A mom believes that her 16 yr. old daughter will not sit for a barium swallow. Are there tricks to expediting this with a resistant patient? Can it be done under anesthesia? General GI issues include hard stool, recent weight gain due to medications and self-injury (hitting self in the head). Any tips would be appreciated.
There are many times when a radiologist will do an upper GI study with a naso-gastric tube in place and drizzle the barium into the esophagus. Of course, it is not easy to get the tube in. If a patient is totally combative, it is not possible to do the test. Sedation can add some risk, as it diminishes the gag reflex and may make them aspirate. If they need to do a small bowel study as part of it, they may insert a tube partway through.
Wrap her in a blanket and put a tube down to give the barium if she won’t drink it – it depends on the indication. If you don’t need to see the esophagus, sometimes they will drink it away from the table and then you can get the pictures needed after the barium is in.
Instead of a barium swallow, an endoscopy (performed by a gastroenterologist) might be preferable to evaluate the upper bowel. Constipation is common with CdLS, and should be addressed with dietary changes and possible medications.
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