Barium swallow (upper GI series)

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 digestive tract (from the mouth to the first part of the small intestine).

Doctors may use it specifically to diagnose esophageal (food pipe) cancer and stomach cancer, as well as head and neck cancers, including:

• Oral cavity (mouth) cancer
• Oropharyngeal (mid-throat) cancer
• Hypopharyngeal (bottom of throat) 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)

How it’s 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 upper digestive tract. This group of X-rays is called an upper GI series.

• You’ll be evaluated using fluoroscopic imaging both upright and laying down on a X-ray capable table.
• You’ll 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 you in different positions. You may need to hold your breath occasionally.

To facilitate an upper GI series, you may be asked to drink a fizzy liquid to distend your stomach with gas to separate the walls of your stomach.

A barium swallow may be used to focus on the throat and esophagus or to examine all of the upper gastrointestinal tract.

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

Though a barium swallow may be used to check for stomach cancer, physicians more often introduce an endoscope through the mouth or nose down the esophagus to do a visual exam of the stomach’s lining and take tissue samples (biopsies). An upper GI series often times provides information complementary to endoscopy.

How to prepare

You shouldn’t undergo a barium swallow if you’ve had recent gastric or esophageal surgery, or trauma to your digestive tract unless specifically ordered by your surgeon. You should also skip the procedure if it’s possible you’re pregnant.

Before the procedure:

• Get a list of ingredients for the form of barium sulfate to be used and tell your doctor if you’re allergic to any of them. Also alert your doctor if you’re allergic to simethicone (Gas-X), the fizzy liquid used to inflate your stomach.
• Inform your care team of any medicines (prescription and over-the-counter), vitamins, supplements and herbal products you take, as well as any illnesses or health conditions you have.
• Your doctor will let you know what you may eat and drink the day leading up to the procedure. You may likely be told to avoid eating or drinking after midnight. Be sure to drink lots of water after the procedure.

Risks

Side effects of barium sulfate 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 you have strong or persistent side effects after the test, tell your care team. Let them know immediately if you have any of these potentially serious side effects:

• Difficulty breathing or swallowing
• Swelling of your throat
• Confusion
• Bluish skin
• Agitation
• Fast heartbeat
• Red skin, itchiness and hives

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.

Your care team may discuss all of the results of your barium swallow test with you, 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 your care team may view the area in greater detail and examine a tissue biopsy.