Barium swallow and barium meal

A barium swallow can help diagnose problems with the back of your mouth and throat (pharynx) and your gullet (oesophagus) using a special X-ray. 

It involves taking X-ray images of your stomach and oesophagus after you’ve drunk a harmless liquid metal called barium contrast. The barium coats your stomach and oesophagus so they show up clearly on the X-ray image. This allows a doctor or radiologist to see a detailed outline of these digestive organs and diagnose any problems.

It is also known as a barium X-ray or barium meal.

An endoscopy is more invasive than a barium swallow as a special tube called an endoscope needs to be passed down through your mouth, down your throat and into your gullet. A barium swallow doesn't require any devices to be passed into your body, you only need to drink a special liquid metal called barium contrast and then have an X-ray.

Both an endoscopy and barium swallow are helpful to diagnose problems with your gastrointestinal system. Some of these disorders can be diagnosed easily using an X-ray with a barium swallow. However, more complex problems may need an endoscopy.

Your doctor may recommend a barium swallow to investigate the cause of symptoms such as:

• Abdominal pain and bloating
• Digestion problems
• Frequent, painful heartburn
• Painful swallowing
• Unexplained weight loss
• Vomiting

A referral letter from a consultant or GP is required before booking any diagnostic investigation.

Common conditions affecting your oesophagus and stomach that can be diagnosed with a barium swallow are:

• An obstruction or narrowing of your oesophagus
• Gastro-osophageal reflux disease (GORD)
• Hiatus hernia
• Structural problems with your gut — this includes abnormal growths (polyps) and abnormal pouches in your intestinal wall (diverticula)
• Stomach ulcers
• Swallowing disorder (dysphagia)

A barium swallow can also identify inflammation, as well as more serious conditions, such as stomach cancer.

A barium swallow can be used to image movement through your gastrointestinal system too, using a continuous X-ray beam (fluoroscopy).  

Sometimes a barium swallow is performed alongside a special kind of endoscopy of the upper gastrointestinal system called an oesophagogastroduodenoscopy (OGD). Barium swallows are also often part of a series of tests to investigate the upper gastrointestinal system and small intestine.

Before your barium swallow, you will be given instructions by your healthcare team on how to prepare. They will tell you not to eat or drink anything for six hours before your barium swallow. However, you can take small sips of water up to two hours before your barium swallow. You may also be advised not to chew gum, eat mints or smoke after midnight the night before your procedure.

If you are having other tests performed or you have certain medical conditions, you may receive slightly different instructions from your healthcare team.

Certain conditions may prevent you from having a barium swallow due to the risk of complications. These conditions include:

• A perforated oesophagus or bowel
• Bowel obstruction
• Difficulty swallowing
• Severe constipation

If you have or previously had any of these conditions, make sure you tell your healthcare team.

It can be difficult to see your stomach and oesophagus clearly in a normal X-ray, which is where a barium swallow can help. 

Getting ready for your barium swallow

You may be asked to change into a hospital gown and will also be given a lead shield or apron to wear over your pelvic area to shield it from unnecessary X-ray radiation. 

You may be asked to take several different positions during your procedure, including standing, sitting or lying down on an X-ray table. 

During your barium swallow

One of our experienced and caring staff will ask you to drink a white liquid containing barium in an X-ray room. It’s fruit flavoured and you’ll need to sip it rather than gulp it. This liquid will coat the lining of your oesophagus and stomach, allowing these structures to be captured more clearly on X-ray images.

As you swallow mouthfuls of this liquid, single X-ray images, a series of X-ray images or continuous real-time X-ray images (fluoroscopy) will be captured of the barium contrast passing down your throat and into your oesophagus. These images will be stored so your doctor can review them later.

You might also be given a muscle relaxant injection to prevent the stomach moving while the images are taken.

Next, the procedure will be repeated but instead of drinking a thick barium contrast liquid, you will drink a thinner version.

After your barium swallow

Once all the X-ray images needed have been taken, you can change back into your normal clothes and go home. You can immediately return to your usual activities, including eating and drinking, unless your doctor advises against it. 

You may feel bloated for a few hours and it's likely you'll be constipated for a few days. Talk to your pharmacist about a mild laxative. Drink plenty of water and eat high fibre foods such as fresh fruit and veg, rice and wholemeal pasta to get things moving.

What does a barium swallow taste like?

Barium contrast is artificially sweetened and flavoured (eg chocolate or strawberry flavoured) to make it more palatable to drink. However, you may still find that it tastes bitter or chalky. 

A barium swallow takes about 20 minutes, although it can be longer. You can go home shortly afterwards.

A radiographer will carry out your barium swallow. A report will be sent to the doctor who requested your scan. This can sometimes take a few days, though we try to get your results to you as quickly as possible. Your radiographer will let you know when you can expect to get your results.

Risks of X-rays

A barium swallow procedure involves the use of X-rays, which are a type of ionising radiation. However, the doses used in medical X-rays are very low — the amount of radiation is the same as the background radiation you’d naturally be exposed to over a few years. It's thought exposure to X-rays may slightly increase your chances of developing cancer many years later, although this risk is thought to be very small.

Nonetheless, X-rays aren't recommended for pregnant women.

At Spire Healthcare, we’re careful to weigh up the benefits and risks of any X-ray and discuss it with you if you have any concerns.

Risks and side effects of barium contrast

There are no known risks associated with the barium contrast liquid and it passes through your body without being absorbed. However, if the barium doesn't promptly completely pass out of your body after your procedure, it can cause temporary constipation.

To avoid the risk of constipation, drink plenty of fluids and eat high-fibre foods after your procedure as these will both help the barium contrast move through your gut and out of your body. If you are still constipated, your doctor may prescribe a laxative.

You may notice that your stools are lighter after your barium swallow. This is due to the barium passing out of your body and once it has all been expelled, your stools will return to their normal colour.

If you have an existing swallowing difficulty, there is a small risk of breathing a small amount of liquid into your lungs (aspiration).

When to see your doctor

If after your procedure, you experience any of the following, you should see your doctor:

• Abdominal pain or bloating
• Difficulty passing stools
• Inability to pass stools
• Stools that are smaller in diameter than usual

Barium swallow and diabetes

As you should not eat or drink for six hours before your barium swallow, if you have diabetes, your doctor will arrange for your procedure to occur in the morning.

If you manage your diabetes by taking tablets, your doctor will tell you not to take your medication before your barium swallow. However, once your procedure is complete, you should take your tablets and have some food.

If you manage your diabetes by taking insulin injections, your doctor will tell you not to take your morning injection and in some cases, not to take your insulin injection the evening before your procedure too. However, once your procedure is complete, you should take your insulin injection and have some food.

If you take long-acting insulin, your doctor will tell you to continue to take your insulin injections as normal.