Barium Study in a Dog
Weight Loss, Vomiting, and Intermittent Soft Stool in a German Shepherd Dog
Frisko panted nervously and looked up at the Doc from underneath steady eyebrows. He doubted he needed to see the doctor. After all, dogs vomit occasionally, right? The 5-year-old male black and tan German Shepherd Dog thought he had everything under control. Except he lost 6 pounds in one month! Oops! Rapid weight loss in a dog for no good reason warrants a trip to the animal hospital.
“I watch him like a hawk and we’re always together. Do you think it’s the twisted stomach again like he had a few years ago?” said Frisco’s dad.
“No, we tacked his stomach that time so it can’t flip anymore. (23% chance the tacking suture breaks down, scientifically speaking.) Besides, those symptoms are sudden and violent, unless there’s a twist that comes and goes on its own, which can be very difficult to diagnose,” said Doc Truli.
Frisco’s complete blood count, 25 blood chemistries, electrolytes, fecal parasite examination and pancreatitis screening test (snap PLI) were normal. His surgery radiographs (x-rays) looked normal.
Frisco's normal abdominal x-ray
Yet clearly, there was something very wrong with Frisco.
“The next step is a barium series,” said Doc Truli.
What Is a Barium Study in a Dog?
A metal called liquid barium is fed to the dog. Silly, enthusiastic dogs (like Pit Bull Terriers) will often just eat the stuff out of a bowl, especially if you put a dollop of cat food on top of it. If you’ve ever tasted barium, it has a chalky, metallic taste. The manufacturers mix barium with strawberry flavor to try to mask the taste. Then you get a chalky, metallic, artificial strawberry taste. Bleck!
There are also newer technology beeds impregnated with barium that are easier to swallow and don’t taste bad. The beads are not always appropriate to show details in the lining of the stomach or intestines, like in Frisco’s case. The barium beads are very good to show the motility, or rate of movement of a substance through the intestinal system.
Stuff That Barium Can Miss
- peach pit
- squeaker from a toy
- fabric
- cat toys
- lymphoma
- inflammatory bowel disease
- pancreatitis
- helicobacter gastritis
Frisco donned a towel and ate barium by 2-ounce (60 mL) oral dosing syringe. The barium gets everywhere if you let it! Since metal shows easily on an x-ray as a solid white area, no barium could touch the dog on the outside of his body. Even a tiny smudge of barium on the fur on his side could happen to cover the pylorus or a critical component of his insides and render the study incomplete or invalid. (Another Murphy’s Law of Medicine: a tiny 1 inch (2.2 cm) smudge will line up exactly over the x-ray area of interest) After 5 syringes, he was loaded for the barium study.
Why Does the Barium Study Take All Day?
Once the barium is loaded into the patient, x-rays are taken every 15 minutes to 1 or 2 hours (depending on the problem being investigated.) The idea is this: the barium should move through normally. The stomach and intestines should fill nicely and evenly, and the barium should move through the esophagus immediately, the stomach in 30 minutes to 2 hours tops, the intestines over a few hours.
Normal: Barium in the stomach and a little in the intestines
The whole thing takes about 12 hours to be sure nothing abnormal is missed. Sometimes, you get lucky and the problem is in the beginning of the body, like the stomach, and the barium outlines the abnormality within the first few x-rays. The abnormal outline is called a filling defect because the barium cannot fill the area as expected. This indicates a possible problem. Of course, x-ray interpretation is part science and part art of medicine. Seeing the problem with your own eyes during endoscopy or surgery is the only way to be sure of the interpretation on the barium study. (As we shall see later in Frisco’s story.)
Sometimes your vet will have you come back in the morning after the study for one last x-ray. Why? Because , if there is any barium held up in the system after 24 hours, that is very abnormal and helps diagnose a serious problem.
Plus, Why So Many X-Rays?
(Does my vet just want to charge more? Or, is my vet being over-cautious?)
Well, this is a time-space continuum sort of problem. The x-rays must be taken at the right time to see the problem. Too much time in between, you’ll miss it completely. Too little time, you’ll be in the x-ray room all day.
There’s a special x-ray technology for pets who need real-time x-rays. It’s called fluoroscopy. A fluoroscope is like a special x-ray unit that shows the pictures on a screen as they happen. It is available usually in one or two university and specialty hospitals per state in the US. Fluoroscopy is an excellent diagnostic modality to determine motility disorders, especially megasophagus and hiatal hernias.
