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MRE imaging for gastrointestinal disorders

Pineapple juice can replace barium contrast during MRI with contrast (MRE)

MRE (Magnetic Resonance Elastography) is a specific type of MRI (Magnetic Resonance Imaging) performed with contrast material to produce detailed images of the small intestine. MRE is preferred over CT (Computed Tomography) to reduce repeated radiation exposure, especially because the nature of IBD requires repeat examinations which can result in large cumulative doses.

However, some patients have concern about using the barium contrast. Mild side effects may include stomach cramps, diarrhea, nausea, vomiting or constipation. Rare side effects include allergic reactions like hives, itching, agitation or fast heartbeat. A patient is at greater risk of an adverse reaction to barium-sulfate contrast materials if he has a history of asthma, hay fever, or other allergies.
As it turns out, there are effective alternatives to using barium, namely the artificial drink Breeza or simply natural pineapple juice. Currently there is no clear unified standard, and it is unfortunate that not all doctors and not all imaging centers are willing to adopt these advanced options due to lack of awareness and indifference to patient’s comfort.

Parents of IBD kids are especially proactive in ensuring their child receives the best care options and are advocating for pineapple contrast when the child is scheduled for MRE.
Below are numerous testimonies from the parents of SCD Families. While some had to accept the old MRE methods, many others managed to convince their providers to use natural pineapple juice instead of barium. These are followed by links to the relevant research, to help you advocate and communicate with your doctor.

Testimonies

MRE has come and my little guy is showing first signs of dreading procedure. Never complains about much but had a lot of feelings today about why him having Crohn’s and feeling like a “robot” that I get to choose what happens to him. What a feeling... he also mentions that he was having such a great day and it was all taken from him by the news of an MRI. I didn’t realize when he was asking how long until this procedure for the last few weeks that he had immense worry about it. Last MRE, the nurse unfortunately had his IV in the wrong placement, which they never fixed, so he was so uncomfortable through the whole hour-long procedure although he did amazing lying still holding his breath for the radiologist for an hour! It is not a children’s hospital so they do not go easy by any means unfortunately.
Us waiting to see progression of the disease brings worry enough as well as the distinct dread my son has for the procedure itself. I prep him, give him talks about how we have got this and to be thankful for the health we have because it could be so much worse. And although it’s true, it isn’t fair ...and I let him know this as well. Of course, there is his brother who also goes through becoming secondary to discussions and appointments of this disease. Never complains, but I know it has to be hard. So a little bit of venting before procedure. Side note is wishing there was a way to only drink Breeza without the IV. Has anyone done this for an MRE?? Squeeze those kiddos tight, comforting is so important through these awful feelings of worry they must go through.

An MRE is really not a huge deal once you can convince your child (took us SIX months and a hamster to convince ours!)..see if your facility has movies they can play during the procedure.

We go Monday for scopes and I’m very anxious too. No symptoms and blood work all ok, but can’t get the calprotectin down enough. I have a feeling MRE is next. He panicked the last time and couldn’t get through it. I worry that something is going on that will require surgery and I feel like I haven’t even really gotten my head wrapped around the fact that he’s got this disease!!! It is so hard and life shouldn’t be this hard.
Last time he drank the breeza, then IV and once we went into the room, I could see the panic setting in. I think that’s the kinky way they can do it.

My daughter refused to drink the barium. After an hour of sitting there, they made a call and then told us she could drink something else instead. They brought her in back and gave her a single serve can of Dole pineapple juice. They said they would have to check to see if they got clear pictures, and they did. I don't think they wanted everyone in the waiting room to catch on to the best kept secretly, or everyone would revolt!

My son just had his first MRE last month. I asked about drinking pineapple juice to the pediatric gastroenterologist and she hadn’t heard of it so she said she was sure they wouldn’t do it. I asked the hospital when we scheduled and they hadn’t heard of it either but said they would ask the radiologist. We were pleasantly surprised when the radiologist looked up studies and decided it was ok to do! He drank 4 cups of pineapple juice and said it wasn’t that hard. I can say that at least drinking juice made it more tolerable for my kiddo.

