Esophagram

An esophagram, also known as a barium swallow, is a medical imaging test that uses X-rays to look at your esophagus (the tube that carries food from your mouth to your stomach). You drink a special liquid called barium, which coats the inside of your esophagus, making it visible on X-ray images. This test helps doctors find problems with how you swallow or issues within your esophagus.

What is Esophagram?

An esophagram, often called a barium swallow, is a diagnostic imaging test that uses X-rays to create pictures of your esophagus. During the test, you drink a liquid containing barium, a chalky substance that coats the inner lining of your esophagus. This coating allows the esophagus to show up clearly on the X-ray images, helping doctors identify structural or functional problems.

An esophagram helps doctors visualize the shape and function of your esophagus, the muscular tube that connects your throat to your stomach. This test can reveal if there are any blockages, narrowing (strictures), or other issues preventing food from moving smoothly. It allows doctors to see how your esophagus works when you swallow. The barium liquid is opaque to X-rays, meaning X-rays cannot pass through it easily. As you swallow the barium, it coats and outlines the inside of your esophagus, making it visible on X-ray images. This allows the radiologist (a doctor specializing in medical imaging) to observe how the barium moves down the tube and identify any structural or movement abnormalities. Sometimes, you may also swallow a barium pill or food to further assess swallowing.

Why it's ordered

Doctors order an esophagram to investigate symptoms related to swallowing difficulties or discomfort in the chest and throat. This test helps identify the cause of problems like pain when swallowing, food getting stuck, unexplained vomiting, or heartburn that doesn't improve with treatment. It can reveal issues such as narrowing of the esophagus, acid reflux, or tumors.

Your doctor might recommend an esophagram if you experience certain symptoms that suggest a problem with your esophagus. These symptoms can include dysphagia (difficulty swallowing), odynophagia (painful swallowing), or persistent heartburn. It can also be used to investigate unexplained vomiting or chronic coughing. The test can help diagnose several conditions. For example, it can show if there is a hiatal hernia (when part of your stomach pushes up through your diaphragm into your chest), strictures (narrowing of the esophagus), diverticula (small pouches that bulge out from the esophageal wall), or tumors. It is also useful for evaluating gastroesophageal reflux disease (GERD), a condition where stomach acid flows back into the esophagus, or assessing motility disorders, which are problems with the esophageal muscles that affect food movement.

How to prepare

Preparing for an esophagram usually involves not eating or drinking for several hours before the test to ensure your esophagus is empty. Your doctor will provide specific instructions, which might include avoiding certain medications. It's important to tell your doctor about all medications you take, any allergies, and if you are pregnant or could be pregnant, as X-rays involve radiation.

To get clear images, your esophagus needs to be empty during the test. Therefore, you will typically be asked not to eat or drink anything for at least 6 to 12 hours before your appointment. This fasting period helps prevent food or liquid from interfering with the barium coating or obscuring the view of your esophagus. You should inform your doctor about all prescription and over-the-counter medications, vitamins, and herbal supplements you are taking. Your doctor will advise you if you need to stop taking any medications before the test, especially those that might affect swallowing or digestion. Do not stop any medications without your doctor's guidance. It is crucial to tell your doctor if you are pregnant or suspect you might be pregnant. X-rays use radiation, which can be harmful to a developing baby. In such cases, your doctor may recommend an alternative test that does not involve radiation. Also, inform the medical staff if you have any allergies, especially to contrast dyes or barium.

What to expect during

During an esophagram, you will stand or lie on an X-ray table while a radiologist or technician takes images. You will be asked to drink a thick, chalky liquid called barium, and sometimes a barium pill or other food. The medical team will take a series of X-rays as you swallow, observing the barium's movement through your esophagus. The test typically takes about 15 to 30 minutes.

When you arrive for your esophagram, you will likely be asked to change into a hospital gown and remove any jewelry or metal objects that could interfere with the X-ray images. You will then be positioned on an X-ray table, which may be tilted at different angles during the procedure. The radiologist or X-ray technologist will give you the barium liquid to drink. This liquid is usually flavored, but it can still have a chalky taste and thick consistency. You will be instructed to swallow the barium at specific times while the X-ray machine captures real-time images, called fluoroscopy. This allows the medical team to watch the barium move through your esophagus. You may be asked to hold your breath briefly, change positions, or swallow a barium pill or a piece of food coated with barium. These actions help the radiologist observe different aspects of your swallowing function and the esophageal structure. The entire procedure usually takes about 15 to 30 minutes, though preparation and post-test instructions might extend your total time at the facility. After the test, you might notice that your stools are white or lighter in color for a day or two. This is normal and due to the barium passing through your digestive system. Drinking plenty of fluids after the test can help flush the barium out of your system and prevent constipation, which can sometimes occur.

