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Risks of barium swallow: The request could not be satisfied


Barium Swallow (Esophagram) – Cabell Huntington Hospital

What is a barium swallow?

A barium swallow is a radiographic (X-ray) examination of the upper gastrointestinal (GI) tract, specifically the pharynx (back of mouth and throat) and the esophagus (a hollow tube of muscle extending from below the tongue to the stomach). The pharynx and esophagus are made visible on X-ray film by a liquid suspension called barium sulfate (barium). Barium highlights certain areas in the body to create a clearer picture. A barium swallow may be performed separately or as part of an upper gastrointestinal (UGI) series, which evaluates the esophagus, stomach, and duodenum (first part of the small intestine).

Fluoroscopy [LINK] is often used during a barium swallow to study moving body structures — similar to an X-ray “movie.” In barium X-rays, fluoroscopy allows the radiologist to see the movement of the barium through the pharynx and esophagus as a person drinks.

What are the reasons for a barium swallow?

A barium swallow may be performed to diagnose structural or functional abnormalities of the pharynx and esophagus. These abnormalities may include, but are not limited to:

  • Cancers of the head, neck, pharynx, and esophagu
  • Tumors
  • Hiatal hernia, an upward movement of the stomach, either into or alongside the esophagus
  • Structural problems such as diverticula, strictures, or polyps (growths)
  • Esophageal varices (enlarged veins)
  • Muscle disorders (pharyngeal or esophageal) such as dysphagia (difficulty swallowing) or spasms (pharyngeal or esophageal)
  • Achalasia, 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

There may be other reasons for your doctor to recommend a barium swallow.

What are the risks of a barium swallow?

You may want to ask your doctor about the amount of radiation used during the procedure and the risks related to your particular situation. It’s a good idea to keep a record of your past history of radiation exposure, such as previous scans and other types of X-rays, so that you can inform your doctor. Risks associated with radiation exposure may be related to the cumulative number of X-ray examinations and/or treatments over a long period of time.

If you’re pregnant or suspect that you may be pregnant, you should notify your doctor. Radiation exposure during pregnancy may lead to birth defects.

Patients who are allergic to or sensitive to medications, contrast dyes, iodine, or latex should notify their doctor.

Constipation or fecal impaction may occur if the barium isn’t completely eliminated from the body.

Contraindications for a barium swallow may include, but are not limited to:

  • Esophageal or bowel perforation/li>
  • Bowel obstruction or severe constipation
  • Pregnancy
  • Severe swallowing difficulty such that aspiration (entry of substances into the lungs) of barium is likely

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

How do I prepare for a barium swallow?

PRECAUTIONS: If you are pregnant or think you may be pregnant, please check with your doctor before scheduling the exam. Notify the radiologist if you have had a recent barium X-ray or gastrointestinal surgical procedure, as this may interfere with obtaining an optimal X-ray exposure of the upper GI area.

EAT/DRINK: You must follow the food and drink guidelines to ensure you are prepared for your exam. The night before your exam, do not eat or drink anything after midnight.

What happens during a barium swallow?

A barium swallow may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices.

Generally, a barium swallow follows this process:

  • You will be asked to remove any clothing, jewelry, or other objects that may interfere with the procedure.
  • If you are asked to remove clothing, you will be given a gown to wear.
  • You will be positioned on an X-ray table that can tilt you from a horizontal to an upright position. You may also be asked to change positions (for example, lying on your side, back, or stomach) at intervals during the procedure.
  • Standard X-rays of the heart, lung and abdomen may be performed first.
  • The radiologist will ask you to take a swallow of a barium drink. The barium is usually flavored, although it may not be very pleasant tasting.
  • As you swallow the barium, the radiologist will take single pictures, a series of X-rays, or a video (fluoroscopy) to observe the barium moving through the pharynx.
  • You may be asked to hold your breath at certain times during the procedure.
  • You may be given a thinner barium drink to swallow. X-rays and/or fluoroscopy will be used to observe the barium’s passage down the esophagus. You may also be asked to swallow a barium tablet — a small, solid pill, which can help to visualize certain structural problems of the esophagus.
  • Once all required X-rays have been taken, you’ll be assisted from the table.

What happens after a barium swallow?

You may resume your normal diet and activities after a barium swallow, unless your doctor advises you differently.

Barium may cause constipation or possible impaction after the procedure if it isn’t completely eliminated from your body. You may be advised to drink plenty of fluids to expel the barium from the body. You may also be given acathartic or laxative to help expel the barium.

Since barium isn’t absorbed into the body but passes through the entire intestinal tract, your bowel movements may be lighter in color until all of the barium has been excreted.

Notify your doctor to report any of the following:

  • Difficulty with bowel movements or inability to have a bowel movement
  • Pain and/or distention of the abdomen
  • Stools that are smaller in diameter than normal

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

Modified Barium Swallow

What is a modified Barium Swallow?

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

Purpose of the Modified Barium Swallow

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

Before the Modified Barium Swallow

  • Tell your doctor if you are or could be pregnant.

What You Experience

  • You may be seated in a special chair designed for this exam.
  • You will consume barium containing product of different consistencies The consistency of the items vary, ranging from thin liquid to semisolid foods (for example, pudding) or solid foods (such as a cookie).
  • As you swallow different amounts of the items, the examiners use fluoroscopic imaging to observe the swallowing process on a television screen in order to determine which foods are difficult for you to swallow and which structures are responsible for the problem. The swallowing process may be observed at normal speed or in slow motion.
  • Other than chewing and swallowing, you must remain still during the procedure.
  • A speech pathologist is present during the test to evaluate your swallowing ability and, if possible, to suggest some possible corrective actions.
  • The test usually takes 30 minutes depending on the findings.

After the Modified Barium Swallow

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


The Modified Barium Swallow Study: When, How, and Why?

CE credit is available for this article at appliedradiology.org/aici.

Dysphagia, or difficulty swallowing, can be caused by a number of conditions, including stroke, oropharyngeal and esophageal cancers and cancer treatments, a number of neurologic diseases, and gastroesophageal reflux disease.1 Procedures that result in long-term and/or complicated intubation can also result in dysphagia, with two-thirds of patients intubated for more than 48 hours following intubation or surgery demonstrating signs and/or symptoms of dysphagia.2,3 As a result of a number of related, potentially serious clinical complications, including starvation, dehydration, airway obstruction, and aspiration, patients with dysphagia experience greater risk of pneumonia, reintubation, and death. 4-6 Although effective management of swallowing disorders has been shown to improve quality of life (QOL), dysphagia has a significant negative impact on both patients and caregivers.7,8

An estimated 8% of the world’s population, or almost 600 million people, are affected by dysphagia.9 Due to the presence of comorbidities, the elderly have additional risk,10 with a reported prevalence of dysphagia of 17%,11 and dysphagia associated with feeding difficulties reported in up to 60% of nursing home residents.11 With the aging of the population, as well as the increasing prevalence of obesity and gastroesophageal reflux disease,10 the number of individuals suffering with dysphagia is expected to rise. Attempts to identify the cause of dysphagia, and the proposal and implementation of effective strategies to minimize the effects of dysphagia, represent important clinical objectives.

The modified barium swallow study (MBSS), a real-time fluoroscopic motion study, is the reference standard to assess swallowing physiology involving the oropharynx and esophagus. Here, we discuss technical considerations for the MBSS as it is performed in adults at The Johns Hopkins Hospital, with a focus on the importance of standardization of contrast, and collaboration between radiologists and speech-language pathologists (SLPs).


The MBSS, also known as a video fluoroscopic swallow study (VFSS), is optimally performed by an SLP together with a radiologist, assisted by a radiologic technologist, to evaluate anatomy and swallowing physiology simultaneously in real time. The goals of the MBSS are to assess both swallowing function and safety (eg, aspiration, choking). In addition to identifying the presence of disordered swallowing physiology, a critical portion of the exam is an evaluation of compensatory strategies the patient may be able to use to enhance swallowing efficiency and/or reduce risk. The report generated from combining outcomes from the patient’s swallowing — with and without compensations — will result in recommendations for the least restrictive but safe dietary consistencies that will keep the patient adequately hydrated and nourished. 12 Depending on the cause of the dysphagia, the patient’s care team may include a number of additional clinicians, including those in gastroenterology, thoracic surgery, neurology, otolaryngology-head and neck surgery, and physical medicine. Collaboration as a multidisciplinary team is essential in the clinical role of the MBSS.

The MBSS was first introduced to SLPs in the 1980s by Jerilyn Ann Logemann, PhD, an SLP at Northwestern University.13 Dr. Logemann was one of the original founding members of the Dysphagia Research Society and associate editor of the journal Dysphagia since its inception in 1985. Several radiologists, including Martin Donner, MD, Bronwyn Jones, MD, and Bob Gayler, MD, have also been influential in the study of dysphagia, contributing to the literature, editing journals, and fostering the growth of medical societies, including the Dysphagia Research Society, which seek to better understand and manage dysphagia.13,14 The work of these individuals was done at The Johns Hopkins Hospital, where they worked for decades to develop and refine the MBSS from both the radiologist’s and SLP’s perspectives.

