Barium Swallow & Meal
Information for Adult Patients
What is a Barium Swallow and Meal?
The stomach, like other parts of the gut, does not show up well on ordinary X-rays, for example, to allow a radiologist to diagnose small ulcers. However, if the lining of the stomach is coated with barium, a white liquid that shows up on X-rays, and if the stomach is also distended by extra gas, which shows up black, then much greater detail is obtained. This is called a barium meal. If the gullet, or oesophagus, is examined at the same time, which it often is, then the examination is called a barium swallow and meal. If the examination is extended to look at the small bowel, then it is known as barium meal and follow through.
Are there any risks?
All X-ray procedures involve exposure to radiation in varying amounts. Although we are exposed to small amounts of background radiation from the environment throughout our lives, large amounts of radiation, either in one go or cumulatively, can add very slightly to the risk of developing cancer. The length and level of exposure to radiation from X-rays in medical procedures is strictly controlled and kept to the minimum possible. In this procedure you will need to be exposed to them for several minutes. This means you will be subject to an amount of radiation comparable to that which we receive naturally from the environment over a period of 12 to 18 months. However, as one in three of us is likely to develop a cancer at some stage during our lives, the added risk of cancer is very small. Also, the risks from missing a serious disorder by not having this investigation are considerably greater.
Are you required to make any special preparations?
Yes, this is most important an accompanying leaflet contains specific instructions about what and when you may eat beforehand, and if you need to take any special medicine before coming to the hospital.
In general, your stomach and small intestine need to be empty for this examination to be successful. Therefore you must not eat or drink anything for several hours beforehand. If you usually take medicines in the morning, do not take your morning dose(s), but bring your medicines to the department with you, and talk to the doctor there about it. If you fail to follow these instructions, you will not be able to have the examination, and another appointment will have to be made, which will delay the diagnosis.
If you are diabetic
If you take insulin or tablets, you need to make sure you have enough to eat on the day before your appointment to prevent low blood sugars. You should follow the advice given by the Radiology Department (in the leaflet which will be sent to you when your appointment is booked)
If you are pregnant
This examination is not advisable for pregnant women, unless there are exceptional circumstances. Please advise the Department in advance if you think you are, or might be, pregnant.
Can you bring a relative / friend?
Yes, but for reasons of safety, they will not be able to accompany you into the X-ray room except in very special circumstances.
When you arrive
You should go to the reception desk in the department, after which a radiographer or other member of staff will show you.
Within the Department the lavatories and public telephone are signposted clearly, should you need to use them at any time.
Upon collection
If you are diabetic or suffer from glaucoma, you must inform the radiographer, and all women who are pregnant, or believe they might be, must also inform the radiographer.
You will be shown to a private cubicle where you can undress. Watches can generally still be worn during the examination, but necklaces will need to be removed. As it is always very difficult to guarantee security in such situations, it is generally better not to wear expensive jewellery when attending.
You will be asked to put on the hospital gown and dressing gown provided. However, you may prefer to bring your own dressing gown if you wish. You will be asked to place your clothes and personal items in a locker, or a basket, which you will keep with you.
Whom will you see?
A small team including a radiologist, a radiographer and perhaps a nurse will usually care you for. Whoever is doing the examination will be watching a television screen at the time, and taking separate X-ray films. Later on the radiologist will review the X-ray images and issue a report.
What happens during the investigation?
You will be taken into the X-ray room and asked to take off the dressing gown but keep on the hospital gown. You will be asked to drink from a beaker containing the barium, a sticky white liquid, which is mildly flavoured, one or two mouthfuls at a time. This coats the lining of the gullet and stomach, so that they show up on the TV monitor and on the X-ray films. You will be positioned in front of the X-ray camera, often standing on a small step attached to the couch in its upright position.
You may then be asked to swallow a dessert spoon of effervescent (fizzy) granules followed by a dessertspoon of liquid neither of which taste unpleasant. This temporarily distends your stomach and will make you feel as though you have had a fizzy drink. In order to prevent your stomach moving on the films, you may be given a small injection in your arm, although this is not always necessary. On rare occasions this injection might cause blurring of your eyesight for 30 minutes or so.
The radiologist watches the monitor and also takes pictures. Once the gullet has been studied, the machine will slowly tilt, so that you are lying horizontally, and more pictures are taken of the stomach. You will be asked to move into different positions and to hold your breath while the pictures are taken. You may also be asked to swallow lying down.
Will it be uncomfortable?
You will feel some minor discomfort from the pinprick of the injection, if you have it. You might feel a very slight discomfort from your stomach being full of air.
How long will it take?
This whole process should take about 10 - 15 minutes. Afterwards you will put on your dressing gown again and sit in the waiting area until the pictures have been processed and the radiologist is satisfied that none of them have to be repeated (usually a 10 - 15 minutes wait). Some images are stored on a computer so in this case there is no delay for film processing. After this, you should be free to dress and leave the department.
If a 'follow through examination' had been requested, this means that films need to be taken of the small bowel. In such a case, you will need to stay in the department for a longer period occasionally as long as 2 or 3 hours, while X-rays are taken at regular intervals.
Are there any after-effects?
You may continue to feel slightly bloated for a short while until the gas in your stomach works its way out. You will be able to eat and drink normally straight away, and, for the first day or so, you should drink plenty of fluids, to help the barium pass out of your system. Your stools will look white and remain discoloured for the next day or so. Some people may get slightly constipated, and taking a mild laxative should help in this case. Barium stools are sometimes difficult to flush from the lavatory pan and might need repeat flushing
If you had the stomach relaxing injection, you must be certain that your eyesight has returned to normal before driving your car. Otherwise you should be able to return to your normal lifestyle and work straight away.
When will you get the results?
After the procedure, the images will be examined further by the radiologist, who will then write a report on the findings. This may take some time to reach your referring doctor, but it is normally available in less than a week. You should ask the radiographer or radiologist for some indication of timing.
If you have a query?
If you have any questions about having the barium swallow and meal, please ring the Radiology Department between 9am and 5pm, Monday to Friday.
Adapted from a document compiled by the Royal College of Radiologists