Upper endoscopy: the gold standard

[Dr Trek 1]

I'd like to get some input on this. I am curious as to what help an upper endoscopy can typically find when when the upper GI series is normal. What I mean is that when ulcers, diverticulitis, hietal hernia, GERD, h. pylori infection, tumors, and polyps are ruled out by the upper GI series, what diagnoses are typical other than unexplained gastritis? Althouhg the upper GI series is a crude test, I am curious as to other diagnoses an endoscopy can provide. Thanks!

---

Members don't see this ad.

 

[shtarker]

Really depends on a thousand things. Just my own experience though... Several episodes of "gastritis" over many years... EGD w/ duodenal biopsies... celiac disease. One in a hundred Americans has it. Never leave it out of your ddx.

 

[mustangsally65]

This is just my anecdotal experience, but I had an upper endoscopy first in April and was told I had a giant hiatal hernia. The upper GI and SBFT that followed a few weeks later reported that everything was normal and there was no evidence of a hiatal hernia.

The endoscopy allows for direct visualization, so my gastroenterologist could see stomach tissue in what should have been the lower esophagus. The tissues look different under endoscopy, and you can also check for damage from acid reflux to the esophagus with an endoscopy. I'm glad I had one.

From what I was told the upper GI was more for a function/motility evaluation. They wanted to see how fast the barium moved through my upper digestive tract. I'm going to see my gastroenterologist next week ( for the first time since my endoscopy) so I'll update you if you're interested and if I learn something more relevant.

Incidentally, I was also tested for IBD and Celiac. Both tests were negative. And as a disclaimer, I'm just a pre-med with digestive problems, so I could be wrong on some of these things. 😛

 

[Loopo Henle]

Barrett's oesophagus
Atrophic gastritis
gastritis, gastritis
aformentioned celiac disease
Mallory Weiss
oesophageal varices
the list goes on an on. Barium swallows are good for big holes, big masses or esophageal dysmotility stuff (achalasia). Endoscopy is better for both direct visualization as well as the ability to biopsy, cauterize, band etc..

 

[Dr Trek 1]

Barrett's oesophagus
Atrophic gastritis
gastritis, gastritis
aformentioned celiac disease
Mallory Weiss
oesophageal varices
the list goes on an on. Barium swallows are good for big holes, big masses or esophageal dysmotility stuff (achalasia). Endoscopy is better for both direct visualization as well as the ability to biopsy, cauterize, band etc..

How about with a normal CBC? Can't Mallory Weiss be ruled out with a normal hemocrit?

 

[Loopo Henle]

How about with a normal CBC? Can't Mallory Weiss be ruled out with a normal hemocrit?

Mallory Weiss much like many things in medicine exists along a spectrum of severity from massive shock inducing hemorrhage to small tears causing only mild hematemesis/streaking. So no, a normal Hct can not rule out or rule in a Mallory Weiss tear. Although they are suspected based on the clinical picture, only upper endoscopy can diagnose them specifically.
My thoughts on barium swallow are this:
Swallowing troubles--> go to town
Stomach troubles, bleeding, anemia etc..- if the Barium swallow is positive, what is the next step? EGD. If the barium swallow is negative but the patient is persistently symptomatic, what is the next step? EGD. Why not cut out the middle man?

 

[eddieberetta]

The role of UGI studies is now mainly for assessment of esophageal motility/gastric emptying, , exclusion of functionally significant anatomic obstructing lesions (webs/rings/slings), non-invasive assessment of reflux, post-surgical assesment to exclude leak / stricture, and post-trauma (same). It may also be used as a first investigation of possible infectious / caustic / inflammatory esophagitis where endoscopy is relatively contraindicated.

There is a grey area of exams done to exclude ulcer/itis in low-risk patients, but as noted the sensitivity is not high enough to exclude disease in persistently symptomatic individuals and I do not recommend UGI studies in this population unless 1.) patient refuses or is unsuitable for endoscopy, 2.) Follow-up of pathologically proven process.

 

[Dr Trek 1]

Mallory Weiss much like many things in medicine exists along a spectrum of severity from massive shock inducing hemorrhage to small tears causing only mild hematemesis/streaking. So no, a normal Hct can not rule out or rule in a Mallory Weiss tear. Although they are suspected based on the clinical picture, only upper endoscopy can diagnose them specifically.
My thoughts on barium swallow are this:
Swallowing troubles--> go to town
Stomach troubles, bleeding, anemia etc..- if the Barium swallow is positive, what is the next step? EGD. If the barium swallow is negative but the patient is persistently symptomatic, what is the next step? EGD. Why not cut out the middle man?

People with an ulcer not caused by h. pylori could be diagnosed with just an upper GI series. It is much cheaper and less invasive than an EGD. I think that is why this "middle step" typically is done.

 

[Loopo Henle]

People with an ulcer not caused by h. pylori could be diagnosed with just an upper GI series. It is much cheaper and less invasive than an EGD. I think that is why this "middle step" typically is done.

Ulcers not caused by H. pylori need to be visualized and biopsied to r/o malignancy which can look identical to a non-malignant ulcer on the barium exam. I would be more apt to do an EGD on someone with a negative H. pylori ulcer then I would on someone with confirmed H. pylori PUD.

 

[bariume]

This is a great discussion. I agree that the radiologic barium swallow/UGI series/SBFT is in essence a "middle man" and that often is not needed in place of a good EGD where you can biopsy for H.pylori CLO test and for histology, and potentially treat lesions. However, there are several reasons why you may want to order one.

Here's a short list that comes to my mind.

1. work up a progressive dysphagia prior to invasive procedure to lessen the risk of a perforation. (Caveat - do not order a barium swallow in an acute dysphagia/foreign body ingestion/meat impaction - the barium will coat the walls of the GI tract and make the EGD views poor and the barium can damage the EGD instrument - EGD should be the first test done after a plain film xray)
2. visualize a small ulcer that cannot be seen easily on EGD due to edematous folds.
3. See protruding lesions in the small bowel that is beyond the 3rd portion of the duodenum (the typical end point of a standard EGD).
4. followup of a known cratered ulcer/defect. (although followup EGD Is usually the standard here)
5. To evaluate a potential gastric outlet obstuction suspected clinically
6. an upper GI evalation for anyone with a tenuous cardiopulmonary status that is too sick to undergo a full endoscopy.
7. a cheap and quick way to get information if an upper endoscopy cannot be conveniently done

 

[Loopo Henle]

3. See protruding lesions in the small bowel that is beyond the 3rd portion of the duodenum (the typical end point of a standard EGD).

I love all this talk about scopes 😍 😍 It makes me so happy 😍
I think you can get to the jejumnum if you push REALLY hard.

 

[Dr Trek 1]

Most GIs use Versaid for endoscopies. What does everything think about the true safety/risk of this drug?