Evaluation of the Small Bowel Barium Motor Meal

Various radiographic methods have been devised for examining the small bowel. Many of the technics, such as the use of the Miller-Abbott tube (1, 7, 25) and the small bowel enema (15, 20, 26, 34, 35), require intubation, a tedious procedure for the active roentgenologist and an uncomfortable experience for the patient. These methods are valuable, however, in selected cases, to demonstrate organic lesions. Examinations utilizing barium in saline followed by large volumes of iced saline, as described by Weintraub and Williams (39), are not physiologic, and a significant percentage of patients cannot tolerate the saline (2, 19). Administration of complex mixtures is not necessary for accurate evaluation of the small bowel; e.g., Brown (8) conducts his examination with a non-flocculating barium suspension (Raybar) mixed with cold water and soda. The use of neostigmine, as advocated by Margulis and his associates (28, 40), shortens the transit time of the barium meal, but only at the expense of alteration in motility and perhaps, as a consequence, in morphology as well. The simplest and most widely used method for demonstration of the small bowel involves the oral ingestion of a barium sulfate suspension, the barium motor meal. The amount of barium mixture necessary to conduct this examination most advantageously is, however, in dispute. Golden (17, 18, 19) suggests that 8 ounces of barium mixture (4 ounces by volume of dry barium sulfate and 4 (18) or 5 ounces (19) of water) is adequate. With larger amounts he feels there is overlapping of loops, particularly in the ileum, without gain in accuracy (19). Marshak (30, 31), on the other hand, believes that 16 to 20 ounces of barium suspension (8 ounces of commercial USP barium sulfate diluted with water to make 16 ounces of mixture) permits more complete filling of the adjacent loops and a better demonstration of the bowel wall with fewer films. He routinely uses flavored regular barium to which a suspending agent (agar or tragacanth) is added, in preference to a colloidal barium preparation. Golden (18) utilizes “nonflocculating” barium in water in most cases; regular barium sulfate in saline is used for patients with suspected disorders of motor function or “malabsorption states.” Because of the large number of patients with suspected intestinal disease referred to the U.S. Army Tropical Research Medical Laboratory and Rodríguez U.S. Army Hospital, a simple but accurate roentgenologic method for evaluating the small bowel was needed. The radiologist (W.L.C.) and the gastroenterologist (M.H.F.) were at odds as to the best method of examining the bowel; the former was an adherent of the small dose, and the latter of the large-volume technic. In an effort to assess these measures and to arrive at a mutually satisfactory method, the study to be reported here was undertaken.