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PubMed1998

Videomanometry of the pharynx in dysphagic patients with laryngeal barium penetration during swallowing.

PURPOSE: This study used simultaneous videomanometry to measure pressure characteristics in a group of patients with evidence of laryngeal and/or tracheal barium penetration, and to compare the results to those of one group of healthy volunteers and one group of patients with dysphagia but a normal barium swallow. MATERIAL AND METHODS: Videomanometry during barium swallowing was performed in 25 patients who showed penetration of barium into the laryngeal vestibule. Manometric abnormalities were determined by comparing these mean values with those of 25 healthy volunteers, and the frequency of manometric abnormalities was compared to that of 19 patients presenting with oropharyngeal dysphagia with a normal barium swallow. RESULTS: The frequency of abnormalities for four parameters (pharyngo-esophageal segment (PES) resting pressure, PES relaxation duration, pharyngeal peak pressure, pharyngeal contraction duration) differed significantly between the patients with penetration and those with normal barium studies. There was, however, no association between manometric abnormalities and the degree of barium penetration. CONCLUSION: The differences in manometric abnormalities between patients with laryngeal penetration and patients with normal barium swallows may be useful in identifying the mechanisms of laryngeal penetration.

Adult↗
PubMed2003

Wireless capsule video endoscopy is a superior diagnostic tool in comparison to barium follow-through and computerized tomography in patients with suspected Crohn's disease.

BACKGROUND: The recently introduced wireless M2A capsule video endoscopy (CVE) has been demonstrated to be superior to barium follow-through and enteroscopy in diagnosing patients with occult blood loss and iron-deficiency anaemia. OBJECTIVE: To further investigate CVE in comparison to barium follow-through and entero-computerized tomography (CT) in establishing the diagnosis of patients with suspected Crohn's disease. DESIGN AND SETTING: The study was conducted in one academic hospital. Twenty patients with recurrent abdominal pain and/or weight loss or chronic diarrhoea underwent barium follow-through as their initial examination, followed by CVE (if there was no stricture) and entero-CT. The radiologist that performed the barium follow-through and entero-CT was blinded to the results of the CVE. A blinded reader who was unaware of the study objective diagnosed the results of the CVE. In most cases in which there was a discrepancy between examinations, colonoscopy and ileoscopy were performed. For each patient, the diagnosis and disease extent were recorded. RESULTS: Twenty patients (13 males, 7 females; mean age 31 years, range 20-57) were included in the study. Ninety-five per cent of the patients had abdominal pain, 75% had diarrhoea, and 65% had weight loss. The mean haemoglobin level of the group was 13.1 g% (range 10-15.5). Only 13 patients underwent entero-CT.CVE confirmed the diagnosis of Crohn's disease that was suspected by alternative methods in six of the 20 patients. CVE made the diagnosis of Crohn's disease in six patients that had normal barium follow-through or entero-CT. CVE ruled out a diagnosis of Crohn's disease suspected by other modalities in three patients. CVE extended the involvement of Crohn's disease in three of the patients, and established new diagnoses in two patients. SUMMARY: CVE established new diagnoses, confirmed existing diagnoses, enlarged the extent of the disease, and ruled out the suspicion of Crohn's disease in 70% of the patients. Barium follow-through established diagnoses, measured the extent of the disease, and ruled out the suspicion of Crohn's disease in 37% of the patients. The capsule detected all of the lesions diagnosed by barium follow-through and entero-CT. CVE detected additional lesions that were not detected by other modalities in 47% of cases and ruled out lesions that were detected by other modalities in 16% of cases (P < 0.05). CONCLUSION: CVE is a superior and more sensitive procedure than barium follow-through and entero-CT in establishing the diagnosis and estimating the extent of Crohn's disease.

Adult↗
PubMed2004

Barium sulphate with a negative zeta potential accelerates skin permeability barrier recovery and prevents epidermal hyperplasia induced by barrier disruption.

