In modified barium swallow, you ingest foods and liquids containing barium sulfate, a contrast dye that sharply outlines your mouth, throat, and esophagus on x-ray film. Using real-time x-rays, or fluoroscopy, a physician and a speech pathologist observe the movement of the barium through these structures on a television monitor. Modified barium swallow is specifically aimed at evaluating the swallowing process in individuals who have difficulty speaking or swallowing food without inhaling, or aspirating, it into the windpipe. Spot x-ray films may be taken of specific abnormalities, and the entire test may be recorded on videotape for later viewing.

Purpose of the Modified Barium Swallow

  • To identify the cause of difficult or impaired swallowing (dysphagia).
  • To help determine the most appropriate treatment or management techniques for swallowing problems.

Who Performs It

  • An ear, nose, and throat specialist (otolaryngologist), a radiologist, and a speech pathologist may all be present.

Special Concerns

  • People who aspirate saliva are not suitable candidates for this test.
  • Pregnant women should not undergo this test because exposure to ionizing radiation may harm the fetus.
  • Failure to remain still while the procedure is being performed may interfere with the accuracy of the results.

Before the Modified Barium Swallow

  • Tell your doctor if you are or could be pregnant.
  • You may be instructed to refrain from eating or drinking anything for 4 hours before the procedure.
  • Tell your doctor about any medications, supplements or vitamins you are taking. You may need to stop taking some of them before the test.
  • At the testing facility, you will be asked to remove your clothes and eyeglasses and to put on a hospital gown.

What You Experience

  • You will either be strapped to an x-ray table that tilts vertically, or you will be seated in a chair.
  • You will consume a barium-containing meal. The consistency of the items in the meal varies, ranging from thin liquid to semisolid foods (for example, applesauce) or solid foods (such as a cookie).
  • As you swallow different amounts of the meal items, the examiners use fluoroscopic imaging to observe the swallowing process on a television screen in order to determine which foods are difficult for you to swallow and which structures are responsible for the problem. The swallowing process may be observed at normal speed or in slow motion.
  • Other than chewing and swallowing, you must remain still during the procedure.
  • A speech pathologist is also normally present during the test to evaluate your swallowing ability and, if possible, to suggest some possible corrective actions.
  • The test usually takes from 30 minutes to 1 hour depending on the findings.

Risks and Complications

  • Although radiation exposure during this test is minimal, you will receive a higher dose than during standard x-ray procedures.

After the Modified Barium Swallow

  • You may leave the testing facility immediately and resume your normal diet and activities.
  • Drink plenty of fluids to help eliminate the barium from your system.
  • Your stool will be chalky and light-colored initially, but it should return to normal color after 1 to 3 days.


  • The doctor will try to identify the nature and origin of your swallowing problem on the viewing monitor during the test. Swallowing difficulties may be caused by a wide variety of conditions, including structural abnormalities, such as tumors or inflammation, or neurologic (nerve) disorders, such as Parkinsonā€˜s disease or post-stroke syndrome.
  • If possible, the speech pathologist will recommend specific corrective actions to help you resolve the swallowing problem during the test and no further testing or treatment is needed.
  • If the test findings are still not definitive after the recorded x-rays and video have been reviewed, or if the test reveals abnormalities that require further evaluation, additional tests such as esophagogastroduodenoscopy may be ordered.


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: 11 Jan 2012

Last Modified: 11 Sep 2015