Barium studies

Barium enema in ulcerative colitis confirms the diagnosis, the extent and severity of the disease; the procedure is contraindicated in those patients at risk of a toxic dilatation. Features of a barium study include:

• loss of haustration
• narrow, straight, inelastic colon
• may be 'spicules' due to tiny ulcer craters
• 'pseudopolyps' may be shown as filling defects

Abnormalities are generally continuous, i.e. there are no 'skip' lesions that are characteristic of Crohn's disease, and confined to the large bowel.

Note - while barium enemas still retain their relevance in specific clinical settings, the use of computed tomography enterography (CTE) or magnetic resonance enterography (MRE) are now used as first-line investigations to exclude active small bowel disease in IBD patients and can be utilized to detect active colonic inflammation.

Reference

1. Carucci LR, Levine MS. Radiographic imaging of inflammatory bowel disease. Gastroenterol Clin North Am. 2002;31:93–117