What is Lower GI Tract X-ray (Radiography)?
Lower gastrointestinal (GI) tract radiography, also called a lower GI or barium enema, is an x-ray examination of the large intestine, also known as the colon. The appendix and a portion of the distal small intestine may also be included. The lower GI uses a special form of x-ray called fluoroscopy and a contrast material called barium.
What are some common uses of the procedure?
A physician may order a lower GI examination to detect:
- benign tumors (such as polyps)
- cancer
- signs of other intestinal illnesses.
The procedure is frequently performed to help diagnose symptoms such as:
- chronic diarrhea
- blood in stools
- constipation
- irritable bowel syndrome
- unexplained weight loss
- a change in bowel habits
- suspected blood loss
- abdominal pain.
Images of the small bowel and colon are also used to diagnose inflammatory bowel disease, a group of disorders that includes Crohn's disease and ulcerative colitis.
Additional Resources
Frequently Asked Questions
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How does the procedure work?
Fluoroscopy uses a continuous x-ray beam to create a sequence of images that are projected onto a fluorescent screen, or television-like monitor. When used with a contrast material, which clearly defines the area being examined by making it appear bright white, this special x-ray technique makes it possible for the physician to view internal organs in motion.
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How is the procedure performed?
The lower GI exam is usually done on an outpatient basis and is often scheduled in the morning to reduce the patient's fasting time. A radiology technologist and a radiologist, a physician specifically trained to supervise and interpret radiology examinations, guide the patient through the barium enema.
The patient is positioned on the examination table and the technologist will then insert a small tube into the rectum. Barium or barium and air may also be injected through the tube. In some circumstances, the radiologist or referring physician may prefer a water and iodine solution rather than barium. Next, a series of x-ray images is taken. The patient may be repositioned frequently on order to image the colon from several angles. When the examination is complete, you will be asked to wait until the radiologist determines that all the necessary images have been obtained. Once the x-ray images are completed, the patient will then expel barium in the restroom. In some cases, the additional x-ray images will be taken. A barium enema is usually completed within 30 to 60 minutes.
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What will I experience during and after the procedure?
As the barium fills your colon, you will feel the need to move your bowel. You may feel abdominal pressure or even minor cramping. Most people tolerate the mild discomfort easily. The tip of the enema tube is specially designed to help you hold in the barium. If you are having trouble, let the technologist know.
During the imaging process, you will be asked to turn from side to side and to hold several different positions. With air contrast studies of the bowel (air contrast barium enema), the table may be turned into an upright position.
After the examination, you may be given a laxative or enema to wash the barium out of your system. You can resume a regular diet and take orally administered medications unless told otherwise by your doctor. You may be able to return to a normal diet and activities immediately after the exam. You will be encouraged to drink additional water for 24 hours after the examination.
Your stools may appear white for a day or so as your body clears the barium liquid from your system. Some people experience constipation after a barium enema. If you do not have a bowel movement for more than two days after your exam or are unable to pass gas rectally, call your physician promptly. You may need an enema or laxative to assist in eliminating the barium.
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Who interprets the results and how do I get them?
A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will discuss the results with you.
