Before an upper gastrointestinal (GI) barium test, patients may receive special instructions, such as to fast for a certain period of time prior to testing. Typically, the patient will be instructed not to eat or drink after midnight the day before the test. Patients are also usually asked to remove all metallic objects (e.g., jewelry) and extraneous clothing prior to the test.

Upper GI barium tests are performed in a physician’s office, hospital or clinic. A mild sedative may be given prior to the procedure.

The patient will then be asked to consume the barium liquid, which coats the lining of the esophagus and stomach. Barium is chalky but has flavoring added and does not taste bad to most people. Depending on the test, it can be in the form of a thin liquid, thick liquid or solid. Adults are usually asked to drink about 1.5 cups of barium, and children are asked to consume less. Patients may take 30 minutes or longer to consume the barium. They may also be instructed to consume baking soda along with the liquid barium because the resulting gas improves the appearance of the barium on x-rays.

The test may be completed slightly differently depending on which type is being performed:

• Barium swallow. Tests may be performed with the patient standing or lying on a tilt table, a special table that can be tilted to allow pictures from various angles. In some cases, images will be taken both with and without using a tilt table. When standing behind a fluoroscope (x-ray machine that combines an x-ray source with a fluorescent screen) the patient may be asked to change position and hold their breath while x-rays are taken. The abdomen may be compressed by a belt or the examiner’s hand during testing. The test can take one to two hours to complete.
  
  
• Modified barium swallow (videofluoroscopy). The patient sits in a special chair during the exam, which uses fluoroscopy with or without cineradiography (which uses a movie camera to turn images produced by standard x-rays or fluoroscopy into a record of movement). The patient ingests small amounts of thin and thickened liquid barium. Depending on the condition, the patient may also ingest a cookie or cracker coated in barium. This test is used when dysphagia (difficulty swallowing) or aspiration (breathing a foreign object into the airway) is suspected. Fasting is not required. A modified barium swallow can also help determine the most appropriate diet for a patient and techniques to reduce the risk of choking and aspiration pneumonia. The test, usually performed in a hospital, can take up to an hour to complete.
  
  
• Barium meal. Typically, the patient will be instructed not to eat or drink after midnight the day before the test. The patient will then digest a meal containing barium. The radiologist uses fluoroscopy to watch how long the stomach takes to digest the meal. If the barium meal is performed within a few days of a barium enema, a cleansing enema and laxative may be required first to clear all barium from the intestines.
  
  
• Small bowel series. Typically, the patient will drink additional barium, and more x-rays will be taken every half hour until the barium reaches the large intestine. The small-bowel series can take two to four hours. A small-bowel series performed in conjunction with a barium swallow can take up to six hours because of the waiting time between the tests.