Understanding your results

After an esophagram, a radiologist will analyze the X-ray images and send a report to your doctor. Your doctor will then discuss the findings with you, explaining what the results mean in the context of your symptoms and medical history. Results may indicate normal esophageal function or identify issues like narrowing, inflammation, or problems with muscle movement.

The radiologist will carefully examine the X-ray images and the fluoroscopy video captured during your esophagram. They look for any abnormalities in the shape, size, or movement of your esophagus. This includes checking for blockages, areas of narrowing (strictures), pouches (diverticula), or signs of inflammation. They also assess how well the muscles of your esophagus are working to push the barium down. Once the radiologist has completed their review, they will prepare a detailed report. This report is then sent to the doctor who ordered your esophagram. Your doctor will interpret these findings in light of your specific symptoms, medical history, and any other tests you may have had. It is important to remember that an esophagram is just one piece of information. Your doctor will combine these results with other clinical data to make an accurate diagnosis and develop a treatment plan if needed. Do not try to interpret the results yourself; always wait for your doctor to explain them.

Risks

An esophagram is generally a safe procedure, but it does involve exposure to a small amount of radiation from the X-rays. There is also a rare risk of an allergic reaction to the barium or, in very rare cases, the barium entering the lungs if you have severe swallowing difficulties. Your doctor will weigh these minimal risks against the benefits of diagnosing your condition.

The primary risk associated with an esophagram is exposure to ionizing radiation. While the amount of radiation used in a single esophagram is generally low, repeated exposure over time can increase your lifetime risk of cancer. Medical professionals use the lowest possible dose of radiation necessary to obtain clear images. If you are pregnant or could be pregnant, the test is usually avoided due to potential risks to the fetus. Another potential, though rare, risk is an allergic reaction to the barium contrast material. Symptoms of an allergic reaction can include hives, itching, difficulty breathing, or swelling. Inform the medical staff immediately if you experience any of these symptoms during or after the test. In very rare instances, especially if you have severe swallowing problems, the barium could accidentally enter your windpipe (trachea) and lungs instead of your esophagus. This is called aspiration and can lead to lung irritation or infection. The medical team will monitor you closely during the test to minimize this risk. Constipation can also occur after the test if the barium is not flushed out of your system with adequate fluids.

Frequently asked questions

How long does an esophagram take?

An esophagram typically takes about 15 to 30 minutes to complete the actual imaging process. However, you should allow for extra time for preparation, changing, and post-test instructions at the facility.

What does barium taste like?

The barium liquid used in an esophagram is often described as having a chalky texture and taste. Many facilities offer flavored barium to make it more palatable, such as vanilla, strawberry, or chocolate.

Can I drive after an esophagram?

Yes, in most cases, you can drive yourself home after an esophagram. The test does not involve sedation or medications that would impair your ability to drive. You should feel well enough to resume your normal activities.

What should I do if I feel constipated after the test?

It is common for barium to cause constipation or make your stools white for a day or two. To help prevent constipation, drink plenty of fluids after the test. If constipation persists or becomes severe, contact your doctor.

Is an esophagram painful?

An esophagram is generally not painful. You might find the barium liquid unpleasant to drink due to its taste and texture, and you may feel some discomfort from lying on the X-ray table or changing positions. However, the procedure itself should not cause pain.

What is the difference between an esophagram and an endoscopy?

An esophagram uses X-rays and barium to visualize the esophagus from the outside, showing its structure and how it functions. An endoscopy (specifically an upper endoscopy) involves inserting a thin, flexible tube with a camera directly into your esophagus, stomach, and duodenum to visually inspect the lining and take tissue samples (biopsies) if needed. They provide different types of information.

Sources

• MedlinePlus — Esophagram
• Mayo Clinic — Esophagram
• Cochrane Library — Esophagram