Pediatric Barium Studies: Radiological Findings Guide

Upper Gastrointestinal Tract Conditions

Gastroesophageal Reflux Disease (GERD)

Spontaneous reflux of contrast into esophagus
Delayed clearance of refluxed material
Thickened esophageal folds
Possible hiatal hernia
Height of reflux column and frequency are important metrics

Tracheoesophageal Fistula

Contrast material entering tracheobronchial tree
Blind-ending esophageal pouch (in type C)
Coiling of nasogastric tube in upper pouch
Air in stomach (in most common type)
Requires immediate cessation of study if aspiration occurs

Achalasia

Bird-beak appearance of distal esophagus
Dilated esophagus above stricture
Delayed emptying of barium
Absence of primary peristalsis
Minimal LES relaxation

Pyloric Stenosis

Elongated pyloric channel ("string sign")
Delayed gastric emptying
Enlarged stomach with peristaltic waves
"Shoulder sign" on fluoroscopy
Double track sign

Duodenal Atresia

"Double bubble" sign
Complete obstruction to passage of contrast
Dilated proximal duodenum
Absence of distal bowel gas
Usually diagnosed on plain radiograph

Lower Gastrointestinal Tract Conditions

Hirschsprung's Disease

Transition zone between dilated and narrowed bowel
Irregular contraction of affected segment
Delayed evacuation (>24 hours)
Saw-tooth appearance in longer segments
Possible microcolon in total colonic involvement

Malrotation

Abnormal position of duodenojejunal flexure
Corkscrew appearance of small bowel
"Bird's beak" sign in volvulus
Spiraling of mesenteric vessels
May require urgent surgical intervention

Intussusception

Filling defect with "coiled spring" appearance
Meniscus sign
Claw sign
Complete obstruction in advanced cases
Possible leading point identification

Inflammatory Bowel Disease

String sign (in Crohn's)
Cobblestone mucosa
Skip lesions (in Crohn's)
Thumb printing (in ulcerative colitis)
Loss of haustra

Meckel's Diverticulum

Contrast-filled outpouching from ileum
Usually on antimesenteric border
May show ulceration
Variable size and shape
Possible connection to umbilicus

Congenital Anomalies

Esophageal Atresia

Blind-ending proximal pouch
Coiling of nasogastric tube
Absence of distal gas (in pure atresia)
H-type fistula demonstration
Limited contrast use recommended

Intestinal Atresia

Dilated proximal bowel
Microcolon distally
Complete cutoff sign
Multiple dilated loops in multiple atresias
Possible associated anomalies

Cloacal Malformation

Common channel visualization
Abnormal communication between systems
Hydrocolpos may be present
Vesicoureteral reflux
Complex anatomy requiring detailed imaging

Duodenal Web

"Windsock" deformity
Partial obstruction pattern
Dilated proximal duodenum
Small central aperture
Delayed passage of contrast

Annular Pancreas

Circumferential narrowing of duodenum
Double bubble appearance
Complete or partial obstruction
Possible associated anomalies
Delayed gastric emptying

Functional Disorders

Gastroparesis

Delayed gastric emptying
Retained gastric contents
Dilated stomach
Poor peristaltic activity
4-hour retention of contrast

Chronic Intestinal Pseudo-obstruction

Dilated bowel loops
Decreased or absent peristalsis
Air-fluid levels
No mechanical obstruction
Slow transit time

Functional Constipation

Rectal fecal retention
Dilated rectum and sigmoid
Delayed transit time
Normal caliber proximal colon
No transition zone

Post-Surgical Findings

Post-Fundoplication

Wrap configuration
Gastric emptying pattern
Possible herniation
Tight wrap appearance
Resolution of reflux

Post-Duodenal Atresia Repair

Anastomotic patency
Residual dilatation
Transit time
Possible stricture
Delayed gastric emptying

Post-Pull-through for Hirschsprung's

Anastomotic integrity
Caliber change
Evacuation efficiency
Possible stricture
Rectal reservoir size

Inflammatory and Infectious Conditions

Eosinophilic Esophagitis

Ring-like indentations
Linear furrows
Small-caliber esophagus
Mucosal irregularity
Possible strictures

Tuberculosis Enteritis

Ileocecal involvement
Contracted cecum
String sign
Ulceration pattern
Possible fistulation

Appendicitis (if barium needed)

Non-filling of appendix
Mass effect
Cecal wall edema
Terminal ileum compression
Not primary diagnostic tool

Motility Disorders

Diffuse Esophageal Spasm

Corkscrew or rosary bead appearance
Simultaneous contractions
Tertiary contractions
Normal LES relaxation
Intermittent nature of findings

Scleroderma

Smooth, dilated esophagus
Decreased peristalsis
Wide-caliber lumen
Poor LES tone
Patulous esophagus

Colonic Dysmotility

Altered transit time
Segmental dilatation
Irregular contraction patterns
Retained contrast material
Variable haustral pattern

Neoplastic Conditions

Gastrointestinal Stromal Tumors (GIST)

Submucosal filling defect
Smooth borders
Possible ulceration
Endoluminal or exophytic growth
Variable size and location

Lymphoma

Multiple filling defects
Luminal narrowing
Mucosal nodularity
Possible mass effect
Segmental involvement

Carcinoid Tumors

Small filling defects
Kinking of bowel
Tethering of mucosa
Possible desmoplastic reaction
Often in terminal ileum

Vascular Anomalies

Portal Hypertension Effects

Esophageal varices
Nodular mucosal pattern
Serpentine filling defects
Gastric varices
Prominent mucosal folds

Median Arcuate Ligament Syndrome

Extrinsic compression of duodenum
Post-stenotic dilatation
Delayed gastric emptying
Variable obstruction with positioning
Possible associated vascular findings

Traumatic Conditions

Post-Caustic Ingestion

Irregular mucosal pattern
Stricture formation
Scarring and webbing
Modified emptying time
Careful contrast administration needed

Foreign Body Related Changes

Filling defects
Possible perforation
Mucosal erosion
Stricture formation
Associated inflammatory changes

Anatomical Variants

Intestinal Malrotation Variants

Non-rotation
Reversed rotation
Mixed rotation
Abnormal mesenteric attachment
Variable small bowel position

Duplication Cysts

Mass effect on bowel
Communication with lumen
Smooth filling defect
Possible associated anomalies
Variable location along GI tract

Heterotopic Pancreas

Submucosal filling defect
Central umbilication
Usually in antrum or duodenum
Preserved mucosal pattern
May show ductal pattern

Post-Inflammatory Conditions

Post-NEC Changes

Stricture formation
Irregular bowel contour
Possible perforation sites
Altered motility
Variable bowel caliber

Post-Radiation Changes

Rigid bowel loops
Reduced bowel mobility
Mucosal pattern changes
Possible strictures
Altered transit time

Metabolic and Systemic Conditions

Cystic Fibrosis GI Manifestations

DIOS pattern
Thick intestinal contents
Delayed transit
Possible intussusception
Meconium ileus in neonates

Immunodeficiency Related Changes

Multiple ulcerations
Irregular mucosal pattern
Possible infections
Lymphoid hyperplasia
Variable bowel wall thickness

Complex Structural Abnormalities

VACTERL Association GI Findings

Esophageal atresia patterns
Duodenal malrotation
Possible anal atresia
Associated vertebral shadows
Multiple system involvement

Prune Belly Syndrome

Malrotation patterns
Dilated bowel loops
Poor bowel fixation
Abnormal bowel position
Associated urological findings

CHARGE Syndrome GI Manifestations

Tracheoesophageal anomalies
Swallowing dysfunction
Possible choanal atresia effects
Gastroesophageal reflux patterns
Aspiration risk signs

Rare Gastrointestinal Conditions

Blue Rubber Bleb Nevus Syndrome

Multiple filling defects
Venous malformations
Variable size lesions
Possible compression effects
Throughout GI tract