Neil A. Ramquist, MD
Diagnostic Radiologist
- Head of Diagnostic Radiology at Rex Hospital
- BS, MD, University of California at Davis
- Chief resident in radiology, Bowman Gray School of Medicine
- Member, American College of Radiology
- Member, Radiological Society of North America
- Native of Wisconsin
Expertise in mammography, CT, and ultrasound
Joined Raleigh Radiology in 1981
Donald G. Detweiler, MD
Diagnostic Radiologist
- President, Raleigh Radiology Associates
- Medical Director, Raleigh Radiology Blue Ridge, Cary and Breast Center
- Chairman, Rex Classic - 2000
- President, Medical Staff Rex Hospital - 1995
- BS, Duke University
- MD, Emory University
- Fellow and resident in diagnostic radiology, University of North Carolina Medical Center
- Native of Illinois
Expertise in mammography, CT, and ultrasound
Joined Raleigh Radiology in 1982
W. Kent Davis, MD
Neuroradiologist
- Medical Director, Raleigh Radiology Cedarhurst, Clayton, Wake Forest, and Brier Creek
- BS, Duke University
- MD, University of North Carolina at Chapel Hill
- Internship in internal medicine, Union Memorial Hospital, Baltimore
- Resident in radiology, Duke University Medical Center
- Fellowship in neuroradiology, Duke University Medical Center
- Certificate of Added Qualifications in Neuroradiology awarded by American Board of Radiology
- Member, American Society of Neuroradiology
- Native of North Carolina
Expertise in head, neck, and spine imaging; breast imaging and breast intervention
Joined Raleigh Radiology in 1990
Andrew B. Weber, MD
Vascular and Interventional Radiologist
- BS, University of Pennsylvania
- MD, Temple University Medical School
- Internship in surgery, York Hospital
- Chief resident, Duke University Medical Center
- Former Chief, Rex Hospital Radiology
- 2009 Chairman, Rex Hospital Open
- Rex Corporate Counsel
- Native of Pennsylvania
Expertise in vascular/interventional radiology and MR angiography
Joined Raleigh Radiology in 1992
Julia K. Taber, MD
Women’s Imaging Radiologist
- Chief of Radiology at Rex Hospital
- BS, Brown University
- MD, Duke University Medical School
- Internship in internal medicine, New York Hospital
- Resident in diagnostic radiology, Duke University Medical Center
- Fellowship in mammography and pediatric radiology, Duke University Medical Center
- Member, Society of Breast Imaging
- Member, American Institute of Ultrasound in Medicine
- Women’s Imaging Radiologist
Expertise in breast imaging, breast intervention, and pediatric radiology
Joined Raleigh Radiology in 1993
Mark H. Knelson, MD
Vascular and Interventional Radiologist
- BS, MD, University of North Carolina at Chapel Hill
- Rotating internship, Case Western Reserve University Hospitals of Cleveland
- Chief resident, Case Western Reserve University Hospitals of Cleveland
- Fellowship, vascular and interventional radiology, Duke University Medical Center
- Certificate of Added Qualifications in Vascular and Interventional Radiology awarded
- American Board of Radiology Assistant professor of radiology, Duke University Medical Center
- Member, Society of Interventional Radiology, American College of Radiology
- Native of North Carolina
Expertise in diagnostic angiography and interventional radiology, nuclear cardiology, and spine intervention
Joined Raleigh Radiology in 1993
Gregory C. Hinn, MD
Musculoskeletal Radiologist
- Head of Musculoskeletal Imaging at Rex Hospital
- BA, University of North Carolina at Chapel Hill
- MD, Bowman Gray School of Medicine at Wake Forest University
- Resident in radiology, University of Virginia Health Sciences Center
- Fellowship in diagnostic and interventional musculoskeletal radiology, University of Virginia Health Sciences Center
- Musculoskeletal radiologist for the North Carolina State University Athletic Department.
- Raised in North Carolina
Expertise in musculoskeletal imaging with bone and joint intervention
Joined Raleigh Radiology in 1995
Gregory A. Bortoff, MD, PhD
Abdominal Imaging Radiologist
- Head of Computed Tomography (CT) at Rex Hospital
- Radiologist Recruiter
- BS, Cornell University
- MD, PhD, State University of New York Health Science Center at Syracuse
- Resident in radiology, Wake Forest University Baptist Medical Center
- Fellowship in abdominal imaging, Wake Forest University Baptist Medical Center
- Member, Radiological Society of North America
- Member, American Roentgen Ray Society
- Native of New York
Expertise in abdominal imaging, including MRI, MRA, ultrasound, oncologic imaging, and PET/CT