Frisco’s Barium Study Was 100% Normal
Normal Barium Study in a Canine: Read from Bottom to Top (Note the times)
A possibility with a barium series – or study – is NO abnormalities! X-rays and Barium can miss the spot, miss the problem, slide past the problem, or the problem could be within the muscle walls of the intestines and not show in the lumen – or interior – where the barium is passing through. Every test has its limits!
Frisco underwent abdominal ultrasound next. Ultrasound is non-invasive; there’s no recovery time. The ultrasound could theoretically tell if Frisco has thickened intestinal walls, large abdominal lymph nodes, or other signs of a reason why he was losing weight.
Guess what happened? Everything looked normal! Believe it or not, tests can all be normal in a severely ill dog.
Frisco’s Endoscopy
The next decision was complicated. Should Frisco undergo abdominal exploratory surgery – called laparotomy – with the idea being, if there is a big problem, it can be surgically fixed right away? Or should the big vomiting German Shepherd undergo endoscopy. He’d need general anesthesia, but he would not have to be “cut.” No surgery! The endoscopy could miss the problem, unless the problem was inside the innards of the stomach or the duodenum – the first par of the small intestine. No endoscope can reach inside all of the intestines. Intestines stretch out up to 70 feet long in a large dog!
Endoscopy was chosen next because it does not involve healing from surgery and the pain of surgery. And good thing we chose endoscopy. Do you want to know what was inside Frisco’s pylorus?
A mop head. Yup. The strands and fibers of a mop head wedged in the outflow valve of the stomach called the pylorus. And, oh boy, was his stomach lining red and angry! Without medical intervention, Frisco would have died!
Doc Truli removed the offending mop head and Frisco received stomach medicine for a month. He’s back to normal after taking his medication!
Go to VirtuaVet’s Long Road to a Simple Answer for another barium study case.
"Petcare decisions are practical, ethical, moral, and spiritual decisions" -Doc Truli
VirtuaVet 
I wonder how many X-Rays were given, my pup got 3 views every hour for 12 hours, I call this excessive and greedy, then came to discover that the clinic was bought out by MARS Petnocare company, un real wonder what the long-term effects are for a poor white dog that has had all of the rays?
Dear Delina,
The # of x-rays snapped is a matter of the medical record (you can see and count them), the x-ray setting for the strength is also a matter of record. Those are facts that can be calculated. Excessive would be a medical decision, usually made by a panel of independent experts. Greedy is a moral and ethical moniker and that is a personal and community decision. In the US, usually capitalism takes care of whether a community feels their veterinarians are greedy, and people stop going to that hospital if they feel it is unfair or out of line for the community. It is standard business practice to give you a written outline of planned services and expected costs with a reasonable range of variation (usually within 20%) of the estimate. I encourage everyone to discuss risks, benefits, and costs of veterinary interventions with their veterinarian before authorizing care. It helps if you trust the doctor and the hospital. If you do not, it makes communication especially difficult.
Your question about x-ray exposure effects long-term is harder to estimate. I do not know if that is known. The idea is the problem should be worse than the risks of the diagnostic radiation.
To give you a general idea of how a barium series is decided: When I prescribed barium series it was often 3 views every 30-60 minutes, sometimes every 15 minutes for the first hour and then spread out once the apparent rate of GI movement for that incident in that pet was intuited from the initial results. Being a white dog has nothing to do with x-ray exposure as x-rays are not like UV from the sun. THe thinking is that, if it is necessary to diagnose and possibly plan life-saving care, the x-ray exposure is worth it. Once when I had my human wrist x-rays, they needed 14 views until they finally found a tiny hairline fracture that was causing the problem! If they did less x-rays and missed the diagnosis, it would be for nothing! And that would be terrible, too.
A word about “3-view” x-rays, because I know lots of people do not know the benefit of them and might think the vet just wants to take more x-rays, maybe for $. When the x-rays (invisible) come out of the x-ray generator tube, they are collimated, but still spread in a cone shape down to the x-ray plate. Any lesions in the animal that are near the top side, facing the tube will be magnified more than lesions closer to the plate on the bottom, because of the cone spreading of the x-ray beam. For instance, research shows a doctor can miss a tiny cancer nodule on the lungs 30% of the time if they do not take 3-views of the chest instead of just the old-fashioned 2-views. So the 3-view thing is the best protocol for the best outcome for your pet.
