Barium swallow

This page was reviewed under our medical and editorial policy by

Henry Krebs, MD, Interventional and Diagnostic Radiologist

This page was updated on November 16, 2023.

A barium swallow is a noninvasive X-ray technique commonly used to examine the throat and esophagus for swallowing difficulties and physical abnormalities, helping to detect problems such as gastroesophageal reflux disease (GERD), ulcers or polyps. It’s also a valuable tool to look for cancer in the upper esophagus.

A barium swallow may also be called by other names, such as an esophagram or barium esophagram.

Barium swallow vs. upper GI series

The care team may use a barium swallow to evaluate the upper esophagus, such as when they want to look for esophageal abnormalities. An upper GI series allows the care team to evaluate more of the upper GI tract, which typically includes the esophagus, stomach and duodenum.

What is a barium swallow test used to diagnose?

Doctors may use it specifically to diagnose esophageal cancer.

In addition to cancer, results from a barium swallow may detect:

  • Ulcers
  • Polyps
  • Hiatal hernia (when part of the stomach protrudes up through the diaphragm)
  • Esophageal stricture (a tight band of tissue)
  • Diverticula (little pouches in the intestinal wall)
  • Motility disorders

What is a modified barium swallow?

A modified barium swallow is a different procedure, typically performed by a speech pathologist rather than a radiologist. The modified procedure may be performed after surgery or radiation therapy to evaluate whether the patient is experiencing side effects such as dysphagia or aspiration.

How is a barium swallow test performed?

The procedure uses X-ray images to follow the progress of a liquid containing barium sulfate, a metallic element from the earth, through the patient's mouth and throat.

  • The patient will be evaluated using fluoroscopic imaging both upright and lying down on a X-ray capable table.
  • The patient will drink a flavored liquid barium drink, which coats the lining of the digestive tract. This chalky liquid is called a contrast medium, as it shows up opaque on X-ray images.
  • A radiologist then begins to take a series of X-ray images with the patient in different positions. The patient may need to hold his or her breath occasionally.

If the patient's symptoms include dysphagia, or problems swallowing, the care team may order a video version of the test to determine the cause and look for signs of esophageal, laryngeal or hypopharyngeal cancers.

When is a barium swallow called an esophagram or other name?

An instrument called a fluoroscope helps track the movement of the barium, which is displayed on a video monitor. In this instance, the test is called an esophagram. Other names for it are modified barium swallow and videofluoroscopy.

The test also may be used if the care team suspects cancer has opened a fistula, or hole, between the esophagus and trachea (windpipe). This serious complication may result in swallowed food and liquid passing into the lungs, where it may cause pneumonia.

How long does a barium swallow test take?

The barium swallow procedure typically takes between five and 10 minutes. Talk to the care team beforehand to get an accurate estimate of how long the test is expected to take.

Preparation for a barium swallow

Patients shouldn’t undergo a barium swallow if it’s possible that they're pregnant.

Before the procedure:

  • Inform the care team of any medicines (prescription and over-the-counter), vitamins, supplements and herbal products the patient takes, as well as any illnesses or health conditions he or she has.
  • The care team will let the patient know what he or she may eat and drink the day leading up to the procedure. The patient may likely be told to avoid eating or drinking after midnight. Be sure to drink lots of water after the procedure.

Barium swallow side effects

Side effects of barium sulfate may include:

  • Stomach cramps
  • Nausea
  • Vomiting
  • Constipation
  • Diarrhea

Nausea and vomiting within a half-hour after swallowing barium are the more prevalent side effects. But overly adverse reactions aren’t common, so if the patient has strong or persistent side effects after the test, tell the care team. Let them know immediately about any of these potentially serious side effects:

  • Difficulty breathing
  • Difficulty swallowing

Understanding results

The upper GI tract—including the stomach, throat and esophagus—typically has a smooth lining, and fluid and structures move in a certain way. A normal result means the size, shape, physical movement and appearance of the area show no irregularities.

  • A barium swallow may detect deviations such as bumps and flat, raised areas indicative of early cancer.
  • Larger abnormalities, such as narrowed sections or holes, point to more complex issues and possibly cancer.

The care team may discuss all of the results of the barium swallow test with the patient, as well as the need for possible follow-up.

A barium swallow alone is often not enough to make a final diagnosis. Other tests, such as esophagoscopy or other endoscopic or other imaging procedures, may need to be done, so that the care team may view the area in greater detail and examine a tissue biopsy.

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Show references
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  • American Cancer Society (2021, January). Stomach Cancer Early Detection, Diagnosis, and Staging.
  • American Cancer Society (2020, March). Testing for Esophageal Cancer.
  • American College of Radiology (2019). ACR Practice Parameters for the Performance of Esophagrams and Upper Gastrointestinal Examinations in Adults.
  • American Cancer Society (2021, January). Tests for Laryngeal and Hypopharyngeal Cancers.
  • American Cancer Society (2021, January). Tests for Stomach Cancer.
  • American Society of Clinical Oncology (2022, October). Oral and Oropharyngeal Cancer: Diagnosis.
  • U.S. National Library of Medicine (2016, July). Barium Swallow.
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  • American Society of Clinical Oncology (2022, September). Head and Neck Cancer: Diagnosis.