Barium Swallow

(Esophagography, Esophagogram)

Procedure Overview

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 (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).

X-rays use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film. X-rays are made by using external radiation to produce images of the body, its organs, and other internal structures for diagnostic purposes. X-rays pass through body tissues onto specially-treated plates (similar to camera film) and a “negative” type picture is made (the more solid a structure is, the whiter it appears on the film).

Fluoroscopy is often used during a barium swallow. Fluoroscopy is a study of moving body structures - similar to an x-ray “movie.” A continuous x-ray beam is passed through the body part being examined, and is transmitted to a TV-like monitor so that the body part and its motion can be seen in detail. In barium x-rays, fluoroscopy allows the radiologist to see the movement of the barium through the pharynx and esophagus as a person drinks it, hence the name barium swallow.

Why is barium used with x-rays?

Barium is a dry, white, chalky, metallic powder that is mixed with water to make a thick, milkshake-like drink. Barium is an x-ray absorber and appears white on x-ray film. When swallowed, a barium drink coats the inside walls of the pharynx and esophagus so that the swallowing motion, inside wall lining, and size and shape of these organs is visible on x-ray. This process shows differences that might not be seen on standard x-rays. Barium is used only for diagnostic studies of the GI tract.

The use of barium with x-rays contributes to the visibility of various characteristics of the pharynx and esophagus. Some abnormalities of the pharynx and/or esophagus that may be detected by a barium swallow include tumors, ulcers, hernias, diverticula (pouches), strictures (narrowing), inflammation, and swallowing difficulties.

Another related procedure that may be used to diagnose upper GI problems is esophagogastroduodenoscopy (EGD). Please see this procedure for additional information.

About the pharynx and esophagus:

Illustration of the anatomy of the digestive system, adult
Click Image to Enlarge

Digestion is the process by which food and liquid are broken down into smaller parts so that the body can use them to build and nourish cells, and to provide energy. Digestion begins in the mouth, where food and liquids are taken in, and is completed in the small intestine.

One of the main functions of the pharynx is swallowing. The main function of the esophagus is the forward propulsion of foods to the stomach.

Reasons for the Procedure

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, the following:

  • cancers of the head, neck, pharynx, and esophagus
  • tumors
  • hiatal hernia - 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 - the lower esophageal sphincter muscle does not relax and allow food to pass into the stomach
  • gastroesophageal reflux disease (GERD) and ulcers

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

Risks of the Procedure

You may want to ask your physician about the amount of radiation used during the procedure and the risks related to your particular situation. It is 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 physician. 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 are pregnant or suspect that you may be pregnant, you should notify your physician. Radiation exposure during pregnancy may lead to birth defects.

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

Constipation or fecal impaction may occur if the barium is not completely eliminated from the body.

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

  • esophageal or bowel perforation
  • 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 upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Certain factors or conditions may interfere with the accuracy of a barium swallow procedure. A recent barium x-ray or cholangiography procedure may interfere with the x-ray exposure of the upper GI area.

Before the Procedure

  • Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
  • You may be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
  • You will be asked to not eat or drink liquids for eight hours before the procedure, generally after midnight.
  • If you are pregnant or suspect that you may be pregnant, you should notify your physician.
  • Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
  • Notify your physician of all medications (prescribed and over-the-counter) and herbal supplements that you are taking. Your physician may advise you to withhold certain medications prior to the procedure.
  • Notify the radiologist if you have had a recent barium x-ray or cholangiography procedure, as this may interfere with obtaining an optimal x-ray exposure of the upper GI area.
  • Based upon your medical condition, your physician may request other specific preparation.

During the Procedure

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 physician’s practices.

Generally, a barium swallow follows this process:

  1. You will be asked to remove any clothing, jewelry, or other objects that may interfere with the procedure.
  2. If you are asked to remove clothing, you will be given a gown to wear.
  3. 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 (e.g., lying on your side, back, or stomach) at intervals during the procedure.
  4. Standard x-rays of the heart, lung, and abdomen may be performed first.
  5. The radiologist will ask you to take a swallow of a thickened barium drink. The barium is usually flavored, although it may not be very pleasant tasting.
  6. 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.
  7. You may be asked to hold your breath at certain times during the procedure.
  8. You will 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 “marshmallow” - a small piece of barium-soaked bread, which can help to visualize certain structural problems of the esophagus.
  9. If an additional procedure called a “small bowel follow through” has been requested, it will be performed after the barium swallow has been completed.
  10. Once all required x-rays have been taken, you will be assisted from the table.

After the Procedure

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

Barium may cause constipation or possible impaction after the procedure if it is not completely eliminated from your body. You may be advised to drink plenty of fluids and eat foods high in fiber to expel the barium from the body. You may also be given a cathartic or laxative to help expel the barium.

Since barium is not 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 physician 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 physician may give you additional or alternate instructions after the procedure, depending on your particular situation.

Online Resources

The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your physician. Please consult your physician with any questions or concerns you may have regarding your condition.

This page contains links to other Web sites with information about this procedure and related health conditions. We hope you find these sites helpful. But please remember we do not control or endorse the information presented on these Web sites, nor do these sites endorse the information contained here.

American Cancer Society

American Gastroenterological Association

National Cancer Institute (NCI)

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

National Institutes of Health (NIH)

National Library of Medicine

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