What is the difference between an Upper Gastrointestinal (GI) series and an esophageal study?

From the Guidelines

An upper GI series is the preferred diagnostic test for evaluating structural and functional abnormalities of the esophagus, stomach, and duodenum, especially when symptoms suggest involvement of multiple parts of the upper digestive tract 1. When deciding between an upper GI series and an esophageal study, it's essential to consider the specific symptoms and suspected conditions.

• An upper GI series is beneficial for evaluating symptoms such as abdominal pain, unexplained weight loss, or suspected ulcers, as it provides a comprehensive examination of the esophagus, stomach, and duodenum 1.
• In contrast, an esophageal study (barium swallow) is preferred when symptoms suggest esophageal issues like dysphagia, heartburn, or regurgitation. The upper GI series is particularly useful in diagnosing conditions like scirrhous gastric carcinoma, which may manifest as diffuse, long-segment, or even short-segment narrowing of a portion of the stomach, and where endoscopy and biopsy have poor sensitivity 1. Key differences between the two procedures include:
• The extent of the examination: upper GI series examines the esophagus, stomach, and duodenum, while an esophageal study focuses specifically on the esophagus.
• The amount of barium required: an esophageal study typically requires less barium.
• The duration of the procedure: an esophageal study usually takes less time to complete, typically 15-30 minutes, compared to 30-60 minutes for a full upper GI series. Ultimately, the choice between these tests depends on the specific symptoms and suspected conditions, with the upper GI series providing a broader evaluation of the upper digestive system 1.

From the FDA Drug Label

ORAL ADMINISTRATION Esophagus and Cardiac Series Undiluted LIQUID POLIBAR PLUS® should be administered orally for double-contrast examination of the esophagus. Stomach LIQUID POLIBAR PLUS® can be used for single or double-contrast examination of the stomach.

The main difference between an Upper GI series and an esophageal examination is the area of focus.

• An Upper GI series typically includes the stomach and small bowel, in addition to the esophagus.
• An esophageal examination is focused on the esophagus. According to the drug label 2, barium sulfate can be used for both types of examinations, with different administration instructions and doses. For an esophageal examination, the typical adult dose is 60 mL to 300 mL. For an Upper GI series, which includes the stomach, the typical adult dose is 150 mL to 340 mL of diluted or undiluted barium sulfate, as applicable.

From the Research

Upper GI Series vs Esophageal Evaluation

• The utility of Upper Gastrointestinal Series (UGIS) in evaluating gastric sleeve stenosis is limited, with a low negative predictive value (NPV) of 12.5% 3.
• In contrast, esophageal evaluation using endoscopy has a higher diagnostic yield, with 87.1% of patients diagnosed with gastric sleeve stenosis on endoscopic evaluation 3.
• A study on upper gastrointestinal series found that symptoms such as dysphagia, UGI hemorrhage, abdominal pain, and chest pain were most predictive of an abnormal UGI series, but the overall sensitivity was 65% 4.
• Esophageal evaluation is crucial in diagnosing conditions such as reflux esophagitis, which can cause severe upper gastrointestinal bleeding (UGIB) 5.
• The prevalence of reflux esophagitis as a cause of severe UGIB has increased significantly over the past three decades, highlighting the importance of esophageal evaluation in patients with UGIB 5.

Diagnostic Approaches

• The American Gastroenterological Association (AGA) recommends a positive symptom-based diagnostic strategy and limited noninvasive testing for evaluating gastrointestinal (GI) symptoms in patients with hypermobile Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorders (HSDs) 6.
• Testing for postural orthostatic tachycardia syndrome (POTS) and mast cell activation syndrome (MCAS) should be considered in patients with hEDS/HSDs and refractory GI symptoms 6.
• Upper endoscopy is a crucial diagnostic tool for evaluating acute upper GI bleeding, with the ability to identify causes such as peptic ulcer, gastroduodenal erosions, and Mallory-Weiss tears 7.