• Clinical science

Esophageal barium swallow (Esophagram)

Abstract

Esophageal barium swallow, also known as esophagogram, is a contrast-enhanced X-ray modality for visualizing the esophagus. It allows for the anatomy and function of the esophagus to be examined and is used in the evaluation of dysphagia, odynophagia, and regurgitation of undigested food particles. Along with esophageal manometry, it is the diagnostic modality of choice for evaluation of esophageal motility disorders.

Indications

Barium swallow is indicated in the evaluation of the following symptoms and related conditions:

Endoscopy should always be considered when evaluating symptoms involving the esophageal region (particularly to rule out carcinoma)!
References:[1][2][3][4]

Contraindications

  • Suspected esophageal perforation (see “Complications” below)
  • Severe dysphagia (risk of aspiration)
  • Pregnancy

References:[4]

We list the most important contraindications. The selection is not exhaustive.

Procedure/application

Esophagram via barium (or gastrografin) swallow

  • Performed after an overnight fast
  • Patient swallows solution containing barium sulfate; (radiopaque heavy metal), followed by single static image
  • Barium solution coats the inner lining of the esophagus, showing the size and shape of the esophagus; , as well as contractions and peristaltic waves.
  • Barium appears white on x-ray; soft tissues appear gray.
  • To enhance visualization, a double-contrast esophagram can be used with air as the second contrast medium. The patient is asked to swallow baking soda crystals, which effervesce in the esophagus and improve visualization of any abnormality.
  • If a perforation is suspected, gastrografin, a water soluble contrast agent should be used in place of barium to avoid complications such as mediastinitis, peritonitis, or pneumonia

Videofluoroscopy (modified barium swallow)

  • Real-time contrast-enhanced imaging
  • Patient swallows barium solution while a continuous x-ray beam is focused on the esophagus.
  • Ideal for continuous evaluation of swallowing mechanism
  • Test of choice for suspected orophagyngeal dysphagia

A barium-based contrast medium is contraindicated in suspected perforation, as leakage increases the risk of severe mediastinitis, peritonitis, or pneumonia!

References:[5][4][6][7]

Complications

References:[8][9][10]

We list the most important complications. The selection is not exhaustive.