We juiced two fresh pineapples. There was some debate in the radiology department about amount to drink. They settled on 12 ounces and the tech then had my UC daughter drink about 18 just to play it safe. Pineapple juice is delicious (especially compared to contrast drink) so she had no trouble downing the 18 ounces. They wanted her to drink it immediately before going into the MRI machine (which was a normal machine). She did get the IV contrast as well which she said made her feel weird and she had a weird taste in her mouth from that. She had no stomach issues this time with the pineapple juice. The first time we did an MRE and she did drink the barium it caused severe stomach pain, lots of trips to the bathroom an entire day spent in bed. With the pineapple juice she was in the mall by noon shopping with a friend like nothing had happened in the morning!! They did offer an alternative drink which was called Breeza, if you can't them to agree on the pineapple juice ask for the Breeza, it was gluten free and while it had illegals it supposedly didn't taste as awful as the previous contrasts.

We went prepared w pineapple juice to the last MRE in Dec. Her GI dr had said she could do white grape juice w miralax, so we were ready w that too. She thought the grape juice option was better bc she would have to drink so much pineapple juice. When we got there, we asked the radiologist about the pineapple juice and she said it was the same amount regardless and the pineapple juice was fine. She even said they used to use pineapple juice all the time.... her results were very clear and readable!

My daughter had an MRE two years ago. It took about 1 hour in the tube. I was in the room the whole time and able to hold her hand for the first 15 minutes or so (she laid her hand up over her head). They gave her a headset that played a movie - she also received instructions from the technician over the headset as to when to hold her breath, stay extra still, etc. Her biggest complaint was that it was very noisy in the tube. And that the IV was uncomfortable. Scheduled for another MRE in a couple of months and already asked the GI to contact radiologist about pineapple juice alternative.

The GI called to say the entire radiology department weighed in on the volume of Pineapple juice needed and they changed it to 10 ounces. She has to drink it immediately before getting on the table not the two hours in advance that we do the barium.

My daughter drank pineapple juice and immediately did test also. All the pictures came out fine.

We were told by Sutter imaging that they would not do the test if he drank pineapple juice.... just FYI. I had all the info to back it up ready and they flat out refused and then the nurse asked why I would want to possibly subject my child to having to have the test twice.

I'm not sure if they are truly opposed to the idea or if there are real restrictions because it's not a hospital-approved practice. (My GI doesn't have say in the matter. It's the radiology dept I have to deal with) I will push if it's simply an issue of ignorance. I'm curious as to whether the radiologist truly has no say in the matter...

Our experience with regular contrast for an MRI was horrible. Our son could barely drink it. It took 45 minutes if pleading (me) and crying(both of us) and near vomiting (him) to get just enough down. The tech was so kind and tried to help best she could. I pray it’s much better for you.

My daughter had Breeza contrast. She liked the taste. She had iv contrast as well. She handled it all without any problem until about 45 minutes after the procedure and she started throwing up. We were already in rush hour traffic. She was symptomatic again after that but with a liquid diet, she progressively got better over a month. The test is important and I know I feel our physician would have ordered if it it wasn’t necessary. My only bit of advice is not to let anyone hurry you out. I’d stay at least an hour after the procedure to make sure there isn’t an adverse reaction based on our experience.

We just used Breeza yesterday. They wouldn't let us use pineapple juice.
So far son is fine, just boosting broth and probiotics. Will let you know if anything changes. We did lots of broth and yogurt leading up to procedure too.

Our 7 years old had an MRE a month after diagnosis, to rule out small bowel involvement. He had to be put under and was given the contrast via tube. He had no ill effects from it - poo went back to 'normal' (for the time) within a day or two. He recovered much faster from it than from the scopes (which he vomited and felt awful after).

I've opted out of the barium for my son. They still did it with the gadolinium contrast (IV). I wasn't thrilled about that one either, but chose the least risky procedure. They don't get as good of a read, but it still works.

Abdominal echography with before procedure 24 h liquids only diet previous day and pineaple juice. This is the compromise for us.

We also got a firm NO on pineapple juice at IWK in Halifax, NS. We were told they don't use barium contrast anymore - kids have to drink a sorbitol drink (Breeza).

They let her do the pineapple juice! Hooray! 56 oz . Now we wait for the results.