BACKGROUND: Barium sulphate, a stable inorganic material, has been used in contrast media and cosmetic products because of its stability. As a negative external electric potential accelerates the skin barrier repair after barrier disruption, we hypothesized that topical application of barium sulphate may affect the skin barrier recovery rate depending on its zeta potential. OBJECTIVES: To investigate whether barium sulphate particles in aqueous solution have different zeta potentials depending on their surface structure, and to investigate the possible relation between zeta potential and skin barrier recovery rate. METHODS: Mice were subjected to tape stripping to disrupt barrier function, or were treated with acetone and kept in a dry environment to induce epidermal hyperplasia. They were then treated with different forms of barium sulphate, and barrier recovery was monitored by measurements of transepidermal water loss. RESULTS: There was a significant correlation between the barrier recovery rate and zeta potential of barium sulphate applied topically. Barium sulphate with a negative zeta potential significantly accelerated barrier recovery, but barium sulphate with a positive zeta potential did not accelerate or even delayed barrier repair. Barium sulphate with a negative zeta potential had an X-ray diffraction pattern different from that with a positive potential. The distribution of calcium in the epidermis was also influenced by the polarity of zeta potential. CONCLUSIONS: These findings suggest a new pharmacological approach towards altering barrier function or epidermal hyperplasia with inorganic particles in healthy and diseased skin.

Administration, Cutaneous↗
PubMed2003

Small bowel: preliminary comparison of capsule endoscopy with barium study and CT.

PURPOSE: To retrospectively compare capsule endoscopic (CE) findings with findings at barium studies or computed tomography (CT) in patients without evidence of small-bowel stricture at barium examination. MATERIALS AND METHODS: Fifty-two patients underwent CE, and the majority (43 of 52) did so for obscure gastrointestinal bleeding. Forty-two (81%) of 52 patients underwent 36 small-bowel follow-through examinations; four, enteroclysis; and 19, contrast material-enhanced CT of the abdomen and pelvis within 6 months of CE (either before or after CE). Imaging results were retrospectively reviewed and compared with CE, standard endoscopic, and surgical results. Findings of any examinations between CE and imaging that were discrepant were retrospectively reviewed by a radiologist not blinded to CE results. Proportion of positive findings at CE was compared with proportion of positive findings at barium studies and CT in the same patients. Statistical significance was calculated with McNemar chi2 statistic. RESULTS: Barium examination findings were positive in one (3%) of 40 patients; CE findings were positive in 22 (55%) (P <.001). CT demonstrated small-bowel findings in four (21%) of 19 patients, but CE demonstrated findings in 12 (63%) of 19 patients (P =.02). The most common CE finding, angioectasia (n = 11), was not detected at any imaging study. More ulcers (n = 8) were detected with CE than with barium study (one of eight) and CT (three of six). At CE, three of five surgically confirmed masses (carcinoid, intussusception, lymphangioma) were identified, but two jejunal tumors were not detected in a patient with poor bowel preparation. At barium study, no masses (zero of five) were detected; at CT, one of four masses was detected. CONCLUSION: In patients without a small-bowel stricture at barium study, more small-bowel disease was found at CE when findings were retrospectively compared with barium examination and CT findings.

Adult↗
PubMed1991

Videoendoscopic evaluation of patients with dysphagia: an adjunct to the modified barium swallow.

The modified barium swallow is currently the most comprehensive, widely available, and easily interpreted technique for the evaluation of patients with dysphagia by the head and neck surgeon. However, it requires the facilities, personnel, and use of a radiology suite, a trained speech pathologist, and exposure of the patient to radiation. It would therefore be helpful to have an adjunctive, physician based, nonradiographic method of examination that could provide information similar to and possibly even more complete than that supplied by the modified barium swallow. Such an adjunctive method could help otolaryngologist-head and neck surgeons confronted by a new patient with swallowing difficulties to orient themselves to the nature and severity of the problem while waiting for the modified barium swallow to be scheduled, performed, and reviewed. It could also be a helpful tool for management of patients with cancer of the head and neck, whose swallowing function may change rapidly in the early postoperative period. In such cases, intervals between modified barium swallow examinations (dictated by concern over radiation exposure) may be too far apart to allow up-to-the-minute decisions on case management. Finally, some patients who may be too ill to travel to the radiology suite might benefit from a bedside procedure that would yield information about swallowing function similar to that provided by the modified barium swallow. Videoendoscopic evaluation of dysphagia (VEED) is a protocol I developed and have used regularly since 1984. Experience with this method of dysphagia evaluation has shown that it answers the needs outlined above. Its usefulness also goes beyond that of the modified barium swallow by providing a more detailed understanding of the component anatomic and functional deficits that comprise a given patient's swallowing problem, information about upper aerodigestive tract sensory deficits, and a means for visual feedback training of pharyngeal and laryngeal musculature. The protocol is reviewed here. Case reports illustrating the clinical usefulness of VEED as an adjunct to the modified barium swallow are also presented, and the relative strengths and weaknesses of VEED and the modified barium swallow are compared.

