Barium Swallow (Esophagus X-ray)

What it is

The esophagus does not show up on an ordinary x-ray. An esophagram makes it visible by having the patient swallow barium, a chalky white liquid that blocks x-rays, while a radiologist watches on a fluoroscope — an x-ray device that shows movement in real time rather than a single frozen frame. The radiologist can see the swallow happen: where the barium goes, how fast, whether it hangs up, whether any of it comes back. Still images are captured during and after, including delayed ones taken once the barium has coated the lining. "Single contrast" means barium alone; a double-contrast study adds gas-forming crystals to puff the esophagus open and coat its walls more thinly, and is coded differently.

Why it is done

• To investigate difficulty swallowing, or the sensation of food sticking
• To look for a narrowing, a ring, a web, or a mass in the esophagus
• To assess reflux, a hiatal hernia, or an outpouching of the esophageal wall
• To check the esophagus after surgery or after a known injury to it

What to expect

Patients are usually asked not to eat or drink for some hours beforehand, so the tract is empty. The exam is done standing, lying, and sometimes tipped head-down on a tilting table, because gravity changes what the study can show. You will be handed a cup of barium and asked to swallow on cue, hold a mouthful, or take repeated gulps while the radiologist watches. It is not painful, but the barium is thick and the positions can be awkward. The study generally takes under half an hour. Barium turns the stool white or light for a day or two afterward and can be constipating; drinking extra fluids helps it clear.

Questions worth asking

• Is this a single-contrast or double-contrast study? They are separate codes at separate prices.
• Is the barium and any other contrast material billed as a supply on top of the exam?
• Will there be a separate professional fee for the radiologist who performs and interprets the study, in addition to the facility's technical charge?
• If the order also includes a stomach and small bowel study, is that one combined charge or two?