Upper gastrointestinal (GI) barium tests are used to help diagnose disorders of the upper and middle portion of the GI (digestive) tract (e.g., esophagus, stomach and duodenum). During these painless tests, a patient drinks white liquid called barium, which coats the digestive tract.
These areas are then highlighted during x-rays to help diagnose the cause of a number of GI symptoms, such as difficulty swallowing, abdominal pain and vomiting. Upper GI barium tests can help reveal blockages, irregular growths, ulcers and other potential abnormalities.
There are several different types of upper GI barium tests. They include:
Barium swallow. Also called a barium x-ray or upper GI series, it involves a liquid barium x-ray of the stomach along with the esophagus, duodenum or both.
Modified barium swallow. Refers to liquid barium testing of the uppermost parts of the digestive tract including the mouth, pharynx (passageway that connects the mouth and nose to the lungs and stomach) and esophagus.
Barium meal. Also known as a barium beefsteak meal, it refers to a test in which the patient digests food containing barium. The test determines whether the stomach can adequately process food.
Small-bowel series. This term refers to a liquid barium x-ray of the small intestine.
Upper GI barium tests may be administered in a physician’s office or the radiology department of a hospital. The images captured during these tests are read and interpreted by a radiologist, who offers an analysis to the patient’s physician. Results are typically ready within a week of the procedure. If abnormalities are discovered, follow-up procedures or treatments may be scheduled.
About upper GI barium tests
Upper gastrointestinal (GI) barium tests help diagnose disorders of the esophagus (tube connecting the mouth to the stomach), stomach and the first part of the small intestine known as the duodenum. Blockages, irregular growths, ulcers and other abnormalities can be revealed by these virtually painless tests, which include the barium swallow, modified barium swallow, barium meal and small-bowel series (which involves x-rays of the small intestine).
During upper GI barium tests, x-rays are taken after the patient drinks white liquid called barium. Barium is a soft metallic element. The type commonly used in medical tests is the compound barium sulfate, which is usually referred to simply as barium. It is radiopaque rather than radioactive, meaning it is not transparent to x-rays or other forms of radiation.
Once the barium has been swallowed, it coats the esophagus, stomach and duodenum. Since radiation will not pass through barium, it appears on x-rays as a light area, making barium a type of contrast medium. Recent research indicates that whole milk may be as effective a contrast medium as barium for some types of x-rays. Although milk may prove to be a more cost-effective alternative in the future, further study is needed.
Barium tests can use various imaging techniques to reveal the workings of the digestive system. Standard x-rays, fluoroscopy, cineradiography or a combination of these techniques may be used. Fluoroscopy uses a video monitor and an x-ray tube that makes an element brighter and easier to see (an image intensifier). Cineradiography (also called videofluoroscopy) uses a video camera to turn images produced by standard x-rays or fluoroscopy into a record of movement. It is used to examine the passage of food through the throat or stomach.
Conditions or situations in which an upper GI barium test may be recommended include:
Swallowing disorders, which may have a wide range of causes (e.g., blockage, narrowing of the esophagus)
Objects lodged in the esophagus or intestines
Disorders of the esophagus, including narrowing or irritation, and abnormally enlarged veins that may cause bleeding
Achalasia (condition in which the valve from the esophagus to the stomach does not relax)
Presence of pouches (diverticula) along the esophagus
Hiatal hernia (defect in which the stomach slides partially into the chest)
Ulcers
Cancerous tumors
Polyps (growths that may be precancerous)
Gastritis (inflammation of the stomach)
Pyloric stenosis (narrowing in the opening of the stomach)
Malabsorption syndrome (inadequate absorption of nutrients in the intestinal tract)
Inflammation of the small intestines
Many of these conditions cause symptoms such as difficulty swallowing (dysphagia), vomiting, regurgitation, diarrhea, constipation and problems with moving objects through the intestines.
Types and differences of upper GI barium tests
The various types of upper GI barium tests include:
Barium swallow. Also called a barium x-ray or upper GI series, it involves a liquid barium x-ray of the stomach along with the esophagus (tube connecting the mouth to the stomach), duodenum (upper part of the small intestine) or both. It has also been used to describe a liquid barium x-ray of the esophagus only (esophagram).
Modified barium swallow. Refers to liquid barium testing of the uppermost parts of the digestive tract including the mouth, pharynx (passageway that connects the mouth and nose to the lungs and stomach) and esophagus. This test is most often used with elderly individuals, people with Parkinson’s disease, stroke patients or those with other neurological disorders. Dysphagia (difficulty swallowing) and aspiration (in which food or liquids enter the airway and lungs) are common concerns among these populations.
Barium meal. Also known as a barium beefsteak meal, it refers to a test in which the patient digests food containing barium. The test determines whether the stomach can adequately process food. The term “barium meal” may also refer to a liquid test assessing the esophagus, stomach and/or duodenum.
Small bowel series. This term refers to a liquid barium x-ray of the small intestines. A small-bowel series is often performed after a barium swallow assessing the esophagus and stomach.
Before and during the upper GI barium test
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.
During these tests, patients may be asked to consume additional amounts of barium as more images are taken.