Aged↗
PubMed1990

Lack of effect of drinking water barium on cardiovascular risk factors.

Higher cardiovascular mortality has been associated in a single epidemiological study with higher levels of barium in drinking water. The purpose of this study was to determine whether drinking water barium at levels found in some U.S. communities alters the known risk factors for cardiovascular disease. Eleven healthy men completed a 10-week dose-response protocol in which diet was controlled (600 mg cholesterol; 40% fat, 40% carbohydrate, 20% protein; sodium and potassium controlled at the subject's pre-protocol estimated intake). Other aspects of the subjects' lifestyles known to affect cardiac risk factors were controlled, and the barium content (as barium chloride) of the drinking water (1.5 L/day) was varied from 0 (first 2 weeks), to 5 ppm (next 4 weeks), to 10 ppm (last 4 weeks). Multiple blood and urine samples, morning and evening blood pressure measurements, and 48-hr electrocardiographic monitoring were performed at each dose of barium. There were no changes in morning or evening systolic or diastolic blood pressures, plasma cholesterol or lipoprotein or apolipoprotein levels, serum potassium or glucose levels, or urine catecholamine levels. There were no arrhythmias related to barium exposure detected on continuous electrocardiographic monitoring. A trend was seen toward increased total serum calcium levels with exposure to barium, which was of borderline statistical significance and of doubtful clinical significance. In summary, drinking water barium at levels of 5 and 10 ppm did not appear to affect any of the known modifiable cardiovascular risk factors.

Adult↗
PubMed1982

Barium enema after colorectal biopsies: experimental data.

The appropriate interval between a colorectal biopsy and a barium enema is controversial. Superficial and deep biopsies, above and below the peritoneal reflection, were performed on 12 dogs. Six control dogs did not have a barium enema. Six study dogs had a barium enema at different postbiopsy time intervals: immediately, 3 days, and 6 days. After superficial biopsies, there was no barium extravasation in any study animal. Histological examination, 48 hr after enema, showed complete epithelialization of all superficial sites on both study and control dogs. When the barium enema was done after a deep biopsy, there was intramural extravasation of barium immediately after biopsy but not after 3 or 6 days. Focal ulcerations were seen microscopically at sites of deep biopsies when the barium enema was performed immediately and 3 days after the diagnostic procedure. All deep biopsy sites were reepithelialized in 6 days. There was no evidence of intraperitoneal or retroperitoneal perforation and no difference in healing of biopsy sites in subjects and control animals. This study in dogs suggests that a barium enema may be performed without hazard immediately after a superficial biopsy of nondiseased colon and 6 days after a deep biopsy.

Animals↗
PubMed1987

Performance of barium examinations after acute myocardial infarction: report of a survey.

A survey of members of the Society of Gastrointestinal Radiologists was conducted to ascertain the standards of practice and timing for elective barium studies of the gastrointestinal tract in patients recovering from acute myocardial infarction. Sixty-two percent of respondents do not have cardiac monitoring apparatus readily available in the fluoroscopy suite. When readily available, such equipment is rarely (42%) or never (58%) used during routine barium examinations. Twenty-four percent of respondents take special precautions when performing examinations on these patients by reducing patient movement, the length of the examination, and the number of radiographs exposed, and by employing cardiac monitoring. Seventy-two (89%) of 81 respondents noted at least one adverse cardiovascular reaction. This was most often chest pain, but there were 10 deaths from cardiac causes. Two-thirds of respondents delay elective barium examinations of any kind for at least 4 weeks after acute myocardial infarction. The remaining one-third perform these studies earlier than 4 weeks. The latter typically limit their studies to the upper gastrointestinal tract (82%), 42% of which are single-contrast; the rest are equally divided between double-contrast and biphasic studies. This minority of radiologists is twice as likely to perform a single-contrast barium enema than a double-contrast barium enema during this period. No such preference for single-contrast (47%) over double-contrast (53%) barium enema is revealed by the majority who delay their elective barium enemas 4 or more weeks. The data indicate a strong preference to defer elective barium examinations a minimum of 4 weeks after acute myocardial infarction. A sizable minority (one-third) of radiologists, however, feel comfortable performing a single-contrast upper gastrointestinal examination at an earlier time.

