What is a barium swallow?

A barium swallow is an imaging test that uses X-rays to look at your upper gastrointestinal (GI) tract above your stomach. This includes the back of your mouth and throat (pharynx) and your esophagus.

You may have just a barium swallow. Or this test may be done as part of an upper GI series. This series looks at your esophagus, stomach, and the first part of the small intestine (duodenum).

X-rays use a small amount of external radiation to create images of your body, its organs, and other internal structures. X-rays are most often used to find bone or joint problems, or to check the heart and lungs. A barium swallow is one type of X-ray.

Fluoroscopy is used during a barium swallow. Fluoroscopy is a special kind of X-ray “movie” that shows the organs in motion.

The test also uses barium. Barium is a substance that makes certain areas of the body show up more clearly on an X-ray. The radiologist will be able to see the size and shape of the pharynx and esophagus. They will also be able to see how you swallow. These details can't be seen on a standard X-ray. Barium is used only for imaging tests for the GI tract.

Why might I need a barium swallow?

A barium swallow can help your provider find the cause for nausea and vomiting, pain in your belly (abdomen), unexplained weight loss, or problems swallowing. It may be done to look for and diagnose problems in the pharynx and esophagus. You may need a barium swallow if your healthcare provider thinks that you have:

• Cancer of the head, neck, pharynx, or esophagus

• Hiatal hernia. This means that your stomach has moved up into or alongside the esophagus.

• Structural problems, such as pouches (diverticula), narrowing (strictures), or growths (polyps)

• Muscle disorders, such as trouble swallowing (dysphagia) or spasms

• Achalasia. This is a condition in which the lower esophageal sphincter muscle doesn't relax and allow food to pass into the stomach.

• GERD (gastroesophageal reflux disease)

• Ulcers

Your healthcare provider may have other reasons to advise a barium swallow. Talk with your healthcare provider about the reason for your test.

What are the risks of a barium swallow?

You may want to ask your healthcare provider about the amount of radiation used during the test. Also ask about the risks as they apply to you.

Consider writing down all X-rays you get, including past scans and X-rays for other health reasons. Show this list to your provider. The risks of radiation exposure may be tied to the number of X-rays you have and the X-ray treatments you have over time.

Tell your provider if:

• You are pregnant or think you may be pregnant. Radiation exposure during pregnancy may lead to birth defects. You should not have this test if you are pregnant.

• You are allergic to or sensitive to medicines, contrast dyes, local anesthesia, iodine, or latex

You may have constipation or impacted stool after the test if all of the barium does not pass out of your body.

You should not have a barium swallow if you have:

• A tear or hole in your esophagus or intestines (perforation)

• Blockage in your intestines or severe constipation

• Severe problems with swallowing. This makes it more likely that barium would accidentally go into your lungs (aspiration).

You may have other risks depending on your specific health condition. Be sure to talk with your healthcare provider about any concerns you have before the procedure.

How do I get ready for a barium swallow?

• Your healthcare provider will explain the procedure to you. Ask them any questions you have about the procedure.

• You may be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if anything is not clear.

• You will need to stop eating and drinking for about 8 hours before the test. You should also avoid chewing gum. Generally, this means after midnight.

• Tell your provider if you are pregnant or think you may be pregnant.

• Tell your provider if you are sensitive or allergic to any medicines, latex, tape, or anesthetic medicines (local and general).

• Tell your provider if you have had a recent barium swallow or upper GI test. This may make it harder to get good X-rays of the lower GI area.

• Tell your provider about all medicines you are taking. This includes prescriptions, over-the-counter medicines, and herbal supplements. You may need to stop taking these before the test.

• Follow any other instructions your provider gives you to get ready.

What happens during a barium swallow?

You may have a barium swallow as an outpatient or as part of your stay in a hospital. The way the test is done may vary depending on your condition and your healthcare provider's practices.

Generally, a barium swallow follows this process:

1. You'll be asked to remove any clothing, jewelry, or other objects that may get in the way of the test.

2. You may be asked to remove clothing. If so, you will be given a gown to wear.

3. You will stand and/or lie on an X-ray table that can move you from a horizontal to an upright position. You may also be asked to change positions during the test. For example, you may need to lie on your side, back, or stomach.

4. The radiologist may take X-rays of your chest and belly (abdomen) first.

5. The radiologist will ask you to take a swallow of a thick, chalky barium drink that resembles a shake. The barium may be flavored like strawberry or chocolate, but it may not taste very good. The barium coats the lining of your GI tract.

6. As you swallow the barium, the radiologist will take single pictures, a series of X-rays, or fluoroscopy to watch the barium moving through your mouth and throat.

7. You may be asked to hold your breath at certain times during the test.

8. The radiologist will use X-rays or fluoroscopy to watch the barium go down your esophagus and then through the rest of your GI tract. You may also be asked to swallow a barium tablet. This is a small pill that can help to show certain problems in the esophagus.

9. Once the radiologist has taken all of the X-rays, you'll be helped from the table.

What happens after a barium swallow?

You may go back to your normal diet and activities after a barium swallow, unless your healthcare provider tells you otherwise.

Barium may cause constipation or impacted stool after the procedure if it isn't completely cleared from your body. You may be told to drink plenty of fluids and eat foods high in fiber to help the rest of the barium leave your body. You may also be given a laxative to help with this.

Your bowel movements may be white or lighter in color until all the barium has left your body.

Call your healthcare provider right away if any of these happen:

• You are unable to have a bowel movement or pass gas

• Pain or swelling of the abdomen

• Fever

Your healthcare provider may give you other instructions, depending on your situation.

Next steps

Before you agree to the test or the procedure, make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure