What is the Barium Swallow Test?

A barium swallow test is an imaging test used to diagnose problems in the upper gastrointestinal (GI) tract. The upper GI tract includes the mouth, back of the throat (pharynx), esophagus (the tube that connects the mouth to the stomach), stomach, and duodenum (the first part of the small intestine).

Other names for this test include esophagogram, barium esophagram, and upper GI series. It uses a continuous X-ray beam to create images of the upper digestive tract (throat and esophagus) as you swallow. These are X-ray images and live video images that allow your doctors to observe your throat and esophagus while swallowing.

During the test, you are asked to swallow a barium sulfate solution. Barium is radiopaque and blocks X-rays. It acts as a contrast agent and enhances the visibility of the gastrointestinal tract on X-ray, allowing for clearer imaging. As barium is swallowed, it will coat the inner lining of the esophagus and the stomach, outlining its shape. This will help identify any perforations, fistulas, strictures, tumors, ulcers, or hiatal hernias. As the barium is swallowed, real-time fluoroscopic images of the esophagus will be taken to evaluate swallowing function and motility by tracking the barium.

What Is A Barium Swallow Test Used For?

A barium swallow study, or barium esophagram, is used to diagnose the cause of difficulties with swallowing and to look for evidence of disease in the esophagus.

Your healthcare provider may recommend a barium swallow test if they suspect problems in your esophagus or if you have symptoms such as:

Difficulty swallowing
Pain with swallowing
Coughing or gagging while swallowing
Regurgitation (bringing up undigested food)
Heartburn
Throat pain or chest pain
Abdominal pain
Bloating
Blood in vomit
Unexplained weight loss

Healthcare providers look for various conditions on a barium swallow, including:

Tissue changes such as inflammation
Ulcers
Blockages
Benign or malignant growths such as polyps or tumors
Structural problems
Muscle disorders
Assessments of the upper gastrointestinal tract after surgeries

What Is A Barium Swallow Test Used To Diagnose?

A barium swallow test can be used to diagnose upper GI tract conditions or identify issues, including:

Swallowing Disorders (Dysphagia):
- Oropharyngeal dysphagia (difficulty initiating swallowing in the mouth)
- Esophageal dysphagia (difficulty moving food down the esophagus)
Esophageal Structural Abnormalities:
- Esophageal Strictures (narrowing of the esophagus caused by acid reflux, scarring, or tumors)
- Diverticula (pouches in the esophagus - Zenker’s or Epiphrenic diverticula)
- Hiatal Hernia (part of the stomach pushing through the diaphragm in the chest)
Gastroesophageal Reflux Disease (GERD) and Complications:
- Acid reflux and regurgitation causing esophagitis
- Barrett’s esophagus
Esophageal Motility Disorders (issues with how food moves down the esophagus):
- Achalasia (lower esophageal sphincter loses relaxation ability causing food to not move further down)
- Esophageal Spasm (abnormal contractions of the esophagus)
- Scleroderma-related motility concerns (weak or absent esophageal contractions)
Tumors or Masses that may cause obstruction of the upper GI tract or swallowing issues
Perforations, Leaks, Fistulas:
- Detects any perforations or abnormal connections between the esophagus and nearby structures caused by trauma, injury, infections, or surgical complications.

How Do I Prepare for the Barium Swallow Test?

Tell your health care provider if you are pregnant or could be pregnant.
Give your doctor a complete list of all your medications, including prescription drugs, over-the-counter medicines, dietary supplements, and herbal products.
Tell your provider if you are allergic to any medicines or contrast agents (for example, barium or iodine).
Be sure to mention to your healthcare provider if you have had any other recent imaging tests. Your provider will want to keep track of all the barium you have received. Ingesting high amounts of barium for a long time can cause kidney damage.

What Should You Not Do Before A Barium Swallow?

You should not eat or drink anything 8 hours before a barium esophagram. This means you should stop eating and drinking at midnight if you’re having a swallowing test the next morning.

Also, avoid smoking, chewing gum, or sucking on hard candy, as these substances can coat your throat and interfere with the results of your barium swallow esophagram.

Your provider may ask you to stop taking certain medications before your X-ray exams. Follow the specific instructions correctly. Some of the medications that might be avoided prior to a barium swallow test are listed below:

Proton Pump Inhibitors and H2 Blockers:
Prokinetic Agents:
- These medications can speed up digestion and mask motility disorders.
- Metoclopramide (Reglan) is an example.
Pain Medications and Muscle Relaxers:
- Some of these medications can slow down digestion.
- Opioids (morphine, oxycodone, hydrocodone).
- Baclofen (muscle relaxant that affects the esophagus).
Anticholinergic Medications:
- These medications can slow down digestion and cause esophageal relaxation.
- Diphenhydramine (Benadryl) and oxybutynin (Ditropan) are examples of such anticholinergics.
Medications That Affect Bowel Movements:
- Laxatives might cause rapid GI transit, altering imaging.
- Constipating medications can slow barium progressions, making interpretation harder.

What Does the Barium Swallow Procedure Involve?

A barium swallow typically takes 30 to 60 minutes to complete. There is no pain or anesthesia involved. The barium drink is flavored, and some people dislike it, while others are indifferent to its taste.

