Barium Swallow | Johns Hopkins Medicine

What is a barium swallow test?

A barium swallow test (cine esophagram, swallowing study, esophagography, modified barium swallow study, video fluoroscopy swallow study) is a special type of imaging test that uses barium and X-rays to create images of your upper gastrointestinal (GI) tract. Your upper GI tract includes the back of your mouth and throat (pharynx) and your esophagus.

Barium is used during a swallowing test to make certain areas of the body show up more clearly on an X-ray. The radiologist will be able to see size and shape of the pharynx and esophagus. He or she will also be able see how you swallow. These details might not be seen on a standard X-ray. Barium is used only for imaging tests for the GI tract.

A barium swallow test may be used by itself or as part of an upper GI series. This series looks at your esophagus, stomach, and the first part of the small intestine (duodenum).

Fluoroscopy is often used during a barium swallow test. Fluoroscopy is a kind of X-ray “movie.”

Why is a swallow test done?

A barium swallow test may be done to look for and diagnose problems in
the pharynx and esophagus. You may need a barium swallow test if your
healthcare provider thinks that you have:

• Cancer of the

  head and neck, pharynx, or

  esophagus

• Hiatal hernia. This means that your stomach has moved up into or alongside
  the esophagus.

• Structural problems, such as pouches (diverticula), narrowing
  (strictures), or growths (polyps)

• Enlarged veins (esophageal varices)

• Muscle disorders, such as difficulty swallowing (dysphagia) or spasms

• Achalasia

  . This is a condition in which the lower esophageal sphincter
  muscle doesn’t relax and allow food to pass into the stomach.

• Gastroesophageal reflux disease (GERD)

  and ulcers

Your healthcare provider may have other reasons to recommend a barium
swallow test.

What are the risks of a barium swallow test?

The risks of a barium swallow test may include problems from radiation
exposure, birth defects and intestinal issues. You should ask your
healthcare provider about the risks as they apply to you.

How can I manage my X-ray exposure?

You may want to ask your healthcare provider about the amount of radiation
used during the swallowing test. Consider writing down all X-rays you get,
including past scans and X-rays for other health reasons. Show this list to
your provider. The risks of radiation exposure may be tied to the number of
X-rays you have and the X-ray treatments you have over time.

How will a barium swallow test affect my stool?

You may have constipation or impacted stool after the swallowing test if
all of the barium does not pass out of your body.

Is it safe to have a barium swallow test while pregnant?

You should also not have a barium swallow test if you are pregnant.
Radiation exposure during pregnancy may lead to birth defects. Tell your
provider if you are pregnant or think you may be pregnant.

When should I avoid a barium swallow test?

You should avoid a barium swallow test if you have any of the following:

• A tear or hole in your esophagus or intestines (perforation)

• Blockage in your intestines or severe constipation

• Severe problems with swallowing. This makes it more likely that
  barium would accidentally go into your lungs (aspiration).

You may have other risks depending on your specific health condition. Tell
your provider if you are allergic to or sensitive to medicines, contrast
dyes, local anesthesia, iodine, or latex. Be sure to talk with your
provider about any concerns you have before the procedure.

How do I prepare for a barium swallow test?

You can prepare for a barium swallow test by considering the following:

• Your healthcare provider will explain the barium swallow test to
  you. Ask him or her any questions you have about the swallowing
  test.

• You may be asked to sign a consent form that gives permission to do
  the swallowing test. Read the form carefully and ask questions if
  anything is not clear.

• You will need to stop eating and drinking for about 8 hours before
  the swallowing test. Generally, this means after midnight.

• Tell your provider if you are pregnant or think you may be pregnant
  before scheduling a barium swallow test.

• Tell your provider if you are sensitive to or are allergic to any
  medicines, latex, tape, or anesthetic medicines (local and general)
  before scheduling a swallowing test.

• Tell your provider about all medicines you are taking. This
  includes prescriptions, over-the-counter medicines, and herbal
  supplements. You may need to stop taking these before the
  swallowing test.

• Tell your healthcare provider if you have had a recent barium
  swallow or upper GI test. This may make it harder to get good
  X-rays of the lower GI area during a barium swallow test.

• Follow any other instructions your provider gives you to get ready
  for the swallowing test.

What does a barium swallow test involve?

Generally, a barium swallow test involves the following process:

• You’ll be asked to remove any clothing, jewelry, or other objects
  that may get in the way of the swallowing test.

• You may be asked to remove clothing. If so, you will be given a
  gown to wear.

• You will lie on an X-ray table that can move you from a horizontal
  to an upright position. You may also be asked to change positions
  during the swallowing test. For example, you may need to lie on
  your side, back, or stomach.

• The radiologist may take X-rays of your chest and belly (abdomen)
  first.

• The radiologist will ask you to take a swallow of a thick, chalky
  barium drink. The barium is usually flavored, but it may not taste
  very good.

• As you swallow the barium, the radiologist will take single
  pictures, a series of X-rays, or fluoroscopy to watch the barium
  moving through your mouth and throat.

• You may be asked to hold your breath at certain times during the
  test.

• You will be given a thinner barium drink to swallow. The
  radiologist will use X-rays or fluoroscopy to watch the barium go
  down your esophagus. You may also be asked to swallow a barium
  tablet. This is a small pill that can help to show certain problems
  in the esophagus.

• Once the radiologist has taken all of the X-rays, you’ll be helped
  from the table.

A barium swallow test may be performed as an outpatient procedure or as
part of your stay in a hospital. The way the test is done may vary
depending on your condition and your healthcare provider’s practices.

What happens after a barium swallow test?

You may go back to your normal diet and activities after a barium swallow
test, unless your healthcare provider tells you otherwise.

How do I manage constipation after a swallowing test?

Barium may cause constipation or impacted stool after the swallowing test
if it isn’t completely cleared from your body. You can manage constipation
by drinking plenty of fluids and eating foods high in fiber to help the
rest of the barium leave your body. You may also be given a laxative to
help with this.

Your bowel movements may be white or lighter in color until all the barium
has left your body.

What are some serious side effects after a barium swallow test?

Call your healthcare provider right away if any of these happen after your
barium swallow test:

• Trouble with bowel movements or you are unable to have a bowel
  movement or pass gas

• Pain or swelling of the abdomen

• Stools that are smaller in size than normal

• Fever

Your healthcare provider may give you other instructions, depending on your
situation.

Barium Swallow – StatPearls – NCBI Bookshelf

Continuing Education Activity

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.

Introduction

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. 

Anatomy and Physiology

As with all imaging, interpretation of a barium esophagram requires a knowledge of anatomy and function.

The esophagus is a roughly 20 to 25 cm portion of the gastrointestinal (GI) tract that lies between the oral cavity and stomach. Its role is to transport both solid and liquid oral intake distally to the rest of the GI tract in a coordinated fashion. [6]

The origin of the esophagus is at the level of the cricoid cartilage. This is where the inferior pharyngeal constrictor muscle abuts the cricopharyngeus muscle. This area is known as the upper esophageal sphincter (UES). At the distal end, the esophagus terminates at the lower esophageal sphincter (LES), which is an area of muscular thickening that occurs where the esophagus passes through its diaphragmatic hiatus. When normal anatomy of the LES is disrupted, such as with a hiatal hernia, the sphincter is mechanically defective and can lead to common pathologies such as gastroesophageal reflux.

The UES serves to prevent air from entering the GI tract and prevent reflux of distal GI tract contents into the pharynx. It is located around 15 cm from the incisors. It is composed mainly of the inferior pharyngeal constrictor musculature, specifically the cricopharyngeal portion (also sometimes referenced as the cricopharyngeus muscle). This is notable as it is the most common site of iatrogenic perforation during endoscopy.

The LES, similar to the UES, plays a critical role in preventing reflux of gastric contents. It is closed at rest but does undergo periodic relaxations from unclear causes and for unclear reasons. As stated earlier, the incompetence of the LES is related to common pathologies such as gastroesophageal reflux disease (GERD) and Barrett metaplasia. [7] The LES is located around 40 cm from the incisors. 

In between the esophageal sphincters is the esophageal body. This serves to propel food to the stomach via peristalsis. Although it is functionally a smooth tube, three anatomic landmarks are clinically important and commonly described in the literature as they cause esophageal narrowing. The first is at the UES at the level of the cricoid cartilage. In the mid-portion, the aortic arch and left mainstem bronchus provide some extrinsic compression. The final narrowing is at the LES, which should denote the esophageal hiatus of the diaphragm.

The histologic structure of the esophagus follows the same general schema seen in other muscular GI tract organs. Its wall is composed of several layers including a squamous epithelial mucosa, a muscular layer, and adventitia as its outermost layer. Note that most intraperitoneal portions of the GI tract have serosa as their outermost layer.

Vascular supply of the esophagus is from the inferior thyroid artery in the cervical portion, by the left gastric and inferior phrenic arteries in the abdomen, and via branches from the bronchial arteries and off the aorta otherwise. Venous drainage is via branches to the azygos and hemiazygos veins except distally, where branches drain to the coronary vein. The coronary vein drains into the portal circulation, which is important as these can become varices in the setting of cirrhosis.

Innervation is via the vagus nerve and adjacent sympathetic trunk.

Indications

Barium swallow studies are used to define the structure and, to a much lesser extent, the function of the esophagus. Pathologies typically seen with barium swallow include esophageal perforations, neoplasms, hiatal hernias, and diverticula. Some motility disorders are also readily diagnosed with barium swallow due to the secondary effects they have on esophageal morphology, though most functional esophageal swallowing pathologies will require a formal modified barium swallow evaluation.  This includes achalasia, which is characterized famously by a “bird beak” appearance and a dilated, tortuous, proximal esophagus. [8] Diffuse esophageal spasm is identifiable by a “corkscrew” sign. [9][10]

Effects or changes in chemical esophageal injury can be studied with barium sallow. In the long term after injury, contrast may be used to identify strictures or sometimes more subtle findings such as ulceration in conjunction with endoscopy. It is important not to obtain barium contrast studies in the acute setting of chemical esophageal injury as it can exacerbate the injury. [11]

A further consideration regarding the choice of swallowed contrast agent in the setting of trauma. For the purposes of this section, trauma will be defined as injury resultant from non-iatrogenic causes such as gunshot wound. Guidelines for nontraumatic esophageal perforation investigations often involve the use of  Gastrografin/diatrizoate (water-soluble) contrast swallow studies initially, followed by a thinned barium swallow study if the study is negative in the face of significant clinical suspicion. This is because barium extravasation into the mediastinum carries a risk of resultant inflammation and is more difficult to wash out than Gastrografin/diatrizoate during surgical exploration. However, a barium contrast study has better sensitivity than that of Gastrografin/diatrizoate in the detection of perforation. In such clinical situations, timeliness of diagnosis is important, and surgical exploration may be likely on a positive swallow study or even already warranted due to other criteria. This would allow for a washout of extravasated contrast, thus minimizing the risks associated with barium while maximizing sensitivity during an urgent workup. Additionally, aspiration of Gastrografin/diatrizoate is known to cause severe pneumonitis. [12] This is of concern in the setting of concomitant tracheal injury that would allow for Gastrografin/diatrizoate to extravasate into the airway. Barium sulfate is not innocuous when aspirated but causes a less severe pneumonitis.

Contraindications

Barium swallow studies should be used in cases of suspected esophageal perforation only after considering the risk of inflammatory mediastinitis. This is not an absolute contraindication and should be weighed against the benefit of obtaining a timely diagnosis. Patients must be capable of swallowing relatively large amounts of contrast without assistance and be able to protect their airway.

Do not administer barium in cases of suspected acute, chemical esophageal injury as there is little useful information to be gained from a contrast swallow study in such cases.

Preparation

For studies focused on the pharynx and esophagus, minimal preparation is required. However, patients should be able to tolerate swallowing liquids.

Technique

The barium swallow exam technique can differ between institutions. Generally, the two components of barium swallow examination involve the evaluation of the hypopharynx/cervical esophagus and the thoracic esophagus using fluoroscopy. The steps are summarized as follows:

1. Upright position – Administration of crystals (effervescent sodium bicarbonate granules) and consumption of water for distension.

2. Upright position – Place the patient in the left posterior oblique position, have the patient drink a mouthful of thick barium while taking spot images from the cervical esophagus to the gastroesophageal junction. These constitute “double-contrast” images.

3. Upright position – Place the patient in the lateral position, cone down to the hypopharynx and video record(~4 frames/second) while the patient swallows a mouthful of thin barium. Acquire a spot distension images while the patient phonates the sounds “aaaaa” and “eeee.” 

4. Upright position – Place the patient in anteroposterior position, cone down to the hypopharynx, and video record(~4 frames/second) while patient swallows a mouthful of thin barium. Acquire a spot distension images while the patient phonates the sounds “aaaaa” and “eeee.” A “trumpet Valsalva” spot image can also be obtained and aims to distend the throat with air.

5. Horizontal position – While in the horizontal position, place the patient in the right anterior oblique position(ie patient should be prone). Have the patient drink thin barium with a straw and watch the contrast descend down the esophagus. Acquire a spot image of the gastroesophageal junction with and without Valsalva. Closely evaluate for a hiatal hernia, reflux, and for signs of dysmotility. Additional images to evaluate for reflux can be performed in the right posterior oblique position(supine) with provocative maneuvers such as coughing, although this might not be appropriate given the low yield of these maneuvers.

6. Upright position – Have the patient swallow a barium tablet with a small amount of water. Observe for uneventful passage to the stomach. Additional sips of water can be consumed if the pill is not transiting to the stomach.

Points to Consider

• While in the right anterior oblique position, the left arm and knee will be flexed and the head rotated left, allowing for some elevation of the left side. 

• The barium volume during each swallow is roughly 100 to 200 cc.

• The goal, typically, is to distend the esophagus for the best resolution.

• The contrast media may be further thinned with water if needed to reveal more subtle lesions.

• The exact thickness of contrast and amount will depend on the local radiology protocol and also the reason for the exam.

• Equipment with a still-image X-ray, while limited, can be sufficient.

Complications

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]

Clinical Significance

As stated earlier, the barium esophagram is a quickly performed, readily available study that is useful in the diagnosis and surveillance of a vast range esophageal diseases. In many cases, it is the first and only imaging study that needs to be performed. Additionally, the study may be used to plan surgical intervention by localizing lesions seen in other modalities, such as on endoscopy. The following list of esophageal pathologies (categorized roughly by type) that may benefit from esophagram in workup is not fully inclusive, but it serves to highlight the diversity of clinical situations where it may play some role.

Structural

Neoplastic, Benign

• Fibrovascular polyps

• Lipomas

• Leiomyomas

Neoplastic, Malignant

Mobility

Traumatic

• Iatrogenic injury – endoscopy, laryngoscopy

• Perforation – blunt/penetrating trauma

• Perforation – effort (Boerhaave’s Syndrome)

• Post-caustic injury stricture

Pediatric

It is important to note that, regardless of the appearance of a lesion discovered on esophagram, all masses, strictures, and complaints of dysphagia require consideration of endoscopy for a complete workup.  

Enhancing Healthcare Team Outcomes

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.

Figure

Single frontal image taken during a barium swallow exam demonstrating contrast in the esophagus. Contributed by Dr.Dawood Tafti, MD

Figure

Single lateral image demonstrates phonation evaluation at the level of the hypopharynx. Contributed by Dr.Dawood Tafti, MD

Figure

Single lateral image of the hypopharynx demonstrates phonation evaluation. Contributed by Dr.Dawood Tafti, MD.

Figure

Single frontal magnified field of view of the hypopharnx during phonation evaluation. Contributed by Dr.Dawood Tafti, MD.

Figure

Single frontal fluoroscopic image at the level of the lower esophagus and stomach demonstrating a pill immediately proximal to the gastroesophageal junction. Contributed by Dr.Dawood Tafti, MD.

References

1.

Yadlapati R, Furuta GT, Menard-Katcher P. New Developments in Esophageal Motility Testing. Curr Treat Options Gastroenterol. 2019 Mar;17(1):76-88. [PubMed: 30712156]

2.

Bülow M. Videofluoroscopic swallow study: techniques, signs and reports. Nestle Nutr Inst Workshop Ser. 2012;72:43-52. [PubMed: 23051999]

3.

