Barium swallow and meal

About barium swallow and meal

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

X-rays usually pass straight through parts of the gut such as your oesophagus, stomach and bowel and so these structures don't show up well on plain X-ray images. However, if your gut wall is coated with barium, the outline of your gut shows up clearly on X-ray images.

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 a barium swallow and meal.

The test is often done as an outpatient procedure in a hospital's imaging or radiology department. It’s usually carried out by a radiologist (a doctor who specialises in using imaging methods to diagnose medical conditions). A radiographer (a health professional trained to perform imaging procedures) will also be present.

A barium swallow and meal test can give your doctor information about your swallowing action, and can pick up patches of irritation such as ulcers, abnormal growths, narrowing or a blockage.

What are the alternatives to barium swallow and meal?

The main alternative to a barium swallow and meal is to have a gastroscopy. A gastroscopy is a procedure used to look inside your oesophagus, stomach and the first part of the small intestine (duodenum) using a narrow, flexible, tube-like telescopic camera called a gastroscope.

Sometimes you may have a CT scan, which uses X-rays to make a three-dimensional image of your gut.

You may need to have a combination of tests to get a diagnosis. Your doctor will explain your options to you.

Preparing for a barium swallow and meal

Your radiographer will explain how to prepare for your examination.

Your stomach and small bowel need to be empty for the test so that the barium can coat every part of your stomach and bowel lining. To achieve this, you will be asked not to eat or drink anything typically for four hours before your test.

It's important to follow the fasting instructions from your hospital carefully. If your stomach or small bowel isn't completely empty, the images from the test will be incomplete and you may need to have the test again.

You should tell your radiographer about any medicines you're taking and if you have any allergies, glaucoma or heart disease. If you usually take medicines in the morning, don’t have your morning dose but take your medicines to hospital and let your radiologist know. If you have any questions about your medicines, contact the radiography department at your hospital or ask your doctor.

If you're a woman of childbearing age, you will be asked if you're pregnant. A barium swallow and meal isn't recommended for pregnant women, unless there is an urgent medical reason. It’s important to tell your radiographer if you could be pregnant.

Your radiographer will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

If you take tablets or insulin for diabetes, you will be given some specific advice about what to do before the test. Make sure you have enough to eat on the day before your appointment to prevent low blood sugar, and follow the advice given by your hospital.

What happens during a barium swallow and meal

The test usually takes 10 to 15 minutes, but you will probably be in the radiology department for about 30 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 that contains barium. The liquid tastes chalky and may be 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 will dissolve in your stomach and produce carbon dioxide gas, which will help your radiographer to take clear X-ray images of your stomach wall. You may also be given an injection of a muscle relaxant to help relax the muscles of your stomach wall and stop your stomach from moving.

Images of your oesophagus will be displayed on a monitor. Your radiographer will take several X-ray images, or a moving series of images, with you in different positions. The X-ray table will then slowly tilt until you’re in a horizontal position and your radiographer will take some more images.

At certain points during the test you may be asked to hold your breath for a couple of seconds. You may also be asked to swallow while lying down.
 

What to expect afterwards

You will usually be able to go home when you feel ready.

If you were given a muscle relaxant, wait at least 30 minutes before driving.

Once home, drink clear fluids regularly and try to eat vegetables, fruit and foods high in fibre. This will help to maintain regular bowel movements and prevent constipation.

A report will be sent to the doctor who requested your test. This can take two weeks to reach your doctor.

What are the risks?

As with every procedure, there are some risks associated with a barium swallow and meal. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your radiographer or radiologist to explain how these risks apply to you.

You will be exposed to some X-ray radiation. In all X-ray examinations, the amount of radiation is kept to the absolute minimum that is necessary. Depending on whether you have just a barium swallow or a barium swallow and meal, the level of exposure is about the same as you would receive naturally from the environment over 12 to 18 months.

If you’re pregnant

Pregnant women are generally advised not to have X-ray tests of their abdomen as there is a risk the radiation may cause some damage to their unborn child. If you could be pregnant, it’s important to tell your doctor or radiographer.

Side-effects

Side-effects 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 a mild laxative.

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, and/or make you need to go more urgently.

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 have any itching or difficulty breathing, tell your radiographer immediately. Medicines are available to treat an allergic reaction.

Is video fluoroscopy the same as a barium swallow?

Answer

Not exactly. Both tests use X-ray images to look at swallowing, but they give different information.

Explanation

A barium swallow involves recording short bursts of moving pictures and is good for showing up the lining of your oesophagus and stomach. Video fluoroscopy is similar in that you will be asked to drink a liquid containing a material that shows up on X-rays. The main difference is that with video fluoroscopy the whole process of swallowing – from your lips to your stomach – is recorded in real time on video. It's particularly useful for problems with the nerves or muscles involved in swallowing. It may be used for young children who are having feeding problems, or for people who have had a stroke and are at risk of inhaling food or drink as they swallow.

As well as a radiographer and radiologist, one or two speech and language therapists will be present during a video fluoroscopy test to help explain what you need to do and to ensure that good images are recorded.

What will happen if my child needs a barium swallow and meal?

Answer

A barium swallow test is sometimes carried out in babies if they are being tested for gastro-oesophageal reflux disease. The barium swallow and meal tests are carried out in children and babies in much the same way as in adults.

Explanation

As with adults, your child's stomach and small bowel need to be empty before he or she has the test. However, usually children don't need to fast for as long as adults. This depends on his or her age, and may also vary between hospitals. Older children generally won't be able to eat anything for about four hours before the procedure, but may be able to drink clear fluids. Younger children will usually need to fast for around two hours before the test. It's important that you follow the fasting instructions in your child's admission letter.

Your child will often be able to choose from a variety of flavourings (such as banana, strawberry or chocolate), which will be added to the barium liquid. Your child will be given the liquid either by a bottle with a teat, or a cup with or without a feeding spout.

You will usually be able to stay in the examination room with your child. If you’re pregnant, you will not be able to stay in the room as there is a risk that the radiation could harm your unborn baby.

Is it normal for my faeces to be white after a barium swallow and meal?

Answer

Yes, it's normal for barium to have this effect.

Explanation

Your faeces are likely to be white, or paler, for a day or so after a barium swallow and meal. This is completely normal and a sign that the barium is passing out of your body.

You may also feel constipated for a few days and possibly will need to take a mild laxative. You can buy these over the counter at a pharmacy. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice. Make sure you drink enough fluids.

In the first couple of days after having a barium swallow and meal, you may also find you need to flush the toilet more than usual after a bowel movement.