BARIUM SWALLOW

 BARIUM SWALLOW

A barium swallow is a type of radiological technique used to examine the upper gastrointestinal tract, which includes the oesophagus, to the stomach. Fluoroscopy is often used during the examination. Fluoroscopy is a method to study the moving body organ structures similar to an x-ray  ―movie.  A continuous s x-ray beam is passed through the body part being examined and is transmitted to a T-V-like monitor so that the body part and its motion can be seen in detail.

Barium sulphate is a metallic compound that shows up on an x-ray and is used to help see abnormalities in the oesophagus and stomach.

Indications

Many problems can be detected with this examination:

1. Narrowing or irritation of the oesophagus (for example, Schatski's ring)
2. Hiatal hernia (an internal defect that causes the stomach to slide partially into the chest)
3. Abnormally enlarged veins in the oesophagus (varices) that cause bleeding 
4. Ulcers
5. Tumours
6.  Disorders of swallowing (dysphagia -difficulty in swallowing), spasms of the oesophagus or pharynx
7. Polyps (growths that are usually not cancerous, but develop into cancer )
8. Gastroesophageal reflux disease (GRED)

Preparation

 The success of the esophagram or upper GI series is for the most part related to patient preparation. It is necessary to stop eating and drinking the night before the test. The presence of food or excess fluid within the upper digestive tract will significantly reduce the diagnostic accuracy of the study and most likely mean the test will have to be cancelled. If patients need to take medications on the morning of the study, we ask that they consult their doctor beforehand. Patients are also asked not to smoke on the morning of the test, as this too alters the accuracy of the study.

Before the examination, the technologist will ask several questions including whether or not the patient has any allergies, any previous surgery, or whether they are taking any medication. As both studies involve a small amount of radiation, the patient must make the technologist and radiologist aware if they are pregnant or think they may be pregnant.

Examination

 Do not hesitate to discuss with the technicians any questions or concerns you may have before, during, or after the barium swallow test.

• The patient will drink about 1 1/2 cups of a barium preparation-a chalky drink with the consistency (but not the flavour) of a milkshake. Children will drink less.
• The barium can be seen on an X-ray as it passes through the digestive tract.
• The barium swallow procedure may take about 30 minutes to finish. In certain cases, it may take up to 60 minutes to fill the stomach. 
• The patient will be strapped securely on his/her back on a table that tilts forward. X- rays to examine your heart, lungs, and abdomen will be taken before you drink the barium. 
• The patient then will be asked to swallow the barium mixture.
• X-rays will be taken again as the barium moves through the digestive system. You will be asked to take more swallows so more pictures can be taken. 
• As the barium moves down your digestive system, the table will be tilted at various angles to help spread the barium for different views. Pressure may be applied to your abdomen to spread the barium. Finally, you will be placed horizontally, asked to take a few more swallows of barium, and X-rayed again.

Complications

 Any fluoroscopy study involves a small amount of radiation. However, through appropriate training, practice, and experience, radiologists ensure that radiation is kept to a minimum by a variety of measures. The radiation dose is small and the benefits of this test far outweigh the risks. The examinations themselves are essentially free of risk. One possible complication in elderly and debilitated patients is an aspiration of a small amount of barium into the lungs. However, this can be identified immediately during the examination, and with subsequent chest, physiotherapy is likely of no long-term significance.

                                                       Barium swallow examination

Ba Swallow

Barium Swallow - Typical film series

Position	Demonstrates
Erect RAO (35-40 degrees)	Esophagus between vertebral column & heart
Erect LAO	Esophagus between the hilar region of the lung & Thoracic spine
Erect AP	Esophagus      through                       superimposed thoracic vertebrae
Lateral	Entire    Esophagus   between             thoracic spine & Heart