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Barium swallow and meal


Expert reviewer, Dr Daniel Boxer, Consultant Radiologist
Next review due October 2020

A barium swallow and meal is a type of X-ray test. It allows your doctor to examine your throat, oesophagus, stomach and the first part of your bowel.

The procedure involves drinking white liquid called barium, and then having X-ray pictures taken. The barium coats the inside of your throat, oesophagus (the pipe that goes from your mouth to your stomach), stomach and small bowel.

You may hear various names for this test, depending on which parts are being examined. A barium swallow test assesses your throat and oesophagus. A barium meal assesses your oesophagus, stomach and just the first part of your bowel. These are the main tests covered here. A barium follow-through is a similar test which assesses your small bowel – see our FAQ below for more information about this.

A barium swallow and meal is usually done during an outpatient visit to the hospital radiology department. It may take about 20 minutes. The procedure is carried out by a radiologist – a doctor who specialises in using imaging methods to diagnose medical conditions. They’ll be helped by a radiographer – a health professional trained to perform imaging procedures.

The test can give your doctor information about your swallowing action. It can also pick up ulcers, abnormal growths, narrowing or a blockage.

Image showing the digestive system

What are the alternatives to barium swallow and meal?

The main alternative to a barium swallow and meal is to have a gastroscopy. This is a procedure to look inside your oesophagus, stomach and the first part of the small intestine. It involves using a narrow, flexible, tube-like telescopic camera called a gastroscope. You can find out more about this test by visiting our page on gastroscopy.

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

Depending on your symptoms, you may need to have 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 give you information before your barium swallow and meal to explain exactly how to prepare for it. It’s important to follow these instructions carefully.

To get good X-ray pictures, your stomach needs to be empty. So you’ll usually be asked not to eat or drink anything for six hours before your test.

If you have diabetes, so that not eating may be a problem for you, talk to your doctor. If the hospital knows you have diabetes, they can give you special advice about how to keep your blood sugar up.

It’s important to tell your radiographer about any medicines you're taking, any medical conditions you have and if you have any allergies.

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 radiology department at your hospital or ask your doctor.

Tell your radiographer if you’re pregnant, or even if you might be. A barium swallow and meal isn’t recommended for pregnant women, unless there’s an urgent medical reason.

Your radiographer or radiologist will discuss with you 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 sign a consent form.

What happens during a barium swallow and meal?

The test usually takes 10 to 20 minutes, but you’ll probably be in the radiology department for about 30 minutes. You can take someone to the hospital with you, but they probably won’t be able to come into the X-ray room. A member of staff will explain what’s going to happen.

You’ll be asked to remove your clothing and put on a hospital gown in a private cubicle. Your radiographer will take you to the X-ray room. They’ll help position you against an upright X-ray table, in front of an X-ray camera.

Your radiologist will ask you to drink some white liquid that contains barium. The liquid can feel chalky and may be mildly fruit-flavoured. See our FAQ below for more information about the barium liquid.

If the test you’re having is a barium meal, your radiologist may ask you to swallow some special granules. These dissolve in your stomach and fizz up, producing 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 to help relax the muscles of your stomach and stop it from moving. You may not have this injection if you have glaucoma or heart problems. So it’s very important that you tell your radiologist if you have these problems, especially glaucoma.

During the procedure, 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 in a horizontal position for some of the images. At some points your radiologist may ask you to hold your breath for a few seconds. And they may ask you to swallow more barium.

Your radiographer and radiologist will explain what’s happening, and what they need you to do, throughout your procedure. If you have any questions or concerns, it’s OK to ask.

What to expect afterwards

You’ll usually be able to go home when you feel ready. If you were given a muscle relaxant, the medicine can sometimes cause temporary blurred vision. If so, don’t drive until this has completely worn off.

You can eat and drink normally after your test.

If you usually take prescription medicines, you can take these as normal afterwards. If you have any questions about your medicines, ask your doctor.

Barium can cause constipation. To help prevent this, drink plenty of clear fluids and try to eat vegetables, fruit and foods high in fibre for a few days.

A report will be sent to the doctor who requested your test. This may take up to two weeks to reach your doctor, but may be sooner. Ask your radiologist when they expect the result to be ready.

What are the risks?

