Barium swallow: definition, process, test results

Definition

What is barium swallow?

The Upper Gastrointestinal (UGI) test series or also known as a barium swallow is a radiographic examination (X-ray) of the upper digestive tract. The esophagus, stomach and duodenum (first part of the intestine) are viewed using an X-ray film with a liquid suspension. This liquid suspension can be barium or a water-soluble contrast liquid. If only the pharynx (the back of the mouth and throat) and the esophagus (the hollow, muscular tube from under the tongue to the stomach) is examined with barium, this procedure is called a barium swallow.

X-rays use electromagnetic rays to produce images of internal tissues, bones and organs on film. X-rays are made using external radiation to produce images of the body, organs and internal structures for diagnostic purposes. The X-ray penetrates the body through the body tissues until a special plate (similar to camera film) and a negative is generated.

When should I have the barium swallow?

Upper gastrointestinal (UGI) is performed to:

• see the cause of digestive disease symptoms, such as difficulty swallowing, vomiting, belching, stomach pain (sore in the stomach) or indigestion
• see a narrowing of the upper digestive tract, ulcers, tumors, polyps, or pyloric stenosis
• see inflammation in the intestines, malabsorption syndrome, or abnormalities in squeezing movements to move food in the intestines (motility disorders)
• see an object that is swallowed

In general, the UGI series is unnecessary if you don't experience symptoms of digestive problems. The UGI series is performed on people who have:

• difficulty swallowing
• possible constipation
• stomach pain that comes and goes with eating
• severe or frequent heartburn

Precautions & warnings

What should I know before having a barium swallow?

Upper endoscopy is performed instead of the UGI test in selected cases. Endoscopy uses a thin, flexible tube (endoscope) to view the lining of the esophagus, stomach and upper small intestine (duodenum).

UGI series tests:

• may not show irritation of the lining of the stomach (gastritis) or esophagus (esophagitis) or ulcers that are less than 0.25 inch (6 mm) in diameter
• cannot indicate Helicobacter pylori bacterial infection, which may be the cause of gastric ulcers

A biopsy cannot be performed during the UGI if problems are found.

Process

What should I do before undergoing barium swallow?

You may be advised to change your diet for 2 or 3 days before the test. Usually, you will be deprived of food for a while before undergoing the test.

Make sure you consult your doctor if you plan to change your medications. Usually, you are allowed to take oral medicine. Avoid changing medicines without consulting your doctor first.

You will be asked to remove any jewelry on your neck, chest, or stomach before the test begins.

How does the barium swallow process?

An X-ray will be taken before you drink the barium solution. Then you will be asked to swallow a small amount of the solution, which will be instructed by the radiologist. At the end of the test, you can swallow 1 cup (240 mL) to 2.5 cups (600 mL) of the barium solution.

The radiologist will see the barium pass through your digestive tract using fluoroscopy and X-rays. The table will be tilted into different positions and you may be asked to change positions to spread out the barium. You will be placed lightly on the abdomen with the radiologist's belt or hand. You will also be asked to cough, to make it easier for the radiologist to see changes in barium flow.

If you are also doing an examination of the small intestine, the radiologist will look for the movement of barium from the small intestine to the large intestine. X-ray images are taken every 30 minutes.

The UGI series test lasts 30 to 40 minutes. The UGI series with examination of the small intestine lasts 2 to 6 hours. In certain cases, you will be asked to come back after 24 hours for another X-ray.

What should I do after having a barium swallow?

After undergoing the UGI series, you are allowed to eat and drink as usual, unless there is a doctor's prohibition.

You may be given a laxative or enema to remove the barium in the intestines and avoid constipation. Drink plenty of water for a few days to flush the barium out of your body.

Explanation of the Test Results

What do my test results mean?

Upper gastrointestinal (UGI) series
Normal:	The esophagus, stomach and duodenum appear normal.
Abnormal:	Narrowing, inflammation, a lump, hiatal hernia, or widening of the veins (varicose veins). Spasms of the esophagus or backflow (reflux) of barium from the stomach.
The presence of ulcers in the stomach or duodenum, tumors, or something pressing on the intestine from outside the digestive tract. Narrowing of the opening between the stomach and small intestine (pyloric stenosis) may be seen.
Any swelling or changes in the lining of the small intestine that indicate poor food absorption, could be due to Chron's disease or Celiac disease.