Gastrointestinal passage (synonym: MDP) is a radiographic procedure used to examine the upper gastrointestinal tract, which includes the esophagus (food pipe), stomach, and duodenum (small intestine). In addition, the jejunum and ileum (small intestine) can also be examined. This is a contrast medium-assisted procedure that is performed under high radiation exposure, so the patient must be informed in detail about the risks and possible complications. Today, the informative value of gastrointestinal passage is surpassed by endoscopic procedures such as gastroscopy (gastroscopy) or endosonography (endoscopic ultrasound (EUS); ultrasound examination performed from the inside, i.e., the ultrasound probe is brought into direct contact with the inner surface (for example, the mucosa of the stomach/intestine) by means of an endoscope (optical instrument)). Gastroscopy allows, for example, the removal of tissue samples for histological (fine tissue) examination. Radiographic examination of the small bowel in clinical practice is preferably performed using Sellink small bowel imaging.
Indications (areas of application)
- Chronic inflammatory bowel diseases – e.g. Crohn’s disease or ulcerative colitis.
- Diverticula – protrusions of the mucosa.
- Gastritis (inflammation of the gastric mucosa) – of varying severity and genesis (cause).
- Gastroesophageal reflux disease (synonyms: GERD, gastroesophageal reflux disease; gastroesophageal reflux disease (GERD); gastroesophageal reflux disease (reflux disease); gastroesophageal reflux; reflux esophagitis; reflux disease; Reflux esophagitis; peptic esophagitis) – inflammatory disease of the esophagus (esophagitis) caused by the pathological reflux (reflux) of acid gastric juice and other gastric contents.
- Gastroparesis (gastric paralysis).
- Hernias – e.g., hiatal hernia (hiatal hernia).
- Congenital (congenital) anomalies – e.g. hypertrophic pyloric stenosis (gastric pyloric stenosis).
- Control of complications after gastric surgery
- Gastric carcinoma (stomach cancer)
- Gastric lymphoma – an extranodal accumulation of lymphocytes localized in the stomach wall in the sense of a lymphoma; it belongs to the non-Hodgkin’s lymphomas.
- Gastric polyps (gastric mucosal growths).
- Gastric outlet stenosis (narrowing of the gastric outlet)
- Esophageal achalasia (synonyms: achalasia; cardiospasm) – dysfunction of the lower esophageal sphincter (esophageal muscles) with the inability to relax; it is a neurodegenerative disease in which nerve cells of the myenteric plexus die. In the final stage of the disease, the contractility of the esophageal muscles is irreversibly damaged, with the result that food particles are no longer transported into the stomach and lead to pulmonary dysfunction by passing into the trachea (windpipe). Typical symptoms of achalasia are: Dysphagia (dysphagia), regurgitation (rebound of food), chest pain (chest pain) and weight loss; as a secondary achalasia, it is usually the result of a neoplasia (malignant neoplasm), such as a cardiac carcinoma (gastric inlet cancer).
- Esophageal carcinoma (esophageal cancer).
- Ulcus pepticum (peptic ulcer; gastric ulcer).
Before the examination
From the evening before the examination, the patient should refrain from eating and drinking, also avoid the consumption of nicotine or chewing gum due to the formation of gastric acid, so that he is sober the next day.
The procedure
Contrast medium is used for the examination; this is usually barium sulfate or water-soluble contrast medium (e.g., Gastrografin) if stenosis (narrowing) is suspected. The contrast medium is administered orally at intervals of 15 to 30 minutes and covers the entire mucosa. To achieve complete coverage, the X-ray table may be tilted and the patient rotated on his or her own axis. The passage of the contrast agent through the esophagus, stomach, duodenum, and small intestine is documented at various time points either by fluoroscopy or by individual radiographs. During gastrointestinal passage, it is possible to assess:
- Anatomy of the organs
- Mucosa – e.g., inflammatory or tumorous changes in mucosal relief.
- Wall contour of the organs
- Swallowing act
- Emptying time
- Passage time of the contrast agent
- Gastrointestinal peristalsis (intrinsic movement of the organs).
To achieve double contrast imaging, a tasteless effervescent powder is usually administered to induce gas evolution (carbon dioxide) and act as a negative contrast agent to cause the gastrointestinal tract to unfold. A drug to inhibit peristalsis of the gastrointestinal tract may be administered (e.g., buscopan).