As with every procedure, there are some risks associated with a barium swallow and meal. Your doctor will have recommended the test because they believe the benefits for you 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 to the absolute minimum that’s necessary. The level of exposure is about the same as you’d get naturally from the environment over 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). This is because there’s a risk the radiation may cause some damage to your unborn child. It’s important to tell your doctor or radiographer if you’re pregnant, or even if there’s a chance you might be.

Side-effects

Side-effects are the unwanted but mostly temporary effects of the procedure.

After having a barium swallow or meal:

  • you may feel bloated for a short while
  • you may feel constipated for a few days and need to take a mild laxative
  • your stools (bowel movements) may appear grey or white for a day or two

The muscle relaxant commonly used for this test can temporarily blur your eyesight and give you a dry mouth. It may also 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 very rare, but you may have an allergic reaction to the barium liquid, or the flavouring it contains. If you have any itching or difficulty breathing, tell your radiographer immediately. Medicines are available to treat an allergic reaction.

There’s always a slight chance that a procedure involving X-rays can cause cancer.

Frequently asked questions

  • A barium follow-through is a test similar to 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 be asked to take a laxative to clear your bowel before you come to the hospital.

    At the beginning of the procedure you’ll be asked to drink a couple of cupfuls of barium liquid. Once the barium has had time to reach your small bowel – perhaps 10 to 15 minutes – you go into the X-ray room. Your radiologist will take images in much the same way as described above for a barium meal. They may need to press on your abdomen at some points to improve the images.

    These images will be repeated at regular intervals – perhaps 15 to 30 minutes apart – until the barium has reached the end of your small bowel.

    A barium follow-through test takes between 45 minutes and three hours. You’ll be able to go home afterwards and eat and drink normally.

  • When you have a barium swallow or meal you’ll be asked to drink a liquid containing barium. Barium is a substance that shows up on X-rays.

    The barium liquid is often described as having the consistency of a milkshake, with a slightly ‘chalky’ feel. To make it more pleasant for you to drink, it’s often flavoured. Flavours may include chocolate or fruit such as strawberry.

    You may find the taste of the barium liquid a little unpleasant, but most people can easily manage to drink it. It may help you to know that children usually drink the barium liquid without any objection.

    If you want to know more about the contents of your barium liquid, ask your radiographer.

  • A barium swallow and meal test is sometimes carried out in children. This may be for swallowing problems, if they have pain in their upper abdomen (tummy) or if they keep vomiting. Their doctor may also recommend the test if they suspect fluid from your child’s stomach is coming back up the gullet (gastro-oesophageal reflux). The tests for children and babies are done in much the same way as for adults.

    As with adults, your child’s stomach needs to be empty before they have the test. How long they have to go without food or drink before the test depends on their age. For very young children this will probably be two hours, for older children four hours. The hospital will tell you how to prepare your child – it’s important to follow their instructions carefully.

    Children usually drink the barium liquid without any problems. It’s like a slightly chalky milkshake with flavourings to make it easier to drink. It may be given with a cup, in a bottle with a teat or gently squirted through a syringe into their mouth. The radiologist may sometimes recommend passing a small tube into your child’s stomach through their nose to give the liquid.

    You’ll usually be able to stay with your child during the procedure. However if you’re pregnant, you mustn’t stay in the room as there’s a risk that the X-ray radiation could harm your unborn baby.

    The medical staff carrying out your child’s barium swallow and meal will do everything they can to keep your child comfortable during the test. They’ll explain what’s going to happen at each stage. If you have questions or concerns, just ask.

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

    More information

    A barium swallow involves taking X-ray pictures and is good for showing up the lining of your oesophagus, stomach and small bowel. Video fluoroscopy is similar in that you will be asked to drink a liquid containing barium. The main difference is that with video fluoroscopy, the whole process of swallowing is recorded in real time on video. You may be tested using a range of consistencies of food – including liquids and solids.

    Other names for this test include modified barium swallow (MBS) or dysphagia barium swallow. Dysphagia means difficulty with swallowing.

    A videofluoroscopic swallow test is particularly useful for examining problems with the nerves or muscles involved in swallowing. It may be used for:

    • young children who are having feeding problems
    • 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 the test. They’ll help explain what you need to do to ensure that good images are recorded.


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  • Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, October 2017
    Expert reviewer, Dr Daniel Boxer, Consultant Radiologist
    Next review due October 2020



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