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.
Barium swallow is indicated in the evaluation of the following symptoms and related conditions:
- Clinical features: dysphagia (inability to swallow or difficulty swallowing), odynophagia (painful swallowing), regurgitation of undigested food, noncardiac retrosternal chest pain (see “Differential diagnoses of acute chest pain” in the article on Boerhaave syndrome)
- Esophageal motility disorders
- Esophageal diverticulum
- Tracheoesophageal fistula
- Esophageal stenoses, constriction
- Esophagogastric anastomosis insufficiency or rupture
- Esophageal cancer
- Hiatal hernia, reflux disorders
Endoscopy should always be considered when evaluating symptoms involving the esophageal region (particularly to rule out carcinoma).
- Suspected esophageal perforation (see “Complications” below)
- Severe dysphagia (risk of aspiration)
We list the most important contraindications. The selection is not exhaustive.
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.
- Generally rare
- Abdominal pain and constipation most common; easily managed with laxatives
- Allergic reactions to barium
- Aspiration of barium can cause hypersensitivity pneumonitis
- Esophageal perforation with barium leakage → mediastinitis, peritonitis
We list the most important complications. The selection is not exhaustive.