Barium Swallow Meal

Upper Gastrointestinal (GI) Tract X-ray (Radiography)​

What is Upper Gastrointestinal (GI) Tract Radiography?

Upper gastrointestinal tract radiography, also called an upper GI, is an X-ray examination of the pharynx, oesophagus, stomach and first part of the small intestine (also known as the duodenum) that uses a special form of x-ray called fluoroscopy and an orally ingested contrast media called barium.  An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging.  Fluoroscopy makes it possible to see internal organs in motion. When the upper GI tract is coated with barium, the radiologist is able to view and assess the anatomy and function of the esophagus, stomach and duodenum. An x-ray examination that evaluates only the pharynx and esophagus is called a barium swallow. In addition to drinking barium, some patients are also given E-Z gas (similar to Alka-Seltzer) to further improve the images. This procedure is called an air-contrast or double-contrast upper GI.

What are some common uses of the procedure?

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

  • ulcers
  • tumours
  • inflammation of the esophagus, stomach and duodenum
  • hiatal hernias
  • scarring
  • blockages
  • abnormalities of the muscular wall of GI tissues
The procedure is also used to help diagnose the cause of symptoms such as:
  • difficulty swallowing
  • chest and abdominal pain
  • reflux (a backward flow of partially digested food and digestive juices)
  • unexplained vomiting
  • severe indigestion
  • blood in the stool (indicating internal GI bleeding)

How should I prepare?

You should inform your physician of any medications you are taking and if you have any allergies, especially to barium.  Women should always inform their physician and Radiographer if there is any possibility that they are pregnant. To ensure the best possible image quality, your stomach must be empty of food. Therefore, you will be instructed not to eat or drink anything (including any medications taken by mouth, especially antacids) and to refrain from chewing gum and smoking after midnight on the day of the examination.  You will be asked to remove some or all of your clothes and to wear a gown during the exam. You may also be asked to remove jewelry, dentures, eye glasses and any metal objects or clothing that might interfere with the x-ray images.  Infants and children may undergo upper GI tract radiography. Usually, there is no special preparation, but your doctor will give you detailed instructions to prepare your child for the examination. The use of barium and the taking of x-ray images are similar to that described for adults.

What does the x-ray equipment look like?

The equipment used for this examination consists of a radiographic table, an x-ray tube and a television-like monitor that is located in the examining room. When used for viewing images in real time (called fluoroscopy), the image intensifier converts x-rays into a video image and these images are stored digitally on our PACS system. You will be given the stored images on a CD or in a film format that you can take back to your referring physician.

How is the procedure performed?

This examination is usually performed on an outpatient basis and is often scheduled in the morning to reduce the patient’s fasting time.  A radiographer, nurse and aradiologiost, a physician specifically trained to supervise and interpret radiology examinations, guide the patient through the upper GI series.  As the patient drinks the liquid barium, which resembles a light-colored milkshake, the radiologist will watch and take images of the barium as it pass through the patient’s digestive tract.The exam table will be positioned at different angles and the patient will be asked to move into different positions. Once the upper GI tract is adequately coated with the barium, still x-ray images will be taken and stored for further review.  For a double-contrast upper GI series, the patient will swallow E-Z gas crystals at the beginning of the examination that create gas in the stomach followed by drinking the barium liquid.  This exam is usually completed within 20 minutes.

What will I experience during and after the procedure?

The liquid barium has a chalky taste that may be masked somewhat by added flavors such as strawberry or vanilla. The examination may also make you feel bloated.  If you are given E-Z gas( gas-producing crystals), you may feel the need to belch. However, the radiologist or nurse will tell you to try to hold the gas in (by swallowing your saliva if necessary) to enhance the detail on the x-ray images.  These actions ensure that the barium is coating all parts of the upper GI tract. As the procedure continues, the technologist or the radiologist may ask you to drink more barium. After the examination, you can resume a regular diet and take orally administered medications unless told otherwise by your doctor.  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.

Who interprets the results and how do I get them?

A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will discuss the results with you.

What are the limitations of Upper Gastrointestinal (GI) Tract Radiography?

Mild irritation of the lining of the stomach or esophagus is difficult to detect, as well as ulcers smaller than ¼ inch in diameter. The test will detect larger ulcers. It can also suggest the presence of underlying infection with the bacterium, Helicobacter pylori, the most common cause of ulcers; but additional noninvasive tests such as a blood test or breath test may be required to confirm this infection. Finally, biopsies of any abnormal areas cannot be performed with this test.