Upper GI Barium X-ray (barium only)

What it is

Endoscopy looks at the lining of the upper digestive tract; this study looks at its behavior. Barium is a dense white liquid that x-rays cannot pass through, so when you swallow it, it traces the inside of the esophagus, stomach and duodenum as a visible column. The radiologist watches that column live on a fluoroscopy monitor — fluoroscopy being x-ray shown as moving video rather than as a single frozen frame — and captures still images along the way.

Because it is a motion study, it answers questions a picture cannot: does the swallow coordinate, does the esophagus push the liquid down or does it stall, does anything flow back up, does the stomach empty through a narrow outlet. Single contrast means barium alone, without the gas-producing crystals used in a double-contrast technique. A plain scout film of the abdomen is taken first, before any barium, and delayed images may be taken later to see how far the barium has travelled.

Why it is done

• To investigate difficulty swallowing, or the sensation of food sticking
• To look for an ulcer, a hernia of the stomach up through the diaphragm, a narrowing, or a blockage at the stomach outlet
• To work up reflux, unexplained vomiting, or upper abdominal pain
• To check the anatomy after surgery on the esophagus or stomach, where the question is whether the reconstruction drains as intended

What to expect

Your stomach must be empty, so you will be told not to eat or drink after a certain hour the night before. You stand or lie on a table that tilts to various angles while you drink the barium on cue, sometimes in a gulp and sometimes slowly. The technologist may press a paddle against your abdomen to spread the barium over the stomach lining. The taste is chalky and the volume is more than most people expect. The examination itself is generally finished within about twenty minutes. Barium turns stool pale for a day or two afterward and can be constipating.

Questions worth asking

• Is the barium contrast included in the price quoted, or billed as a separate item on top of the procedure?
• Are the scout film and any delayed images part of this one charge, or do they add charges?
• If the radiologist decides during the exam to switch to a double-contrast technique, does the code and the price change?
• Would my insurer cover an upper endoscopy instead, and how do the two compare in out-of-pocket cost for my situation?