After the upper GI barium test
Patients may require a brief recovery period immediately following the procedure. In most cases, they are able to return home shortly after the procedure.
The barium may cause constipation and make the patient’s stool turn gray or white for a few days after the procedure. Patients may receive a cleansing enema or be asked to take a laxative that will help flush the remaining barium from their body. They may also be urged to drink extra fluid and eat high-fiber foods for several days after the procedure. Patients should contact their physician if they discover that their stool still is not a normal color, or if they are unable to have a bowel movement, two or three days after the test.
The images captured during an upper GI barium test will be read and interpreted by a radiologist, who will then offer an analysis to the patient’s physician. If no abnormalities are discovered, the test is considered to be negative. A positive test indicates that an abnormality was found, which may require further testing, treatments or medications. The physician will discuss the findings with the patient. Typically, results are ready within a week of the procedure.
Potential risks with upper GI barium tests
In most cases, barium x-rays are administered with no difficulty or lasting complications. However, risks of upper barium x-rays may include:
Constipation. Patients will often be advised to expel the barium and avoid constipation by eating high-fiber foods, using laxatives or drinking extra fluid.
Radiation. Fluoroscopy and cineradiography can emit more radiation than standard x-rays.
Allergic reaction. Some patients may have an allergic reaction to the barium.
Aspiration. Occurs when barium accidentally ends up in the windpipe (trachea).
Infection. This occurs infrequently during upper GI barium tests, but requires prompt treatment. A common symptom of infection is fever.
Hypoglycemia. The fasting usually required for most types of barium x-rays can cause low glucose (blood sugar). The physician may issue special instructions for patients with diabetes.
Intestinal obstruction. If the barium is not defecated it can harden in the intestine. A white stool is normal for up to three days after barium x-rays. The patient should notify the physician if there is no white stool or if there are other bowel problems. Intestinal obstruction could lead to potentially fatal barium poisoning.
Poisoning. Normally, the body cannot absorb barium sulfate (the full name for barium) because this compound is not water soluble. Poisoning can occur in the rare cases in which water-soluble barium compounds are accidentally used instead of insoluble forms, or in which intestinal blockage prevents the body from expelling barium sulfate. Symptoms of barium poisoning include diarrhea, nausea and vomiting, and stomach pain. In severe cases the body can lose so much potassium that paralysis or death can result.
Upper GI barium tests may not be appropriate for everyone. For instance, patients with kidney damage should discuss potential risks with their physician because barium can worsen such damage. The physician may recommend that kidney patients protect their kidneys by drinking water before and after x-rays.
In addition, upper GI barium tests are not typically recommended for pregnant women as exposure to radiation may potentially harm a developing fetus.
Patients should seek prompt medical attention if they experience any of the following:
Vomiting
Pain
Bleeding
Breathing difficulties
Chest pain
Tests that may follow upper GI barium tests
A physician may order follow-up tests to diagnose problems with the gastrointestinal (GI) system. Depending on symptoms, a physician may order one or more of the following tests of the upper GI tract:
Manometry. A manometer (tube lined with pressure gauges) guided down the throat measures the contractions of the esophagus (esophageal manometry) and/or stomach (gastric manometry). It may be used in suspected cases of gastroparesis or other conditions involving the nerves or muscles of the upper digestive system.
Endoscopy. The physician guides a fiber-optic viewing tube (endoscope) through the patient’s mouth to examine the esophagus or stomach for lesions, blockage or other problems.
Ultrasound. A probe delivers harmless sound waves. An ultrasound creates pictures that outline the organs but does not detail the lining of the GI system. An abdominal ultrasound can show excess formation of fluid or abnormal size or shape of an organ.
Esophageal pH test. This test measures the acidity in the throat. It can indicate acid reflux, the abnormal presence of stomach acid in the esophagus.
Bravo capsule pH monitoring system. This test allows physicians to measure the acidity in the throat 24 hours beyond the traditional and routinely used esophageal pH measuring sytem.
Bernstein test(esophageal acid perfusion test). This test for esophagitis (inflammation of the esophagus) introduces a small quantity of acid in the esophagus through a nasogastric tube to reproduce symptoms of heartburn. However, this test is rarely performed due to the availability of more effective diagnostic tests.
Gastric emptying scan (GES). The patient eats food containing a tracer (a radioisotope, with a low, safe level of radiation). The patient then lies down and a scanning machine is placed above the abdomen for several hours. The tracer allows the machine to track the radioactivity in the stomach and show how fast the food exits the organ. gastroparesis is suspected if the stomach retains more than half the food after two hours.
Antroduodenal motility study. The patient is sedated or has the throat numbed. A tube is passed down the throat and through the stomach into the duodenum. Sensors in the tube measure the contractions of the digestive tract at rest and after a meal and reveal whether emptying of the stomach is delayed.
Questions for your doctor
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to upper gastrointestinal (GI) barium tests:
Which conditions can be detected with upper GI barium tests?
What are the different types of upper GI barium tests?
Which upper GI barium test is most appropriate for me?
How should I prepare for the test?
Will I be conscious during the test?
Should I plan on having someone drive me home from the test?
Will my upper GI barium test be uncomfortable or painful?
What are the risks associated with the test?
Should I restrict my activities following the test? For how long?
