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X-rays, perhaps one of the most common – and oldest – medical imaging techniques, give the doctor a ‘snapshot’ of the chest, abdomen or bones. In order for soft tissue such as the digestive tract to show up on the x-ray properly, a ‘contrast’ substance needs to be introduced. Contrast substances such as barium are swallowed, injected into the rectum or injected into the blood vessels.

Abdominal x-rays: Abdominal radiography normally looks at the pattern of gas (wind) in the digestive tract – this can give a lot of information about what is happening inside the abdominal cavity. It can show intestinal obstructions and also give important clues to the extent and severity of diseases like UC. It does not normally involve a contrast element.

Joint radiography: While bones aren’t digestive organs, they can be affected by IBDs. Bone x-rays can show inflammation in the spine, joints, pelvis or hips.

Bone densitometry (DEXA scan): If malnutrition has been a chronic problem, or if steroids have been taken for a significant period of time, there is always a chance that there is insufficient calcium stored in the bones – which may eventually lead to osteoporosis and bone fractures. DEXA scans check the density of bones in the lower spine and femur (thigh) bone and are often given to patients who suffer with UC or Crohn’s.

Barium meal and barium swallow: A barium meal involves swallowing a drink of liquid barium – a contrast medium that shows up the oesophagus, stomach and duodenum. It is normally used to highlight lesions. A barium swallow, or follow-through, is done to track the speed at which the liquid travels through the upper part of the digestive tract and small intestine.

Small bowel enema: If really detailed pictures of the small intestine are needed, or if a barium follow-through has not produced satisfactory results, then a small bowel enema may be done. Here, barium and air are pumped directly into the small intestine through a fine tube that is passed down the oesophagus and stomach. It produces detailed pictures, but may be more uncomfortable than a barium swallow.

Barium enema: Barium enemas give x-ray pictures of the large intestine. Barium and air are pumped into the rectum using a tube, and then an air-filled balloon is placed just inside the rectum to prevent the contents from slipping out (although they always feel as if they’re just about to). Several x-rays are taken as the body is tipped to each side to move the barium into the right positions. Barium enemas are given on an empty colon, so you will be given drugs beforehand to empty your bowels – make sure you are not far from a bathroom when this happens. After this test you will pass thick, clay-like stools that can be very difficult to flush away. The best tip is to empty your bowels as much as possible immediately after the x-ray while still in hospital. If you are still passing clay when you get home, tip a whole bucket of water down the toilet immediately after you flush, to help move the barium. And don’t worry – your stools will soon return to normal.