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Re: Chronic constipation




Dear Michael !

My experts in radiology do agree with you

Sincerely yours


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Datum : 2016-11-23 - 18:52 (UTC)
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Ämne : Re: Chronic constipation


Dear Professor Einar Arnbjörnsson,

Thank you for having raised the issue of the appropriateness of the barium enema, what is very important for pediatric surgeons and radiologists. I think there is a mistake to simplify the indications for the use of different contrast agents. The barium enema is not abandoned. It is used not as widespread as before, but it has its testimony: inflammatory diseases of the colon [1]; for cancer diagnosis (rare) [2,3]; for diverticular hemorrhage treatment [4]; polyposis  and fistulos diagnosis [5];and diagnosis of the megacolon, including Hirschsprung disease, Chagos diseases,  and functional constipation. This is due to the fact that the barium is deposited on the mucosa and makes clearer the transition zone in Hirschsprung disease and improves the visualization of the mucosa in any forms of colon inflammation (colitis).

Water-soluble contrast enema is used: after surgery, where possible leakage of the contrast medium into the abdominal cavity; in colostography for  visualization of the urethral fistula;  in the treatment  of the sigmoid colon volvulus.


  1. B KolarJ Speranza,1 S Bhatt, and V Dogra. Crohn's disease: Multimodality Imaging of Surgical Indications, Operative Procedures, and Complications. J Clin Imaging Sci. 2011; 1: 37. Published online 2011 Jul 14.doi:  10.4103/2156-7514.82966

  2. Halligan S1, Dadswell E2, Wooldrage K2,  et al. Computed tomographic colonography compared with colonoscopy or barium enema for diagnosis of colorectal cancer in older symptomatic patients: two multicentre randomised trials with economic evaluation (the SIGGAR trials).Health Technol Assess. 2015 Jul;19(54):1-134. doi: 10.3310/hta19540.

  3. Psarelli ESarkar S. The 5-year outcome of patients having incomplete colonoscopy. Colorectal Dis. 2015 Apr;17(4):298-303. doi: 10.1111/codi.12901.

  4. Matsuura M1, Inamori M1, Nakajima A1, et al. Effectiveness of therapeutic barium enema for diverticular hemorrhage. World J Gastroenterol. 2015 May 14;21(18):5555-9. doi: 10.3748/wjg.v21.i18.5555.

  5. Korelitz BI1, Taunk R2, Kesar V2 et al. Segmental sigmoid polyposis as a colonoscopic indicator of an ileosigmoid fistula in Crohn's ileitis. J Crohns Colitis. 2015 Apr;9(4):339-41. doi: 10.1093/ecco-jcc/jjv028. Epub 2015 Jan 29.

  6. Peyvasteh M1, Askarpour S1, Ostadian N1, et al. DIAGNOSTIC ACCURACY OF BARIUM ENEMA FINDINGS IN HIRSCHSPRUNG'S DISEASE. Arq Bras Cir Dig. 2016 Jul-Sep;29(3):155-158. doi: 10.1590/0102-6720201600030007.

  7. Yu Z, Liu Q, Xiao Z, Li D, Huang X, Huang Z. Preliminary exploration on accurately preoperative evaluation of colonic lesions in slow transit constipation complicated with adult megacolon]. Zhonghua Wei Chang Wai Ke Za Zhi. 2016 Sep 25;19(9):1049-1053. Chinese.

  8. Qiu JF1, Shi YJHu L, Adult Hirschsprung's disease: report of four cases. Int J Clin Exp Pathol. 2013 Jul 15;6(8):1624-30. Print 2013.

  9. Salvador F1, Mego M2, Sánchez-Montalvá A2, et al. Assessment of rectocolonic morphology and function in patients with Chagas disease in Barcelona (Spain). Am J Trop Med Hyg. 2015 May;92(5):898-902. doi: 10.4269/ajtmh.14-0546. Epub 2015 Mar 16.





От: Einar Arnbjörnsson <>
Отправлено: 19 ноября 2016 г. 21:42
Кому: Levin Michael
Тема: Re: Chronic constipation


You are right, there are some differences between these contrast media. The solution used at my department are indeed isotonic, but no doubt different from the abandoned Barium enema. I intend to ask my radiologists on his point of view.

Sincerely yours

Professor Einar Arnbjörnsson


From: Levin Michael

Sent: Saturday, November 19, 2016 6:55 PM

To: Einar Arnbjörnsson

Subject: Re: Chronic constipation


Professor Einar Arnbjörnsson, thanks for your letter!

   A barium suspension is chemically inert and completely safe in any amount. Water-soluble contrast media are hypertonic solutions. They cause an increase of the bowel tone and so frequently used for the colon cleansing.  The increasing tone leads to narrowing of the colon lumen and decrease of its volume. Thus, the principle of standardization of the method is violated and the results of such study are not reliable. Furthermore, the use of large volumes of hypertonic saline is not safe for the patient.  It seems to me that this is an example of that medicine walks on the trail of that imposed on us by the manufacturers of drugs and devices.


Your faithful

Levin M.


От: Einar Arnbjörnsson <>
Отправлено: 19 ноября 2016 г. 18:19
Кому: Levin Michael
Тема: Re: Chronic constipation


Dear colleague!

I do enjoy your writing.

My radiologist do not use barium contrast any more. Instead they favor water soluble contrast media, Omnipack or Visipack.

We usually do not ask for the size of the colon but are interested in the recto-anal inhibitory reflex and variations in lumen size only.

But your opinion is of value and should be published,

Your faithful

Professor Einar Arnbjörnsson



From: Levin Michael

Sent: Friday, November 18, 2016 5:37 PM

To: Arnbjörnsson Einar

Subject: Chronic constipation

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