Desai JP, Moustarah F. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): May 27, 2021. Esophageal Stricture. [PubMed: 31194366]

4.

Debi U, Sharma M, Singh L, Sinha A. Barium esophagogram in various esophageal diseases: A pictorial essay. Indian J Radiol Imaging. 2019 Apr-Jun;29(2):141-154. [PMC free article: PMC6639862] [PubMed: 31367085]

5.

Jaffer NM, Ng E, Au FW, Steele CM. Fluoroscopic evaluation of oropharyngeal dysphagia: anatomic, technical, and common etiologic factors. AJR Am J Roentgenol. 2015 Jan;204(1):49-58. [PMC free article: PMC4331119] [PubMed: 25539237]

6.

Chaudhry SR, Bordoni B. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Feb 7, 2021. Anatomy, Thorax, Esophagus. [PubMed: 29494119]

7.

Sanghi V, Thota PN. Barrett’s esophagus: novel strategies for screening and surveillance. Ther Adv Chronic Dis. 2019;10:2040622319837851. [PMC free article: PMC6435879] [PubMed: 30937155]

8.

O’Neill OM, Johnston BT, Coleman HG. Achalasia: a review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol. 2013 Sep 21;19(35):5806-12. [PMC free article: PMC3793135] [PubMed: 24124325]

9.

Ishii T, Akaishi T, Abe M, Takayama S, Koseki K, Kamei T, Nakano T. Importance of Barium Swallow Test and Chest CT Scan for Correct Diagnosis of Achalasia in the Primary Care Setting. Tohoku J Exp Med. 2019 Jan;247(1):41-49. [PubMed: 30662021]

10.

Filicori F, Dunst CM, Sharata A, Abdelmoaty WF, Zihni AM, Reavis KM, Demeester SR, Swanström LL. Long-term outcomes following POEM for non-achalasia motility disorders of the esophagus. Surg Endosc. 2019 May;33(5):1632-1639. [PubMed: 30232618]

11.

De Lusong MAA, Timbol ABG, Tuazon DJS. Management of esophageal caustic injury. World J Gastrointest Pharmacol Ther. 2017 May 06;8(2):90-98. [PMC free article: PMC5421115] [PubMed: 28533917]

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Trulzsch DV, Penmetsa A, Karim A, Evans DA. Gastrografin-induced aspiration pneumonia: a lethal complication of computed tomography. South Med J. 1992 Dec;85(12):1255-6. [PubMed: 1470976]

13.

Hamid M, Ullah W, Ur Rashid M, Amjad W, Mukhtar M, Hurairah A. An Esophagogram or Tracheobronchogram? A Review of Barium Sulfate Aspiration. J Investig Med High Impact Case Rep. 2018 Jan-Dec;6:2324709618802872. [PMC free article: PMC6172932] [PubMed: 30302346]

Barium Swallow Study (Esophagram)

What is an esophagram?

Your doctor has suggested you have an esophagram as part of you evaluation at National Jewish Health. The test evaluates the esophagus. The esophagus is the anatomical structure that goes from the throat to the stomach. This will help your doctor identify possible problems and the best treatment.

How do you get ready for the test? 

• Adults – No solid foods 4 hours prior to procedure. Adult patients may be on a clear liquid diet 2 hours prior to the procedure. Take medications at the regular times with a small sip of water.

• Children – No solid foods 6 hours prior to procedure. A clear liquid diet anytime prior to the procedure is fine. Give medications if necessary at the regular times with small sip of water.

• Infants – Do not eat or drink 4 hours prior to procedure. Your child should be thirsty and ready to drink upon arrival for the barium swallow study. Bring a special cup or sippy cup your child likes to use. If your child drinks best from a bottle, bring a bottle. Give medications at the regular times with a small amount of water.

• Wear clothing that you can remove from the waist up. You will be given a gown to wear.

• The esophagram uses x-rays and anyone who is pregnant cannot be in the room during the x-ray.

What happens during an Esophagram Study?

Before the study you/your child will need to remove all clothing and jewelry from the waist up. You will be given a hospital gown to wear. The study is completed in a radiology (x-ray/fluoroscopy) room. If a child is having the esophagram, a family member or caregiver will be encouraged to stay in the x- ray room to make it easier for the child. The radiologist or radiology practitioner assistant (RPA) operates the fluoroscopy equipment and takes
 images of the esophagus. A report will be sent to your physician within 24 hours.

You/your child will be asked to drink 1 to 2 cups of barium. The barium is a contrast material that makes liquids show up on the image screen as gray or black. You/your child will drink the barium while standing up and while lying down.

If you have any questions or don’t understand the instructions please ask.

What does barium taste like?

Barium comes in several different consistencies and is artificially sweetened and flavored.

What should you do after the test?

Barium rarely causes any problems. It passes through the digestive system. Drink extra fluids for 12 to 24 hours after the study. If your/your child becomes constipated after the study, drink more liquids. If the constipation continues, talk with your doctor.

How long will the test take?

The esophagram will take about 30 minutes. Some of the time is taken preparing for the study.

How do you get to your appointment?

Your appointment is in the Institute for Advanced Biomedical Imaging (Radiology). You will be directed where to go when you check-in. If you have any questions you can contact Advanced Biomedical Imaging (Radiology) at 303.398.1611.

This information has been approved by Will Cook, R.T. M.A. and Eric Yager R.T.(R)(CT)(BD) (January 2017).

Swallow Study – Southwest Medical Center

What is a Swallow Study?

A Swallow Study is an x-ray examination of the pharynx, and esophagus that uses a special form of x-ray called fluoroscopy and an orally ingested contrast material called barium or gastroview.

An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging.

Fluoroscopy makes it possible to see internal organs in motion. When the pharynx and esophagus are coated with barium, the radiologist is able to view and assess their anatomy and function.

What are some common uses of the procedure?

• A Barium Swallow helps evaluate and detect:
  • tumors
  • inflammation of the esophagus, stomach and duodenum
  • hiatal hernias
  • scarring
  • blockages
  • abnormalities of the muscular wall of GI tissues

• The procedure is also used to help diagnose symptoms such as:
  • difficulty swallowing
  • chest and abdominal pain
  • reflux (a backward flow of partially digested food and digestive juices)
  • unexplained vomiting
  • severe indigestion

How should I prepare?

You should inform your physician of any medications you are taking and if you have any allergies, especially to barium or iodinated contrast materials. Also inform your doctor about recent illnesses or other medical conditions.

Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby.

To ensure the best possible image quality, your stomach must be empty of food. Therefore, you will likely be asked not to eat or drink anything (including any medications taken by mouth, especially antacids) and to refrain from chewing gum and smoking after midnight on the day of the examination.

You may be asked to remove some or all of your clothes and to wear a gown during the exam. You may also be asked to remove jewelry, eye glasses and any metal objects or clothing that might interfere with the x-ray images.

What does the x-ray equipment look like?

The equipment typically used for this examination consists of a radiographic table, an x-ray tube and a television-like monitor that is located in the examining room or in a nearby room. When used for viewing images in real time (called fluoroscopy), the image intensifier (which converts x-rays into a video image) is suspended over a table on which the patient lies. When used for taking still pictures, the image is captured electronically.

For a barium swallow, you will begin the test standing and then later, the table will be laid down for more x-rays.

How does the procedure work?

X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on a special digital image recording plate.

Fluoroscopy uses a continuous x-ray beam to create a sequence of images that are projected onto a fluorescent screen, or television-like monitor. When used with a contrast material, which clearly defines the area being examined by making it appear bright white, this special x-ray technique makes it possible for the physician to view internal organs in motion. Still images are also captured and stored electronically on a computer.

Until recently, x-ray images were maintained as hard film copy (much like a photographic negative). Today, most images are digital files that are stored electronically. These stored images are easily accessible and are sometimes compared to current x-ray images for diagnosis and disease management.

How is the procedure performed?

This examination is usually performed on an outpatient basis and is often scheduled in the morning to reduce the patient’s fasting time.

A radiologic technologist and a radiologist, a physician specifically trained to supervise and interpret radiology examinations, guide the patient through the Barium Swallow series.

