Barium swallow and meal
- Dr Andrew Milestone, Consultant Gastroenterologist and Physician
A barium swallow and barium meal are types of X-ray test. These allow your doctor to look closely at the inside of your throat, oesophagus, stomach, and the first part of your bowel. The tests may help to diagnose problems with swallowing, eating, and drinking.
About a barium swallow and meal
Barium swallow and barium meal are medical tests that you usually have as an outpatient in a hospital’s X-ray department. These tests aren’t used very often these days. You drink a white liquid called barium and then have X-rays. The barium coats the inside of your throat, oesophagus (the pipe that goes from your mouth to your stomach), stomach, and small bowel.
This test has a different name depending on which area of your body your doctor is examining.
- A barium swallow test looks at your oesophagus.
- A barium meal test looks at your stomach.
- A barium swallow and meal looks at your oesophagus and stomach.
You may have these tests if you have:
- swallowing problems
- indigestion
- acid reflux
- delayed stomach emptying
A video fluoroscopic swallow test is similar to a barium swallow. But your doctor can watch how you swallow in real time, on video. This test is particularly useful if you have nerve or muscle problems when you swallow.
Alternatives to a barium swallow or meal
The main alternative to a barium swallow and meal is a gastroscopy (also called an endoscopy). This test looks inside your oesophagus, stomach, and the first part of your small intestine. It involves using a narrow, flexible, tube-like telescopic camera called a gastroscope.
Your doctor may suggest a gastroscopy if they need to take samples of tissue (biopsies). An advantage of a barium test is that your doctor can watch the muscles moving as you swallow.
Your doctor may also suggest you have:
- a CT (computed tomography) scan – this uses X-rays to create pictures of your gut
- an MRI/CT enterogram – to look at your small bowel
- a CT colonography – to look at your large bowel
- oesophageal manometry – to look at how well your oesophagus is working
Depending on your symptoms, you may need a combination of tests to get a diagnosis. Ask your doctor to explain your options to you.
Preparing for a barium swallow and meal
Your hospital will explain exactly how to prepare for your test. It’s important to follow their instructions.
To get good X-ray pictures, your stomach needs to be empty. This means you usually can’t eat or drink anything for six hours before your test. If your child is having the procedure, they’ll also need to stop eating and drinking beforehand. Your hospital will tell you how long for. If you’re having a barium follow-through, you may also have to take a mild laxative to clear your bowel before you come to the hospital.
If you have diabetes, tell the X-ray department as soon as you get your appointment. The hospital will then give you advice on keeping your blood sugar up and managing your insulin or tablets.
It’s important to tell your radiographer about all the medicines you take, and if you have any medical conditions or allergies. If you usually take medicines in the morning, don’t have your morning dose unless you’ve agreed this with your doctor beforehand. Take your medicines to hospital and let your radiologist know. If you have any questions about your medicines, contact the radiology department at your hospital or ask your doctor.
Tell your radiographer if you are, or could be, pregnant. The test uses X-rays, which aren’t recommended if you’re pregnant, unless there’s an urgent medical reason. Your doctor may ask you to have a pregnancy test if there’s any chance you could be pregnant.
If you’re having a barium meal, tell the doctor if you have heart problems or an eye disease called glaucoma. It’s important that they know, as having one or both of these conditions means you can’t have a muscle relaxant during the procedure.
Your radiographer or radiologist will talk through what will happen before, during, and after your procedure. This is your chance to ask any questions you have. If you don’t want to have the procedure, you don’t have to. If you’re happy to go ahead, they’ll ask you to give consent, either verbally or in writing.
Barium swallow and meal procedure
The test usually takes about 20 minutes. You can take someone to the hospital with you, but they won’t usually be able to come into the X-ray room. A member of staff will explain what’s going to happen.
If your child is having the procedure, you can usually stay with them. You’ll have to wear a lead apron to protect you from the X-rays. But you can’t stay in the room if you’re pregnant. There’s a risk that the X-ray radiation could harm your unborn baby.
A radiologist will carry out your procedure. This is a doctor who specialises in using X-rays and scans to diagnose medical conditions. A radiographer will help. This is a healthcare professional trained to take X-rays and scans.
Preparing for the test
First, you undress in a private cubicle, remove any metal or jewellery and put on a hospital gown. Your radiographer will take you to the X-ray room. They’ll ask you to stand in front of an upright X-ray table, in front of an X-ray camera and make sure you’re in the correct position.
