Barium Swallow (Esophagram) - Cabell Huntington Hospital

What is a barium swallow?

A barium swallow is a radiographic (X-ray) examination of the upper gastrointestinal (GI) tract, specifically the pharynx (back of mouth and throat) and the esophagus (a hollow tube of muscle extending from below the tongue to the stomach). The pharynx and esophagus are made visible on X-ray film by a liquid suspension called barium sulfate (barium). Barium highlights certain areas in the body to create a clearer picture. A barium swallow may be performed separately or as part of an upper gastrointestinal (UGI) series, which evaluates the esophagus, stomach, and duodenum (first part of the small intestine).

Fluoroscopy [LINK] is often used during a barium swallow to study moving body structures — similar to an X-ray "movie." In barium X-rays, fluoroscopy allows the radiologist to see the movement of the barium through the pharynx and esophagus as a person drinks.

What are the reasons for a barium swallow?

A barium swallow may be performed to diagnose structural or functional abnormalities of the pharynx and esophagus. These abnormalities may include, but are not limited to:

Cancers of the head, neck, pharynx, and esophagu
Tumors
Hiatal hernia, an upward movement of the stomach, either into or alongside the esophagus
Structural problems such as diverticula, strictures, or polyps (growths)
Esophageal varices (enlarged veins)
Muscle disorders (pharyngeal or esophageal) such as dysphagia (difficulty swallowing) or spasms (pharyngeal or esophageal)
Achalasia, a condition in which the lower esophageal sphincter muscle doesn't relax and allow food to pass into the stomach
Gastroesophageal reflux disease (GERD) and ulcers

There may be other reasons for your doctor to recommend a barium swallow.

What are the risks of a barium swallow?

You may want to ask your doctor about the amount of radiation used during the procedure and the risks related to your particular situation. It's a good idea to keep a record of your past history of radiation exposure, such as previous scans and other types of X-rays, so that you can inform your doctor. Risks associated with radiation exposure may be related to the cumulative number of X-ray examinations and/or treatments over a long period of time.

If you're pregnant or suspect that you may be pregnant, you should notify your doctor. Radiation exposure during pregnancy may lead to birth defects.

Patients who are allergic to or sensitive to medications, contrast dyes, iodine, or latex should notify their doctor.

Constipation or fecal impaction may occur if the barium isn't completely eliminated from the body.

Contraindications for a barium swallow may include, but are not limited to:

Esophageal or bowel perforation/li>
Bowel obstruction or severe constipation
Pregnancy
Severe swallowing difficulty such that aspiration (entry of substances into the lungs) of barium is likely

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

How do I prepare for a barium swallow?

PRECAUTIONS: If you are pregnant or think you may be pregnant, please check with your doctor before scheduling the exam. Notify the radiologist if you have had a recent barium X-ray or gastrointestinal surgical procedure, as this may interfere with obtaining an optimal X-ray exposure of the upper GI area.

EAT/DRINK: You must follow the food and drink guidelines to ensure you are prepared for your exam. The night before your exam, do not eat or drink anything after midnight.

What happens during a barium swallow?

A barium swallow may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor's practices.

Generally, a barium swallow follows this process:

You will be asked to remove any clothing, jewelry, or other objects that may interfere with the procedure.
If you are asked to remove clothing, you will be given a gown to wear.
You will be positioned on an X-ray table that can tilt you from a horizontal to an upright position. You may also be asked to change positions (for example, lying on your side, back, or stomach) at intervals during the procedure.
Standard X-rays of the heart, lung and abdomen may be performed first.
The radiologist will ask you to take a swallow of a barium drink. The barium is usually flavored, although it may not be very pleasant tasting.
As you swallow the barium, the radiologist will take single pictures, a series of X-rays, or a video (fluoroscopy) to observe the barium moving through the pharynx.
You may be asked to hold your breath at certain times during the procedure.
You may be given a thinner barium drink to swallow. X-rays and/or fluoroscopy will be used to observe the barium's passage down the esophagus. You may also be asked to swallow a barium tablet — a small, solid pill, which can help to visualize certain structural problems of the esophagus.
Once all required X-rays have been taken, you'll be assisted from the table.

What happens after a barium swallow?

You may resume your normal diet and activities after a barium swallow, unless your doctor advises you differently.

Barium may cause constipation or possible impaction after the procedure if it isn't completely eliminated from your body. You may be advised to drink plenty of fluids to expel the barium from the body. You may also be given acathartic or laxative to help expel the barium.

Since barium isn't absorbed into the body but passes through the entire intestinal tract, your bowel movements may be lighter in color until all of the barium has been excreted.

Notify your doctor to report any of the following:

Difficulty with bowel movements or inability to have a bowel movement
Pain and/or distention of the abdomen
Stools that are smaller in diameter than normal

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

Modified Barium Swallow

What is a modified Barium Swallow?

During a modified barium swallow, you ingest foods and liquids containing barium sulfate, a contrast dye that sharply outlines your mouth, throat, and esophagus on x-ray film. Using real-time x-rays, or fluoroscopy, a physician and a speech pathologist observe the movement of the barium through these structures on a television monitor. Modified barium swallow is specifically aimed at evaluating the swallowing process in individuals who have difficulty speaking or swallowing food without inhaling, or aspirating, it into the windpipe.

Purpose of the Modified Barium Swallow

To identify the cause of difficult or impaired swallowing (dysphagia).
To help determine the most appropriate treatment or management techniques for swallowing problems.

Before the Modified Barium Swallow

Tell your doctor if you are or could be pregnant.

What You Experience

You may be seated in a special chair designed for this exam.
You will consume barium containing product of different consistencies The consistency of the items vary, ranging from thin liquid to semisolid foods (for example, pudding) or solid foods (such as a cookie).
As you swallow different amounts of the items, the examiners use fluoroscopic imaging to observe the swallowing process on a television screen in order to determine which foods are difficult for you to swallow and which structures are responsible for the problem. The swallowing process may be observed at normal speed or in slow motion.
Other than chewing and swallowing, you must remain still during the procedure.
A speech pathologist is present during the test to evaluate your swallowing ability and, if possible, to suggest some possible corrective actions.
The test usually takes 30 minutes depending on the findings.

After the Modified Barium Swallow

You may leave the testing facility immediately and resume your normal diet and activities, unless instructed differently by the speech pathologist.
Drink plenty of fluids to help eliminate the barium from your system.
Your stool will be chalky and light-colored initially, but it should return to normal color after 1 to 3 days.

Results

Your physician will receive a copy of the radiologists final report.
If possible, the speech pathologist will recommend specific corrective actions to help you resolve the swallowing problem during the test and no further testing or treatment is needed.