Barium Swallow Test

What is a Barium Swallow Test? 

A Barium Swallow Test (also known as a modified barium swallow study, video fluoroscopy swallow study, esophagram, swallowing study or esophagography) is a type of imaging test that uses a substance called barium sulfate and X-rays to create detailed images of the gastrointestinal (GI) tract. 

During the procedure, the patient swallows a chalky barium drink, which makes the structures of the upper GI tract show up more clearly on an X-ray. The upper GI tract includes the back of your mouth and throat (pharynx), esophagus, stomach and the first part of the small intestine (duodenum).

  • Upper GI Series and Barium Swallow Testing – An upper GI series is an imaging test that looks at your upper gastrointestinal tract, including the esophagus, stomach and the first part of the small intestine (duodenum). A barium swallow test is sometimes performed as part of an upper GI series.
  • Barium Swallow and Fluoroscopy – Fluoroscopy is a kind of “X-ray movie” often utilized during a barium swallow test or Upper GI series. Fluoroscopy allows doctors to see the movement of the barium through the upper GI tract and how the tissues are interacting with each other as the patient swallows. 

Why is Barium Used in a Barium Swallow Test?

Barium is a contrast medium, and is used during a swallowing test to make the structures of the upper GI tract show up clearly on an X-ray. Barium sulfate is not radioactive. It absorbs X-rays — a property called being “radio opaque.” Because of this trait, barium appears white in X-ray imaging. As a patient swallows a liquid containing barium sulfate, barium coats the inner surfaces of the esophagus, stomach and other tissues of the digestive tract.

Once X-ray images are taken, barium allows the radiologist to more clearly see details of the upper GI tract, including any damage or problems that could be causing symptoms the patient might be having.  

Why is a Swallow Test Usually Performed?

A barium swallow test is usually performed to look for and diagnose problems in the Upper GI tract. A Barium swallow can help diagnose a variety of conditions involving the digestive tract including: 

  • Unexplained nausea and vomiting
  • Abdominal pain
  • Unexplained weight loss
  • Muscle disorders in the throat or trouble swallowing (AKA dysphagia)
  • Cancer of the pharynx or esophagus
  • Hiatal hernia, in which the stomach has intruded into the chest cavity or been forced into the space alongside the esophagus. 
  • Structural problems like pouches (diverticula), narrowing (strictures), or growths (polyps) in the esophagus or throat
  • Achalasia, a condition in which the lower esophageal sphincter muscle doesn’t relax to allow food to pass from the esophagus into the stomach 
  • GERD (gastroesophageal reflux disease), which is a condition in which stomach acid and undigested food are regurgitated into the esophagus and throat 
  • Gastric ulcer, which are sores that can form in the lining of the stomach 

What are the Risks of a Barium Swallow Test?

The risks involved in a Barium Swallow Test are generally very low. However, be sure to talk to your doctor before a barium swallow test if you: 

  • Have a hole or tear (perforation) in your esophagus or intestines
  • Have intestinal blockage or severe constipation
  • Have severe swallowing issues, which might cause you to accidentally inhale the barium solution into your lungs (aspiration) 
  • Are pregnant or think you may be pregnant, as barium absorbs X-rays. Radiation exposure may lead to issues with a developing fetus. 
  • Are allergic to latex, iodine, local anesthesia or contrast dyes  

Is it Safe to Have a Barium Swallow Test While Pregnant?

You should not have a barium swallow test if you are pregnant. Radiation exposure from X-rays during pregnancy can harm a developing fetus and could lead to birth defects. Be sure to tell your provider if you are pregnant or think you may be pregnant before undergoing a barium swallow test.

How to Prepare for a Barium Swallow Test

Preparation for a barium swallow test isn’t difficult. The following items should be considered while preparing:

  • Tell your provider if you are pregnant or think you may be pregnant before scheduling a barium swallow test
  • Before the swallowing test, tell your provider if you’re allergic to any medicines, latex or anesthetics
  • Talk to your doctor about any medicines you are taking, including vitamins, herbal supplements, over-the-counter medications and prescription medications. 
  • Your healthcare provider will explain the barium swallow test to you, and ask you to sign a consent form. Read the form carefully, and ask your doctor about anything you’re unsure about. 
  • You’ll need to stop drinking and eating (including chewing gum) at least 8 hours before the swallowing test. Usually, you will be instructed to stop eating and drinking at midnight the night before the procedure
  • If you’ve recently had a barium swallow or upper GI test, tell your doctor, as the previous test may make it more difficult to get clear images during a barium swallow test.

How is a Barium Swallow Test Performed?

A barium swallow study may be performed as an outpatient procedure or as part of a longer hospital stay. Generally, the test follows this basic procedure:

  • You’ll be asked to remove any jewelry, and may be asked to remove your clothing. If so, you will be given a gown to wear.
  • You will lie on an X-ray table that can move from an upright to a horizontal position. You may also be asked to change positions during the swallowing test, lying on your side, back or stomach so the technician can get images from specific angles. 
  • Before the test, the radiologist will ask you to drink a contrast medium containing barium. It’s usually thick, chalky and may have an unpleasant flavor. 
  • As you swallow the barium, the radiologist may take a series of X-rays, single images, or use fluoroscopy to watch the barium moving through your mouth and throat.
  • You may be asked to hold your breath at certain times during the test.
  • You may also be asked to swallow a barium tablet. This is a small pill containing barium that can help reveal certain problems in the GI tract.
  • Once the radiologist has taken all of the required X-ray images, you’ll be allowed to get dressed and leave the exam room.

What Happens After a Barium Swallow Test?

You can go back to your normal diet and activities immediately after a barium swallow test, unless your physician tells you otherwise.

Until the barium clears from your body, you may have issues with your bowel movements, including constipation. Be sure to drink plenty of water and eat a diet that’s high in fiber for a few days to help expel the remaining barium. 

Note that the stool you pass after a barium swallow test may be pale or white in color. This is normal, and should stop once the barium is out of your system.

When Should I Contact My Doctor After a Barium Swallow Test?

Following a barium swallow test, contact your doctor if you experience any of these symptoms:

  • A fever
  • An inability to pass gas or have a bowel movement at all
  • Severe abdominal pain
  • Swelling of the abdomen