The Johns Hopkins MBSS protocol: Technical and patient considerations

Patients with suspected dysphagia are first clinically evaluated — for inpatients, at the bedside by an SLP, or for outpatients, by an SLP or other specialty clinician in an outpatient setting. If appropriate after the clinical evaluation, the patient is referred for an MBSS. Exceptions where the patients are automatically sent for an MBSS include new tracheostomy placements and those for whom it is necessary to rule out an esophageal leak. The MBSS is not appropriate in cases when the patient is unable to be cooperative, or if they have an allergy to one or more of the additives in barium sulfate contrast agents (very rare).1

At the start of the MBSS, the patient is typically standing or seated in a special chair, and placed in the space between the fluoroscopic table and the image intensifier. Variations in X-ray equipment (eg, C-arm vs standard fluoroscopic unit) or limitations in the patient’s mobility (eg, ability to sit or stand) can necessitate modifications in patient positioning. In terms of temporal resolution, 30 frames per second, which is the standard continuous fluoroscopic image rate, is required during the swallow study to allow for the freeze-frame and slow-motion video viewing essential to understanding swallowing physiology.15 The standard lateral view is from lips to cervical spine and from the nasopharynx to the upper esophageal sphincter (with care taken to minimize eye exposure).16 Use of typical lead shielding for both clinicians and patients has been shown to be adequate for protection during the MBSS.17,18

Prior to the MBSS, preliminary scout images are reviewed for any findings that potentially impact swallowing physiology (eg, swelling, arthritis, abnormal air), and a pre-examination discussion occurs between the radiologist and SLP. Then, for most patients, both lateral and anterior-posterior (AP) views will be obtained during swallowing (Figures 1-3). The SLP and the radiologist then follow the standardized protocol set forth by the Modified Barium Swallowing Impairment Profile (MBSImP). 16 The MBSImP protocol necessitates the use of Varibar® barium sulfate (Bracco Diagnostics Inc., Monroe Twp., NJ),19,23 the only standardized preparation of barium sulfate specifically for use during the MBSS. To this end, patients are presented with a series of the barium-sulfate–containing products, from thin to thick in consistency, and from a lower volume to higher volume; specifically, 5 mL thin liquid, graduating to 15 mL thin liquid, then a single sip from a cup or straw, then continuous sips from a cup or straw, progressing similarly to nectar, to honey, to pudding, and finally, to a cookie dipped in pudding.12 Most often, a complete series from thin to barium-coated cookie is completed, but exceptions exist where the clinical scenario dictates omitting consistencies or changing the order in which they are given, at the discretion of the SLP and radiologist. In the lateral view, it is relatively easy to observe most of the components of swallowing, with the exceptions of pharyngeal contraction, lateralization of residue, and the esophagus, which are better evaluated in the AP view. Therefore, toward the end of exam, the patient is turned to the AP view to assess these components. The appearance of glottic closure and opening (ie, adduction and abduction of the arytenoid cartilages) is also assessed by eliciting phonation in the AP view. It should be noted that a full evaluation of the esophagus cannot be done following a full pharynx exam, since the various consistencies of barium sulfate will interfere with esophagus mucosal assessment. In addition, a proper esophageal evaluation includes the horizontal orientation for evaluation of peristalsis and gastroesophageal reflux.

During the examination, the radiologist and SLP are viewing the same images to evaluate swallowing physiology. As both radiologist and SLP have a unique expertise and perspective, having both present and interacting to interpret the fluoroscopy images contributes to the quality of the exam and improves patient outcomes.24 In addition, as the exam is performed in real time, there are clear advantages to having two individuals observing and/or reviewing the swallow study. Both the continuous dialogue and the collaboration between the two specialists and the patient are considered necessary for a most effective and successful MBSS.

Once disordered swallowing physiology is identified, the SLP can implement a compensatory posture (eg, tucking the chin down, turning or tilting the patient’s head to the right or left) or maneuver (eg, supraglottic swallow, Mendelsohn maneuver) to attempt to change the swallowing dynamics on the next swallow of the same volume/consistency, improving function and/or safety.25

After the exam, the SLP uses slow motion and frame-by-frame analysis to carefully review the MBSS images and recommend a therapeutic regimen, often in consultation with the radiologist. The regimen is individually tailored to the patient’s specific swallowing physiology to improve his or her ability to obtain adequate and safe nutrition, and may be composed of any combination of postures, exercises, and/or diet consistency changes.

The MBSS is a diagnostic study; it is not a screening that provides a binary “pass” or “fail” result, nor is it a test to determine the presence of aspiration. The MBSS provides a real-time assessment of swallowing physiology and functional outcome, a necessary step toward safe swallowing and rehabilitation.

Importance of standardization

The MBSS is, to some extent, a subjective test; therefore, standardizing the exam has the potential to increase its robustness and decrease the variability of its results. Beneficial effects of standardization also include increased inter-rater reliability, enhanced communication between the radiologist and SLP, and increased capability of clinicians to determine which strategies potentially improve swallowing function and/or safety. In addition, such standardization facilitates intrapatient, interpatient, and cross-population comparisons, while contributing to the clinical training of both radiologists and SLPs who execute and are interested in MBSSs.

There are two main aspects of the MBSS that have been successfully standardized: (1) the barium products of various consistencies used during the exam, and (2) the method of assessment and reporting of the MBSS results.

Standardized barium-sulfate-containing contrast agent consistencies

To date, the Varibar series is the only FDA-approved set of standardized barium sulfate products available in varying consistencies for evaluation of the oropharyngeal swallow and esophageal clearance.19-23 Varibar is made specifically for oropharyngeal swallow examinations and is available in 5 consistencies (ie, thin liquid, thin honey, honey, nectar, pudding), all containing the same concentration of barium sulfate (40% weight/volume).19-23,26 Use of a set of standardized barium sulfate contrast agents in place of homemade barium sulfate products reduces preparation time and wasted materials, supports high-quality imaging,27,28 and enables reproducible results.27-30 Moreover, nomenclature is standardized such that all clinicians are using the same terminology to describe the clinical findings with the different consistency products — so regardless of where the examination is performed, thin liquid, honey, etc., always means the same thing.

Standardization of scoring and reporting the MBSS with the MBSImP

The MBSImP, developed by Bonnie Martin-Harris, PhD and colleagues, is a standardized protocol to interpret and communicate swallowing impairment in a manner that is specific, consistent, accurate, and objective.16 The MBSImP scores 17 identified components of swallowing function and bolus clearance during the MBSS for each barium-sulfate–containing product.16 The MBSImP is particularly powerful because it is used in conjunction with the Varibar series such that all patients are assessed with standardized barium sulfate measurements and consistencies, ensuring that the same information (eg, definitions of mild, moderate, severe for each component for each consistency) is recorded in the patient’s record. At The Johns Hopkins Hospital, the use of the MBSImP is part of the training for all staff administering and scoring the MBSS.


Patients with suspected dysphagia are best evaluated by a radiologist together with an SLP, using the MBSS (ie, real-time fluoroscopy). To enhance robustness of the MBSS, both the barium sulfate contrast and the swallowing function scoring are standardized using Varibar and the MBSImP, respectively. More than just a diagnostic exam, MBSS allows for strategies to be evaluated that are likely to improve the swallowing function, safety, and QOL in dysphagia patients.

Acknowledgements: The authors thank Bronwyn Jones, MD, and Bob Gayler, MD, for expert review of this article, and Cindy Schultz, PhD, for medical writing assistance.


  1. Peterson R. Modified Barium Swallow for Evaluation of Dysphagia. Radiol Technol. 2018;89:257-275.
  2. Skoretz SA, Flowers HL, Martino R. The incidence of dysphagia following endotracheal intubation: a systematic review. Chest. 2010;137:665-673.
  3. Skoretz SA, Yau TM, Ivanov J, Granton JT, Martino R. Dysphagia and associated risk factors following extubation in cardiovascular surgical patients. Dysphagia. 2014;29:647-654.
  4. Palmer JB, Drennan JC, Baba M. Evaluation and treatment of swallowing impairments. Am Fam Physician. 2000;61:2453-2462.
  5. Popa Nita S, Murith M, Chisholm H, Engmann J. Matching the rheological properties of videofluoroscopic contrast agents and thickened liquid prescriptions. Dysphagia. 2013;28:245-252.
  6. Macht M, Wimbish T, Clark BJ, et al. Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness. Crit Care. 2011;15:R231.
  7. Singh S, Hamdy S. Dysphagia in stroke patients. Postgrad Med J. 2006;82:383-391.
  8. Namasivayam-MacDonald AM, Shune SE. The Burden of Dysphagia on Family Caregivers of the Elderly: A Systematic Review. Geriatrics (Basel). 2018;3:1-14.
  9. Cichero JA, Lam P, Steele CM, et al. Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management: the IDDSI Framework. Dysphagia. 2017;32:293-314.
  10. Aslam M, Vaezi MF. Dysphagia in the elderly. Gastroenterol Hepatol (N Y). 2013;9:784-795.
  11. Jardine M, Miles A, Allen JE. Swallowing function in advanced age. Curr Opin Otolaryngol Head Neck Surg. 2018;26:367-374.
  12. Martin-Harris B, Jones B. The videofluorographic swallowing study. Phys Med Rehabil Clin N Am. 2008;19:769-785.
  13. Logemann JA. Manual for the videofluorographic study of swallowing. 2nd ed. ProEd; Austin: 1993.
  14. Jones B, Donner, MW. Normal and abnormal swallowing: Imaging in diagnosis and therapy. Springer Verlag; New York: 1991.
  15. Bonilha HS, Blair J, Carnes B, et al. Preliminary investigation of the effect of pulse rate on judgments of swallowing impairment and treatment recommendations. Dysphagia. 2013;28:528-538.
  16. Martin-Harris B, Brodsky MB, Michel Y, et al. MBS measurement tool for swallow impairment–MBSImp: establishing a standard. Dysphagia. 2008;23:392-405.
  17. Hayes A, Alspaugh JM, Bartelt D, et al. Radiation safety for the speech-language pathologist. Dysphagia. 2009;24:274-279.
  18. Bonilha HS, Huda W, Wilmskoetter J, Martin-Harris B, Tipnis SV. Radiation Risks to Adult Patients Undergoing Modified Barium Swallow Studies. Dysphagia. 2019;Mar 4.
  19. VARIBAR® THIN LIQUID (barium sulfate) for oral suspension full Prescribing Information. Monroe Twp., NJ: Bracco Diagnostics Inc.; April 2019.
  20. VARIBAR® THIN HONEY oral suspension full Prescribing Information. Monroe Twp., NJ: Bracco Diagnostics Inc.; January 2018.
  21. VARIBAR® HONEY (barium sulfate) oral suspension full Prescribing Information. Monroe Twp., NJ: Bracco Diagnostics Inc.; March 2018
  22. VARIBAR® NECTAR (barium sulfate) oral suspension full Prescribing Information. Monroe Twp., NJ: Bracco Diagnostics Inc.; February 2018
  23. VARIBAR® PUDDING (barium sulfate) oral paste full Prescribing Information. Monroe Twp, NJ: Bracco Diagnostics Inc.; Oct. 2016.
  24. Jones J. Case Study: Collaboration Comes Standard. March 2018. Available at: https://www.acr.org/-/media/ACR/Files/Case-Studies/Quality-and-Safety/CollaborationComesStandard/Imaging3_CollaborationComesStandard_March3018-(1).pdf. Accessed: June 4, 2019.
  25. Martin BJ, Logemann JA, Shaker R, Dodds WJ. Normal laryngeal valving patterns during three breath-hold maneuvers: a pilot investigation. Dysphagia. 1993;8:11-20.
  26. Steele CM, Barbon C, Namasivayam A. Best Practices in Videofluoroscopy. Dysphagia Cafe. Available at: https://dysphagiacafe.wordpress.com/2014/03/19/best-practice-in-videofluoroscopy-by-dr-catriona-steele-carly-barbon-and-ashwini-namasivayam/. Accessed May 20, 2019.
  27. Robbins JA, Nicosia M, Hind JA, Gill GD, Blanco R, Logemann J. Defining Physical Properties of Fluids for Dysphagia Evaluation and Treatment. Perspectives on Swallowing and Swallowing Disorders. Dysphagia. 2002;11:16-19.
  28. Martin-Harris B, Humphries K, Garand KL. The Modified Barium Swallow Impairment Profile (MBSImP™©) – Innovation, Dissemination and Implementation. Perspectives of the ASHA Special Interest Groups. 2017:2:129-138.
  29. Hind J, Divyak E, Zielinski J, et al. Comparison of standardized bariums with varying rheological parameters on swallowing kinematics in males. J Rehabil Res Dev. 2012;49:1399-1404.
  30. Steele CM, Molfenter SM, Péladeau-Pigeon M, Stokely S. Challenges in preparing contrast media for videofluoroscopy. Dysphagia. 2013;28:464-467.