Joined Raleigh Radiology in 1999
Jerry L. Watson, MD
Abdominal Imaging Radiologist
- BS with honors, Johns Hopkins University
- MD, University of Texas, Southwestern Medical Center at Dallas
- Resident in radiology, University of North Carolina at Chapel Hill
- Fellowship in abdominal imaging, University of North Carolina at Chapel Hill
- Chief of Radiology, 67th Combat Support Hospital, United States Army, Germany 1996–1998
- Native of Georgia
Expertise in abdominal imaging, including MRI, MRA, ultrasound, breast intervention, oncologic imaging, and PET/CT
Joined Raleigh Radiology in 1999
Cynthia S. Payne, MD
Vascular and Interventional & Neuroradiologist
- MD, Medical College of Ohio
- Internship, Mount Auburn Hospital, Harvard Medical School
- Resident, neurology and radiology, Duke University Medical Center
- Fellowships in molecular neurogenetics, vascular/interventional radiology and neuroradiology, Duke University Medical Center
- Certificate of Added Qualifications in Neuroradiology, Vascular and
- Interventional Radiology awarded by American Board of Radiology
- Director of neuro-interventional radiology, Greater Baltimore Medical Center
- Native of North Carolina
Expertise in vascular and interventional radiology, diagnostic, and interventional neuroradiology
Joined Raleigh Radiology in 2001
Tracey E. O’Connell, MD
Musculoskeletal Radiologist
- BA, University of Colorado at Boulder
- MD, University of North Carolina at Chapel Hill
- Resident in radiology, University of North Carolina at Chapel Hill
- Fellowship in musculoskeletal radiology, Duke University Medical Center
- Member, Radiological Society of North America
- Native of California
Expertise in musculoskeletal imaging with bone and joint intervention and abdominal imaging including MRI, MRA, CT, and ultrasound
Joined Raleigh Radiology in 2001
Jennifer S. Van Vickle, MD
Abdominal Imaging Radiologist
- Head of Ultrasound at Rex Hospital
- BA, University of Chicago, M.Div and Th.M, Duke University
- MD, Duke University Medical Center
- Internship in internal medicine, Duke University Medical Center
- Resident in diagnostic radiology, Duke University Medical Center
- Fellowship in abdominal imaging and mammography, Duke University Medical Center
- Native of Missouri
Expertise in breast imaging, breast intervention, abdominal and pelvic imaging, including CT, ultrasound, and MRI
Joined Raleigh Radiology in 2002
Gintaras E. Degesys, MD
Musculoskeletal Radiologist
- BA with high honors, Kenyon College
- MD, University of Cincinnati College of Medicine
- Internship and chief resident, Northwestern University
- Fellowship in interventional and abdominal imaging, Duke University Medical Center
- Certificate of Added Qualifi cations in Vascular and Interventional Radiology awarded by American Board of Radiology
- Native of Ohio
Expertise in musculoskeletal imaging, breast intervention, and abdominal imaging and intervention
Joined Raleigh Radiology in 2002
Laura O. Thomas, MD
Abdominal Imaging Radiologist
- Head of Rex Breast Care Center at Rex Hospital
- Radiologist Recruiter
- BA, Princeton University
- MD, Duke University Medical School
- Internship in internal medicine, UNC Hospitals
- Chief resident, Duke University Medical Center
- Fellowship in women’s and abdominal imaging, Duke University Medical Center
- Native of Missouri
Expertise in breast imaging, breast intervention, abdominal imaging, oncologic imaging, and PET/CT
Joined Raleigh Radiology in 2003
John G. “Jay” Alley, Jr, MD
Neuroradiologist
- Vice Chief of Radiology at Rex Hospital
- BA, University of North Carolina at Chapel Hill
- Post-Baccalaureate Premedical Program, Columbia University, New York
- MD, University of North Carolina School of Medicine
- Co-chief resident in diagnostic radiology, University of North Carolina Hospitals
- Fellowship in neuroradiology, University of North Carolina Hospitals
- Native of North Carolina
Expertise in neuroradiology
Joined Raleigh Radiology in 2004
Todd J. Roth, MD
Abdominal Imaging Radiologist
- BS, University of Texas, Austin
- MD, University of Texas Health Sciences Center, San Antonio
- Residency, Baptist Medical Center, Wake Forest University, Winston-Salem
- Fellowship in abdominal imaging, Baptist Medical Center, Wake Forest University
- Native of Kansas
Expertise in abdominal and pelvic MRI, MRA, CT, and ultrasound
Joined Raleigh Radiology in 2004
Steven R. Carter, MD
Musculoskeletal Radiologist
- BS, University of Virginia
