Barium Swallow Test (Esophagram)

A barium swallow is a test that shows what’s happening inside your esophagus when you swallow. It’s also called an esophagram.

During a barium swallow test, you’ll drink a liquid with a small amount of barium in it. Barium is a substance that makes your body parts show up more clearly on X-rays. This type of X-ray is called a fluoroscopy. It uses short bursts of an X-ray beam to record your esophagus in action.

What is a barium swallow test used to diagnose?

You may have this test if your healthcare provider thinks you might have a disorder affecting your esophagus. Common disorders include:

• Achalasia
• Difficulty swallowing
• Esophageal atresia
• Esophageal cancer
• Esophageal diverticulum
• Esophageal spasms
• Esophageal stricture or narrowing
• Esophageal web
• Esophagogastric junction outflow obstruction (lower esophageal sphincter doesn’t relax)
• Hiatal hernia
• Polyps
• Sore (ulcer) in the lining of your esophagus

How does a barium swallow test work?

In a barium swallow (esophagram), a safe substance called barium gives your healthcare provider a view of the inside of your esophagus. As you swallow, video images of your esophagus appear on a computer screen.

Your technician may use a solution that contains barium and baking soda crystals (“effervescent granules”). The crystals produce gas, which helps inflate your esophagus. This makes it easier to see its lining. It also helps your radiologist better see narrowing, strictures and hernias.

Your technician may give you a barium tablet to swallow. This helps your radiologist spot narrowing and strictures.

How do I prepare for a barium swallow?

You’ll meet with your healthcare provider so they can explain the esophagram procedure. They’ll ask if you’re allergic to barium. If you are, they’ll plan on using iodine (a mineral) as the contrast agent instead.

The test exposes you to a small, safe amount of radiation. But radiation exposure from X-rays can build up. It’s important that your provider knows about any recent X-rays. That way, they can schedule the barium swallow at the right time. Be sure to let them know if there’s a chance you may be pregnant.

The radiology department may ask you to:

• Stop eating or drinking for a certain amount of time before the test
• Avoid activities like chewing gum or sucking on hard candy that can coat your throat

What to expect during an esophagram

This is an outpatient procedure with no sedation involved. That means you’ll go home the same day. Part of the test involves lying on a table that will tilt. So, you should wear comfortable clothes. The test steps are:

1. You’ll stand during the first part of the test. Your provider will explain where you should stand. Then, they’ll hand you the barium solution.
2. You’ll start to sip and swallow the solution. It contains sweeteners and flavoring. But it may still taste a bit chalky.
3. Your provider will tell you when to take a sip and when to swallow.
4. Video images will show your esophageal muscles moving as you swallow. These will appear on the provider’s computer screen.
5. They’ll ask you to turn in different directions.
6. Next, you’ll lie on the tilting table. Your provider may ask you to change positions on the table. You may lie on your back, side or stomach.
7. They can move you into an upright position so you can continue drinking the barium solution.
8. Your provider will continue to monitor the computer screen as barium moves through your esophagus.

How long does a barium swallow test take?

The barium swallow process takes about 20 to 30 minutes. At the end of the test, your provider may ask you to swallow a barium tablet with water. This is to check for esophageal strictures.

Barium swallow side effects

The barium solution may make your belly feel bloated or cause cramps. You may have constipation. These side effects should ease up as barium passes out of your body when you poop. Drinking lots of water after the test may help move things along. Don’t be alarmed if your poop is white. That’s just the barium leaving your body.

What to expect after a barium swallow

Your healthcare provider will let you know the test results. In a follow-up visit, they’ll explain what the results mean. They’ll discuss any next steps, like other tests or treatment.

When should I call my healthcare provider?

Call your healthcare provider if you have test side effects that won’t go away, like a bloated belly. A barium swallow may not be the cause. But it’s always a good idea to notify your care team about esophagus or gut issues that don’t go away.