Barium swallow is an imaging test of the pharynx, esophagus and proximal stomach. It may be performed as a single or double contrast study. The study is often “modified” to suit the history and symptoms of the individual patient, but it is often useful to evaluate the entire pathway from the lips to the gastric fundus. It is also known as oesophagogram.

Indications: – Dysphagia and Pain, Assessment of oesophageal fistula, Assessment of the site of perforation and Assessment of a hiatus hernia.

Contraindications: – Esophageal perforation, pregnancy and bowel obstruction.

Contrast Medium: – E-Z HD 250% 100 ml (or more, as required), Gastrografin and LOCM (approx. 350 mg I/ml).

Equipment & Patient Preparation: –Rapid serial radiography (2 frames/s) or video recording may be required for assessment of the laryngopharynx and upper esophagus during deglutition. No patient preparation is required.

Preliminary Film: – A control film is advised prior to a water-soluble study if perforation is suspected. 

Technique: –An ample mouthful of barium is swallowed and spot films of the upper and lower esophagus are taken. If rapid serial radiography is required, it may be performed in the right lateral, RAO and PA positions.


  • Films taken for this procedure may be-
  1. AP erect and supine
  2. Prone
  3. RAO & LAO
  4. RPO & LPO
  5. Spot films if required

Modification of Technique: – To demonstrate a tracheo-esophageal fistula in infants, a nasogastric tube is introduced to the level of the mid-oesophagus and the contrast agent (barium or LOCM) is syringed in to distend the esophagus. This will force the contrast medium through any small fistula which may be present. 

Aftercare: – No aftercare is required.

Complications: –Leakage of barium from an unsuspected perforation and aspiration.