Step-by-Step Process

You will change into a hospital gown.
The radiology team may ask you to remove any jewelry or objects that could interfere with the swallowing test.
The test is done on an X-ray table that can be placed in different positions, including an upright position and a horizontal position.
Your radiologist may ask you to change positions during the test. For example, they may want you to lie on your back, stomach, or side.
The test will start with the radiologist obtaining an X-ray of your chest and abdomen.
You will then be asked to swallow a thick, chalky barium solution.
Your radiologist will take a single X-ray or a series of X-ray images as you swallow the barium drink. Fluoroscopy (video images) can also be obtained, allowing your doctors to observe the movement of the barium through your throat and esophagus.
You may be asked to hold your breath for a few seconds at certain times during the barium swallow esophagram.
Next, you will receive a thinner barium drink or a barium tablet to swallow. The radiologist will again observe the passage of barium using X-rays or fluoroscopy.
Once the test is completed, you’ll step off the X-ray table and change back to your clothes.

What Happens After the Barium Swallow Test?

Most people can return to a normal diet and activities immediately after a barium swallowing study. Barium is not absorbed by the body, making it safe to use for this type of imaging.

How Long Does It Take To Recover From A Barium Swallow?

Recovery from a barium swallow is typically very quick, and you can resume all normal activities immediately. However, you may notice white stools for 1-3 days as the barium passes through your system. It’s important to drink plenty of fluids during this time to help flush it out and prevent constipation.

Can I Drive Myself Home After A Barium Swallow Test?

Yes, you can drive yourself home after a barium swallow test. A barium swallow esophagram is done without the use of anesthesia or sedating medications.

What Are the Side Effects After a Barium Swallow Test?

Some people experience bloating and cramping after a barium esophagram test. These side effects are temporary and usually ease on their own.

As mentioned before, a barium swallow test can also cause temporary constipation. Drink lots of water and eat high-fiber foods over the next few days to help clear out the barium from your body and prevent constipation. You may need to treat constipation with an over-the-counter (OTC) laxative.

Potential Risks and Complications

A barium swallow study is done using X-ray imaging and exposes you to a low dose of radiation. This is a safe amount, but your radiation exposure can add up if you have too many X-ray treatments or studies in a short period of time.
Pregnant patients should avoid radiation exposure due to a risk of congenital abnormality (birth defects). Before scheduling a barium swallow test, tell your doctor if you’re pregnant or might be pregnant. Your doctor may recommend other tests that do not involve radiation exposure.
There is a small risk of an allergic reaction to the barium contrast solution.
Other potential complications of a barium swallow include bowel obstruction or aspiration pneumonia from swallowing the barium into the lungs. These are very rare.
For a patient with suspected esophageal perforation, a barium swallow is not the preferred test. If the perforation is large enough, barium can leak into the chest or surrounding tissues leading to severe inflammation in the mediastinum, lungs, or peritoneum. A water-soluble contrast study with Gastrografin is typically done for safety reasons.

Contact your healthcare provider if you develop severe constipation (no bowel movement for two or more days after the test). Seek emergency medical care if you develop signs and symptoms of an allergic reaction (skin rash, hives, itching, swelling, difficulty breathing).

Who Should Avoid a Barium Swallow Test?

People with the following conditions should avoid a barium swallow test:

A perforation (tear or hole) in the esophagus or intestines.
Severe constipation.
Blockage in the intestines.
Severe dysphagia (trouble with swallowing), which can increase the risk of aspiration (barium accidentally going into the lungs).
Allergy to barium.
Pregnant patients.

What Are Other Tests To Evaluate The Upper GI Tract?

There are several different types of swallow tests, endoscopies, and X-ray exams for the upper GI tract. You may have one or more of these tests, depending on your symptoms.

Bedside Swallow Test involves doing certain movements like sticking out your jaw, smacking your lips, and swallowing different foods and liquids while your healthcare provider observes you.

Esophagoscopy is an imaging test performed under general anesthesia. Passing a device called a scope, which has a camera and light source, through the mouth and into the esophagus, the surgeon can view the inside of the esophagus on a monitor.

Transnasal esophagoscopy is done by advancing a scope through the nose into the esophagus. This procedure does not require the use of anesthesia.

Fiberoptic Endoscopic Evaluation of Swallow (FEES) is done using a thin, flexible tube called an endoscope, which has a light and camera at its tip. The endoscope is passed through your nose to the back of your throat. You are asked to eat and drink foods and liquids that contain a special dye. This allows your healthcare provider to observe the movement of the food in your throat when you swallow.

Modified Barium Swallow Study (MBSS), also called a videofluoroscopic swallow study (VFSS), is a type of special X-ray that helps radiologists and speech-language pathologists identify the causes of dysphagia (trouble swallowing). It involves swallowing barium-coated foods and liquids that can be seen clearly on the X-ray as they move through your upper GI tract. The test provides real-time live video images using an instrument called a fluoroscope.

Upper GI Endoscopy, also called an esophagogastroduodenoscopy (EGD), is where they insert an endoscope through your mouth into your throat and take pictures of your upper GI tract (esophagus, stomach, and first part of the small intestine) and obtain a biopsy (tissue sample). An upper GI endoscopy is more invasive than a barium swallow but provides more information about the upper GI tract and is generally one of the most widely used tests.

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