What Is a Barium Swallow Test?

Whenever you swallow food or liquid, there are actually many steps to get the contents from your mouth into your stomach. The upper part of the gastrointestinal (GI) tract coordinates these steps between your throat, esophagus, and stomach. A barium swallow — sometimes called an “upper GI series” or “esophagram” — is a test that checks the structure and function of all these parts of the swallowing process. 

During this test, you drink a liquid that contains barium. This makes the liquid visible on X-rays, so a radiologist can see the shape of the upper GI tract. A special type of X-ray, called fluoroscopy, then makes a video as the liquid travels from the mouth, through the esophagus, and down to the stomach. This can help healthcare providers diagnose several different conditions. Let’s talk more about what this study involves, when it’s used, and what it can diagnose. 

When is a barium swallow test used? 

Swallowing might seem simple, but it's actually a complex process. It requires that our nerves and muscles perform several coordinated steps: 

• The muscles of the throat have to cover the airway to allow the contents to safely travel into the esophagus. 

• Muscles in the esophagus then have to squeeze food into the stomach. 

• There is a valve at the bottom of the esophagus, called a sphincter, that relaxes so food can enter the stomach. 

• That sphincter then needs to tighten again as the stomach starts its digestion process. This tightening stops the stomach contents from going in the wrong direction and traveling back up into the esophagus. 

Given the complexity of this process, sometimes things can go wrong. And there are a variety of conditions that can affect different stages of this process. This can lead to symptoms such as:

• Coughing or choking on food

• Pain with swallowing

• Regurgitation of food

• Feeling like food gets stuck in the esophagus

• Heartburn

• Pain in the upper part of the abdomen

When someone develops these symptoms, a barium swallow can sometimes help to diagnose the problem.

What can a barium swallow diagnose?

A barium swallow can diagnose problems with how the upper GI tract functions or how it is shaped. 

Conditions that might affect the function of the upper GI tract include:

• Achalasia: The muscles in the lower part of the esophagus can’t squeeze food into the stomach.

• Hyperstensive esophageal sphincter: The sphincter doesn’t open properly to allow for food to move into the stomach.

• Spasms of the esophagus: The esophagus squeezes too hard and at the wrong times.

• Esophageal dysmotility: The entire esophagus doesn’t push food down to the stomach with enough strength.

• Gastrointestinal reflux disease (GERD): Acid in the stomach travels up into the esophagus and causes heartburn.

Some of the conditions that change the physical shape of the GI tract include:

• Strictures: These are ring-like narrowings in the esophagus.

• Tumors: These can be in the esophagus or stomach.

• Diverticuli: These are small pouches in the walls of the esophagus where food can get trapped.

• Hiatal hernias: Normally, the esophagus and the stomach meet at a hole (called the hiatus) between the chest and the abdomen. A hiatal hernia is when part of the stomach slides up past this hole and into the chest. This can cause pain or gastric reflux.

• Ulcers: These are in the wall of the stomach. There is a protective coating that lines the stomach that prevents acid from harming the wall of the stomach. If this lining erodes away, ulcers can form and lead to stomach pain.

How does a barium swallow test work?

Your provider will give specific instructions before you get a barium swallow. Usually, this means not eating anything after midnight the night before your test. Your provider will also let you know if you should avoid certain medications the day before the test.

On the day of your test, it helps to wear loose or comfortable clothing. This is because your healthcare team may ask you to change position throughout the test. You might sit, stand, or lie down to get the barium to travel to different areas.

During the test, you’ll drink a liquid containing barium. This is a chalky liquid, which is usually flavored to make it taste better. While you swallow this, a fluoroscopy machine will take a video of the barium as it moves down your upper GI tract. Then a radiologist or a GI specialist will review the video to look for any abnormalities.

Are there any downsides to a barium swallow?

A barium swallow is a safe and easy procedure with few side effects. If someone does experience side effects, they are usually mild and related to the way our body digests the barium. They include:

• Nausea when drinking the solution

• Constipation or chalky stool in the days following the test 

The other thing to consider is that a barium swallow test can’t diagnose everything. If a defect in the GI tract is small, a barium swallow might miss it. Or the results might not give a clear answer to what is causing your symptoms. So people often need other studies after a barium swallow to clarify what’s going on, such as:

• Esophagogastroduodenoscopy (EGD): For an EGD, or upper GI scope, a specialist inserts a camera into the mouth and upper GI tract to take a direct look at the structures.

• Esophageal manometry: This is a method of measuring how strong the esophagus squeezes. 

• Esophageal pH monitoring: This is a way to check how much acid is in the esophagus.

• Swallow study: This test involves swallowing liquids of various thicknesses, which can assess how well the body gets food and liquids from the mouth to the esophagus.

Even when your test results are normal or inconclusive, the good news is that a barium swallow still rules out several other conditions. But it might not give you the final answer. And more testing may be necessary.