Barium Swallow

Benefits vs. Risks

• safe, noninvasive procedure.
• accurate evaluation of the esophagus, stomach and duodenum.
• allergic reactions are rare.
• No radiation remains in a patient's body
• no side effects in the typical diagnostic range for this exam.

• a slight chance of cancer
• patients may be allergic to the flavoring added to some brands of barium.
• There is a slight chance that some barium could be retained.
• Contraindicated in :

Bowel obstruction

Pregnancy

Perforation

Aspiration

Indication

1.Dysphagia

2.Globus sensation & chocking

3. suspected Aspiration

To diagnose :

• Cancers of the head, neck,

pharynx, and esophagus

• Hiatal hernia.
• Structural problems. Such as diverticula, strictures, or polyps
• Esophageal varices
• Muscle disorders (spasm)
• Achalasia.
• GERD and ulcers

Normal swallowing

Limitation

• Not good for evaluating small ulcers
• Cannot test for H. pylori or take biopsies of ulcers
• Not specific for diagnosis of esophagitis
• Not possible to provide interventions for any lesions

Views

• Lateral view
• AP view
• double constract

Analysis

3.Cricopharyngeal dysfunction

-Insufficient opening

-Premature closure

• Asymmetry
• Stasis
• Cricopharyngeal dysfunction
• Aspiration

to take home message

2. Stasis

1. Asymmetry

• Barium swallow allow the radiologist to evaluate a wide range of problems.
• patient should not eat or drink liquids for 8 hrs before the procedure.
• In unilateral pharyngeal paralysis stasis can be prevented by turning the head towards the affected side or by manually compressing it.
• Patients with aspiration before swallowing due can be helped by flexing their head during chewing
• In patients with aspiration during or after swallowing the 'supraglottic swallow' may help.
• Before swallowing a deep breath is taken.

3.Aspiration

- Insufficient opening of

Cricopharyngeal muscle

-Paresis of pharyngeal constrictor

References

Any Question ?

• Case study : A patient with dysphagia to solids and liquidsIkuo Hirano, M.D.

• Swallowing disorders - interpretation of radiographic studies , Robin Smithuis

• ACR PRACTICE PARAMETER FOR THE PERFORMANCE OF THE MODIFIED BARIUM SWALLOW

Thank you

- normal finding , - head turn ,

- tumer of the pharynx - unilateral paresis

Abnormal Findings

1.

2.

4.

3.

• DDx ?

A 43 yr old man with HTN and a 5 yr history of dysphagia.

Solids but occasionally liquids, are sticking at the level of his upper sternum with every meal.

It is relived by repeated swallows or by drinking water.

He has noticed the spontaneous regurgitation of clear, foamy liquid and undigested food into his mouth. His wife has noted that he coughs at night and has lost 7 to 8 lb.

Also complain of episodes of squeezing chest pain not radiating, occur at any time of day, unrelated to physical activity or meals. Drinking cold water sometimes helps alleviate the pain.

• Next step ?

Barium Swallow

Objectives

• What is Barium swallow ?
• Normal swallowing
• Indication
• How to analyze
• Abnormal findings
• Benefits and risks
• Limitation

is a radiographic (X-ray) examination of the upper GI tract,

specifically the pharynx and the esophagus

by using a liquid suspension called barium sulfate (barium).

Fluoroscopy is often used during a barium swallow.

to see the movement of the barium through the pharynx and esophagus as a person drinks.

what is Barium swallow

5.

63 year old male

Complaints of chronic

bad breath and regurgitation

of undigested food when

laying down at night.

By Thana Namer

6.

29 year old female with a past medical hx of HIV

Complains of 8 pound weight loss

and pain on swallowing.

Also feels like food is getting stuck in her throat

7.

49 year old male

Complains of progressive dysphagia, weakness and double vision that are worse at the end of the day and improve upon awakening in the morning. Denies any pain with swallowing. Nonsmoker and nonalcoholic