As the patient drinks the liquid barium, which resembles a light-colored milkshake, the radiologist will watch the barium pass through the patient’s digestive tract on a fluoroscope, a device that projects radiographic images in a movie-like sequence onto a monitor. You will be asked to move into different positions while drinking so that all anatomy can be seen clearly. Once the esophagus is adequately coated with the barium, still x-ray images will be taken and stored for further review.

The patient will be asked to hold very still and may be asked to keep from breathing for a few seconds while the x-ray picture is taken to reduce the possibility of a blurred image. The patient will also be asked to swallow at certain times, so that the esophagus will be full of barium at the time the pictures are taken.

When the examination is complete, you will be asked to wait until the radiologist determines that all the necessary images have been obtained. This exam is usually completed within 20 minutes.

What will I experience during and after the procedure?

Occasionally, patients find the thick consistency of the barium unpleasant and difficult to swallow. The liquid barium has a chalky taste.

Being tilted on the examination table can be uncomfortable for some patients. The examination may also make you feel bloated.

The technologist can minimize patient movement by automatically tilting the examining table. These actions ensure that the barium is coating all necessary anatomy. As the procedure continues, the technologist or the radiologist will ask you to drink more barium. You may hear the mechanical noises of the radiographic apparatus moving into place during the exam.

After the examination, you can resume a regular diet and take orally administered medications unless told otherwise by your doctor.

The barium may color your stools gray or white for 48 to 72 hours after the procedure. Sometimes the barium can cause temporary constipation, which is usually treated by an over-the-counter laxative. Drinking large quantities of fluids for several days following the test can also help. If you are unable to have a bowel movement or if your bowel habits undergo any significant changes following the exam, you should contact your physician.

Who interprets the results and how do I get them?

A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will discuss the results with you. Your physician should receive a report from the radiologist within 24 to 48 hours of the exam.

What are the benefits vs. risks?

• Benefits
  • A barium swallow is an extremely safe, noninvasive procedure.
  • The results of the barium swallow usually leads to accurate evaluation of the esophagus and stomach.
  • Because barium is not absorbed into the blood, allergic reactions are extremely rare.
  • No radiation remains in a patient’s body after an x-ray examination.
  • X-rays usually have no side effects in the diagnostic range.

• Risks
  • There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk.
  • The effective radiation dose from this procedure is about 6 mSv, which is about the same as the average person receives from background radiation in two years.
  • Occasional patients may be allergic to the flavoring added to some brands of barium. If you have experienced allergic reactions after eating chocolate, certain berries or citrus fruit, be sure to tell your physician or the technologist before the procedure.
  • There is a slight chance that some barium could be retained, leading to a blockage of the digestive system. Therefore, patients who have a known obstruction in the GI tract should not undergo this examination.
  • Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant.

What are the limitations of Swallow Study?

Mild irritation of the lining of the stomach or esophagus is difficult to detect, as well as ulcers smaller than ¼ inch in diameter. The test will detect larger ulcers. It can also suggest the presence of underlying infection with the bacterium, Helicobacter pylori, the most common cause of ulcers; but additional noninvasive tests such as a blood test or breath test may be required to confirm this infection. Finally, biopsies of any abnormal areas cannot be performed with this test.

Barium Swallow | Outpatient Diagnostic Center | Saint Joseph Hospital

What can I expect?
A Barium Swallow (Esophagus) demonstrates the structure and function of the esophagus. This study will take approximately 20 minutes. An Upper GI series demonstrates the structure and function of the stomach. This study will take approximately 30 minutes. A Small Bowel series demonstrates the structure and function of the small bowel. This study normally lasts for approximately one and one-half hours but can take longer depending on your digestive system. In some cases you will need to have a series of images taken every 30 minutes for up to four (4) hours. You will drink a chalky liquid called barium to outline your esophagus, stomach and small bowel on the x-ray. The radiologist and technologist will watch the progress of the barium on an x-ray imaging screen while turning you in different positions. Several x-rays will be taken during this time.

What do I do if there is a possibility that I might be pregnant?
If there is a possibility that you are pregnant, please tell the technologist before the exam.

Are any activities restricted after this procedure?
No, you may continue your normal activities unless otherwise instructed.

Do I need to make changes to my diet?
Following the exam, you may return to your normal diet. Drink plenty of fluids for the remainder of the day. Your bowel movements may have a chalky appearance for a couple of days following your study.

Do I need to adjust any medications?
Your medicines should not be stopped unless your doctor tells you to.

My doctor requested that I bring my films to my next appointment, what do I do?
Saint Joseph has implemented a new imaging archiving system which allows physicians to digitally view your images in their offices. The technologist that performs your procedure will also be able to provide you with a CD (computerized disk) to take with you upon request. If you did not receive a CD from the technologist and you need a copy of your images, you can also contact the Radiology Imaging Library at 859.313.2290 . If someone else is going to pick up your CD, you must call us and give us their information and they must present a picture ID.

Saint Joseph Outpatient Diagnostic Center
Saint Joseph Office Park – Bldg. C
1401 Harrodsburg Road, Ground Floor
Lexington, KY 40504
859.313.4747

Modified Barium Swallow (Cookie Swallow)

The modified barium swallow is done at the Department of Pediatric Radiology of UPMC Children’s Hospital. You will begin the appointment by meeting with a speech/language specialist, who is specially trained in swallowing disorders, to discuss your concerns about your child’s swallowing problems and answer any questions you may have about the test. The modified barium swallow will be done in a fluoroscopy (floor-OS-co-pee) room with:

• The speech/language specialist
• A pediatric radiology doctor who will be taking the X-ray pictures of your child’s throat
• An X-ray technologist who will be helping the doctor

In the room, you will see an X-ray machine, a television screen and a special chair. You might explain to your child that the X-ray machine is a large camera for taking pictures that will be shown on the television.

• Your child will be awake during this test.
• Your child will be asked to sit up in the chair just as he or she would eat at home.
• A seat belt will be placed over your child’s waist in the chair but your child will not be restrained.
• The speech/language specialist will mix the foods and liquids that are brought from home with a milky material called barium that will make the foods and drinks show up on the X-ray as your child is swallowing. You may want to explain to your child that the barium will change the taste and appearance of the foods and liquids.
• As your child eats and drinks the foods and liquids mixed with barium, the doctor will move the X-ray camera next to your child. The camera will come close to, but not touch, your child.
• The speech/language specialist may try to help your child swallow better by using different cups or bottles that have been brought from home, as well as straws and syringes.
• The speech/language specialist may also try thickening bottle feedings, typically by using barium mixed with either pudding or rice cereal.
• When the X-rays are complete, the speech/language specialist will meet with you in a consultation area to discuss the results of the exam. Recommendations to improve the way your child swallows will be given to you at this time.

As a parent, you may have concerns about radiation exposure. UPMC Children’s takes every precaution to make sure your child is safe.

• Our goal is to do the test correctly and thoroughly, while exposing your child to the smallest amount of radiation necessary to take the X-rays.
• Advances in equipment and film have lowered the amount of radiation your child will receive.
• All of the equipment is inspected regularly.
• Parts of the body that are not being X-rayed will be protected with a lead cover or apron when possible.

Barium Swallow/Upper GI | Baptist Health Louisville, KY

What is a Barium Swallow Test of the Upper Gastrointestinal (G.I.) Exam?

An upper G.I. (UGI) examination is a diagnostic procedure that uses a contrast agent, called barium, to produce images of your upper gastrointestinal tract, including the esophagus, stomach and small intestine (small bowel). Using a type of x-ray, called Fluoroscopy, the UGI exam can detect problems with your upper digestive system and this procedure helps your doctor identify problems, with minimal risk and discomfort to you.

Can I Eat Before a Barium Swallow Test?

• Do not eat or drink anything, including chewing gum, for eight to 12 hours before the exam – so your stomach and upper digestive tract are completely empty. You may brush your teeth but avoid swallowing any water. 

How Do I Prepare for My Exam?

To prepare for the UGI exam you should:

• Remove any piercings from the abdomen and chest – so they do not interfere with the images produced during the exam.
• Inform the technologist if you may be pregnant. If there is a possibility of pregnancy, a pregnancy test will be ordered before the exam.

