- What is a barium swallow/meal?
- What does the procedure involve?
- How do I prepare for a barium swallow/meal?
- What will the results show?
Both barium swallows and barium meals are investigations of the upper gastrointestinal tract which use a contrast substance called barium which shows up on X-ray. Barium is a chalky mixture which needs to be swallowed in order to slowly pass through the bowel and create a lining on the inner wall of the gastrointestinal tract. Without the barium the lining is normally difficult to visualise. A series of X-rays are taken to allow the doctor to identify areas of abnormality such as tumours, inflammation or ulcers.
A barium swallow examines the oesophagus (the first part of the gastrointestinal tract where food passes when it is swallowed) to identify any reflux (movement of substances the wrong direction that can cause indigestion) or abnormal motility. Barium meal on the other hand examines further down to the stomach and duodenum (first section of the small intestine) to investigate causes of bleeding, vomiting or severe upper abdominal pain. Both procedures are considered to be relatively safe but sometimes other investigations such as endoscopy may be better considered a better investigation as they provide more detail.
Barium swallows (oesophagus) and barium meals (stomach and duodenum) are techniques used to visualise the interior of the upper gastrointestinal tract using the radio-opaque substance barium. It is normally performed in hospital radiology departments. For the procedure you will be required to wear a hospital gown and drink approximately one cup of a barium solution which comes as a flavoured milky drink. This coats the inside lining of the oesophagus, stomach and small intestine. The doctor will then take lots of X-ray images of you standing and then lying down in many different positions. This ensures all angles are examined and that the contrast medium lines all areas of the gastrointestinal tract wall. The X-rays will be both still images (which you may be required to hold your breath for) and short video images seen up on a television monitor. In some cases a muscle relaxant will be injected into the abdomen to prevent the bowel contracting and inhibiting the images.
For barium meal studies the barium is combined with a fizzy mixture that produces gas in the bowel. This is called a double contrast study. The gas expands the stomach and intestines and helps push the barium against the wall. This allows more detail to be visualised. The procedure will normally take around half an hour but if the radiologist considers the images obtained not to be good enough quality, more pictures will be taken. In some cases the barium may be followed through the entire small intestine for the next hour or so depending on the speed of your bowel movements. This is called a small bowel follow through but it is better to do this separately as it uses slightly different methods.
The procedure should not be painful but some patients may find it uncomfortable due to the gas causing an urge to burp. After the procedure you can normally go home promptly and resume normal activities and diet. You should not drive immediately after the procedure because some of the drugs can affect vision. You may feel a bit ill after the procedure and can be quite constipated for several days. You should drink lots of fluid and eat lots of fruit to minimise the constipation. Your bowel motions will also be pale due to the contrast passing through the body. After the procedure the radiologist will carefully examine all the images and write a detailed report. You will then have a follow up appointment with your doctor to discuss the results and the need for further investigations or treatment.
Prior to the procedure you doctor will explain the procedure, the reason for the investigation and possible risks before getting you to sign an informed consent form. The procedure is usually performed at a hospital via an outpatient appointment. You will normally have to fast (not eat or drink anything except water) for eight hours before the procedure to ensure the upper gastrointestinal tract is empty so food does not obstruct the view.
Smoking is also not recommended for several hours before the procedure as this can cause secretions to build up which again can obstruct the image. If you have diabetes special arrangements may be required regarding fasting so you should discuss this with your doctor.
Your doctor may order a barium investigation for the following symptoms:
- Difficulty swallowing.
- Severe upper abdominal or chest pain.
- Unexplained vomiting.
- Blood in your bowel motions.
Barium swallow and meal both show the lining of the upper gastrointestinal tract which allows your doctor to identify abnormal areas. This may include sites of blockage, narrowing, ulceration, abnormal growths, filling defects or damage to the digestive tract lining. The doctor can use the results to determine the most likely cause of your symptoms to allow follow up investigations and treatments. In some cases no abnormalities may be identified.
You will be required to make a follow up appointment with your doctor to discuss the results of the test and the next course of action.
Barium swallow and barium meal are considered to be safe procedures but there is a small risk of complications. These include:
- Potential spillage of barium- Barium should not be used in patients whom the doctor suspects there may be a significant hole in the gastrointestinal lining. In most cases barium will not be used until this condition has been excluded by other investigations. Normally however, the contrast is not absorbed into the body so should not cause side-effects.
- Bowel obstruction- Barium should not be used in patients with a suspected bowel obstruction as the barium can solidify and worsen the obstruction.
- Radiation exposure– A small radiation dose is received during the procedure but the increased risk of cancer or mutations is extremely low. Pregnant women should not have this procedure performed due to the possible risks of radiation to the unborn fetus.
- Allergic reactions to the contrast.
- Suction of the contrast into the airways instead of the gastrointestinal tract.
- Blurred vision- The muscle relaxant injection can impair near vision for about half an hour so you should make sure you do not drive for this period.
- Constipation– Patients can experience constipation for a few days after the examination so you should drink lots of fluid and eat plenty of fruit to try and prevent it during this period. Stools are also likely to be pale due to the contrast.
- Further investigations- Since these procedures rely on X-ray images a lot of detail can be missed, particularly if the abnormalities are mild or lesions are flat. You may require an endoscopic procedure (where a slender tube with a camera is inserted down the throat) to directly visualise the walls or to take tissue samples (biopsy).
Your doctor will explain these risks in further detail and offer you the opportunity to ask questions about any particular concerns you may have.
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- Halliday KE, Patel SR & Baker WN. Case report: colonic obstruction following small bowel barium study. The British Journal of Radiology, Vol 66, Issue 788 725-726.