Upper Gastrointestinal (UGI) with Small Bowel Series

An upper gastrointestinal (GAS-tro-in-TEST-in-al) series, or UGI, is an X-ray test that shows the structure of the upper gastro¬intestinal tract, which is the part of the body that food passes through as it is digested. The upper gastrointestinal tract includes the esophagus, which is the tube in the neck that connects the mouth to the stomach through which food passes as it is eaten; the stomach; and, sometimes, the small intestine. When the UGI is ordered with a small bowel series, the upper gastrointestinal tract AND the entire small intestine will be examined.

• X-ray pictures are taken after your child drinks a special liquid called barium (BARE-ee-um) that coats and outlines the upper gastrointestinal system and small intestine.
• A UGI with small bowel series shows doctors how well the upper gastrointestinal tract and the entire small intestine are working.
• A UGI with small bowel series gives doctors detailed information about your child's upper gastrointestinal tract and small intestine that they cannot learn from a physical examination.

On the day of the test, your child should not eat or drink anything before the test is done, following these guidelines:

• Neonate to 23 months – 2 hours before
• 24 months to 10 years – 4 hours before
• Over 10 years – 8 hours before
• If you have any questions regarding these instructions, please contact the Department of Pediatric Radiology.
• You may bring along a “comfort” item—such as a favorite stuffed animal or “blankie”—for your child to hold during the test.

The UGI with small bowel series test is done at the Department of Pediatric Radiology of Children’s Hospital. In the examination room will be a pediatric radiology doctor, who will be taking the X-ray pictures of your child's upper gastrointestinal system, and an X-ray technologist, who will be helping the doctor. You will see an X-ray machine, a long table, and a television screen. You might explain to your child that the X-ray machine is a large camera for taking pictures that will be shown on the screen. If your child has any questions, the doctor or X-ray technologist will be happy to answer them before the test.

Your child will be asked to take off his or her clothing and put on a hospital gown. When your child is ready, he or she will go into the fluoroscopy (floor-OS-co-pee) room and the test will begin.

• Your child will be awake during this test.
• Your child will be asked to lie down on the table.
• In the fluoroscopy room, your child will be given a milky liquid called barium in a cup to drink through a straw. This liquid allows the doctors to see the gastrointestinal system more clearly on the X-ray pictures. Barium looks like a milkshake, but does not have a pleasant taste. The doctor or X-ray technologist can add flavoring to the barium to make it taste better if your child wants it flavored.
• If your child is unable to drink the barium, a thin flexible tube may be placed through his or her nose to get the barium into the esophagus.
• As your child drinks the barium, the doctor will move the X-ray camera over your child. The camera will come close to, but not touch, your child.
• The doctor will begin to take the X-ray pictures as the barium is swallowed and passes through the esophagus into the stomach. Your child will be asked to continue to drink the barium while the doctor takes the X-ray pictures.
• The X-ray pictures will allow the doctor to watch the progress of the barium through the gastrointestinal system.
• Your child will be asked to roll from side to side while the doctor takes X-ray pictures.
• When the milky liquid moves to your child’s small intestine, the first part of the test, the UGI, is complete. Now the small bowel series will begin.
• Because the small bowel series tracks the progress of the barium through the entire small intestine, it usually takes two to three hours, or more, to complete. Your child may be given another cup of barium to drink. The barium can again be flavored if your child wants it.
• Your child will then be moved back to the waiting room. The X-ray technologist will periodically take your child to an X-ray room for a series of timed X-ray pictures of your child’s abdominal, or belly, area. These pictures will usually be taken anywhere from 15 minutes to one hour apart. You and your child will be able to return to the waiting room between these timed X-rays.
• When the X-rays show that the barium has gone through the entire small intestine, your child may have X-ray pictures taken of his or her terminal ileum (ILL-ee-um), which is where the large and small intestines meet.
• When the milky liquid moves through your child’s terminal ileum, the UGI with small bowel series test is complete.

As a parent, you may have concerns about radiation exposure. Children’s Hospital takes every precaution to make sure your child is safe.

• Our goal is to do the test correctly and thoroughly, while exposing your child to the smallest amount of radiation necessary to take the X-ray.
• Advances in equipment and film have lowered the amount of radiation your child will receive.
• All of the equipment is inspected regularly.
• Parts of the body that are not being X-rayed will be protected with a lead cover or apron when possible.

We welcome your help and support during this test. Parents or guardians are invited to join your child in the examination room. Other children can wait in the waiting room, or the Lemieux Sibling Center if siblings are ages 3 to 12 who are toilet trained.

• This test involves the use of radiation. Women who are pregnant or believe they may be pregnant should limit exposure to X-rays. In this case, please bring another adult who can stay with your child during the test.

The X-ray technologist will show you where to stand in the examination room during the test. Please follow the instructions of the medical professionals performing the test.

• The most important role of a parent and guardian during the test is to help your child stay calm and relaxed. It is important that your child stays still when the X-ray pictures are being taken.
• The best way to help your child stay calm is for you to stay calm.
• We encourage you to talk to your child and hold his or her hand.
• Please do not distract the medical team or interrupt the test in any way.
• We welcome your questions, but please ask them either before or after the test.

The UGI with small bowel series takes several hours to complete— sometimes two or three hours, or more. When the doctor and X-ray technologist have taken all the X-rays they need, they will check to make sure the pictures are clear, which takes only a few minutes. When they are satisfied with the pictures, the UGI with small bowel series is finished.

• Before leaving, you will be told about any follow-up care.
• After the test, your child can return to normal activities and resume a normal diet.
• Your child’s bowel movements will look white for a day or two because of the barium. White bowel movements are normal.
• Your child should drink plenty of liquids to allow his or her bowel movements to return to normal.
• Your child may have some constipation. Drinking lots of liquids will help. Your child may also take a mild laxative.
• If your child’s constipation continues, please contact your family doctor or PCP for advice and treatment.
• A report of your child’s UGI with small bowel series will be sent to the doctor who prescribed it, usually within 48 hours. If the results are urgent, the referring doctor will be contacted immediately.
• Please contact the doctor who prescribed the test for the results.
• If you have any other questions or concerns about the test, please call the Department of Pediatric Radiology and a nurse or X-ray technologist will discuss them with you.

If your child has any special needs or health issues you feel the doctor needs to know about, please call the Department of Pediatric Radiology at Children’s before the test. It is important to notify us in advance about any special needs.

Preparing your child beforehand, as well as comforting your child during the test, will help your child have a more positive experience. Sometimes it is difficult to know how to explain tests to children. If you have any questions about ways to prepare or support your child, or feel your child will have difficulty during the test, please call the Department of Pediatric Radiology at Children’s and ask to speak with the Child Life Specialist.