Cronkhite-Canada Syndrome

Multiple polyps
Mucosal edema
Protein-losing pattern
Altered mucosal folds
Diffuse involvement

Intestinal Lymphangiectasia

Thickened mucosal folds
Nodular filling defects
Small bowel dilation
Delayed transit
Possible protein loss pattern

Post-Transplant Findings

Post-Small Bowel Transplant

Anastomotic configuration
Mucosal pattern changes
Transit time alterations
Possible rejection signs
Bowel wall thickness changes

Post-Liver Transplant GI Changes

Portal hypertension resolution
Varices changes
Bowel motility patterns
Possible biliary complications
Vascular anastomosis effects

Neurodevelopmental Condition Effects

Cerebral Palsy GI Manifestations

Swallowing dysfunction pattern
Delayed gastric emptying
Reflux findings
Aspiration risk signs
Altered colonic transit

Muscular Dystrophy GI Effects

Dysphagia patterns
Delayed emptying
Possible gastroparesis
Altered peristalsis
Risk of aspiration signs

Autonomic Dysfunction

Variable motility patterns
Gastroparesis findings
Intestinal pseudo-obstruction
Altered sphincter function
Transit time variations

Parasitic Conditions

Ascariasis

Linear filling defects
Multiple worm shadows
Possible obstruction
Bowel wall edema
Migration tracks

Schistosomiasis

Colonic wall thickening
Polypoid lesions
Sandy mucosal pattern
Possible strictures
Portal hypertension effects

Metabolic Storage Diseases

Glycogen Storage Disease

Delayed gastric emptying
Hepatomegaly effect
Altered bowel position
Possible compression
Modified transit patterns

Amyloidosis

Fine mucosal granularity
Bowel wall thickening
Motility disorders
Possible strictures
Small bowel dilatation

Emergency Conditions

Midgut Volvulus

Corkscrew appearance
Bird beak sign
Complete obstruction
Abnormal SMA relationship
Surgical emergency

Necrotizing Enterocolitis

Pneumatosis intestinalis
Fixed dilated loops
Portal venous gas
Possible perforation
Contrast study contraindicated in acute phase

Toxic Megacolon

Massive colonic dilatation
Loss of haustration
Mucosal islands
Possible perforation
Contrast study usually contraindicated

Connective Tissue Disorders

Ehlers-Danlos Syndrome

Intestinal diverticula
Spontaneous perforation sites
Altered bowel mobility
Possible hiatal hernia
Abnormal bowel positioning

Marfan Syndrome

Increased bowel length
Redundant loops
Possible intestinal dilatation
Abnormal fixation
Modified transit patterns

Osteogenesis Imperfecta

Colonic redundancy
Possible herniation
Altered bowel position
Vertebral compression effects
Transit time variations

Immunological Disorders

Common Variable Immunodeficiency

Nodular lymphoid hyperplasia
Small bowel fold thickening
Possible strictures
Infection patterns
Malabsorption signs

Chronic Granulomatous Disease

Inflammatory strictures
Skip lesions
Possible fistula formation
Bowel wall thickening
Granuloma-related findings

IgA Deficiency

Mucosal fold patterns
Possible celiac-like changes
Infection susceptibility signs
Transit alterations
Variable absorption patterns

Endocrine System Effects

Diabetic Gastropathy

Delayed gastric emptying
Altered peristalsis
Possible bezoar formation
Retained food residue
Modified transit time

Thyroid Disease Effects

Hyper/hypo motility patterns
Transit time changes
Possible megacolon
Esophageal mobility changes
Absorption pattern variations

Addison's Disease

Hypomotility patterns
Possible mucosal atrophy
Delayed emptying
Altered absorption
Transit time changes

Nutritional Disorders

Severe Malnutrition

Mucosal atrophy
Decreased fold pattern
Transit time alterations
Small bowel dilatation
Possible bacterial overgrowth signs

Vitamin D Deficiency

Osteomalacia effects
Possible compression
Modified bowel position
Transit variations
Absorption pattern changes