If you have questions about the preparation or procedure, please call your physician’s office. Report to the registration area 30 minutes prior to your scheduled exam time to complete the registration process.

How Does a Barium Swallow Work?

For this exam, you will change from your clothing into a hospital gown so the area to be examined can be easily accessed. A technologist will gently position you on a special tilting table with a fluoroscope  (an X-ray machine combined with a television monitor). A radiologist or a radiology physician’s assistant will perform the UGI exam. These individuals specialize in the study of imaging tests, such as X-ray images, ultrasound, CT, etc., to assure the most accurate results from your examination.

You will be asked to drink a liquid barium mixture while the radiologist or physician’s assistant watches the barium flow through your digestive tract. In addition, “spot films” will be taken of the areas your doctor wants to study. You will be asked to turn and hold several positions so the radiologist can get images from many different angles.

How Long Will the Exam Take?

Time will vary significantly, depending on the nature of the study and other factors. Average time for UGI exams is 30 to 40 minutes. If you are also scheduled for small bowel series, the time will be considerably longer.
For small bowel series, the barium you drink is followed through 22 feet of your small intestine by taking abdominal images every 30 minutes until the barium has reached the colon. This usually takes a minimum of 60 minutes but everyone’s digestive system is different, so your study may take more or less time.

What Happens After My Exam?

After the exam, you are free to return to your normal activities and usual diet unless told otherwise by your physician.  Barium may cause constipation and It is normal for the barium to give a whitish color to your stool for the next day or two. You will need to increase your water intake and possibly take a mild laxative in order to clear the barium from your system within a day or two of your exam. If you have trouble with constipation normally, you should consult your physician for a specific treatment plan.

After your study is completed, the radiologist will interpret your images and send a written report to your physician. Your physician will review the results of the exam with you at your next scheduled appointment.

90,000 What is a modified barium swallow?

Modified barium swallow is a medical examination performed while the patient is eating and drinking to identify problems with swallowing. Some problems can be difficult to detect under normal conditions, even with close observation. The use of X-ray fluoroscopy in a modified barium swallow reveals throat structures and their behavior when the patient eats and drinks. This test requires the presence of the pathologist’s speech language together with the radiologist to monitor the fluoroscopy.

This test is also known as “cookie swallow”, a reference to one of the foods that the patient may ask to eat during the procedure. A doctor may recommend modified barium swallow if the patient has difficulty speaking or eating, has a persistent cough, or has a wet or clogged voice for no apparent reason. The patient may be aspirating a small amount of food or liquid while eating, or may have muscle dysfunction that makes it difficult to swallow.The test takes about 90 minutes.

Patients do not need to take any special barium swallowing medication other than bringing some food from home. In the case of young children, a food mix that the child loves may be helpful. In a hospital or imaging center, a technician will mix food with barium. A speech language therapist may also perform a consumption assessment before the patient has eaten to discuss the situation.

The modified barium swallow itself takes 10 to 15 minutes.The patient sits or stands in front of the fluoroscopy machine and consumes food and liquids as directed. The radiologist will make a video for the pathologist’s speech language to evaluate later, and she can also watch the test in real time. She can give the patient a taste of different foods and drinks. Barium is opaque and highlights the structures of the mouth and upper esophagus in favor of the speech-language pathologist.

After the modified barium swallow, the patient may meet with a speech therapist to discuss the results and some treatment options.These can include therapy, surgery, and other steps. It is important to know that this test is different from barium swallowing, which is done to visualize the esophagus all the way to the top of the stomach. This test is designed to detect reflux and other medical problems that may not be apparent when using a modified barium swallow.

OTHER LANGUAGES

90,000 What is an esophagram?

An esophagram is an examination of the esophagus using X-rays and a radiopaque contrast agent, usually barium.This test is also known as barium swallow or gastrointestinal tract. A doctor may request an esophagram to assess a patient’s ability to swallow, find causes of bleeding in the esophagus, and check for other gastrointestinal health problems. The test can usually be taken on an outpatient basis and the risks associated with this procedure are very low.

In the esophagram, the patient swallows a mixture of barium sulfate and water. The mixture can be flavored to make it more palatable, but the experience is generally unpleasant.A series of X-rays are taken as barium passes through the patient’s esophagus and upper gastrointestinal tract. These x-rays are taken to look for a medical problem, such as painful swallowing. The barium will pass through the patient’s body and be excreted along with other waste products.

The x-ray exposure associated with the esophagram is relatively low and is considered an estimated risk to the patient. The value of diagnostic testing is considered important enough to expose the patient to a small amount of radiation.If the patient requires additional medical imaging using X-rays and other radiation, the history of the recent esophagram will be considered when deciding how to proceed. Generally, patients are not at risk of injury from nuclear imaging because their exposure is low and imaging studies are rare.

As an alternative to an esophagram, your doctor may consider endoscopy, in which a camera is inserted into the esophagus and used to examine its structure and general physical condition.This can sometimes reveal problems that will not be visible on an x-ray and can eliminate the need for costly and invasive exploratory surgery to examine the esophagus. This test is done with the patient under sedation for convenience and can also be done on an outpatient basis.

When an esophagram is recommended, the patient may ask why the test is being requested and if there are any alternatives. The physician should be able to provide detailed information about the test and discuss possible treatment options that may be recommended once the results are available.Esophagram test results can take several days, depending on whether the radiologist is available to read images immediately or needs to be sent.

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Adapting Human Videofluoroscopic Swallow Study Methods to Detect and Characterize Dysphagia in Murine Disease Models

Hundreds of mouse models (mouse and rat) are commercially available for the study of human diseases.However, only three models of mouse disease have been specifically investigated in relation to dysphagia: the mouse model of ALS ^13.14 and the rat model of Parkinson’s disease ^12.15-17 and course ^{18.9076 Each of these preliminary studies uses different techniques for assessing dysphagia, making it impossible to infer meaningful comparisons between species and diseases. This serious limitation can be overcome in future studies using the recently developed murine VFSS protocol, which allows an objective quantification of numerous parameters of the swallow self-feeding animal.}

Successful VFSS results depend on three important components: 1) test chambers that allow automatic feeding while standing unrestrained in an enclosed space, 2) recipes that mask the taste / odor aversion of commercially available oral contrast AGEnta, and 3) Test protocol per step -a-step that allows you to quantify swallow physiology. The cumulative effect produces a comfortable, low voltage, with an automatic feed of environmental expertise, which induces typical feeding and swallowing behaviors.Eliminating one or more of these components will have a negative impact on research results. Examples of adverse effects include inability to maintain the animal’s fluoroscopy visual field, unwanted behaviors that distract from binge drinking, aversion to oral contrast media, and inability to quantify parameters to swallow due to episodes of inadequate drinking.

The main challenge in obtaining optimal VFSS results was the development of a suitable test chamber.Numerous changes to our prototype design have culminated in observation cameras that keep mice in sight and prevent behaviors that distract from drinking. The cameras were made with milling machines to obtain the same dimensions of TDe pipes and end caps, thus allowing component interchangeability over multiple cameras of the same diameter. The internal dimensions (diameter and length) were chosen to be slightly larger than the body size of an adult mouse, which was in a narrow test chamber, which is sufficient to walk in a straight line and turn around.The narrow design, combined with the strategic positioning of the spout and PEG-bowl only at the end, keeps the head and body of the mice aligned to the length of the chamber while drinking. Once incorporated into drinking, the mice remain remarkably self-stabilized on a spout or bowl for several seconds at a time, resulting in minimal artifact movement to interfere with testing. Thus, it is possible to obtain undistorted, macro observation / video recording and videofluoroscopic images of mice drinking in the lateral and dorsal-ventral planes.

Mice (and other small rodents) naturally tend to seeK shelter in small spaces. As a result, they are free to enter the test chamber (already closed at one end by means of an end cap) when it is in the aviary, thereby eliminating the stress / anxiety caused by handling (i.e. manually picking an animal to place it in the chamber). After the mouse enters the chamber, the other end is closed by attaching the ^{2 nd} end.This design prevents leakage while creating a low alarm test chamber for mice to explore freely.