My Radiologist has agreed to pineapple juice but she mentioned something else they are using now called glucagon. This was not used at his last MRE 2 years ago and they had very clear pictures. She told me it was my option whether to use it or not, but she would recommend. Have any of you gotten an MRE with pineapple juice and opted out of the glucagon and still gotten clear pictures?
-Glucagon is given to temporarily stop the bowel Motion in order to get better images. It's given for a different reason than the gadolinium.
-My son had glucagon with his first MRE when he was seven. Then when he had 2nd one done at Boston Children's which they called an MRI not an MRE and there's a reason for that.. but they don't give glucagon to young kids there. But when he gets his MRE this summer I think he gets glucagon because of his age. he's 11. We were told the same that images are much better with aglucagon in the majority of places do use it but obviously Glucagon dose cause nausea in some people but my son didn't have any problems
-It's routine to give the oral contrast _volume or a different barium solution or a Miralax solution or now pineapple juice as people are reporting which is awesome. But then they also given IV contrast. And glucagon depending on the center.
-Yes, they are doing an IV contrast. The radiologist was very nice and told me that using the glucagon was my choice.

They don’t let you sit touching your child, but I’ve been allowed to stay in the room. We were not allowed pineapple juice either. It was an emphatic no.

The doctor was from the radiology department. She came across aggressive at first, which I advised that I did not appreciate. The MRE was completed with 2 bottles of Breeza for oral contrast, contrast via IV and no glucagon. After the test she advised that pineapple juice would not have given the clear images needed.

I juiced four fresh pineapples and brought it with me in a cooler. We had a lot left-over. When our ped GI agreed to the MRE I mentioned the pineapple juice as an alternative to the barium and she was fine with that (I had my laptop with links to studies with me). At the time of our appointment there were no notes in the order regarding the pineapple juice but the tech cheerfully agreed to contact the Radiologist who would read the results.
The Radiologist said 110ml over about 20-30 minutes immediately before going back for the MRE so it had time to work its way down. My son was 13, 5'6", about 106 pounds at the time. He did do the IV contrast.
No discomfort other than fullness from so much liquid. I will add even before his Crohn's diagnosis he has never had any stomach discomfort from any food he eats.
He was awake during the MRE (it was a regular tube).

I wanted to comment and update with our experience using pineapple juice as an oral contrast medium for my 9 year old daughter. This is kind of long winded but am hopeful it can help someone in the future. Upon making our appointment I spoke with an MRI tech who told me that the standard oral contrast is Breeza but in rare instances pineapple juice is used for children with allergies/intolerances/aversions. However, it would increase the amount of necessary liquid from 1000ml (Breeza) to 2000ml (PJ) and we would need to bring our own. Fast forward two weeks and I get the confirmation call from the outpatient site we were going to and when I asked about the pineapple juice the tech told me that she had never heard of anyone using it and that she didn't know why another tech would have told me it is possible. I pushed back (respectfully but very firmly) and said that we were on a medical diet and that if need be I would reach out to my GI doctor to confirm they are okay with the use of the PJ. She was not super thrilled but made a note and said in the end the decision would be up to the radiologist. Luckily when I contacted my GI team they immediately responded with knowledge of the use of PJ in MREs and contacted the radiology department for me. On MRE day we brought 2 bottles (just shy of 2000 ml) of organic Lakewood brand 100% pineapple juice ((very cold)) in a cooler. We were met by a tech who was empathetic and kind and had actually performed an MRE on a young patient in the past using PJ bc he was also on SCD and after learning about it from the very knowledgeable mother said she completely understood why one would not want to break diet if it is possible. That said, she stated that bc there is little knowledge of its efficacy we wouldn't really know if it will work until she is in the MRI machine. I had also researched articles on how much oral contrast was necessary for kids and while not necessarily citing the use of PJ most studies say that kids should drink 20ml/kg ((which would have put my daughter at 500ml as she was right around 25kg at the time)) to a max of 1200ml so while I brought 2 I really had no intention of allowing my daughter to consume both bottles. We had 90 minutes for her to drink the contrast or juice. The nurse told us that if we chose Breeza she would need to drink 1000ml and if we chose PJ she would need to drink a minimum of 1500ml. I was shooting for 1000ml ((double the 20ml/kg dose)) and told the nurse that, she said that she felt more comfortable with her trying for 1500ml, so we settled on attempting 1200ml but would really just see how it went with my daughter. She actually took the first bottle pretty easily. It helped that she was not allowed to eat breakfast bc she was hungry. And we opened the second bottle and attempted some more but she was starting to get uncomfortable so we stopped. If I had to guess I would say she got at most 1100ml but likely closer to the 1000ml mark in about 75 minutes. She then had her IV placed and right before she went in the exam room I tried to get her to drink just a bit more. I have never seen an MRE performed but I was able to stay with her the whole time. She had to get the exam performed in a prone position ((laying on her tummy)) so as to distend the colon as much as possible and got to listen to and watch a movie. She was very comfortable the whole time but the breath holds sometimes lasted for a good 15 seconds and that was a little challenging for her. The nurse and tech called in the radiologist to look at the images from the exam prior to injecting the IV contrast and after getting approval that the images were fine we moved on and finished the exam. The exam lasted about 45 minutes total and she did great. So, my advice would be to check ((and double check)) with as many people as possible prior to the exam that the use of PJ is okay. I thought we were in the clear after speaking with the first tech and came to find out that if I hadn't asked a second time we likely would not have been met with the same response. Make sure your GI team is on board to help you get approval from the radiology department if you receive any pushback. I do not think the patient needs to drink nearly as much as they claim they have to but given the uncertainty most medical professionals have, I think they err on the side of caution. If they overfill their stomachs with the juice it doesn't make it go into the intestines any faster, they just get uncomfortable and risk throwing up. My daughter got a little uncomfortable towards the end of her prep but did not have any issues afterward. So maybe having info on the fact that most studies recommend a maximum of 1200ml for oral contrast in kids made it easier for me to advocate for what my upper limit was for my daughter. Her images turned out to be perfectly fine using the PJ. I think everyone who worked with us happy to learn about the option of successfully using the PJ and my hope is that with more and more of us advocating for our children to use it, it will become more easily accepted by the medical professionals preforming these exams. Sorry for the novel but hopefully this helps someone in the future.

