Barium Swallow

What you should know

• Barium swallow, also called an esophagram, is an x-ray procedure to examine the esophagus (food pipe) using barium. Liquid barium is a white, chalky contrast material that helps the esophagus show up better on the x-ray. The esophagus is the tube that carries food and liquid from the mouth to the stomach. With a barium swallow, diseases and other problems that affect the esophagus may be diagnosed. These may include heartburn or esophageal bleeding, blockage, cancer (tumor), hernia (defective walls), or diverticuli (pouches). A barium swallow may also help caregivers learn what is causing troubled or painful swallowing.
  
  
• A barium swallow may be done on an out-patient basis or during a hospital stay. Barium is mixed with water and drank to give a better view of the esophagus. With a barium swallow, conditions of the esophagus may be diagnosed and proper treatment may be given.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

• Barium swallow is a common and safe procedure. You may have cramping abdominal (stomach) pain, vomiting, or more problems swallowing. The barium may harden, if it is not passed from your body, and may cause a blockage in your digestive tract. The barium may leak out of your esophagus iif it has perforations or it may go down your airway. If it goes down your airway, the heart and brain may not get oxygen, which can be life-threatening. Following your caregiver's advice after the procedure may decrease your chances of having problems.
  
  
• Without this procedure, your exact disease may not be diagnosed and proper treatment may not be given. The signs and symptoms you have may continue and worsen. You may have problems eating, digesting food, or moving your bowels, which may lead to other serious medical problems. Ask your caregiver if you are worried or have questions about your procedure, medicine, or care.

Getting Ready

The week before your procedure:

• Ask your caregiver if you need to start a special diet a few days before the procedure.
  
  

The day before your procedure:

• Ask a family member or friend to drive you home after your procedure. Try not to drive yourself home.
  
  
• Ask your caregiver before using any over-the-counter or herbal medicine or supplement. If you regularly use these medicines or supplements, tell your caregiver.
  
  
• You may be asked to stop smoking. Ask your caregiver for more information if you have trouble stopping smoking.
  
  
• A contrast material will be used during your procedure to help caregivers see the esophagus better. People who are allergic to dyes, iodine, or shellfish (lobster, crab, or shrimp) may also be allergic to barium. Tell your caregiver if you have allergies to any food, medicines, latex, or contrast material.
  
  
• Tell your caregiver if you have had a barium swallow, barium enema (lower GI test), or other similar procedures before and when they were done.
  
  
• Tell your caregiver if you are pregnant or have other diseases, such as perforations (holes) in the esophagus. Certain medicines may not be good for you.
  
  
• You may need to have a chest x-ray, manometry, or blood, urine, or stool tests. Ask your caregiver for more information about these tests. Write down the date, time, and location of each test.
  
  
• Ask caregivers about directions for eating and drinking.
  
  
  • Avoid eating or drinking foods with sugar or dairy products, such as milk, cream, or cheese.
    
    
  • Clear liquid diets or a diet that helps clean out your digestive tract may be started. Clear liquids may include plain gelatin, unsweetened fruit juices, clear soup, or broth.

The night before your procedure:

• Avoid eating and drinking 12 hours before your procedure.
  
  
• You may take your medicine with sips of water.

The day of your procedure:

• Write down the correct date, time, and location of your procedure.
  
  
• Do not eat or drink anything on the morning of your procedure. The pictures may not be seen clearly if your esophagus or stomach is not empty.
  
  
• Ask your caregiver before taking any medicines on the day of your procedure. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• If you are staying in the hospital after your procedure, bring your personal belongings with you. These include your bathrobe, toothbrush, denture cup (if needed), hairbrush, and slippers.
  
  
• Wear loose fitting, comfortable clothes. Avoid wearing turtlenecks and other tight-fitting clothes, a watch, or jewelry. You will be asked to put on a hospital gown before the procedure.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do the procedure. It also explains the problems that may happen, and your choices. Be sure all your questions have been answered before you sign this form.

Treatment

What will happen:

• You will be taken on a cart to the radiology (x-ray) room and then moved onto a special bed or table. Your caregiver may give you glucagon or an anti-spasmodic (prevents spasms) medicine that will help relax and decrease the movement of your esophagus. While standing, X-ray pictures will be taken before you drink the barium. Your caregiver will watch the whole procedure on a small video screen and record it.
  
  
• In a single contrast barium swallow, you will drink 1 or 2 large barium mixtures. These mixtures may look like milkshakes, but taste chalky due to the barium. If a double contrast barium swallow is to be done, you will first have to take baking soda and an anti-foaming agent. These substances will produce air or carbon dioxide (gas) to help expand (distend) your stomach and small bowel. Pictures will be taken to see how the air or gas moves inside your stomach and small bowel. You will be asked to swallow the barium, which may make you want to vomit (throw up) as it passes down your throat. You will have to sit up and stand still, or turn to your sides as pictures are taken. Try to swallow and hold everything inside while these pictures are taken.
  
  
• You will then be transferred onto a special table or bed that will move in many positions. You will be asked to lie on your back and straps will be put around you to hold you securely on the table as it moves. As the table moves and the barium spreads inside your stomach and intestines, more pictures will be taken.

After your procedure:

You may lie in bed and rest for a while since the procedure may be a little tiring. When caregivers see that you are OK, you may be allowed to go home. If caregivers want you to stay in the hospital, you will be taken back to your hospital room. Ask your caregiver for information on how to take care of yourself after your procedure.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your appointment on time.
  
  
• You have a fever.
  
  
• You have questions or concerns about your procedure.

Seek Care Immediately if

• You are not able to eat or drink, or are urinating less or not at all.
  
  
• You are vomiting (throwing up) or your vomit has blood or bile in it.
  
  
• You have blood in your bowel movement (BM).
  
  
• Your abdomen becomes tender and hard.
  
  
• Your signs and symptoms are getting worse.