• Clinical science

Esophageal barium swallow (Esophagram)

Summary

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

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.
  • 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 oropharyngeal 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.

  • 1. Cook IJ. Diagnostic Evaluation of Dysphagia: Examination of the Patient With Dysphagia. In: WebMD. Diagnostic Evaluation of Dysphagia: Examination of the Patient With Dysphagia. New York, NY: WebMD. http://www.medscape.org/viewarticle/575754. Updated January 1, 2008. Accessed April 7, 2017.
  • 2. Sawyer MAJ. Achalasia Imaging. In: Lin EC. Achalasia Imaging. New York, NY: WebMD. http://emedicine.medscape.com/article/363551. Updated February 11, 2017. Accessed April 7, 2017.
  • 3. Malagelada J-R, Bazzoli F, Boeckxstaens G, et al. World gastroenterology organisation global guidelines: dysphagia - global guidelines and cascades update September 2014. Journal of Clinical Gastroenterology. 2015; 49(5): pp. 370–378. doi: 10.1097/mcg.0000000000000307.
  • 4. Bell DJ, Jones J, et al. Barium Swallow. https://radiopaedia.org/articles/barium-swallow. Updated April 7, 2017. Accessed April 7, 2017.
  • 5. Agabegi SS, Agabegi ED. Step-Up To Medicine. Baltimore, MD, USA: Wolters Kluwer Health; 2015.
  • 6. Mahler M. Grainger & Allisons's Diagnostic Radiology; Abdominal Imaging; 6th Edition. London, United Kingdom: Elsevier; 2016: p. 21.
  • 7. Lembo AJ. Oropharyngeal Dysphagia: Clinical Features, Diagnosis, and Management. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/oropharyngeal-dysphagia-clinical-features-diagnosis-and-management. Last updated September 6, 2017. Accessed April 17, 2018.
  • 8. Hundemer GL, Kumar V, Vaduganathan M. Large-volume barium aspiration. Proc (Bayl Univ Med Cent). 2015; 28(2): pp. 183–184. url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4365113/.
  • 9. UpToDate. Barium: Drug Information. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/barium-drug-information. Last updated January 1, 2017. Accessed May 26, 2017.
  • 10. Smith HJ, Jones K, Hunter TB. What happens to patients after upper and lower gastrointestinal tract barium studies?. Invest Radiol. 1998; 23(11): pp. 822–826. pmid: 3061971.
  • Herold G. Internal Medicine. Cologne, Germany: Herold G; 2014.
  • The American College of Radiology. Practice Parameter for Imaging Pregnant or Potentially Pregnant Patients with Ionizing Radiation. https://www.acr.org/~/media/9E2ED55531FC4B4FA53EF3B6D3B25DF8.pdf. Updated January 1, 2013. Accessed April 7, 2017.
last updated 12/12/2019
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