Barium enemas in the frail elderly - Tips from Other Journals

Date: June, 1992

Barium enema is a common diagnostic procedure used for the evaluation of bowel symptoms and signs, but it requires careful bowel preparation for optimal results. To determine the frequency of and predictors for inadequate barium studies in elderly patients, Gurwitz and colleagues retrospectively evaluated the results of a series of barium enemas in a group of nursing home residents.

The investigators reviewed the medical records of 171 residents of a long-term care facility who underwent examination with barium enema. The mean age of the patients was 85.3 years; the average number of chronic medical problems per patient was 5.4. Before the procedure, all patients followed a careful three-day bowel preparation regimen and abdominal films were obtained to evaluate the adequacy of the bowel preparation.

Fifty-two percent of the studies were reported to be inadequate by the radiologist. The presence of stool in the bowel was a factor in almost 90 percent of these cases. Chronic laxative and/or cathartic use was the only factor found to be associated with an inadequate barium study.

The authors conclude that even with careful preparation and evaluation, many barium enemas in the frail elderly are not adequate. Based on these findings, the need for barium enema examination, as currently performed, deserves careful consideration in elderly patients. These patients require special attention to bowel preparation, especially if they are chronic users of laxatives and/or cathartics. (American Journal of Medicine, January 1992, vol. 92, p. 41.)

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