Barium Swallow or Esophagram Quick Reference Guide for Physicians

The esophagram or barium swallow is a test whereby a patient is instructed to drink a barium sulfate compound that enables the radiologist to study the function and appearance of the esophagus and assess the swallowing process.


The esophagram can assess symptoms of painful or difficult swallowing, bloodstained vomit, abdominal pain and weight loss. The radiologist is able to detect narrowing or irritation of the esophagus, blockages, hiatal hernia, or abnormally enlarged veins that may cause bleeding in the esophagus, ulcers, polyps, or tumor.


Pregnancy. known or suspected esophageal perforation.

Patient Preparation

Eat/drink nothing by mouth on the day of the exam

CPT code


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General Information

What is a barium swallow (or esophogram)?

A barium swallow is an x-ray examination of the pharynx and esophagus using fluoroscopy and an orally ingested contrast material called barium.

Fluoroscopy makes it possible to see internal organs in motion. When coated with barium, the radiologist is able to view and assess the anatomy and function of the pharynx and esophagus. In addition to drinking barium, some patients are also given baking-soda crystals (similar to Alka-Seltzer) to further improve the images. This procedure is called an air-contrast or double-contrast upper GI.

An upper GI examination helps evaluate digestive function and can detect:

The procedure is also used to help diagnose the cause of symptoms such as:

Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. Your patient may be asked to remove some or all of your clothes and to wear a gown during the exam. Your patient may also be asked to remove jewelry, dentures, eye glasses and any metal objects or clothing that might interfere with the x-ray images.

How is the procedure performed?

As the patient drinks the liquid barium, which resembles a light-colored milkshake, the radiologist will watch the barium pass through the patient's digestive tract on a fluoroscope, a device that projects radiographic images in a movie-like sequence onto a monitor. The exam table will be positioned at different angles and the patient's abdomen may be compressed to help spread the barium. Once the GI tract is adequately coated with the barium, still x-ray images will be taken and stored for further review.

Children usually drink barium contrast material without any objection. If a child will not drink the contrast, the radiologist may need to pass a small tube into the stomach to complete the examination.

The patient will be asked to hold very still and may be asked to keep from breathing for a few seconds while the x-ray picture is taken to reduce the possibility of a blurred image.

For a double-contrast upper GI series, the patient will swallow baking-soda crystals that create gas in the stomach while additional x-rays are taken.

When the examination is complete, your patient will be asked to wait until the radiologist determines that all the necessary images have been obtained.

This exam is usually completed within 20 minutes.

What will the patient experience during and after the procedure?

After the examination, your patient can resume a regular diet and take orally administered medications.

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

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