Modified Barium Swallow

What you should know

• Modified barium (BAR-e-um) swallow, also called MBS, is an x-ray procedure which uses barium to examine problems with swallowing. Liquid barium is a white, chalky contrast material that helps the esophagus (food pipe) show up better on x-ray. The esophagus is the tube that carries food and liquid from the throat to the stomach. With MBS, diseases and other problems that affect swallowing may be diagnosed. These may include cancer (tumor), strictures (narrowing), hernia (defective walls), or diverticuli (pouches in the esophageal wall). Other structures involved in swallowing may also be seen on a video screen while the procedure is taking place. These include the mouth, tongue, throat, and muscles in the upper, middle, or lower esophagus.
  
  
• An MBS may be done on an outpatient basis or while you are confined in the hospital. X-ray pictures are taken while drinking liquids and eating foods. Barium is mixed with liquids and foods, such as puddings or cookies, to show how they pass the esophagus. This may help check what liquids or foods are safe to swallow. MBS may also detect if food or liquids go into the larynx (windpipe) and lungs. With MBS, problems related to swallowing 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

• Modified barium swallow is a common and safe procedure, but may cause side effects. You may have cramping abdominal (stomach) pain, vomiting, or more problems swallowing. The barium may harden if it is not cleared from your body, and block your digestive tract. Barium may also leak out if your esophagus has perforations or may go down your airway (windpipe). This may go into your lungs and cause infections or trouble breathing. If it causes trouble breathing, the heart and brain may not get enough oxygen, which can be life-threatening. Following your caregiver's advice after the procedure may decrease your chances of having any problems.
  
  
• Without this procedure, your exact disease may not be diagnosed and proper treatment not be given. The signs and symptoms you have may continue and worsen. You may have problems eating, digesting food, or moving your bowel that 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 day before your procedure:

• Ask a family member or friend to drive you home after your procedure. Do not drive yourself home.
  
  
• Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• Tell your caregiver if you have allergies to any food or contrast material. 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 when the last time was that you had a barium swallow, barium enema (lower GI tests), or other similar procedures.
  
  
• Tell your caregiver if you are pregnant or have other diseases, such as perforations (holes) in the esophagus.
  
  
• You may need to have a chest x-ray, manometry, or blood, urine, or stool tests. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.
  
  
• Directions for eating and drinking:
  
  
  • Clear liquid diets or a diet that helps clean your esophagus and stomach may be started. Clear liquids may include plain gelatin, unsweetened fruit juices, clear soup, or broth.
    
    
  • Ask your caregiver for more information about your special diet. He may also suggest that you start on a special diet a few days earlier.

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. You may also need a warm water enema the morning of your procedure.
  
  
• Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
  
  
• What to bring: You may want to bring items such as a toothbrush and bathrobe.
  
  
• Do not wear tight-fitting clothes on the day of your procedure or surgery.
  
  
• 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 stretcher to the radiology (x-ray) room and then moved onto a special bed or table. Your caregiver may give you medicines to help relax and decrease the movement of your esophagus. While standing, X-ray pictures will be taken before you drink barium. Your caregiver will watch the whole procedure on a small video screen and record it.
  
  
• During the procedure, a special caregiver called speech pathologist will give you barium mixtures to drink. These mixtures may look like milkshakes but taste chalky due to the barium. You may have an urge to vomit (throw up) as the barium passes down your throat. You will have to sit up, stand still, and move your neck and head as pictures are taken. You will be asked to keep on breathing, talking, swallowing, and change head positions as you take in liquids.
  
  
• If you are able to swallow liquids without any problems, swallowing foods will then be tested. These foods will have different thickness or textures. You may be given barium-coated puddings and cookies, or barium tablets to swallow. Pictures will be taken to see how food goes down your throat, esophagus and stomach. When the procedure is finished, you will have to drink lots of liquids. This is done to get rid of whatever barium is left inside your body. Additional pictures may be taken after you have passed out as much barium as possible.

After your procedure:

You may lie in bed and rest for a while since the procedure may be tiring. You may need to go back to the bathroom to pass the remaining barium from your body. 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.

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 vomiting (throwing up) or your vomit has blood or bile in it.
  
  
• You have trouble breathing.
  
  
• Your signs and symptoms are getting worse.