- MS, Medical College of Virginia
- MD, Medical College of Virginia
- Internship in internal medicine, MCV
- Chief resident, diagnostic radiology, Emory University
- Fellowship in musculoskeletal imaging, Emory University
- Member, American Roentgen Ray Society, American College of Radiology, Radiological Society of North America
- Musculoskeletal radiologist for the Carolina Hurricanes
- Native of Richmond, Virginia
Expertise in musculoskeletal radiology
Joined Raleigh Radiology in 2005
Satish Mathan, MD
Vascular and Interventional Radiologist
- Head of Interventional and Vascular Radiology at Rex Hospital
- BS, University of California at Santa Barbara
- MD, Medical College of Wisconsin
- Internship, Santa Clara Valley Medical Center, San Jose, CA
- Chief resident, University of North Carolina Hospitals, Chapel Hill, NC
- Fellowship in vascular and interventional radiology, University of North Carolina Hospitals
- Member, Society of Interventional Radiology, American College of Radiology
- Native of Raleigh, North Carolina
Expertise in interventional radiology
Joined Raleigh Radiology in 2005
Andrew G. Moran, MD
Nuclear Medicine Radiologist
- Head of Nuclear Medicine Radiology at Rex Hospital
- BS, Idaho State University
- MD, Utah School of Medicine
- Residency, Duke University Medical Center
- Fellowships in body imaging and nuclear radiology, Duke University Medical Center
- Member, Society of Nuclear Medicine
- Native of California
Expertise in abdominal imaging, oncologic imaging, nuclear medicine and PET/CT
Joined Raleigh Radiology in 2006
Joshua B. Mitchell, MD
Musculoskeletal Radiologist
- BA, University of Virginia
- MD, University of Tennessee College of Medicine
- Internship, Medical University of South Carolina
- Chief resident, Medical University of South Carolina
- Fellowship in musculoskeletal radiology, University of Florida
- Member, American College of Radiology, South Carolina
- Radiological Society, Association of University Radiologists, Radiological Society of North America
- Native of Chattanooga, Tennessee
Expertise in musculoskeletal imaging
Joined Raleigh Radiology in 2007
Jeffrey Browne, MD
Musculoskeletal Radiologist
- BS, Boston College
- MD, University of Connecticut School of Medicine
- Internship, St. Raphael’s Hospital
- Residency, Duke University Medical Center
- Fellowship in musculoskeletal radiology, Duke University Medical Center
- Member, American College of Radiology, Radiological Society of North America and American Roetgen Ray Society.
- Native of Connecticut
Expertise in musculoskeletal imaging
Joined Raleigh Radiology in 2008
Michael C. Hollingshead, MD
Neuroradiologist
- Head of Neuroradiology at Rex Hospital
- BA, University of North Carolina at Chapel Hill
- MD, University of North Carolina at Chapel Hill
- Internship, University of North Carolina at Chapel Hill
- Residency, University of North Carolina at Chapel Hill
- Fellowship in neuroradiology, University of North Carolina at Chapel Hill
- Certificate of added Qualifications in Neuroradiology awarded by American Board of Radiology
- Member, American Society of Neuroradiology, American College of Radiology,Radiological Society of North America
- Native of Massachusetts
Expertise in neuroradiology
Joined Raleigh Radiology in 2008
Jason R. Harris, MD
Vascular and Interventional Radiologist
- BS, Brigham Young University
- MD, Harvard Medical School
- Internship, Newton-Wellesley Hospital, Newton, Massachusetts
- Residency, Massachusetts General Hospital, Boston, Massachusetts
- Fellowship in vascular and interventional radiology, Duke University Medical Center
- Member, American College of Radiology, Society of Interventional Radiology
- Native of California
Expertise in vascular and interventional and musculoskeletal radiology
Joined Raleigh Radiology in 2008
You should inform your physician of any medications you are taking and if you have any allergies, especially to iodinated contrast materials. Also inform your doctor about recent illnesses or other medical conditions.
You can take your usual prescribed oral medications with limited amounts of water. The day before the exam remain on clear liquids all day drinking 8 oz. of water each hour. For your meals, you can drink sugar free drinks (no milk or creamer), clear broths, sugar free gelatin, and sugar free popsicles. You can pick up your prep and instructions from our Blue Ridge, Ceadrhurst and Cary facilities.
Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation.
