Barium swallow
A barium swallow is a diagnostic imaging procedure that involves ingesting barium sulfate, a substance that enhances X-ray visibility, to examine various parts of the upper digestive tract, including the mouth, throat, esophagus, stomach, and small intestine. The test is primarily performed to identify cancers in these areas, such as oral cavity, throat, vocal cords, esophageal, and stomach cancers, as well as polyps and other abnormalities. Patients typically undergo preparation that includes dietary restrictions and may need to fast prior to the exam.
During the procedure, patients drink a thick barium solution, which may be flavored, while X-ray images are taken to visualize the passage of barium through the digestive system. A double-contrast barium swallow may also be conducted, involving the ingestion of gas-producing substances to improve imaging quality. The procedure is generally low-risk, though it does involve some radiation exposure and potential for allergic reactions or gastrointestinal complications.
After the test, patients are advised to drink fluids to help eliminate the barium from their system, and they may notice changes in the color of bowel movements for a brief period. The results are interpreted by a radiologist and reviewed by the ordering physician to detect any abnormalities like tumors or polyps.
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Barium swallow
ALSO KNOWN AS: Barium swallow X-ray, barium swallow exam, barium swallow test, barium meal, double-contrast barium swallow, upper gastrointestinal (GI) series, esophagraphy, esophagogram, esophagram
DEFINITION: A barium swallow is a diagnostic test in which the patient ingests barium sulfate, a radiopaque contrast medium. It is used with X-rays to detect mouth, throat, vocal cords, esophagus, stomach, and small intestine cancers.
Cancers diagnosed:Oral cavity (mouth) cancer; oropharyngeal (throat) cancer; vocal cord cancer, including laryngeal and hypopharyngeal cancer, glottic cancer, supraglottic cancer, subglottic cancer; esophageal cancer; stomach cancer; stomach polyps, which may precede stomach cancer; small intestine cancer, including carcinoid tumors, gastrointestinal stromal tumors, lymphomas, and adenocarcinoma
Why performed: A barium swallow with X-rays is performed to help diagnose cancer of the mouth, throat, vocal cords, esophagus, stomach, and small intestine. When swallowed, barium sulfate shows up on X-rays and highlights the linings of the above-mentioned structures. A double-contrast barium swallow involves swallowing substances that create air in the stomach to expand it, allowing a better view. Although advanced imaging techniques have begun to replace barium swallows in many clinical practices, the procedure still remained in use in the 2020s.
Patient preparation: Patients may be placed on a restricted diet a few days before the test. Patients should not eat, drink, chew gum, or smoke after midnight before the test. Patients receive instructions from their doctors about swallowing medications. The stomach needs to be empty for the procedure. In some cases, the stomach contents are removed through a tube placed in the nose. For women, a pregnancy test may be performed to ensure that the patient is not pregnant.
A barium swallow is an outpatient procedure that is performed at a hospital radiology department, outpatient radiology center, or doctor’s office. The test does not require anesthesia, and patients are awake. A barium swallow usually takes from thirty to sixty minutes, depending on the extent of the procedure. Patients disrobe and wear a gown for the test. Patients need to remove metal objects that may interfere with the X-rays, including glasses, dentures, and jewelry.
Steps of the procedure: The patient’s vital signs are taken before the test and monitored during the test. Patients may sit, stand, or lie on an X-ray table for the procedure. Patients may be secured to the X-ray table if it is tilted to allow images to be taken from various angles.
X-rays of the patient’s heart, lungs, and abdomen are taken. Then, patients drink sixteen to twenty ounces of barium sulfate. The barium sulfate is mixed in a thick drink that may have flavor added to it; otherwise, the drink is described as tasting chalky. The examination table may be tilted, or pressure may be applied to the patient’s abdomen to help spread the barium. The barium is viewed on a barium fluoroscope monitor as it travels through the upper digestive tract. Still X-ray images can be taken at any time. Patients may need to drink more barium sulfate as the test progresses.
For a double-contrast barium swallow, the patient swallows baking soda crystals. The baking soda creates gas, and the air expands the stomach. Additional images are taken, and the patient is repositioned, or the examination table is tilted as necessary.
After the procedure: Patients should drink plenty of fluids to help remove the barium from their bodies. Patients can eat a regular diet unless instructed otherwise. Bowel movements will contain barium for one to two days following the tests. The barium may make bowel movements appear white, gray, or pink in color.
Risks: A barium swallow is considered a low-risk procedure. The radiation exposure is low, but it carries a small risk of cancer. Patients may be allergic to the flavorings that are mixed with the barium drink. Occasionally, the barium may harden, resulting in intestinal blockage or constipation. Patients should contact their doctor if they have not had a bowel movement within one to two days of the procedure.
Results: The X-ray films are read by a radiologist. The ordering doctor may review the films as well. The linings of healthy structures are free of abnormal growths or polyps. Any abnormalities, such as cancer or precancerous tissues, appear as growths or polyps.
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