Barium Swallow: Procedure, Preparation, Risks, and Results

Understand the full barium swallow process—from preparation to aftercare, risks, and interpreting your test results.

By Medha deb

Created on Oct 3, 2025

Understand the full barium swallow process—from preparation to aftercare, risks, and interpreting your test results.

A barium swallow is a widely used, minimally invasive X-ray test that enables detailed visualization of the upper digestive system. This procedure helps healthcare providers investigate symptoms such as swallowing difficulties, persistent pain, or unexplained weight loss, and it identifies various conditions affecting the mouth, throat, esophagus, and even parts of the stomach and small intestine.

What Is a Barium Swallow?

A barium swallow is a special X-ray examination focused on evaluating how food and liquid move through the upper gastrointestinal (GI) tract. The test uses barium sulfate, a safe, radiopaque contrast material that highlights the inner walls of the digestive tract on X-ray images.

Also called: Esophagogram, barium esophagram, upper GI series
Structures visualized: Mouth, pharynx (throat), esophagus, initial portion of the stomach and small intestine
Primary purpose: Detecting disease, dysfunction, obstructions, or structural abnormalities

Why Is a Barium Swallow Done?

The barium swallow procedure is ordered by healthcare professionals to diagnose or investigate a range of symptoms or suspected conditions affecting the upper digestive system. Your doctor may recommend this test if you have symptoms suggestive of:

Difficulty swallowing (dysphagia)
Pain during swallowing (odynophagia)
Regurgitation of food
Chronic heartburn or acid reflux
Throat or chest pain
Persistent cough or hoarseness
Unexplained vomiting (with or without blood)
Abdominal pain or bloating
Unexplained weight loss

Common conditions assessed using a barium swallow:

Structural abnormalities (strictures, narrowing, or blockages)
Esophageal cancer or tumors
Polyps, ulcers, or fistulas
Hiatal hernia (stomach bulging through the diaphragm)
Esophagitis (inflammation)
Motility disorders (problems with muscular coordination, e.g., achalasia)
Assessment of previous surgical changes

Preparation: How to Get Ready for a Barium Swallow

To ensure the test is accurate, your gastrointestinal tract must be empty.

Fasting: Do not eat or drink—usually for 6 to 8 hours before the test.
Medications: You may be asked to pause or adjust certain medications. Always inform your doctor about any prescriptions, over-the-counter drugs, and supplements you take.
Allergies and medical history: Let your care provider know if you have any food or medication allergies, particularly to barium or contrast dyes, or if you have ongoing medical conditions.
Clothing and jewelry: You will likely change into a hospital gown and must remove metallic objects (like necklaces, earrings, or underwire bras) so that the images remain clear.
Instructions for children:
- Young children and infants may require different fasting periods—always consult the pediatric provider for age-appropriate instructions.

If you are pregnant, or think you might be, let your doctor know, as radiation from X-ray tests poses a risk to the developing fetus.

What Happens During a Barium Swallow?

The test is performed in a radiology department or hospital suite, often by a radiologist and/or radiologic technologist. Here’s what you can typically expect:

Arrival and Setup
- You will register and be taken to a private changing area where you can change into a hospital gown.
- Your care team will explain the test and ask about allergies, medications, and fasting status.
- Any removable items—dental appliances, eyeglasses, jewelry—should be set aside.
Initial X-rays
- A baseline X-ray may be taken before you swallow any barium, to establish a reference image.
Swallowing the Barium Solution
- You will be asked to sip or drink a thick, chalky barium solution. This may be flavored to make it easier to swallow.
- Barium will coat the lining of your mouth, throat, and esophagus.
X-ray Imaging with Swallowing
- As you swallow the barium, the radiologist will take a series of X-rays—sometimes in rapid succession—or perform live fluoroscopy (a continuous X-ray video stream) to observe the movement of barium.
- You may be asked to change positions (stand, lie on your back or side, or tilt the table), hold your breath momentarily, or swallow different consistencies of barium (thicker paste, liquid, or even a barium ‘tablet’).
Additional Imaging
- Sometimes, gas-producing crystals or powders (effervescent agents) are also swallowed to create a double-contrast effect, providing even more detail by expanding the organs.
Completion
- Once all required images are acquired, you can change back into your clothes and recover in the waiting area or go home.

What to Expect After a Barium Swallow

Most patients return to normal daily activities soon after the procedure. A few things to remember:

Bowel Changes: Stools may appear white or light due to barium residue for a day or two.
Hydration: Drink plenty of fluids to help flush remaining barium from your system and prevent constipation.
Diet: Resume normal eating unless your doctor gives special instructions.
Side Effects: Mild constipation or a sensation of fullness may occur. Rarely, you may experience nausea or abdominal cramping.

