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The barium swallow study, also known as a barium esophagogram or esophagram, is a contrast-enhanced radiographic study commonly used to assess structural characteristics of the entire esophagus. It may be used for the diagnosis of a wide range of pathologies including esophageal motility disorders, strictures, and perforations. It may also be used to characterize more distal pathology such as a hiatal hernia or gastric volvulus. This activity reviews the barium swallow study, its indications, and contraindications, and highlights the role of the interprofessional team in evaluating patients with esophageal pathology. Objectives: Identify the anatomical structures evaluated by a barium swallow study. Describe the technique for performing a barium swallow study. Review the potential risks and benefits of performing a swallow study using barium versus gastrogaffin. Explain the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected by esophageal pathology undergoing a barium swallow study. Access free multiple choice questions on this topic.

The barium swallow study, also known as a barium esophagogram or esophagram, is a contrast-enhanced radiographic study commonly used to assess structural characteristics, and to some extent the functional characteristics of the esophagus. [1] It is important to distinguish this from a "modified barium swallow" study or a "videofluoroscopic swallow study."  The videofluoroscopic swallow study examines the mechanics of swallowing and is performed in conjunction with a speech pathologist. [2] A barium swallow study may be used in the diagnosis of a wide range of pathologies including esophageal motility disorders, strictures, and perforations. [3] [4]  It may also be used to characterize more distal pathology such as hiatal hernias, gastroesophageal reflux, or gastric volvulus. A barium swallow study can also be used to obtain some details and evaluation of the swallowing process at the pharyngeal level, although this is often served by a Videofluoroscopic Swallow Study. [5] The barium esophagogram is noninvasive and readily performed, requiring only radiographic still-image capability and contrast medium. As such, it is a useful exam despite the current wide availability of CT imaging. The use of barium sulfate contrast is considered to result in a more sensitive study when compared to those utilizing water-soluble agents such as Gastrografin/diatrizoate. Barium provides better contrast images.

Oral barium contrast has relatively few adverse effects in standard practice. Most commonly, patients complain of nausea and vomiting within 30 minutes of ingestion. Hypersensitivity reactions have been reported but are uncommon. Most adverse effects are related to extravasation of contrast into the mediastinum or from aspiration.[13]

The barium swallow test is usually performed by a radiologist. However, the ordering of the test may be done by a nurse practitioner, primary physician gastroenterologist, surgeon, neurologist or speech therapist. The test is primarily used to assess structural characteristics of the entirety of the esophagus. It may be used in the diagnosis of a wide range of pathologies including esophageal motility disorders, strictures, and perforations. It may also be used to characterize more distal issues such as a hiatal hernia or gastric volvulus. It may also be used in some capacity to evaluate swallowing at the pharyngeal level, but that is a function that is often served by a Videofluoroscopic Swallow Study (modified barium swallow study). The barium esophagogram is noninvasive and readily performed, requiring only radiographic still-image capability and contrast medium. As such, it is still a useful exam despite the current wide availability of CT imaging. The use of barium, specifically, barium sulfate, is considered to result in a more sensitive study when compared to those utilizing water-soluble agents such as Gastrografin/diatrizoate.