Barium Swallow / Barium Meal

A barium examination of the throat and esophagus is referred to as barium swallow test. A barium examination of the stomach and the first part of the small intestine) is called a barium meal test. The patient swallows a variable combination of barium (a liquid that enhances X-ray images) and gas (also known as fizzes), and stands in front of an X-rays scanner.

Indications

The barium swallow test, or esophagram, is useful for investigating patients with a variety of complaints that may be due to abnormalities within the esophagus. A few examples of such symptoms include difficulty swallowing (dysphagia), heartburn (dyspepsia), or gastroesophageal reflux (GERD).

The esophagram may reveal abnormalities which account for one or more of the above symptoms. Abnormalities include strictures, ulceration of the esophagus, hiatal hernia (abnormal positioning of a portion of the stomach within the chest), presence of a mass lesion such as a polyp within the esophagus, and gastroesophageal reflux.

Whereas the esophagram consists only of a detailed examination of the esophagus, a barium meal test (or upper GI series) evaluates the stomach and upper small intestine. This test, as well as identifying some of the disorders of the esophagus already described, may also identify the presence of ulcers or tumors within the stomach.

Preparation

The success of the esophagram or upper GI series is for the most part related to patient preparation. It is necessary to stop eating and drinking the night before the test. The presence of food or excess fluid within the upper digestive tract will significantly reduce the diagnostic accuracy of the study and most likely mean the test will have to be canceled. If patients need to take medications on the morning of the study, we ask that they consult their doctor beforehand. Patients are also asked not to smoke on the morning of the test, as this too alters the accuracy of the study.

Prior to the examination the technologist will ask a number of questions including whether or not the patient has any allergies, any previous surgery or whether they are taking any medication. As both studies involve a small amount of radiation, it is important that the patient makes the technologist and radiologist aware if they are pregnant or think they may be pregnant.

The examination

At the beginning of the examination the patient will be asked to swallow liquid barium and a combination of granules and citric acid. The granules and citric acid together produce carbon dioxide which distends the barium coated esophagus and stomach. It is most important that the gas produced by the fizzes remains within the stomach so maintaining maximum distension. It is therefore necessary for the patient not to burp even if they feel they need to. The radiologist uses a fluoroscopy unit (X-ray machine) to visualize the esophagus and stomach. The patient is asked to stand or lie in different positions in order to produce the best images. Each time an X-ray is taken the patient is asked to hold their breath for a brief moment. After completion of the examination the patient waits briefly in order to make sure that the images are entirely satisfactory before being discharged.

What happens after the test?

Following the procedure the patient can return immediately to normal diet and activity. It is usually advisable for the patient to drink more water than is usual, as this will help to relieve any constipation that may occur following the barium examination. The bowel movements may appear white or light for a day or two and this is entirely normal.

Complications

Any fluoroscopy study involves a small amount of radiation. However, through appropriate training, practice, and experience, radiologists ensure that the radiation is kept to a minimum by a variety of measures. The radiation dose is small and the benefits of this test far outweigh the risks. The examinations themselves are essentially free of risk. One possible complication in elderly and debilitated patients is aspiration of a small amount of barium into the lungs. However, this can be identified immediately during the examination, and with subsequent chest physiotherapy is likely of no long-term significance.