In barium swallow, you ingest a liquid mixture containing barium sulfate, a chalky contrast dye that delineates internal structures on x-ray films. The barium, which is opaque to x-rays, sharply outlines the inner lining of the esophagus, revealing any structural or tissue abnormalities. The esophagus—the muscular passage that contracts and relaxes to carry food from the throat to the stomach.

Purpose of the Barium Swallow

  • To detect hiatal hernia, a condition in which a portion of the stomach protrudes upward through the diaphragm
  • To diagnose esophageal diverticula (abnormal outpouchings) or varices (abnormally dilated blood vessels)
  • To identify any tumors, strictures, ulcers, or polyps affecting the esophagus, or motility disorders that affect the swallowing function of the esophagus

Who Performs Barium Swallow

Special Concerns about Barium Swallow

  • Patients with an intestinal obstruction should not undergo this procedure. The barium may create a stone like impaction.
  • When esophageal perforation or rupture is suspected, barium is not used because leakage of the dye could worsen any existing infection. A water-soluble contrast agent, diatrizoate (Gastrografin), is usually substituted.
  • Pregnant women should not undergo this test because exposure to ionizing radiation may harm the fetus.
  • Individuals with a poor swallowing reflex may inadvertently aspirate barium into their lungs. Your swallowing reflex may be assessed before the test.

Before the Barium Swallow

  • Do not eat or drink anything after midnight on the day before the test.
  • You are usually required to wear a hospital gown.
  • You should not smoke after midnight on the day of the test.
  • You will be instructed to remove any metallic objects, such as jewelry, dentures, or hairpins, before the test begins.

What You Experience

  • In a radiology room, you are strapped securely to a tilting x-ray table.
  • You will be given a thick, milkshake-like liquid containing the barium sulfate. The barium has an unpleasant chalky taste, but it is usually flavored to increase its palatability.
  • As you sip the barium mixture, you will be moved through various position changes.
  • The radiologist observes the flow of the dye through the esophagus using fluoroscopic imaging, which transmits continuous, moving x-ray images onto a viewing screen.
  • Spot x-rays are taken of any significant abnormalities. As each x-ray film is obtained, you will be instructed to hold your breath and remain perfectly still.
  • The test takes about 10 - 15 minutes to perform.
  • There is no discomfort associated with this procedure.

Risks and Complications of Barium Swallow

  • Although radiation exposure is still minimal, you will receive a higher dose of radiation during fluoroscopy than during standard x-ray procedures.
  • The barium may accumulate and block the intestines if it is not eliminated from your system within a day or two.

After Barium Swallow

  • Air in your stomach may cause you to feel slightly bloated for a short while.
  • Drink plenty of fluids to help eliminate the barium from your system. Your doctor may also give you a mild laxative to purge your body of the contrast agent.
  • You are free to resume your normal diet and activities.
  • Your stool will be chalky and light-colored initially, but it should return to normal color after 1 to 3 days.
  • If diatrizoate was used rather than barium, you may experience diarrhea.

Barium Swallow Results

  • The doctor will examine the recorded x-ray images for evidence of any abnormality.
  • If a definitive diagnosis can be made based on the images, your doctor will recommend an appropriate course of treatment, depending on the specific problem.
  • In some cases, additional tests, such as endoscopic biopsy of the esophagus or esophageal function studies, may be needed to further evaluate abnormal results and establish a diagnosis.


The Johns Hopkins Consumer Guide to Medical Tests

Simeon Margolis, M.D., Ph.D., Medical Editor

Updated by Remedy Health Media

Publication Review By: the Editorial Staff at

Published: 10 Jan 2012

Last Modified: 10 Jan 2012