Barium Sulfate↗
PubMed1990

[Evaluation of tiny abnormal mucosal findings on double contrast barium enema study].

Tiny abnormal mucosal findings on double contrast barium enema studies in 104 cases were classified into 5 patterns, as follows 1) small elevation, 2) elevation with barium fleck, 3) spotty barium fleck, 4) ill defined barium fleck and 5) barium fleck with halo. Each mucosal pattern was correlated with age, sex and symptoms, as well as the coexistence of the fine network pattern. They were compared with those of 86 control cases. 44 histologically proven cases were reviewed in order to clarify the clinical significance of the above 5 patterns. Incidence of the tiny mucosal findings was 4.8% (104/2186). 1) small elevation, 2) spotty barium fleck, 3) ill defined barium fleck and 4) barium fleck with halo were suggested the possibility of inflammatory bowel diseases.

Adolescent↗
PubMed1985

Effect of barium ion on p-aminohippurate transport in basolateral membrane vesicles isolated from rat kidney cortex.

To clarify the cause of the stimulation of p-aminohippurate (PAH) accumulation in rat kidney cortical slices by barium, an experiment was carried out with basolateral membrane vesicles isolated from rat kidney cortex. The effect of barium on PAH uptake by the membrane vesicles was compared with that of verapamil which also stimulated PAH accumulation in the slices. The enzyme marker for basolateral membrane, (Na+ + K+)- ATPase, was enriched 15-fold and the brushborder enzyme marker, alkaline phosphatase, was 1.3-fold in our membrane preparation. Contamination in this preparation by lysosomes, mitochondria and cytosol was also low but that by endoplasmic reticulum was slightly high as judged by the enzyme markers. PAH uptake by the membrane vesicles possessed the usual characteristics, i.e., sodium-dependence and probenecid-sensitivity. PAH uptake by the membrane vesicles was enhanced by barium, but not by verapamil. On the other hand, barium did not affect tetraethylammonium (TEA) uptake by the vesicles, and verapamil strongly inhibited it. Manganese also stimulated PAH uptake to the same extent as did barium, but calcium and strontium did not affect the uptake. Barium did not act on sodium transport in the membrane vesicles. An 'anion-sensitively transported lipophilic cation', triphenylmethylphosphonium iodide (TPMP), uptake was depressed by barium. These results suggest that barium stimulates selectively PAH uptake in basolateral membrane vesicles. Its stimulatory action may contribute at least partly to an increase in PAH accumulation in rat kidney cortical slices by this ion and may prove useful in an analysis of the mechanism of PAH transport system in renal basolateral membranes.

Acid Phosphatase↗
PubMed1988

Use of the modified barium swallow in the rehabilitation of the swallowing mechanism.

Swallowing is a rapid, dynamic and complex process. Surgical treatment of head and neck malignancies produces significant alterations in the swallowing mechanism. The modified barium swallow allows assessment of these physiologic and anatomic derangements in the postoperative patient. Small amounts of liquid barium, barium paste and a cookie coated with barium are ingested by the patient and the swallowing mechanism is recorded by videofluoroscopy. Unlike the routine barium swallow in which only the esophageal stage of swallowing is studied, using the modified barium swallow all four stages of swallowing are studied with particular emphasis on the oral and pharyngeal stages. Our experience with the modified barium swallow has shown it to be a valuable adjunct in the rehabilitation of the post-surgical patient allowing the otolaryngologist and speech pathologist to identify and modify swallowing abnormalities. Presentation of specific swallowing mechanism deficits as demonstrated using the modified barium swallow will be shown and appropriate therapeutic interventions discussed.

Aged↗
PubMed1986

Barium sulfate products for roentgenographic examination of the gastrointestinal tract.

Characteristics of barium sulfate contrast agents used in roentgenographic studies are described. Barium sulfate can be used as a single contrast agent in the gastrointestinal tract; it can also be used for positive contrast in studies that use air for negative contrast (double-contrast examinations). Barium sulfate can be used to opacify the GI tract in preparation for computerized tomography of the abdomen. Barium sulfate products are available in powder form or as viscous suspensions. Product formulas and barium sulfate concentrations are varied to produce adequate coating and visualization of the portion of the GI tract to be examined, and the dosage is determined by the specific procedure. Double-contrast studies delineate fine details of the GI mucosa; preparations used in these studies contain smaller barium particles than those used in single-contrast studies. Agents that produce carbon dioxide are usually administered for double-contrast studies; the gas distends the stomach or intestine so the barium can cover the entire surface. Formulations of barium sulfate products vary so that a product appropriate for the specific procedure can be selected. These products also vary in cost, ease of reconstitution, and, for oral preparations, acceptability to patients.

