What is a barium swallow?

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.

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.

Bibliography

Carver, Elizabeth, and Barry Carver. Medical Imaging: Techniques, Reflection, and Evaluation. 2nd ed. Edinburgh: Churchill, 2012. Print.

Drop, A., et al. “The Modern Methods of Gastric Imaging.” Annales Universitatis Mariae Curie-Skłodowska 59.1 (2004): 373–81. Print.

Eisenberg, Ronald L., and Alexander R. Margulis. A Patient's Guide to Medical Imaging. New York: Oxford UP, 2011. Print.

Gore, R. M., et al. “Upper Gastrointestinal Tumours: Diagnosis and Staging.” Cancer Imaging 29.6 (2006): 213–17. Print.

Hosaka, K. “Radiological Investigation of the Mucosae Around Early Gastric Cancers.” Journal of Gastroenterology 41.10 (2006): 943–53. Print.

Kunisaki, C., et al. “Outcomes of Mass Screening for Gastric Carcinoma.” Annuals Surgical Oncology 13.2 (2006): 221–28. Print.

Levine, M. S., and S. E. Rubesin. “Diseases of the Esophagus: Diagnosis with Esophagography.” Radiology 237.2 (2005): 414–27. Print.

Pasławski, M., J. Złomaniec, E. Rucińska, and W. Kołtyś. “Synchronous Primary Esophageal and Gastric Cancers.” Annales Universitatis Mariae Curie-Skłodowska 59.1 (2004): 406–10. Print.

Summers, D. S., M. D. Roger, P. L. Allan, and J. T. Murchison. “Accelerating the Transit Time of Barium Sulphate Suspensions in Small Bowel Examinations.” European Journal of Radiology 62.1 (2007): 122–25. Print.

“Upper GI and Small Bowel Series.” MedlinePlus. Natl. Lib. of Medicine, 8 Oct. 2012. Web. 27 Aug. 2014.