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Barium swallow and meal

Published by Bupa's health information team, July 2009.

This factsheet is for people who are considering having a barium swallow and meal, or who would like information about it.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your doctor's advice.

About barium swallow and meal
What are the alternatives?
Preparing for your test
About the procedure
What to expect afterwards
What are the risks?
Questions and answers
Related topics
Further information
Sources

About barium swallow and meal

A barium swallow and meal is type of X-ray test that allows your doctor to examine your throat, oesophagus (the pipe that goes from your mouth to your stomach), stomach and the first part of the bowel (duodenum).

X-rays usually pass straight through parts of the gut such as the oesophagus, stomach and bowel and so these structures don't show up well on plain X-ray images. However, if the gut wall is coated with barium, a white liquid that X-rays can't pass through, a much clearer image of the outline of the gut can be captured.

If your stomach is being examined, the test is called a barium meal. If your oesophagus is examined at the same time, it's called having a barium swallow and meal.

A barium swallow and meal test can help work out why you're getting symptoms such as difficult or painful swallowing, heartburn, reflux and abdominal pain. The tests give your doctor information about the swallowing action, and can pick up patches of irritation such as ulcers, abnormal growths, narrowing or a blockage.

The examination is routinely done as an out-patient procedure in the imaging or radiology department.

Sometimes your radiographer will give you gastrografin instead of barium. Gastrografin is a water-soluble liquid that shows up on X-rays and is safe to use if it's possible there may be a leak in your gut. Ask your doctor or radiographer for more information.

What are the alternatives?

The main alternative to a barium swallow or meal is to have a gastroscopy. This looks directly at the first part of your digestive system - from your throat to the start of your small intestine - using a narrow, flexible, tube-like telescopic camera called a gastroscope.

Alternative imaging procedures include magnetic resonance imaging (MRI) and computerised tomography (CT). Your doctor will discuss which procedure is most suitable for you.

Preparing for your test

If you usually take medicines (for example, tablets for blood pressure), continue to take this as usual unless your doctor specifically tells you not to. If you're unsure about taking your medication, please contact the radiography department or ask your doctor.

In general, your stomach and small bowel need to be empty for this test, so it's important that you follow the fasting instructions in the letter you receive from the hospital. Typically, apart from a small sip of water with any medicines you usually take, you must not eat or drink for about six hours before the test. You may have occasional sips of water until two hours beforehand.

If you have diabetes

If you take insulin for diabetes, make sure the hospital staff are aware of this in advance of your test - they will give you specific instructions. It's important that you don't have a 'hypo'.

You must tell your radiographer about any medicines you're taking and if you have any allergies, glaucoma or heart disease. If you're a woman of childbearing age, you will be asked if you're pregnant.

This test isn't recommended for pregnant women, unless there is an urgent medical reason. Please tell your radiographer if you could be pregnant.

Your radiographer will explain the procedure and ensure that you're happy to proceed with the test.

About the procedure

The test usually takes 15 to 20 minutes.

In a private cubicle, you will be asked to remove your clothing and put on a hospital gown.

You will be taken to the X-ray room where you will be asked to drink some white liquid containing barium. The liquid is usually mildly fruit-flavoured and you will be asked to sip one or two mouthfuls at a time. You will need to hold a mouthful of barium and swallow when your doctor or radiographer asks you to.

Your radiographer will help position you in front of an X-ray camera, often with you standing on a small step of an upright X-ray table.

You may then be asked to swallow a dessertspoon of granules followed by a dessertspoon of liquid. The granules dissolve in your stomach and produce carbon dioxide gas (like an effervescent vitamin tablet does). Having liquid and gas inside the stomach gives particularly useful X-ray images of the stomach wall. You may also be given an injection of a muscle relaxant to help relax the muscles of the stomach wall and stop your stomach from moving.

Images of your oesophagus will be displayed on a TV screen. This is called fluoroscopy. Once the oesophagus has been studied and X-rays taken, the table will slowly tilt so that you're lying down and more pictures will be taken.

At certain points during the process you may be asked to hold your breath for a couple of seconds. You may also be asked to swallow while lying down. You may have to move into different positions so your organs can be seen clearly.

What to expect afterwards

When you feel ready, you will be able to go home.

If you were given a muscle relaxant, wait an hour before driving. It's best to arrange for someone to drive you home.

Once home, drink clear fluids regularly and try to eat vegetables, fruit and high-fibre foods. This helps to maintain regular bowel movement and prevent constipation.

A report will be sent to the doctor who requested your test. This can take several days.

What are the risks?

Barium swallow and meal tests are commonly performed and generally safe. In order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications for this procedure.

You will be exposed to some X-ray radiation. Depending on whether you have just a barium swallow or a barium swallow and barium meal, the level of exposure is about the same as you would receive naturally from the environment over 8 to 16 months.

If you are pregnant

Pregnant women are advised not to have X-rays as there's a risk the radiation may cause some damage to the unborn child. If you could be pregnant, please tell your doctor or radiographer.

Side-effects

These are the unwanted but mostly temporary effects you may get after having the procedure. After having a barium swallow or meal you may feel bloated for a short while. You may also feel constipated for a few days and need to take mild laxatives.

The muscle relaxant commonly used for this test can temporarily blur your eyesight, give you a dry mouth and make it harder than usual to pass urine. These effects usually wear off after about 15 to 30 minutes.

Complications

Complications are when problems occur during or after the procedure. It's possible to have an allergic reaction to the flavouring added to some barium brands. If you experience any itching or difficulty in breathing, tell your radiographer immediately. Medicines are available to treat any allergic reaction.

Ask your doctor to explain how these risks apply to you. The exact risks will differ for every person. This is one of the reasons why we have not included statistics here.