic stool softener. If someone is impacted the gastrograffin can not only be diagnostic but therapeutic. For those around long enough to remember a milk and molasses enema it has about the same effect.

We order it on the floor for impacted patients who are unresponsive to fleets. Took a while for radiology to get on board, but since this is the techs least favorite test they were all for it.

David Carpenter, PA-C

Thanks, David. I wasn't aware of that. I just knew that I didn't have the problems w/the Gastrofin that I do w/the barium.

Usually the problem is the other way. Gastrograffin gives most patients diarrhea. It would be nice if there was a neutral contrast agent.

David Carpenter, PA-C

I'm one of the minority of crohnies who is prone to constipation rather than diarrhea. I thought I'd read that they are having some success w/just water as the oral "contrast" for CTs. Maybe it was just for CTEs they've been experimenting w/water as a contrast agent??

Just CTE. If you don't use some type of contrast agent for a contrast study it doesn't help much. The water in the CTE is to distend the bowel so you can see the wall and the wall pattern. We get some really nice CTE's with water. One of our radiologists has a protocol for drinking the water instead of putting in a catheter. It works pretty well if you have a fast scanner.

David Carpenter, PA-C

How good is the CTE at detecting or indicating inflammation of the small intestinal wall? I know it is good for displaying narrowing, dilatation, wall thickness, etc. but what about inflammation?

Have you have any experience w/the nuclear white blood cell scans for inflammation in the small intestine? At one time Dr Charron in Pittsburgh was advocating the Ceretec WBC to screen pediatric patients for Crohns. Then I was seeing the term Indium WBC scan. I understand the theory, the "marked" WBC tend to congregate at sites of inflammation. It sounds intriguing. But doesn't seem to be widely used. They use a CT scanner for that, don't they?