Normal barium swallow exam. Interactive version.
A barium swallow (or esophagography) is a medical imaging procedure used to examine the upper GI (gastrointestinal) tract, which includes the esophagus and, to a lesser extent, the stomach.
Barium sulfate is a type of contrast medium that is opaque to X-rays. As the patient swallows the barium suspension, it coats the esophagus with a thin layer of the barium. This enables the hollow structure to be imaged.
This is commonly used with baking soda (sodium bicarbonate crystals) to produce gas (see Reactions of sodium bicarbonate). On fluoroscopy, as gas is low in density, and the X-rays pass through very easily, they will appear as white patches, as opposed to the black produced by relatively dense, X-ray opaque barium. As such, it is extremely useful in providing a contrast to the barium, to produce a double contrast image, to allow better visualisation of the contrasting features within the mucosal layer of the esophagus.
Barium sulfate is an irritant outside the gastrointestinal tract. In cases where a leak is suspected or desired to be demonstrated, contrast imaging involving the use of water-soluble contrast media containing iodine is used.
As with all X-rays, the barium swallow technique employs radiation, and may irradiate the patient unnecessarily. The barium swallow should not be used unless required, and, although it cannot be replaced by endoscopy as for the barium enema, it should be avoided as much as possible for children and pregnant women.
The patient is asked to swallow liquid or powdered barium sulfate in several forms, as indicated by the facility's protocol and patient-specific concerns. It may be delivered as a suspension in water, in a puree such as applesauce, or on a cracker or cookie. Fluoroscopy images are taken as the barium is swallowed, typically at a rate of 2-3 frames per second. The patient is asked to swallow the barium-laced substances a number of times, whilst seated or standing in different positions, i.e. anterior-posterior, oblique and lateral, to assess the 3D structure as best as possible. A speech-language pathologist will administer the protocol and interpret the images with the patient and review the recordings afterward. He or she will assess swallow safety on the various food textures tested, and may also have the patient attempt compensatory swallowing maneuvers (e.g. head turn, chin tuck) during the study to assess these maneuvers' effects on swallow function.
Pathologies detected on a Barium Swallow include:
- Cancer of esophagus
- Tracheoesophageal fistula
- Schatzki ring
- Gastroesophageal reflux disease (GERD/GORD)
- Zenker's diverticulum
- Hiatus hernia
- Obstruction of esophagus
- Esophageal stricture
- Cancer of stomach
- dysphagia lusoria
- eosinophilic esophagitis
- American Speech-Language-Hearing Association - Guidelines for Speech-Language Pathologists Performing Videofluoroscopic Swallowing Studies
- Boon et al. Davidson's Principles & Practice of Medicine, 20th Edition, Chapter 22
- Harvard Health Publications — Diagnostic Tests — Barium Swallow
- Medline Plus Medical Encyclopedia