CME Doctors' Resources - Barium Investigations
This summary was prepared by Dr Felicity Goodyear-Smith, Goodfellow Unit, Department
of General Practice & Primary Health Care, University of Auckland and Dr Stephen
Wood, Radiology Registrar, Auckland.
Barium Swallow
About Barium Swallow
Barium X-ray examination of the upper gastro-intestinal tract: barium swallow/meal
- Procedure Description
Barium studies (X-rays) of the oesphagus, stomach and duodenum are used to diagnose
abnormalities of the gastrointestinal tract, such as tumours, ulcers and other inflammatory
conditions, hernias, and obstructions (strictures).
Description of Procedure
A barium swallow involves partially filling the oesophagus and stomach with barium
liquid while X-ray images are taken.
Barium studies involve X-rays of the GI tract taken in conjunction with the use
of a diluted barium sulphate solution lining the area of the bowel under examination.
Barium sulphate is a radiopaque metallic contrast medium. Often the studies are
termed double contrast by virtue of use of gas as a second contrast medium.
A barium swallow is usually performed on an outpatient basis.
The patient is positioned on an X-ray fluoroscopy table and images are obtained
during and after the ingestion of barium sulphate. Depending on the indication the
examination will include images of the oro-pharynx, oesophagus, stomach and small
bowel, particularly the duodenum. The patient will be examined in erect and supine/prone
positions and may be given a gas forming mixture for a double contrast examination.
Advantages of Barium Swallow/Meal:
- Useful for functional assessment - allows the assessment of motility, reflux and
distension.
- In comparison to gastroscopy, barium swallow is safer.
- Available
resource. It is difficult to compare costs between barium studies and
endoscopy and they may be of comparable costs. However is some centres barium studies
are much more accessible to GPs and may be arranged with much less delay for the
patient than gastroscopy.
Disadvantages of Barium Swallow/Meal:
- Not as comprehensive or accurate method for diagnosis of some conditions in comparison
to gastroscopy.
- Not able to take samples or provide treatment as part of the procedure.
- Radiation exposure. Dose is 2 - 3 millisieverts compared with chest film 0.06 millisieverts
and background radiation of 2millisieverts per year. Users of ionising radiation
are required to inform all women of child bearing age about the risks of radiation
in pregnancy. Pregnancy is a relative contraindication to the use of radiation but
generally in the context of the barium enema the urgency is such that can delay
or choose alternative investigation.
Potential Difficulties that may Arise out of a Barium Swallow/Meal Referral:
- Discomfort of air insufflation. Poor tolerance of swallowed gas mixture can make
for poor stomach and oesophageal distension.
- Where buscopam injection is used to relax bowel for better pictures, patients may
experience some blurring of vision.
- Tendency of barium to cause constipation in the days following the procedure.
- Need for an interpreter in non-English speaking patients.
Indications for Barium Swallow:
- Dysphagia, pain on swallowing
- Assessment of tracheo-oesophageal fistula in children
- Assessment of site of perforation.
Indications for Barium Meal:
- Dyspepsia
- Reflux
- Weight loss
- Upper abdominal mass
- GI haemorrhage or unexplained iron deficiency anaemia
- Partial obstruction
- Suspected hiatus hernia
Other Upper GI Barium Studies
Modified barium swallow - involves eating of various barium-coated foods and is
used to investigate physical causes of dysphonia (requires specialist input from
a speech/language therapist), and swallowing.
Barium meal follow-through - time-consuming and now a relatively uncommon procedure.
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Images from a Barium Swallows/Meals
Click on these images for an enlarged view - opens in a separate window which you
will need to close.
Oesophageal Stricture due to Alkali Ingestion |
Corkscrew Oesophagus Caused by Severe Dysmotility |
Gastric Ulcer Body of the Stomach |
Erosive Gastritis |
Oesophageal Stricture Secondary to Ulceration |
Oesophageal Perforation |
Adenocarcinoma of the Stomach |
Infiltrative Carcinoma of the Stomach |
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Patient Information
(This patient information is
available as a PDF file from which you may print copies - you will need
an acrobat reader)
Information for the Patient on Barium Swallow and Meal
Most facilities will provide a local information sheet and this information should
be considered in conjunction with that.
A barium swallow ('upper GI series') is a special X-ray examination of the oesophagus
(gullet), the stomach and small intestine. You will be given a drink of a liquid
which will outline the gullet and stomach to show them up clearly on X-ray films.
The examination usually takes about 30 min although it can be up to 1-2 hours if
the small bowel is also assessed.
A plain X-ray gives minimal detail about the inside of the bowel. Standard X-rays
show bony structures well and give less detail about soft tissues and hollow organs
such as the intestine, therefore you will be asked to swallow a liquid that does
show up on X-rays (barium). The barium will temporarily coat the inside lining of
the oesophagus, stomach, and intestine, allowing the outline of these organs to
be visible on the X-ray pictures. A barium swallow can therefore be helpful in diagnosing
cancers, ulcers, problems that cause narrowing of the oesophagus, some causes of
inflammation in the intestine, and some swallowing problems.
Preparation:
What is required for preparation will be explained to you by the unit you attend.
In general,
- You must fast (not eat or drink) for 8 hours prior to the procedure.
- If you are on medication, do not take the morning dose.
The Procedure:
- The examination is conducted by a radiologist (a doctor specialising in medical
diagnosis by X-ray) and a radiographer (a technician trained in the use of medical
x-ray equipment).
- Before the examination, you may be given an injection to relax your muscles.
- After this, you may be given a mixture to swallow to form gas in the stomach. Swallow
quickly to prevent foaming in the mouth and try not to belch.
- Next, you will be given Barium sulphate liquid to drink. This, together with the
gas will outline the stomach clearly. You may feel a sense of distension and discomfort,
but this should quickly pass.
- A special X-ray tube (fluoroscope) is connected to a television monitor. As you
drink, the doctor will observe the filling of the gullet and stomach through the
X-ray TV screen. You will be filmed in various positions including lying down.
- Films will be taken in the best positions for diagnosis.
- Sometimes, the examination may be extended to parts of the small intestine. This
procedure is known as the Barium Meal Follow - Through examination and may take
a further 1 to 2 hours (this is to allow time for the barium to reach your small
intestine).
After the Procedure:
- You may have food and drink after the examination.
- You should drink plenty of fluids to avoid constipation.
- Your faeces may appear white in colour for a few days. Do not be alarmed as this
is due to the residual barium in your bowels.
Risks and Potential Complications:
- Barium swallow and meal are very safe procedures and complications are extremely
rare. Despite some discomfort during the procedure most people tolerate it very
well.
- After the examination your bowel will expel the barium, which is not absorbed by
your body. Barium liquid may cause constipation. Following the examination you should
eat foods high in fibre and drink plenty of fluids to help expel the barium from
the body. Your faeces (stool) will have a whitish colour to it until the barium
has all been passed. You may be required to take a mild laxative.
- X-ray procedures should be avoided wherever possible during pregnancy. If you are,
or suspect you might be, pregnant, please make sure that the doctors, nurses and
/or technicians caring for you know this before you have a barium meal / swallow
examination.
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