E-Z-Paque (oral and rectal)

Uses

Barium Suphate is used to help doctors examine the esophagus (tube that connect mouth and stomach), stomach and intestine using X-rays or computed tomography (CAT scan, CT Scan; a type of body scan that uses a computer to put together X-ray images to create cross sectional or three dimensional picture of the inside of the body). Barium sulphate is a class of medications called radiopaque contrast media. Its works by coating the esophagus, stomach or intestine with a material that is not absorbed into the body so that diseased or damaged areas can be clearly seen by X-ray examination or CT scan.

E-Z-Paque (oral and rectal) is also used to associated treatment for these conditions: Radiologic examination of the gastrointestinal tract

How E-Z-Paque (oral and rectal) works

Barium sulfate is a heavy metal with a high atomic number (Z=56) and a K shell binding energy (K-edge of 37.4 keV) very close to that of most diagnostic x-ray beams. Due to these characteristics, barium is an ideal medium for the absorption of x-rays .

Barium sulfate is essentially not absorbed from the GI tract nor metabolized in the body. Barium sulfate is used to fill the gastrointestinal tract lumen or to coat the mucosal surface and is administered orally, rectally, or instilled into an enterostomy tube or catheter , .

Barium sulfate enhances delineation of the GI tract. The barium suspension covers the mucosal surface of the GI tract, allowing its shape, distensibility, motion, integrity, continuity, location within the torso, relationship to other organs to be closely examined . Various abnormalities, such as benign or malignant tumors, ulcers, strictures, diverticula, inflammation or infection, altered motility, displacement and other pathology can thereby be identified , .

At lower concentrations (higher dilution), barium enhances the conspicuity of the GI tract to differentiate the GI tract from various abdominal organs in computed tomography examinations (CT scans) of the abdomen. Improved delineation of the gastrointestinal tract lumen and mucosa may be reached by contrast provided by gas (by the addition of bicarbonate or gas-filled balloons) in addition to the barium . This is known as a double-contrast procedure. Osmotically active agents (for example, sorbitol) are also used to induce fluid accumulation and distension of the GI system to enhance visualization .

Dosage

E-Z-Paque (oral and rectal) dosage

Barium Sulphate comes as a powder to be mixed with water, a suspension (liquid), a paste, and a tablet. The powder and water mixture and the suspension may be taken by mouth or may be given as an enema (liquid that is instilled into the rectum), and the paste and tablet are taken by mouth. Barium Sulphate is usually taken one or more times before an X-ray examinations or CT scan. If you are using a Barium Sulphate enema, the enema will be administered by medical staff at the testing center. If you are taking Barium Sulphate by mouth, you may be given the medication after you arrive at the testing center or you may be given the medication to take at home at specific times the night before and/or the day of your test. If you are taking Barium Sulphate at home, take it exactly as directed. Do not take more or less of it or take it more often or at different times than directed. Shake the liquid well before each use to mix the medication evenly. If you are given a powder to mix with water and take at home, be sure that you are also given directions for mixing and that you understand these directions. Ask your doctor or staff at testing center if you have any questions about mixing your medications. You will be given specific directions to follow before and after your test. You may be told to drink only clear liquid after a certain time the day before your test, not to eat or drink after a specific time, and/or to use laxatives or enemas before your test. You may also be told to use laxatives to clear the Barium Sulphate from your body after your test. Be sure that your understand these directions and follow them carefully. Ask your doctor or the staff at the testing center if you are not given directions or if you have questions about.

Side Effects

Common side effects are: severe stomach pain, severe cramping, diarrhea, or constipation, sweating, ringing in your ears, confusion, fast heart rate, pale skin, weakness

Toxicity

Acute Exposure

Nausea, vomiting, diarrhea and abdominal cramping may occur . Acute exposure to barium sulfate may irritate the eyes and respiratory tract. Exposure to inhalation or other forms can affect the nervous system and lead to hypokalemia, which can contribute to cardiovascular rhythm abnormality . Hypersensitivity, gastrointestinal transit delay, obstruction, aspiration pneumonitis and systemic embolization of barium sulfate are more serious complications of administration . In addition, fatalities have occurred due to aspiration pneumonitis, barium sulfate impaction, intestinal perforation with subsequent peritonitis and granuloma formation, and vasovagal and syncopal episodes , .

*Chronic Exposure *

The lungs may be affected by repeated or prolonged exposure to dust particles, resulting in baritosis (a type of benign pneumoconiosis) . Inhalation of barium sulfate dust may lead to a benign pneumoconiosis ("baritosis") with conspicuous radiographic characteristics but no signs of impairment of pulmonary function .

Intra-abdominal leakage

Intra-abdominal leakage may occur during or after administration of barium sulfate . Caution is advised in patients with a history of food aspiration and in patients with diagnosed swallowing disorders .

