Barium Radiography

An imaging method complementary to gastroscopy that evaluates the structure and motility of the pharynx, esophagus, stomach, and duodenal wall using X-ray images obtained after the patient drinks a special barium solution.

Indication

• Difficulty swallowing (dysphagia), the sensation of food sticking in the throat, and coughing during meals
• Suspected esophageal motility disorders — particularly achalasia and esophageal spasm
• Investigation of esophageal strictures, rings, webs, and diverticula (pouches)
• Evaluation of gastroesophageal reflux and hiatal hernia
• Assessment of anatomy and leak after gastric surgery (e.g., sleeve gastrectomy, bypass)
• Suspected gastric outlet obstruction, ulcer, tumor, or pyloric stenosis
• Selected patients who are unsuitable for endoscopy or in whom complementary information is needed

Preparation

• Fasting for at least 6 hours before the procedure — no water, tea, or smoking
• Medications taken should be reviewed with the physician; especially medications affecting gastric motility may be temporarily stopped
• If diabetes, kidney failure, or known swallowing problems are present, this must be reported before the appointment
• If pregnancy is suspected or confirmed, the procedure should be postponed — for radiation safety reasons
• Bringing along previous endoscopy, barium radiography, and upper abdominal imaging reports

How it's performed

1. The patient changes into a gown; metal accessories and jewelry are removed
2. A white, chalky-tasting barium liquid is given by the radiologist or technician; the patient is asked to swallow it
3. During and after swallowing, the patient stands in different positions on the imaging table (standing, lying, on the side)
4. With the help of a fluoroscopy device, the progression of barium through the pharynx, esophagus, stomach, and duodenum is monitored in real time
5. If needed, double-contrast imaging is performed by giving an effervescent powder
6. Static X-ray films are taken at certain stages; the total duration is generally 20-40 minutes

Post-procedure

• No special observation period is required after the procedure; the patient returns to daily activity immediately
• Drinking plenty of water after the procedure is recommended to help eliminate barium from the bowel
• Stool color may appear whitish/light for 1-3 days, which is normal
• A high-fiber diet, or a mild laxative if recommended by the physician, can support bowel movements
• After the radiologist prepares the report, the result is evaluated together with the referring physician

Risks

• Barium aspiration — risk of barium entering the airway in patients with swallowing difficulty (rare)
• Possibility of barium hardening in the bowel and causing constipation or, rarely, obstruction
• Very rare allergic reactions to barium sulfate
• Low-dose radiation exposure during pregnancy unless medically necessary
• If perforation is suspected, water-soluble contrast should be preferred over barium; otherwise there is a risk of mediastinitis/peritonitis

FAQ

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