Barium and iodinated contrast media for opacification of the lumen of the GI tract

What are the roles of barium and water-soluble (iodinated) contrast media for opacification of the lumen of the gastrointestinal (GI) tract? 

Barium contrast media, which consist of barium sulfate particles suspended in water, are usually preferred over water-soluble iodinated agents because they produce better images as a result of greater mucosal detail, are more resistant to dilution, and are less costly. Currently, iodinated contrast media use is primarily limited to situations in which barium is contraindicated, as with cases of potential intestinal perforation or leak, cases prior to surgical procedures involving the bowel, and cases for confirmation of the position of a percutaneously placed bowel catheter. Water-soluble contrast is ideally suited for use in patients with suspected perforation of a hollow viscus as it is rapidly absorbed from all extraluminal spaces. No untoward effects have been reported from the presence of iodinated contrast in the mediastinum, pleural cavity, or abdomen. Barium, on the other hand, has a propensity to incite an inflammatory reaction if it leaks into the peritoneal cavity, resulting in granulomatous peritonitis. In cases of aspirated barium, serious consequences may result, particularly in patients with pneumonia or adult respiratory distress syndrome


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