As a veterinarian, I always dreaded barium series because there is always a chance of a “false negative” where the problem does not show on the study and it is time-consuming (takes hours and hours) and it is expensive, I did like that occasionally, the barium itself would coat and soothe the gastrointestinal tract and help cure the pet.
Thank you for your challenging questions.
Doc Truli
How much for everything to find this .. our dog has gone thru the barium and xrays .. an enema, where she was drained more or less, but now still isn’t pooping and still has the cough .. we have at least with hospital stay for 3 days and all at least $1500 to $2000 .. so what am I looking at if this endoscopy has to be done .. I don’t have 5 or 6 thousand dollars to put out for a “could be this” opinion ..
Dear Ray,
A barium study in the United States usually costs as much as the many x-rays they need to take. So $65-$95, depending on the size of the dog for the barium swallow, then x-rays on a schedule until the problem shows. That could be 5 or 6 x-rays or 15 or 20! If 2 x-rays cost $150 or so, well, you can see how that would add up. Endoscopy usually runs $1500+ anesthesia, etc. So here’s the interesting ethical thing – fairness thing – to consider. A vet is supposed to “first do no harm.” So the barium study is non-invasive. The endoscopy is somewhat low risk, depending on how stable your dog is for anesthesia. However, those are time consuming and expensive tests and of course, may not diagnose the problem.
The old-fashioned way to handle a problem was called “exploratory laparotomy.” When we did not have endoscopy, or x-rays, or time to do a barium study for a day, the vet would do surgery, open up the abdomen, and feel and look for the problem. Down side: surgery and surgical healing. Up side: diagnose and fix the problem at the same time. Down side: you don’t know what you are getting into. Barium study and endoscopy can help you plan a surgery, or avoid a surgery.
Money-wise, that’s a separate thing. If you do not have the money to do all these tests and still have money left for treatment. you may have a tough decision to make. It is not the vet’s fault that the tests are inconclusive. It is not even their fault if they find the problem on the endoscopy, but did the barium first. Or vice-versa. We do not have meta-data (big umbrella studies) like they do in human medicine to tell us what course of action is most likely to fix the problem. So it is an educated guess, common-sense, logic. Very stressful for everyone involved, not the least your dog. That is the state of veterinary medicine today. Luckily, vet med still costs about 10% of human med. So it shouldn’t be $100,000 to treat your dog, like it would be for a human kid.
You can also seek a second opinion. There’s a catch to that, though. It can cost a lot more to go through everything with another vet and find out that the answers are still inconclusive. Sometimes you get more for your money sticking it out with the first vet. But if you have doubts, it is reasonable to ask for a referral to a specialist who can review your case and give their opinion and options. It doesn’t mean you have to do the options they offer.
Good luck!
Doc Truli
Our dog seems to have a similar problem. She is a nine-year old wire fox terrier. She has not eaten right for over 2 weeks now. She is not vomiting any more, but her appetite has not returned. We took her to the vet last week, and all of her blood work came back normal. She is currently back at the vet for the barium studies. They did take an xray and I saw the gas pockets in her intestine and a mass of something. They gave her an enema hoping she would just pass whatever it was. They said it could just be fecal matter. I just called back to check and they said the barium isn’t passing through as it should. We are hoping surgery is not necessary but it may be. She has never been a dog to swallow or eat anything other than food. She does have a habit of not chewing her food up. It was interesting to read this article but it is pretty much the same thing we have been experiencing with our dog.
What state are you located in? And also, what was the total Vet bill?
Florida. Total bill for barium study? This varies depending on the case. It should be barium, barium administration, and then however many x-rays are needed until you find the problem. So, if barium is $40, admin is $85 (3 people needed), hospitalization ($9-$40), x-rays (2 people to take, plus $75,000 machine to do + licensing+ radiation safety measures+ paid staff training) so usually about $75 each x-ray. You can easily spend $450-$800 on a barium series.
Then there’s the cost of interpretation. Most general practitioners do not even charge for it. A board-certified radiologist fee on your bill might be $95-$125. That’s just to interpret it after it’s done!
-Doc Truli