X-rays can help in the diagnosis and management of Inflammatory Bowel Diseases (IBD), particularly in evaluating the small intestine. Colonoscopy can only tell us about the last few inches of the small intestine (The actual size of the small intestine is about 10-12 feet in length in an adult–imagine holding a tennis racket above your head. The small intestine is approximately the same length as the tip of that racket to the floor–and the healthy surface is about the size of a single tennis court because of all the folds inside). 

Different types of x-rays are intended for different uses. Recently, there's been increased recognition of the amount of radiation generated with each of the exams. 

Abdominal x-rays are pictures of the abdomen (that area between the chest and the lower parts of the hips). The x-rays are taken when the person is lying down and sometimes when standing as well. They are useful to tell when an excess of gas is present and backed up because of a blockage or when the bowel has been shifted from its normal position, but they are otherwise not very useful in IBD. 

An Upper GI series with small bowel imaging was the standard x-ray exam in the past. The patient drinks barium, which outlines the GI system and it can then tell if there's a narrowing (a stricture) and sometimes if there's an open fistula extending from the intestine. Because the doctors take multiple pictures as the barium moves through the small intestine, this exam subjects the patient to increased radiation.

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