Zinc Deficiency

Mucosal pattern changes
Altered absorption
Modified motility
Possible inflammation signs
Transit time variations

Complex Surgical Conditions

Post-Gastric Pull-up

New anatomical configuration
Anastomotic appearance
Transit patterns
Possible stricture formation
Aspiration risk signs

Post-Colonic Interposition

Graft position
Peristaltic patterns
Anastomotic integrity
Transit function
Possible redundancy

Post-Intestinal Lengthening

STEP procedure patterns
Bianchi procedure findings
Transit time changes
Absorption capacity signs
Motility patterns

Rare Metabolic Conditions

Mitochondrial Disease GI Effects

Pseudo-obstruction patterns
Motility disorders
Variable transit time
Possible megacolon
Absorption variations

Lipid Storage Diseases

Organomegaly effects
Bowel wall thickening
Modified transit
Compression patterns
Absorption changes

Microvillus Inclusion Disease

Dilated bowel loops
Fluid level patterns
Altered mucosal relief
Transit variations
Secretory pattern

Chromosomal Disorders

Down Syndrome GI Manifestations

Duodenal stenosis pattern
Hirschsprung's association
Possible atlantoaxial instability effects
Celiac disease patterns
Modified transit times

Williams Syndrome

Possible arterial compression
Gastric emptying variations
Altered bowel position
Cardiovascular effects on GI tract
Transit pattern changes

Turner Syndrome

Possible intestinal telangiectasia
Inflammatory bowel patterns
Celiac disease association
Modified bowel position
Cardiovascular effects on GI tract

Neurocutaneous Syndromes

Neurofibromatosis

Gastrointestinal neurofibromas
Filling defects
Possible compression effects
Mucosal pattern changes
Variable bowel caliber

Tuberous Sclerosis

Hamartomatous polyps
Multiple filling defects
Possible mass effect
Modified transit patterns
Variable bowel involvement

Sturge-Weber Syndrome

Possible GI tract angiomas
Venous malformations
Variable filling defects
Modified mucosal pattern
Transit variations

Bone Marrow Transplant Effects

Acute GVHD

Mucosal edema
Luminal narrowing
Altered fold pattern
Modified transit time
Possible ulceration signs

Chronic GVHD

Esophageal webs
Stricture formation
Scleroderma-like pattern
Modified motility
Absorption changes

Post-VOD Changes

Portal hypertension effects
Bowel wall edema
Modified transit
Possible ascites effect
Varices patterns

Radiation Effects

Acute Radiation Enteritis

Mucosal edema
Fold thickening
Luminal narrowing
Hypomotility
Transit delay

Chronic Radiation Effects

Stricture formation
Fixed loops
Mucosal atrophy
Altered peristalsis
Possible fistulation

Radiation-Induced Dysmotility

Variable transit times
Altered peristaltic waves
Modified bowel tone
Segmental effects
Absorption changes

Iatrogenic Conditions

Post-Chemotherapy Changes

Mucositis pattern
Altered motility
Modified absorption
Possible ulceration
Transit variations

Medication-Induced Changes

NSAID-induced strictures
Potassium pill effects
Iron pill related changes
Bisphosphonate patterns
Modified transit times

Post-Ablation Effects

Stricture formation
Wall irregularity
Modified motility
Possible perforation
Healing pattern changes

Rare Infectious Complications

CMV Enteritis

Mucosal ulceration
Wall thickening
Possible strictures
Modified transit
Absorption changes

Fungal Infections

Candida esophagitis pattern
Aspergillus involvement
Mucormycosis effects
Transit modifications
Possible perforation

Mycobacterial Infections

Ileocecal involvement
Stricture formation
Fistula patterns
Modified transit
Lymphadenopathy effects

Note: Many of these conditions require correlation with clinical findings, laboratory results, and other imaging modalities for accurate diagnosis. Some findings may be subtle or variable depending on disease stage and treatment status.

Note: This guide is for educational purposes and should be used in conjunction with clinical findings and other imaging modalities. Radiation protection principles should always be followed, especially in pediatric patients.