An esophagram, also known as a barium swallow, is a medical imaging test that uses X-rays and a special contrast material, barium, to visualize the esophagus. The barium coats the inner lining of the esophagus, allowing healthcare providers to observe its structure and function as you swallow. This helps identify various issues affecting the food pipe.
What an Esophagram Involves
During an esophagram, you will stand or lie on an X-ray table. A medical technologist or radiologist will ask you to drink a liquid containing barium sulfate, a chalky, white substance. This barium may be flavored, and sometimes gas-producing crystals are added to create an “air-contrast” that enhances image clarity.
As you swallow the barium, the radiologist uses a continuous X-ray beam, known as fluoroscopy, to watch its movement through your throat and esophagus in real-time. This dynamic imaging allows them to observe the muscles of your esophagus at work. You may be asked to hold your breath or change positions, such as lying on your side, back, or stomach, to obtain various views of the esophagus as the barium travels down to your stomach.
Conditions an Esophagram Can Reveal
An esophagram can reveal a range of conditions affecting the esophagus. It is useful for investigating swallowing difficulties, medically termed dysphagia, by showing how food and liquids move through the esophageal tube. This allows doctors to pinpoint areas of abnormal movement.
The procedure can also identify gastroesophageal reflux disease (GERD) and hiatal hernias. For GERD, the esophagram can visualize the backward flow of stomach contents into the esophagus. For a hiatal hernia, it shows if a portion of the stomach has pushed up into the chest cavity through the diaphragm.
Strictures or narrowing of the esophagus, caused by inflammation, scarring, or tumors, are visible on an esophagram. These constrictions can impede the passage of food and liquids. Abnormal growths like tumors or polyps within the esophagus can also be detected as they disrupt the smooth outline created by the barium.
Motility disorders, such as achalasia or esophageal spasms, are also revealed. Achalasia, characterized by the lower esophageal sphincter’s inability to relax, appears as a tapered narrowing at the end of the esophagus, sometimes described as a “bird’s beak” appearance. Esophageal spasms appear as uncoordinated, strong muscle contractions.
Small pouches that bulge outward from the esophageal wall, known as diverticula, are identified. These pouches can trap food particles, leading to symptoms like regurgitation. The esophagram is also effective in locating foreign bodies lodged in the esophagus, providing precise anatomical information for their removal.
Preparing for the Procedure
Preparing for an esophagram involves specific instructions to ensure clear and accurate images. You will be asked to fast for several hours before the test, often 6 to 8 hours, meaning no food or drink. This ensures your esophagus and stomach are empty for optimal visualization.
It is also advised to avoid chewing gum, smoking, or sucking on hard candy before the procedure, as these can stimulate saliva production or interfere with the barium coating. Inform the medical staff about any known allergies, especially to contrast materials, or if you are pregnant or suspect you might be. Diabetic patients may receive specific instructions regarding medication and blood sugar management.
You may be asked to remove jewelry, dentures, eyeglasses, and any metal objects or clothing that could interfere with the X-ray images. Wearing loose-fitting clothing that is easy to remove is recommended. Bringing a list of your current medications is helpful for the medical team.
After the Esophagram
Following an esophagram, you can resume your normal diet and activities immediately. It is common to experience temporary side effects related to the barium contrast material. Your stools may appear white or lighter in color for a day or two as the barium passes through your digestive system.
To help the barium clear from your body and prevent constipation, it is recommended to drink plenty of fluids, such as water, for 24 to 48 hours after the procedure. If constipation occurs, a mild, over-the-counter laxative may be suggested. A radiologist, a physician specializing in interpreting medical images, will analyze the X-ray images and send a report to your referring doctor. Your doctor will then discuss the findings with you during a follow-up appointment.