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A female patient prepares for an imaging test.
A female patient prepares for an imaging test.
A female patient prepares for an imaging test.

Barium Swallow

What is a barium swallow test?

A barium swallow test (cine esophagram, swallowing study, esophagography, modified barium swallow study, video fluoroscopy swallow study) is a special type of imaging test that uses barium and X-rays to create images of your upper gastrointestinal (GI) tract. Your upper GI tract includes the back of your mouth and throat (pharynx) and your esophagus.

Barium is used during a swallowing test to make certain areas of the body show up more clearly on an X-ray. The radiologist will be able to see size and shape of the pharynx and esophagus. He or she will also be able see how you swallow. These details might not be seen on a standard X-ray. Barium is used only for imaging tests for the GI tract.

A barium swallow test may be used by itself or as part of an upper GI series. This series looks at your esophagus, stomach, and the first part of the small intestine (duodenum).

Fluoroscopy is often used during a barium swallow test. Fluoroscopy is a kind of X-ray “movie.”

Why is a swallow test done?

A barium swallow test may be done to look for and diagnose problems in the pharynx and esophagus. You may need a barium swallow test if your healthcare provider thinks that you have:

  • Cancer of the head and 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)

  • Enlarged veins (esophageal varices)

  • Muscle disorders, such as difficulty 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.

  • Gastroesophageal reflux disease (GERD) and ulcers

Your healthcare provider may have other reasons to recommend a barium swallow test.

What are the risks of a barium swallow test?

The risks of a barium swallow test may include problems from radiation exposure, birth defects and intestinal issues. You should ask your healthcare provider about the risks as they apply to you.

How can I manage my X-ray exposure?

You may want to ask your healthcare provider about the amount of radiation used during the swallowing test. 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.

How will a barium swallow test affect my stool?

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

Is it safe to have a barium swallow test while pregnant?

You should also not have a barium swallow test if you are pregnant. Radiation exposure during pregnancy may lead to birth defects. Tell your provider if you are pregnant or think you may be pregnant.

When should I avoid a barium swallow test?

You should avoid a barium swallow test if you have any of the following:

  • 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. Tell your provider if you are allergic to or sensitive to medicines, contrast dyes, local anesthesia, iodine, or latex. Be sure to talk with your provider about any concerns you have before the procedure.

How do I prepare for a barium swallow test?

You can prepare for a barium swallow test by considering the following:

  • Your healthcare provider will explain the barium swallow test to you. Ask him or her any questions you have about the swallowing test.

  • You may be asked to sign a consent form that gives permission to do the swallowing test. 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 swallowing test. Generally, this means after midnight.

  • Tell your provider if you are pregnant or think you may be pregnant before scheduling a barium swallow test.

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

  • 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 swallowing test.

  • Tell your healthcare 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 during a barium swallow test.

  • Follow any other instructions your provider gives you to get ready for the swallowing test.

What does a barium swallow test involve?

Generally, a barium swallow test involves the following process:

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

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

  • You will 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 swallowing test. For example, you may need to lie on your side, back, or stomach.

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

  • The radiologist will ask you to take a swallow of a thick, chalky barium drink. The barium is usually flavored, but it may not taste very good.

  • 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.

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

  • You will be given a thinner barium drink to swallow. The radiologist will use X-rays or fluoroscopy to watch the barium go down your esophagus. 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.

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

A barium swallow test may be performed as an outpatient procedure 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.

What happens after a barium swallow test?

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

How do I manage constipation after a swallowing test?

Barium may cause constipation or impacted stool after the swallowing test if it isn't completely cleared from your body. You can manage constipation by drinking plenty of fluids and eating 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.

What are some serious side effects after a barium swallow test?

Call your healthcare provider right away if any of these happen after your barium swallow test:

  • Trouble with bowel movements or you are unable to have a bowel movement or pass gas

  • Pain or swelling of the abdomen

  • Stools that are smaller in size than normal

  • Fever

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

senior male drinking water

Johns Hopkins Swallowing Center

The Johns Hopkins Swallowing Center offers specialized swallowing evaluation, diagnosis and treatment for patients with swallowing disorders. Our multidisciplinary team of experts, including laryngologists and speech-language pathologists (SLPs), are committed in providing you with the highest-level of individualized care.

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