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X-ray of the stomach and duodenum
Last reviewed: 05.07.2025
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Radiation and endoscopic examinations form the basis of comprehensive diagnostics of stomach diseases. Among radiation methods, X-ray is of primary importance. The plan of X-ray examination (X-ray) of the stomach and duodenum depends on the anamnesis data and clinical picture of the disease.
In emergency diagnostics, i.e. in acute conditions, the patient undergoes X-ray examination of the chest and abdominal organs in vertical and horizontal positions. Artificial contrast of the digestive tract is performed only for special indications.
Preparation for X-ray of the stomach and duodenum
Screening examinations of the stomach during a medical examination are carried out on special X-ray diagnostic devices - gastrofluorographs - under the control of X-ray television scanning. The examination is carried out on an empty stomach. 20-30 minutes before it, the patient puts 2-3 Aeron tablets under the tongue to relax the stomach. A specially prepared highly concentrated suspension of barium sulfate is used as a contrast agent, and a fanulated gas-forming drug is used to stretch the stomach. X-ray photography is performed in several standard projections with the patient in vertical and horizontal positions. The resulting images are called "gastrofluorograms". Their size, unlike conventional X-ray films, is small - 10x10 or 11x11 cm, the number is 8-12. If pathological changes are detected in the images, the patient is usually referred for fibrogastroscopy. Conducting screening mass X-ray examinations is justified in those geographical areas where the incidence of stomach cancer is high.
Preparation for X-ray of the stomach and duodenum
Normal stomach and duodenum
Before taking the contrast mass, there is a small amount of air in the stomach. When the body is in a vertical position, the gas bubble is located in the area of the vault. The rest of the stomach is a ridge with thick and maximally close walls.
The contrast mass swallowed by the patient, in a vertical position of the body, gradually passes from the esophagus into the stomach and descends from the cardiac opening into the body, sinus and antral section. Already after the first small swallows of barium, folds of the gastric mucosa appear - the relief of the internal surface of the organ appears. This folded relief is not constant and reflects the physiological state of the stomach.
Normal X-ray anatomy of the stomach and duodenum
Diseases of the stomach and duodenum
Indications for radiological examination of the stomach are very broad due to the high prevalence of "stomach" complaints (dyspeptic symptoms, abdominal pain, loss of appetite, etc.). Radiological examination is performed when there is a suspicion of peptic ulcer, tumor, in patients with achylia and anemia, as well as with gastric polyps that for some reason have not been removed.
Chronic gastritis. In recognizing gastritis, the main role is given to clinical examination of the patient in combination with endoscopy and gastrobiopsy. Only by histological examination of a piece of gastric mucosa can the form and prevalence of the process and the depth of the lesion be determined. At the same time, in case of atrophic gastritis, X-ray examination is equivalent in efficiency and reliability to fibrogastroscopy and is second only to biopsy microscopy.
Gastric and duodenal ulcers. Radiography plays an important role in recognizing ulcers and their complications.
When performing an X-ray examination of patients with gastric ulcer and duodenal ulcer, the radiologist faces three main tasks. The first is to assess the morphological state of the stomach and duodenum, primarily to detect the ulcer defect and determine its position, shape, size, outline, and the state of the surrounding mucous membrane. The second task is to examine the function of the stomach and duodenum: to detect indirect signs of ulcer disease, to establish the stage of the disease (exacerbation, remission), and to assess the effectiveness of conservative therapy. The third task is to recognize complications of ulcer disease.
Stomach cancer. Initially, the tumor is an island of cancerous tissue in the mucous membrane, but later on, various tumor growth paths are possible, which predetermine radiographic signs of small cancer. If necrosis and ulceration of the tumor predominate, then its central part sinks in comparison with the surrounding mucous membrane - the so-called deep cancer. In this case, double contrasting reveals a niche of irregular shape with uneven contours, around which there are no areolas. The folds of the mucous membrane converge toward the ulceration, slightly expanding in front of the niche and losing their outlines here.
Benign tumors of the stomach. The radiographic picture depends on the type of tumor, its stage of development and growth pattern. Benign tumors of epithelial nature (papillomas, adenomas, villous polyps) originate from the mucous membrane and protrude into the lumen of the stomach. At first, an unstructured rounded area is found among the areolas, which can only be seen with double contrast of the stomach. Then, a local expansion of one of the folds is determined. It gradually increases, taking the form of a rounded or slightly elongated defect. The folds of the mucous membrane bypass this defect and are not infiltrated.
Postoperative diseases of the stomach. X-ray examination is necessary for timely detection of early postoperative complications - pneumonia, pleurisy, atelectasis, abscesses in the abdominal cavity, including subphrenic abscesses. Gas-containing abscesses are relatively easy to recognize: on images and during transillumination, it is possible to detect a cavity containing gas and liquid. If there is no gas, then a subphrenic abscess can be suspected by a number of indirect signs. It causes a high position and immobilization of the corresponding half of the diaphragm, its thickening, unevenness of outlines. "Sympathetic" effusion in the costophrenic sinus and foci of infiltration at the base of the lung appear. Sonography and computed tomography are successfully used in the diagnosis of subphrenic abscesses, since accumulations of pus are clearly outlined in these studies. An inflammatory infiltrate in the abdominal cavity produces an echo-heterogeneous image: there are no areas free of echo signals. An abscess is characterized by the presence of a zone devoid of such signals, but a denser rim appears around it - a display of the infiltrative shaft and pyogenic membrane.