Upper GI

Summary
FAQ
Doctors
Exam Prep

What is Upper Gastrointestinal (GI) Tract Radiography?

Upper gastrointestinal tract radiography, also called an upper GI, is an x-ray examination of the pharynx, esophagus, stomach and first part of the small intestine (also known as the duodenum) that uses a special form of x-ray called fluoroscopy and an orally ingested contrast material called barium.
Fluoroscopy makes it possible to see internal organs in motion. When the upper GI tract is coated with barium, the radiologist is able to view and assess the anatomy and function of the esophagus, stomach and duodenum.

An x-ray examination that evaluates only the pharynx and esophagus is called a barium swallow.
In addition to drinking barium, some patients are also given baking-soda crystals (similar to Alka-Seltzer) to further improve the images. This procedure is called an air-contrast or double-contrast upper GI.

What are some common uses of the procedure?

An upper GI examination helps evaluate digestive function and to detect:

ulcers
tumors
inflammation of the esophagus, stomach and duodenum
hiatal hernias
scarring
blockages
abnormalities of the muscular wall of GI tissues

The procedure is also used to help diagnose symptoms such as:

difficulty swallowing
chest and abdominal pain
reflux (a backward flow of partially digested food and digestive juices), also known as gerd
unexplained vomiting
severe indigestion
blood in the stool (indicating internal GI bleeding)

Additional Resources

www.radiologyinfo.org/content/upper_gi.htm

Frequently Asked Questions

How does the procedure work?

Fluoroscopy uses a continuous x-ray beam to create a sequence of images that are projected onto a television-like monitor. When used with a contrast material, it clearly defines the area being examined by making it appear bright white.
How is the procedure performed?

This examination is usually performed on an outpatient basis and is often scheduled in the morning to reduce the patient's fasting time.

A radiologic technologist and a radiologist, a physician specifically trained to supervise and interpret radiology examinations, guide the patient through the upper GI series. As the patient drinks the liquid barium, which resembles a light-colored milkshake, the radiologist will watch the barium pass through the patient's digestive tract on a fluoroscope, a device that projects radiographic images in a movie-like sequence onto a monitor. The exam table will be positioned at different angles and the patient's abdomen may be compressed to help spread the barium. Once the upper GI tract is adequately coated with the barium, still x-ray images will be taken and stored for further review. The patient must hold very still and may be asked to keep from breathing for a few seconds while the x-ray picture is taken to reduce the possibility of a blurred image.

For a double-contrast upper GI series, the patient will swallow baking-soda crystals that create gas in the stomach while additional x-rays are taken. When the examination is complete, you will be asked to wait until the radiologist determines that all the necessary images have been obtained. This exam is usually completed within 20 minutes.

Neil A. Ramquist, MD

Diagnostic Radiologist

Medical Director of Diagnostic Imaging 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, Breast Center, and Cary Women's Imaging 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 and Breast Imaging and Intervention Radiologist

Medical Director, Raleigh Radiology Cedarhurst, Clayton, Wake Forest, and Brier Creek
Former President of Raleigh Radiology
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 & 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

Vice President of Medical Staff Officers & Committees of Rex Hopsital
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

Medical Director, Musculoskeletal Imaging at Rex Hospital
Medical Director, MRI 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

Director of Raleigh Radiology Recruiting
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

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 & Abdominal Imaging 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

Medical Director 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 & Abdominal Imaging 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

Director 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

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, PET/CT, oncologic imaging and abdominal imaging
Joined Raleigh Radiology in 2004

Todd J. Roth, MD

Abdominal Imaging Radiologist

Vice Chief of Radiology at Rex Hospital
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, 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

Medical Director for Interventional Services at Rex Hospital & Raleigh Radiology
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, Society of Skeletal Radiology
Member, American College of Radiology
Member, American Roentgen Ray Society
Member, Radiological Society of North America
Member, Association of University Radiologist
Member, North Carolina Medical Society
Native of Chattanooga, Tennessee

Expertise in musculoskeletal imaging
Joined Raleigh Radiology in 2007

Jeffrey Browne, MD

Musculoskeletal Radiologist

Medical Director of CT for Rex Hospital
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

Medical Director of Neuroimaging 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

Kirk Peterson, MD

Abdominal Imaging Radiologist

BS, Florida Agricultural and Mechanical University-Tallahassee, FL
MD, University of South Carolina School of Medicine
Resident in radiology, University of North Carolina at Chapel Hill
Fellowship in abdominal imaging, Duke University Medical Center
Member, Radiological Society of North America
Member, American Roentgen Ray Society
Member, American College of Radiology
Native of Florida

Expertise in abdominal imaging, including MRI, MRA, and ultrasound
Joined Raleigh Radiology in 2010

How should I prepare?

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.

To ensure the best possible image quality, your stomach must be empty of food. The day before the exam remain on a clear liquid all day drinking 8 oz of water each hour. (For breakfast, lunch (noon) and dinner (5:00 pm) patient can drink sugar free drinks (no milk or creamer), clear broths, sugar free gelatin, sugar free popsicles.) The patient can pick up prep and instructions from our Blue Ridge, Cedarhurst and Cary facilities.