Barium esophagram or barium swallow is often ordered by your doctor to investigate why you may be having symptoms related to your upper gastrointestinal tract. These symptoms may include difficulty swallowing, food getting stuck in your chest, indigestion, reflux and others. The test is usually done in the radiology department. Both a radiologist and a technologist are usually present during the exam.
You will be asked to take swallows of barium which is a white chalky substance. The barium allows the lining of the esophagus to be seen on x ray. In many cases, you will also be asked to swallow a fizzy mixture which produces gas and allows the radiologist to see more detail. While not tasting great, barium is tolerated fairly well by patients. The fizzy crystals will make you want to burp, but it’s important that you don’t as the gas buildup allows the radiologist to see more detail.
During the actual exam, the radiologist will instruct you to swallow the barium and will take X-rays in standing and lying positions. You may be asked to swallow a barium pill to see how it goes down. The technologist will assist the radiologist in positioning the patient and making sure the exam goes smoothly.
This is a safe procedure and I rarely see problems. It is possible that the barium you swallow may go into your lungs. In most cases this is benign as barium does not usually cause problems in the lungs. The radiation exposure you get is fairly small and should not pose a big risk. Barium spillage into your abdomen is a concern as it can cause inflammation. This is only a concern if your bowel is perforated and you will be sick and your doctors will usually know. If your bowel is obstructed, this can cause things to get worse. Perhaps the most common risk is constipation which can be lessened by drinking Plenty of fluids.
After the test, the radiologist will provide a detailed report of findings. Common findings found are areas of narrowing, hernias, problems with how your esophagus pushes food through, reflux of stomach acid, and less commonly masses. Sometimes the test is normal while endoscopy will pickup abnormalities.
In my practice, many patients who have this test have already had endoscopy or are scheduled. It is complementary information. The esophogram is not nearly as good as endoscopy at detecting abnormalities of the lining of the esophagus, the most important being cancer. Endoscopy is usually done by a specially trained doctor called a gastroenterologist. He will place a scope down your throat and look with a camera at your esophagus. In all cases, your doctor will know best how to treat the findings of an esophogram based on your complaints. Your doctor may also order more testing based on the findings.