The square shape of the camera provides built-in stability of movement, which allows it to be used in a standing manner, thereby eliminating the need for testing in a standard rodent cage. The entire apparatus is lightweight, portable, stackable for storage, sturdy, easy to clean, and autoclavable. While the cameras were originally developed for use with fluoroscopy, they are also compatible with pinpoint radiography, neuroimaging (eg, MRI, PET, CT), and visual / observation video recording of various behaviors.

The second major coping problem is masking taste / odor aversion with contrast agents (eg barium sulfate and Iohexol). Given that taste sensitivity varies between mouse strains ^19-21 and possibly as old as 90,075 22.23, 90,076 needed to determine a single test solution that was acceptable to all mice, regardless of strain and age. This result is important to provide a direct comparison of swallow function / dysfunction across strains and ages, eliminating mixed results due to differences in rheological (e.g. viscosity, density , etc.) and the chemical properties of the solutions under study. To this end, we developed a simple, rapid gustatory screening approach to identify the preferred taste enhancer to mask the aversion to taste / odor contrast agents in VFSS mice. The methods were simulated after a short-term exposure test that requires lick meter (i.e. lick sensor) to record lick prices within the first 2 min after the water regulation period (e.g. water retention overnight) in order to cause thirst 90,075 24.25. Lickometer was not available for this study; Therefore, preference was evaluated for behavioral observations as well as standard video recording techniques for licking speeds that were previously tested in our laboratory at ^13,14. Using this flavoring screening approach, chocolate was identified as the preferred flavor enhancer for the C57 and C57 / SJL strains. Specifically, 100% of the mice in each cage drank easily the chocolate-flavored solution within 30 seconds of exposure, with several mice drinking simultaneously into the spout.However, barium supplementation resulted in only short binges from most mice, regardless of barium or chocolate concentration.

An alternative to barium iohexol, an iodine-based contrast agent that has only recently been recognized as Sui Barium Sulfate Alternative Table for Human VFSS ^10; Therefore, it has not yet been standardized for this purpose. Several different concentrations of chocolate-flavored iohexol have been suggested to mice. Recipes containing up to 50% stock iohexol solution (350 mg iodine per ml) were easily drank from most mice after an overnight water regulation period.Higher concentrations as a result of behavior avoidance. A 50% iohexol (350 mg iodine per ml) solution obtained sufficient radiodensity at the same time to be swallowed by mice, while lower concentrations were significantly less noticeable and inhibited quantitative physiology. Therefore, the optimal solution for testing VFSS with mice was identified as a 50% iohexol solution with chocolate flavor added. Repeat taste testing does not lead to avoidance behavior or side effects.

The third challenge was to overcome the hindered mice from turning / tilting their head while drinking, which is behind visualization of the swallowing mechanism during VFSS. Drinking from a PEG bowl located directly above the floor at one end of the chamber has solved this problem. There are several additional advantages to using a PEG ball instead of a bottle sipper tube. For example, the calibrated volume of liquid can be pipetted into PEG dishes through a vent in the end cap of the sheath. This approach allows one to quantify the minute volume of the test solution consumed during the VFSS test period is short.In addition, an increase in the surface area of ​​the test solution in the PEG bowl, compared to the small orifice of the Sipper tube, may provide an increased olfactory stimulus for further motivation to drink. Peg-bowls may be better suited for learners or smaller mice to strain, and the height of the bowl is a standardized distance from the floor. In contrast, the length of the Sipper tube must be adjusted to accommodate the different sizes of mice, which adds another potentially confusing variable to consider.In addition, in mouse mode, neurological diseases may have difficulty reaching the Sipper tube bottle due to limb movement disorders, while they can easily reach the PEG bowl. Mice with tongue and / or jaw dysfunction may not be able to press the ball sufficiently in the chute to access the fluid; using PEG bowls can eliminate this shame. For these reasons, the use of pin bowls over Sipper Tubes is the preferred method for murine VFSS testing.However, surveillance cameras were designed to accommodate a spout to drink as needed. An important caveat to consider is that licking rates are known to differ between a spout and a drinking bowl ^13.26. Therefore, the choice of either a spout or a PEG bowl for VFSS must be consistent within and between experiments.

The fourth challenge was to quantify the Swallow parameters for mice that are comparable to the VFSS parameters commonly used in human research and clinical practice.Our preliminary results indicated that the type of fluoroscopy system determines which swallow parameters can be investigated in mice. Most research centers and healthcare facilities have high energy (75-95 kV, 1-5 mA) fluoroscopes designed for use with humans and large animals, which result in exceptionally poor image quality when testing mice and other small animals. As an example, a recent study using a high energy fluoroscope with rats was able to identify only 4 quantitative estimates of the parameters of swallow ^12, and we were able to identify only 7 parameters of Swallow for mice in the present study.To overcome this serious problem, we recently obtained a low energy consumption fluoroscopy called LabScope (Glenbrook Technologies). The system is a miniature fluoroscope that generates a continuous cone-beam of X-rays with photon energies between 15 and 40 kV and a peak tube current of 0.2 mA (8 W maximum power). The lower energy levels of this system are better attenuated by the thin bone and soft tissues of the mice and thus provide HIGH contrast resolution than the conventional (i.e.e. high energy) fluoroscopes. The LabScope X-ray beam is aimed at 5 cm in the diameter of the image intensifier, which is noticeably smaller than the 15-57 cm in the diameter of the image intensifier tubes of conventional fluoroscopes. The minimum source-to-amplifier distance (SID) of the LabScope is ~ 6 cm (as opposed to ~ 30 cm for conventional fluoroscopes), which provides greater scalability. In addition, LabScope uses a patented technology that digitally magnifies an image up to 40 times in real time without changing the SID.The result is essentially an X-ray microscope that can zoom in and out in real time to view small areas of interest, such as the swallowing mechanism of a mouse.

The main advantage of this low energy fluoroscopy system is improved radiation safety. In addition to animals that received low doses of radiation from the LabScope, researchers using the system are exposed to significant forest radiation scatter. Irradiation directly in front of the device on the control panel is 10.3 μR / h.At 1 m in front of the device, exposure drops to 580 μR / h. Most other locations in the room have very low exposure below 10 μR / h. Despite this improvement, we have taken additional measures to improve radiation safety. For example, leaded acrylic shielding was added around the LabScope to block scattered X-ray photons, allowing researchers to conduct mouse VFSS testing without wearing anything shielding (such as lead aprons, thyroid shields, and goggles).In addition, transparent acrylic allows mice to be visualized from a distance. In addition, radiation safety is ensured by a motorized scissor lift table that is remotely controlled by an investigator. From a distance of up to 3 m from the fluoroscope, researchers can use a remote-controlled device to adjust the vertical and horizontal position of the camera for observation in the X-ray BEAm. As a result, the anatomical ROI can be maintained within the fluoroscopy field of view while the mouse moves freely in the viewing chamber.Although the scissor lift was designed for use with the LabScope, it is also compatible for use with conventional fluoroscopes to improve radiation safety for researchers. A final step to improve radiation safety in murine VFSS involves the use of a liquid syringe delivery system. This system includes 3-4 feet (or more, if necessary) length of PE pipes, which allows fast and efficient delivery of liquids to PEG bowls from a distance. This syringe delivery system for liquids, in combination with surveillance cameras, can also be used with conventional fluoroscopes.

Preliminary work using LabScope, in combination with the new VFSS mouse protocol, demonstrates a major advantage over conventional systems: the number of parameters swallowed can be reliably quantified Iš by almost twice. However, the soft tissue structures of the swallowing mechanism of (eg, tongue, velum, posterior pharyngeal wall, and epiglottis) in mice are not directly visible when using low or high energy fluoroscopy systems.Thus, we focused on a quantitative measure of bolus flow rather than the biomechanics of swallowing. We were mainly interested in parameters that can be quantified based on units of time, area, distance, volume , etc., rather than using scaled Likert-type measures. Numerous bolus flow parameters meeting these requirements have been described in the human VFSS literature, for example oral transit time ^27-29 pharyngeal transit time ^27-33 and esophageal transit time ^{34-36, named} , but some are …Bolus transport through the oral cavity was not readily discernible in mice, probably due to the small size of the bolus when spontaneously drinking. However, we were able to reliably quantify pharyngeal and esophageal transit times, as well as several other measures pertaining to bolus flow and clearance. Determination of additional parameters of the translational swallow is expected as we optimize the capabilities of LabScope.

The results of this study showed that, in mice, take several rhythmic licks after a sip during spontaneous drinking, with each small liquid bolus sequentially filling the vallecular space before inducing a pharyngeal sip.This behavior, which is typical for mammals that use licking as the main means after swallowing liquids ^37-40, resembles the rhythmic suck-swallowing model of human swallowing in infants and all preschool mammals in general. Infant swallowing physiology is characterized by multiple rhythmic sucks followed by a reflexive swallow pharynx, usually described as a swallow suck cycle ^37.41-43. Therefore, the rhythmic tongue and jaw movements involved in the ingestive licking behavior of mice may be more comparable to the ingestive sucking behavior of the hum.children, not a drinking cup of children and adults. Therefore, we have been quantifying the lick speed and lick swallow ratio of mice for future comparisons with the ratio of suck speed and suck to swallow human babies. Perhaps the murine VFSS study will provide insight into developmental swallowing disorders.

As with any new research method, areas for improvement have been identified. For example, the murine VFSS protocol was developed using only the C57 and C57 / SJL mouse strains; it has not yet been tested in rats.Surveillance cameras should be increased in size (diameter and length) to accommodate the larger body size of the rats. It is also unknown if chocolate-flavored iohexol is suitable as a versatile mouse solution for VFSS testing. Thus, a larger scale trial with multiple strains of mice and rats is warranted for this purpose. In addition, the use of barium as a contrast agent for VFSS mice should not be ruled out. Mice have a clear preference for iohexol recipes over barium; However, more careful and systematic attempts to mask the taste / odor aversion of barium can provide tasty alternatives to iohexol.Future studies comparing the effects of iohexol and barium sulfate (as well as other potential oral contrast agents) on taste preference and swallow physiology in mice and rats will undoubtedly provide important information that is directly related to translational and human VFSS.

VFSS with humans involves multiple food and liquid consistencies, and dysphagia is most evident when thin fluids and dry, solid foods are swallowed ^44.45. The murine VFSS protocol is therefore being expanded to include additional consistencies that may aid in the detection and quantification of dysphagia in disease models. He will also need to test the fluid viscosity of VFSS mice recipes in order to adjust the viscosity to match those used during human VFSS. The solution of these limits will facilitate the identification of translational VFSS biomarkers of dysphagia that can be directly correlated between mice, rats, and humans.

The utility of murine VFSS can be significantly improved by implanting radiopaque markers into the soft tissue structures of the swallowing mechanism that are otherwise invisible, thereby allowing studies of the biomechanics of swallowing. This approach has been successfully used over the years to study the biomechanics of swallowing in infant pigs using an assortment of metal staples and wires ^37.42. We expect that the use of similar, but smaller, markers in mice would quantify several additional parameters of swallow compared to larger mammals, including humans.We are currently developing a methodology for implanting radiopaque markers in the tongue, soft palate, pharynx, larynx, and proximal esophagus in mice to test this hypothesis.

Video Recording The frame rate of LabScope and conventional fluoroscopes is limited to 30 frames per second (FPS). However, our preliminary results showed that the entire pharyngeal swallowing stage for healthy mice occurs in less than 66 ms 90,087 (i.e., 90,088 2 frames), which is about 10 times faster than humans.Thus, the pharyngeal phase of swallowing in mice occurs so quickly that details are not visible at 30 frames per second with the camera. A high frame rate (likely> 100 frames per second) will be necessary to sufficiently visualize and quantify the extremely fast and complex movements of the pharyngeal stage during swallowing in mice and other rodents. Combined with high frame rates, including Biplanar 3D fluoroscopy imaging technology, of course, expand the mouse VFSS utility. Thus, future design considerations should include higher camera frame rates and dual-plane imaging capabilities.

Finally, low doses of radiation have been shown to cause infertility in female C57 mice as a result of altered ovarian levels stimulated by hormones, which could shame the lifespan of the study ^46. Results specifically related to the effects of repeated exposure to low doses of radiation associated with VFSS testing has not yet been studied in mice, other animals, and humans. However, ovarian dysfunction (not related to radiation exposure) in human women has been associated with gastrointestinal motility disorders, and specifically for dysphagia in some cases ^47, which provides another nuance to be considered when developing future VFSS studies involving women (animals and people).The exclusion of females should be avoided, as significant gender differences in swallow function have been reported for humans 90,075 48.49 90,076 and will be important for detection and characterization in animal models of the disease as well. Thus, results from longitudinal studies of VFSS in mice and rats of both sexes have enormous translational potential for humans with respect to Dysphagia, as well as the risks associated with low dose radiation exposure associated with retesting VFSS.

Barium Swallow

Contents:

Definition

What is a Barium Swallow?

Upper gastrointestinal test (UGI) or also called barium swallow is an x-ray (X-ray) examination of the upper digestive tract. The esophagus, stomach, and duodenum (the first part of the intestine) are visible using liquid suspension x-ray films. This liquid suspension can be barium or a water-soluble contrast fluid.When only barium examines the pharynx (the back of the mouth and throat) and the esophagus (the muscular canal from the base of the tongue to the stomach), this procedure is called barium swallowing.

X-rays use electromagnetic light to produce images of internal tissues, bones and organs in film. X-rays are taken using external radiation to produce images of the body, organs, and internal structures for diagnostic purposes. X-rays enter the body through the tissues of the body until special plates (similar to film for cameras) and negatives appear.

When do I need to swallow barium?

Upper gastrointestinal tract (UGI) is performed for:

• See the causes of symptoms of digestive diseases such as difficulty swallowing, vomiting, belching, abdominal pain (abdominal pain) or indigestion
• See a narrowing of the upper digestive tract tract, ulcers, tumors, polyps, or pyloric stenosis
• See bowel inflammation, malabsorption syndrome or abnormal squeezing movements to move food into the intestine (motility abnormalities)
• See an object swallowed

In general, the UGI series is not needed if you have no symptoms of digestive problems.The UGI series is for people who have:

• difficulty swallowing
• the possibility of constipation
• abdominal pain that comes and goes when eating
• severe or frequent heartburn

Prevention and prevention

What I need to know before you pass the barium swallow?

In some cases, an upper endoscopy is performed instead of the UGI test. Endoscopy uses a thin, flexible tube (endoscope) to see the lining of the esophagus, stomach, and upper small intestine (duodenum).

UGI Series Test Series:

• May not show irritation of the gastric mucosa (gastritis) or esophagus (esophagitis) or ulcers that are less than 0.25 inches (6 mm) in diameter
• May not show Helicobacter pylori bacterial infection. which could be the cause of stomach ulcers

A biopsy cannot be done during the UGI if a problem is found.

process

What should I do before having a barium swallow?

You may be advised to change food 2 or 3 days before the test.You will usually be prohibited from eating for a few minutes before taking the test.

Be sure to consult your doctor if you plan to change medications. You are usually allowed to take oral medications. Avoid changing medications without first consulting your doctor.

Before starting the test, you will be asked to remove jewelry on your neck, chest or abdomen.

How does the process of swallowing barium take place?

X-rays will be taken before drinking the barium solution.You will then be asked to swallow the solution as instructed by the radiologist. At the end of the test, you can swallow 1 cup (240 ml) to 2.5 cups (600 ml) of barium solution.

Radiologists will see barium through the gastrointestinal tract using fluoroscopy and fluoroscopy. The table will tilt in different positions and you may be asked to change position to distribute the barium. You will be put lightly pressure on your abdomen using a belt or the hand of the radiologist. You will also be prompted to cough so that the radiologist can more easily see changes in barium flow.

If you also do an examination of the small intestine, the radiologist will see the transfer of barium from the small intestine to the large intestine. X-rays are taken every 30 minutes.

The UGI series test lasts 30 to 40 minutes. The UGI series with examination of the small intestine lasts from 2 to 6 hours. In some cases, you will be asked to return after 24 hours to return for an x-ray.

What should I do after passing the barium swallow?

After completing the UGI series, you are allowed to eat and drink as usual, unless your doctor tells you to.

You may be given a laxative or enema to remove the barium in your intestines and avoid constipation. Drink plenty of water over several days to remove barium from your body.

Explanation of test results

What do the test results mean?

Hello Health Group does not provide medical advice, diagnosis or treatment.

Barium Swallow

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Bari swallow (upper gastrointestinal series or “upper GI series”)

What is a test?

Barium Labyrinth or Upper GI Series is an X-ray test used to examine the upper digestive tract (esophagus, stomach and small intestine). Since these organs are usually not visible on x-rays, you need to swallow barium, the liquid that appears on x-rays.Barium temporarily covers the lining of the esophagus, stomach, and intestines, making the outline of these organs visible on x-rays. This test is useful for diagnosing cancer, ulcers, problems that cause narrowing of the esophagus, some causes of inflammation in the intestines, and some problems with swallowing.

How do I prepare for the test?

Tell your doctor and X-ray technicians if there is a possibility that you may be pregnant. If you have diabetes and are taking insulin, discuss this with your doctor before the test.

Stop eating and drinking the night before your test. This is important because food in your stomach or intestines can prevent doctors from seeing the clear outlines of these structures on x-rays. Generally, you do not need to take your regular pills, but you should consult your doctor.

What happens during the test?

You are wearing a hospital test gown. At the beginning of the test, you drink barium, a liquid similar to a milkshake but not very tasty (most patients say it tastes like chalk).You may also be asked to swallow several pills that “sizzle,” causing air bubbles to be released in your stomach. This may make you feel like burping, but try not to. You will get better pictures if you can keep it from coming off.

The X-ray technician may ask you to stand or lie in different positions for the next few minutes to help diffuse the fluid you have swallowed.Most often, X-rays are taken while you are lying on your back on a table. The X-ray machine or table is moved several times so that it can photograph all internal structures. You are asked to hold your breath for each shot so that your breathing movement does not obliterate the image.

What risks are there from the test?

There are no significant risks. During the test, you are exposed to a small amount of radiation, but the amount of radiation is too small to cause any health problems.

Do I have to do something special after completing the test?

After the test, you can eat normally and carry out your normal activities. You should drink more water than usual to help clear out the barium and prevent constipation, which can be a side effect of the test. Your stools may appear light in color for several days.

How long did it take before the test result was received?

An X-ray unit takes 30 minutes to an hour to develop photographs of your barium swallow, and it will take additional time for the doctor to examine the X-rays and decide what they look like.You can usually get results within a day or two.

90,000 💊 Barium Swallow: what to expect, side effects and cost

What is a barium swallow?

The Barium Labyrinth is a special type of X-ray test that helps your doctor look closely at the back of the mouth and throat, known as the pharynx, and the tube that extends from the back of the tongue to the stomach, known as the esophagus.

Your doctor may ask you to make a barium swallow to help diagnose any complications that make it difficult for you to swallow or if they suspect you have an upper gastrointestinal (GI) disorder.Your upper gastric tract includes:

• esophagus
• stomach
• first part of the small intestine called duot enum

To make the barium maze, you swallow a fine white substance known as barium. It is often mixed with water to make a thick milkshake-like drink. When swallowed, this liquid coats the inside of your upper GI.

Barium absorbs X-rays and appears white on X-ray film.This helps to highlight these organs, as well as their internal lining and the movement of your swallowing in the X-ray image. These images help your doctor diagnose any gastrointestinal disorder.

Intended Purpose What condition helps to diagnose the barium swallow?

Your doctor may order a barium tube to help diagnose possible structural or functional problems with your upper GI tract. Some common problems that barium diabetes can cause include:

• hiatus hernia
• inflammation
• rubble
• Muscle disorders that can lead to difficulty swallowing or spasms
• gastroesophageal reflux disease (GERD)
• ulcers
• both cancerous and non-cancerous tumors

Sometimes the barium swallow is performed as part of a series of X-rays that look at the entire upper gastric tract.A continuous x-ray, called a fluoroscope, is often used during barium swallowing to capture movement through your gastrointestinal tract.

A common test that accompanies the barium maze is upper GI endoscopy, also known as esophagogastroduodenoscopy or EGD. Barium swallows are also often performed as part of a series of GI and small bowel tests.

Preparation How to prepare for baric swallow

It is important to follow the dietary advice your doctor gives you before your procedure.You should not eat or drink anything six hours before your procedure. You can take small sips of water up to two hours before your procedure.

If you are doing additional tests or have any existing medical conditions, your doctor’s instructions may be slightly different. You must notify your doctor prior to your procedure if you have or have had any of the following conditions:

• perforation of the esophagus or intestines
• intestinal obstruction
• Difficulty swallowing
• strong constipation

These conditions may disqualify you from doing the barium maze, as they increase the risk of complications.

Procedure What to Expect

Your doctor will refer you to your local radiology office for your barium swallow. The procedure must be completed by a trained radiology technician. From start to finish, barium swallow takes about 30 minutes. You will receive results within a few days after the procedure.

Once you are in the radiology facility, you will be asked to take off your clothes and jewelry and lock your belongings in a locker. You will be transferred to a medical gown provided by your doctor.

Your specialist will place you on the X-ray table. They may ask you to reposition your body as they take standard x-rays of your heart, lungs, and abdomen.

Then your technician will give you a barium drink to swallow. They will take a single X-ray, a series of X-rays, or fluoroscopy to see how the barium travels down your throat. You may need to hold your breath at certain times to prevent movement from X-ray images.

Next, the technician will give you a finer barium drink to swallow. They will take x-rays or fluoroscopy again to see how the barium moves up the esophagus.

When all X-rays are complete, you can pack your belongings and leave. You can return to your normal diet and daily activities after the barium swallowing procedure, unless your doctor recommends otherwise.

Within a few days, your doctor’s office will be in contact with your test results and schedule any follow-up action that may be required.

ImagesBarium swallowing images

Here is an example of a routine barium swallow study showing that barium (a dark liquid) moves down the esophagus without any leakage or regurgitation (reflux):

Image source: Photo: Anka Friedrich / Wikimedia Commons. Wikimedia. org / wiki / File: Normal_barium_swallow_animation. gif

Photo: Anka Friedrich / commons. Wikimedia. org

TasteWhat makes barium swallow taste?

The baryon you swallow is artificially flavored and sweetened.However, many people report that it tastes bitter or petty.

Costaarium cost swallow

If you have health insurance, the barium maze can be covered in whole or in part. If you don’t have insurance, the procedure can cost between $ 300 and $ 450. This covers the time it takes for your doctor to interpret the X-rays, as well as the cost of the technicians who perform the procedure.

Side Effects Side Effects in Barium

If barium is not completely eliminated from your body after the procedure, it can sometimes cause constipation or fecal impotence.You should drink plenty of fluids and eat foods high in fiber to help move barium through your digestive tract and out of your body. If that doesn’t work, your doctor may give you a laxative to help move it.

After the procedure, you may notice that your bowel movements are lighter in color. This is because your body does not absorb barium. Your stool will return to its normal color once all of the barium is expelled.

Do not forget to see a doctor immediately if:

• You have problems with bowel movements or no bowel movement.
• You have pain or bloating in your stomach.
• You have smaller stools than usual.

In addition, barium swallows include irradiation like all X-ray procedures. The risks of complications associated with radiation exposure accumulate over time and are associated with the number of X-ray exams and procedures a person receives in their life. It may be helpful to share your previous radiation therapy protocol with your doctor before swallowing barium.

Exposure to radiation during pregnancy can cause birth defects in unborn fetuses. Because of this, pregnant women should not undergo barium swallow procedures.

Barium Labyrinth vs. Endoscopy Baryon Swallow vs. Endoscopy

Barium swallow is a less invasive way of looking at the upper gastric tract than endoscopy. Barium swallows are a useful diagnostic tool for checking for upper gastrointestinal abnormalities that are easily diagnosed with X-rays alone.More complex disorders require endoscopy.

Tips How to Stay Comfortable

Here’s how to care before, during and after the barium swallow:

Tips

• Wear unassuming clothing that is easy to remove and put back.
• Remove all home decorations before proceeding.
• Be sure to eat and drink enough the night before your procedure, before starting quickly at midnight. This can help schedule your barium swallow for the first thing in the morning, so you don’t have to avoid eating or drinking for too long.