A Barium Swallow, also called an Esophagram, is a study of the esophagus, including the mouth and stomach as needed. Since some pictures of the stomach may be needed, it is often recommended that you do not eat or drink anything after midnight the night before your exam, though this is not as strictly enforced as it would be for an Upper GI or other GI studies. In this exam, the radiologist and the technologist assisting him or her will be taking pictures of your esophagus, first under fluoro (a common term used for fluoroscopy) and then using regular x-rays.

When you report to the radiology department for your exam, the technologist will first escort you to a changing room, where you will be instructed to remove everything from the waist up and to put on a hospital gown. You will then be shown to the x-ray room where your exam will be performed, and the technologist will ask you questions about your problem that lead to your doctor ordering this exam. You will then be positioned in font of the x-ray table (which will have been rolled up into a standing position) in either a standing or sitting position (standing is usually preferred), and given a cup of barium which is a thick, chalky fluid. The radiologist will then watch under fluoro as you drink the barium according to directions he or she will give you as you drink. The radiologist will follow the barium down your esophagus to the stomach, watching for signs of problems and taking an occasional picture. Once the radiologist has seen enough, the technologist will then take several regular x-rays as you drink a bit more barium. Once the radiologist has reviewed your films and determined that he or she has everything needed, you will be released. That's all there is to this exam.

Occasionally, your doctor may suspect some complication, such as a fistula (a hole between two parts of the body where no hole should be) or a perforation, that will cause the exam to be done with a "water soluble" contrast agent or medium instead of Barium. This is done because your body can absorb a water soluble contrast and eliminate it through the kidneys, where it cannot absorb barium but must pass it through the digestive tract and out the other end.

Another study your doctor may order is a Modified Barium Swallow, commonly referred to as a "Cookie Swallow". This exam, commonly done in conjunction with someone from speech therapy, watches as you swallow various barium coated foods in addition to drinking the liquid barium. Examples of food items used in this exam are: bits of cookies, miniature marshmallows, bite sized crackers, and broken up hamburgers. This study is often video taped, instead of using still pictures, and is used when your doctor suspects a problem with the action of swallowing instead of a problem with the esophagus itself.

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