Your radiologist will ask you to drink a white liquid containing barium. The liquid is a bit like a chalky milkshake. It may taste a bit fruity. Barium isn’t all that pleasant to drink, but most people manage without any problems.
If you’re having a barium meal, your radiologist may ask you to swallow some granules. These dissolve in your stomach and fizz up to produce gas. This expands your stomach, which helps make the X-ray pictures clearer. You may feel the need to burp, but it’s important to hold the air in if you can.
Your radiologist may also give you an injection of a muscle relaxant (such as hyoscine) to relax your stomach muscles. You may feel your heart rate increase when you have the injection. Tell the doctor if you have heart problems or an eye disease called glaucoma. Having one or both of these conditions means you can’t have the injection.
During the test
During the test, your radiologist will take several X-ray images, or a moving series of images, with you in different positions. The X-ray table may slowly tilt until you’re lying down for some of the images. Your radiologist may ask you to hold your breath for a few seconds at times. And they may ask you to swallow more barium. They may also ask you to swallow some marshmallow or biscuit to see how food goes down when you swallow.
If you’re having a barium follow-through, the radiologist may press down on your tummy at some point or ask you to change position.
Throughout your procedure, your radiographer and radiologist will explain what’s happening, and what they need you to do. If you have any questions or are worried about anything, it’s OK to ask.
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What to expect after barium swallow and meal
You can usually go home when you feel ready. If you had the muscle relaxant injection, you may have dizziness or blurred vision. This is only temporary – but don’t drive until it’s completely worn off.
You can eat and drink normally after your test. You can also take your usual medicines. If you have any questions about your medicines, ask your doctor.
Barium can cause constipation. To prevent this, drink plenty of clear fluids and try to eat lots of vegetables, fruit, and foods high in fibre for a few days.
The test results will be sent to your GP and the doctor who asked for the test. This can take up to two weeks. Ask your radiologist when they expect to have the results.
Risks of barium swallow and meal
As with every procedure, having a barium swallow and meal has a few risks. Your doctor recommended the test because they believe the benefits outweigh the risks. You can ask them to discuss the risks and benefits with you. It’s your decision whether to go ahead with any procedure your doctor offers.
X-ray radiation
Having a barium swallow and meal exposes you to some X-ray radiation. The chances of this radiation causing you problems in the future are very small. But it could slightly increase your risk of developing a cancer in the future. In all X-ray examinations, the amount of radiation is kept as low as possible.
If you’re pregnant
If you’re pregnant, doctors usually say you shouldn’t have X-rays of your tummy. There’s a risk that radiation can harm your unborn baby. It’s important to tell your doctor or radiographer if there’s any chance you may be pregnant.
Difficulty swallowing
The barium can occasionally go down the wrong way into your lungs. This may be harmful to your lungs. So tell the doctor if you have problems with choking or swallowing.
Side-effects of barium swallow and meal
Side-effects are the unwanted but temporary effects of any medical procedure or treatment.
After a barium swallow or meal, you may:
- feel bloated for a short while
- have constipation for a few days and need to take a mild laxative
- have white or grey poo for a day or two
The muscle relaxant usually used for this test can cause temporary dizziness or blurred eyesight, a fast heartbeat, and a dry mouth. It can also cause difficulty peeing – if you have this after your test, tell your doctor.
Complications of barium swallow and meal
Complications are problems that occur during or after a procedure.
It’s very rare, but you may have an allergic reaction to the barium liquid. Before you have the test, tell your doctor and radiographer if you have any allergies. If you have any itching or difficulty breathing, tell your radiographer immediately. The doctor will have medicines on hand to treat any allergic reaction.
A barium follow-through is like a barium meal. But it looks for problems in your small bowel instead. For more information, see our about a barium swallow and meal section.
After your procedure, you can eat and drink normally again. Drink lots of clear fluids and eat high-fibre foods, such as fruit and vegetables, to prevent constipation. For more information, see our what to expect after barium swallow and meal section.
Both tests use X-ray images and involve drinking barium liquid. But your doctor uses them to look at different parts of your digestive system. For more information, see our about a barium swallow and meal section.
X-rays
An X-ray machine works by projecting a beam of X-rays through the part of your body that your doctor needs to look at
CT scan
A CT scanner is a large, ring-shaped machine used to diagnose and monitor a number of different health conditions
Gastroscopy
A gastroscopy is a procedure that allows a doctor to look inside your oesophagus , your stomach and part of your small intestine.
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- Victoria Goldman, Freelance Health Editor