** A note on GI perforation**

Perforation of the colon after rectal administration of barium sulfate suspension has been reported due to the increased hydrostatic pressure of the instilled suspension, trauma to the colon from an enema tip, or forceful or deep insertion of a non-flexible enema tip. Perforation of the bowel has been followed by peritonitis, adhesions, granulomas, and death . This is a rare occurrence. Injury to the rectal mucosa or anal canal due to the enema tip or retention balloon is likely the most common traumatic cause of perforation during treatment. Inflation of a balloon within a stricture, neoplasm, inflamed rectum, or stoma is hazardous, and caution should be exerted .

Carcinogenicity and mutagenicity

No animal studies have been performed to evaluate the carcinogenicity of barium sulfate or potential effects on reproduction . Elective contrast radiography of the abdomen is not routintely recommended during pregnancy because of the risks to the fetus from radiation exposure .

Precaution

General: Diagnostic procedures which involve the use of radiopaque contrast agents should be carried out under the direction of personnel with the requisite training and with a thorough knowledge of the particular procedure to be performed. A history of bronchial asthma, atopy, as evidenced by hay fever and eczema, a family history of allergy, or a previous reaction to a contrast agent warrant special attention. Caution should be exercised with the use of radiopaque media in severely debilitated patients and in those with marked hypertension or advanced cardiac disease.

Anaphylactic and allergic reactions have been reported during double contrast examinations in which glucagon has been used.

Ingestion of barium sulfate suspension is not recommended in patients with a history of food aspiration. If barium sulfate suspension is aspirated into the larynx, further administration of the suspension should be immediately discontinued.

Patient preparation for diagnostic gastrointestinal examinations frequently requires cathartics and a liquid diet. The various preparations can result in water loss for the patient. Patients should be rehydrated quickly following a barium sulfate suspension examination of the gastrointestinal tract.

Pregnancy: Safe use of barium sulfate during pregnancy has not been established. Barium sulfate should be used in pregnant women only if the possible benefits outweigh the potential risks. Elective radiography of the abdomen is considered to be contraindicated during pregnancy due to the risk to the fetus from radiation exposure. Radiation is known to cause harm to the unborn fetus exposed in utero.

Food Interaction

Elimination Route

Barium sulfate is not absorbed following oral or rectal administration with a normal gastrointestinal tract. In patients with a normal GI tract, barium sulfate is normally excreted within 24 hr after oral ingestion. Post rectal administration of barium sulfate suspensions, the drug is generally excreted when the enema is released. Some barium may remain in the colon for several weeks, however, and eventually clears, especially in patients with impaired intestinal peristalsis . It is difficult to quantify the uptake of ingested barium because of a number of factors affect its absorption. The presence of sulfate in food can cause the precipitation of barium sulfate .

The following is the approximate time to peak opacification of organs by barium sulfate in a healthy GI tract:

Esophagus, stomach, and duodenum uptake of barium sulfate occurs almost immediately after oral administration .

Small intestine uptake is dependent on gastric emptying rate and viscosity of the preparation; it may be delayed 15-90 minutes post ingestion .

Small intestine (enteroclysis studies) uptake is immediate, following direct instillation .

Colon and distal small intestine uptake are dependent on patient positioning. Hydrostatic pressure also determines the rate and degree of opacification .

Clearance

The rate of excretion of barium sulfate is dependent on the route of administration and the status of peristaltic activity and motility of the gastrointestinal tract .

Elimination Route

Barium sulfate is excreted unchanged in the feces .

Pregnancy & Breastfeeding use

Safe use of barium sulfate during pregnancy has not been established. Barium sulfate should be used in pregnant women only if the possible benefits outweigh the potential risks. Radiation is known to cause harm to the unborn fetus exposed in utero.

Contraindication

Barium sulfate products are contraindicated in patients with known or suspected obstruction of the colon, known or suspected gastrointestinal tract perforation, suspected tracheoesophageal fistula, obstructing lesions of the small intestine, pyloric stenosis or known hypersensitivity to barium sulfate formulations.

Acute Overdose

In rare instances, immediate repeat oral examinations may lead to severe stomach cramps and diarrhea. Cases reported implicate a total dose in the range of 30 ounces (900 mL) of a 115% w/v barium sulfate suspension. Instances of this type have resolved spontaneously and they are not considered to be life-threatening.

Interaction with other Medicine

Pediatrics: Two deaths of infants from barium aspiration have been reported; however, the volume of aspirated material rather than the nature of the material was probably the responsible factor.

Geriatrics: Diagnostic studies performed to date have not demonstrated geriatrics-specific problems that would limit the usefulness of barium sulfate in the elderly. However, colon distention has caused electrocardiographic changes, especially in geriatric patients with a history of cardiac disease.

Storage Condition

Store at 25° C

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