Esophagram - Uses, Procedure, Risks, Alternatives, and Contraindications

Introduction:

Esophagram is also known as barium swallow study or esophagography. It is a special test using barium to detect diseases affecting the upper gastrointestinal tract (GI). The upper GI tract includes the throat, esophagus, stomach, and the first part of the small intestine. Esophagram may be used by itself or taken as a part of an upper GI series.

What Are the Uses of Esophagram?

Esophagram is used to diagnose the following conditions:

• Peptic ulcer (raw, painful area on the lining of the stomach, food pipe, and intestine).

• Inflammation (swelling) of the food pipe.

• Blockages.

• Hiatal hernia (a condition in which part of the stomach pushes into the chest cavity).

• GERD (a condition in which stomach acid flows back into the food pipe and irritates the lining of the food pipe).

• Cancerous or noncancerous tumor.

• Structural problems in the gastrointestinal tract such as polyps (abnormal growths) and diverticula (pouches in the intestinal wall).

• Achalasia (a condition in which muscles of the food pipe fail to relax and allow food to enter the stomach).

When Is Esophagram Taken?

Esophagram or barium swallow study is recommended for patients having the following symptoms:

• Difficulty in swallowing.

• Vomiting without a known reason.

• Stomach pain.

• Difficulty in swallowing.

• Abdominal and chest pain.

• Blood in the stool.

How Does Barium Work in the Esophagram?

Barium is a white-colored substance mixed with water to make it like a thick milkshake to drink during the procedure. When it passes through the body, barium coats the food pipe and stomach, which makes the organ visible on an X-ray, it will appear as black or white during imaging on the screen.

How Do You Prepare for an Esophagram?

• Adults - Adult patients are instructed not to take a solid diet four hours before the procedure. They can have a clear liquid diet two hours before the procedure. Take regular medicines with a small sip of water.

• Children - Children should not take any solid foods six hours before the procedure. They can take a liquid diet anytime before the procedure. Take regular medicines before the procedure with water.

• Infants - You should not give anything to the child to eat or drink 4 hours before the procedure. Your child should be thirsty enough to drink the barium liquid while given during the test. Regular medications can be taken with a small sip of water.

What Are the Factors to Be Considered Before Taking the Esophagram?

There are certain factors that should be considered before the test. They are:

• Diabetes - People with high blood sugar levels will be scheduled with an early morning appointment for the barium swallow test. If they take regular medication to control sugar levels, they are advised to bring the medicine and food and take it once the test is finished.

• Glaucoma - Glaucoma is an eye disease causing vision loss by damaging the optic nerve. Patients with glaucoma will not be given the stomach relaxing injection.

• Heart Diseases - Patients with any heart disease will not be given a stomach relaxing injection.

• People Under Insulin Medication - Patients taking Insulin medicine for high blood sugar are advised to skip their morning dose and previous evening dose of medication.

How Is the Esophagram Taken?

Before the procedure, the patient is asked to remove their regular clothing above the waist and remove the jewels or any objects above the waist. If the patient is a child, a family member or caretaker of the child will be allowed to stay in the X-ray room. The patient will be given a gown to wear. Achalasia patients may be given injections to relax the stomach muscles.

Once the patient is ready, the radiologist will place the patient on the X-ray table and ask them to change the position of the body to take standard X-rays of the lungs, heart, and abdomen. After that, they will be given 1 to 2 cups of drink that contains barium. If the child refuses to drink the liquid, the radiologist may pass a tube into the stomach for examination. They will take a single or series of X-rays or fluoroscopy (X-ray video) to watch the barium pass in through your pharynx. The patient will be asked to hold their breath for a few seconds to get a better image.

Finally, they may give thinner barium liquid to drink, and they will again take X-rays and fluoroscopy to watch out for the barium movement. After that, the patient may leave the room. This test may take an hour to complete. In addition to barium, some patients may be asked to drink baking soda crystals to get precise images. This procedure is called a double-contrast upper GI.

When Should You Avoid Esophagram?

You should avoid esophagram or barium swallow study if you have any of the following conditions:

• Bowel obstruction.

• Intestinal or esophageal perforation (tear or hole in your food pipe or intestine).

• Difficulty swallowing.

• Severe constipation.

• Radiation exposure in pregnant women during the test may cause birth defects to the baby in the womb.

What Are the Risks Associated With Esophagram?

• Nausea -The patient may feel a vomiting sensation after the esophagram or barium swallow test. This symptom may improve once barium passes out of the body.

• Constipation -Patients may have difficulty in passing stool after the test. Having fibrous food and drinking plenty of water may flush out the barium from your body. Doctors may give laxatives (medicine to loosen the stool) to treat constipation.

• Radiation Exposure -Some patients may worry about X-ray exposure during the procedure. But the amount of radiation is minimal.

• Temporary Blurred Vision -Sometimes, the patient can have temporary blurred vision due to the injection to relax the stomach.

• Passing White Stool -Patients may pass white-colored stools after the test a few times which is normal.

What Are the Alternatives for Esophagram?

• Gastroscopy- Gastroscopy is a diagnostic procedure in which a narrow, flexible tube along with a telescopic camera passes through the food pipe to visualize the food pipe, stomach, and parts of the small intestine.

• Computed Tomography (CT) - CT is a diagnostic scan used to see the inside of your body. CT may be combined with gastroscopy to visualize the inside of the stomach.

Conclusion:

Esophagram effectively shows the outline and functional status of the upper GI tract. It is a quick and less invasive imaging tool when compared to endoscopy. This is a contrast-enhanced radiographic study as it uses barium and is more sensitive when compared to those studies using water-soluble agents such as gastrografin. This procedure does not require hospitalization.