Barium Swallow

(Single Contrast)

In a barium swallow test, X-ray images are taken of the pharynx (throat) and the esophagus

Barium Swallow indications

Muscle disorders (pharyngeal or esophageal), such as dysphagia (difficulty swallowing) or spasms (pharyngeal or esophageal) gastroesophageal reflux disease (GERD) and ulcers esophageal varices (enlarged veins) structural problems, such as diverticula, strictures, or polyps (growths that are usually not cancerous, but could be precancerous). hiatal hernia - upward movement of the stomach, either into or alongside the esophagus achalasia - the lower esophageal sphincter muscle does not relax and allow food to pass into the stomach Tumors Assessment of tracheo-oesophageal fistula Pre-operative assessment of Carcinoma of the bronchus. Assessment of perforation site.

BARIUM SWALLOW procedure

Contrast media 100ml or more of 150% w/v barium sulphate suspension, Up to 100 ml of 75% w/v barium sulphate suspension for tracheo oesophageal fistula investigation. For assessment of perforation water soluble contrast media must be used, e.g. Gastromiro.

 Patient Preparation None, but as for barium meal if stomach is also to be examined. Preliminary film A control film is taken in case of suspected perforation???why???

Equipment
Fluoroscopy with rapid film capability 10 frames/second Fluoroscopy table with 90/20 tilt. Special "feeding" equipment may be required, i.e. straws and feeding cups

Technique / Typical Film Series

The patient stands erect R.A.O. position to throw the oesophagus clear of the spine. An ample mouthful of barium is swallowed, and spot films of the upper and lower oesophagus are taken. Oesophageal varices are best seen in the prone R.P.O. position, as they will be more distended. If rapid serial radiography is required, it may be performed in: the right lateral R.A.O PA positions.

 To demonstrate a tracheo-oesophageal fistula in infants, a fine nasogastric tube is introduced to the level of mid-oesophagus, and the diluted barium is syringed in to distend the oesophagus. It is important to take lateral radiographs or the fistula may be missed. An n.g. tube is used since infants might reflux into the trachea if swallowing from a bottle.

Complications
1. Barium leakage from an unsuspected perforation. 2. Aspiration.

RAO
Evaluation Criteria Oesophagus midway between heart and spine. Entire oesophagus coated with contrast agent No superimposition of upper limbs.

lateral
Evaluation criteria. Oesophagus positioned between heart and spine. Shoulder girdle not superimposed on oesophagus. The entire oesophagus is coated with contrast agent

PA
Evaluation Criteria The entire oesophagus is coated with contrast agent. No evidence of rotation, e.g. symmetry of sternoclavicul ar joints.

Achalasia

GERD

Esophageal cancer

Corrosive Stricture