Barium Sulfate↗
PubMed1994

[Barium-pudding: a new medium for videofluoroscopic examination].

The evaluation of swallowing function is crucial in the management of dysphagic patients. It includes clinical assessment and laboratory tests that consist of fiberoptic endoscopic examination of swallowing (FEES) and videofluoroscopic examination. The "modified barium swallow" has been regarded as the standard procedure of videofluoroscopic examination since its introduction in 1983. The technique enables the entire process of deglutition to be observed with the benefits of safety, easily performance, and information. However, pitfalls developed in patients with pseudobulbar paralysis. Discrepancy always occurs between barium meals and real food and the refusal of swallow and misswallowing to the airway in videofluoroscopic examination sometimes occurs because of the unsatisfactory taste of barium meal. All these things make the procedure impractical and inaccurate. We developed a barium sulfate pudding that is better tasting, similar to real food as a pudding, is adequate to visualise on videofluoroscopic examination, and has the ability to represent the patient's capacity to swallow solid food. We present a case of hypoxic encephalopathy where the patient was considered to be in danger of aspiration when swallowing any consistency of foods. Barium-pudding study showed the patient had the ability to eat solid food with safety. We removed her nasogastric tube following barium-pudding assessment and successfully restored her oral feeding function within 2 weeks. Barium-Pudding is a better medium of videofluoroscopic examination by which to evaluate the swallowing function of solid food than Barium paste in patient, who have disturbed swallowing.

Aged↗
PubMed1995

The effect of barium sulphate on small bowel motility in man.

OBJECTIVE: To investigate the effect of barium sulphate on small bowel motor activity. METHODS: Nine healthy male volunteers underwent two separate, ambulatory 24 h manometry studies. Jejunal motor activity was recorded during fasting and after ingestion of 300 ml volumes of barium, water or a glucose solution (1380 kJ). Recordings were analysed visually for recurrence of phase III of the migrating motor complex, and a validated computer program was used to calculate the incidence and amplitude of contractions. RESULTS: Phase III reappeared 71 +/- 10 min after ingestion of barium sulphate. This interval was not significantly different after the intake of water (60 +/- 8 min) or in the fasted state (88 +/- 21 min), but it was significantly shorter than after ingestion of a glucose solution (136 +/- 17 min). The mean incidence of contractions after ingestion of barium was 3.0 +/- 0.5/min. This was significantly higher than that observed after water (1.9 +/- 0.4/min) and also significantly higher than during fasting (1.5 +/- 0.3/min), but not significantly different from the incidence of contractions after ingestion of a glucose solution (2.2 +/- 0.4/min). The mean amplitude of contractions after ingestion of barium was 24.2 +/- 1.4 mmHg. This was significantly higher than the amplitude of contractions during fasting (19.5 +/- 1.0 mmHg), but not significantly different from that after water intake (23.7 +/- 1.3 mmHg) or after ingestion of a glucose solution (21.4 +/- 1.3 mmHg). CONCLUSION: Small bowel motor activity after ingestion of barium sulphate differs distinctly both from the interdigestive and from the postprandial motor pattern. Barium suspensions do not interrupt the migrating motor complex with a typical 'fed' pattern, but contractions are more frequent after ingestion of barium than after the intake of water and are both more frequent and of greater force than the contractions observed during the fasted state.

Adult↗
PubMed2002

Poisoning as a result of barium styphnate explosion.

BACKGROUND: Acute barium poisoning is most often the result of accidental or suicidal ingestion of the rodenticide, barium carbonate. We describe a trauma patient whose condition was complicated by severe acute barium toxicity from an explosion of the propellant, barium styphnate. In addition to critical injuries, the patient manifested classic signs of barium toxicity including repeated profound hypokalemia, cardiac arrhythmias, respiratory failure, prolonged gastrointestinal dysfunction, paralysis, myoclonus, hypertension, and profound lactic acidosis. METHODS: The patient required lidocaine for ventricular bigeminy, massive infusions of potassium, prolonged ventilatory support, and parenteral nutrition to manage the effects of barium toxicity. RESULTS: He is the first reported case to demonstrate recurrent profound hypokalemia as an effect of blood transfusions. CONCLUSIONS: Considering the paucity of information concerning management of this life-threatening problem, the pathophysiology of barium toxicity, including the transfusion related hypokalemia, and its management is reviewed.

