Esophagram

What is an esophagram?

An esophagram (sometimes called an esophagogram or esophagography) is an X-ray exam of your esophagus. This type of X-ray exam doesn’t just take still pictures. The esophagram is a fluoroscopic X-ray exam, which means it takes X-rays as a live video. This way, healthcare providers can see your esophagus in action while you swallow. Your healthcare provider might suggest an esophagram to investigate problems in your esophagus, such as swallowing problems or reflux.

Is esophagram the same as a barium swallow test?

Yes, the barium swallow test is another name for an esophagram. The nickname comes from the contrast agent that makes your esophagus show up in X-rays. Barium sulfate is used in many types of radiology exams to coat your insides and help them show up better on images. For the esophagram, you’ll swallow a solution with barium in it. The barium will coat your esophagus as it travels down to your stomach, and your technician will be able to watch it happen.

What does an esophagram look for?

The esophagram visualizes your esophagus (food pipe) and what happens inside when you swallow. Your healthcare provider might want to see what’s going wrong with your ability to swallow if you’re having difficulties, or they might want to look for evidence of disease on the inside of your esophagus.

Some things they might look for include:

• Ulcers.
• Tumors.
• Polyps.
• Blockages.
• Tissue changes.
• Inflammation.
• Structural abnormalities.
• Muscular disorders.

An esophagram can help identify a variety of esophageal disorders, including:

• Dysphagia.
• Acid reflux (GERD).
• Esophageal cancer.
• Achalasia.
• Esophageal spasms.
• Eosinophilic esophagitis.
• Esophageal diverticulum.
• Esophageal strictures.
• Hiatal hernia.

When would this procedure be needed?

Your healthcare provider might take an esophagram as part of a general upper gastrointestinal (GI) series of X-rays. The upper GI series takes fluoroscopic X-rays of your entire upper gastrointestinal tract, including your esophagus, stomach and duodenum (the first part of your small intestine). Healthcare providers recommend comprehensive GI X-ray exams when you have mysterious symptoms and they need to screen for a wide range of possible causes. If they already suspect your problem is in your esophagus, they may recommend an isolated esophagram to look for the problem there.

How is an esophagram performed?

An esophagram is a type of fluoroscopy or fluoroscopic X-ray exam. Instead of taking isolated X-ray snapshots, a fluoroscopy procedure passes a continuous X-ray beam through your body to display a continuous video image on a screen. This allows healthcare providers to watch your body mechanics in action — in this case, the actions of your upper digestive tract after you swallow. To make these mechanisms show up on the fluoroscopy, you’ll swallow a special solution containing a contrast material called barium. Barium is chalky and white and shows up great in black-and-white images, but it can be unpleasant to drink.

What is the difference between an esophagram and an endoscopy?

An upper endoscopy exam is more invasive than an esophagram, but it can show the upper GI tract in more detail if needed. An endoscopy involves passing a tiny lighted video camera on a tube down your throat, through your esophagus and into your stomach and duodenum. You may need to be medicated for this exam to help you relax and numb your throat. Most of the time, your healthcare provider will recommend an esophagram first, but they may need to follow up with an endoscopy in some cases. Some patients, such as pregnant people, may require an endoscopy instead to avoid the radiation exposure associated with X-ray exams.

How do I prepare for an esophagram?

To prepare for your esophagram:

• Your stomach should be empty for the exam. You’ll be asked not to eat or drink anything for six hours prior.
• You’ll be asked to avoid anything else that might coat your throat, such as smoking, chewing gum or sucking on hard candy.
• Let your healthcare provider know if you have had other X-rays recently. They’ll schedule your exam accordingly to limit your radiation exposure.
• Be sure to let your healthcare provider know if you have any known allergy to the contrast agent (barium). They can use an alternative contrast (iodine) if you do.

What happens during an esophagram procedure?

Here’s what you can expect during your esophagram:

• When you arrive for the exam, you’ll change into a hospital gown.
• You’ll begin the exam in the standing position.
• Your technician will give you a liquid barium solution to drink. The solution is sweetened and flavored, but it may taste a bit chalky.
• Sometimes the solution also contains baking soda crystals that produce gas. This is called air-contrast. The gas helps “inflate” the esophagus so that the lining shows up better in images.
• Your technician will watch the muscles of your esophagus working as you swallow the barium solution. The fluoroscope will project video images onto a screen as the solution travels down into your stomach.
• Your technician will ask you to turn in different positions while you continue sipping the solution.
• After standing, you’ll be asked to lie on a tilting table on your stomach. You’ll continue sipping the solution while your technician takes images in this position.
• If you had gas crystals in your solution, you may feel like burping in this position. Your technician will ask you to try to hold it in until after the exam.
• The entire procedure takes about 30 to 60 minutes.

What should I expect after the test?

After your esophagram:

• You can resume your normal diet and habits immediately after the test.
• You’ll continue to pass barium in your poop for the next several days. It may make your poop look white.
• Barium can cause temporary constipation. Be sure to drink lots of water over the next few days to help clear it out. If necessary, you may treat constipation with an over-the-counter (OTC) laxative.
• Your healthcare provider will contact you within a couple of days to discuss your test results.

What are the risks or side effects of the test?

Some risks and side effects of this test include:

• X-ray imaging exposes your body to a low dose of radiation. It’s considered a safe amount, but you should avoid having too many X-rays too close together.
• You should avoid radiation exposure if you’re pregnant. There’s a slight risk it could cause birth defects (congenital conditions).
• You may experience bloating, cramping or constipation after drinking the barium solution. These symptoms are temporary and should ease up after the barium has passed from your system.
• There’s a slight risk of an allergic reaction to the contrast solution.

A note from Cleveland Clinic

X-ray technology is the oldest and most frequently used type of medical imaging, with a long tradition of maintaining safe levels of radiation exposure. Healthcare providers take care to use the lowest radiation dose possible and minimize stray radiation by carefully controlling X-ray beams. Only the body part under examination should be exposed. While frequent small doses of radiation could add up to greater risk, side effects from a typical stand-alone X-ray exam are rare. The risks of anesthesia and other more invasive procedures are greater. In most cases, the benefits of radiology far outweigh the risks.