Barium swallow and meal
Your health expert: Dr Amy Agahi, Radiology Registrar and Clinical Fellow at Bupa
Content editor review by Liz Woolf, February 2021
Next review due February 2024
A barium swallow and barium meal are types of X-ray test. They allow your doctor to examine your throat, oesophagus, stomach and the first part of your bowel.
These tests can give your doctor information about your swallowing action. They may also pick up ulcers, abnormal growths, narrowing or a blockage.
About a barium swallow and meal
Barium swallow and barium meal are medical tests that are usually done as an outpatient in the hospital’s X-ray department. They involve drinking a white liquid called barium and then having X-rays taken. 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 the body your doctor is examining. A barium swallow test looks at your throat and oesophagus. A barium meal looks at your oesophagus, stomach and the first part of your bowel. A barium follow-through is a similar test to look at your small bowel – there is more about this in our FAQ section.
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 might 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.
Another possibility is a CT (computed tomography) scan, which uses X-rays to produce pictures of your gut.
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. Not eating can be a problem if you have diabetes, so tell the X-ray department as soon as you get your appointment. If the hospital knows about it, they can 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 any medical conditions or allergies you have. 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. Because of the X-rays, this test isn’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 is any possibility you could be pregnant.
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.
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 health 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 that contains barium. The liquid is a bit like a chalky milkshake. They may offer you a choice of flavours, such as chocolate and strawberry, but this isn’t always available. 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 to relax the muscles of your stomach and stop it moving. 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 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 eat some marshmallow or biscuit to see how it goes down as you swallow.
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 concerns, it’s OK to ask.
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What to expect afterwards
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. If you take prescription medicines, take them as you usually would. 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 requested your test. It can take up to two weeks, but may be sooner. Ask your radiologist when they expect to have the results.
Risks of barium swallow and meal
As with every procedure, there are some risks associated with a barium swallow and meal. 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. In all X-ray examinations, the amount of radiation is kept as low as possible. The radiation exposure is about the same as you’d get naturally from the environment in eight months (barium swallow) or 16 months (barium meal).
If you’re pregnant
If you’re pregnant, doctors usually say you shouldn’t have X-ray tests of your abdomen (tummy). There’s a risk that radiation can harm a baby in the womb. It’s important to tell your doctor or radiographer if there is any chance you might be pregnant.
Difficulty swallowing
The barium can occasionally go down the wrong way so tell the doctor if you have problems with choking or food going down the wrong way when you eat or drink.
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 pulse and a dry mouth. It can also cause difficulty peeing – if you have this after your test, tell your doctor.
As this test involves X-rays, it could slightly increase your risk of developing a cancer in the future. If you are concerned, talk to your doctor. But remember that the radiation dose is low. The benefit to your health of having this investigation is likely to be far greater than any risk.
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, although this is more likely to be due to the flavouring it contains. Before you have the test, tell your doctor and radiographer about any allergies you have. 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 beyond the stomach, in the small intestine. This test is also known as a small bowel meal.
You prepare for this test in much the same way as you would prepare for a barium swallow and meal. You may also have to take a mild laxative to clear your bowel before you come to the hospital.
To start the procedure, you drink a couple of cups of barium liquid. Once the barium has reached your small bowel – perhaps 10 to 15 minutes – you go into the X-ray room. You have X-rays taken lying on the examination table. the radiologist may press on your abdomen at some points or ask you to change position. This is to help improve the images.
You have X-rays taken around every 15 minutes or so, until the barium has reached the end of your small bowel. If the barium is slow to move through your small bowel, the doctor may give you an injection of anti-sickness medicine to speed things up.
A barium follow-through test takes between 45 minutes and three hours. You can go home afterwards and eat and drink normally. Your poo will look white or pale for a few days afterwards.
The tests for children and babies are done in much the same way as for adults. A barium swallow and meal test are sometimes carried out in children if they:
- have swallowing problems
- have pain in the upper abdomen (tummy)
- keep being sick
- may have gastro-oesophageal reflux – fluid from your child’s stomach coming back up the oesophagus (gullet)
Your child’s stomach needs to be empty before they have the test. How long they can’t eat or drink beforehand depends on their age. For very young children it’s usually two hours and for older children four hours.
Children usually drink the barium without any problems. It’s like a slightly chalky milkshake with flavourings to make it taste nicer. They can have it in a cup, a bottle with a teat or gently squirted through a syringe into their mouth. Sometimes the radiologist may recommend giving the barium through a thin tube, put up your child’s nose and down into their stomach.
You can usually stay with your child during their procedure. You’ll have to wear a lead apron for protection 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.
These tests are similar, but they give different information. Both use X-ray images to look at swallowing and involve drinking barium liquid. The main difference with video fluoroscopy is that your doctor can watch how you swallow in real time, on video. You may have to swallow a range of consistencies of foods, both liquids and solids.
Other names for this test include modified barium swallow (MBS) or dysphagia barium swallow. Dysphagia means difficulty swallowing.
This test is particularly useful if there are problems with nerves or muscles involved in swallowing. It may be used for:
- young children with feeding problems
- people who’ve had a stroke and are at risk of choking as they swallow
As well as a radiographer and radiologist, there may be a speech and language therapist there during the test. They’ll help to explain what you need to do to ensure that good images are recorded.
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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This information was published by Bupa's Health Content Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals and deemed accurate on the date of review. Photos are only for illustrative purposes and do not reflect every presentation of a condition.
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