A barium swallow is a special type of X-ray test that helps your doctor take a close look at the back of your mouth and throat, known as the pharynx, and the tube that extends from the back of the tongue down to the stomach, known as the esophagus.
Your doctor may ask you to do a barium swallow to help diagnose any conditions that make it difficult for you to swallow or if they suspect that you have a disorder of the upper gastrointestinal (GI) tract. Your upper GI tract includes:
- the esophagus
- the stomach
- the first part of the small intestine, called the duodenum
To do a barium swallow, you swallow a chalky white substance known as barium. It’s often mixed with water to make a thick drink that looks like a milkshake. When it’s swallowed, this liquid coats the inside of your upper GI.
Barium absorbs X-rays and looks white on X-ray film. This helps highlight these organs, as well as their inside linings and the motion of your swallowing, on the X-ray image. These images help your doctor diagnose any disorders of the GI tract.
Your doctor may order a barium swallow to help diagnose a possible structural or functional problem with your upper GI tract. Some common problems that a barium swallow may help diagnose include:
- hiatal hernia
- muscle disorders that could lead to difficulty swallowing or spasms
- gastroesophageal reflux disease (GERD)
- both cancerous and noncancerous tumors
Sometimes a barium swallow is done as part of a series of X-rays that look at the whole upper GI tract. A continuous X-ray beam, called a fluoroscopy, is often used during a barium swallow to capture movement through your GI tract.
A common test that accompanies the barium swallow is the upper GI endoscopy, also known as an esophagogastroduodenoscopy, or EGD. Barium swallows are also often done as part of an upper GI and small bowel series of tests.
It’s important to follow the dietary guidelines your doctor gives you before your procedure. You are not supposed to eat or drink anything for six hours before your procedure. You may take small sips of water up until two hours before your procedure.
If you are getting additional tests done or have any existing medical conditions, the directions your doctor gives you may be slightly different. You should notify your doctor before your procedure if you have or have had any of the following conditions:
- an esophageal or bowel perforation
- bowel obstruction
- difficulty swallowing
- severe constipation
These conditions may disqualify you from doing a barium swallow, as they increase the risk of complications.
Your doctor will direct you to your local radiology facility for your barium swallow. A trained radiology technician will perform the procedure. From start to finish, a barium swallow takes about 30 minutes. You will get your results within several days of your procedure.
Once you’re at the radiology facility, you will be asked to remove your clothing and jewelry and secure your belongings in a locker. You’ll change into a medical gown provided by your doctor.
Your technician will position you on an X-ray table. They may ask you to move your body position as they take standard X-rays of your heart, lungs, and abdomen.
Then, your technician will give you a barium drink to swallow. They will take single X-rays, a series of X-rays, or a fluoroscopy to watch how the barium moves through your pharynx. You might have to hold your breath at certain times to prevent any movement from disrupting the X-ray images.
Next, the technician will give you a thinner barium drink to swallow. They will again take X-rays or a fluoroscopy to watch how the barium moves down the esophagus.
When all X-rays are complete, you can gather your things and leave. You can go back to your normal diet and daily activities after your barium swallow procedure unless your doctor advises otherwise.
Your doctor’s office will be in touch within a few days to go over the results of your test and to schedule any follow-ups that may be needed.
Here is an example of a normal barium swallow study, in which the barium (the dark liquid) is seen moving down the esophagus without any leakage or regurgitation (reflux):
Image source: Photo: Anka Friedrich / Wikimedia Commons via commons.wikimedia.org/wiki/File:Normal_barium_swallow_animation.gif
Photo: Anka Friedrich / commons.wikimedia.org
The barium you swallow is artificially flavored and sweetened. However, many people report that it tastes bitter or chalky.
If you have health insurance, a barium swallow may be fully or partially covered. If you don’t have insurance, the procedure may cost between $300 and $450. This covers the costs of your doctor’s time interpreting the X-rays as well as the cost of the technicians who perform the procedure.
If the barium is not completely expelled from your body after the procedure, it can sometimes cause constipation or fecal impaction. You should drink lots of fluids and eat high-fiber foods to help move the barium through your digestive tract and out of your body. If that doesn’t help, your doctor might give you a laxative to help move it through.
After your procedure, you might notice that your bowel movements are lighter in color. This happens because your body doesn’t absorb the barium. Your stool will return to its normal color once all the barium has been expelled.
Be sure to contact your doctor right away if:
- You have trouble having a bowel movement or can’t have a bowel movement.
- You have pain or bloating in your abdomen.
- You have stools that are smaller in diameter than usual.
Also, barium swallows involve exposure to radiation, like all X-ray procedures. The risks of complications related to radiation exposure accumulate over time and are linked to the number of X-ray exams and treatments a person receives in their life. It can be helpful to share a record of past radiation procedures with your doctor before your barium swallow.
Exposure to radiation during pregnancy can cause birth defects in unborn fetuses. Because of this, pregnant women should not undergo barium swallow procedures.
The barium swallow is a less invasive way to look at the upper GI tract than an endoscopy. Barium swallows are a useful diagnostic tool for checking for upper GI tract disorders that can be easily diagnosed with X-ray alone. More complex disorders require endoscopy.
Here’s how to stay comfortable before, during, and after a barium swallow:
- Wear loose-fitting clothing that’s easy to remove and put back on.
- Remove all jewelry at home before you go in for your procedure.
- Be sure to eat and drink enough the night before your procedure before starting your fast at midnight. It may help to schedule your barium swallow for first thing in the morning so you don’t have to avoid food or drink for too long.
- Be prepared for the barium to taste unpleasant.
- Bring something to eat and drink after your procedure. Foods that are high in fiber — including fruits like apples, bananas, and raspberries — can help prevent constipation as well as get rid of the taste.
- Make sure you drink eight 8-ounce glasses of water a day after your procedure.