If you have persistent constipation (no bowel movement in 2–3 days), severe abdominal pain, vomiting, or any allergic reaction symptoms, contact your healthcare provider immediately.

Risks and Complications

Barium swallow is considered a safe test for most people, but as with any medical procedure, certain risks exist:

Radiation exposure: Although relatively low, barium swallow uses X-rays, which confer a small radiation dose.
Constipation: Barium can firm up the bowels, sometimes leading to hard stools or rarely, bowel obstruction.
Allergic reactions: Very uncommon, but may include skin rash, itchiness, or difficulty breathing.
Barium leakage: In cases of esophageal tear or perforation (rare), barium might leak outside the digestive tract, potentially causing complications.
Pregnancy risk: Radiation is generally avoided in pregnant women due to risks for the fetus.

Special Types of Barium Swallow Studies

Modified Barium Swallow: Involves swallowing different food textures or consistencies (liquid, thickened fluid, soft solids) to assess swallowing disorders more precisely. Speech-language pathologists often participate in these assessments.
Double-Contrast Barium Swallow: Air or gas-producing agents are ingested along with barium, highlighting the gastrointestinal lining with even greater accuracy and revealing subtle abnormalities.

Alternatives and Additional Diagnostic Tests

In some cases, your doctor may recommend a barium swallow as a first diagnostic step or in combination with other tests, such as:

Upper endoscopy (EGD): Involves inserting a flexible tube to directly examine the esophagus, stomach, and duodenum and allows tissue biopsy.
CT scan: Cross-sectional imaging of abdominal organs.
Esophageal manometry: Measures muscle pressure and movement in the esophagus.
pH monitoring: Detects acid reflux episodes.

How Long Does a Barium Swallow Take?

For adults, the test usually lasts between 30–60 minutes.
With additional imaging phases or special protocols, it may run longer.
Children and infants may have shorter test times but often require additional support for comfort.

Barium Swallow: Interpreting Results

X-rays and video images taken during the test are reviewed by a radiologist. The report, which highlights any structural or functional issues (such as narrowing, masses, hernias, or abnormal motility) is sent to your referring healthcare provider. Together, you can review these findings and decide on next steps, which might include further evaluation, referral to a specialist, or a new treatment plan.

**Common Findings on a Barium Swallow**
Finding	What It Means
Stricture	Narrowing of the esophagus, often due to scarring, inflammation, or tumors
Hiatal hernia	Part of the stomach bulges into the chest through the diaphragm
Tumor or polyp	Unusual growth, possibly benign or malignant
Ulcer	Sore or erosion of the tissue lining of the gut
Diverticula	Outpouchings from the wall of the esophagus
Motility disorder	Problems in the coordinated muscular action needed for swallowing

When Should You Call Your Healthcare Provider?

Fever over 101ºF (38.3°C)
Persistent constipation not relieved by fluids or mild laxatives
Severe abdominal pain, vomiting, or signs of intestinal blockage
Difficulty breathing, swelling of throat or face, rash, or hives

Questions to Ask Your Doctor Before the Barium Swallow

What symptoms are we investigating with this test?
Do I need to stop any medications before my appointment?
Are there any alternatives if I can’t have a barium swallow?
How soon will the results be available?
What risks should I be aware of, given my health history?

Frequently Asked Questions (FAQs)

Q: Does the barium swallow procedure hurt?

A: The test itself is not painful. Some people may feel discomfort from the taste or texture of the barium solution or from having to drink it quickly. Minor cramping or fullness is possible during and shortly after the test.

Q: Can children have a barium swallow?

A: Yes, children and even infants can undergo a barium swallow. The procedures and preparation are tailored by age and weight, and parents will receive age-specific fasting and testing instructions.

Q: How do I get the barium out of my body?

A: Barium is not absorbed into the bloodstream. Drinking water and other fluids after the test helps flush the compound through your digestive tract and out of your system.

Q: Is it safe during pregnancy?

A: Unless absolutely necessary, X-rays should not be performed during pregnancy because of the risk to the developing fetus. Notify your healthcare provider if you are or think you might be pregnant.

Q: What if I have trouble swallowing the barium?

A: Your care team can help by adjusting the consistency or flavor, or by taking additional time. If swallowing is very difficult or dangerous, your doctor may consider alternative tests.

References

Author

medha deb

Medha Deb is an editor with a master's degree in Applied Linguistics from the University of Hyderabad. She believes that her qualification has helped her develop a deep understanding of language and its application in various contexts.

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