Accidents, Occupational↗
PubMed1987

Effects of sodium and calcium concentration on the barium chloride-induced electrical and contractile responses of the guinea pig vas deferens.

1. The mechanism of 10 mM barium chloride-induced electrical and contractile responses of the guinea pig vas deferens was investigated using calcium channel blockers and by modifying the Na+ and Ca2+ concentrations of the nutritional solution. Isometric contraction and membrane depolarization were measured simultaneously by the sucrose-gap technique. 2. In the absence of added Ca2+ there was a decay of the contractile but not of the depolarizing effect, which was independent of the frequency of 10 mM barium chloride administration. However, both barium-induced contraction and depolarization were reduced and the former more rapidly in a Ca2+-free solution (0.5 mM EGTA). 3. In low-Na+ solution (16 mM) there was a 3-fold increase in depolarization and no change in contraction, but in a low-Na+ Ca2+-free solution (0.5 mM EGTA), only contraction was reduced. 4. Nifedipine blocked both barium-induced contraction and depolarization in a dose-dependent manner when the organs were bathed in regular nutrient solution. In contrast, in low-Na+ solution only 50% of the depolarization was blocked by 10(-6) M nifedipine, which completely inhibited contraction. Both barium-induced contraction and depolarization in low-Na+ Ca2+-free solution were blocked by 10(-3) M LaCl3. 5. These data indicate that in the presence of calcium, barium mobilizes extracellular calcium through voltage-dependent channels and the contraction is due to the entry of calcium. In contrast, in the absence of added Ca2+ or in Ca2+-free solutions (0.5 mM EGTA), barium enters through the voltage-dependent channel and the contraction is reduced because the intracellular stores of calcium are limited.

Animals↗
PubMed1986

How useful is the barium enema in the diagnosis of infantile Hirschsprung's disease?

We studied the usefulness of the barium enema to rule out Hirschsprung's disease (congenital megacolon) in the evaluation of infants with constipation. Results from barium enemas in 58 constipated infants and children who underwent rectal suction biopsies to rule out aganglionosis were evaluated in retrospect for the presence of a transition zone, delayed evacuation of barium, and colonic anatomic abnormalities. As expected, the presence of a transition zone was most accurate in predicting Hirschsprung's disease. Eighty percent of infants with aganglionosis had a roentgenographic transition zone, while 20% did not. Twenty-nine percent of infants with a suspected roentgenographic transition zone did not have aganglionosis. Delayed evacuation of barium was a poor predictor of aganglionosis. The presence of delayed evacuation of barium did not improve the accuracy of the transition zone to predict Hirschsprung's disease. Barium enemas did not reveal any additional colonic anatomic defects other than a transition zone to account for constipation in our study group. These results demonstrated that the barium enema is not a specific enough screening procedure to rule out Hirschsprung's disease in the unobstructed infant. Rectal suction biopsy is diagnostic and should be performed as the procedure of choice in those infants suspected of having Hirschsprung's disease.

Barium Sulfate↗
PubMed1994

Double-contrast barium enema and flexible sigmoidoscopy for routine colonic investigation.

Over a 3-year period, all patients referred for barium enema examination had a double-contrast barium enema and flexible sigmoidoscopy performed on the same day. A total of 462 joint examinations were performed. Abnormalities were found in 193 patients by the use of barium enema, 164 patients by using sigmoidoscopy and 294 by the use of both methods of investigation. Sigmoidoscopy was superior to barium enema in the detection of polyps and inflammatory bowel disease but barium enema was more sensitive for diverticular disease. The presenting symptoms had no predictive value in distinguishing carcinoma, polyps and diverticular disease. Diverticular disease did not reduce the sensitivity of barium enema examination to polyps in the sigmoid colon. Fibreoptic sigmoidoscopy immediately before barium enema was well tolerated by patients. The investigations were complementary in the diagnosis of colonic polyps, inflammatory bowel disease and diverticular disease.

Barium Sulfate↗