Barium swallow is an X-ray examination of the upper gastrointestinal tract. It involves swallowing a solution containing barium sulfate, a metallic compound which is easily visualized on X-ray images. Barium coats the walls of the pharynx and esophagus and appears white on the images. It can be tracked as it moves through the digestive system by performing a series of X-rays. A barium swallow can help identify problems with swallowing and diagnose abnormalities of the esophagus and stomach.
Indications
Barium swallow test is used to diagnose the structural or functional abnormalities of the upper gastrointestinal tract such as:
- Swallowing disorders
- Narrowing or irritation of the esophagus
- Hiatal hernia, a defect that causes the stomach to partially slide into the chest
- Enlarged esophageal veins
- Ulcers
- Tumors
- Precancerous growths called polyps
- Gastroesophageal reflux disease or GERD
Pre-procedural preparation
You will be asked to consume a low-fiber diet for 2 to 3 days before the test. Your doctor will advise you to stop smoking if you smoke and have nothing to eat after midnight before the test. Inform your doctor if you are pregnant or allergic to any medications, latex, tape, or anesthesia. Also, inform the doctor if you have undergone any barium X-ray or bile duct radiography recently. You will be asked to remove all jewelry before the test.
Procedure
A barium swallow test is performed in the following manner:
- Standard chest and abdominal X-rays are initially performed.
- You are asked to drink about 1½ cups of the chalky barium preparation
- You will lie on an X-ray table that can be tilted from a horizontal to an upright position.
- X-rays are obtained as you swallow the preparation and while the barium passes through your digestive system.
- The table will be tilted so that the barium spreads and X-rays can be captured at various angles. Your doctor may apply pressure to the abdomen to spread the barium inside. You will be asked to swallow more of the barium preparation to obtain additional images.
- The barium swallow procedure takes about 30-60 minutes to finish.
Post-Procedural Care
Following the barium swallow procedure, you can resume a normal diet unless your doctor advises a modified diet. You may have white or light-colored stools for 1-3 days. Sufficient fluids should be consumed to help flush the barium out of your system and prevent constipation. A high-fiber diet including raw fruits and vegetables can also prevent constipation.
Risks and complications
The barium swallow is generally a safe test but as with any procedure complications may occur and can include:
- Allergic reaction or anaphylaxis
- Constipation
- Accidental entry of the barium into the windpipe
Summary
A barium swallow test uses X-ray imaging to aid in diagnosing abnormalities of the upper gastrointestinal tract. It is a safe procedure with minimal risks. Talk to your doctor about any concerns you have regarding the procedure.
A barium meal examination includes a study of the oesophagus, stomach and duodenum. A routine examination is a double contrast study; a positive contrast (barium) is used in addition to gas-producing agents to distend the viscus. The patient is fasted for 6-8 hours prior to the examination. Essential drugs can usually be taken, but advice should be sought from the Radiologist. Sometimes a single contrast examination (dilute barium only) is used in patients with suspected gastric or duodenal obstruction or in very immobile patients. Barium is contra-indicated if there is a known or suspected perforation. In such cases, either a water-soluble iodinated contrast such as Gastrograffin, or a non-ionic agent is used. Gastrografin is very hyperosmolar and may cause pulmonary oedema if aspirated into the airways. If there is a perceived risk of aspiration, non-ionic contrast is used.
A barium swallow is an examination that focuses on the oesophagus. This tends, nowadays, to be a multiphasic examination with double and single contrast views. The study is usually tailored to the patient's symptoms and a good history is essential. Attention is paid during the examination to morphological abnormalities of the hypopharynx and oesophagus, evidence of gastro-oesophageal reflux and swallowing function - the hypopharyngeal phase and oesophageal motility. Solid boluses (e.g. bread, marshmallows) can be given to assess motility. The examination can be recorded on conventional film, rapid-sequence camera film or video (i.e. video-fluoroscopy).
A videofluoroscopic study of swallowing can be performed on patients with neuromuscular problems of deglutition and hypopharyngeal function. This examination is often performed in the company of a speech pathologist. Various consistencies of bolus can be tested using thin liquids, purees and solids. The study aids in both diagnosis and management of patients with these problems.
The small bowel is examined by a 'dedicated' small bowel barium study rather than a 'follow-through' after a barium meal. Radiologists will vary as to whether this is performed by giving the patient a large volume of dilute barium to drink or by a small bowel enema (intubated small bowel study or enteroclysis). Although more accurate for some pathology, the latter examination requires intubation of the jejunum. Unless contraindicated, some form of purgation is given prior to small bowel studies to clear the right side of the colon. Increasingly, small bowel barium studies are being replaced by dedicated CT (or less commonly, MRI) studies of the small intestine.
Most examinations of the large bowel are 'double-contrast' barium enemas (DCBE). Single contrast examinations may be performed on very elderly, immobile patients or on patients with unprepared bowel to determine the presence and site of obstruction. In the presence of a known or suspected perforation a water-soluble contrast agent is used instead of barium. For an accurate DCBE, thorough colon cleansing is imperative. A variety of cleansing regimes are in use. A barium enema should not be performed within 6 days of a prior rigid sigmoidoscopic biopsy or a polypectomy. However, following a superficial biopsy (ie through a flexible sigmoidoscope or colonoscope) a barium enema can be undertaken immediately. CT colonography ('virtual colonoscopy') is gradually replacing DCBE in the radiological investigation of colorectal neoplasms.