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Swallowing Study | Michigan Medicine

Test Overview

A swallowing study is a test that shows what your throat and esophagus do while you swallow. The test uses X-rays in real time (fluoroscopy) and records what happens when you swallow. While you swallow, the doctor and speech pathologist watch a video screen.

For a swallowing study, you will swallow liquid mixed with a substance called barium. Or you might swallow solid foods coated with barium.

The barium shows the movements of your throat and esophagus on the X-ray while you swallow.

Why It Is Done

The test helps your doctor see why you’re having trouble swallowing. After treatment, it can also show your doctor if the treatment worked.

How To Prepare

Your doctor may tell you not to eat anything after midnight the night before the test.

How It Is Done

Before the test

  • Remove any jewelry that might get in the way of the X-ray picture.
  • You may need to take off all or most of your clothes around the area being X-rayed.
  • You may be given a gown to wear during the test.
  • A lead shield will be placed over your pelvic area to protect it from radiation.

During the test

  • You will stand or sit in front of the X-ray machine while the test is done.
  • The doctor and a speech pathologist will guide you through a series of swallowing steps.
  • Depending on the type of study, you will swallow liquid mixed with barium or solid foods coated with barium.
  • While you swallow, the doctor and speech pathologist will watch the video screen. They may ask you to take different positions to see how they affect your swallowing. The X-rays are recorded so they can be looked at later.

How long the test takes

The test will take about 20 to 30 minutes.

How It Feels

You won’t feel any pain from the X-ray. The barium liquid is thick and chalky, and some people find it hard to swallow. A sweet flavor, like chocolate or strawberry, is used to make it easier to drink.


The barium in the food isn’t harmful.

Some people gag when they drink the barium fluid. In rare cases, a person may choke and inhale (aspirate) some of the liquid into the lungs.

There is a small chance that the barium will block the intestine or leak into the belly through a perforated ulcer.

If your doctor thinks you may be at risk for complications, he or she may use a special type of contrast material (Gastrografin) instead of barium.

There is always a small chance of damage to cells or tissue from being exposed to any radiation, even the low level of radiation used for this test.



The throat and esophagus look normal while you swallow. They do not have swelling, an injury, narrowing, or foreign objects.


The throat and esophagus don’t look normal while you swallow. The test shows swelling, an injury, narrowing, or foreign objects that make it hard to swallow.


Current as of:
September 23, 2020

Author: Healthwise Staff
Medical Review:
Kathleen Romito MD – Family Medicine
Adam Husney MD – Family Medicine
Martin J. Gabica MD – Family Medicine
Peter J. Kahrilas MD – Gastroenterology

Current as of: September 23, 2020

Healthwise Staff

Medical Review:Kathleen Romito MD – Family Medicine & Adam Husney MD – Family Medicine & Martin J. Gabica MD – Family Medicine & Peter J. Kahrilas MD – Gastroenterology

Barium Swallow | Hackensack Meridian Health

You may have a barium swallow as an outpatient 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.

  • You’ll be asked to remove any clothing, jewelry, or other objects that may get in the way of the 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 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 that resembles a shake. The barium is usually flavored like strawberry or chocolate, but it may not taste very good. The barium coats the lining of your GI tract.

  • 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.

  • The radiologist will use X-rays or fluoroscopy to watch the barium go down your esophagus and then through the rest of your GI tract. 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. The technician may put pressure on your belly to help move the barium through your GI tract.

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

  • Barium Swallow Barium Meal | MUSC Health

    A barium examination of the throat and esophagus is referred to as barium swallow test. A barium examination of the stomach and the first part of the small intestine) is called a barium meal test. The patient swallows a variable combination of barium (a liquid that enhances X-ray images) and gas (also known as fizzes), and stands in front of an X-rays scanner.


    The barium swallow test, or esophagram, is useful for investigating patients with a variety of complaints that may be due to abnormalities within the esophagus. A few examples of such symptoms include difficulty swallowing (dysphagia), heartburn (dyspepsia), or gastroesophageal reflux (GERD).

    The esophagram may reveal abnormalities which account for one or more of the above symptoms. Abnormalities include strictures, ulceration of the esophagus, hiatal hernia (abnormal positioning of a portion of the stomach within the chest), presence of a mass lesion such as a polyp within the esophagus, and gastroesophageal reflux.

    Whereas the esophagram consists only of a detailed examination of the esophagus, a barium meal test (or upper GI series) evaluates the stomach and upper small intestine. This test, as well as identifying some of the disorders of the esophagus already described, may also identify the presence of ulcers or tumors within the stomach.


    The success of the esophagram or upper GI series is for the most part related to patient preparation. It is necessary to stop eating and drinking the night before the test. The presence of food or excess fluid within the upper digestive tract will significantly reduce the diagnostic accuracy of the study and most likely mean the test will have to be canceled. If patients need to take medications on the morning of the study, we ask that they consult their doctor beforehand. Patients are also asked not to smoke on the morning of the test, as this too alters the accuracy of the study.

    Prior to the examination the technologist will ask a number of questions including whether or not the patient has any allergies, any previous surgery or whether they are taking any medication. As both studies involve a small amount of radiation, it is important that the patient makes the technologist and radiologist aware if they are pregnant or think they may be pregnant.

    The examination

    At the beginning of the examination the patient will be asked to swallow liquid barium and a combination of granules and citric acid. The granules and citric acid together produce carbon dioxide which distends the barium coated esophagus and stomach. It is most important that the gas produced by the fizzes remains within the stomach so maintaining maximum distension. It is therefore necessary for the patient not to burp even if they feel they need to. The radiologist uses a fluoroscopy unit (X-ray machine) to visualize the esophagus and stomach. The patient is asked to stand or lie in different positions in order to produce the best images. Each time an X-ray is taken the patient is asked to hold their breath for a brief moment. After completion of the examination the patient waits briefly in order to make sure that the images are entirely satisfactory before being discharged.

    What happens after the test?

    Following the procedure the patient can return immediately to normal diet and activity. It is usually advisable for the patient to drink more water than is usual, as this will help to relieve any constipation that may occur following the barium examination. The bowel movements may appear white or light for a day or two and this is entirely normal.


    Any fluoroscopy study involves a small amount of radiation. However, through appropriate training, practice, and experience, radiologists ensure that the radiation is kept to a minimum by a variety of measures. The radiation dose is small and the benefits of this test far outweigh the risks. The examinations themselves are essentially free of risk. One possible complication in elderly and debilitated patients is aspiration of a small amount of barium into the lungs. However, this can be identified immediately during the examination, and with subsequent chest physiotherapy is likely of no long-term significance.

    Barium Swallow Article

    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.


    • 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.


    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.


    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.


    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.


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


    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.


    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.


    • Esophageal diverticula (Zenker’s, mid-esophageal, and epiphrenic)
    • Strictures
    • Ulcerations
    • Hiatal hernia

    Neoplastic, Benign

    • Fibrovascular polyps
    • Lipomas
    • Leiomyomas

    Neoplastic, Malignant

    • Adenocarcinoma
    • Small cell carcinoma
    • Gastrointestinal stromal tumor (potentially)
    • Leiomyosarcoma


    • Achalasia
    • Hypertensive lower esophageal sphincter
    • Diffuse esophageal spasm
    • Ineffective esophageal motility/hypotensive peristalsis


    • Iatrogenic injury – endoscopy, laryngoscopy
    • Perforation – blunt/penetrating trauma
    • Perforation – effort (Boerhaave’s Syndrome)
    • Post-caustic injury stricture


    • Esophageal atresia/stricture
    • Tracheoesophageal fistula

    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.

    (Click Image to Enlarge)

    Single frontal image taken during a barium swallow exam demonstrating contrast in the esophagus.

    Contributed by Dr.Dawood Tafti, MD

    (Click Image to Enlarge)

    Single lateral image demonstrates phonation evaluation at the level of the hypopharynx.

    Contributed by Dr.Dawood Tafti, MD

    (Click Image to Enlarge)

    Single lateral image of the hypopharynx demonstrates phonation evaluation.

    Contributed by Dr.Dawood Tafti, MD.

    (Click Image to Enlarge)

    Single frontal magnified field of view of the hypopharnx during phonation evaluation.

    Contributed by Dr.Dawood Tafti, MD.

    (Click Image to Enlarge)

    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.

    Making an important pediatric diagnostic test easier to swallow | MUSC

    More than half a million children are diagnosed with swallowing problems each year. The gold standard for diagnosing swallowing problems is the videofluoroscopic swallow study, also known as the modified barium swallow study. While effective, the test has the drawback of exposing children to ionizing radiation. MUSC researcher Heather Bonilha, Ph.D., has received a five-year, almost $2.4 million grant from the National Institute of Diabetes and Digestive and Kidney Diseases to gather data on how best to maximize the diagnostic accuracy of the swallow study while minimizing the risk posed by ionizing radiation. 

    “This test is our way to visualize a patient’s swallow,” explained Bonilha, who is an associate professor in the College of Health Professions. “It’s like an X-ray movie that lets us see what isn’t working when a patient swallows. It’s also used to test different treatment options so we can recommend the best treatment.”

    “When you change the pulse rate of a modified barium swallow study to attempt to reduce radiation, you’re actually changing the information you get and your diagnosis and treatment recommendations,”

    — Dr. Heather Bonilha

    Obtaining that X-ray movie of the swallow requires the use of ionizing radiation. Although the radiation causes no immediate damage (i.e., it does not cause burns), its cumulative effect on a child’s cancer risk is not known. 

    That lack of evidence has had led to a high degree of variability in how the test is conducted. Some clinicians trust that the test is safe and use the radiation they feel is necessary to obtain diagnostic accuracy. However, existing evidence does not rule out the potential of long-term consequences due to the radiation exposure in children. Others fear the potential cancer risks and lower the frequency at which the radiation is pulsed per second to minimize radiation exposure. However, Bonilha explained, doing so can reduce the study’s diagnostic precision. 

    “When you change the pulse rate of a modified barium swallow study to attempt to reduce radiation, you’re actually changingthe information you get and your diagnosis and treatment recommendations,” said Bonilha. 

    Bonilha surveyed 21 relatively large hospitals, six general hospitals and 15 children’s hospitals across the country about their approaches to the swallow study. Survey results showed that 47% of hospitals use pulse rates less than the recommended 30 pulses per second. 

    “So this is a widespread practice, which is really impacting the ability to diagnose swallowing impairment accurately in children,” said Bonilha.  

    More evidence is needed to find the right balance in children – one that ensures both safety and diagnostic accuracy. With that evidence in hand, clinicians will be able to adopt a more uniform approach to conducting this important pediatric study. 

    Bonilha and her colleagues previously answered these questions for clinicians treating adult patients in a March 2019 article in Dysphagia. That study showed that the recommended modified barium swallow radiation exposure for adults was very safe, posing little cancer risk.

    “For adults, radiation exposure from modified barium swallow studies was very, very low,” said Bonilha. “On average, it was 0.2 millisieverts, which, for perspective, is a lesser amount of radiation than is emitted from a person’s body in a year and similar to that associated with living on earth for 32 days. It’s a fifth of that of a mammogram and about an eighth of a head CT. So it puts modified barium swallow studies for adults in the very low radiation exposure range and shows there is a very low cancer risk.”

    But those findings in adults can’t just be applied to children, because developing cells in the thyroid and other organs have been shown to be more susceptible to radiation than mature ones. 

     Dr. Heather Bonilha 

    “The cancer risk for exposure of the thyroid is exponentially higher in children, especially female children, than in adults,” explained Bonilha. “The cancer risk per hundred thousand exposed to radiation is 634 for female infants but only 115 for male infants and four for 50-year-old women.”

    Although children have smaller bodies that don’t require as much radiation, their anatomical structures are smaller and often require greater magnification, meaning they will receive more radiation. They also have more years than adults to develop cancer.

    The new grant will enable Bonilha’s team to gather the evidence to assess the safety and diagnostic accuracy of the swallow study at various pulse rates in children of both sexes and all ages. This grant is the continuation of one that resulted directly from her research as one of the first K scholars of the South Carolina Clinical & Translational Research (SCTR) Institute, the Clinical and Translational Science Awards hub headquartered at MUSC. SCTR’s K program aims to transition early-stage investigators to an independent research career through a guided, mentored program.

    The team involved in this study includes MUSC researchers Sameer V. Tipnis, Ph.D., a medical physicist in the Department of Radiology, and Paul J. Nietert, Ph.D., a statistician in the Department of Public Health Sciences and director of SCTR’s  Biostatistics, Epidemiology and Research Design program. The team is collaborating with Maureen A. Lefton-Greif, Ph.D., a leading expert in pediatric swallowing impairment at Johns Hopkins University. For the earlier study in adults, they had also worked with Bonnie Martin-Harris, Ph.D., a leading expert in modified barium swallow studies at Northwestern University.

    The team will use previously obtained X-ray movies of swallow studies, simulate the lower pulse rate that many hospitals are using and show them to clinicians to see if they can still accurately diagnose the swallowing problem. In addition, it will track how much radiation was directed to which organs in these patients and then use that, along with their sex and age, to determine their cancer risks mathematically. 

     Bonilha believes the findings of these studies will have direct clinical relevance.

    “Regardless of how this project turns out, we’ll have supporting evidence for how clinicians’ practice patterns can progress,” she said. “So we’ll have a much better idea of whether we can move forward with using this exam in a very liberal fashion or whether we need to have higher safeguards in place.”  

    Clinical Research Deglevation Disorders: Cold Liquid Barium – Clinical Research Register

    Detailed Description

    Swallowing dysfunction, medically defined as dysphagia, usually occurs in newborns. prematurely due to inadequate timing and coordination of the necessary sensorimotor sequences for safe swallowing. Approximately 70% of preterm infants will be diagnosed with oral, pharyngeal and / or esophageal dysphagia, with an inverse relationship between severity and gestational age at birth.(1)

    Swallowing is extremely important for the infant and child to meet their nutritional needs. needs for growth and development. If swallowing is impaired, the consequences can be devastating to the infant, which can lead to complications including pneumonia, respiratory illness, impaired growth, or failure to develop (1-6). difficulty swallowing, therefore, are of great medical importance to the medical team working with these babies.

    Video Fluoroscopic Swallowing Examination (VFSS) is a widely used test for the diagnosis of neonatal dysphagia.VFSS is the definitive study to objectively assess the adequacy of airway protection during swallowing and the ability to simultaneously view the bolus as it passes through the oral, pharyngeal, and esophageal stages of swallowing. (7) For vial-fed infants, the physician relies on VFSS to both detect and correct swallowing. During VFSS, several therapies or modifications are used. improve swallowing safety in infants, such as varying teat flow rates, (8,9) feeding positions, (10) or stimulation of infant suckling attacks.(11) The most commonly used modification is to thicken infant formula or breast milk to a thicker consistency, (12-14) however, thickening causes some difficulty, making it an undesirable option for young children treated in a neonatal intensive care unit (NICU) (15). difficulties have led doctors to use alternative therapies to treat infants with dysphagia. An alternative method is to feed the baby with cold liquid to encourage safer swallowing.(16-20)

    The original data obtained by these researchers showed for the first time that cold fluid swallowing reduces airway disturbance in premature infants with dysphagia compared to room temperature of the fluid. In particular, the occurrence of deep penetration (p = 0.029), aspiration (0.017), light penetration (p = 0.044), and nasopharyngeal reflux (p = 0.006) decreased significantly in the cold swallowing state (CS) compared to room temperature, the swallowing state (RTS ) during VFSS Similar results have been documented in adults with dysphagia.(21-35) These positive effects are theoretically due to the cold liquid. providing sensory receptors in the pharynx increases sensory information that induces more efficient swallowing movements. (12,13,21-23)

    The original study evaluated 5 sips of cold liquid that provided important information. regarding the direct effect of cold fluids on the pharyngeal mechanism of swallowing in premature infants with dysphagia. additional information regarding the duration of these beneficial effects is needed to prove its reliability as a bedside modification.The study is designed to evaluate the mechanism of swallowing in premature infants with dysphagia after feeding with cold fluids for 10 minutes, in order to objectively determine any changes over time.

    In addition to the paucity of data on the improvement of swallowing function over time, the safety of cold fluid feeding in preterm infants remains questionable. Hypothermia or indigestion is of greatest concern for these babies.functions due to the low temperature of the liquid. The effects of cold stress in infants are seen in all body systems, including cool skin, tachypnea, respiratory distress, desaturation, increased apnea and bradycardia episodes, increased gastric acid residues, and vomiting. (36) Several earlier studies have evaluated the effects of cold feeding on healthy and healthy premature babies, however, the study populations may not be representative of today’s premature newborn population due to significant medical advances and increased survival of extremely premature babies.

    Holt and colleagues (37) found no difference in sleep patterns, vocalization, motor skills, and other consumption, feeding behavior, weight gain, fever, or regurgitation in premature infants with weight & gt; 1500 g when fed with cold food. Gonzalez and colleagues (38) found no significant difference in temperature in the armpits or in gastric debris in premature infants fed cold (0-4 ° C) milk at room temperature (25 ° C). The participants included 14 preterm infants with a gestational age at birth (GAB) of 28-30 weeks and a mean corrected gestational age of 32 weeks.Anderson and Berset (39) found no differences in antral or duodenal motor activity in infants. as assessed by manometry, and gastric emptying in cold (6 ° C), room temperature (24 ° C), or body temperature (37 ° C) in the feeding groups. This study included preterm infants with GAB 25-36 weeks, mean birth weight 915-2455 g. Adjusted gestational age 32-36 weeks at birth. Research time. Feedings were given in random order for three fluid temperatures.at all temperatures, they found that all infants drank about a third of the bolus feeding time at 20 minutes, and at all temperatures, about 10-20% of the bolus feed. remained in the stomach 2 hours after eating. The authors suggest that thermoreceptors in the gastrointestinal tract do not work in this age group.

    Blumenthal et al. (40) found no statistical difference between the rate of gastric emptying. cold (0-4 ° C), room temperature (25 ° C) or body temperature (37 ° C) according to the formula 20 healthy premature babies with an average birth weight of 2.75 ± 0-18 (range 1.49- 3.38) kg and a gestation period of 37-7 ± 0.6 (range 34-41) weeks.They also reported that cold feeding was well tolerated in all infants and had no obvious clinical effects.

    To assess the potential risks of cold stress, each participant’s body temperature will be taken before and after exposure to cold fluids. To assess the functioning of the digestive system, the stomach contents of each participant will be obtained before and after exposure to cold fluid using a nasogastric tube (NGT) extraction of stomach contents.If the child does not have a nasogastric tube inserted during the study, patients will be included, but documentation of the temperature of the stomach contents will not be received. …

    Methods for diagnosing laryngeal cancer at the Ichilov oncology center

    Head of the oncology department at the Ichilov clinic.
    Oncologist with 20 years of experience.

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    How to get remote cancer treatment in Israel during the coronavirus epidemic?

    A thorough and accurate diagnosis of laryngeal cancer is the first step of in developing a treatment plan.Throat cancer treatment specialists at Ichilov Cancer Center use a wide range of tools and technologies designed to diagnose laryngeal cancer and assess the disease with a focus on speed of medical care and timely results .

    During the first two days after your arrival at our hospital, we will perform a full range of diagnostic tests and carefully review your medical records and medical history. Your doctor will also do a physical exam.This information helps us formulate individualized treatment recommendations tailored to you and your needs.


    A tissue or cell sample from the throat is required for a biopsy, which must be performed prior to treatment. Types of biopsies commonly used to diagnose throat and other head and neck cancers:

    • Postoperative biopsy . During this procedure, a small piece of tissue is cut from the abnormal-looking area.Since the larynx is located deep within the neck, specimen removal is a complex procedure. Biopsies of this area are usually performed in the operating room with general anesthesia given to prevent pain.
    • Fine needle aspiration (FNA) . A very thin needle attached to a syringe is used to extract (aspirate) cells from a tumor or tumor.

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    Imaging Tests

    Various imaging tests can be performed to help formulate a throat cancer diagnosis, including:

    • Computed Tomography (CT).Computed tomography can provide information about the size, shape, and position of any tumors, and can also help identify enlarged lymph nodes that may contain cancer cells.
    • Barium ingestion . A barium swallow test can show abnormalities in various parts of the throat and can often reveal small early tumors.
    • Magnetic Resonance Imaging (MRI). Usually, an MRI scan can be used to look for throat cancer.An MRI provides a very detailed view and can help determine if the cancer has spread to other areas of the neck or other areas of the body.
    • Positron Emission Tomography (PET). For patients diagnosed with throat cancer, PET / computed tomography can be used to determine if cancer has spread to the lymph nodes, to determine the origin of the cancer when it is first found in the lymph nodes, or to check the body for the spread of cancer cells.
    • X-ray . A chest x-ray can be done to check if the cancer has spread to the lungs. Cancer will not be present in the lungs if it does not progress.

    Get cancer diagnosed at the oncology center

    Other diagnostic procedures

    Other diagnostic procedures to evaluate throat cancer:

    • Panandoscopy . It is a diagnostic test used to examine the upper digestive system, including the larynx, esophagus, stomach, and the first part of the small intestine.In this test, a person is given general anesthesia in an operating room so that the entire area of ​​the body can be thoroughly examined for cancer. Endoscopes are used to look at the back of the throat, larynx, esophagus, and possibly the trachea and bronchi. This procedure also examines other parts of the nose, mouth, and throat, including the trachea and esophagus. The doctor at the cancer center performing the procedure will look for any visible signs of a tumor. Doctors can use a special instrument through the scope to biopsy pieces of tissue that look potentially cancerous.
    • Laryngoscopy . For this procedure, a diagnostic oncologist may spray your nose or the back of your throat with pain medication to avoid pain. Because throat cancer is close to other areas of the head and neck, the doctor may also examine the mouth, nose, and neck.
    • Pharyngoscopy . As with laryngoscopy, your doctor may use a spray to numb the back of your throat. Because laryngeal cancer increases the risk of other types of head and neck cancer, an oncologist at Ichilov will also examine the mouth, tongue, larynx, and neck for signs of abnormalities.

    More details about the treatment of laryngeal cancer at the Ichilov oncology center.

    Cost of laryngeal cancer treatment in Israel

    Below is a table in which you will find the prices of some types of diagnostics and treatment of laryngeal cancer in the Ichilov oncology center.

    559245 9000 Voice prosthesis implantation

    Type of diagnosis or treatment Cost
    CT 463 $
    Radiotherapy for laryngeal cancer – 1 field 186 $
    570 $

    How to start treatment in Israel?

    You can take the first step to recovery right now.To do this, fill out an application and one of our doctors will contact you within 2 hours, or call: + 972-3-376-03-58 in Israel and + 7-495-777-6953 in Russia.

    This consultation does not commit you to anything and is completely free . We guarantee you complete confidentiality and medical secrecy. We will help you as we have helped other patients.


    Esophageal cancer

    In 2002, in Russia, the total number of patients with esophageal cancer was 7124 cases, of which 75% of tumors were diagnosed in men.At the same time, the peak incidence fell on the age of 80-84 years.

    In 2004, an estimated 14,250 new cases of esophageal cancer will be identified in the United States. About 13,300 patients will die from this disease.

    Cancer of the esophagus is three times more common in men than in women. In countries such as Iran, northern China, India and South Africa, the incidence of esophageal cancer is 10 to 100 times higher than in the United States.

    Risk factors for esophageal cancer.

    Several risk factors are known that can contribute to the development of esophageal cancer.

    Age. The incidence of esophageal cancer increases with age and peaks by the age of 70-80. For people under 40 years of age, the chance of developing esophageal cancer is 1 in 100,000 people.

    Pol. Compared to women, men develop esophageal cancer 3 times more often.

    Race. 90,039 African Americans are 2.5 times more likely to have esophageal cancer compared to whites.

    The reason for this difference is not clear.

    Tobacco. Tobacco use (cigarettes, cigars, smoking pipe tobacco and tobacco chewing) is a major risk factor for esophageal cancer. The longer a person has used tobacco, the higher their risk of developing this type of cancer.

    The risk of developing adenocarcinoma of the esophagus is 2 times higher in smokers of one or more packs of cigarettes per day. More than half of cases of squamous cell carcinoma of the esophagus are associated with smoking.

    Alcohol. Long-term alcohol consumption is an important risk factor for esophageal cancer, especially of the squamous cell type.

    Although alcohol is not an important risk factor as smoking, the combined effects of both increase the risk of developing esophageal cancer compared to the influence of either of these factors.

    Barrett’s esophagus. This condition is associated with prolonged reflux of liquid stomach contents into the lower esophagus. At the same time, some patients complain of heartburn. Many people have no symptoms. Barrett’s esophagus is a risk factor for the development of adenocarcinoma.

    Power supply features. Inadequate intake of fruits, vegetables, and minerals, and especially vitamins A, C and riboflavin, may increase the risk of esophageal cancer. On the other hand, overeating leading to obesity increases the risk of esophageal adenocarcinoma.

    Eating very hot food is thought to increase the risk of esophageal cancer.

    Impact of environmental factors. Dry cleaning workers exposed to perchlorethylene and chemical fumes are at increased risk of esophageal cancer.

    Ingestion of alkali. Alkali is a chemical used both in industry and in the home. This substance can damage and destroy cells. Children who find lye and swallow it have an increased risk of esophageal cancer as they reach adulthood. Cancer occurs on average 40 years after the ingestion of alkali.

    Achalasia. In this disease, the ability to relax the smooth muscle sphincter in the lower esophagus is impaired.As a result, food and liquid hardly enter the stomach and stagnate in the esophagus, leading to its expansion, and squamous cell carcinoma develops in 6% of patients with achalasia.

    Keratoderma (tylosis). This is a rare inherited condition that causes excess skin formation on the palms and soles.

    A mutation in the chromosome 17 gene is thought to be responsible for keratoderma in some patients with esophageal cancer. People with this condition have a very high risk (40%) of developing esophageal cancer and therefore need early and regular screening, including endoscopy.

    Hernia of the esophagus. Protrusion of the esophageal wall into its lumen leads to difficulty in swallowing food. This condition can occur in people with various genetic abnormalities (tongue, nails, spleen, and other organs). Moreover, 1 in 10 patients with this syndrome eventually develop squamous cell carcinoma of the esophagus.

    What to do if you suspect esophageal cancer?

    If you develop symptoms suspicious of esophageal cancer, you should immediately consult a doctor who recommends an examination to confirm the diagnosis.

    Contrast examination of the esophagus with barium.

    Several X-rays are taken after swallowing barium. Barium coats the lining of the esophagus and provides a clear picture. Any changes in the lining of the esophagus will be visible on radiographs.


    This research method uses a flexible tube with illumination and a video camera at the end. The doctor has the opportunity to examine in detail the condition of the esophagus and stomach.If an area suspicious for a tumor is detected, a tissue biopsy is performed for microscopic examination. On the basis of an endoscopic examination, it is possible to draw a conclusion about the possibility of removing the tumor.

    Computed tomography

    CT makes it possible to determine the extent of the spread of the tumor and to decide on the tactics of treatment.

    Endoscopic ultrasound is a new method for determining the degree of damage to the esophagus for the solution of surgical tactics.

    Thoracoscopy and laparoscopy make it possible to identify the affected lymph nodes inside the thoracic and abdominal cavities after the introduction of a hollow tube with illumination (thoracoscope or laparoscope) into them.

    In addition, it is possible to take a piece of tissue suspicious for a tumor for microscopic examination.

    Is early detection of esophageal cancer possible?

    There are currently no methods for early diagnosis of esophageal cancer in the general population.However, people with high-risk factors should be monitored and screened for the earliest possible detection of esophageal cancer.

    • People with high-risk factors such as keratoderma (tylosis) should undergo regular endoscopy with biopsies of suspicious areas of the esophageal mucosa and subsequent examination under a microscope.
    • If the patient has Barrett’s esophagus, endoscopy and biopsy should be performed (according to different recommendations) every 2-3 years or 5 years.If dysplasia (altered, but not tumor cells) is found, the examination should be performed annually.

    If severe dysplasia is detected, then some doctors recommend removing part of the esophagus or the entire organ, taking into account the general condition of the patient.

    This is because the risk of adenocarcinoma of the esophagus is very high, or the tumor already exists but has not yet been identified. The prognosis for such patients is relatively favorable.

    This tactic allows you to diagnose cancer at an early stage, which has a positive effect on the results of treatment.

    Diagnosis of esophageal cancer

    In most patients, esophageal cancer is detected after the onset of symptoms. However, it is not uncommon for symptoms to appear already in the later stages, which negatively affects the results of treatment.

    Problems with swallowing (dysphagia).

    This is the most common symptom of the disease. The patient has a sensation of food stuck in the chest. In such a situation, the tumor, as a rule, already occupies half of the lumen of the esophagus. Solid food in the form of bread and meat gets stuck in the esophagus and does not pass into the stomach.People with dysphagia usually switch to softer and even liquid foods for easier swallowing.


    In rare cases, pain in the middle of the chest or a tight or burning sensation may be signs of esophageal cancer. However, these symptoms can be caused by something else, such as heartburn. Pain during swallowing usually indicates a widespread tumor process.


    Almost half of patients with esophageal cancer experience weight loss due to insufficient food intake due to problems with swallowing.In addition, some patients have decreased appetite.

    Other symptoms.

    Hoarseness, hiccups, pneumonia, and high blood calcium levels are usually late signs of esophageal cancer. However, other medical conditions can also cause these symptoms.

    Barium contrast x-ray is usually performed at the initial stage of the examination. The method allows you to identify changes in the mucous membrane of the esophagus, including a tumor.

    Endoscopy. In this method, a flexible tube is inserted into the esophagus with a light and a small video camera at the end. If a tumor is found, a piece of tissue is taken for microscopic examination. If the tumor narrows the lumen of the esophagus and prevents the passage of food, then the opening of the esophagus can be widened. In addition, during the study, the question of the patient’s treatment tactics is being decided.

    Computed tomography (CT) makes it possible to determine the prevalence of the process, which helps to develop a plan for the operation.

    Endoscopic ultrasound helps to determine the degree of damage to the esophagus and to develop a surgical approach to the patient’s treatment.

    Bronchoscopy allows you to examine the trachea and bronchi to determine the extent of the esophageal tumor.

    Positron Emission Tomography (PET). With this method, radioactive glucose is injected into a vein. Tumor tissue quickly accumulates glucose, which can be seen on a special apparatus.

    This study allows you to identify tumor foci outside the primary affected organ and helps to determine the stage of the disease.

    Thoracoscopy and laparoscopy make it possible to detect tumor lymph nodes in the chest and abdominal cavities, as well as to take pieces of tissue for microscopic examination. The information obtained is important for the development of patient treatment tactics.

    Esophageal cancer treatment

    Various methods are used to treat patients with esophageal cancer, including surgery, radiation therapy, and chemotherapy.Other methods, such as palliative care, are used to relieve pain, but the tumor itself is not affected.

    The choice of treatment method depends on the stage of the disease and the general condition of the patient. With each method of treatment, side effects are possible, which the doctor will inform about.

    The amount of surgery will depend on the stage of the cancer and the patient’s condition. The operation can be combined with other treatments such as chemotherapy and radiation.

    Two main types of surgery are used: esophagectomy (removal of the esophagus together with nearby lymph nodes and then connecting the rest of the esophagus to the stomach) and esophagogastrectomy (removal of the lower esophagus and upper stomach together with nearby lymph nodes). At the same time, the connection of the esophagus with the stomach is performed.

    Chemotherapy alone cannot cure a patient of esophageal cancer unless used in combination with radiation or surgery.

    Side effects of chemotherapy include nausea, vomiting, loss of appetite, baldness, mouth ulcers, increased likelihood of infections, bleeding, fatigue and shortness of breath.

    Most side effects go away after treatment is completed.

    This method is used to kill tumor cells or reduce the size of a tumor. Radiation alone, as a rule, does not give the chance to completely cure cancer. Therefore, it is used in combination with surgery and chemotherapy.This method makes it possible to relieve symptoms associated with swallowing problems, pain, etc.

    Side effects of radiation therapy include skin changes, upset stools, increased fatigue, shortness of breath.

    Photodynamic therapy (PDT) is usually used for relapse (return) of esophageal cancer after radiation therapy. A harmless chemical is injected into a vein and accumulates in the tumor. Then, through the endoscope, a special laser beam is applied to the tumor.The laser beam converts the injected chemical into a new compound that can kill cancer cells. At the same time, the negative impact on healthy tissues is minimal.

    What happens after treatment for esophageal cancer ends?

    If, after completing treatment for esophageal cancer, you develop any symptoms, such as swallowing problems or chest pain, you should see a doctor immediately.

    After the treatment, a regular examination of the state of the upper gastrointestinal tract with the help of barium and computed tomography is carried out in order to detect early recurrence (return) of the tumor.Early detection of recurrence will help alleviate many of the symptoms and improve survival.

    Esophageal cancer is often associated with weight loss and weakness due to impaired swallowing. Doctor’s advice will help solve this problem.

    If you smoke, quitting smoking is a very important step. As a result, your appetite and general condition will improve. In addition, quitting smoking will reduce the likelihood of a new cancer.

    Treatment of esophageal cancer in Israel

    Cancer that develops in the esophagus has a number of symptoms:

    1. Difficulty swallowing – a tumor is blocking the passage of food through the esophagus, interfering with swallowing.
    2. Weight Loss – Due to difficulty swallowing and other effects of the disease, patients with esophageal cancer may lose weight unnecessarily. Weight loss is one of the main and important complaints in gastroenterology and, as a rule, indicates serious diseases, including cancer of the esophagus.
    3. Chest pain – Typically, an upset esophagus can present with chest pain and also occurs in esophageal cancer.
    4. Choking while eating – Because the tumor blocks the passage of food in the esophagus, many times people suffering from esophageal cancer choke when they eat.The reason is probably the rise of food from the tumor, which is blocking the passage, up and the entry of food into the trachea.
    5. Cough and hoarseness – Often, the swelling can press on the trachea, nerves, or vocal cords and cause hoarseness.

    Causes of esophageal cancer

    Esophageal cancer develops after the appearance of mutations in the cells of the esophagus, which lead to their accelerated growth and the appearance of a tumor. The cause of the tumors is not known, but frequent irritation of the esophagus appears to increase the risk of cancer.
    Common risk factors include smoking, drinking alcohol, esophageal diseases (such as reflux), eating canned food, a history of radiation therapy to the head and neck area, and development of Barrett’s esophagus (a precancerous condition after recurrent reflux in which the lining of the esophagus changes ).

    Diagnosis of esophageal cancer in Israel

    Since the signs of esophageal cancer are very general and can appear with any disease of the esophagus, after patients come with the appropriate complaints, they undergo several procedures to diagnose various diseases of the esophagus, including esophageal cancer.The main procedures for the diagnosis of esophageal cancer in Israel are:

    • Endoscopy is a routine test that allows you to see the inside of the esophagus and look for changes such as tumors. If neoplasms are detected, during endoscopy, it is possible to take a biopsy from the tumor to study it and assess the situation and prognosis.
    • X-ray after swallowing barium – allows you to check the passage through the esophagus, and when a tumor appears, corresponding changes may appear on the image.
    • CT – if we are really talking about cancer of the esophagus, then it is customary to perform computed tomography to assess the spread of the tumor and other organs, to identify metastases.

    Staging of esophageal cancer:

    After diagnosing esophageal cancer, it is necessary to determine the stage of the disease, which will help to decide on the type of treatment and will make it possible to assess the prognosis.

    The stage of the disease is determined by the following factors:

    Stage I – The tumor is limited only to the esophageal mucosa.

    Stage II – the tumor has penetrated into several layers of the esophagus, but does not spread to other organs. Cancer may spread to the lymph nodes in the coming years.

    Stage III – a tumor that has penetrated into all layers of the esophagus and, in addition, has approached the lymph nodes or penetrated into nearby organs.

    Stage IV – a tumor that metastases to other organs of the body.

    Treatment of esophageal cancer in Israel

    Treatment of esophageal cancer in Israel depends on the stage of the tumor and the state of health of the patient and includes:
    Surgical treatment – used to remove the tumor.Depending on the spread, it is possible to remove only the tumor or to remove part of the esophagus. As a last resort, part of the stomach is removed.
    Chemotherapy is the treatment of cancer with chemical drugs that destroy tumor cells.
    Radiation therapy – In some cases, the use of radiation in the neck area allows the destruction of the tumor.

    Clinics and medical centers working with Clinics Direct specialize in the treatment of esophageal cancer at various stages.
    We make sure that our patients receive all the necessary answers to all questions about the type and course of treatment from the best specialists in this field.
    If you are interested in diagnostics of esophageal cancer in Israel or treatment of esophageal cancer in Israel, leave your application on our website or call one of our phones, and we will provide you with all the necessary information about the types and costs of treatment.

    Private pathology. Acute intestinal nep-ty | vitaclinicwixcom-

    Acute intestinal obstruction in dogs and cats

    What is this?

    Intestinal obstruction is characterized by a violation of the movement of intestinal contents as a result of narrowing or complete blockage of the intestinal lumen, dysfunction or compression.

    The mechanism of occurrence is distinguished:

    • mechanical

    • functional (or dynamic) intestinal obstruction.

    By the nature of the course, intestinal obstruction can be:

    • full (acute)

    • incomplete (partial)

    • idle

    • complicated.

    Mechanical obstruction

    occurs due to tumors, blockage of the intestinal lumen by foreign bodies, intussusception (screwing the intestine into itself), stenosis (narrowing) or changes in the intestinal lumen as a result of external pressure.

    Functional or dynamic intestinal obstruction

    is spastic (colic, pain of the abdominal and peritoneal organs) and paralytic (inflammation, metabolic disorders, internal and external toxins)

    Complicated intestinal obstruction

    proceeds with symptoms of acute circulatory disorders of the intestinal walls (thrombosis of the mesenteric vessels, retroperitoneal bleeding, prolonged exposure to a foreign body) up to necrosis.

    What does it look like?

    Main signs of intestinal obstruction:

    • pain of varying intensity, the animal cannot find a place for itself

    • or, on the contrary, refuses to get up, avoiding any movement.

    • With spastic obstruction, pain occurs suddenly and is significantly pronounced.

    • In case of obstruction as a result of a foreign body, the pain is initially localized at the site of the lesion, later becomes diffuse, and completely stops with necrosis of the intestinal wall.

    • vomiting – An important diagnostic sign of intestinal obstruction.

    At first, there is vomiting of undigested food, then bile, later intestinal contents with a characteristic fecal odor can join. The higher (closer to the stomach) the blockage, the more intense the vomiting.

    With low intestinal obstruction, vomiting is less intense and occurs many hours after feeding. With low colonic obstruction, vomiting may not be at all.

    • violation of the discharge of gases and feces.

    What is this?

    1. Intestinal obstruction is characterized by a violation of the movement of intestinal contents as a result of narrowing or complete blockage of the intestinal lumen, dysfunction or compression.

    2. By the mechanism of occurrence, mechanical and functional (or dynamic) intestinal obstruction is distinguished.

    3. By the nature of the course, intestinal obstruction can be complete (acute) or incomplete (partial), simple or complicated.Mechanical obstruction occurs due to tumors, blockage of the intestinal lumen by foreign bodies, intussusception (screwing the intestine into itself), stenosis (narrowing) or changes in the intestinal lumen as a result of external pressure. Functional or dynamic intestinal obstruction is spastic (colic, pain of the abdominal and peritoneal organs) and paralytic (inflammation, metabolic disturbances, internal and external toxins) exposure to a foreign body) up to necrosis.

    4. Diagnostics

    One of the most important factors in the diagnosis of intestinal obstruction is –

    • collection of a complete anamnesis (history of life and illness). It is necessary to take into account the age of the animal, data on vaccination (vaccinations) and deworming (antihelminthic treatments), dietary habits and behavior of the animal (what it plays, whether it picks up food on the street), the availability of data on previously performed abdominal operations, chronic inflammation of the digestive system, accompanied by periodic vomiting and stool disorder, time and characteristics of the course of the last episode of the disease.Thus, young, unvaccinated dogs, puppies and kittens who do not undergo regular deworming, as well as suckling puppies and kittens that were left without a mother, during the period of transfer to artificial feeding, are predisposed to intussusceptions and paralytic obstruction. Dogs and cats that have a habit of stealing from trash bins, picking up bones in the street, and playing with stones, chestnuts, small toys, beer corks, etc., are at risk of intestinal obstruction if these items are accidentally swallowed.Cats often swallow threads (sometimes with needles), New Year’s rain and tinsel, textiles and their own fur, which forms lumps in the stomach and can also cause mechanical intestinal obstruction. Elderly animals are prone to low colonic obstruction with physical inactivity, impaired intestinal motility (diverticulum (dilation) of the rectum in dogs), feeding on bones, especially boiled ones. In middle-aged and older cats, intestinal obstruction can occur as a result of volumetric enlargement of the mesenteric lymph nodes and lymph nodes of the intestinal wall in viral leukemia of cats.In older dogs, intestinal obstruction is caused by bowel cancer (thin section, cecum, rectum), prostate enlargement due to inflammation, cysts, adenomas and cancer (in males), and tumors of the uterine body and vagina in bitches.

    • After collecting the anamnesis, the doctor carefully examines the animal, carefully and carefully probes and listens to the abdomen, examines the oral cavity (ulcers, necrosis, threads under the tongue, the color of the mucous membranes, etc.), measure the temperature, and, if necessary, conduct a rectal examination.Based on the results of the anamnesis and clinical examination, the doctor may recommend laboratory tests (general and biochemical blood tests, virological tests: for canine parvovirosis and viral leukemia of cats, etc.). Disruption of the body’s organs and systems can lead to intestinal obstruction (functional), and intestinal obstruction, with accompanying symptoms (vomiting, impaired intestinal absorption and blood circulation) can lead to serious disturbances in the balance of the body (accumulation of toxic products and metabolic products, development of renal failure and much more).

    • Radiography. X-rays belong to special studies if intestinal obstruction is suspected. The abdominal cavity is removed from the lateral lying position (it is possible to detect radiopaque foreign bodies, such as bones, metal objects, dense feces, the presence of effusions in peritonitis) or standing (they detect free gas in the abdominal cavity with intestinal perforations or uniform accumulation of gas in the intestinal loops from above with In unclear cases, a study is carried out with barium sulfate (radiopaque substance, given to the animal with food or liquid).A series of images is taken at certain time intervals to assess the time and quality of the passage of intestinal contents.


    Animals suspected of intestinal obstruction are subject to hospitalization and comprehensive examination.

    After identifying the cause, form and level of intestinal obstruction, conservative or surgical treatment of the patient is recommended.

    In unclear cases, the doctor MUST offer a diagnostic operation

    (which can become healing along the way).

    For spastic obstruction, perirenal novocaine blockade and antispasmodics (no-shpa, baralgin, platifillin) are used. With paralytic obstruction, in addition to general detoxification, ganglion blockers, morphine preparations, analgin in dogs and parenteral novocaine blockade can be used.


    During the operation, the task of the surgeon is to identify and eliminate the cause of intestinal obstruction. The surgeon determines the viability of the intestinal wall, in case of necrosis, he resects (removes) the affected area, removes toxic or mechanical contents from the intestinal lumen and abdominal cavity, in case of perforations (ruptures) restores the integrity and tightness of the intestinal wall, removes tumors and adhesions.In addition to surgical treatment, patients with acute intestinal obstruction require intensive anti-shock therapy, measures to combat intoxication and humoral disorders.

    Intestinal obstruction in dogs – symptoms, treatment

    Intestinal obstruction is a syndrome characterized by partial or complete impairment of the movement of contents through the digestive tract. In dogs, it can be caused by mechanical obstruction, as well as by impaired bowel movement.

    The syndrome is diagnosed in dogs, regardless of their age and breed. However, a special risk group includes stray animals that can eat foreign objects. For more information on how intestinal obstruction develops and what needs to be done by the owner of the animal, read on.

    See this article:

    Signs of intestinal obstruction
    Forms and features of the disease
    What to do?
    Diagnostics of the condition
    Treatment of intestinal obstruction
    Rehabilitation after surgery
    Prevention of the disease


    Obesity, a sedentary lifestyle, chronic constipation are factors that provoke the development of intestinal obstruction in dogs.They enhance the severity of symptoms, and also make the clinical picture even more vivid and noticeable.

    Major causes of intestinal obstruction in dogs are:

    • Incorrect power supply .

    Bones, indigestible veins, low-grade meat, missing food are some of the factors that can cause intestinal obstruction. This is due to the fact that the solid parts of the food are able to close the lumen of the digestive tube.

    • Power supply violation .

    If the pet has been starving for a long time (for example, for 2-3 or more days did not have access to food), and then received a large portion of food, then intestinal intussusception is not excluded, i.e. the introduction of one part of it into the lumen of another.

    • Ingestion of foreign objects.

    By mistake, the dog can swallow inedible items (for example, sewing utensils, rags, stones, plastic bags, parts from a toy construction set).Young pets picking up litter on the street are in a special risk group.

    • Diseases caused by parasitic worms.

    Helminthic infestations provoke mechanical blockage of the intestine and the inability to move products along it. The most widespread are tapeworms, as well as the nematodes Toxascaridis leonina, parasitizing in the intestine.

    • Various pathologies .

    Among them: benign and malignant neoplasms, disorders of peristalsis, diseases of the gastrointestinal tract, etc.They can lead to dynamic intestinal obstruction in dogs.

    Signs of intestinal obstruction

    The first sign that is important to pay attention to is the absence of a chair for more than 12-24 hours. The impossibility of defecation is observed, despite the fact that the pet has a clear need for emptying (for example, he asks for a walk).

    At the same time, the general condition of the animal worsens. The pet does not play, avoids active movements. There may be a restless and anxious state, whining, and in especially severe cases, even squealing.

    The muscles of the abdominal region are in a tense state. In this case, the dog does not allow himself to be stroked on the belly. Some animals show aggression due to strong and persistent painful sensations.

    Main symptoms of intestinal obstruction in dogs:

    • full water refusal,
    • no appetite,
    • impossibility of defecation,
    • vomiting of foam or bile,
    • abdominal distention,
    • increased salivation,
    • blanching of mucous membranes,
    • pain on palpation,
    • unnatural pose,
    • general oppression,
    • decrease in body temperature (below 38 ° C).

    Abdominal pain can be of varying intensity: from mild (occurs only on palpation of the damaged abdominal region) to strong (it is constantly present, therefore the pet “does not find a place for itself” and stretches its hind limbs, trying to relieve pain).

    The frequency of gagging is determined by the location of the obstruction. The closer it is to the stomach, the more often vomiting. In cases where the dog has obstruction of the low colon, vomiting may be absent altogether.

    Does your pet show one or more signs? Seek professional veterinary attention immediately. The sooner the veterinarian takes action, the lower the likelihood of dangerous consequences and death!

    Forms and features of the disease

    Acute intestinal obstruction (AIO). It comes on suddenly and develops rapidly. It is characterized by pronounced signs. The acute form of the disease poses a serious danger to the life and health of dogs, therefore, requires immediate access to professional veterinary help.

    Chronic intestinal obstruction (CCI). In the initial stages, it develops asymptomatically. Signs of pathology are growing gradually: first, there is a deterioration in appetite and only after a while – a complete refusal to eat. Most often, the chronic form of obstruction occurs as a result of diseases of the organs of the gastrointestinal tract.

    What to do?

    Without urgent medical care, intestinal obstruction is fatal.If you suspect a disease, immediately take your pet to the veterinarian.

    To increase your dog’s chances of recovery, you need to:

    1. Go to veterinary clinic immediately . Never self-medicate or give your pet laxatives. This can lead to irreversible consequences for the health and life of the dog.
    2. Describe the condition of the animal most accurately to the veterinarian . Let us know why you decided to ask for help.If you know what reasons led to the development of obstruction, also inform the specialist about them.
    3. Answer all doctor’s questions veterinarian . About what kind of life the dog led, what was the care of the pet, the regime of the day, the likelihood of swallowing a foreign object. Be sure to inform about past or existing diseases.

    Status Diagnosis

    If you suspect a bowel obstruction, contact your veterinarian.After a thorough visual examination and palpation, the veterinarian will perform a two-view X-ray examination of the abdomen. This will allow you to determine where the foci of gas formation, the density of which is lower than the density of soft tissues, are located.

    Additionally, X-ray images show signs of inflammation affecting the serous membranes of the abdominal cavity (peritonitis). Its presence indicates the need for emergency surgery.

    Assigned studies:

    • body temperature measurement,
    • general / biochemical blood test,
    • stool analysis (if possible).

    If a simple study did not allow an accurate diagnosis to be made, an X-ray with contrast is prescribed. Barium sulfate is used as a contrast agent. In appearance, it is a fine-crystalline white powder that does not have a specific odor. It is not absorbed from the intestine and is traced in the images by a contrasting (white) spot.

    Treatment of intestinal obstruction

    In 9 out of 10 cases, a surgical (operative) method is used in the treatment of intestinal obstruction in dogs.An exception is partial obstruction (for example, blockage of the intestine with sand or hard feces), to eliminate which it is sufficient to use enemas. In other situations, an emergency operation is prescribed.

    To facilitate bowel movements, natural vegetable oils are introduced through the oral cavity. Laxative drugs are prescribed only by a veterinarian with caution.

    Surgical intervention for the treatment of intestinal obstruction in dogs is performed under general anesthesia (anesthesia).The technique of the operation is determined by the factor that provoked the development of the disease in the animal.

    If necrosis is not detected on the intestinal walls and blood circulation is maintained, then the veterinarian’s task is to ensure the maximum safety of the organ. If the necrotic process has already begun, then the affected area is completely removed.

    Rehabilitation after surgery

    After surgery, close monitoring of the condition of the pet is necessary. A fast diet is recommended for the first 24 hours.Make sure your pet has easy access to clean, fresh water. Then broth and liquid cereals are gradually introduced into the diet. The main thing is to feed the pet in small portions.

    Parenteral nutrition is used in parallel. Plasma substitutes and nutrients are administered intravenously to the dog in the form of solutions. A course of antibiotics is prescribed, which must be given to the pet at the same time to prevent the development of a surgical infection. In addition, it is required to monitor the progress of recovery and re-undergo an ultrasound examination.

    Other features of rehabilitation after surgery:

    • 14 days after the operation, it is necessary to include fermented milk products (low-fat cottage cheese, yogurt, kefir) in the diet,
    • gradually you need to introduce oatmeal and buckwheat porridge, as well as boiled vegetables, with the exception of potatoes and cabbage,
    • it is important to provide the dog with complete rest, even short walks on a leash are allowed no earlier than 7-10 days after the intervention,
    • the duration of walks after obtaining permission from the veterinarian must be increased gradually: from 5-10 minutes or more,
    • are additionally prescribed immunomodulators and mineral and vitamin complexes that improve the condition of the pet after the intervention.

    Disease prevention

    The most common cause of intestinal obstruction is improper feeding of dogs. Do not give your pet bones, food from the table, flour products. Make sure your dog does not eat household items or trash. Work with your pet so that he takes food only from the owner and in a specific place.

    Basic preventive measures:

    • To avoid the development of intestinal obstruction , watch out for physical activity.Consult with your veterinarian what load will be most optimal for your pet, taking into account its weight and body characteristics;
    • Don’t forget about deworming . It should be carried out once every 3 months to prevent the development of helminthic invasions. It is mandatory even if your pet does not go out and does not come into contact with other animals;
    • Use only special toys for training and playing with animals. Never give pebbles, sticks or foam objects to your pet.He can swallow them, which will cause the development of intestinal obstruction;
    • While walking, make sure that the dog does not try to swallow foreign objects. Be sure to use a leash. It is possible that even trained animals, smelling an attractive smell for them, swallow foreign objects.


    Without seeking professional veterinary help in the clinic, the probability of death is almost 100%. It is impossible to prescribe competent treatment at home.In addition, in most cases, emergency surgery is required.

    If you go to the veterinarian immediately when the first signs appear (absence of stool, appetite disorder, fever, etc.), then the prognosis is favorable. After the operation, it is enough to follow simple recommendations to restore the pet’s health.

    Remember that the condition of the dog depends on your attentiveness and care!

    See also:

    X-ray with barium

    Barium is used to examine the gastrointestinal tract (GIT).

    Barium is a white liquid that is visible on x-rays. Barium passes through the digestive system and coats the inside of the esophagus, stomach, or intestines, resulting in the contours of the organs on the x-ray.

    The barium test is performed under the following conditions:

    Frequent, painful heartburn;

    Gastric reflux;

    Difficulty swallowing.

    This method helps to identify in humans:


    Abnormal growths;


    What happens before, during and after swallowing barium?

    People who receive a barium x-ray should not eat or drink for several hours before the test. Some doctors recommend not chewing gum, smoking cigarettes after midnight on the night before diagnosis. The test takes about 60 minutes and takes place in the X-ray department of the hospital. The person will need to change into a hospital gown.

    In the X-ray room, a person drinks a barium liquid.It often tastes like chalk, but is also flavored. In some cases, the person is given an injection to relax the stomach.

    The person can stand or lie on the folding table, this allows fluid to pass through the gastrointestinal tract. People do not need to stay in the hospital after the test and can return home immediately. Results are usually available within 1-2 weeks.

    Risks and side effects

    Patients may feel nauseous when swallowing barium.The symptoms of nausea usually go away as soon as the barium passes through the digestive system. Patients may have white stools after a barium x-ray. Some people worry about being exposed to radiation. However, the amount of radiation a person is exposed to is minimal.

    Do not take x-rays with barium

    During pregnancy;

    Glaucoma or heart problems;

    People who use insulin in their treatment will be asked to skip their morning dose.They should receive insulin and food after the test.

    Barium enema

    Another type of barium test is the barium enema. Barium enemas are used by doctors to examine the colon and rectum. This test usually takes about 40 minutes. The person is given a laxative the day before the barium enema is given.

    During the test, a person lies on their side on a table in the X-ray room. An enema containing barium and water is fed into the rectum through a small plastic tube.Air is also pumped through the tube to inflate the intestines. The table is tilted to allow the barium to pass through the entire colon. This allows the radiologist to clearly see any changes in the colon.

    After a barium enema, people may experience cramps or diarrhea. As with barium swallowing, patients may have white stools. There is very little risk of rupture of the intestinal mucosa with this test. This complication occurs only with very severe intestinal inflammation.

    Alternatives to contrast radiography

    An alternative to contrast radiography is gastroscopy .