Barium Swallow (Video Esophagram)

Barium Swallow Preparation - click for PDFBarium Swallow Image

For patient safety, patients exceeding the posted weight restrictions will not be done at London X-Ray Associates. The weight limit for all Ultrasound exams is 350 lbs.


The barium swallow is an x-ray examination of the esophagus - the long tube between the mouth and the stomach. Passing small highly controlled amounts of radiation through the body and capturing the resulting shadows on film creates x-ray images. Most people are familiar with plain x-rays which produce a still picture of the body. A similar imaging method, fluoroscopy, uses x-rays to capture a moving image of an organ. Both still x-ray images and fluoroscopy are usually used during a barium swallow. The patient drinks barium, a liquid that blocks x-rays. The shadows cast by this liquid allow us to determine the cause of swallowing difficulties in many cases. This procedure takes 5 - 15 minutes.

Common Reasons for a Barium Swallow

Some of the more common reasons why your doctor would order a barium swallow include:

  • Food or liquids getting stuck during swallowing
  • Food or liquids coming back up after swallowing
  • The sensation of a lump in the throat
  • Pain during swallowing
  • Coughing or choking during swallowing

Who should not have a Barium Swallow?

The barium swallow, and indeed all x-ray examinations, should not be performed on pregnant women except when the information provided by the test is vital to treatment of the patient and there are no suitable alternatives. A barium swallow should not be done if there has been surgery on the esophagus or stomach within the last two weeks. The barium swallow is usually not indicated when there is an object stuck in the esophagus. Anyone with a strawberry allergy should have this test done at a hospital.

How do I prepare for the test?

The presence of food within the esophagus or stomach may mask or be confused with abnormalities. Preparation for barium swallow is aimed at clearing these areas of food. Preparation is as follows:

  • Nothing to eat or drink after midnight prior to the examination (small amounts of water may be taken with medication)
  • No breakfast on the morning of the examination. Patients with afternoon appointments may have 1 slice of dry toast and one cup of clear liquid not later than 8:00 a.m. on the morning of the examination.

Who performs the examination?

The examination is performed by an x-ray technologist and a radiologist (a doctor who specializes in reading x-rays and other images and doing procedures requiring imaging) performs the examination.

What happens during the examination?

After registering with the receptionist, you will be asked to change into a gown. You will have to remove all of your clothing except your underwear, shoes and socks. You will be taken to an x-ray room. The first x-ray pictures are taken standing up. The technologist will ask you to drink a fizzy liquid akin to Bromoseltzer or Eno. This fills the esophagus and stomach with gas, allowing the lining to be better seen. Try not to burp until the test is over. Then you will be asked to drink a thick, chalky liquid - barium. Drink all of the liquid as fast as you are able. While you are drinking, several x-rays are taken - try to hold as still as possible, even after the barium is gone.

You will then be provided with a pillow and the x-ray machine will be gradually tilted until you are lying down. While laying down you will have to drink additional barium, this time thinner in consistency. The technologist will likely tilt the table upright once again and have you swallow more thin barium. You may also be asked to swallow a piece of marshmallow.

During the examination, the technologist will take x-ray pictures in a variety of different positions. You will be asked to hold your breath during most of the pictures.

What can I expect after the examination?

The fizzy liquid may produce burping after the examination. The barium will not irritate your stomach or bowels but you may have a heavy sensation. The barium can produce constipation. You can avoid this by drinking extra fluids after the procedure. Otherwise, you may resume a normal diet and normal activity. Your stools may appear white when the barium is passed.

What are the risks of the procedure?

All x-rays involve receiving a controlled amount of radiation. The risk associated with the radiation received during a single x-ray examination is very small. While the exact likelihood is controversial, there is a very small chance of the radiation contributing to the development of a malignancy many years in the future. The risks involved in everyday activities such as driving a car are far higher. Generally, the risk of not doing the x-ray far outweighs the risk of the small amount of radiation involved.

There is a very small risk of aspirating the barium (having it go down the wrong way).

Occasionally, residual barium may harden in the colon (large bowel) after the procedure, producing constipation. As mentioned above, this can be avoided by drinking extra fluids after the procedure. Allergy to barium or the fizzy liquid are extremely rare.

Who interprets the results and how do I get them?

The results are interpreted by one of our radiologists and the results are sent to the doctor who ordered the barium by courier or fax.

Arrangements to discuss the results of the barium swallow can be made with the doctor who ordered it.

Are childcare (baby sitting) services available while I have my exam?

No childcare services are available. Please prearrange the following:
Adult supervision in the waiting room must be provided at all times for children while you, the caregiver, are having your exam completed. London X-Ray Associates staff will not be able to provide any childcare needs. We ask that all children be supervised by an adult, other than the patient, while at London X-Ray Associates.
Thank you.