Date reviewed: July 2019
Date of next review: July 2020
What is a barium swallow?
A barium swallow is a special type of X-ray test that helps your doctor take a close look at the back of your mouth and throat, known as the pharynx, and the tube that extends from the back of the tongue down to the stomach, known as the esophagus.
Your doctor may ask you to do a barium swallow to help diagnose any conditions that make it difficult for you to swallow or if they suspect that you have a disorder of the upper gastrointestinal (GI) tract. Your upper GI tract includes:
- the esophagus
- the stomach
- the first part of the small intestine, called the duodenum
To do a barium swallow, you swallow a chalky white substance known as barium. It’s often mixed with water to make a thick drink that looks like a milkshake. When it’s swallowed, this liquid coats the inside of your upper GI.
Barium absorbs X-rays and looks white on X-ray film. This helps highlight these organs, as well as their inside linings and the motion of your swallowing, on the X-ray image. These images help your doctor diagnose any disorders of the GI tract.
Your doctor may order a barium swallow to help diagnose a possible structural or functional problem with your upper GI tract. Some common problems that a barium swallow may help diagnose include:
Sometimes a barium swallow is done as part of a series of X-rays that look at the whole upper GI tract. A continuous X-ray beam, called a fluoroscopy, is often used during a barium swallow to capture movement through your GI tract.
A common test that accompanies the barium swallow is the upper GI endoscopy, also known as an esophagogastroduodenoscopy, or EGD. Barium swallows are also often done as part of an upper GI and small bowel series of tests.
It’s important to follow the dietary guidelines your doctor gives you before your procedure. You are not supposed to eat or drink anything for six hours before your procedure. You may take small sips of water up until two hours before your procedure.
If you are getting additional tests done or have any existing medical conditions, the directions your doctor gives you may be slightly different. You should notify your doctor before your procedure if you have or have had any of the following conditions:
- an esophageal or bowel perforation
- bowel obstruction
- difficulty swallowing
- severe constipation
These conditions may disqualify you from doing a barium swallow, as they increase the risk of complications.
Your doctor will direct you to your local radiology facility for your barium swallow. A trained radiology technician will perform the procedure. From start to finish, a barium swallow takes about 30 minutes. You will get your results within several days of your procedure.
Once you’re at the radiology facility, you will be asked to remove your clothing and jewelry and secure your belongings in a locker. You’ll change into a medical gown provided by your doctor.
Your technician will position you on an X-ray table. They may ask you to move your body position as they take standard X-rays of your heart, lungs, and abdomen.
Then, your technician will give you a barium drink to swallow. They will take single X-rays, a series of X-rays, or a fluoroscopy to watch how the barium moves through your pharynx. You might have to hold your breath at certain times to prevent any movement from disrupting the X-ray images.
Next, the technician will give you a thinner barium drink to swallow. They will again take X-rays or a fluoroscopy to watch how the barium moves down the esophagus.
When all X-rays are complete, you can gather your things and leave. You can go back to your normal diet and daily activities after your barium swallow procedure unless your doctor advises otherwise.
Your doctor’s office will be in touch within a few days to go over the results of your test and to schedule any follow-ups that may be needed.
Here is an example of a normal barium swallow study, in which the barium (the dark liquid) is seen moving down the esophagus without any leakage or regurgitation (reflux):
Photo: Anka Friedrich / commons.wikimedia.org
The barium you swallow is artificially flavored and sweetened. However, many people report that it tastes bitter or chalky.
If you have health insurance, a barium swallow may be fully or partially covered. If you don’t have insurance, the procedure may cost between $300 and $450. This covers the costs of your doctor’s time interpreting the X-rays as well as the cost of the technicians who perform the procedure.
If the barium is not completely expelled from your body after the procedure, it can sometimes cause constipation or fecal impaction. You should drink lots of fluids and eat high-fiber foods to help move the barium through your digestive tract and out of your body. If that doesn’t help, your doctor might give you a laxative to help move it through.
After your procedure, you might notice that your bowel movements are lighter in color. This happens because your body doesn’t absorb the barium. Your stool will return to its normal color once all the barium has been expelled.
Be sure to contact your doctor right away if:
- You have trouble having a bowel movement or can’t have a bowel movement.
- You have pain or bloating in your abdomen.
- You have stools that are smaller in diameter than usual.
Also, barium swallows involve exposure to radiation, like all X-ray procedures. The risks of complications related to radiation exposure accumulate over time and are linked to the number of X-ray exams and treatments a person receives in their life. It can be helpful to share a record of past radiation procedures with your doctor before your barium swallow.
Exposure to radiation during pregnancy can cause birth defects in unborn fetuses. Because of this, pregnant women should not undergo barium swallow procedures.
The barium swallow is a less invasive way to look at the upper GI tract than an endoscopy. Barium swallows are a useful diagnostic tool for checking for upper GI tract disorders that can be easily diagnosed with X-ray alone. More complex disorders require endoscopy.
Here’s how to stay comfortable before, during, and after a barium swallow: