Common indications for radiologic examination of the stomach include epigastric pain, nausea, vomiting, hematemesis, and abdominal masses.

Fluoroscopy:

X-ray beams are produced continuously, passed through the patient, and fall on a fluorescent screen. The image is greatly enhanced by passing through an image intesifier. A camera captures the enhanced image and displays it on a monitor in real-time; images are then continuously updated. Note that black and white are typically inverted from plain film appearance.

The stomach is imaged as part of an upper gastrointestinal series (UGIS) in which the esophagus, stomach, and duodenum are imaged concurrently. Examination may be performed using single-contrast or double-contrast techniques. Patients are asked to be NPO 8 hours prior to examination to ensure adequate gastric emptying.

Single-contrast study: The stomach is filled and distended with dilute barium or a water-soluble contrast agent. Water-soluble contrast should be used when perforation or post-operative anastomotic failure is suspected. The stomach is compressed either manually or by positioning to allow for adequate x-ray penetration in the evaluation of each anatomical segment. Single-contrast technique assesses thickness of the gastric folds and evaluation of gastric emptying. Large luminal defects can be detected.

Double-contrast study: The stomach is temporarily paralyzed by administration of glucagon, filled with dense barium, and distended with gas using effervescent granules. Hence both barium and air are used for contrast. Images are obtained as the patient rolls in various positions to coat the gastric mucosa with contrast. Double-contrast technique provides improved visualization of the gastric mucosa.

See Procedures Manual for more detailed information on trauma.

Computed Tomography (CT):

CT of the stomach has limited applications and is typically reserved for further evaluation of already established abnormalities; however, CT may disclose gastric findings when used in the routine evaluation of abdominal pain.

Ultrasound:

Ultrasonography is employed in the diagnosis of hypertrophic pyloric stenosis in neonates. The utility of ultrasound is otherwise limited by intraluminal air.