I wanted to share an update post MRE using Pineapple juice as the contrast. We were having a repeat MRE because our daughter was considered indeterminate IBD by her gastro even though she presented with mainly UC symptoms she had a questionable area in her small intestines on the Jan MRE. We brought 32 ounces of pineapple juice (brought extra) the radiologists wanted her to drink 10 ounces but the tech asked her to drink double that just in case (he had never heard of anyone using pineapple juice). The images were clear, one radiologist said it wasn't clear enough a second radiologist said no issues reading and seeing what she needed (shows you that more than one set of eyes with pineapple juice might be needed). What I took away from this MRE are a few great things, one that pushing for the pineapple juice was worth it, no side effects my 15 yo went to the mall to shop that afternoon as if nothing happened, unlike the first MRE where she was chained to a toilet with diarrhea for the entire weekend feeling nauseous. I also learned about a new oral contrast that they had (named Breeza) that is sugar free and gluten free supposedly tastes like sprite (per tech) seemed to be improvement from the milky gross stuff that wasn't even labeled with ingredients at our first MRE. If you can't get them to agree to pineapple juice ask for this stuff, it has SCD illegals but seems better than the milky alternative if you had to use it.

I use Trader Joes Pineapple juice not from concentrate. I plan to buy two half gallons for the procedure. This is in their refrigerator section.

My daughter doesn't like pineapple but with it being such a short amount to drink, she may go for that!! She did use the breeza contrast the last time and says it does taste like flat sprite but her problem is drinking such a big amount!!

Don't let the docs tell you your child MUST drink all that barium. Its false. Also, if they say they HAVE to have the glucagon shot, also, not true. DO NOT let them starve your kid for hours on end before the procedure. 4 hours is MORE than sufficient.
Because of our son, and what we've gone through the last year to include 2 colonoscopy/endoscopy procedures, 2 MREs, PICC line procedure, etc the children's hospital GI team has come up with a new protocol for the MREs. My son is proof (twice!) that not ALL the theories that docs have been taught to do and continue to push on us for this procedure is necessary! We got them to start looking outside the box. You must be your child’s ADVOCATE. Docs work for us. Not the other way around. Yes, it’s a delicate dance of being diplomatically stern and constantly researching on my own. Docs have repeatedly admitted to learning A LOT from their patients and their parents because we LIVE it daily. It has become our lifestyle. We can't just sit back and follow every standard protocol out there just because.
In paying attention to MY son, and NOT comparing him to others, I have unveiled so many different things that the docs simply overlooked because they get stuck in their standard protocols.
DO NOT BE AFRAID TO SPEAK UP! You are your child's voice!

Research and studies

Pineapple juice as a negative oral contrast agent in magnetic resonance cholangiopancreatography: a preliminary evaluation

Effectiveness of natural oral contrast agents in magnetic resonance imaging of the bowel 

Bowel Contrast Agents 

What are contrast materials and how do they work?

 

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